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A nurse is caring for a client in a provider's office.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Condition:

Rheumatoid arthritis

Actions to Take:

Assess joints for warmth and redness.
Assess for paresthesias.

Parameters to Monitor:

Weight-bearing joints.
Decreased immunity.

Rationale:

Condition Choices

Osteoporosis: Osteoporosis primarily leads to bone demineralization and increased fracture risk rather than inflammatory joint pain, swelling, and systemic symptoms such as fever and fatigue. The client’s symptoms, including joint inflammation and subcutaneous nodules, are not characteristic of osteoporosis.
Osteoarthritis: Osteoarthritis typically presents with asymmetric joint involvement, stiffness that worsens with activity, and crepitus in weight-bearing joints. The client’s symptoms, including symmetric joint swelling, prolonged morning stiffness, and systemic inflammation markers, are more consistent with an autoimmune disorder like rheumatoid arthritis.
Rheumatoid arthritis: The presence of bilateral joint pain, stiffness, swelling, subcutaneous nodules, and elevated inflammatory markers (ESR and CRP) strongly suggests rheumatoid arthritis. The morning stiffness, systemic symptoms like fatigue and low-grade fever, and the impact on mobility further support this diagnosis.
Gout: Gout is characterized by acute, episodic joint pain, typically affecting the metatarsophalangeal joint of the big toe. The client’s symptoms are more widespread and chronic, involving multiple joints and systemic inflammation, which is not typical of gout.

Actions to Take

Assess joints for warmth and redness: Inflammation in rheumatoid arthritis leads to synovial swelling, warmth, and redness. Regular assessment helps track disease progression and the effectiveness of treatment.
Assess for paresthesias: Chronic inflammation and joint deformities in rheumatoid arthritis can lead to nerve compression, resulting in numbness or tingling, particularly in the hands and feet.
Assess for crepitus in weight-bearing joints: Crepitus is more commonly associated with osteoarthritis due to cartilage degeneration. While rheumatoid arthritis affects weight-bearing joints, it does so through inflammatory destruction rather than mechanical wear.
Recommend the client spend at least 5 min outside in the sun daily: Sun exposure can help with vitamin D synthesis, but rheumatoid arthritis is not primarily related to vitamin D deficiency. This intervention is more relevant for osteoporosis management.

Parameters to Monitor

Weight-bearing joints: Rheumatoid arthritis commonly affects the knees, hips, and other weight-bearing joints, contributing to mobility issues and falls. Monitoring joint involvement helps assess disease progression.
Decreased immunity: Rheumatoid arthritis and its treatments, such as immunosuppressive medications, increase the risk of infections. Monitoring for signs of immunosuppression is essential for early intervention.
Joint inflammation in the big toe: This is more indicative of gout, which presents with acute episodes of pain and swelling in the first metatarsophalangeal joint rather than the widespread, chronic inflammation seen in rheumatoid arthritis.
Calcium and vitamin D levels: While important for bone health, these levels do not provide direct insight into rheumatoid arthritis progression. They are more relevant in osteoporosis management.
Cervical neck pain: While rheumatoid arthritis can affect the cervical spine, particularly at the atlantoaxial joint, the primary concern is peripheral joint inflammation and systemic symptoms rather than isolated neck pain.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

The first action the nurse should take is assess for dizziness when standing followed by increase dietary iron intake.

Rationale:

Assess for dizziness when standing: The client’s orthostatic hypotension (BP drops from 132/60 to 102/50 mmHg upon standing) and tachycardia (HR 108/min) suggest possible symptomatic anemia. Evaluating for dizziness ensures client safety and helps determine the severity of anemia-related hypoxia.

Increase dietary iron intake: The client has iron deficiency anemia (low hemoglobin, hematocrit, RBC count, and ferritin). Since they follow a vegan diet, increasing plant-based iron sources (e.g., leafy greens, legumes, fortified cereals) and vitamin C intake can improve iron absorption.

Incorrect:

Administer IV fluids: While anemia can cause orthostatic hypotension, fluid resuscitation is not the first-line intervention unless dehydration is present.

Check for signs of bleeding: The client reports no pain or discomfort, and there is no evidence of active bleeding. Anemia is more likely due to chronic dietary deficiency rather than acute blood loss.

Administer vitamin B12 supplements: The client’s vitamin B12 level is slightly low but not critically deficient. The primary issue is iron deficiency, not pernicious anemia.

A. "Use the incentive spirometer every 4 hours." B. "Avoid coughing during and after the session." C. "Remove the mouthpiece and exhale quickly." D. "Place the mouthpiece in your mouth and inhale slowly."

Correct Answer is D

Explanation

A. "Use the incentive spirometer every 4 hours.": Incentive spirometry is typically recommended every 1 to 2 hours while awake to promote lung expansion and prevent atelectasis. Less frequent use may not provide adequate lung re-expansion, especially after surgery.

B. "Avoid coughing during and after the session.": Coughing is encouraged after using an incentive spirometer to help clear secretions and prevent respiratory complications such as pneumonia. Suppressing a cough can lead to mucus retention and increased risk of infection.

C. "Remove the mouthpiece and exhale quickly.": The client should exhale normally before using the spirometer, then inhale slowly through the mouthpiece to maximize lung expansion. Rapid exhalation does not promote adequate alveolar inflation.

D. "Place the mouthpiece in your mouth and inhale slowly.": Slow, deep inhalation through the spirometer allows for maximum lung expansion, reducing the risk of atelectasis. The client should maintain a steady breath to ensure optimal lung inflation and hold it for a few seconds before exhaling.

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Naxlex Comprehensive Predictor Exams

A nurse in a provider's office is caring for a client. Complete the following sentence by using the lists of options. The first action the nurse should take is ____ followed by _____ .

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

A nurse is providing education to a client who has a prescription for incentive spirometry. Which of the following instructions should the nurse include in the teaching?

Correct Answer is D

Explanation

A nurse is planning care for a client who has full-thickness burns on the lower extremities. Which of the following interventions should the nurse include?

The nurse is caring for the client who has iron deficiency anemia. Which of the following instructions should the nurse include? Select all that apply.

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A nurse is caring for a client who has a nasogastric tube. The nurse should monitor the client for which of the following findings?

A nurse is providing teaching to a client who has a new permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching?

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