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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 C

Explanation

A. Instruct the client to report bleeding: While important, assessing for bleeding is not the immediate priority. Minor blood-tinged sputum can be expected, but significant bleeding should be reported. Ensuring airway protection comes first.

B. Inform the client they might experience a low-grade fever: A mild fever may occur within the first 24 hours after bronchoscopy due to irritation, but addressing airway safety and aspiration risk takes precedence.

C. Check the client's gag reflex: The gag reflex must return before offering oral intake to prevent aspiration. The local anesthetic used for the procedure can suppress the reflex, increasing the risk of aspiration if the client drinks or eats too soon.

D. Provide the client with sips of water: Fluids should not be given until the gag reflex has returned. Providing water too soon could result in aspiration, leading to complications such as pneumonia.

A. Blood glucose level B. Bowel sounds C. Blood pressure D. Pain level E. Electrocardiogram findings F. Lung sounds G. Troponin T level

Correct Answer is ["C","D","E","G"]

Explanation

Pain level: Chest pain rated at 7/10 with radiation to the left arm, along with diaphoresis and nausea, indicates a potential acute coronary syndrome, likely a myocardial infarction. Immediate intervention is necessary to relieve pain and address the underlying cause, as this could prevent further complications and potential cardiac damage.
Electrocardiogram findings: ST-segment elevation and T wave changes suggest an ST-elevation myocardial infarction (STEMI), which requires urgent medical attention. Prompt identification and activation of treatment protocols, such as percutaneous coronary intervention (PCI) or thrombolytic therapy, are critical to restore blood flow and minimize myocardial damage.
Troponin T level: An elevated troponin T level (0.40 ng/mL, with a normal range <0.1 ng/mL) indicates myocardial injury, supporting the diagnosis of an acute myocardial infarction. Immediate management is essential to mitigate further cardiac injury and ensure appropriate treatment is initiated based on the severity of the elevation.
Blood pressure: While the blood pressure reading of 164/80 mm Hg indicates hypertension, it is not critically high and does not require immediate intervention like the other findings. However, elevated blood pressure in the context of a myocardial infarction can increase myocardial oxygen demand, leading to further complications, thus it should be monitored closely.

Blood glucose level: The blood glucose level of 103 mg/dL is within normal limits (74-106 mg/dL) and does not indicate an immediate concern. Although monitoring blood glucose is essential in clients with diabetes, it is not a priority in the context of acute coronary syndrome.
Bowel sounds: The presence of bowel sounds indicates gastrointestinal function and does not require immediate follow-up in this context. While it’s important to assess overall health, bowel sounds are not a priority when addressing acute cardiac symptoms.
Lung sounds: Clear lung sounds indicate that there is no pulmonary congestion or other respiratory complications at this time. While lung assessment is essential for overall patient evaluation, clear lung sounds do not require immediate follow-up in this acute setting.

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A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

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Correct Answer is ["C","D","E","G"]

Explanation

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