Exhibits

The healthcare provider (HCP) is reviewing the client's laboratory results and imaging and has diagnosed the client with rheumatoid arthritis.

Drag from Word Choices to complete the sentence.

Due to the new diagnosis of rheumatoid arthritis, the nurse should recognize that the client is at risk for
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,
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and
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.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B","dropdown-group-3":"C"}

Rationale for Correct Choices:

Impaired physical mobility: Rheumatoid arthritis leads to joint inflammation, stiffness, and potential deformities. These symptoms may result in decreased range of motion and difficulty with physical movements, contributing to impaired mobility.
Acute pain: RA causes acute inflammation in the joints, resulting in pain, especially during flare-ups. The client experiences pain and stiffness in the hands and wrists, which aligns with the acute pain risk associated with RA.
Knowledge deficit: Newly diagnosed RA patients often lack understanding about the disease process, treatment options, and lifestyle modifications. The nurse needs to recognize that the client requires education to manage their condition effectively and understand the long-term implications.

Rationale for Incorrect Choices:

Electrolyte imbalance: Electrolyte imbalances are not a typical complication of rheumatoid arthritis. While certain medications used to treat RA (like corticosteroids) can impact electrolyte levels, this is not an immediate concern or a direct risk associated with RA itself.

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Correct Answer is D

Explanation

A. Blood alcohol level of 0.09% (19.5 mmol/L): This alcohol level indicates mild intoxication. It can cause slurred speech and gait changes, but the effects are usually transient and less concerning than drug toxicity. It should be monitored, but is not as urgent as lithium toxicity.

B. Weight loss of 10 lb (4.5 kg) in past month: This degree of weight loss may suggest poor nutritional intake or a depressive episode, but it is not immediately life-threatening. It requires follow-up but does not explain the acute neurological signs the client is exhibiting.

C. Six hours of sleep in the past three days: Severe sleep deprivation can exacerbate mood instability in bipolar disorder, but it does not account for slurred speech or gait disturbances. This concern is significant for mental health management but not the priority in this situation.

D. Serum lithium level of 1.6 mEq/L (1.6 mmol/L): This is above the therapeutic range and suggests lithium toxicity, which can cause neurological signs such as slurred speech and ataxia. Immediate reporting is crucial to prevent progression to more severe toxicity, including seizures or coma.

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

Explanation

Rationale:

Respirations: After administering morphine, it is crucial to monitor the client's respirations because opioids can cause respiratory depression, which may be more pronounced in elderly patients or those who are in pain and immobile.
Deep breathing techniques: The nurse should encourage deep breathing techniques. This helps improve lung expansion and reduces the risk of respiratory complications such as pneumonia and atelectasis, especially in a client with decreased mobility due to pain and injury.

Rationale for Incorrect Options:

Heart rate: While heart rate monitoring is important, it is not the primary concern immediately after morphine administration. The client's respiratory status takes precedence, especially considering the risk of opioid-induced respiratory depression.
Blood pressure: While blood pressure monitoring is essential, morphine administration primarily affects the respiratory system, not the circulatory system. The nurse should prioritize respiratory monitoring over blood pressure unless the patient exhibits signs of hypotension.
Range of motion exercises: Range of motion exercises are important for mobility and rehabilitation, but they are not a priority immediately following the trauma and morphine administration. The client should be assessed and stabilized before beginning exercises.
Joint protection techniques: Joint protection techniques are beneficial in long-term rehabilitation, but in the acute phase, the priority is to manage the fracture, pain, and prevent further complications.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Exhibits Choose the most likely options for the information missing from the statements by selecting from the lists of options provided. The nurse monitors the client's dropdownafter administering the morphine. The nurse should include dropdownto reduce complications of the client's injury.

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

Explanation

A young adult is brought to the emergency department after taking a handful of drugs. The client is unresponsive, so an endotracheal tube (ETT) is inserted. How should the nurse determine if the ETT is correctly placed? Select all that apply.

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