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Patient Data

Exhibits

Based on the nurse’s assessment, history and flow sheet, which condition is the client most likely experiencing?

Osteoarthritis

Gout

Rheumatoid arthritis

Septic arthritis

Cellulitis

Answer and Explanation

The Correct Answer is B

Rationale for Correct Choice:

Gout: The client presents with acute, severe pain, redness, warmth, and swelling in the right great toe, which is classic for a gout flare. The pain onset is sudden and worsens rapidly, consistent with the patient’s history of previous attacks. Presence of hard, firm deposits (tophi) under the skin further supports chronic hyperuricemia and gout.

Rationale for Incorrect Choices:

Osteoarthritis: Typically causes gradual joint pain, stiffness, and decreased range of motion, often affecting weight-bearing joints symmetrically. The acute, excruciating pain and swelling described here are inconsistent with osteoarthritis.
Rheumatoid arthritis: Usually presents with symmetric joint involvement, morning stiffness, and systemic symptoms. The unilateral acute attack of a single joint does not align with the typical RA pattern.
Septic arthritis: Often presents with rapid-onset joint pain, swelling, and fever. While the client has mild fever, there is a history of recurrent gout attacks and typical tophi, making gout more likely; septic arthritis is less likely without systemic toxicity or significant joint effusion requiring aspiration.
Cellulitis: Presents with redness, warmth, swelling, and sometimes fever, usually without joint involvement or hard deposits. The pain is localized to the joint itself rather than diffuse soft tissue, making cellulitis less likely.

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Correct Answer is C

Explanation

Rationale:
A. Client describes a schedule for antacid use with other prescribed medications: While antacids may be part of postoperative care, they do not directly address the symptoms of nausea, diarrhea, and diaphoresis that occur after meals following a Billroth II procedure.

B. Client agrees to participate in a variety of stress reduction techniques: Stress management is beneficial for overall health, but it does not specifically target postprandial symptoms related to dumping syndrome.

C. Client selects a pattern of small meals alternating with fluid intake: This outcome directly addresses the management of dumping syndrome, a common complication after Billroth II surgery. Small, frequent meals and separating solids from liquids slow gastric emptying and help prevent postprandial hypotension, nausea, and diarrhea.

D. Client expresses a willingness to reduce nicotine intake: Smoking cessation is important for general healing and gastrointestinal health, but it does not specifically mitigate the acute postprandial symptoms associated with dumping syndrome.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"F"}

Explanation

Rationale for Correct Choices:

Pain: The client reports severe, persistent pain rated 8/10 in the right great toe that has lasted 9 days. Acute gout attacks cause intense joint pain due to urate crystal deposition, making pain the most immediate and significant risk requiring nursing intervention.
Inflammation: Assessment findings show redness, warmth, and swelling at the affected joint. These signs indicate active inflammation caused by urate crystal deposition, which can worsen tissue damage and joint function if not managed promptly.

Rationale for Incorrect Choices:

Contracture: While chronic gout or repeated attacks can eventually lead to joint deformities or contractures, this is a long-term complication, not an immediate risk during an acute attack.
Decreased circulation: There is no evidence of impaired blood flow to the affected joint; capillary refill and skin perfusion are not compromised.
Discoloration: Although redness is present, discoloration as a separate risk is not the primary concern; it is part of the inflammatory response rather than a distinct complication.
Enlarged tophi: Tophi form over time with chronic hyperuricemia; the client currently presents with small hard deposits, indicating early tophi formation, but enlargement is not an immediate risk during the acute attack.

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Patient Data Exhibits Based on the nurse’s assessment, history and flow sheet, which condition is the client most likely experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Two weeks following a Billroth II (gastrojejunostomy), a client develops nausea, diarrhea, and diaphoresis after every meal. When the nurse develops a teaching plan for this client, which expected outcome statement is the most relevant?

Correct Answer is C

Explanation

The healthcare provider places prescriptions to determine the extent of the client's condition. Exhibits Based on the client's laboratory findings, the nurse recognizes that the client is having an acute gout attack and is most at risk for dropdown and dropdown in his affected joint.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"F"}

Explanation

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The nurse is assessing a client who is newly diagnosed with hypothyroidism. Which assessment finding requires immediate intervention?

Patient Data

Exhibits

Based on the nurse’s assessment, history and flow sheet, which condition is the client most likely experiencing?