You are working in a busy outpatient client and performing assessment on a new patient. The patient reports pain and morning stiffness in the bilateral hands. You see what looks like large nodules on the knuckles, swan-neck deformity of the fingers, and ulnar deviation of the fingers as well. What is your patient's MOST LIKELY diagnosis?

Osteoarthritis

Rheumatoid arthritis

Lupus arthritis

Gouty Arthritis

Answer and Explanation

The Correct Answer is B

A.   Osteoarthritis (OA) typically presents with joint pain and stiffness, but it is usually unilateral and does not cause the same types of deformities seen in RA. OA also tends to develop over time without the systemic symptoms associated with RA.
B.   The combination of bilateral pain and morning stiffness in the hands, along with the presence of large nodules (likely rheumatoid nodules), swan-neck deformities, and ulnar deviation, is characteristic of rheumatoid arthritis (RA). RA is an autoimmune disorder that affects joints symmetrically and commonly leads to these specific deformities.
C.   Lupus arthritis can cause joint pain and swelling, but it is often accompanied by other systemic symptoms like skin rashes (butterfly rash), fatigue, and organ involvement. The specific deformities noted (swan-neck and ulnar deviation) are more closely aligned with RA than lupus.
D.   Gout is characterized by sudden, severe attacks of pain, often in the big toe or foot, and is caused by the deposition of urate crystals in the joints. It does not typically present with the deformities or patterns seen in the described patient.

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Correct Answer is A

Explanation

A. Morphine is a strong opioid analgesic that is effective for managing severe pain, especially in acute situations like a vaso-occlusive crisis. Administering it intravenously allows for rapid onset of pain relief, which is critical given the severity of the patient’s symptoms. Continuous dosing (ATC—around the clock) ensures that pain is managed effectively.
B. Fentanyl patches are typically used for chronic pain management and take time to reach effective levels in the bloodstream (up to 12 hours or longer). In the case of acute severe pain from a vaso- occlusive crisis, this option would not provide immediate relief.
C. While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve mild to moderate pain, it is not adequate for severe pain management. Additionally, in the setting of sickle cell disease, patients may be at risk for renal issues, making high doses of NSAIDs potentially harmful.
D. Hydromorphone is also a strong opioid analgesic; however, administering it orally may not be effective for severe pain management in an acute situation. IV administration of opioids is preferred for immediate and potent pain relief during a vaso-occlusive crisis.

A. PT/INR B. C-reactive protein (CRP) C. Erythrocyte sedimentation rate (ESR) D. Procalcitonin (PCT)

Correct Answer is A

Explanation

A. PT (Prothrombin Time) and INR (International Normalized Ratio) are tests primarily used to evaluate blood coagulation and the effectiveness of anticoagulant therapy. While they can provide some insight into a patient's overall health, they are not specific indicators of inflammation.
B. CRP is a protein produced by the liver in response to inflammation. It is a well-established marker for detecting acute inflammation and is commonly used in clinical settings to assess inflammatory conditions.
C. ESR measures how quickly red blood cells settle at the bottom of a test tube. An elevated ESR is a classic indicator of inflammation in the body and is commonly used in diagnosing various inflammatory conditions.
D. Procalcitonin is a biomarker that can indicate bacterial infections and systemic inflammation. It is increasingly used in clinical practice to assess the severity of infection and inflammation, particularly in cases of sepsis.

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Naxlex Comprehensive Predictor Exams

A patient who has sickle cell disease was admitted with a vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the following analgesic medications will be MOST appropriate to administer to the patient?

Correct Answer is A

Explanation

Which of the following lab tests is NOT commonly ordered to ascertain whether the patient is experiencing large amounts of inflammation?

Correct Answer is A

Explanation

The medical team believes that your patient has been suffering from a severe Viral infection, and has ordered blood to be drawn for laboratory analysis. You know that which of the following types of white blood cells is MOST associated with a Viral illness?

The nurse is teaching an elderly client the risks of infection for older adults. Which of the following factors would the nurse include in the education? (Select all that apply.)

A nurse is providing teaching for a client who has stage 2 HIV disease and is having difficulty maintaining normal weight. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?

Which of the following are common signs or symptoms of GI bleeding? (Select all that apply)

A clinic nurse is working with an older client. What action is most important for preventing infections in this client?

A nurse is teaching a client who has SLE (Lupus) about self-care. Which of the following statements by the client indicates an understanding of the teaching?

You are caring for a patient who has Sickle Cell Disease (SCD) who is in the hospital for an acute worsening of their disease. Your patient is receiving ATC opioids for their severe pain, when they suddenly report a new sharp pain in their left shoulder. What is your BEST action?

Your cancer patient has bone marrow suppression from their chemotherapy treatments, and is scheduled to receive Epoetin Alfa shots 3 times per week. Which of the following lab values would cause you to hold the administration of the medication for safety concerns?