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. Leukocytosis refers to an elevated white blood cell (WBC) count, typically above the normal range (approximately 4,000 to 10,000 WBCs per microliter of blood). A count of 22,000 indicates leukocytosis, which may be due to infection, inflammation, stress, or other conditions.
B. A left shift refers to an increase in immature white blood cells, particularly neutrophil precursors, in the bloodstream. It often indicates an acute infection or inflammatory response. While the WBC count of 22,000 may suggest a left shift, it does not confirm it without further analysis of the differential count of the WBCs.
C. Erythrocytosis is an increase in red blood cells (RBCs), not white blood cells. Therefore, this option is incorrect. A high WBC count does not indicate changes in red blood cell levels.
D. Neutropenia refers to a decreased number of neutrophils, which are a type of white blood cell. Given the WBC count of 22,000, neutropenia is not applicable and is therefore incorrect.

A. Provide calm reassurance while reassessing blood pressure B. Administer Epinephrine 1:1.000 IM C. Place on Nasal Cannula 6 Lpm D. Raise the HOB to high fowlers

Correct Answer is B

Explanation

A. While it’s important to provide reassurance, this option does not directly address the acute symptoms of respiratory distress and hypotension. Monitoring blood pressure is essential, but immediate action to treat the underlying issue is more critical.
B. This is the priority intervention in the case of suspected anaphylaxis. Epinephrine acts quickly to counteract severe allergic reactions, relieving bronchospasm, increasing heart rate, and raising blood pressure. Given the patient's wheezing and hypotension, administering epinephrine is crucial.
C. Administering oxygen can be beneficial, especially if the patient is experiencing respiratory distress. However, it does not address the potential anaphylactic reaction or the drop in blood pressure directly. It should be part of the management but not the priority.
D. Elevating the head of the bed can help improve breathing, especially if the patient is in respiratory distress. However, this action alone does not address the potential life-threatening aspects of anaphylaxis.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a WBC count of 22,000. The nurse should conclude that the client has which of the following?

Correct Answer is A

Explanation

Your patient with Iron deficiency anemia is receiving Iron Dextran when their blood pressure suddenly starts to drop, their respiratory rate increases, and their breath becomes wheezy- sounding. Your PRIORITY intervention will be:

Correct Answer is B

Explanation

You are caring for a patient with an Absolute Neutrophil Count (ANC) of 400. The physician orders the patient to be placed on neutropenic precautions. Which of the following would be appropriate to implement? (Select all that apply)

Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions. are needed for patients who must be placed on bleeding precautions? (Select all that apply)

A transfusion of packed red blood cells (PRBCs) has been infusing for 5 minutes when the patient becomes flushes and tachypneic and says, "I'm having chills. Please get me a blanket." Which action should the nurse take first?

All of the following are common causes of Iron deficiency anemia, EXCEPT?

A nurse is caring for a client who has pneumonia. Assessment findings include T 100.4 deg F, RR 30, BP 130/76, HR 100, and SpO2 91% on room air. Which of the following is the PRIORITY intervention?

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.)

You are planning on transfusing a unit of blood. Which of the following are appropriate measures to take? (Select all that apply)

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?