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 B

Explanation

A. While rinsing fruits is good practice, it may not fully eliminate the risk of pathogens, especially for someone with a compromised immune system.
B. This statement is the best indication of understanding how to prevent infections. Changing kitty litter can expose the client to Toxoplasma gondii, which is particularly risky for immunocompromised individuals. Wearing gloves is a direct and effective precaution.
C. Although wearing an N95 mask can be appropriate in certain situations, it may not be necessary for all interactions with sick family members. A standard surgical mask is often sufficient.
D. Cooking vegetables is a good practice for food safety, especially for immunocompromised individuals, but this statement is more general than specifically addressing a particular risk.

A. Airplane flights B. Dehydration C. Cold weather D. Illness E. Flashing light patterns on television

Correct Answer is ["A","B","C","D"]

Explanation

A. Airplane flights can trigger a crisis due to changes in altitude and decreased oxygen levels in the cabin. The lower atmospheric pressure and reduced oxygen can contribute to sickling of red blood cells, increasing the risk of a crisis.
B. Dehydration is a significant trigger for sickle cell crises. It can lead to hemoconcentration, making the blood more viscous and promoting sickling of the red blood cells. Maintaining hydration is crucial for preventing crises.
C. Exposure to cold weather can trigger vaso-occlusive crises in sickle cell patients. Cold temperatures can cause blood vessels to constrict, reducing blood flow and increasing the likelihood of sickling and pain episodes.
D. Any illness, particularly infections, can trigger a sickle cell crisis. Infections can lead to increased metabolic demand, dehydration, and inflammatory responses, all of which can contribute to vaso- occlusion and pain.
E. While certain sensory stimuli can affect individuals with various conditions (like migraines), flashing light patterns on television are not commonly recognized triggers for a sickle cell crisis. There is no substantial evidence linking this to vaso-occlusive events in sickle cell disease.

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Naxlex Comprehensive Predictor Exams

A nurse is providing teaching for a client who has stage 3 HIV disease (AIDS). Which of the following statements by the client should indicate to the nurse an understanding of the teaching?

Correct Answer is B

Explanation

Which of the following factors are known to commonly trigger a crisis in patients with sickle cell disease? (Select all that apply)

Correct Answer is ["A","B","C","D"]

Explanation

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

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

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?

A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate?

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)