You are working in a busy outpatient clinic and performing assessment on a new patient. The patient reports pain in the left ankle and big toe. You see what looks like a large tophi on the left toe. The patient's BMI is 38, and the patient reports drinking beer several nights a week. What is your patient's MOST LIKELY diagnosis?

Gouty arthritis

Rheumatoid arthritis

Lupus

Osteoarthritis

Answer and Explanation

The Correct Answer is A

A.   Gouty arthritis, or gout, is characterized by the accumulation of uric acid crystals in the joints, leading to sudden and severe pain, especially in the big toe (podagra). The presence of tophi (deposits of uric acid crystals under the skin) on the left toe is a classic sign of chronic gout. The patient's high BMI and frequent beer consumption also increase the risk for elevated uric acid levels, contributing to gout.
B.   Rheumatoid arthritis is an autoimmune condition that typically causes symmetric joint pain and stiffness, often involving the small joints of the hands and feet. It is less likely to present with tophi and is usually not linked to a history of beer consumption or a specific joint (like the big toe) in isolation.
C.   Systemic lupus erythematosus (SLE) can cause joint pain, but it usually involves multiple joints in a symmetrical pattern and is associated with a range of other systemic symptoms. The presence of tophi and the specific pain in the big toe point more toward gout.
D.   Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints and can cause pain, especially with movement. However, it does not typically cause the acute attacks or the presence of tophi that are characteristic of gout.

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Correct Answer is A

Explanation

A. This is the first and most critical action to take. The patient's symptoms suggest a possible transfusion reaction, which can be life-threatening. Stopping the transfusion immediately prevents further exposure to potentially harmful blood components.
B. Administering oxygen may be necessary if the patient exhibits signs of respiratory distress or hypoxia. However, this action should come after ensuring that the transfusion is stopped and the patient is stabilized, as continuing the transfusion could exacerbate the reaction.
C. While providing warmth can help alleviate chills, it is not the priority action. The patient's safety is more important, and symptoms of a transfusion reaction must be addressed first.
D. Checking the temperature can provide useful information about the patient's condition, especially if a fever is present, but it is not an immediate priority. The focus should be on stopping the transfusion and managing the acute symptoms.

A. TPN should flow through a filtered IV line B. No other drugs should be infused through the TPN line C. If TPN gets stopped or runs out, hang a bag of D10% W D. TPN IV tubing and bag should be changed every 24 hrs E. TPN should be administered through a central line

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

Explanation

A. Using a filtered IV line helps remove any particulate matter that could be present in the TPN solution, reducing the risk of complications such as phlebitis or embolism.
B. TPN should have its own dedicated line to prevent incompatibilities and ensure the TPN solution is delivered without interference. Infusing other medications through the same line can lead to complications and reduce the effectiveness of TPN.
C. If TPN gets stopped or runs out, a bag of 5% dextrose in water (D5W) should be hung to prevent hypoglycemia. D10% is too concentrated and can cause hyperglycemia.
D. To minimize the risk of infection and maintain sterility, TPN bags and tubing should be replaced every 24 hours. This helps prevent bacterial growth in the TPN solution.
E. TPN is typically administered through a central line because it allows for the infusion of hypertonic solutions that can irritate peripheral veins. Central lines provide better access to larger blood vessels, reducing the risk of complications.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

Which of the following is are appropriate nursing interventions to ensure the safety of a patient who is receiving Total Parenteral Nutrition (TPN)? (Select all that apply)

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

Explanation

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A patient with iron deficiency anemia who is taking oral iron supplements is evaluated by the nurse in the outpatient clinic. Which finding by the nurse is of MOST concern?

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 to transfuse a unit of PRBC's to your patient. You know that when you arrive at the blood bank and they hand you the unit of blood, you have how long to start the transfusion from that time?

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