Exam 3 Flashcards
OA VS Rheumatoid Arthritis
RA- bilateral , worse w/ resting, swollen synovial membrane
OA, unilateral, worse with movement , bone ends rub together
Autoimmune disorder that involves GI andmight need swallow study?
Systemic Sclerosis (SSC)
butterly rash with?
Lupus Erythematosus
-Systemic Lupus Erythematosus
1 reason people die of SLE?
kidney disease
SLE vs SSC
-SLE is chronic, progressive, inflammatory connective tissue disorder –> kidney failure
(systemic or discoid)
-SSC is -Chronic, inflammatory, autoimmune connective tissue disorder –joints/skin/GI/kidney
(limited or diffuse)
types of traction used to provide pain relief
skin traction, running traction
traction that attaches to bones
skeletal
what 2 types of traction determine if patient can move or not?
balanced and running
patient movement does not impact this kind of traction
balanced
balanced traction
Fractured extremity is suspended with two opposing forces Patient movement does not impact traction Used for alignment
running traction
Force exerted in one plane only (fractured limp is the opposing force) Patient movement will impact traction (the person’s limb is the opposing force) Used for rest, pain management and sometimes alignment
fatty emboli syndrome manifestations
Lungs (low O2, Dyspnea, tachypnea)
Brain (Confusion, headache, seizure, altered LOC)
Skin (Petechia on neck, chest and arms)
priority actions for fatty emboli syndrome?
oxygenation and albumin fluids
**prevention!
A patient is in the ED and has a new cast/ cast has just been
completed on the right forearm. What is your priority assessment?
Priority Education?
CMS
-teaching the patient to check for sensation, movement,
warmth, color
priority assessments and actions for forearm open fracture
Remove jewelry Perform NV assessment (CMS) Immobilize Elevate Ice and pain management (further medical interventions including reduction and immobilization)
Which discharge instruction will the emergency department nurse
include for a patient with a sprained ankle?
A) Keep the ankle loosely wrapped with gauze.
B) Apply a heating pad to reduce muscle spasms.
C) Use pillows to elevate the ankle above the heart.
D) Gently move the ankle through the range of motion
C) Use pillows to elevate the ankle above the heart.
Which statement by the patient indicates a good
understanding of the nurse’s teaching about a new short-
arm synthetic/ fiberglass cast?
A) “I can get the cast wet as long as I dry it right away with a hair dryer.”
B) “I should avoid moving my fingers and elbow until the cast is removed.”
C) “I will apply an ice pack to the cast over the fracture site off and on for
24 hours.”
D) “I can use a cotton-tipped applicator to rub lotion on any dry areas
under the cast.”
C) “I will apply an ice pack to the cast over the fracture site off and on for
24 hours.”
A patient who has had open reduction and internal fixation (ORIF) of left lower leg
fractures continues to complain of severe pain in the leg 15 minutes after
receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is
cool to the touch. Which action should the nurse take next?
A) Notify the health care provider.
B) Assess the incision for redness.
C) Reposition the left leg on pillows.
D) Check the patient’s blood pressure.
A) Notify the health care provider.
Which action will the nurse take in order to evaluate the effectiveness of Buck’s traction for a patient who has an intracapsular fracture of the right femur? A) Assess for hip pain. B) Assess for contractures. C) Check peripheral pulses. D) Monitor for hip dislocation.
A) Assess for hip pain.
A patient with a right lower leg fracture will be discharged home with
an external fixation device in place. Which information will the nurse
teach?
A) “Check and clean the pin insertion sites daily.”
B) “Remove the external fixator for your shower.”
C) “Remain on bed rest until bone healing is complete.”
D) “Take prophylactic antibiotics until the fixator is removed.”
A) “Check and clean the pin insertion sites daily.”
A patient who has had open reduction and internal fixation (ORIF) of a hip fracture
tells the nurse he is ready to get out of bed for the first time. Which action should
the nurse take?
A) Check the patient’s prescribed weight-bearing status.
B) Use a mechanical lift to transfer the patient to the chair.
C) Delegate the transfer to nursing assistive personnel (NAP).
D) Decrease the pain medication before getting the patient up.
A) Check the patient’s prescribed weight-bearing status.
The nurse is caring for a patient who is to be discharged from the
hospital 4 days after insertion of a femoral head prosthesis using a
posterior approach. Which statement by the patient indicates a need
for additional instruction?
A) “I should not cross my legs while sitting.”
B) “I will use a toilet lift on the toilet seat.”
C) “I will have someone else put on my shoes and socks.”
D) “I can sleep in any position that is comfortable for me.”
D) “I can sleep in any position that is comfortable for me.”
When giving home care instructions to a patient who has comminuted left forearm
fractures and a long-arm cast, which information should the nurse include?
A) Make sure that only clean objects be used to scratch the skin underneath
the cast.
B) Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
C) Call the health care provider for loss of sensation of the hand.
D) Keep the hand immobile to prevent soft tissue swelling.
C) Call the health care provider for loss of sensation of the hand.
A patient is being discharged 4 days after hip arthroplasty using the
posterior approach. Which patient action requires intervention by
the nurse?
A) The patient uses crutches with a swing-to gait.
B) The patient leans over to pull on shoes and socks.
C) The patient sits straight up on the edge of the bed.
D) The patient bends over the sink while brushing teeth.
B) The patient leans over to pull on shoes and socks.
After being hospitalized for 3 days with a right femur fracture, a
patient suddenly develops shortness of breath and tachypnea. The
patient tells the nurse, “I feel like I am going to die!” Which action
should the nurse take first?
A) Stay with the patient and offer reassurance.
B) Administer prescribed PRN O2 at 4 L/min.
C) Check the patient’s legs for swelling or tenderness.
D) Notify the health care provider about the symptoms.
B) Administer prescribed PRN O2 at 4 L/min.
A patient arrived at the emergency department after tripping over a
rug and falling at home. Which finding is most important for the
nurse to communicate to the health care provider?
A) There is bruising at the shoulder area.
B) The patient reports arm and shoulder pain.
C) The right arm appears shorter than the left.
D) There is decreased shoulder range of motion.
C) The right arm appears shorter than the left.
A young adult arrives in the emergency department with ankle swelling and
severe pain after twisting an ankle playing basketball. Which of these prescribed
interprofessional interventions will the nurse implement first?
A) Send the patient for ankle x-rays.
B) Immobilize the ankle and apply an ice pack.
C) Administer naproxen (Naprosyn) 500 mg PO.
D) Give acetaminophen with codeine
B) Immobilize the ankle and apply an ice pack.
Which nursing action for a patient who has had right hip arthroplasty
can the nurse delegate to experienced unlicensed assistive
personnel (UAP)?
A) Reposition the patient every 1 to 2 hours.
B) Assess for skin irritation on the patient’s back.
C) Teach the patient quadriceps-setting exercises.
D) Determine the patient’s pain intensity and tolerance.
A) Reposition the patient every 1 to 2 hours.
The second day after admission with a fractured pelvis, a patient
suddenly develops confusion and is disoriented X 3 (Oriented only
to person). Which action should the nurse take first?
Take the blood pressure.
Assess patient orientation.
Check the O2 saturation.
Observe for facial asymmetry.
Check the O2 saturation.
After a motorcycle accident, a patient arrives in the emergency
department with severe swelling of the left lower leg. Which action
will the nurse take first?
A) Elevate the leg on 2 pillows.
B) Apply a compression bandage.
C) Assess leg pulses and sensation.
D) Place ice packs on the lower leg.
C) Assess leg pulses and sensation.
Which finding in a patient with a Colles’ fracture of the left wrist
is most important to communicate immediately to the health care
provider?
Swelling is noted around the wrist.
The patient is reporting severe pain.
The wrist has a deformed appearance.
Capillary refill to the fingers is prolonged.
Capillary refill to the fingers is prolonged.
OA nursing intervention
OA (Non-nursing: Analgesics (non opioid) & Surgery) Exercise and Rest balance Swimming, walking, cycling Hot or cold therapy (focus on heat) Home adjustments Weight control Supplements Glucosamine Chondroitin Position Shoes
RA nursing interventions
RA (Non-nursing pharmacology targets immune system) Pain Rest (Balance & Set priorities) Position Ice Heat/ Paraffin Hot Shower in the morning Mobility Occupational therapy Assistive devices Fatigue Pace activities/ rest and activity
early vs late RA
Early = vague symptoms, fatigue, malaise, low grade fever, joint
pain
Late= Joint deformity with more joint involvement
—> intervention: need more assistance devices/pt/ot
When a patient has one hot, swollen, painful joint and a
diagnosis of RA, should you be concerned about this
finding? Provide rationale for your answer.
Infection- needs to be ruled out and treated before making
assumptions that it is something else
If your patient with RA complains of cervical
pain, what should you assess and prioritize?
Breathing- RA of cervical spine can potentially be life-
threatening
Discuss the pathophysiology of systemic lupus
erythematosus (SLE) and compare to systemic sclerosis
(SS).
SLE –> Autoimmune in nature- includes formation of immune
complexes (the autooantibody attaches to the target cell AKA
antigen AKA self-cell) which invade healthy tissue and can
cause impairment of blood flow to tissue. These complexes
really like the kidneys
SS –> Complex autoimmune disorder that leads to fibrosis of
tissue (and hence organs)
SLE manifestations
“Butterfly” rash Fever Fatigue Weakness Weight loss Anorexia Polyarthritis Osteonecrosis Muscle atrophy Myalgia + Kidney failure, lung effusions, pneumonia,pericarditis Reynaud’s, Neuro issues, lymph enlargement
SS manifestations
See CREST for limited form
Joint pain
Joint stiffness
Pitting edema of hands, fingers and forearms
Edema may progress
Shiny skin
Taut/ no wrinkles
+ Digestive issues (includes swallowing problems),
Cardiovascular issues (includes Raynaud’s), Lung
problems, Kidney failure
SLE interventions
SLE (non-nursing pharmacology targeted at
immune system)
- Skin protection
- Mild soap, lotion, cosmetics
- –Avoid direct sunlight
- – Sunscreen
Hair treatment Importance of recognizing exacerbations--> Fever Misunderstanding/ knowledge deficit Monitor kidneys Teach patients about fever – sign of exacerbation
Systemic Sclerosis interventions
SS (non-nursing pharmacology targeted at immune system) ----Comfort See RA interventions for joint pain/ fatigue Bed Cradle Foot board Room temperature Gloves and socks (if tolerated)
Eliminate cigarette smoke
Reduce stress
Swallow Study/ safety
SLE vs systemic sclerosis: sun protection primary intervention?
SLE
swallow study- SLE or SS?
SS
early sign fever- SS or SLE?
SLE
comfort primary intervention- SLE or SS?
SS
Discuss two important educational points you should
provide your patient with SLE that are different from RA.
Fever – sign of exacerbation
Need to protect skin
Also- monitoring kidneys
What is the most common cause of death for someone
with SLE? Why?
Kidney failure- immune complexes are nephrophilic and can collect there are cause damage to glomerulus
diffuse vs limited systemic sclerosis location
diffuse = all over limited= head, forearms, lower legs
CREST- limited or diffuse systemic sclerosis
limited
what can cause gout?
Increased levels of uric acid
type of gout that can occur at any age
secondary
What is the first typical finding from gout?
Acute gouty arthritis
“Attack”
Excruciating pain and inflammation
Metatarsophalangeal joint of great toe (Podagra)
Gout education for patients
Easily managed with pharmaceuticals Colchicine Allopurinol Take maintenance medication after meals Encourage fluids Low Purine diet No organ meat, shellfish, oily fish with bones Avoid aspirin Avoid diuretics Avoid stress Stress management
The nurse teaches a 64-yr-old man with gouty arthritis
about food that may be consumed on a low-purine diet.
The patient’s choice of which food item would indicate an
understanding of the instructions?
A) Eggs
B) Liver
C) Salmon
D) Turkey
A) Eggs
Which nursing intervention would be most appropriate
for a patient with Sjögren’s syndrome?
A) Ambulate with assistive devices
B) Use lubricating eye drops frequently
C) Administer acetaminophen as needed
D) Apply ice or heat compresses to affected areas
B) Use lubricating eye drops frequently
A female patient’s complex symptomatology over the
past year has led to a diagnosis of systemic lupus
erythematosus (SLE). Which statement demonstrates the
patient’s need for further teaching about the disease?
A) “I’ll try my best to stay out of the sun this summer.”
B) “I know that SLE is associated with exacerbations”
C) “I’m hoping surgery will be an option for me in the future.”
D) “I understand I’m going to be vulnerable to getting infections.”
C) “I’m hoping surgery will be an option for me in the future.”
A patient is admitted for pneumonia and experiences a
gout attack of the large left toe. What interventions
should the nurse include in the care plan? (Select all that
apply)
A) Bed Cradle
B) Massage of large toe
C) Allopurinol
D) Colchicine
E) Aspirin
A) Bed Cradle
C) Allopurinol
D) Colchicine
Which of the following is the most important assessment
finding for a patient with Systemic Sclerosis?
A) Fingertips are blue and cyanotic
C) Patient is having difficulty swallowing
D) Patient has a skin breakdown on top of toe
E) Patient has a new pleural rub
C) Patient is having difficulty swallowing
Which of the following is a priority assessment finding for a patient with SLE? A) A fever B) Fatigue C) Constipation
A) Fever
A person who is HIV seropositive, has a CD4 count of 250 and a history of
pneumocystis jeroveci pneumonia has AIDS.
TRUE or False.
AIDS- defined by CDC count < 200 or by >200 with an AIDS defining illness (such as PCP)
Why is it such a big deal that CD4 (T helper cells) are attacked by the HIV virus?
CD4 cells are responsible for signaling other immune cells to defend body
from infectious agents. Destruction of the T helper cells causes the body to
be vulnerable to infections
What does acute HIV infection look like?
2-4 weeks after initial exposure to HIV, development of fever, malaise and
flu-like symptoms
How long does it take for someone to go from being HIV positive to having AIDS (without antiretroviral therapy)
10 years
Can I get HIV from? Tattoo Ear piercing- Emptying a urine bag- Wiping someone’s tears- Mosquito bites- Toilet seats-
NO to all of these
What is the benefit of the 4th generation HIV testing?
Detects earlier and more accurately (21 days)
What are the three ways HIV is spread? Provide examples of each.
Parenteral, Sharing IV needles, blood transfusions (screening reduces
risk)
Sexual Vaginal, Anal, Oral
Perinatal Placenta, Vaginal childbirth, breastfeeding
What are the safety precautions for healthcare workers
when caring for patients who are HIV+?
Standard precautions
A patient is admitted to the hospital with disseminated MAC. Which
of the following would the nurse expect to find (check all that apply)
- Patient’s CD4+ count is 100 cells/mm^3
- The patient is not on antiretroviral therapy
- The patient is on antiretroviral therapy
- Patient’s CD4+ count is 34 cells/mm^3
- Patient has a high viral load
Patient’s CD4+ count is 34 cells/mm^3
The patient is not on antiretroviral therapy
A patient with AIDS is hospitalized with pneumocystis
pneumonia. The patient’s CD4+ count is critically low.
Discuss priorities for infection prevention for this patient.
Optimize oxygenation/ Support/ treat with antimicrobials
Infection prevention reverse isolation (know what this looks like – no
fresh flowers, no sick visitors, strict handwashing before entering room,
etc…)
Antiretroviral therapy
You are seeing a patient with AIDS in the clinic with who has had a
significant weight loss and has chronic diarrhea. Discuss
educational priorities.
Determine cause and whether it can be treated
Managing symptoms
Address nutrition/ food choices/ fluid intake
Monitor I’s and O’s
Skin integrity
The nurse is caring for a patient newly diagnosed with Human Immunodeficiency
Virus (HIV). What lab value does the nurse explain to the patient the criteria for
AIDS diagnosis is based on?
A) Presence of HIV antibodies
B) CD4+ T cell count below 200/μL
C) Presence of oral hairy leukoplakia
D) White blood cell count below 5000/μL
B) CD4+ T cell count below 200/μL
When teaching a patient infected with HIV regarding transmission of
the virus to others, which statement made by the patient would
indicate a need for further teaching?
A) “I will need to isolate any tissues I use so as not to infect my family.”
B) “I will notify all of my sexual partners so they can get tested for HIV.”
C) “Unprotected sexual contact is the most common mode of transmission.”
D) “I do not need to worry about spreading this virus to others by sweating at
the gym.”
A) “I will need to isolate any tissues I use so as not to infect my family.”
The nurse is providing postoperative care for a patient with human
immunodeficiency virus (HIV) infection after an appendectomy.
What type of precautions should the nurse observe to prevent the
transmission of this disease?
A) Droplet precautions
B) Contact precautions
C) Airborne precautions
D) Standard precautions
D) Standard precautions
The nurse is monitoring the effectiveness of antiretroviral therapy
(ART) for a patient with acquired immunodeficiency syndrome
(AIDS). Which of the following laboratory results are evidence the
medications are effective?
A) Increased viral load
B) Decreased neutrophil count
C) Increased CD4+ T cell count
D) Decreased white blood cell count
C) Increased CD4+ T cell count
severe osteoporosis can or cannot have hip replacement?
NOT!
What are the differences in cemented and fit-pressed joint replacements?
Differences in precautions?
Cemented is fixed hardware immediately whereas fit-pressed requires
bone to fuse hardware. Cement- weight bearing is allowed immediately
after surgery, no weight-bearing immediately after surgery for fit-pressed
Mrs. Calhoun has OA and is 40 lbs overweight. She is in the clinic and states that her pain is getting worse. What are your priorities?
Priorities- further assess pain. Discuss relationship between weight and
OA while the root causes of obesity are complex and require addressing with compassion (and an understanding that weight loss is not a simple task [or a fix-all]), it is important for our patients to be aware of the relationship. Weight loss can help to alleviate the pain associated with OA.
What are the manifestations of OA?
What causes OA?
Joint stiffness and pain that Diminishes after rest Worsens after activity Limited ROM Crepitus Enlarged hardened joints Atrophy of muscles
Wear and tear Repetitive activity/ overuse Injury Obesity (contributes) Diseases
Who has osteoporosis? Who has osteopenia? (Based on bone
density test)
TSCORE
-1.5 , -3, +1, 0, -2.7, -2
T-score of -1.5 Osteopenia T-score of -3 Osteoporosis T-score of +1 T-score of 0 T-score of -2.7 Osteoporosis T-score of -2 Ostepenia
You are tasked with planning an osteoporosis prevention event.
Who will your focus population be?
Under 30, especially females (College? HS?, etc…)
You have a patient admitted for pneumonia who has a history of severe
osteoporosis. What are your priorities regarding the OP? Discuss specific
strategies to ensure your priorities are met.
Injury prevention! Fall precautions (all of the specifics that come with
preventing falls)
What are risk factors for osteomyelitis?
Infections Catheters IV drug use Salmonella Poor dental care Trauma
What are the manifestations of osteomyelitis?
Bone pain (localized), worsens with movement, fever,
Redness, swelling, tender, heat
What are priorities of care for osteomyelitis?
Antibiotic treatment! Assessing for ability to adhere to medications.
Pain management
Wound management
