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NUR 211 FINAL EXAM 2025 STUDY QUESTIONS
AND ANSWERS GRADED A+
A Nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?
Facial rash
Thickened skin
Chronic back pain
Iritis
Facial rash
Rationale: SLE causes a characteristic facial "butterfly" rash that is dry, scaly, red, and raised
A nurse is providing discharge teaching to a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse include?
Avoid using moisturizing lotions on the skin
Wash the hair with a mild protein shampoo.
Apply powder liberally to sensitive skin areas.
Use a sun-blocking agent with a sun protection of at least 15.
Use a sun-blocking agent with a sun protection of at least 15.
Rationale: Clients who have SLE are prone to hair loss. They should use a mild protein shampoo and ... avoid treatments that can damage the hair and scalp, such as dyes and permanents.
Clients who have SLE should not use powder or other drying skin products on their skin. Clients who have SLE should apply non-perfumed moisturizing lotions liberally to the skin
A nurse is caring for a client who has a new diagnosis of systemic lupus erythematosus (SLE) and asks where this disease originates within the body. The nurse should tell the client that SLE originates in which of the following locations in the body?
Connective tissue
Muscle tissue
Peripheral vascular system
Connective tissue
Rationale: SLE originates in the connective tissues of the body and affects all organ systems.
Diarrhea
Fatigue
Pruritus
Blurry Vision
Rationale: When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of
hydroxychloroquine toxicity and can be an indication of retinal damage.
A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE?
Exercise
Infection
Pregnancy
Sunlight
Exercise
Rationale: Deconditioning and muscle atrophy occurs as a result of lack of mobility. The nurse should encourage client to engage in conditioning exercises alternated with periods of rest.
Rationale:Exposure to sunlight and artificial ultraviolet light can cause for an exacerbation of SLE manifestations, especially the characteristic skin manifestations of lesions and butterfly rash.
Rationale:Pregnancy can cause an exacerbation of SLE, probably due to hormonal changes. The client should be advised of the risks and must be monitored closely for effects on the renal and cardiovascular systems if she decides to get pregnant.
Rationale:Infection is a major stressor on the body and can trigger an exacerbation of the SLE disease process. In addition, many clients who have SLE take steroid medications that place them at higher risk for infection.
A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function?
Serum creatinine
Blood urea nitrogen (BUN)
Serum sodium
Urine-specific gravity
Serum Creatinine
production and utilization.Rationale: Clients who are taking glucocorticoids may have increased susceptibility to infection due to the suppression of both the immune system and neutrophils production to fight infection.
Rationale: Clients who are taking high-dose, long-term use of glucocorticoids decreases the intestinal
absorption of calcium; therefore, calcium supplements with vitamin D are recommended.
A nurse in a provider's office is assessing a client who has rheumatoid arthritis (RA). Which of the following findings is a late manifestation of this condition?
Anorexia
Knuckle deformity
Low-grade fever
Knuckle deformity
Rationale: Joint deformity is a late manifestation of RA.
A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?
Stop the infusion.
Call the client's provider.
Elevate the head of the bed
Auscultate the client's breath sounds.
Stop the infusion
Rationale: When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.
Rationale: The nurse should auscultate the client's breath sounds; however, another action is the priority. Rationale: The nurse should elevate the head of the bed; however, another action is the priority. Rationale: The nurse should call the client's provider; however, another action is the priority.
What drug is used for the maintenance of sickle cell disease?
Hydroxyurea
hydroxychloroquine
Hydromorphone
Hydroxyurea
Rationale: Hydroxyurea is used in the treatment of sickle cell disease.
A nurse in a providers office is talking with a client about risk factors for osteoporosis. Which of the following factors should the nurse include? (select all that apply)
Aging
Caffeine intake
Secondhand smoke
Obesity
Long term steroid use
Aging
Caffeine intake
Secondhand smoke
Long term steroid use
Rationale: Sedentary lifestyle is correct. Immobility depletes bone. Obesity is incorrect. Women who are obese have a greater capacity for storing estrogen to help maintain acceptable levels of calcium. Aging is correct. Women lose bone due to estrogen depletion after menopause. Caffeine intake is correct. Excessive caffeine intake causes calcium loss in the urine. Secondhand smoke is correct. Smoking is a risk factor for osteoporosis, both active and passive (secondhand) smoking. Long term steroid use is correct, this places the client at risk for bone demineralization with long term use.
A nurse is teaching a client at high risk for osteoporosis about dietary measures she can take to increase her calcium level. The nurse should advise the client to increase her intake of:
Carrots
Spinach
Cabbage
Potatoes
Spinach
Rationale: One cup of cooked spinach contains 200 mg of calcium. Most vegetables contain considerably less calcium, except for kale, collard greens with stems, and turnip greens, which are also good sources of calcium.
A nurse is caring for a client who has osteoporosis and is taking a calcium supplement. When the client tells the nurse she has been having some flank pain, which of the following adverse effects should the nurse suspect?
Renal stones
Hepatitis
Hip fracture
High-impact aerobics
Walking briskly and weight training
Riding a bicycle
Stretching and swimming exercises
Walking briskly and weight training
Rationale: Weight-bearing exercises/weight training is CORRECT! they are essential for maintaining bone mass. Walking is an appropriate activity for an older client to promote weight bearing and to maintain bone mass.
Rationale: Riding a bicycle provides no weight-bearing advantages.
Rationale: Stretching and swimming exercises provide no weight-bearing advantages.
Rationale: High-impact aerobics can injure bones that have lost density.
A nurse is performing a physical examination of an older adult client who is postmenopausal and has a history of osteoporosis and a body mass index of 23. Which of the following spinal deformities should the nurse expect to find in this client?
Lordosis
Kyphosis
Scoliosis
Ankylosis
Kyphosis
Rationale: Kyphosis, a forward "stooping" posture with a loss of height, is an angulation of the posterior curve of the thoracic spine, usually a result of osteoporosis. It is most common in older adults and increases with aging and vertebral fractures.
Rationale: Scoliosis is a lateral curvature of the thoracic spine, most often in adolescents.
Rationale: Ankylosis is an immobility and consolidation of a joint, often a result of a congenital disorder or scarring.
Rationale: Lordosis or swayback is an exaggerated lumbar curve or anterior convexity of the lumbar spine that is common with obesity and pregnancy.
A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report? (Select all that apply.)
Tinnitus
Jaw pain
Drowsiness
Dysphagia
Jaw pain
Rationale: A history of low-trauma fracture after age 50 is a risk factor, not childhood fractures Rationale: Low body weight with a thin build is a risk factor, not large body stature. Rationale: High alcohol intake of 3 or more drinks a day is a risk factor, not low consumption
What are some potential complications of a sickle cell crisis?
Thrombosis and infarction, cardiovascular collapse, cerebral occlusion, Acute chest syndrome (common cause for hospitalization for SCD patients) , pulmonary infiltrate.
What are some diagnostic tests for sickle cell diesease?
Initial testing in the U.S. is done on newborns. Obtain a heelstick and test for presence of HbS.
Reticulocyte count: reticulocytes are immature red blood cells. Reticulocyte count would be elevated in sickle cell crisis.
What is the expected treatment for someone with sickle cell disease?
Hydroxurea - management for sickle cell disease. It increases fetal hemoglobin and decreases sickling of red blood cells. Adverse effect: bone marrow suppression and WBC, RBC, and Platelet inhibition.
Morphine PCA pump - instruct patient not to let family push button. Monitor for respiratory depression and sedation.
Non-pharmacological: Do NOT use hot & cold therapy. Cold causes vasoconstriction and increases the risk for sickling of cells. Heat can cause inflammation and increase burn injury risk. Can use light massage.
What education about SCD should be provided to the patient and family?
Provide information about treatment.
For parents/caregivers: look for signs of dehydration such as dry mucous membranes, weight loss, & sunken fontanelles (in infants). Give specific instructions about how many ounces of liquid the child needs to drink each day. It is okay to use flavored popsicles and drinks to increase fluid intake in children.
Provide patient/caregiver with careful instructions on infusion therapy and to monitor for signs of iron overload.
Medical ID bracelet
Current Vaccinations
Provide ongoing support, refer to support groups.
Encourage activity with appropriate periods of rest.
Ways to decrease caregiver role strain for someone caring for an individual with SCD.
Determine the ability of the caregiver to administer medications and fluids to provide adequate nutrition.
Assess caregiver's knowledge of signs of infection and sickle cell crisis and when to seek medical care.
Refer parents for genetic counseling, especially if they plan on having more children.
Provide referrals to support groups
Provide resources, including information about respite care for parents and information as needed for siblings.
What is a drug that is used to treat Lupus (and rheumatoid arthritis), and is a category X pregnancy risk?
A chronic autoimmune disease causing inflammation of connective tissue.
Risk factors of RA
Family history
Smokers
Obesity
Physical, emotional trauma
Exposure to pollution, insecticides, occupational exposures
What are some clinical manifestations of RA?
Slow, insidious onset
Joint deformities
Boutonniere deformity of the thumb
Swan-neck deformity of fingers
Inflammation of eyes, lungs, heart, kidneys, GI tract
Sjogren's syndrome: Dry mouth and eyes "hallmark" signs
What diagnostic testing is done to confirm Rheumatoid arthritis?
Look at history, Physical Exam, Lab findings
RA factor
ESR and CRP
Anti-CCP (more specific)
X-rays/CT
Examination of synovial fluid
What is the expected pharmacologic treatment of rheumatoid arthritis?
Disease modifying anti-rheumatic drugs (DMARDS)
Methotrexate
NSAIDS (pain only)
Hydroxychloroquine (plaquenil)
Short term steroids - often used as a "bridge" while a drug is taking effect or during severe disease flare up. Monitor for infections, never stop taking medication abruptly, monitor glucose level, monitor I/Os.*
What are some nursing diagnoses for Rheumatoid arthritis?
Chronic pain
Fatigue
Ineffective role performance
Disturbed body image
Impaired physical mobility
Anxiety
Activity intolerance
Self-care deficit
What is the main goal of treatment for RA?
