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NUR355 MEDSURG EXAM 2|2025-2026|
QUESTIONS&ANSWERS|ALREADY GRADED A+
Name three risk factors of osteoarthritis (OA) Age, previous injury to a joint, and genetics (Female gender and metabolic disorders such as diabetes) A new pt complains to the nurse about her arthritis, she states it is in both her hands equally and she is concerned she is experiencing an external curving of her fingers now. The nurse recognizes the pt has this type of arthritis. rheumatoid arthritis A pt is taking daily Ibuprofen for OA. The nurse teaches the pt to monitor for these GI symptoms regarding chronic Ibuprofen use. black/tarry stools This antidepressant drug is at times used to treat the pain of fibromyalgia. duloxetine (Cymbalta) Three criteria for diagnoses of SLE Butterfly (malar) rash, positive antinuclear antibody test, and alopecia A pt has edema, redness (erythema) and warmth to an area. The nurse would describe this best as this Inflammation
A pt is experiencing a flare of her SLE after a vacation to sunny Florida. The nurse explains the potential causes to the pt could be these three things? Change in diet, increased stress due to travel, and increased sun exposure during vacation A pt with SLE is taking this medication which prompts the provider to make sure the pt is getting regular eye exams. hydroxychloroquine A nurse suspects a pt's SLE is worsening and attacking the kidneys when he sees an elevation in this lab creatinine A pt asks how he will know his antiviral therapy for HIV is working. The nurse responds that his labs will show this. lowered viral load and elevated CD4 count This lab value will be elevated in the presence of bacterial infections. neutrophil count. will also take WBCs or absolute neutrophil count (ANC) A pt has COVID, the nurse institutes these isolation precautions outside the patient's room Droplet A nurse recognizes this as a contraindication to receiving the influenza vaccine.
A pt states she walked through poison ivy and now has an itching rash. The nurse recognizes the pt is going through this type of reaction. type 4 hypersensitivity reaction Name two drugs used to treat hypersensitivity type I reactions. (Drug or drug class is acceptable) epinephrine and antihistamines (ex. Benadryl) will also accept steroids (ex. Solumedrol) Besides medications for anaphylaxis, what two interventions will the nurse provide? administer oxygen and place pt in high Fowler's position A pt asks what areas of the body where gout could develop. The nurse knows to respond with this answer foot/ankle, hands, knee JOINTS A pt asks what causes gout, the nurse knows to respond with this answer. uric acid build-up in a joint A nurse is giving education regarding gout to a pt. The nurse will include these three things. reduce ETOH, lose weight, and eat a diet low in purines A pt with a GI bleed has a type II hypersensitivity reaction and asks the nurse what caused it. The nurse's most likely response is this the blood you received after GI bleed caused your reaction
A nurse knows to education the diabetic pt about this when the pt has prednisone prescribed for her RA. increase or elevation of blood sugars due to the prednisone A pt recently took Augmentin for bronchitis; he now has persistent diarrhea. The nurse suspects the pt has this. C. Diff Types of immunity active immunity (natural and artificial immunity), passive immunity and innate what is active natural immunity? being exposed to the pathogen through infection with the actual disease what is active Artificial? vaccines what is Innate/Passive immunity? breast feeding
STOP infusion, CHANGE tubing and PUSH normal saline, MAINTAIN airway and NOTIFY RRT, ADMINISTER O2 and MONITOR What medicine is used for RH reactions? rogam Type 3 hypersensitivity immunity response Examples of type 3 reactions SLE (systemic lupus), RA (rheumatoid arthritis), Serum sickness (snake bites) Type 4 hypersensitivity delayed responses Examples of type 4 reactions poison ivy, TB skin test Type 5 hypersensitivity stimulated antibodies
Examples of type 5 reactions hyperthyroidism->graves disease Risk factors of hiv/aids unprotected intercourse and IV drug use Patho of HIV/AIDS when rapid rise in HIV viral load and CD4+ falls below 200 cells/mm3 it turns into AIDS Meds/Tx of HIV/AIDS protective isolation= reverse. Antiretroviral therapy (ART) Nursing education for HIV safe sex Nursing Interventions for HIV universal precautions and protective Complications of HIV kaposi's sarcoma. Opportunistic infection->sepsis->death
kidneys Normal range of creatinine is 0.6-1. What is the role of creatinine helps with muscles How do NSAIDS impact your creatinine levels can raise the level If you have a patient on long term NSAID use you should monitor creatinine What does serum uric acid levels tell us if pt has gout What is the normal serum uric acid level 1.5-6.
Anything above 6.5 means pt has gout When you have sepsis, what lab value would you expect to be high? WBC What is abnormal for WBC count anything above 11000 If pt has sepsis monitor vs and o When patient has sepsis every vital is high except? BP When looking at sepsis also draw lactate level Lactate levels tell us what about sepsis? how far we are
Fibromyalgia Nursing Interventions
- NSAIDs:
- Pregabalin (Lyrica)-used to treat nerve pain
- Duloxetine (Cymbalta)- an antidepressant that raises serotonin and norepinephrine and can help calm pain signals in the brain.
- Distraction, imagery (cognitive behavioral therapy), relaxation What to do if you have fibromyalgia? Get physically active with regular aerobic exercise- experts recommended that adults be moderately active for 150 minutes a week. Walk, bike, or swim 30 minutes a day Osteoarthritis clinical manifestation
- Progressive pain over time (increased after exercise)
- Bony swelling (Heberden's nodules)
- Overproduction of synovial fluid (enlarging the joint)
- Joints affected often unilaterally OA risk factors
- over 65
- woman
- bone deformities-some people are born with malformed joints or defective cartilage, which can increase the risk of OA
- obesity and in activity
- certain occupations. if your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop OA
- other diseases, having diabetes, underactive thyroid, gout or pagets disease of bone can increase your risk of developing OA rheumatoid arthritis Relieving pain and discomfort Medications:
- steroids (prednisone)—SE of prednisone include increased blood sugars, hunger, irritability, upset stomach (take w/ food) Medications on a schedule can help with chronic pain—true for any chronic pain process** Pathology of gout Urate crystals are deposited in joints, bone, and soft tissues clinical manifestation of gout Limited range of motion Inflammation (signs of inflammation, including redness, warmth, & edema) Lingering discomfort, labs may show an increase in uric acid serum levels (>6. MG/DL), best diagnostic is joint aspiration to assess for uric acid crystals directly Intense joint pain risk factors of gout Males 40-60 yrs old Females 55-70 yes old
Complement tests—such as kidney function, example a sudden elevated Creatinine could indicate acute glomerulonephritis or rhabdomyolysis brought on by SLE flare interventions of SLE Hydroxychloroquine—SE include retinal toxicity (get an eye exam!) Corticosteroids Prednisone, Methylprednisolone manifestations of SLE Fatigue Butterfly-shaped rash on the face (malar rash) worsen with sun exposure Alopecia (hair loss) Positive ANA 5 types of hypersensitivity Immediate rapid Allergic reaction Cytotoxic Reaction Immune complex reaction Delayed hypersensitivity reaction, T-cell mediated Stimulated sepsis-pneumonia, uro- Shivering, fever, or very cold Extreme pain or general discomfort
Pale of discolored skin Sleepy, difficult to awaken, confused, change in mental status Impending doom, I feel like I may die Short of breath A nurse questions which order in a pt with gout? •a. indomethacin
- b. Toradol
- c. aspirin •d. naproxen C. aspirin Fibromyalgia Chronic nerve pain due to inflammation. Fibromyalgia can be treated with off label medications like cymbalta Cymbalta is an antidepressant. Suppresses the neurotransmitters to change the way the neurons respond to pain Other forms of treatment for fibromyalgia NSAIDS (Pregablin & Lyrica), exercise, and cognitive behavioral therapy
Rheumatoid arthritis is bilateral Rheumatoid arthritis S&S heberden's nodes, enlarged joint size, increased pain with exacerbation, red, hot, and swollen joints Gout uric acid crystals in blood Gout risk factors alcohol use (beer), obesity (bmi over 30) Clinical manifestations of gout red great toe. What social activities should gout patients avoid doing? drinking
Gout can be treated with NSAIDS (ibuprofen) Regular dose of aspirin with gout (81 mg a day??) SLE systemic lupus erythematosus Criteria for diagnosis of SLE A.N.A test, and alopecia SLE rash butterfly or malar Patient teaching for SLE lower sun exposure (for rash) SLE treatment with hydroxychloroquine, what should the nurse assess eyes
