Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
Which lab result would be consistent with a diagnosis of rheumatoid arthritis?
A. Elevated rheumatoid factor
Elevated rheumatoid factor (RF), an autoantibody, is present in 70-80% of rheumatoid arthritis (RA) patients. It contributes to immune complex formation, driving synovial inflammation and joint damage. This lab result is a key diagnostic marker, making it consistent with RA and critical for confirming the diagnosis.
B. Decreased C-reactive protein
Decreased C-reactive protein (CRP) is inconsistent with RA, which typically shows elevated CRP due to systemic inflammation. CRP reflects acute-phase response in active RA, and low levels suggest inactive disease or another condition, making this result inaccurate for supporting an RA diagnosis.
C. Normal erythrocyte sedimentation rate
Normal erythrocyte sedimentation rate (ESR) is not typical in active RA, where ESR is elevated due to inflammation-driven increases in plasma proteins. Normal ESR may occur in remission but does not support an active RA diagnosis, making this result inconsistent with the condition.
D. Low antinuclear antibody levels
Low antinuclear antibody (ANA) levels are not specific to RA and are more associated with systemic lupus erythematosus. While some RA patients may have low ANA, it is not a diagnostic marker for RA, making this result irrelevant and inconsistent with confirming rheumatoid arthritis.
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Full Explanation
Choice A reason: Elevated rheumatoid factor (RF), an autoantibody, is present in 70-80% of rheumatoid arthritis (RA) patients. It contributes to immune complex formation, driving synovial inflammation and joint damage. This lab result is a key diagnostic marker, making it consistent with RA and critical for confirming the diagnosis.
Choice B reason: Decreased C-reactive protein (CRP) is inconsistent with RA, which typically shows elevated CRP due to systemic inflammation. CRP reflects acute-phase response in active RA, and low levels suggest inactive disease or another condition, making this result inaccurate for supporting an RA diagnosis.
Choice C reason: Normal erythrocyte sedimentation rate (ESR) is not typical in active RA, where ESR is elevated due to inflammation-driven increases in plasma proteins. Normal ESR may occur in remission but does not support an active RA diagnosis, making this result inconsistent with the condition.
Choice D reason: Low antinuclear antibody (ANA) levels are not specific to RA and are more associated with systemic lupus erythematosus. While some RA patients may have low ANA, it is not a diagnostic marker for RA, making this result irrelevant and inconsistent with confirming rheumatoid arthritis.
Similar Questions
The client has been diagnosed with type 1 diabetes mellitus and has been prescribed Humulin R insulin. The patient will take the dose at 0900. When should the client be sure to have a snack or meal?
A. 0900-0930
Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.
B. 1100-1130
Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.
C. 1400-1430
By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.
D. 1700-1730
At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.
Full Explanation
Choice A reason: Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.
Choice B reason: Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.
Choice C reason: By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.
Choice D reason: At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.
Which statement about proton pump inhibitors (PPIs) should be included in a client education workshop?
A. PPIs are used for long-term management of ulcers and gastric reflux disease
PPIs are used for short-term treatment of ulcers and gastroesophageal reflux disease (GERD), typically 4-8 weeks, not long-term, due to risks like nutrient deficiencies or infections. Long-term use is reserved for specific conditions like Barrett’s esophagus, making this statement inaccurate for general use.
B. PPIs are useful because they are available both orally and IV
While PPIs are available orally and intravenously, this is not the primary focus of patient education. Their efficacy in suppressing acid production is more critical than administration routes. This statement is less relevant, as it does not address therapeutic use or safety considerations.
C. Treatment with PPIs causes very few adverse effects in the older client
PPIs cause adverse effects in older adults, including increased risks of fractures, Clostridium difficile infection, and vitamin B12 deficiency due to prolonged acid suppression. This statement is inaccurate, as older clients are particularly susceptible to these risks, requiring careful monitoring during PPI therapy.
D. Treatment focuses on the lowest dose for the shortest time period
PPI treatment emphasizes the lowest effective dose for the shortest duration to minimize risks like infections, fractures, or nutrient malabsorption. This approach balances acid suppression with safety, especially for ulcers or GERD, making this statement accurate and critical for patient education on safe use.
Full Explanation
Choice A reason: PPIs are used for short-term treatment of ulcers and gastroesophageal reflux disease (GERD), typically 4-8 weeks, not long-term, due to risks like nutrient deficiencies or infections. Long-term use is reserved for specific conditions like Barrett’s esophagus, making this statement inaccurate for general use.
Choice B reason: While PPIs are available orally and intravenously, this is not the primary focus of patient education. Their efficacy in suppressing acid production is more critical than administration routes. This statement is less relevant, as it does not address therapeutic use or safety considerations.
Choice C reason: PPIs cause adverse effects in older adults, including increased risks of fractures, Clostridium difficile infection, and vitamin B12 deficiency due to prolonged acid suppression. This statement is inaccurate, as older clients are particularly susceptible to these risks, requiring careful monitoring during PPI therapy.
Choice D reason: PPI treatment emphasizes the lowest effective dose for the shortest duration to minimize risks like infections, fractures, or nutrient malabsorption. This approach balances acid suppression with safety, especially for ulcers or GERD, making this statement accurate and critical for patient education on safe use.
The health care provider recommends daily fiber supplements for an elderly client who is experiencing frequent constipation. What statement is important for the nurse to include when educating a client about these supplements?
A. Bulk-forming agents decrease the absorption of nutrients in the intestines so you will need a daily vitamin
Bulk-forming fiber supplements, like psyllium, increase stool bulk without significantly decreasing nutrient absorption. While high doses may slightly affect mineral uptake, routine vitamin supplementation is not required. This statement is inaccurate, as nutrient malabsorption is not a primary concern with fiber supplements.
B. Fiber can exacerbate your constipation if you do not drink at least 8 glasses of water daily
Fiber supplements require adequate hydration (at least 8 glasses of water daily) to swell and soften stool, promoting bowel movements. Insufficient water can cause fiber to harden, worsening constipation. This statement is accurate, as hydration is critical for the efficacy and safety of fiber supplements.
C. If you take fiber long term, you can become dependent on it to have a bowel movement
Long-term fiber use does not cause dependency; it mimics natural dietary fiber, promoting regular bowel movements. The colon adapts to increased bulk without losing intrinsic motility. This statement is inaccurate, as fiber supports, not undermines, normal bowel function in chronic use.
D. Your bowel regimen will improve if you delay responding to your urge to defecate
Delaying the urge to defecate can worsen constipation by causing stool to harden and reducing rectal sensitivity. Prompt response to bowel urges promotes regularity. This statement is inaccurate, as it contradicts the goal of improving bowel regimen with fiber supplementation.
Full Explanation
Choice A reason: Bulk-forming fiber supplements, like psyllium, increase stool bulk without significantly decreasing nutrient absorption. While high doses may slightly affect mineral uptake, routine vitamin supplementation is not required. This statement is inaccurate, as nutrient malabsorption is not a primary concern with fiber supplements.
Choice B reason: Fiber supplements require adequate hydration (at least 8 glasses of water daily) to swell and soften stool, promoting bowel movements. Insufficient water can cause fiber to harden, worsening constipation. This statement is accurate, as hydration is critical for the efficacy and safety of fiber supplements.
Choice C reason: Long-term fiber use does not cause dependency; it mimics natural dietary fiber, promoting regular bowel movements. The colon adapts to increased bulk without losing intrinsic motility. This statement is inaccurate, as fiber supports, not undermines, normal bowel function in chronic use.
Choice D reason: Delaying the urge to defecate can worsen constipation by causing stool to harden and reducing rectal sensitivity. Prompt response to bowel urges promotes regularity. This statement is inaccurate, as it contradicts the goal of improving bowel regimen with fiber supplementation.