Multidimensional Care I (Rasmussen College) (MDC1)

The correct answer is: C. A client on Methotrexate with a fever.

Explanation 

C. A client on Methotrexate with a fever.

Methotrexate is an immunosuppressive drug commonly used to treat rheumatoid arthritis, lupus, and other autoimmune disorders. A fever in a client taking Methotrexate could indicate a serious infection or bone marrow suppression, leading to neutropenia (low white blood cell count), which increases the risk of life-threatening infections. Because of the potential for sepsis, this client should be seen first for immediate evaluation, including vital signs, blood cultures, and a complete blood count (CBC).

Explanation of Incorrect Answers:

A. A client with chronic rheumatic pain.

While pain management is important, chronic pain is not an immediate life-threatening condition. This client can be assessed after addressing the client with a fever on Methotrexate, as infection poses a greater immediate risk.

B. A client with lupus asking for dinner.

A client requesting food is stable and does not have an urgent medical concern. While lupus can have serious complications, there is no immediate danger based on the provided information.

D. A client with multiple children sitting.

This option does not indicate any urgent medical needs or distress. Unless additional information suggests an emergency, this client does not need immediate attention.

Summary:

The priority is the client on Methotrexate with a fever (option C) due to the risk of infection and neutropenia, which can lead to sepsis if not treated promptly. The other clients are stable and can be assessed afterward.

The correct answer is: A. Administer topical hydrocortisone.

Explanation 

A. Administer topical hydrocortisone

Clients with systemic lupus erythematosus (SLE) often experience skin rashes, including the characteristic butterfly rash across the cheeks. Topical corticosteroids like hydrocortisone help reduce inflammation, redness, and itching associated with SLE-related skin conditions. This is a common treatment to manage cutaneous lupus symptoms.

Explanation of Incorrect Answers:

B. Intense cold therapy to the extremities

Cold therapy is not recommended for clients with SLE, especially those with Raynaud’s phenomenon (a common complication of lupus). Intense cold exposure can worsen vasoconstriction, leading to poor circulation, pain, and potential tissue damage. Instead, clients should keep their extremities warm and well-protected.

C. Administer antibiotics

SLE is an autoimmune disease, not a bacterial infection, so antibiotics are not a standard treatment unless the client has a secondary bacterial infection (e.g., pneumonia, urinary tract infection). Lupus itself is not caused by bacteria, so antibiotics would not be an appropriate routine intervention.

D. Encourage ultraviolet (UV) light exposure

UV light exposure triggers lupus flares and worsens skin symptoms, making this a harmful intervention. SLE clients are advised to avoid direct sunlight, wear protective clothing, and use sunscreen to prevent photosensitivity reactions.

Summary:

For clients with SLE, the appropriate nursing intervention is administering topical hydrocortisone to manage skin inflammation and rashes. Cold therapy is not recommended, antibiotics are only used for infections, and UV light exposure can worsen symptoms

The correct answer is: C. The Joint Commission.

Explanation:

The National Patient Safety Goals (NPSGs) are established by The Joint Commission (TJC) to improve patient safety in healthcare settings. These goals focus on critical areas such as correct patient identification, effective communication, medication safety, infection prevention, and reducing the risk of patient harm. The NPSGs are updated regularly based on sentinel event data, patient safety trends, and expert recommendations.

Why the Other Options Are Incorrect:

A. Medicare 

Medicare, under the Centers for Medicare & Medicaid Services (CMS), regulates healthcare payment policies and quality reporting but does not create the National Patient Safety Goals. However, CMS does have safety initiatives that align with TJC’s goals.

B. The American Nurses Association 

The American Nurses Association (ANA) advocates for nursing standards, ethics, and policies but does not directly establish the NPSGs. It does, however, support initiatives that improve patient safety.

D. The Institute of Medicine

The Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), provides research and policy recommendations on healthcare quality and safety but does not publish the NPSGs. However, its landmark report, "To Err Is Human," helped shape modern patient safety initiatives.

Summary:

The National Patient Safety Goals (NPSGs) are published by The Joint Commission (TJC) to enhance patient safety in healthcare. While organizations like CMS, ANA, and NAM influence safety standards, only TJC is responsible for setting the NPSGs.

The correct answer is: D. Use a mechanical lift to reposition the client every 2 hours.

Explanation:

Friction and shear injuries occur when the skin is dragged across a surface, causing damage to the underlying tissue. This is a major concern in geriatric, immobile, and sedated clients, especially those who are intubated, as they cannot reposition themselves. Using a mechanical lift helps reduce friction and shear by lifting rather than dragging the client. It ensures safe repositioning without excessive pressure on the skin, reducing the risk of pressure injuries (bedsores). Repositioning every 2 hours is a standard nursing intervention to prevent skin breakdown.

Why the other choices are incorrect:

A. Postpone daily bed bath

This is incorrect because daily hygiene is important for infection prevention, skin integrity, and overall comfort. While excessive bathing can dry out the skin, proper skin care with moisturizers helps prevent skin breakdown. The key to reducing shear and friction is safe repositioning, not avoiding hygiene care.

B. Elevate the client’s head of the bed to 45 degrees

This is incorrect because elevating the head of the bed above 30 degrees increases shear forces. When the bed is elevated too high, the client’s body slides downward, causing the skin and deeper tissues to move at different rates, increasing the risk of skin damage. The head of the bed should be kept at 30 degrees or lower unless contraindicated (e.g., risk for aspiration).

C. Caregiver independently slides the client up in bed

This is incorrect because sliding a client up in bed without using proper techniques (e.g., lift sheet, draw sheet, or mechanical lift) creates significant shear forces. This can tear fragile skin, leading to pressure injuries. Instead, a two-person assist with a lift sheet or mechanical lift should be used.

Summary:

To minimize friction and shear injury, a mechanical lift should be used to reposition the client every 2 hours. This prevents dragging of the skin and reduces pressure injury risk. Proper positioning techniques, including keeping the head of the bed at 30 degrees or lower when possible, using lift sheets, and ensuring regular skin care, are essential in preventing skin breakdown in geriatric and immobile clients.

The correct answers are:

A. Candidiasis

C. Pneumocystis jiroveci pneumonia

E. Non-Hodgkin’s lymphoma

Explanation:

Opportunistic infections (OIs) are infections that occur in individuals with weakened immune systems, such as those with acquired immunodeficiency syndrome (AIDS). These infections are caused by organisms that usually do not cause disease in people with healthy immune systems but become pathogenic when immunity is compromised.

A. Candidiasis

This is correct because candidiasis (thrush) is a common fungal opportunistic infection in AIDS patients. It affects the mouth, throat, and vagina, leading to symptoms such as white patches, difficulty swallowing, and pain. Candidiasis occurs due to the weakened immune response in individuals with AIDS.

C. Pneumocystis jiroveci pneumonia (PJP)

This is correct because PJP is a life-threatening opportunistic infection seen in AIDS patients. It is caused by Pneumocystis jiroveci, a fungal organism that affects the lungs, leading to severe pneumonia, shortness of breath, cough, and fever. PJP was once a major cause of death in AIDS patients before the use of antiretroviral therapy (ART) and prophylactic antibiotics.

E. Non-Hodgkin’s lymphoma (NHL)

This is correct because NHL is an AIDS-defining cancer that occurs due to the immune system’s inability to fight abnormal cell growth. It is classified as an opportunistic malignancy because it is more likely to develop in people with AIDS than in the general population.

Why the other choices are incorrect:

B. Hodgkin's lymphoma

This is incorrect because Hodgkin’s lymphoma is not considered an opportunistic infection. While individuals with AIDS may have an increased risk for some cancers, Hodgkin’s lymphoma is not an AIDS-defining illness according to the CDC.

D. Clostridium difficile (C. diff)

This is incorrect because C. difficile is not classified as an opportunistic infection specific to AIDS. While C. diff causes severe diarrhea and colitis, it is usually associated with prolonged antibiotic use rather than HIV/AIDS-related immune suppression.

Summary:

The correct opportunistic infections associated with AIDS are Candidiasis, Pneumocystis jiroveci pneumonia, and Non-Hodgkin’s lymphoma. These conditions arise due to severe immune suppression. Hodgkin’s lymphoma is not an AIDS-defining illness, and Clostridium difficile is not classified as an opportunistic infection specific to AIDS.

The correct answer is: A. "Ice packs can be used to reduce swelling but should be removed after 20 minutes."

Explanation:

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that affects the joints, leading to pain, swelling, and stiffness. Nonpharmacological interventions, such as ice and heat therapy, can help manage symptoms. Cold therapy (ice packs) helps reduce inflammation, numb pain, and decrease swelling, making it particularly useful during acute flare-ups. Ice should not be applied for more than 20 minutes at a time to prevent tissue damage or reduced blood flow.

Cold therapy constricts blood vessels, reducing swelling and inflammation. Limiting ice application to 20 minutes at a time prevents cold-related skin damage (frostbite) and reduced circulation.

Why the Other Options Are Incorrect:

B. "Apply ice packs, it is generally okay to keep them on for up to one hour at a time." 

Prolonged ice application (more than 20 minutes) can cause tissue damage and poor circulation, worsening pain and stiffness. Guidelines recommend 15-20 minutes of ice therapy, followed by at least a 40-minute break.

C. "Heat always makes the swelling go down. You don’t need any other interventions." 

Heat therapy helps with joint stiffness but does NOT reduce swelling. While heat improves blood flow and reduces muscle tension, it can worsen inflammation if used during an active flare-up. A combination of heat (for stiffness) and ice (for inflammation) is recommended depending on symptoms.

D. "Try a high-impact exercise like running to loosen up your joints and reduce pain."

High-impact activities (e.g., running, jumping) can worsen joint damage in RA patients by putting excessive stress on inflamed joints. Instead, low-impact exercises like swimming, yoga, or range-of-motion exercises are safer and more effective for improving joint mobility without increasing pain.

Summary:

 For rheumatoid arthritis, ice therapy is effective for reducing swelling and inflammation, but it should only be applied for 20 minutes at a time. Heat therapy is useful for stiffness, but not swelling. High-impact exercises should be avoided to prevent joint damage. 

The correct answer is: A. A client with sudden and increasing pain in his fractured arm

Explanation:

The nurse should always prioritize clients based on the urgency and severity of their condition. In this case, sudden and increasing pain in a fractured arm could indicate a serious complication such as compartment syndrome, neurovascular compromise, or worsening injury. Compartment syndrome is a medical emergency where increased pressure within a muscle compartment cuts off circulation and nerve function, potentially leading to permanent damage if not treated quickly. Other possible complications include nerve or vascular injury, which require immediate assessment. Since sudden and severe pain is a warning sign of a serious complication, this client must be assessed immediately to prevent permanent damage or loss of function.

Why the other choices are incorrect:

B. A client with a fractured ankle who would like a glass of water

This is incorrect because the need for hydration is important but is not an urgent or life-threatening situation. The nurse can delegate this task to an unlicensed assistive personnel (UAP) while attending to more critical clients.

C. A client with rheumatoid arthritis and a scheduled pain medication

This is incorrect because while pain management is important, scheduled pain medication does not take priority over a potential medical emergency (such as compartment syndrome). This client can safely wait while the nurse assesses the client with increasing pain.

D. A client being discharged in two hours and needs to be taught how to use his crutches

This is incorrect because discharge teaching is important, but it is not a critical or life-threatening concern. The nurse can provide teaching once the urgent assessment and care of the priority client are completed.

Summary:

The nurse should see the client with sudden and increasing pain in the fractured arm first because this could indicate a serious complication such as compartment syndrome or neurovascular impairment, which requires immediate intervention. The other clients have non-urgent needs that can be addressed after this priority assessment.

The correct answer is: D. Assembly line worker.

Explanation

D. Assembly line worker

Carpal tunnel syndrome (CTS) is a repetitive motion injury caused by compression of the median nerve in the wrist. It is common in occupations that involve repetitive hand and wrist movements, forceful gripping, and prolonged flexion or extension of the wrist. Assembly line workers are at high risk because they perform repetitive tasks, often for long periods, without variation in movement.

Explanation of Incorrect Answers:

A. Truck driver

Truck drivers primarily use their hands for steering, but their wrist movements are not as repetitive or forceful as those of an assembly line worker. While prolonged gripping of the steering wheel may contribute to wrist discomfort, CTS is not a common occupational hazard for truck drivers compared to jobs requiring continuous wrist flexion and extension.

B. Nursing assistant

Nursing assistants perform a variety of tasks, including lifting, repositioning patients, and using medical equipment, but they do not typically engage in highly repetitive hand and wrist movements that directly lead to CTS. They are more likely to develop back or shoulder injuries rather than carpal tunnel syndrome.

C. Elementary school teacher

While teachers write on boards, grade papers, and use computers, these activities do not involve the level of repetitive strain necessary to cause carpal tunnel syndrome. Teachers may experience hand fatigue or general discomfort, but they are not at high risk for CTS compared to assembly line workers.

Summary:

The occupation most associated with carpal tunnel syndrome is an assembly line worker, as it involves continuous, repetitive wrist motions that contribute to median nerve compression. Truck drivers, nursing assistants, and teachers do not perform the same level of repetitive hand movements that significantly increase CTS risk.

The correct answer is: C. Natural passive.

Explanation

C. Natural passive

Passive immunity occurs when antibodies are transferred from one person to another rather than being produced by the recipient's own immune system. In the case of natural passive immunity, a mother passes preformed antibodies (IgG) to her fetus through the placenta. This provides temporary immunity to the newborn until their immune system matures and begins producing its own antibodies.

Explanation of Incorrect Answers:

A. Natural active

Natural active immunity occurs when a person is exposed to a pathogen naturally (such as through infection) and their immune system produces antibodies in response. This type of immunity is long-lasting because memory cells are formed. Example: A child who recovers from chickenpox develops natural active immunity.

B. Artificial active

Artificial active immunity occurs when a person is given a vaccine containing a weakened or inactivated form of a pathogen, stimulating their immune system to produce antibodies and memory cells. Example: Getting a measles, mumps, and rubella (MMR) vaccine.

D. Artificial passive

Artificial passive immunity occurs when a person receives pre-formed antibodies through an injection rather than producing them naturally. This provides immediate but short-term immunity. Example: A person exposed to rabies receives rabies immune globulin (RIG) to provide temporary protection.

Summary:

Natural passive immunity occurs when a mother passes antibodies to her fetus through the placenta, providing short-term immunity. Unlike active immunity, which requires the immune system to produce its own antibodies, passive immunity is temporary because no memory cells are formed.