A 75-year-old female patient complains of fatigue as well as pain and stiffness of the shoulders and neck. There is no history of trauma or exercised-induced pain. Medications include a beta blocker and ACE inhibitor
Medical history includes giant cell arteritis and Raynaud's syndrome. Physical examination is unremarkable. There is no swelling or erythema over the temporal arteries. There is no swelling, erythema, limitation in range of motion or point tenderness over the shoulder joints. The neck has normal range of motion and no tenderness or swelling. Which of the following disorders should be included in the list of possible diagnoses?
A. Rheumatoid arthritis
B. Polymyalgia rheumatic
C. Drug-induced myalgia
D. Fibromyalgia
ANS: B
Polymyalgia rheumatica is usually identified in adults aged 60 or older. The actual etiology of this condition is unknown. Giant cell arteritis occurs in about 15% of those with polymyalgia rheumatica, and the two conditions may be different expressions of the same etiology. The patient typically complains of sudden onset of widespread pain. Commonly affected sites include the neck, shoulders, and pelvis. Pain is accompanied by fatigue and stiffness. The stiffness is most profound in the morning. There is no actual muscle weakness. Unlike RA, there is no small joint inflammation and effusion.
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A patient who is critically ill is attached to a saturation of mixed venous oxygen monitor (SvO2) and has an SvO2 value that is trending downward and is currently below normal at 55%. What clinical abnormality should the nurse suspect?
A) Increased cardiac output B) Fever and shivering C) Fluid volume overload D) Oversedation
In the nephrotic syndrome, the glomeruli are damaged by inflammation and allow small _______ to pass through into the urine
ANS:
A patient who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the physician prescribe?
A) Ipratropium or budesonide B) Isoetharine or montelukast C) Nedocromil or cromolyn D) Aminophylline or caffeine
The nurse is assessing a terminally ill patient for clinical signs of impending death. When assessing the patient's respirations, the nurse would expect:
1. deep, clear breath sounds. 2. noisy, wet-sounding respirations. 3. even, unlabored respirations. 4. shallow, clear breath sounds.