NR 464 COMPREHENSIVE EXAM 2025 QUESTIONS WITH
ANSWERS GUARANTEE A+
✔✔RA NANDAs (3)
Goals of RA (5) - ✔✔-Impaired physical mobility
-Chronic pain
-Disturbed body image
-Satisfactory pain management
-Minimal loss of functional ability
-Participate in therapeutic regimen
-Maintain + self-image
-Perform self-care
✔✔***RA nursing implementations (3) - ✔✔Lightweight splints
-Removed at regular intervals & reapply
-Perform ROM
-Plan care around morning stiffness
-Relieve joint stiffness and increase ability for ADLs
-Sit in warm shower
-Sit in tub with warm towels around shoulder
-Soak hands in warm water
✔✔***RA Ambulatory and home care:
Rest (3)
Body alignment (2) - ✔✔Alternate rest periods with activity
Avoid total bed rest 8-10 hours of sleep + daytime rest to avoid stiffness
Avoid overexertion
-Avoid flexion positions
-Never place pillows under knees. Firm mattress
✔✔***RA Ambulatory and home care: Joint protection (3) - ✔✔Modify tasks for less
stress of joints
,Energy conservation
-Work simplification techniques
-Pacing & organizing
-Use of carts
-Joint protective devices
-Delegation
OT
-Assistive devices
✔✔***RA: Cold and heat therapy
Cold (3) FOR WHAT - ✔✔-Relieves pain, stiffness and muscle spasm
-Beneficial during periods of DISEASE EXACERBATION
-Application only 10-15 minutes at one time
✔✔***RA: Cold and heat therapy
Moist Heat (4) FOR WHAT - ✔✔Heating pads, moist hot packs, paraffin baths, warm
baths/showers
Relieve CHRONIC STIFFNESS
Only 20 minutes at a time
Be alert for burn potential
✔✔***RA: Exercise plan (5) - general - ✔✔Individualized exercise plan to reinforce
program participation and ensure correct performance
Recreational & therapeutic exercise
Gentle ROM exercises done daily
Aquatic exercises in warm water beneficial
Limit 1-2 reps during acute inflammation
✔✔***RA Psychological support (7) - ✔✔Pt teaching important
Consider value system & perception of disease
Constantly challenge by problems, vulnerable to unproven/dangerous remedies
,Help recognize fears & concerns
Eval of family support system
Financial planning
Self-help groups
✔✔SLE: AKA Lupus
What type of disease is it?
Can cause what?
2 facts
Prevention? - ✔✔Chronic, multisystem inflammatory autoimmune disease
Major body organs and systems to fail
Spontaneous remissions/exacerbations
Onset may be acute or insidious
Prevention not possible - promote early dx and tx
✔✔***Lupus is most common in what population? (5) - ✔✔Women of childbearing years
(10x more likely to develop)
AFRICAN AMERICANS, Asians, Hispanics, Native Americans
✔✔Lupus Etiology?
***Most probable causes (5) - ✔✔Unknown
-Genetic influence
-Hormones
-Environmental factors
-INFECTIOUS AGENTS
-Certain meds (Pronestyl, Apresoline, antiseizure meds)
✔✔***What is happening pathophysiology wise in Lupus (2) - ✔✔Overaggressive
autoimmune reactions directed against constituents of:
-Cell nucleus (ANA)
-Single/double stranded DNA
, Ab response r/t B & T cell hyperactivity
✔✔***Lupus S/S: Dermatologic (6) - ✔✔Dry, scaly, raised rash (Butterfly rash)
Lesions most evident w/ exposure to sunlight or UV light (PHOTOSENSITIVE)
Upper body or individual round lesions (discoid/coin like)
Alopecia
Oralnasopharyngeal ulcers (~33%)
Sjogren's syndrome
✔✔Suggestions for Lupus patients (6) - ✔✔Use mild protein shampoos b/c alopecia
Avoid harsh hair treatments until hair grows during remission b/c of alopecia
Soft toothbrush
Avoid eating hard/sharp foods
Try to avoid stressful situations
Smoking cessations
✔✔***Lupus S/S for musculoskeletal (4) - ✔✔Polyarthritis (90%) with morning stiffness
Arthritis (Swan neck, ulnar deviation)
Myalgia
Risk for bone loss/fx
✔✔Initial complaints of Lupus (3)
***What may precede an exacerbation or FLARE of disease activity?
Nursing care (2) - ✔✔Fatigue
Fever
Joint/muscle pain
Generalized complaints such as FEVER, weight loss, arthralgia, and excessive fatigue
-Monitor s/s of flare
ANSWERS GUARANTEE A+
✔✔RA NANDAs (3)
Goals of RA (5) - ✔✔-Impaired physical mobility
-Chronic pain
-Disturbed body image
-Satisfactory pain management
-Minimal loss of functional ability
-Participate in therapeutic regimen
-Maintain + self-image
-Perform self-care
✔✔***RA nursing implementations (3) - ✔✔Lightweight splints
-Removed at regular intervals & reapply
-Perform ROM
-Plan care around morning stiffness
-Relieve joint stiffness and increase ability for ADLs
-Sit in warm shower
-Sit in tub with warm towels around shoulder
-Soak hands in warm water
✔✔***RA Ambulatory and home care:
Rest (3)
Body alignment (2) - ✔✔Alternate rest periods with activity
Avoid total bed rest 8-10 hours of sleep + daytime rest to avoid stiffness
Avoid overexertion
-Avoid flexion positions
-Never place pillows under knees. Firm mattress
✔✔***RA Ambulatory and home care: Joint protection (3) - ✔✔Modify tasks for less
stress of joints
,Energy conservation
-Work simplification techniques
-Pacing & organizing
-Use of carts
-Joint protective devices
-Delegation
OT
-Assistive devices
✔✔***RA: Cold and heat therapy
Cold (3) FOR WHAT - ✔✔-Relieves pain, stiffness and muscle spasm
-Beneficial during periods of DISEASE EXACERBATION
-Application only 10-15 minutes at one time
✔✔***RA: Cold and heat therapy
Moist Heat (4) FOR WHAT - ✔✔Heating pads, moist hot packs, paraffin baths, warm
baths/showers
Relieve CHRONIC STIFFNESS
Only 20 minutes at a time
Be alert for burn potential
✔✔***RA: Exercise plan (5) - general - ✔✔Individualized exercise plan to reinforce
program participation and ensure correct performance
Recreational & therapeutic exercise
Gentle ROM exercises done daily
Aquatic exercises in warm water beneficial
Limit 1-2 reps during acute inflammation
✔✔***RA Psychological support (7) - ✔✔Pt teaching important
Consider value system & perception of disease
Constantly challenge by problems, vulnerable to unproven/dangerous remedies
,Help recognize fears & concerns
Eval of family support system
Financial planning
Self-help groups
✔✔SLE: AKA Lupus
What type of disease is it?
Can cause what?
2 facts
Prevention? - ✔✔Chronic, multisystem inflammatory autoimmune disease
Major body organs and systems to fail
Spontaneous remissions/exacerbations
Onset may be acute or insidious
Prevention not possible - promote early dx and tx
✔✔***Lupus is most common in what population? (5) - ✔✔Women of childbearing years
(10x more likely to develop)
AFRICAN AMERICANS, Asians, Hispanics, Native Americans
✔✔Lupus Etiology?
***Most probable causes (5) - ✔✔Unknown
-Genetic influence
-Hormones
-Environmental factors
-INFECTIOUS AGENTS
-Certain meds (Pronestyl, Apresoline, antiseizure meds)
✔✔***What is happening pathophysiology wise in Lupus (2) - ✔✔Overaggressive
autoimmune reactions directed against constituents of:
-Cell nucleus (ANA)
-Single/double stranded DNA
, Ab response r/t B & T cell hyperactivity
✔✔***Lupus S/S: Dermatologic (6) - ✔✔Dry, scaly, raised rash (Butterfly rash)
Lesions most evident w/ exposure to sunlight or UV light (PHOTOSENSITIVE)
Upper body or individual round lesions (discoid/coin like)
Alopecia
Oralnasopharyngeal ulcers (~33%)
Sjogren's syndrome
✔✔Suggestions for Lupus patients (6) - ✔✔Use mild protein shampoos b/c alopecia
Avoid harsh hair treatments until hair grows during remission b/c of alopecia
Soft toothbrush
Avoid eating hard/sharp foods
Try to avoid stressful situations
Smoking cessations
✔✔***Lupus S/S for musculoskeletal (4) - ✔✔Polyarthritis (90%) with morning stiffness
Arthritis (Swan neck, ulnar deviation)
Myalgia
Risk for bone loss/fx
✔✔Initial complaints of Lupus (3)
***What may precede an exacerbation or FLARE of disease activity?
Nursing care (2) - ✔✔Fatigue
Fever
Joint/muscle pain
Generalized complaints such as FEVER, weight loss, arthralgia, and excessive fatigue
-Monitor s/s of flare
