NSG555 / NSG 555 Exam 4 (Latest 2024 / 2025 Update): Nurse Practitioners in Primary Care I | Questions and Verified Answers | 100% Correct | Grade A - Wilkes

Exam 4: NSG555 / NSG 555 (Latest 2024 / 2025 Update) - Nurse Practitioners in Primary Care II Exam | Questions and Verified Answers | 100% Correct | Grade A - Wilkes Q: Which are symptoms of rheumatoid arthritis (RA) that distinguish it from osteoarthritis (OA)? (Select all that apply.) Extra-articular inflammatory signs History of injury to affected joints Morning stiffness of at least 1 hour Symmetric tender, swollen joints Unilateral joint involvement: Answer: A, C, D The clinical presentation of RA includes extra-articular symptoms, morning stiffness lasting at least 1 hour, and symmetric, bilateral joint involvement. OA often has a history of previous injury and is usually asymmetric and may be unilateral. Q: A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the provider order initially to manage this patient's symptoms? A trial of sulfasalazine and methotrexate Biologic anti-tumor necrosis factor agents Changing to a COX-1 inhibitor medication Corticosteroid injections every 3 months: Answer: C NSAIDs have been shown to reduce pain and stiffness and reduce progression of structural damage if administered continuously. Patients should try at least two NSAIDs before other medications are attempted. Sulfasalazine and methotrex- ate have not been shown to be significantly effective for axial disease. Biologic anti-tumor necrosis factor medications are given only after failure of two NSAIDs. Corticosteroid injections are not indicated. Q: A patient is treated for a urinary tract infection and, 3 weeks later, presents with pain and swelling of one knee and in one hand, along with inflammation in both eyes. What will the provider suspect as the cause of these symptoms? a. Ankylosing spondylitis Infectious arthritis Psoriatic arthritis Reactive arthritis: Answer: D Reactive arthritis can cause arthritis, urethritis, and inflammation of the eyes 1 to 6 weeks after a prior infection. Ankylosing spondylitis generally presents with lower back inflammation. Psoriatic arthritis is associated with psoriasis. Reactive arthritis is not related to infection in the involved joints. Q: A patient reports a history of recurrent lower back pain for 6 months. The patient describes the pain as a deep ache and stiffness that is worse upon awakening and improves after walking. Which findings will the examiner elicit to help make a clinical diagnosis of ankylosing spondylitis? (Select all that apply.) Assessment of the degree of lumbar lordosis Evaluation of lateral thoracic spine flexion Measurement of chest expansion Noting the degree of cervical kyphosis Observation for scapular asymmetry: Answer: A, B, C Examination of the spine will show loss of the normal lumbar lordosis, decreased thoracic spine flexion, and diminished chest expansion. Cervical kyphosis is not assessed. Scapular asymmetry evaluates for scoliosis. Q: A patient with systemic lupus erythematosus (SLE) develops end-stage re- nal disease. Because of the underlying SLE, what treatment is recommended for this patient? Dialysis only Immunosuppressant therapy Kidney transplantation Palliative care: Answer: C Patients with SLE who develop renal failure may require dialysis and then kidney transplantation; most who undergo transplant do relatively well because of the immunosuppression given to prevent graft rejection. Immunosuppressant therapy is given for graft rejection and does not treat end-stage renal failure. Palliative care is not the only option for this patient. Q: Which laboratory tests may help distinguish systemic lupus erythemato- sus (SLE) from other systemic rheumatologic disorders? Antinuclear antibody titer C-reactive protein Rheumatoid factor Serum complement levels: Answer: D With SLE, complement levels may decrease because of the activation and depo- sition of immune complexes in tissues. The other tests are non-specific tests for inflammation and rheumatologic disorders. Q: A patient with systemic lupus erythematosus (SLE) has frequent symp- toms and has been taking prednisone for each episode. The provider plans to start hydroxychloroquine and the patient asks why this medication is necessary. What will the provider tell this patient about this medication? It is effective in reducing disease flares and for tapering steroids. It is given in conjunction with steroids to improve outcomes. It lowers blood pressure and decreases the risk for renal disease. It prevents the need for bisphosphonate therapy.: Answer: A Hydroxychloroquine is effective in managing musculoskeletal, cutaneous, and serosal manifestations of SLE and allows tapering of steroids and reduces disease flares. Cyclophosphamide is given with prednisone to improve renal outcomes. Hydroxychloroquine is not given for effects on blood pressure and kidneys. Calcium and vitamin D are given to prevent the need for bisphosphonates. Q: Which is a distinctive finding in patients who are diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA)? Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) Hepatitis B virus (HBV) surface antigen Increased eosinophils Positive antinuclear antibodies (ANA): Answer: C