Question

A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

Answer 1

Correct Answers:

Report unexplained bruising to the provider.
Avoid people who have infections.
Do not drink alcoholic beverages while taking this medication.

Rationale :

🔹 Bruising: Methotrexate can cause bone marrow suppression, leading to thrombocytopenia and easy bruising.

🔹 Infection risk: The medication is immunosuppressive, so clients should avoid sick contacts.

🔹 Alcohol: Drinking alcohol increases hepatotoxicity risk when taking methotrexate.

🔹 NSAIDs caution: NSAIDs do not minimize adverse effects; they may increase methotrexate toxicity.

🔹 Onset: Methotrexate effects are not immediate; therapeutic benefit may take weeks.

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Answer 2

Correct Answers:

It is acceptable to discard the first urine sample at the beginning of the 24-hour period.

Rationale :

🔹 Start point: First morning urine is discarded to ensure accurate 24-hour measurement.

🔹 Collection: All subsequent urine is collected for 24 hours in a single container.

🔹 Storage: The urine should be refrigerated to prevent breakdown of cortisol.

🔹 Hydration: Clients should maintain normal fluid intake; do not restrict water.

🔹 Purpose: Ensures accurate assessment of daily cortisol secretion.

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Answer 3

Correct Answers:

To diagnose Cushing's syndrome

Rationale :

🔹 Mechanism: Dexamethasone suppresses cortisol in healthy individuals, but not in Cushing’s syndrome.

🔹 Evaluation: Measures serum or urine cortisol after steroid administration.

🔹 Differentiation: Helps distinguish endogenous cortisol overproduction.

🔹 Other conditions: Addison’s disease involves cortisol deficiency, not suppression testing.

🔹 Monitoring: Provides confirmation for hypercortisolism and guides treatment.

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Answer 4

Correct Answers:

Moon face
Purple striations
Buffalo hump

Rationale :

🔹 Buffalo hump: Fat accumulation in upper back is classic for Cushing’s.

🔹 Moon face: Facial fat redistribution causes round, full appearance.

🔹 Purple striations: Skin thinning with stretch marks on abdomen or thighs.

🔹 Alopecia: May occur but is less specific; tremors are not typical.

🔹 Clinical relevance: Recognizing these signs aids in early diagnosis and treatment planning.

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Answer 5

Correct Answers:

Erythrocyte sedimentation rate (ESR)

Rationale :

🔹 Inflammation marker: ESR decreases with effective anti-inflammatory therapy.

🔹 Rheumatoid factor: Not responsive to daily aspirin; more diagnostic than therapeutic.

🔹 WBC & ANA: Not used to monitor aspirin efficacy.

🔹 Therapeutic goal: Reduce pain, swelling, and systemic inflammation.

🔹 Documentation: ESR trends indicate treatment effectiveness over time.

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Answer 6

Correct Answers:

Decreases inflammation

Rationale :

🔹 Anti-inflammatory: Prednisone suppresses immune-mediated inflammation in RA.

🔹 Symptom relief: Reduces joint pain, swelling, and stiffness.

🔹 Other options: Does not improve bone density or peripheral blood flow.

🔹 Immunosuppressive caution: Prednisone increases infection risk, not reduces it.

🔹 Monitoring: Assess symptom improvement and side effects regularly.

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Answer 7

Correct Answers:

Increase in insulin requirements due to corticosteroids increasing insulin resistance.

Rationale :

🔹 Hyperglycemia risk: Corticosteroids increase hepatic glucose production.

🔹 Insulin resistance: Peripheral tissues respond less to insulin, requiring higher doses.

🔹 Monitoring: Blood glucose levels should be checked more frequently during steroid therapy.

🔹 Dose adjustment: Insulin doses may need temporary increase to maintain glucose control.

🔹 Patient education: Clients should report hyperglycemia symptoms such as polyuria or thirst.

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Answer 8

Correct Answers:

"I will limit my alcohol intake."

Rationale :

🔹 Alcohol effect: Alcohol increases uric acid levels, worsening gout attacks.

🔹 Dietary guidance: High-purine foods should be limited, not emphasized.

🔹 Hydration: Clients should increase fluids, not restrict to 1 liter.

🔹 Aspirin caution: Daily aspirin can affect uric acid metabolism; dose adjustments may be needed.

🔹 Patient education: Lifestyle modifications are key to preventing future attacks.

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Answer 9

Correct Answers:

Cortisol levels above 40 mcg/dL

Rationale :

🔹 Excess cortisol: Cushing’s syndrome is characterized by hypersecretion of cortisol, so elevated urine cortisol confirms the diagnosis.

🔹 Reference range: Normal 24-hour urine cortisol is typically 20–40 mcg/dL; values above this indicate abnormal cortisol production.

🔹 Diagnostic significance: High urine cortisol correlates with clinical features such as moon face, buffalo hump, and purple striae.

🔹 Repeat confirmation: Often, the test may be repeated or combined with dexamethasone suppression to confirm hypercortisolism.

🔹 Patient safety and monitoring: Elevated cortisol levels require further evaluation and treatment to prevent complications like hypertension, hyperglycemia, and immunosuppression.

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Answer 10

Correct Answers:

No change in cortisol levels after ACTH administration

Rationale :

🔹 Primary adrenal insufficiency: The adrenal glands are unable to produce cortisol despite ACTH stimulation.

🔹 Diagnostic marker: Lack of cortisol response confirms adrenal gland dysfunction (Addison’s disease).

🔹 Differentiation: In secondary adrenal insufficiency (pituitary problem), cortisol may increase slightly, since adrenal glands are still responsive.

🔹 Other hormones: Aldosterone may also be low, contributing to hypotension and electrolyte imbalances.

🔹 Clinical relevance: Early recognition prevents adrenal crisis, which can be life-threatening.

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Custom Haynes Fall 2025 ADN 252 Exam 4

No.

1 :
A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 :
Which of the following statements is correct regarding the collection of a 24-hour urine cortisol test?

3 :
What is the primary purpose of the dexamethasone suppression test?

4 :
A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

5 :
A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?

6 :
A nurse is teaching a client who has a new prescription for prednisone to treat rheumatoid arthritis. The nurse should inform the client that which of the following is a therapeutic effect of this medication?

7 :
A client with diabetes mellitus is prescribed corticosteroids for SLE. What effect should the nurse anticipate on the client's insulin requirements?

8 :
A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?

9 :
A patient with suspected Cushing's syndrome is undergoing a 24-hour urine test for cortisol. Which result would most likely confirm the diagnosis?

10 :
Which of the following results from an ACTH stimulation test is indicative of primary adrenal insufficiency?

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Custom Haynes Fall 2025 ADN 252 Exam 4

No.

1 : A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 : Which of the following statements is correct regarding the collection of a 24-hour urine cortisol test?

3 : What is the primary purpose of the dexamethasone suppression test?

4 : A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

5 : A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?

6 : A nurse is teaching a client who has a new prescription for prednisone to treat rheumatoid arthritis. The nurse should inform the client that which of the following is a therapeutic effect of this medication?

7 : A client with diabetes mellitus is prescribed corticosteroids for SLE. What effect should the nurse anticipate on the client's insulin requirements?

8 : A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?

9 : A patient with suspected Cushing's syndrome is undergoing a 24-hour urine test for cortisol. Which result would most likely confirm the diagnosis?

10 : Which of the following results from an ACTH stimulation test is indicative of primary adrenal insufficiency?

1 :
A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 :
Which of the following statements is correct regarding the collection of a 24-hour urine cortisol test?

3 :
What is the primary purpose of the dexamethasone suppression test?

4 :
A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

5 :
A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?

6 :
A nurse is teaching a client who has a new prescription for prednisone to treat rheumatoid arthritis. The nurse should inform the client that which of the following is a therapeutic effect of this medication?

7 :
A client with diabetes mellitus is prescribed corticosteroids for SLE. What effect should the nurse anticipate on the client's insulin requirements?

8 :
A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?

9 :
A patient with suspected Cushing's syndrome is undergoing a 24-hour urine test for cortisol. Which result would most likely confirm the diagnosis?

10 :
Which of the following results from an ACTH stimulation test is indicative of primary adrenal insufficiency?