RPN Care of Chronic Illness 4 — Questions and Answers
Question 1: A patient with systemic lupus erythematosus (SLE) asks why they should avoid sunlight. The nurse's best response is:
- Sunlight causes photosensitivity and can trigger disease flares (Correct answer)
- Sunlight depletes vitamin D and worsens joint pain
- Sunlight increases risk of hypertension in SLE patients
- Sunlight reduces the effectiveness of immunosuppressive medications
Correct answer: Sunlight causes photosensitivity and can trigger disease flares
UV radiation triggers photosensitivity reactions and can precipitate SLE flares.
Question 2: A patient with end-stage renal disease on hemodialysis reports feeling itchy all over. This is most likely caused by:
- An allergic reaction to the dialysis membrane
- Accumulation of phosphorus and uremic toxins (Correct answer)
- Dehydration from excessive fluid removal during dialysis
- Low hemoglobin causing skin changes
Correct answer: Accumulation of phosphorus and uremic toxins
Uremic pruritus is caused by buildup of phosphorus and uremic toxins in patients with inadequate renal clearance.
Question 3: A patient with Crohn's disease is experiencing a flare. Which dietary approach is typically recommended during active disease?
- High-fiber diet rich in raw fruits and vegetables
- Low-residue diet with small, frequent meals (Correct answer)
- High-fat diet to increase caloric density
- Unlimited dairy products to boost calcium intake
Correct answer: Low-residue diet with small, frequent meals
A low-residue diet reduces bowel irritation and the frequency of stool during active Crohn's flares.
Question 4: A patient with heart failure has a weight gain of 3 pounds overnight. What is the most appropriate nursing action?
- Reassure the patient that weight fluctuation is normal
- Encourage the patient to increase physical activity
- Notify the physician and review fluid intake (Correct answer)
- Reduce the patient's meal size to decrease sodium
Correct answer: Notify the physician and review fluid intake
Rapid weight gain of 2-3 pounds overnight indicates fluid retention requiring prompt provider notification.
Question 5: A nurse is teaching a patient with hypertension about lifestyle modifications. Which instruction has the greatest impact on blood pressure reduction?
- Reduce alcohol intake to no more than two drinks per day
- Increase aerobic exercise to at least 150 minutes per week
- Follow the DASH diet emphasizing fruits, vegetables, and low-fat dairy (Correct answer)
- Reduce coffee consumption to one cup per day
Correct answer: Follow the DASH diet emphasizing fruits, vegetables, and low-fat dairy
The DASH diet consistently shows significant blood pressure reduction and is a cornerstone of hypertension lifestyle management.
Question 6: A patient with chronic pain rates pain at 8/10 despite scheduled analgesia. Which term describes this pain?
- Neuropathic pain
- Breakthrough pain (Correct answer)
- Psychosomatic pain
- Referred pain
Correct answer: Breakthrough pain
Breakthrough pain is pain that exceeds the control provided by a scheduled analgesic regimen and requires additional intervention.
Question 7: A patient with epilepsy is prescribed phenytoin. Which instruction about this medication is most important?
- Take phenytoin only when a seizure is imminent
- Never stop phenytoin abruptly without physician guidance (Correct answer)
- Phenytoin can be safely taken with antacids to reduce GI upset
- Expect orange-colored urine as a harmless side effect
Correct answer: Never stop phenytoin abruptly without physician guidance
Abrupt discontinuation of phenytoin can precipitate status epilepticus, a life-threatening condition.
RPN Care of Chronic Illness 4
A patient with systemic lupus erythematosus (SLE) asks why they should avoid sunlight.
The nurse's best response is: