Canadian Registered Nurse Examination
CRNE Case 2

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Canadian Registered Nurse Examination Case I




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Situation: Mrs. Garcia, 40 years old, has been diagnosed with an acute generalized exacerbation of rheumatoid arthritis. Her husband and daughters want to be involved in her treatment and care at home. The entire family has come to the rheumatology clinic for Mrs. Garcia's scheduled appointment.

1. What advice should the nurse give to Mrs. Garcia and her family to promote her comfort?

a) place a pillow under her knees when supine
b) sleep on her side with pillows behind her
c) sit in a low, soft chair
d) apply splints to her wrists in slight dorsiflexion

2. Mr. Garcia asks what he can do to help promote his wife's independence. What should the nurse recommend?

a) install a raised toilet seat to make sitting down and getting up more comfortable
b) build a wheelchair ramp as a wheelchair will eventually be necessary
c) hire a nursing aide to help with activities of daily living and housekeeping
d) remove hand splints each morning and encourage lifting light weights

3. Mrs. Garcia tells the Canadian registered nurse that it is difficult at times to perform active range-of-motion exercises. What should the nurse do?

a) assess to see whenever she needs to be admitted to hospital
b) advise her to wait until the pain subsides before exercising
c) refer her to a community-based physiotherapist for daily exercises
d) encourage the family to help her perform passive range-of-motion exercises

4. what strategy should the nurse suggest to Mrs. Garcia's daughters to help relieve their mother's pain?

a) allow her medications to take effect
b) encourage her to watch television
c) walk around the block with her every day
d) put a warm, moist cloth on her joints for 20 minutes

5. What is the best way to ensure that Mrs. Garcia's plan of care will be effective?

a) follow a standardized plan of care for rheumatoid arthritis
b) collaborate with Mrs. Garcia and her family in developing the plan of care
c) review the current literature for new treatments and approaches
d) give Mrs. Garcia and her family a copy of the written plan of care



Canadian Registered Nurse Examination:
Answers and Rationale

1) D - Correct
- this is the approved positioning for splintingA - Incorrect - a pillow should not be placed under the knees because it increases the risk of flexion contractures
B - Incorrect - proper body positioning is essential, and the person should lie flat with only one pillow under the head
C - Incorrect - it is difficult to sit in and get out of a low, soft chair

2) A - Correct
- assistive devices may improve independence in activities of daily living (ADL) such as toileting
B - Incorrect - there is no indication that this adaptation to the environment is necessary at this time. There is no indication that Mrs. Garcia's condition will deteriorate to the point of requiring a wheelchair
C- Incorrect - although Mrs. Garcia may need help with ADL, there is no indication that she requires constant supervision and assistance.
D - Incorrect - during an acute exacerbation, Mrs. Garcia should be resting the joints with passive range-of-motion exercises.

3) D - Correct
- Canadian registered nurse encouraged exercises to prevent joint stiffness and promote mobility. If active exercises cannot be done, passive exercises should be done. This also encourages family participation.
A - Incorrect - this intervention does not promote mobility. There are no indications that Mrs. Garcia requires inpatient care.
B - Incorrect - some pain may be experienced; however, it is important to preserve range-of-motion in the joints to promote mobility.
C - Incorrect - a physiotherapist is not required to perform normal range-of-motion exercises. The family is capable and represents a cost-effective choice in providing this intervention.

4) D - Correct
- heat applications are helpful in relieving pain, stiffness and muscle spasms. Moist compresses achieve maximum effectiveness within 20 minutes of application.
A - Incorrect - this statement does not empower the daughters to help no encourage them to be involved in their mother's care.
B - Incorrect - although a distraction technique is appropriate during the chronic stage, it is not the most effective intervention during an acute phase.
C - Incorrect - active o passive range-of-motion exercises is important for all joints. Going for walk once a day exercises lower body joints only and would not help with overall pain relief.

5) B - Correct
-collaboration with Mrs. Garcia and her family is essential in developing an effective plan of care, in order to address their concerns and issues.
A - Incorrect -standardized plans of care may serve as a guide only and should be individualized to address the family's concerns.
C - Incorrect -reviewing literature does not involve collaboration with the family or ensure that the plan of care will be effective.
D - Incorrect -if the nurse develops a plan of care without Mrs. Garcia or her family's collaboration, it will not be an effective plan of care, as it may not address their concerns and issues.


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