Question 1

A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management?

Accepted Answer

Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.

Question 2

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says,

Accepted Answer

Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

Question 3

A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will need to monitor

Accepted Answer

Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.

Question 4

A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question?

Accepted Answer

Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

Question 5

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication?

Accepted Answer

Hyperglycemia is a side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication.

Question 6

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care?

Accepted Answer

Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

Question 7

A concerned parent who lives in an area endemic for Lyme disease asks the nurse what precautions should be taken for the disease. The nurse will teach the parent that

Accepted Answer

Erythema migrans is the typical early lesion associated with a tick bite causing Lyme disease. Treatment with antibiotics can prevent the later stages of Lyme disease. The initial symptoms are headache, chills, stiff neck, fatigue, and joint and muscle pain. Ticks should be removed with tweezers.

Question 8

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is

Accepted Answer

The patient's statement about not going anyplace because of hating the way he or she looks supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

Question 9

A patient with fibromyalgia syndrome (FMS) tells the nurse, "I don't know why the doctor has prescribed amitriptyline (Elavil) for me. I don't feel depressed, just tired and achy." The most appropriate response by the nurse is, "The Elavil

Accepted Answer

Elavil is ordered to improve sleep, to decrease stress and fatigue, and as an adjuvant medication for pain control. It would not be ordered to prevent depression, although it might be ordered to treat depression in a patient with FMS. Elavil is not a muscle relaxant or an antiinflammatory drug, although medications from these categories are used in treating FMS.

Question 10

A patient who has had fatigue and muscle weakness for several years is diagnosed with chronic fatigue syndrome. The patient expresses anger at the health care professional for not offering relief of the symptoms and also anger at family members for saying "snap out of it and get busy." Based on the patient's statements, the nurse identifies a nursing diagnosis of

Accepted Answer

The patient's statements support the problem and etiology of powerlessness related to lack of control. The patient does not complain about activity intolerance. Although the patient may have risk for altered family process, but there are not enough data to support this diagnosis. The patient is not expressing low self-esteem or feelings of inadequacy regarding meeting role expectations.

Question 11

A patient with an acute attack of gout is treated with colchicine. The nurse determines that the drug is effective upon finding

Accepted Answer

Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in pain.

Question 12

The nurse teaches a patient diagnosed with progressive systemic sclerosis about health maintenance activities. The nurse determines that additional instruction is needed when the patient says,

Accepted Answer

Because of the esophageal scarring, patients should sit up for 2 hours after eating. The other patient statements are correct and indicate that the teaching has been effective.

Question 13

A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of

Accepted Answer

The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.

Question 14

A patient is hospitalized with an acute attack of primary gout, which is affecting the left great toe and ankle. The outcome that the nurse determines as most important is that the patient

Accepted Answer

The priority patient outcome for an acute attack of gout is to control pain. A low-purine diet would be encouraged, but a purine-free diet is not the most important patient outcome during an acute attack. Lack of development of tophi and minimal function loss are also long-term outcomes, but they are not as important as pain control during an acute attack.

Question 15

A patient hospitalized for IV corticosteroid therapy to treat polymyositis has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is

Accepted Answer

The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses are also appropriate but are not as high a priority as the maintenance of the patient's airway.

Question 16

A patient has systemic sclerosis manifested by the CREST syndrome. During assessment of the patient, the nurse would expect to find

Accepted Answer

Raynaud's phenomenon is one aspect of the CREST syndrome. Bony ankylosis is not a symptom of systemic sclerosis, which does not affect bone. Weight loss occurs with CREST syndrome as a result of esophageal scarring. Burning, itching, and photosensitivity of the eyes are not associated with systemic sclerosis.

Question 17

The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "That drug has too many side effects; I would rather wait until my joint problems are worse before beginning any drugs." The most appropriate response by the nurse is

Accepted Answer

Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

Question 18

A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n)

Accepted Answer

SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.

Question 19

The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed?

Accepted Answer

The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.

Question 20

A patient is hospitalized for onset of diffuse erythema of the upper body with periorbital edema. The health care provider suspects dermatomyositis. In planning care for the patient, the nurse anticipates that the collaborative care of the patient will involve

Accepted Answer

Dermatomyositis is initially treated with high-dose steroids. Eye dryness is not a manifestation of dermatomyositis and artificial tears are not routinely needed. Topical corticosteroids may be used to treat the skin rash. EMG evaluation is done because this disease involves muscle changes, not neurologic changes.

Quiz 65: Nursing Management: Arthritis and Connective Tissue Diseases

A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid) . Which information about the patient's home routine indicates a need for teaching regarding gout management?

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE) , the nurse determines that teaching about the disease has been effective when the patient says,