Question 1

The nurse is assessing a client who is taking hydroxychloroquine to treat rheumatoid arthritis. Which of the following findings is most important to report to the health care provider?

Accepted Answer

Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.

Question 2

Which of the following actions should the nurse implement for a client with septic arthritis?

Accepted Answer

Local hot compresses can also help relieve pain associated with septic arthritis. Only gentle ROM exercises are advocated. The temperature should be monitored often but the BP does not need to be assessed q4h.

Question 3

The nurse is caring for a client with polymyositis and has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?

Accepted Answer

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

Question 4

Which of the following statements by a young adult female client with systemic lupus erythematosus (SLE) indicates that the client has understood the nurse's teaching about management of the condition?

Accepted Answer

Severe skin reactions can occur in clients with SLE who are exposed to the sun. Clients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal anti-inflammatory drugs are used to treat the musculo-skeletal manifestations of SLE.

Question 5

Which of the following clients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)?

Accepted Answer

OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky.

Question 6

The nurse is caring for a client with an acute attack of gout in the left great toe and has a new prescription for probenecid. Which of the following information about the client'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 client is taking probenecid. The client'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 client with gout.

Question 7

The nurse is caring for a client with systemic lupus erythematosus (SLE) who has a facial rash and alopecia who tells the nurse, "I hate the way I look! I never go anywhere except here to the health clinic." Which of the following is an appropriate nursingdiagnosis for the client?

Accepted Answer

The client's statement about not going anywhere because they hate they way they look supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for clients with SLE, but the information about this client does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this client.

Question 8

The nurse is reviewing laboratory data for a client who is taking methotrexate to treat rheumatoid arthritis. Which of the following information is most important to communicate to the health care provider?

Accepted Answer

Bone marrow suppression is a possible adverse effect of methotrexate, and the client's low WBC count places the client at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in rheumatoid arthritis. The blood glucose is normal.

Question 9

The nurse is caring for a client with rheumatoid arthritis who refuses to take the prescribed methotrexate, telling the nurse "That drug has too many adverse effects. My arthritis isn't that bad yet." Which of the following responses is most appropriate?

Accepted Answer

Disease-modifying antirheumatic 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 client to understand is that it is important to start DMARDs as quickly as possible.

Question 10

The nurse has completed the health history with a female client who is taking methotrexate to treat rheumatoid arthritis. Which of the following information about the client is most important for the nurse to report to the health care provider?

Accepted Answer

Methotrexate is teratogenic, and the client should be taking contraceptives during methotrexate therapy and up to 3 months after therapy. The other information will not impact the choice of methotrexate as therapy.

Question 11

The health care provider has prescribed the following collaborative interventions for a client who is taking azathioprine for systemic lupus erythematosus. Which of the following orders should the nurse question?

Accepted Answer

Live virus vaccines, such as varicella, are contraindicated in a client taking immuno-suppressive drugs. The other orders are appropriate for the client.

Question 12

The nurse is caring for a client who has systemic sclerosis manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) syndrome. Which of the following actions should the nurse include in the plan of care?

Accepted Answer

Keeping the room warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose levels or to assist the client to the bathroom every 2 hours.

Question 13

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

Accepted Answer

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

Question 14

The nurse is reviewing laboratory results for a client with systemic lupus erythematosus (SLE). Which of the following results is most important to communicate to the health care provider?

Accepted Answer

The mild proteinuria indicates possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a client with SLE. A drop in CRP shows an improvement in the inflammatory process.

Question 15

The nurse is caring for a client with dermatomyositis who is receiving long-term prednisone therapy. Which of the following findings is most important to report to the health care provider?

Accepted Answer

Corticosteroid use is associated with increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne also are adverse effects of corticosteroid use, but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.

Question 16

To determine whether a client with joint swelling and pain has systemic lupus erythematosus, which test will be most useful for the nurse to review?

Accepted Answer

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

Question 17

The nurse is caring for a client with gout and has a red, painful left great toe. Which of the following nursing actions should be included in the plan of care?

Accepted Answer

Since any touch on the area of inflammation may increase pain, bedding should be held away from the toe and touching the toe will be avoided. Elevation of the foot will not reduce the pain, which is caused by the urate crystals. Acetaminophen can be used for pain relief.

Question 18

The nurse is conducting client teaching with a client who has systemic lupus erythematosus and is prescribed hydroxychloroquine. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

Funduscopic and visual field examinations must be performed by an ophthalmologist every 6-12 months when patients are on hydroxychloroquine. Hydroxychloroquine is often used to treat fatigue and moderate skin and joint problems. Unlike the rapid response noted with corticosteroids, effects of antimalarial therapy may not be noticed for several months. Flares may also be prevented with these drugs.

Question 19

The nurse is caring for a client with an exacerbation of rheumatoid arthritis (RA) and is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the client is experiencing an adverse effect of the medication?

Accepted Answer

Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this adverse 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 adverse effects of the medication.

Question 20

The nurse is teaching a client diagnosed with progressive systemic sclerosis about health maintenance activities. Which of the following client statements indicates the need for additional instruction?

Accepted Answer

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

Quiz 67: Nursing Management Arthritis and Connective Tissue Diseases