Deck 65: Nursing Management: Arthritis and Connective Tissue Diseases

Question 1

A long-term care patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of

A) sertraline ( Zoloft ).
B) famotidine ( Pepcid ).
C) oxycodone ( Roxicodone ).
D) hydrochlorothiazide ( HydroDIURIL ).

Answer 1

hydrochlorothiazide ( HydroDIURIL ).

Question 2

A 26-year-old patient with urethritis and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with

A) anakinra (Kineret).
B) etanercept (Enbrel).
C) doxycycline (Vibramycin).
D) methotrexate (Rheumatrex).

Answer 2

doxycycline (Vibramycin).

Question 3

When helping a patient with rheumatoid arthritis ( RA ) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with

A) a warm bath followed by a short rest.
B) a short routine of isometric exercises.
C) active range-of-motion ( ROM ) exercises.
D) stretching exercises to relieve joint stiffness.

Answer 3

a warm bath followed by a short rest.

Question 4

Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?

A) Affected joints should not be exercised when pain is present.
B) Application of cold packs before exercise may decrease joint pain.
C) Exercises should be performed passively by someone other than the patient.
D) Walking may substitute for range-of-motion (ROM) exercises on some days.

Question 5

Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?

A) Exercise by taking long walks.
B) Do daily deep breathing exercises.
C) Sleep on the side with hips flexed.
D) Take frequent naps during the day.

Question 6

While working at a summer camp, the nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the camp clinic complaining of chills and muscle aches. Which action should the nurse take next?

A) Palpate the abdomen.
B) Auscultate the heart sounds.
C) Ask the patient about recent outdoor activities.
D) Question the patient about immunization history.

Question 7

A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis ( RA ) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate?

A) "You may need to see a family therapist for some help."
B) "Tell me more about the situations that are causing stress."
C) "Perhaps it would be helpful for you and your family to get involved in a support group."
D) "Your family may need some help to understand the impact of your rheumatoid arthritis."

Question 8

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

A) relief of joint pain.
B) increased urine output.
C) elevated serum uric acid.
D) decreased white blood cells ( WBC ).

Question 9

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective?

A) Blood glucose test
B) Liver function tests
C) C-reactive protein level
D) Serum electrolyte levels

Question 10

Which assessment finding about a patient who has been using naproxen (Naprosyn) for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?

A) The patient has dark colored stools.
B) The patient's pain has not improved.
C) The patient is using capsaicin cream (Zostrix).
D) The patient has gained 3 pounds over 3 weeks.

Question 11

When teaching a patient who has rheumatoid arthritis ( RA ) about how to manage activities of daily living, the nurse instructs the patient to

A) stand rather than sit when performing household chores.
B) avoid activities that require continuous use of the same muscles.
C) strengthen small hand muscles by wringing sponges or washcloths.
D) protect the knee joints by sleeping with a small pillow under the knees.

Question 12

A 22-year-old patient hospitalized with a fever and red, hot, and painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient

A) has a parent who has reactive arthritis.
B) is sexually active and has multiple partners.
C) recently returned from a trip to South America.
D) had several sports-related knee injuries as a teenager.

Question 13

Anakinra ( Kineret ) is prescribed for a patient who has rheumatoid arthritis ( RA ). When teaching the patient about this drug, the nurse will include information about

A) self-administration of subcutaneous injections.
B) taking the medication with at least 8 oz of fluid.
C) avoiding concurrently taking aspirin or nonsteroidal antiinflammatory drugs ( NSAIDs ).
D) symptoms of gastrointestinal ( GI ) irritation or bleeding.

Question 14

A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which action will the nurse take?

A) Draw blood for rheumatoid factor analysis.
B) Teach the patient about injection of the nodule.
C) Assess the nodules for skin breakdown or infection.
D) Discuss the need for surgical removal of the nodule.

Question 15

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

A) blood glucose.
B) blood pressure.
C) erythrocyte count.
D) lymphocyte count.

Question 16

A home health patient with rheumatoid arthritis ( RA ) complains to the nurse about having chronically dry eyes. Which action by the nurse is most appropriate?

A) Reassure the patient that dry eyes are a common problem with RA.
B) Teach the patient more about adverse affects of the RA medications.
C) Suggest that the patient start using over-the-counter ( OTC ) artificial tears.
D) Ask the health care provider about lowering the methotrexate ( Rheumatrex ) dose.

Question 17

When caring for a patient with a new diagnosis of rheumatoid arthritis, which action will the nurse include in the plan of care?

A) Instruct the patient to purchase a soft mattress.
B) Teach patient to use lukewarm water when bathing.
C) Suggest that the patient take a nap in the afternoon.
D) Suggest exercise with light weights several times daily.

Question 18

When caring for a patient who has osteoarthritis, the nurse will anticipate the need to teach the patient about which of these medications?

A) Adalimumab ( Humira )
B) Prednisone ( Deltasone )
C) Capsaicin cream ( Zostrix )
D) Sulfasalazine ( Azulfidine )

Question 19

After the nurse has finished teaching a patient with osteoarthritis ( OA ) of the left hip and knee about how to manage the OA, which patient statement indicates a need for more education?

A) "I can take glucosamine to help decrease my knee pain."
B) "I will take 1 g of acetaminophen ( Tylenol ) every 4 hours."
C) "I will take a shower in the morning to help relieve stiffness."
D) "I can use a cane to decrease the pressure and pain in my hip."

Question 20

Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis ( OA ) of the left knee?

A) Heberden's nodules
B) Pain upon joint movement
C) Redness and swelling of the knee joint
D) Stiffness that increases with movement

Question 21

When the nurse is reviewing laboratory data for a patient who is taking methotrexate ( Rheumatrex ) to treat rheumatoid arthritis, which information is most important to communicate to the health care provider?

A) The blood glucose is 75 mg/dL.
B) The rheumatoid factor is positive.
C) The white blood cell ( WBC ) count is 1500/mL.
D) The erythrocyte sedimentation rate is elevated.

Question 22

After obtaining the health history from a 28-year-old woman who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis, which information about the patient is most important for the nurse to report to the health care provider?

A) The patient had a history of infectious mononucleosis as a teenager.
B) The patient is trying to have a baby before her disease becomes more severe.
C) The patient has a family history of age-related macular degeneration of the retina.
D) The patient has been using large doses of vitamins and health foods to treat the RA.

Question 23

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?

A) The patient's blood glucose is 165 mg/dL.
B) The patient has no improvement in symptoms.
C) The patient has experienced a recent 5-pound weight loss.
D) The patient's erythrocyte sedimentation rate ( ESR ) has increased.

Question 24

A patient with dermatomyositis is receiving long-term prednisone (Deltasone) therapy. Which assessment finding by the nurse is most important to report to the health care provider?

A) The blood glucose is 112 mg/dL.
B) The patient has painful hematuria.
C) The patient has an increased appetite.
D) Acne is noted on the back and face.

Question 25

A patient with rheumatoid arthritis refuses to take the prescribed methotrexate (Rheumatrex), telling the nurse "That drug has too many side effects. My arthritis isn't that bad yet." The most appropriate response by the nurse is

A) "You have the right to refuse to take the methotrexate."
B) "Methotrexate is less expensive than some of the newer drugs."
C) "It is important to start methotrexate early to decrease the extent of joint damage."
D) "Methotrexate is effective and has fewer side effects than some of the other drugs."

Question 26

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

A) acute pain related to inflammation.
B) risk for aspiration related to dysphagia.
C) risk for impaired skin integrity related to scratching.
D) disturbed visual perception related to eyelid swelling.

Question 27

A patient has systemic sclerosis manifested by CREST ( calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia ) syndrome. Which action will the nurse include in the plan of care?

A) Avoid use of capsaicin cream on hands.
B) Keep patient's room warm and draft free.
C) Obtain capillary blood glucose before meals.
D) Assist to bathroom every 2 hours while awake.

Question 28

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?

A) The patient sleeps about 8 to 10 hours every night.
B) The patient usually eats beef once or twice a week.
C) The patient generally drinks about 3 quarts of juice and water daily.
D) The patient takes one aspirin a day prophylactically to prevent angina.

Question 29

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 anywhere except here to the health clinic." An appropriate nursing diagnosis for the patient is

A) activity intolerance related to fatigue and inactivity.
B) impaired social interaction related to lack of social skills.
C) impaired skin integrity related to itching and skin sloughing.
D) social isolation related to embarrassment about the effects of SLE.

Question 30

A patient who had arthroscopic surgery of the left knee 5 days ago is admitted with a red, swollen, and hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

A) The blood pressure is 88/46 mm Hg.
B) The white blood cell count is 14,200/µL.
C) The patient is taking ibuprofen (Motrin).
D) The patient says the knee is very painful.

Question 31

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?

A) The patient requires a 2-hour midday nap.
B) The patient has been taking 16 aspirins daily.
C) The patient sits on a stool when preparing meals.
D) The patient sleeps with two pillows under the head.

Question 32

During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (select all that apply)?

A) sleep disturbances.
B) multiple tender points.
C) cardiac palpitations and dizziness.
D) multijoint pain with inflammation and swelling.
E) widespread bilateral, burning musculoskeletal pain.

Question 33

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

A) Rheumatoid factor ( RF )
B) Antinuclear antibody ( ANA )
C) Anti-Smith antibody ( Anti-Sm )
D) Lupus erythematosus ( LE ) cell prep

Question 34

The nurse obtains this information when assessing a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis. Which symptom is most important to report to the health care provider?

A) Abdominal cramping
B) Complaint of blurry vision
C) Phalangeal joint tenderness
D) Blood pressure 170/84 mm Hg

Question 35

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

A) "I should lie down for an hour after meals."
B) "Paraffin baths can be used to help my hands."
C) "Lotions will help if I rub them in for a long time."
D) "I should perform range-of-motion exercises daily."

Question 36

When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus ( SLE ), which result is most important to communicate to the health care provider?

A) Decreased C-reactive protein ( CRP )
B) Elevated blood urea nitrogen ( BUN )
C) Positive antinuclear antibodies ( ANA )
D) Positive lupus erythematosus cell prep

Question 37

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

A) A 56-year-old man who is a member of a construction crew
B) A 24-year-old man who participates in a summer softball team
C) A 49-year-old woman who works on an automotive assembly line
D) A 36-year-old woman who is newly diagnosed with diabetes mellitus

Question 38

When caring for a patient with gout and a red and painful left great toe, which nursing action will be included in the plan of care?

A) Gently palpate the toe to assess swelling.
B) Use pillows to keep the left foot elevated.
C) Use a footboard to hold bedding away from the toe.
D) Teach patient to avoid use of acetaminophen (Tylenol).

Question 39

The health care provider has prescribed the following collaborative interventions for a 49-year-old who is taking azathioprine ( Imuran ) for systemic lupus erythematosus. Which order will the nurse question?

A) Draw anti-DNA blood titer.
B) Administer varicella vaccine.
C) Use naproxen ( Aleve ) 200 mg BID.
D) Take famotidine ( Pepcid ) 20 mg daily.

Question 40

Which statement by a 24-year-old woman with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about management of the condition?

A) "I will use a sunscreen whenever I am outside."
B) "I will try to keep exercising even if I am tired."
C) "I should take birth control pills to keep from getting pregnant."
D) "I should not take aspirin or nonsteroidal anti-inflammatory drugs."