Deck 67: Nursing Management Arthritis and Connective Tissue Diseases

Question 1

The nurse is caring for a client with an acute exacerbation of rheumatoid arthritis and is prescribed prednisone. Which of the following laboratory results should 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

Answer 1

C-reactive protein level

Question 2

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

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

Answer 2

Ask the client about recent outdoor activities.

Question 3

The nurse is teaching a client with osteoarthritis (OA) of the left hip and knee about how to manage the OA. Which of the following client statements 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 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."

Answer 3

"I will take 1 g of acetaminophen every 4 hours."

Question 4

The nurse is caring for a client with gout and takes losartan for control of the condition. Which of the following laboratory results should the nurse plan to monitor in the client?

A)Blood glucose
B)Blood pressure
C)Erythrocyte count
D)Lymphocyte count

Question 5

The nurse is planning care for a client who has osteoarthritis. Which of the following medications should the nurse anticipate being prescribed for the client?

A)Adalimumab
B)Prednisone
C)Capsaicin cream
D)Sulphasalazine

Question 6

The nurse is caring for a young adult client hospitalized with a fever and red, hot, painful knees and is suspected of having septic arthritis. Which of the following information obtained during the nursing history indicates a risk factor for septic arthritis?

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 7

The nurse is caring for a client with an acute attack of gout and is being treated with colchicine. Which of the following assessment data indicates the effectiveness of this mediation?

A)Relief of joint pain
B)Increased urine output
C)Elevated serum uric acid
D)Decreased white blood cells

Question 8

Which of the following information should the nurse include whenteaching range-of-motion exercises to a client 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 client.
D)Walking may substitute for range-of-motion (ROM) exercises on some days.

Question 9

Aclient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the client's elbows. Which of the following actions should the nurse take?

A)Draw blood for rheumatoid factor analysis.
B)Teach the client 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 10

The nurse is assisting a client with rheumatoid arthritis (RA) to plan a daily routine. Which of the following information should the nurse include when discussing the most helpful way to start the day?

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

Question 11

Which of the following information should the nurse include when teaching a client 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 12

The nurse is caring for a young adult client with urethritis and knee pain who has been diagnosed with reactive arthritis. Which of the following medications should the nurse include in the teaching plan?

A)Anakinra
B)Etanercept
C)Doxycycline
D)Methotrexate

Question 13

The nurse is caring for a client who has rheumatoid arthritis (RA) and is prescribed anakinra. Which of the following information should the nurse include when teaching the client about this drug?

A)Self-administration of subcutaneous injections
B)Take the medication with at least 240 mL of fluid.
C)Avoid concurrently taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
D)Symptoms of gastrointestinal (GI) irritation or bleeding

Question 14

The nurse is caring for a client who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The client tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the followingresponses 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 15

The nurse is caring for a client in a long-term care facility who takes multiple medications and has developed acute gouty arthritis. Which of the following medications should not be given until the health care provider has been consulted?

A)Sertraline
B)Famotidine
C)Oxycodone
D)Hydrochlorothiazide

Question 16

The home health nurse is visiting a client who has rheumatoid arthritis (RA) and tells the nurse about having chronically dry eyes. Which of the following actions by the nurse is most appropriate?

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

Question 17

The nurse is teaching a client who has rheumatoid arthritis (RA) about how to manage activities of daily living. Which of the following information should the nurse include in the teaching plan?

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 18

The nurse is caring for a client with a new diagnosis of rheumatoid arthritis. Which of the following actions should the nurse include in the plan of care?

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

Question 19

Which of the following findings should the nurse expect when assessing an older-adult client who has osteoarthritis (OA) of the left knee?

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

Question 20

Which of the following assessment findings about a client who has been using naproxen for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?

A)The client has dark-coloured stools.
B)The client's pain has not improved.
C)The client is using capsaicin cream.
D)The client has gained 3 pounds over 3 weeks.

Question 21

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?

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

Question 22

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

A)Hot compress on affected area tid
B)Active ROM exercises qid
C)Monitor BP q4h
D)Passive ROM exercises bid

Question 23

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?

A)Acute pain related to biological injury agent (inflammation)
B)Risk for aspiration as evidenced by barrier to elevating upper body
C)Risk for impaired skin integrity as evidenced by excretions
D)Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)

Question 24

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?

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."

Question 25

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)?

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 26

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?

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

Question 27

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?

A)Activity intolerance related to immobility
B)Impaired social interaction related to insufficient knowledge about how to enhance mutuality
C)Impaired skin integrity related to excretions
D)Social isolation related to difficulty establishing relationships (embarrassment about the effects of SLE)

Question 28

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?

A)The blood glucose is 4.2 mmol/L.
B)The rheumatoid factor is positive.
C)The white blood cell (WBC) count is 1.5 * 10?/L.
D)The erythrocyte sedimentation rate is elevated.

Question 29

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?

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 adverse effects than some of the other drugs."

Question 30

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?

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

Question 31

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?

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

Question 32

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?

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

Question 33

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?

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

Question 34

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?

A)Decreased C-reactive protein (CRP)
B)Mild proteinuria
C)Positive antinuclear antibodies (ANA)
D)Positive lupus erythematosus cell prep

Question 35

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?

A)The blood glucose is 6.2 mmol/L.
B)The client has painful hematuria.
C)The client has an increased appetite.
D)Acne is noted on the back and face.

Question 36

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?

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

Question 37

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?

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 client to avoid use of acetaminophen.

Question 38

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?

A)Has a rapid therapeutic response
B)Vision assessment every 6-12 months
C)Does not prevent flare-ups of symptoms
D)Can only be administered intravenously

Question 39

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?

A)The client's blood glucose is 9.2 mmol/L.
B)The client has no improvement in symptoms.
C)The client has experienced a recent 2.5 kg weight loss.
D)The client's erythrocyte sedimentation rate (ESR) has increased.

Question 40

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?

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 41

The nurse is assessing a client with fibromyalgia. Which of the following symptoms should the nurse expect the client 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 musculo-skeletal pain

Question 42

The nurse is conducting discharge teaching with a client who has systemic lupus erythematosus. Which of the following information should the nurse discuss with this client? (Select all that apply.)

A)Use of heat for arthralgia
B)Avoidance of physical stress
C)Use an unscented powder after bathing
D)Refrain from daily exercise
E)Use sunscreen when exposed to sun