Deck 67: Nursing Management: Arthritis and Connective Tissue Diseases

Question 1

During assessment of patients,the nurse recognizes that which of the following patients is at the greatest risk for OA?

A) A 56-year-old man who is a member of a construction crew
B) A 42-year-old woman who works on an automotive assembly line
C) A 24-year-old man who participates in his employer's softball team
D) A 36-year-old woman who is newly diagnosed with diabetes mellitus

Answer 1

A 42-year-old woman who works on an automotive assembly line

Question 2

A young man hospitalized with severe pain in the knees and hips,a fever,and shaking chills is suspected of having septic arthritis.Which of the following information obtained from the patient during the nursing history indicates a risk factor for septic arthritis?

A) His father has Reiter syndrome.
B) He recently returned from a trip to South America.
C) He has a history of intermittently treated gonorrhea.
D) He had a number of sports-related knee and hip injuries as a teenager.

Answer 2

He has a history of intermittently treated gonorrhea.

Question 3

When teaching a patient to protect the small joints affected by RA,what should the nurse instruct the patient to do?

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.

Answer 3

Avoid activities that require continuous use of the same muscles.

Question 4

When teaching a patient with OA of the left hip and lower lumbar vertebrae about management of the condition,the nurse determines that additional instruction is needed when the patient gives which of the following responses?

A) "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
B) "A warm shower in the morning will help relieve the stiffness I have when I get up."
C) "I should try to stay active throughout the day to keep my joints from becoming stiff."
D) "I should take no more than 1 g of acetaminophen four times a day to help control the pain."

Question 5

The biological agent anakinra (Kineret)is prescribed for a patient who has moderately severe RA.When teaching the patient about this medication,what information will the nurse include?

A) Symptoms of gastrointestinal irritation or bleeding
B) Self-administration of subcutaneous injections
C) Taking the medication with at least 235 mL of fluid
D) Avoiding concurrently taking aspirin or NSAIDs

Question 6

Which one of the following medications would the nurse teach the patient to take with food or milk?

A) Ibuprofen (Advil)
B) Capsaicin
C) Diclofenac diethylamine (Voltaren)
D) Triamcinolone (Aristospan)

Question 7

A 71-year-old obese man has bilateral OA of the hips.The nurse teaches the patient that the most beneficial measure to protect his joints is to do which of the following activities?

A) Use a wheelchair to avoid walking as much as possible.
B) Use a weight-reduction diet to obtain a healthy body weight.
C) Use a walker for ambulation to relieve the pressure on his hips.
D) Sit in chairs that do not cause his hips to be lower than his knees.

Question 8

When helping a patient with RA plan a daily routine,the nurse informs the patient that it is most helpful to start the day with which of the following activities?

A) A warm bath followed by a short rest
B) A 10-minute routine of isometric exercises
C) Stretching exercises to relieve joint stiffness
D) Range-of-motion exercises followed by application of capsaicin cream

Question 9

In teaching a patient with ankylosing spondylitis about management of the condition,what should the nurse instruct the patient to do?

A) Sleep on his side with his hips flexed.
B) Take slow,long walks as a form of exercise.
C) Perform daily chest expansion and deep-breathing exercises.
D) Maintain 10 to 12 hours of bed rest daily to prevent pressure on weight-bearing joints.

Question 10

A 58-year-old woman has been diagnosed with primary OA of her hands and feet.She is very upset about the diagnosis and tells the nurse she is too young to have arthritis and at this rate she will be hopelessly crippled by the time she is 70.What is the best response to the patient?

A) Osteoarthritis can be well controlled with a regimen of exercise,diet,and medications.
B) Osteoarthritis is an inflammatory disease of the joints,which may occur at any age.
C) Joint degeneration with pain and deformity occurs in the majority of people by the age of 60.
D) Osteoarthritis is more common with aging but usually is localized and does not cause deformity.

Question 11

A patient with an acute exacerbation of RA has localized pain and inflammation of the fingers,wrists,and feet,with swelling,redness,and limited movement of the joints.In developing a plan with the patient to promote the management of the disease,what does the nurse recognize is an appropriate outcome for the patient at this time?

A) Maintain a positive self-image.
B) Perform activities of daily living independently.
C) Achieve satisfactory control of pain and fatigue.
D) Make a successful adjustment to the disease progression.

Question 12

When reviewing laboratory data for a patient who is taking methotrexate,which information is most important to communicate to the physician?

A) The platelet count is 130,000 cells/microlitre.
B) The white blood cell (WBC)count is 1500 cells/microlitre.
C) The blood glucose is 7.2 mmol/L (130 mg/dL).
D) The potassium concentration is 5.2 mmol/L.

Question 13

Prednisone is prescribed for a patient with an acute exacerbation of RA.When the patient has a follow-up visit 1 month later,the nurse recognizes that the patient's response to the treatment may be best evaluated by which of the following?

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

Question 14

The nurse emphasizes the need for range-of-motion exercises for a patient who is having an acute exacerbation of RA with joint pain and swelling in both hands.What should the nurse teach the patient?

A) The joints should not be exercised when pain is present.
B) Cold applications to the joints before exercise will decrease the pain.
C) The exercises should be performed passively by someone other than the patient.
D) Joint motion required for activities of daily living is sufficient exercise for the joints.

Question 15

Which anatomical stage of RA is the patient in when the patient has bony ankylosis?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 16

A 60-year-old woman has primary osteoarthritis (OA)of the left knee.What is a finding that the nurse would expect to be present on examination of the patient's knee?

A) Heberden's nodules
B) A reddened,swollen joint
C) Pain on joint movement
D) Stiffness that increases with movement

Question 17

The physician prescribes methotrexate (Rheumatrex)for a 28-year-old woman with stage II,moderate rheumatoid arthritis (RA).When obtaining a health history from the patient,the nurse consults with the physician on finding which of the following information?

A) The patient has a history of infectious mononucleosis as a teenager.
B) The patient has a family history of macular degeneration of the retina.
C) The patient had been trying to have a baby before her disease became more severe.
D) The patient has been using large doses of vitamins and health foods in an effort to control her disease.

Question 18

A home care patient with RA complains to the nurse about having chronically dry eyes and a dry mouth.Which nursing action is most appropriate?

A) Have the patient withhold the daily methotrexate until talking with the physician.
B) Reassure the patient that dry eyes and mouth are very common with RA.
C) Teach the patient to use an antiseptic mouthwash three times daily.
D) Suggest that the patient start using over-the-counter (OTC)artificial tears.

Question 19

A patient with hip pain is diagnosed with OA.The nurse may need to teach the patient about the use of which of the following?

A) Prednisone (Deltasone)
B) Capsaicin cream (Zostrix)
C) Sulphasalazine (Salazopyrin)
D) Doxycycline (Vibramycin)

Question 20

The physician has prescribed naproxen (Naprosyn)twice daily for a patient with OA of the hands.The patient tells the nurse after 3 weeks of use that the medication does not seem to be effective in controlling the pain.The nurse's response to the patient is based on what knowledge?

A) It can take up to 4 to 6 weeks for nonsteroidal anti-inflammatory drugs (NSAIDs)to reach therapeutic levels in the blood.
B) If NSAIDs are not effective in controlling her symptoms,corticosteroids are the next medication of choice.
C) The patient is probably not compliant with the drug therapy because of the need for frequent dosing.
D) Another type of NSAID may be indicated because of variations in individual response to the drugs.

Question 21

The home health care nurse is doing a follow-up visit to a patient with recently diagnosed RA.Which nursing assessment indicates that more patient teaching is needed?

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

Question 22

Which of the following is a major problem facing many patients with chronic fatigue syndrome (CFS)?

A) Obesity
B) Malnutrition
C) Financial instability
D) Homelessness

Question 23

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 gives which of the following responses?

A) "I should lie down for an hour after meals."
B) "Lotions will help if I rub them in for a long time."
C) "I should perform range-of-motion exercises to all joints daily."
D) "I can try biofeedback training to raise the temperature in my fingers and toes."

Question 24

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

A) The patient takes one aspirin a day prophylactically to prevent angina.
B) The patient sleeps about 8 to 10 hours every night.
C) The patient generally drinks about 2.8 L of juice and water daily.
D) The patient usually eats beef once or twice a week.

Question 25

A patient has been diagnosed with early systemic lupus erythematosus (SLE)involving her joints.In teaching the patient about the disease,the nurse includes which of the following information?

A) SLE is a hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant.
B) SLE is an autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body.
C) SLE is a disorder of immune function,but it is extremely variable in its course,and its progression cannot be predicted.
D) During an acute exacerbation of SLE,the body produces antibodies that bind with cells with estrogen receptors,causing an inflammatory response.

Question 26

A patient is being assessed for a diagnosis of RA.Which of the following total scores on the American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis would be interpreted as a definite diagnosis of RA?

A) 0
B) 2
C) 4
D) 6

Question 27

A patient with gout tells the nurse that he takes losartan (Cozaar)for control of his condition.What history should the nurse ask the patient about?

A) Hypertension
B) Diabetes mellitus
C) Renal insufficiency
D) Immunosuppressant therapy

Question 28

A young woman is upset about the unsightly rash on her face and the hair loss she is experiencing as a result of her SLE.She refuses to see friends and will not go out of her home except to visit the health clinic.What nursing diagnosis should the nurse document for the patient?

A) Ineffective coping related to inadequate support system
B) Impaired skin integrity related to itching and skin sloughing
C) Social isolation related to embarrassment about the effects of SLE
D) Impaired social interaction related to lack of social skills

Question 29

The mother of a family who lives in an area endemic for Lyme disease asks the nurse what precautions should be taken for the disease.The nurse's response to the woman is based on what knowledge?

A) Transmission of the disease can be prevented by covering ticks attached to the skin with oil to suffocate them.
B) An early sign of Lyme disease is a lesion at the bite site that increases in size and has a red border and clear centre.
C) Early treatment of the infection with antiviral agents can prevent the development of cardiac and neurological manifestations.
D) If Lyme disease is transmitted by a tick,symptoms of nausea,vomiting,and diarrhea occur before the onset of joint pain.

Question 30

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

A) Maintains a purine-free diet
B) Experiences no evidence of tophi
C) Experiences satisfactory pain relief
D) Has minimal loss of function of the affected joint

Question 31

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

A) Bony ankylosis of the small joints
B) The presence of intention tremors of the hands
C) Burning,itching,and photosensitivity of the eyes
D) A history of numbness and tingling with colour changes in the fingers and toes

Question 32

A patient with polymyositis is hospitalized during an onset of active inflammation.What is a nursing diagnosis that is appropriate for the patient at this time?

A) Risk for aspiration related to dysphagia
B) Acute pain related to muscle inflammation
C) Risk for impaired skin integrity related to pruritus
D) Ineffective breathing pattern related to immobility

Question 33

Following instruction for a patient with newly diagnosed SLE,the nurse determines that teaching about the disease has been effective when the patient gives which of the following responses?

A) "I should expect to have a fever all the time with this disease."
B) "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."
C) "I should try to ignore my symptoms as much as possible and have a positive outlook."
D) "If I become pregnant,a therapeutic abortion can prevent an exacerbation of symptoms."

Question 34

A 19-year-old patient who is taking azathioprine (Imuran)for SLE has a checkup before leaving home for college.The physician writes all of these orders.Which one should the nurse question?

A) Administer naproxen (Aleve)200 mg twice daily.
B) Give measles-mumps-rubella immunization.
C) Draw anti-DNA titre.
D) Administer famotidine (Pepcid)20 mg daily.

Question 35

The physician plans to prescribe methotrexate to a patient with newly diagnosed RA.The patient tells the nurse,"That medication has too many side effects.I would rather wait until my joint problems are worse before beginning any medications." Which is the most appropriate response?

A) "You should tell the doctor how you feel so the two of you can make a decision together."
B) "It is important to start methotrexate early in order to decrease the joint damage."
C) "Methotrexate is not expensive and will be cheaper to take than other possible drugs."
D) "Methotrexate is very effective and has no more side effects than the other available drugs."

Question 36

A patient with polyarthralgia with joint swelling and pain is being evaluated for SLE.The nurse knows that which of the following serum test results is the most specific for SLE?

A) The presence of rheumatoid factor
B) The presence of antinuclear antibody
C) The presence of anti-Smith antibody
D) The presence of lupus erythematosus cells

Question 37

A patient with an acute attack of gout is treated with colchicine.The nurse determines that the drug is effective on observing which of the following findings?

A) Relief of pain
B) Increased urine purine levels
C) Increased urine uric acid levels
D) Decreased serum uric acid levels

Question 38

When caring for a patient with fibromyalgia syndrome,the nurse knows that although multiple drugs are used for symptom control,which of the following medications has had the best results in the treatment of the overall symptoms of the disorder?

A) Diazepam (Valium)
B) Amitriptyline (Elavil)
C) Ibuprofen
D) Cyclobenzaprine (Flexeril)

Question 39

A patient with an acute exacerbation of SLE is hospitalized with incapacitating fatigue,fever,and acute pain in her hands and wrists.A urinalysis reveals proteinuria and hematuria,and the physician prescribes corticosteroids.During the acute phase of the patient's illness,what is it most important for the nurse to do?

A) Institute seizure precautions.
B) Orient her frequently to time and place.
C) Monitor intake,output,and daily weight.
D) Protect her from injury that may cause bleeding.

Question 40

A 62-year-old patient is hospitalized for onset of diffuse erythema of his upper body with periorbital edema.The physician suspects dermatomyositis.In planning care for the patient,what should the nurse anticipate that the collaborative care of the patient will involve?

A) Instillation of artificial tears
B) Local steroid injections of skin lesions
C) Administration of high-dose corticosteroids
D) Electroencephalogram evaluation for central nervous system inflammation

Question 41

When reading the history and physical on a patient with fibromyalgia syndrome,the nurse reads that the lateral epicondyle is a tender point for this patient.Based on knowledge about tender points in fibromyalgia,the nurse would avoid which area of the patient's body?

A) Back of the neck
B) Upper shoulders
C) Elbow area
D) Knee area