Question 1

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems.Which statement by the nurse is most appropriate?

Accepted Answer

Kidney stones are common in clients with gout,so drinking plenty of water will help prevent this from occurring.Citrus juice is high in ash,which can help prevent the formation of stones,but the value of this recommendation is not clear.Clients with gout should not eat organ meats or fish with bones,such as sardines.

Question 2

A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi).What information is most important to include?

Accepted Answer

This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections.Teach the client to avoid large crowds and people who are ill.The other instructions do not pertain to golimumab.

Question 3

A client comes to the family medicine clinic and reports joint pain and stiffness.The nurse is asked to assess the client for Heberden's nodules.What assessment technique is correct?

Accepted Answer

Herberden's nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal joints.To assess for this finding,the nurse inspects the client's distal fingertips.These nodules are not found in the abdomen,lymph nodes,or wrists.

Question 4

A nurse is discharging a client after a total hip replacement.What statement by the client indicates good potential for self-management?

Accepted Answer

There are many precautions clients need to take after hip replacement surgery,including not bending more than 90 degrees at the hips,continuing prescribed exercises,not crossing the legs,and washing the incision daily and patting it dry.

Question 5

A client recently diagnosed with systemic lupus erythematosus (SLE)is in the clinic for a follow-up visit.The nurse evaluates that the client practices good self-care when the client makes which statement?

Accepted Answer

Good self-management of the skin in SLE includes protecting the skin from sun exposure,using sunblock,avoiding drying agents such as powder,and avoiding tanning beds.

Question 6

The nurse is caring for a client using a continuous passive motion (CPM)machine and has delegated some tasks to the unlicensed assistive personnel (UAP).What action by the UAP warrants intervention by the nurse?

Accepted Answer

For infection control (and to avoid tripping on it),the CPM machine is never placed on the floor.The other actions are appropriate.

Question 7

A nurse is caring for a client with systemic sclerosis.The client's facial skin is very taut,limiting the client's ability to open the mouth.After consulting with a registered dietitian for appropriate nutrition,what other consultation should the nurse facilitate?

Accepted Answer

With limited ability to open the mouth,dental hygiene may be lacking.The nurse should encourage the client to see a dentist.The other referrals are not related to the mouth.

Question 8

A client in the orthopedic clinic has a self-reported history of osteoarthritis.The client reports a low-grade fever that started when the weather changed and several joints started "acting up," especially both hips and knees.What action by the nurse is best?

Accepted Answer

Osteoarthritis is not a systemic disease,nor does it present bilaterally.These are manifestations of rheumatoid arthritis.The nurse should assess for other manifestations of this disorder,including subcutaneous nodules and Baker's cysts.Podagra and tophi are seen in gout.Acetaminophen is not used for rheumatoid arthritis.Telling the client that the symptoms will fade with weather changes is not accurate.

Question 9

A client has rheumatoid arthritis that especially affects the hands.The client wants to finish quilting a baby blanket before the birth of her grandchild.What response by the nurse is best?

Accepted Answer

Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility.The nurse can suggest this comfort measure.Increasing pain pills will not help with movement.Ice has limited use unless the client has a "hot" or exacerbated joint.The client wants to finish her project,so the nurse should not negate its importance by telling the client it is destroying her joints.

Question 10

A client is getting out of bed into the chair for the first time after an uncemented hip replacement.What action by the nurse is most important?

Accepted Answer

The client with an uncemented hip will be on toe-touch only right after surgery.The nurse should ensure there is adequate help to transfer the client while preventing falls.Slippery socks will encourage a fall.Elevating the leg greater than 90 degrees is not allowed.

Question 11

A nurse is teaching a female client with rheumatoid arthritis (RA)about taking methotrexate (MTX)(Rheumatrex)for disease control.What information does the nurse include? (Select all that apply.)

Accepted Answer

MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA.MTX can cause liver toxicity,so the client should be advised to avoid medications that contain acetaminophen.It may take 4 to 6 weeks for effectiveness.MTX can cause immunosuppression,so avoiding sick people and crowds is important.Folic acid helps reduce side effects for some people.Pregnancy and breast-feeding are contraindicated while on this drug.

Question 12

A client is scheduled to have a hip replacement.Preoperatively,the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery.What action by the preoperative nurse is most important?

Accepted Answer

The preoperative nurse should ensure that all valid consents are on the chart,including one for blood transfusions if this may be needed.Administering preoperative medications is important for all preoperative clients and is not specific to this client.Teaching in the preoperative area should focus on immediate concerns.

Question 13

A client takes celecoxib (Celebrex)for chronic osteoarthritis in multiple joints.After a knee replacement,the health care provider has prescribed morphine sulfate for postoperative pain relief.The client also requests the celecoxib in addition to the morphine.What action by the nurse is best?

Accepted Answer

Despite getting an opioid analgesic for postoperative pain,the nurse should be aware that the client may be on other medications for arthritis in other joints.The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain.The nurse should consult the provider about continuing the celecoxib while the client is in the hospital.The other responses are not warranted,as the client should be restarted on this medication postoperatively.

Question 14

An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm³,red blood cell count: 3.2/mm³,hemoglobin: 9 g/dL,hematocrit: 32%.What intervention by the nurse is most appropriate?

Accepted Answer

This client is anemic,which needs correction prior to surgery.While eating iron-rich foods is helpful,to increase the client's red blood cells,hemoglobin,and hematocrit within 2 months,epoetin alfa is needed.This colony-stimulating factor will encourage the production of red cells.The client's white blood cell count is normal,so avoiding infection is not the priority.

Question 15

A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications.What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.)

Accepted Answer

There are many nonpharmacologic means for controlling the symptoms of fibromyalgia,including acupuncture,stretching,tai chi,low-impact aerobics,swimming,biking,strengthening,massage,stress management,and hypnosis.Dietary supplements and vigorous aerobics are not recommended.

Question 16

A client has newly diagnosed systemic lupus erythematosus (SLE).What instruction by the nurse is most important?

Accepted Answer

Fever is the classic sign of a lupus flare and should be reported immediately.Rest and nutrition are important but do not take priority over teaching the client what to do if he or she develops an elevated temperature.Daily weights may or may not be important depending on renal involvement.

Question 17

A nurse is caring for a client after joint replacement surgery.What action by the nurse is most important to prevent wound infection?

Accepted Answer

Preventing surgical wound infection is a primary responsibility of the nurse,who must use aseptic technique to change dressings or empty drains.The other actions do not prevent infection but can lead to early detection of an infection that is already present.

Question 18

A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta).The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed.What response by the nurse is best?

Accepted Answer

Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine,which reduces the pain from fibromyalgia.The other answers are inaccurate.

Question 19

A client has been diagnosed with rheumatoid arthritis.The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community.The elder is expected to attend social events and make community decisions.Stress seems to exacerbate the condition.What action by the nurse is best?

Accepted Answer

The nurse needs a more thorough understanding of the client's culture,including the meaning of illness and the ramifications of the elder not being able to perform traditional duties.This must be done prior to offering any possible solutions.If the nurse does not understand the consequences of what is suggested,the client may simply be unwilling to listen or participate in problem solving.The other options may be reasonable depending on the outcome of a better cultural understanding.

Question 20

The nursing student studying rheumatoid arthritis (RA)learns which facts about the disease? (Select all that apply.)

Accepted Answer

RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints.Antibodies are created that lead to inflammation.Clients often report morning stiffness.Permanent damage can be avoided with aggressive,early treatment.

Quiz 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems.Which statement by the nurse is most appropriate?

A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi) .What information is most important to include?

A client comes to the family medicine clinic and reports joint pain and stiffness.The nurse is asked to assess the client for Heberden's nodules.What assessment technique is correct?

A nurse is discharging a client after a total hip replacement.What statement by the client indicates good potential for self-management?

A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit.The nurse evaluates that the client practices good self-care when the client makes which statement?

The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP) .What action by the UAP warrants intervention by the nurse?

A nurse is caring for a client with systemic sclerosis.The client's facial skin is very taut,limiting the client's ability to open the mouth.After consulting with a registered dietitian for appropriate nutrition,what other consultation should the nurse facilitate?

A client in the orthopedic clinic has a self-reported history of osteoarthritis.The client reports a low-grade fever that started when the weather changed and several joints started "acting up," especially both hips and knees.What action by the nurse is best?

A client has rheumatoid arthritis that especially affects the hands.The client wants to finish quilting a baby blanket before the birth of her grandchild.What response by the nurse is best?

A client is getting out of bed into the chair for the first time after an uncemented hip replacement.What action by the nurse is most important?

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control.What information does the nurse include? (Select all that apply.)

A client is scheduled to have a hip replacement.Preoperatively,the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery.What action by the preoperative nurse is most important?

A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints.After a knee replacement,the health care provider has prescribed morphine sulfate for postoperative pain relief.The client also requests the celecoxib in addition to the morphine.What action by the nurse is best?

An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm³,red blood cell count: 3.2/mm³,hemoglobin: 9 g/dL,hematocrit: 32%.What intervention by the nurse is most appropriate?

A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications.What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.)

A client has newly diagnosed systemic lupus erythematosus (SLE) .What instruction by the nurse is most important?

A nurse is caring for a client after joint replacement surgery.What action by the nurse is most important to prevent wound infection?

A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta) .The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed.What response by the nurse is best?

The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)