Question 1

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

Accepted Answer

The patient's dry eyes are consistent with Sjögren's syndrome,a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not a side effect of methotrexate. A focus on the prognosis for RA is not helpful. The dry eyes are not caused by RA treatment but by the disease itself.

Question 2

Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA)of the knee?

Accepted Answer

Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is associated with inflammatory arthritis such as rheumatoid arthritis. Stiffness in OA is worse right after the patient rests and decreases with joint movement.

Question 3

The nurse teaching a support group of women with rheumatoid arthritis (RA)about how to manage activities of daily living suggests they should

Accepted Answer

Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase joint stress. Patients are encouraged to position joints in the extended (neutral)position. Sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion.

Question 4

Which assessment finding for a patient using naproxen (Naprosyn)to treat osteoarthritis is likely to require a change in medication?

Accepted Answer

Dark-colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. The patient's ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain,but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.

Question 5

The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding

Accepted Answer

Colchicine reduces joint pain in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day during acute gout would increase urine output but would not indicate the effectiveness of colchicine. Elevated serum uric acid would result in increased symptoms. The WBC count might decrease with decreased inflammation but would not increase.

Question 6

A patient with gout has a new prescription for losartan (Cozaar)to control the condition. The nurse will plan to monitor

Accepted Answer

Losartan,an angiotensin II receptor antagonist,will lower blood pressure. It does not affect blood glucose,red blood cells,or lymphocytes.

Question 7

A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA)and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?

Accepted Answer

The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.

Question 8

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

Accepted Answer

No more than 4 g of acetaminophen (1 g every 6 hours)should be taken daily to decrease the risk for liver damage. Regular exercise,moist heat,and supportive equipment are recommended for OA management.

Question 9

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

Accepted Answer

Deep-breathing exercises are used to decrease the risk for pulmonary complications that may result from reduced chest expansion that can occur with AS. Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.

Question 10

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

Accepted Answer

Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.

Question 11

The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding?

Accepted Answer

The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.

Question 12

A patient reporting painful urination 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

Accepted Answer

Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and requires 3 months of treatment with doxycycline. The other medications are used for chronic inflammatory problems such as rheumatoid arthritis.

Question 13

Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

Accepted Answer

Adequate rest helps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints,use warm baths to relieve stiffness,and use a firm mattress. When the disease is stabilized,a therapeutic exercise program is usually developed by a physical therapist to include exercises that improve flexibility and strength of affected joints,as well as the patient's general endurance.

Question 14

A patient hospitalized with a fever and red,hot,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

Accepted Answer

Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis.

Question 15

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

Accepted Answer

Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected,instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs),and these should not be discontinued.

Question 16

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis?

Accepted Answer

C-reactive protein is a serum marker for inflammation,and a decrease would indicate the corticosteroid therapy was effective. Blood glucose and serum electrolytes will also be monitored to assess for side effects of prednisone. Liver function is not routinely monitored in patients receiving corticosteroids.

Question 17

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take?

Accepted Answer

Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor,and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.

Question 18

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA)plan to start each day with

Accepted Answer

Taking a warm shower or bath is recommended to relieve joint stiffness,which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day,when joint stiffness is decreased.

Question 19

The nurse will anticipate the need to teach a patient who has osteoarthritis (OA)about which medication?

Accepted Answer

Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with rheumatoid arthritis.

Question 20

Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?

Accepted Answer

Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic,patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility,so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.

Quiz 64: Arthritis and Connective Tissue Diseases

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

Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?

The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should

Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication?

The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding

A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor

A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?

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

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

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

The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding?

A patient reporting painful urination 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

Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA) ?

A patient hospitalized with a fever and red,hot,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

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

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis?

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take?

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with

The nurse will anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?

Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?