Question 1

The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

Accepted Answer

Because of the esophageal scarring,patients should sit up for 2 hours after eating. The other patient statements are correct and indicate teaching has been effective.

Question 2

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?

Accepted Answer

The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.

Question 3

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak,hoarse voice. The safety priority for the patient is addressing the

Accepted Answer

The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other concerns are also appropriate but are not as high a priority as the maintenance of the patient's airway.

Question 4

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

Accepted Answer

Corticosteroid use is associated with an increased risk for infection,so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose,increased appetite,and acne are also adverse effects of corticosteroid use but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.

Question 5

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

Accepted Answer

Live virus vaccines,such as varicella,are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

Question 6

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

Accepted Answer

Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.

Question 7

The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed?

Accepted Answer

The joints should be maintained in an extended position to avoid contractures,so patients should use a small,flat pillow for sleeping. Rest,aspirin,and energy management are appropriate for a patient with RA and indicate teaching has been effective.

Question 8

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

Accepted Answer

OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise,such as softball,reduces the risk for OA. Diabetes is not a risk factor for OA. Sedentary work is not a risk factor for OA.

Question 9

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

Accepted Answer

Keeping the room warm will decrease the incidence of Raynaud's phenomenon,one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose or to assist the patient to the bathroom every 2 hours.

Question 10

Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA)is experiencing a side effect of prednisone?

Accepted Answer

Corticosteroids have the potential to cause diabetes mellitus. The finding of elevated blood glucose reflects this side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR with no improvement in symptoms would indicate the prednisone was not effective but would not be side effects of the medication.

Question 11

When the nurse brings medications to a patient with rheumatoid arthritis,the patient refuses the prescribed methotrexate. The patient tells the nurse,"My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is

Accepted Answer

Disease-modifying antirheumatic drugs (DMARDs)are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate,but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

Question 12

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate?

Accepted Answer

Methotrexate is teratogenic,and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.

Question 13

Which result for a patient with systemic lupus erythematosus (SLE)is most important for the nurse to communicate to the health care provider?

Accepted Answer

Elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows decreased inflammation.

Question 14

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red,swollen,hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

Accepted Answer

The low blood pressure suggests the patient may be developing septicemia as a complication of septic arthritis. Immediate blood cultures and initiation of antibiotic therapy are indicated. The other information is typical of septic arthritis and should also be reported to the health care provider,but it does not indicate any immediately life-threatening problems.

Question 15

Which statement by a patient with systemic lupus erythematosus (SLE)indicates the patient has understood the nurse's teaching about the condition?

Accepted Answer

Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

Question 16

Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)?

Accepted Answer

Bone marrow suppression is a possible side effect of methotrexate,and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in RA. The blood glucose is normal.

Question 17

A 25-yr-old female patient with systemic lupus erythematosus (SLE)who has a facial rash and alopecia tells the nurse,"I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of

Accepted Answer

The patient's statement about not going anywhere because of hating the way he or she looks expresses social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE,but the information about this patient does not support this. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

Question 18

Which finding for a patient who is taking hydroxychloroquine (Plaquenil)to treat rheumatoid arthritis is likely to be an adverse effect of the medication?

Accepted Answer

Plaquenil can cause retinopathy. The medication should be stopped. Other findings are not related to the medication although they will also be reported.

Question 19

Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?

Accepted Answer

Because ankylosing spondylitis results in flexion deformity of the spine,postures that extend the spine (e.g.,sleeping on the back and with a flat pillow)are recommended. HLA-B27 antigen is assessed for initial diagnosis but is not needed annually. To counteract the development of flexion deformities,the patient should choose activities that extend the spine,such as swimming. Heat application is used to decrease localized pain.

Question 20

The nurse is planning care for a patient with hypertension and gout who has a red,painful right great toe. Which nursing action will be included in the plan of care?

Accepted Answer

Because any touch on the area of inflammation may increase pain,bedding should be held away from the toe,and touching the toe should be avoided. Elevation of the foot will not reduce the pain,which is caused by urate crystals. Acetaminophen can be used for pain management.

Quiz 64: Arthritis and Connective Tissue Diseases

The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak,hoarse voice. The safety priority for the patient is addressing the

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

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

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

The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA) . Which assessment made by the nurse indicates more patient teaching is needed?

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

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

Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

When the nurse brings medications to a patient with rheumatoid arthritis,the patient refuses the prescribed methotrexate. The patient tells the nurse,"My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate?

Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider?

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red,swollen,hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition?

Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA) ?

A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse,"I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication?

Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?

The nurse is planning care for a patient with hypertension and gout who has a red,painful right great toe. Which nursing action will be included in the plan of care?