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?

Accepted Answer

C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels also will be monitored to check for adverse effects of prednisone. Liver function is not routinely monitored for clients receiving steroids.

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?

Accepted Answer

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

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?

Accepted Answer

No more than 4 g of acetaminophen should be taken daily to avoid liver toxicity. The other client statements are correct and indicate good understanding of OA management.

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?

Accepted Answer

Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.

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?

Accepted Answer

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

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?

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 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?

Accepted Answer

Colchicine produces pain relief in 24-48 hours by decreasing inflammation. The recommended increase in fluid intake of 2-3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in pain.

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?

Accepted Answer

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

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?

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 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?

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 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?

Accepted Answer

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

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?

Accepted Answer

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

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?

Accepted Answer

Anakinra is administered by subcutaneous injection. GI bleeding is not an adverse effect of this medication. Because the medication is injected, instructions to take it with 240 mL of fluid would not be appropriate. The client is likely to be concurrently taking Aspirin or NSAIDs, and these should not be discontinued.

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?

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 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?

Accepted Answer

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

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?

Accepted Answer

The client's dry eyes are consistent with Sjögren syndrome, a common extra-articular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not an adverse effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.

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?

Accepted Answer

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

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?

Accepted Answer

Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid arthritis. Clients are taught to avoid stressing joints, to use warm baths to relieve stiffness, and to use a firm mattress.

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?

Accepted Answer

Initial symptoms of OA include pain with joint movement. Heberden nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA), and stiffness in OA is worse right after the client rests and decreases with joint 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?

Accepted Answer

Dark-coloured stools may indicate that the client is experiencing gastrointestinal bleeding caused by the naproxen. The information about the client's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment or counselling 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.

Quiz 67: Nursing Management Arthritis and Connective Tissue Diseases