Question 1

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?

Accepted Answer

Sleeping with two pillows under the head can lead to neck stiffness and pain in patients with rheumatoid arthritis (RA), indicating a need for more education on proper sleeping positions to avoid exacerbating symptoms.

Question 2

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

Accepted Answer

Financial instability is a major issue for many patients with chronic fatigue syndrome (CFS). The condition is often misunderstood and misdiagnosed, leading to difficulties in obtaining proper medical care and disability benefits. Additionally, the high cost of treatments and medications can place a significant financial burden on patients and their families. Obesity and malnutrition may be secondary issues due to the limited mobility and lack of energy associated with CFS, but they are not the primary problem. Homelessness may be a rare occurrence but is not a common problem among CFS patients.

Question 3

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?

Accepted Answer

Lying down for an hour after meals is not a recommended health maintenance activity for patients with progressive systemic sclerosis. This condition can affect the digestive system, and lying down immediately after eating can exacerbate reflux symptoms or other gastrointestinal issues. The other options (B, C, D) are appropriate health maintenance activities for managing symptoms of progressive systemic sclerosis.

Question 4

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?

Accepted Answer

Taking aspirin can worsen gout symptoms as it interferes with the excretion of uric acid, which contributes to the formation of urate crystals that cause gout attacks. The patient needs to be educated about avoiding aspirin and other medications that can exacerbate gout symptoms. The patient's sleep, fluid intake, and diet are all within normal limits and do not suggest a need for further teaching about gout management.

Question 5

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?

Accepted Answer

Systemic lupus erythematosus (SLE) is a disorder of immune function that can affect many different parts of the body, including joints. It is highly variable in its course, and the progression of the disease cannot be accurately predicted. SLE is not solely a hereditary disorder of women, nor does it only show symptoms during pregnancy. Additionally, SLE does not involve the destruction of all nucleated cells in the body, as described in choice B. Choice D is also incorrect, as SLE exacerbations are not caused by the binding of antibodies to cells with estrogen receptors.

Question 6

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?

Accepted Answer

A total score of 6 or higher on the American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis is interpreted as a definite diagnosis of RA. The criteria include the number and location of joints with swelling and tenderness, blood tests for rheumatoid factor and anti-citrullinated protein antibody, and symptom duration. A score of 0 or 2 indicates a low probability of RA, while a score of 4 indicates a high probability but not a definite diagnosis.

Question 7

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?

Accepted Answer

Losartan is an angiotensin receptor blocker (ARB) that is primarily prescribed for the treatment of hypertension. While losartan has been shown to have beneficial effects on gout, such as reducing the risk of gout attacks, it is not primarily prescribed for the treatment of gout. Therefore, the nurse should ask the patient about their history of hypertension to determine if losartan is being used for its primary indication. The other options listed (B, C, and D) are not directly related to the use of losartan for gout or hypertension. However, the nurse should still ask about these conditions since they may impact the patient's overall health and medical management.

Question 8

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?

Accepted Answer

The patient's refusal to see friends and socializing indicates social isolation related to embarrassment about the effects of SLE. This nursing diagnosis addresses the patient's emotional distress and social withdrawal, which could impact her overall well-being and quality of life. Ineffective coping may also be a concern, but this option does not address the patient's specific issue of social isolation. Impaired skin integrity and impaired social interaction are not the most appropriate options for this scenario.

Question 9

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?

Accepted Answer

The early sign of Lyme disease at the bite site is called erythema migrans, which is a circular rash that expands over time and has a red border and clear centre. This is the most common first symptom of Lyme disease and can occur within a few days to weeks after the tick bite. It is important for individuals living in endemic areas to check themselves and their family members for tick bites and to seek medical attention if an erythema migrans rash is present.

Question 10

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?

Accepted Answer

Pain relief is the most important outcome for the patient with an acute attack of primary gout as it directly affects the patient's comfort and quality of life. Maintaining a purine-free diet and preventing tophi formation are long-term goals but are not as urgent as immediate pain relief during an acute attack. Minimal loss of function is also important, but it may take longer to achieve compared to pain relief.

Question 11

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

Accepted Answer

The CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) is a type of systemic sclerosis. Patients with this syndrome may experience numbness and tingling with colour changes in the fingers and toes (Raynaud's phenomenon), which is a hallmark of the condition. Bony ankylosis of the small joints (choice A) is not a characteristic feature of systemic sclerosis, and intention tremors of the hands (choice B) may be seen in other conditions such as Parkinson's disease. Burning, itching, and photosensitivity of the eyes (choice C) are more commonly associated with conditions such as lupus.

Question 12

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?

Accepted Answer

Polymyositis can cause dysphagia, which increases the risk for aspiration. Aspiration can lead to further complications, including pneumonia, so identifying and addressing this risk is important. Acute pain, impaired skin integrity, and ineffective breathing pattern may also be present, but the highest priority should be given to the risk for aspiration.

Question 13

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?

Accepted Answer

Restricting exposure to sunlight can help prevent flare-ups of SLE, as sunlight can trigger symptoms. Choices A and C are incorrect as fever and ignoring symptoms are not appropriate responses to SLE. Choice D is incorrect as therapeutic abortion is not commonly recommended as a treatment for SLE.

Question 14

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?

Accepted Answer

The patient is taking azathioprine, which is an immunosuppressive medication. Giving a live vaccine such as the measles-mumps-rubella vaccine can increase the risk of infection. The nurse should question this order and consult with the healthcare provider before administering the vaccine. The other orders are appropriate for a patient with SLE taking azathioprine. Naproxen can be used for pain relief, drawing anti-DNA titers is a routine test to monitor SLE, and famotidine can be used to prevent gastrointestinal side effects from azathioprine.

Question 15

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?

Accepted Answer

Starting methotrexate early in the course of rheumatoid arthritis (RA) is important to decrease joint damage and slow the progression of the disease. This approach can help maintain joint function and quality of life.

Question 16

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?

Accepted Answer

The presence of anti-Smith antibody is the most specific serum test for SLE. While antinuclear antibodies (B) are commonly present in SLE, they can also be present in other autoimmune diseases, as well as in healthy individuals. Rheumatoid factor (A) is not specific to SLE and can be present in other rheumatic diseases. Lupus erythematosus cells (D) were historically used for diagnosis but are not as specific as the anti-Smith antibody test.

Question 17

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?

Accepted Answer

Colchicine is effective in treating acute gout attacks primarily by reducing inflammation and thereby relieving pain. It does not directly affect urine purine levels, urine uric acid levels, or serum uric acid levels in the context of its effectiveness in acute gout management.

Question 18

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?

Accepted Answer

Amitriptyline (Elavil) has been shown to be effective in treating the overall symptoms of fibromyalgia syndrome, including pain, fatigue, and sleep disturbances. Diazepam and cyclobenzaprine are muscle relaxants that may be used to treat muscle spasms associated with fibromyalgia, but they do not address the full spectrum of symptoms. Ibuprofen may provide some pain relief but does not address the other symptoms of fibromyalgia.

Question 19

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?

Accepted Answer

During the acute phase of SLE, the patient may experience renal involvement, as evidenced by proteinuria and hematuria. Therefore, it is crucial for the nurse to closely monitor the patient's intake, output, and daily weight to assess the severity of the renal involvement and the effectiveness of treatment. Although seizure precautions, orientation, and injury prevention are important aspects of patient care, they are not the most critical during the acute phase of SLE with renal involvement.

Question 20

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?

Accepted Answer

The presence of diffuse erythema and periorbital edema suggest dermatomyositis, an auto-immune disorder that involves skin and muscle inflammation. The treatment of choice is high-dose corticosteroids to suppress inflammation and preserve muscle function. Instillation of artificial tears may be necessary for patients with dry eyes, but it is not specific to dermatomyositis. Local steroid injections may help reduce inflammation in skin lesions, but they are not sufficient for managing the systemic nature of the disease. An electroencephalogram (EEG) is not routinely done for dermatomyositis as it primarily affects the skin and muscles, not the central nervous system.

Quiz 67: Nursing Management: Arthritis and Connective Tissue Diseases