Deck 65: Nursing Management: Arthritis and Connective Tissue Diseases

Question 1

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. When the patient has a follow-up visit 1 month later, the nurse recognizes that the patient's response to the treatment may be best evaluated by

A) blood glucose testing.
B) liver function tests.
C) serum electrolyte levels.
D) C-reactive protein level.

Answer 1

C-reactive protein level.

Question 2

When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to

A) stand rather than sit when performing household chores.
B) avoid activities that require continuous use of the same muscles.
C) strengthen small hand muscles by wringing sponges or washcloths.
D) protect the knee joints by sleeping with a small pillow under the knees.

Answer 2

avoid activities that require continuous use of the same muscles.

Question 3

The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient with osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use that the drug does not seem to be effective in controlling the pain. The nurse should teach the patient that

A) another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of variations in individual response to the drugs.
B) it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood.
C) if NSAIDs are not effective in controlling symptoms, corticosteroids are the next drug of choice.
D) adding a twice-daily aspirin to the naproxen may improve the effectiveness of the drug.

Answer 3

another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of variations in individual response to the drugs.

Question 4

When teaching range-of-motion exercises to a patient who is having an acute exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both hands, the nurse teaches the patient that

A) affected joints should not be exercised when pain is present.
B) cold applications before exercise will decrease joint pain.
C) exercises should be performed passively by someone other than the patient.
D) regular walking may substitute for range-of-motion (ROM) exercises on some days.

Question 5

When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae about management of the condition, the nurse determines that additional instruction is needed when the patient says,

A) "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
B) "A warm shower in the morning will help relieve the stiffness I have when I get up."
C) "I should try to stay active throughout the day to keep my joints from becoming stiff."
D) "I should take no more than 1 g of acetaminophen four times a day to control the pain."

Question 6

A home health patient with rheumatoid arthritis (RA) complains to the nurse about having chronically dry eyes and a dry mouth. Which action by the nurse is most appropriate?

A) Have the patient withhold the daily methotrexate (Rheumatrex) until talking with the health care provider.
B) Reassure the patient that dry eyes and mouth are very common with RA.
C) Teach the patient to use an antiseptic mouth wash tid.
D) Suggest that the patient start using over-the-counter (OTC) artificial tears.

Question 7

When the nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex), which information is most important to communicate to the health care provider?

A) The platelet count is 130,000/ml.
B) The white blood cell count (WBC) is 1500/ml.
C) The blood glucose is 130 mg/dl.
D) The potassium is 5.2 mEq/L.

Question 8

A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The best response by the nurse is that

A) progression of OA can be prevented with a regimen of exercise, diet, and drugs.
B) OA is an inflammatory process with periods of exacerbation and remission.
C) joint degeneration with pain and deformity occurs with OA by age 60 to 70.
D) OA is common with aging, but usually it is localized and does not cause deformity.

Question 9

When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with

A) a warm bath followed by a short rest.
B) a 10-minute routine of isometric exercises.
C) stretching exercises to relieve joint stiffness.
D) active range-of-motion (ROM) exercises.

Question 10

In teaching a patient with ankylosing spondylitis (AS) about the management of the condition, the nurse instructs the patient to

A) sleep on the side with hips flexed.
B) take slow, long walks as a form of exercise.
C) perform daily deep-breathing exercises.
D) take frequent naps during the day.

Question 11

A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate?"

A) "Your family may need some help to understand the impact of your rheumatoid arthritis."
B) "You may need to see a family therapist for some help."
C) "Perhaps it would be helpful for you and your family to get involved in a support group."
D) "Tell me more about the situations that are causing stress."

Question 12

A 22-year-old patient hospitalized with severe pain in the knees and a fever and shaking chills is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient

A) has a parent who has reactive arthritis.
B) recently returned from a trip to South America.
C) is sexually active and has multiple partners.
D) had several sports-related knee injuries as a teenager.

Question 13

When screening patients at a community center, the nurse will plan to teach ways to reduce risk factors for osteoarthritis to a

A) 24-year-old man who participates in a summer softball team.
B) 36-year-old woman who is newly diagnosed with diabetes mellitus.
C) 49-year-old woman who works on an automotive assembly line.
D) 56-year-old man who is a member of a construction crew.

Question 14

A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to teach the patient about the use of

A) prednisone (Deltasone).
B) capsaicin cream (Zostrix).
C) sulfasalazine (Azulfidine).
D) doxycycline (Vibramycin).

Question 15

A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would expect to be present on examination of the patient's knee is

A) Heberden's nodules.
B) redness and swelling of the knee joint.
C) pain upon joint movement.
D) stiffness that increases with movement.

Question 16

A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches the patient that the most beneficial measure to protect the joints is to

A) use a wheelchair to avoid walking as much as possible.
B) sit in chairs that do not cause the hips to be lower than the knees.
C) use a walker for ambulation to relieve the pressure on the hips.
D) eat according to a weight-reduction diet to obtain a healthy body weight.

Question 17

The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient, the most important information for the nurse to communicate to the health care provider is that the patient has

A) a history of infectious mononucleosis as a teenager.
B) a family history of age-related macular degeneration of the retina.
C) been trying to have a baby before her disease becomes more severe.
D) been using large doses of vitamins and health foods to treat the RA.

Question 18

The biologic agent anakinra (Kineret) is prescribed for a patient who has moderately severe rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about

A) symptoms of gastrointestinal (GI) irritation or bleeding.
B) self-administration of subcutaneous injections.
C) taking the medication with at least 8 oz of fluid.
D) avoiding concurrently taking aspirin or NSAIDs.

Question 19

A patient who had arthroscopic surgery of the left knee 5 days previously is admitted with a red, swollen, and hot-to-touch knee. Which of these assessment data obtained by the nurse should be reported to the health care provider immediately?

A) The white blood cell count is 14,200/ml.
B) The patient rates the knee pain at 9 on a 10-point pain scale.
C) The patient has recently taken ibuprofen (Motrin).
D) The oral temperature is 104.1° F degrees.

Question 20

A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrists, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time is to

A) maintain a positive self-image.
B) perform activities of daily living independently.
C) achieve satisfactory control of pain.
D) make a successful adjustment to disease progression.

Question 21

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

A) The patient takes one aspirin a day prophylactically to prevent angina.
B) The patient sleeps about 8 to 10 hours every night.
C) The patient generally drinks about 3 quarts of juice and water daily.
D) The patient usually eats beef once or twice a week.

Question 22

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says,

A) "I should expect to have a low fever all the time with this disease."
B) "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."
C) "I should try to ignore my symptoms as much as possible and have a positive outlook."
D) "I can expect a temporary improvement in my symptoms if I become pregnant."

Question 23

A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will need to monitor

A) blood pressure.
B) blood glucose.
C) erythrocyte count.
D) lymphocyte count.

Question 24

A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question?

A) Naproxen (Aleve) 200 mg BID
B) Give measles-mumps-rubella (MMR) immunization
C) Draw anti-DNA titer
D) Famotidine (Pepcid) 20 mg daily

Question 25

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication?

A) The patient has experienced a recent 5-pound weight loss.
B) The patient's erythrocyte sedimentation rate (ESR) has increased.
C) The patient's blood glucose is 166 mg/dl.
D) The patient has no improvement in symptoms.

Question 26

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care?

A) Institute seizure precautions.
B) Reorient to time and place PRN.
C) Monitor intake and output.
D) Place on cardiac monitor.

Question 27

A concerned parent who lives in an area endemic for Lyme disease asks the nurse what precautions should be taken for the disease. The nurse will teach the parent that

A) early treatment of the infection with antiviral agents can prevent the development of cardiac and neurologic manifestations.
B) if Lyme disease is transmitted by a tick, symptoms of nausea, vomiting, and diarrhea occur before the onset of joint pain.
C) transmission of the disease can be prevented by covering ticks attached to the skin with oil to suffocate them.
D) an early sign of Lyme disease is a lesion at the bite site that increases in size and has a red border and clear center.

Question 28

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is

A) activity intolerance related to fatigue and inactivity.
B) impaired skin integrity related to itching and skin sloughing.
C) social isolation related to embarrassment about the effects of SLE.
D) impaired social interaction related to lack of social skills.

Question 29

A patient with fibromyalgia syndrome (FMS) tells the nurse, "I don't know why the doctor has prescribed amitriptyline (Elavil) for me. I don't feel depressed, just tired and achy." The most appropriate response by the nurse is, "The Elavil

A) is ordered to prevent depression from occurring."
B) will improve the quality of your sleep at night."
C) relaxes your muscles and helps prevent spasm."
D) has antiinflammatory actions to reduce joint pain."

Question 30

A patient who has had fatigue and muscle weakness for several years is diagnosed with chronic fatigue syndrome. The patient expresses anger at the health care professional for not offering relief of the symptoms and also anger at family members for saying "snap out of it and get busy." Based on the patient's statements, the nurse identifies a nursing diagnosis of

A) activity intolerance related to fatigue.
B) powerlessness related to lack of control over illness.
C) altered family process related to illness of family member.
D) situational low self-esteem related to inability to meet role expectation.

Question 31

A patient with an acute attack of gout is treated with colchicine. The nurse determines that the drug is effective upon finding

A) relief of joint pain.
B) increased urine output.
C) elevated serum uric acid.
D) decreased white blood cells (WBC).

Question 32

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 says,

A) "I should lie down for an hour after meals."
B) "Lotions will help if I rub them in for a long time."
C) "I should perform range-of-motion exercises daily."
D) "Paraffin baths can be used to help my hands."

Question 33

A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of

A) rheumatoid factor.
B) anti-Smith antibody (Anti-Sm).
C) antinuclear antibody (ANA).
D) lupus erythematosus (LE) cell prep.

Question 34

A patient is hospitalized with an acute attack of primary gout, which is affecting the left great toe and ankle. The outcome that the nurse determines as most important is that the patient

A) maintains a purine-free diet.
B) experiences no evidence of tophi.
C) expresses satisfactory pain relief.
D) has minimal functional loss in joints.

Question 35

A patient hospitalized for IV corticosteroid therapy to treat polymyositis has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is

A) risk for aspiration related to dysphagia.
B) acute pain related to inflammation.
C) risk for impaired skin integrity related to scratching.
D) disturbed visual perception related to eyelid swelling.

Question 36

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

A) bony ankylosis of the small joints in the feet.
B) a recent history of significant weight gain.
C) burning, itching, and photosensitivity of the eyes.
D) a history of numbness and tingling in the fingers.

Question 37

The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "That drug has too many side effects; I would rather wait until my joint problems are worse before beginning any drugs." The most appropriate response by the nurse is

A) "You should tell the doctor how you feel so the two of you can make a decision together."
B) "It is important to start methotrexate early in order to decrease the joint damage."
C) "Methotrexate is not expensive and will be cheaper to take than other possible drugs."
D) "Methotrexate is very effective and has no more side effects than the other available drugs."

Question 38

A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n)

A) hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant.
B) autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body.
C) disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.
D) disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response.

Question 39

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

A) The patient sleeps with two pillows under the head.
B) The patient has been taking 16 aspirins daily.
C) The patient requires a 2 hour midday nap.
D) The patient sits on a stool when preparing meals.

Question 40

A patient is hospitalized for onset of diffuse erythema of the upper body with periorbital edema. The health care provider suspects dermatomyositis. In planning care for the patient, the nurse anticipates that the collaborative care of the patient will involve

A) instillation of artificial tears.
B) local steroid injections of skin lesions.
C) administration of high-dose corticosteroids.
D) electromyelographic (EMG) evaluation for meningeal inflammation.

Question 41

When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE), which result is most important to communicate to the health care provider?

A) Elevated blood urea nitrogen (BUN) and creatinine
B) Positive lupus erythematosus cell prep
C) Positive antinuclear antibodies (ANA)
D) Decreased C-reactive protein (CRP)

Question 42

During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (Select all that apply.)

A) sleep disturbances.
B) multiple tender points.
C) urinary frequency and urgency.
D) cardiac palpitations and dizziness.
E) multijoint pain with inflammation and swelling.
F) widespread bilateral, burning musculoskeletal pain.