Question 1

A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect?

Accepted Answer

A)   Tinnitus
B)   Visual changes
C)   Stomatitis
D)   Hirsutism B

Question 2

A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand irritation when her call bell isnt answered immediately. What would be the most appropriate response?

Accepted Answer

A)   You seem like youre feeling angry. Is that something that we could talk about?
B)   Try to remember that stress can make your symptoms worse.
C)   Would you like to talk about the problem with the nursing supervisor?
D)   I can see youre angry. Ill come back when youve calmed down. A

Question 3

A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient?

Accepted Answer

A)   Referral for assistive devices
B)   Teaching about symptom management
C)   Referral to classes to stop smoking
D)   Setting up an exercise program B

Question 4

A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care?

Accepted Answer

A)   Fatigue Related to Anemia
B)   Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism
C)   Acute Confusion Related to Increased Serum Ammonia Levels
D)   Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit

Question 5

A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection?

Accepted Answer

A)   Petechiae
B)   Butterfly rash
C)   Jaundice
D)   Skin sloughing

Question 6

A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patients health should the nurse focus most closely during the visit?

Accepted Answer

A)   The patients understanding of rheumatoid arthritis
B)   The patients risk for cardiopulmonary complications
C)   The patients social support system
D)   The patients functional status

Question 7

A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make?

Accepted Answer

A)   Ensuring adequate rest
B)   Limiting exposure to sunlight
C)   Limiting intake of alcohol
D)   Smoking cessation

Question 8

A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize?

Accepted Answer

A)   Assessment for subtle signs of bleeding disorders
B)   Assessment of the metatarsal joints and phalangeal joints
C)   Assessment for thoracic pain that is exacerbated by activity
D)   Assessment for headaches and jaw pain

Question 9

A patient with SLE has come to the clinic for a routine check-up. When auscultating the patients apical heart rate, the nurse notes the presence of a distinct scratching sound. What is the nurses most appropriate action?

Accepted Answer

A)   Reposition the patient and auscultate posteriorly.
B)   Document the presence of  S3\mathrm{S}_{3}S3​  and monitor the patient closely.
C)   Inform the primary care provider that a friction rub may be present.
D)   Inform the primary care provider that the patient may have pneumonia.

Question 10

A nurse is planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this womans care needs?

Accepted Answer

A)   Ineffective Role Performance Related to Pain
B)   Risk for Impaired Skin Integrity Related to Myalgia
C)   Risk for Infection Related to Tissue Alterations
D)   Unilateral Neglect Related to Neuropathic Pain

Question 11

A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications?

Accepted Answer

A)   Corticosteroids
B)   Gold-containing compounds
C)   Antimalarials
D)   Salicylate therapy

Question 12

A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem?

Accepted Answer

A)   Rheumatoid arthritis (R
A)  
B)   Systemic lupus erythematosus
C)   Osteoporosis
D)   Polymyositis

Question 13

A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply.

Accepted Answer

A)   Erythrocyte count
B)   Erythrocyte sedimentation rate
C)   Creatinine clearance
D)   C-reactive protein
E)   D-dimer

Question 14

A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients care, what goal should the nurse include?

Accepted Answer

A)   The patient will express satisfaction with her ability to perform ADLs.
B)   The patient will recover from OA within 6 months.
C)   The patient will adhere to the prescribed plan of care.
D)   The patient will deny signs or symptoms of OA.

Question 15

A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply.

Accepted Answer

A)   Surgical treatment options
B)   The importance of weight loss
C)   Managing Raynauds-type symptoms
D)   Smoking cessation
E)   The importance of vigilant skin care

Question 16

A patient has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply.

Accepted Answer

A)   PMR has an association with the genetic marker HLA-DR4.
B)   Immunoglobulin deposits occur in PMR.
C)   PMR is considered to be a wear-and-tear disease.
D)   Foods high in purines exacerbate the biochemical processes that occur in PMR.
E)   PMR occurs predominately in Caucasians.

Question 17

A clinic nurse is caring for a patient newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient?

Accepted Answer

A)   Impaired Urinary Elimination Related to Neuropathy
B)   Altered Nutrition Related to Impaired Absorption
C)   Disturbed Sleep Pattern Related to CNS Stimulation
D)   Fatigue Related to Pain

Question 18

A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment?

Accepted Answer

A)   The patient will need daily blood testing for the duration of treatment.
B)   The patient must stop all other drugs 72 hours before starting prednisone.
C)   The drug should be used at the highest dose the patient can tolerate.
D)   The drug should be used for as short a time as possible.

Question 19

A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved?

Accepted Answer

A)   Angiography
B)   Myelography
C)   Paracentesis
D)   Arthocentesis

Question 20

A nurse is providing care for a patient who has a rheumatic disorder. The nurses comprehensive assessment includes the patients mood, behavior, LOC, and neurologic status. What is this patients most likely diagnosis?

Accepted Answer

A)   Osteoarthritis (O
A)  
B)   Systemic lupus erythematosus (SL
E)  
C)   Rheumatoid arthritis (R
A)  
D)   Gout

Exam 38: Assessment and Management of Patients With Rheumatic Disorders