Question 1

A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurses response to the patient?

Accepted Answer

A)  New evidence shows CAM to be as effective as medical treatment. 
B)  CAM therapies negate many of the benefits of medications. 
C)  CAM therapies typically do more harm than good. 
D)  Evidence shows minimal benefits from most CAM therapies.

Question 2

A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize?

Accepted Answer

A)  Take OTC calcium supplements consistently. 
B)  Restrict consumption of foods high in purines. 
C)  Ensure fluid intake of at least 4 liters per day. 
D)  Restrict weight-bearing on right foot.

Question 3

A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor?

Accepted Answer

A)  The patient has a 30 pack-year smoking history. 
B)  The patients body mass index is 34 (obese). 
C)  The patient has primary hypertension. 
D)  The patient is 58 years old.

Question 4

A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA?

Accepted Answer

A)  Cool joints with decreased range of motion 
B)  Signs of systemic infection 
C)  Joint stiffness, especially in the morning 
D)  Visible atrophy of the knee and shoulder joints

Question 5

A patient with SLE asks the nurse why she has to come to the office so often for check-ups. What would be the nurses best response?

Accepted Answer

A)  Taking care of you in the best way involves seeing you face to face. 
B)  Taking care of you in the best way involves making sure you are taking your medication the way it is ordered. 
C)  Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. 
D)  Taking care of you in the best way involves drawing blood work every month.

Question 6

A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse
Emphasize the need for continued adherence to the prescribed medication?

Accepted Answer

A)  To avoid complications such as venous thromboembolism 
B)  To avoid the progression to osteoporosis 
C)  To avoid the progression of GCA to degenerative joint disease 
D)  To avoid complications such as blindness

Question 7

A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential adverse effect?

Accepted Answer

A)  Infection 
B)  Acute confusion 
C)  Sedation 
D)  Malignant hyperthermia

Question 8

A nurses plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals?

Accepted Answer

A)  Maximize range of motion while minimizing exertion 
B)  Increase joint size and strength 
C)  Limit energy output in order to preserve strength for healing 
D)  Preserve and increase range of motion while limiting joint stress

Question 9

A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. Which of the following is the most appropriate action?

Accepted Answer

A)  Arrange a family meeting in order to explore assisted living options. 
B)  Refer the patient to a support group. 
C)  Arrange for the patient to be assessed in her home environment. 
D)  Refer the patient to social work.

Question 10

A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following?

Accepted Answer

A)  Autoimmune processes in the joints 
B)  Chronic metabolic acidosis 
C)  Increased uric acid levels 
D)  Unstable serum calcium levels

Question 11

A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug?

Accepted Answer

A)  I have this ringing in my ears that just wont go away. 
B)  I feel so foggy in the mornings and it takes me so long to wake up. 
C)  When I eat a meal thats high in fat, I get really nauseous. 
D)  I seem to have lost my appetite, which is unusual for me.

Question 12

A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement?

Accepted Answer

A)  Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels. 
B)  Ill try to be as physically active as possible between flare-ups. 
C)  Ill make sure to monitor my body temperature on a regular basis. 
D)  Ill stop taking my steroids when I get relief from my symptoms.

Question 13

A patient with polymyositisis experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action?

Accepted Answer

A)  Initiate a program of passive range of motion exercises 
B)  Facilitate referrals to occupational and physical therapy 
C)  Administer skeletal muscle relaxants as ordered 
D)  Encourage a progressive program of weight-bearing exercise

Question 14

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following?

Accepted Answer

The answer of A nurse is providing care for a...

Question 15

Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings?

Accepted Answer

A)  Hyperuricemia 
B)  Increased erythrocyte sedimentation rate 
C)  Elevated serum creatinine 
D)  Decreased platelets

Question 16

A 40-year-old woman was diagnosed with Raynauds phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are stiff, like the skin is being stretched from all directions. The nurse should recognize the need for medical referral for the assessment of what health problem?

Accepted Answer

A)  Giant cell arteritis (GC
A)  
B)  Fibromyalgia (FM) 
C)  Rheumatoid arthritis (R
A)  
D)  Scleroderma

Question 17

A patient has just been told by his physician that he has scleroderma. The physician tells the patient that he is going to order some tests to assess for systemic involvement. The nurse knows that priority systems to be assessed include what?

Accepted Answer

A)  Hepatic 
B)  Gastrointestinal 
C)  Genitourinary 
D)  Neurologic

Question 18

A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patients adherence to her medication regimen?

Accepted Answer

A)  Encourage the patient to store the bottles with their tops removed. 
B)  Have a trusted family member take over the management of the patients medication regimen. 
C)  Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. 
D)  Have the patient approach her primary care provider to explore medication alternatives.

Question 19

The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome?

Accepted Answer

A)  Raynauds phenomenon 
B)  Thyroid dysfunction 
C)  Esophageal varices 
D)  Osteopenia

Exam 38: Assessment and Management of Patients With Rheumatic Disorders