LEWIS- CH 64 Flashcards
Which finding should the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?
a. Presence of Heberden’s nodules
b. Discomfort with joint movement
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement
ANS: B Initial symptoms of OA include pain with joint movement. Heberden’s nodules occur on the fingers. Redness of the joint is associated with inflammatory arthritis such as rheumatoid arthritis. Stiffness in OA is worse right after the patient rests and decreases with joint movement.
The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication?
a. The patient has gained 3 pounds.
b. The patient has dark-colored stools.
c. The patient’s pain affects multiple joints.
d. The patient uses capsaicin cream (Zostrix).
ANS: B Dark-colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. The patient’s ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling 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.
The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. Which patient statement indicates to the nurse a need for additional teaching?
a. “A shower in the morning will help relieve stiffness.”
b. “I can exercise every day to help maintain joint mobility.”
c. “I will take 1 gram of acetaminophen (Tylenol) every 4 hours.”
d. “I can use a cane to decrease the pressure and pain in my hip.”
ANS: C No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily to decrease the risk for liver damage. Regular exercise, moist heat, and supportive equipment are recommended for OA management.
The nurse should anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?
a. Prednisone
b. Adalimumab (Humira)
c. Capsaicin cream (Zostrix)
d. Sulfasalazine (Azulfidine)
ANS: C Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with rheumatoid arthritis.
A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should the nurse take?
a. Draw blood for rheumatoid factor analysis.
b. Teach the patient about injections for the nodules.
c. Assess the nodules for skin breakdown or infection.
d. Discuss the need for surgical removal of the nodules.
ANS: C 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.
Which action should the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?
a. Instruct the patient to purchase a soft mattress.
b. Encourage the patient to take a nap in the afternoon.
c. Teach the patient to use lukewarm water when bathing.
d. Suggest exercise with light weights several times daily.
ANS: B Adequate rest helps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress. When the disease is stabilized, a physical therapist usually develops a therapeutic exercise program that includes exercises that improve flexibility and strength of affected joints, as well as the patient’s general endurance.
A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take?
a. Ask the HCP about discontinuing methotrexate.
b. Remind the patient that RA is a chronic health condition.
c. Suggest the patient use over-the-counter (OTC) artificial tears.
d. Teach the patient about adverse effects of the RA medications.
ANS: C The patient’s dry eyes are consistent with Sjögren’s syndrome, a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eyedrops is recommended. The dry eyes are not caused by RA treatment but by the disease itself.
Which information should the nurse include when preparing teaching materials for a patient who has an exacerbation of rheumatoid arthritis?
a. Affected joints should not be exercised when pain is present
b. Applying cold packs before exercise may decrease joint pain
c. Exercises should be performed passively by someone other than the patient
d. Walking may substitute for range-of-motion (ROM) exercises on some days
ANS: B Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility,
Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis?
a. Blood glucose
b. C-reactive protein
c. Serum electrolytes
d. Liver function tests
ANS: B C-reactive protein is a serum marker for inflammation, and a decrease would indicate the corticosteroid therapy was effective. Blood glucose and serum electrolytes will also be monitored to assess for side effects of prednisone.
What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?
a. Protect the knee joints by sleeping with a small pillow under the knees.
b. Strengthen small hand muscles by wringing out sponges or washcloths.
c. Avoid activities requiring repetitive use of the same muscles and joints.
d. Stand rather than sit when performing daily household and yard chores.
ANS: C Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase joint stress. Patients are encouraged to position joints in the extended (neutral) position. Sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion.
How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day?
a. A brief routine of isometric exercises
b. A warm bath followed by a short rest
c. Active range-of-motion (ROM) exercises
d. Stretching exercises to relieve joint stiffness
ANS: B 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.
Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug?
a. Avoiding aspirin use.
b. Giving subcutaneous injections.
c. Taking the medication with water.
d. Recognizing gastrointestinal bleeding.
ANS: B Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued.
. A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make?
a. “You need to see a family therapist for some help with stress.”
b. “Tell me more about the situations that are causing you stress.”
c. “Perhaps it would be helpful for your family to be in a support group.”
d. “Your family should understand the impact of your rheumatoid arthritis.”
ANS: B 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.
Which information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about managing the condition?
a. Exercise by taking long walks.
b. Do daily deep-breathing exercises.
c. Sleep on the side with hips flexed.
d. Take frequent naps during the day.
ANS: B Deep-breathing exercises are used to decrease the risk for pulmonary complications that may result from reduced chest expansion that can occur with AS. Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.
A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. What long-term therapy should the nurse plan to explain to the patient?
a. methotrexate
b. anakinra (Kineret)
c. etanercept (Enbrel)
d. doxycycline (Vibramycin)
ANS: D Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and requires 3 months of treatment with doxycycline. The other medications are used for chronic inflammatory problems such as rheumatoid arthritis.
What finding should indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout?
a. Reduced joint pain
b. Increased urine output
c. Elevated serum uric acid
d. Increased white blood cells
ANS: A Colchicine reduces joint pain in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day during acute gout would increase urine output but would not indicate the effectiveness of colchicine. Elevated serum uric acid would result in increased symptoms. The WBC count might decrease with decreased inflammation but would not increase.
A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose? a. sertraline (Zoloft).
b. famotidine (Pepcid)
c. hydrochlorothiazide.
d. oxycodone (Roxicodone).
ANS: C Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.
. Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse’s teaching about the condition?
a. “I will exercise even if I am tired.”
b. “I will use sunscreen when I am outside.”
c. “I should avoid nonsteroidal antiinflammatory drugs.”
d. “I should take birth control pills to avoid getting pregnant.”
ANS: B Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.
A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, “I never leave my house because I hate the way I look.” Which patient problem should the nurse plan to address?
a. Social isolation
b. Activity intolerance
c. Impaired skin integrity
d. Impaired social interaction
ANS: A The patient’s statement about not going anywhere because of hating the way he or she looks expresses social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.
A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus?
a. Rheumatoid factor (RF)
b. Antinuclear antibody (ANA)
c. Anti-Smith antibody (Anti-Sm)
d. Lupus erythematosus (LE) cell prep
ANS: C The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.
A patient with hypertension and gout has a red, painful right great toe. Which action should the nurse include in the plan of care for this patient?
a. Gently palpate the toe to assess swelling.
b. Use pillows to keep the right foot elevated.
c. Use a footboard to hold bedding away from the toe.
d. Teach the patient to avoid acetaminophen (Tylenol).
ANS: C Because any touch on the area of inflammation may increase pain, bedding should be held away from the toe, and touching the toe should be avoided. Elevation of the foot will not reduce the pain, which is caused by urate crystals. Acetaminophen can be used for pain management.
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, “My arthritis isn’t that bad yet. The side effects of methotrexate are worse than the arthritis.” What is the most appropriate response by the nurse?
a. “You have the right to refuse to take the methotrexate.”
b. “Methotrexate is less expensive than some of the newer drugs.”
c. “It is important to start methotrexate early to decrease the extent of joint damage.”
d. “Methotrexate is effective and has fewer side effects than some of the other drugs.”
ANS: C Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.
q
Which assessment information should indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?
a. The patient has joint pain and stiffness.
b. The patient’s blood glucose is 165 mg/dL.
c. The patient has experienced a recent 5-pound weight loss.
d. The patient’s erythrocyte sedimentation rate (ESR) has increased.
ANS: B Corticosteroids have the potential to cause diabetes. The finding of elevated blood glucose reflects this side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR with no improvement in symptoms would indicate the prednisone was not effective but would not be side effects of the medication.
The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed?
a. The patient takes a 2-hour nap each day.
b. The patient has been taking 16 aspirins each day.
c. The patient sits on a stool while preparing meals.
d. The patient sleeps with two pillows under the head.
ANS: D The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. Rest, aspirin, and energy management are appropriate for a patient with RA and indicate teaching has been effective.
