Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

SG 73. A patient is prescribed amitriptyline for the diagnosis of fibromyalgia. What is the classification of this medication? a. Anti-inflammatory b. Antirheumatic c. Antidepressant d. Antipsychotic

c. Antidepressant

SG 65. For a patient in the early phase of scleroderma, the nurse is most likely to observe which signs/symptoms during the physical examination? a. Digit necrosis with severe pain b. Localized hardening of the skin c. Arthralgia and joint stiffness d. Dysphagia and esophagitis

c. Arthralgia and joint stiffness

SG 59. Based on the nurse's knowledge of the most common cause of death for patients with systemic lupus erythematosus, which laboratory tests will the nurse closely monitor when caring for these patients? a. Cardiac enzymes and sedimentation rate b. Blood urea nitrogen and creatinine c. Complete blood count and platelet count d. Liver enzymes and cholesterol levels

b. Blood urea nitrogen and creatinine

SG 42. Which patient-reported symptom(s) would typify early rheumatoid arthritis? a. "I feel tired and weak." b. "I feel like my hands are burning." c. "I have sever stiffness in the morning." d. "I have gained a lot of weight."

a. "I feel tired and weak."

SG 4. The nurse is interviewing a middle-aged woman who reports chronic joint pain and stiffness. Which patient statement is indicative of early osteoarthritis? a. "My joint pain diminishes after rest and worsens after activity." b. "I have discomfort with slight motion or even when at rest." c. "I have a tingling sensation and sometimes numbness in my joints." d. "There are bony lumps in some of my finger joints."

a. "My joint pain diminishes after rest and worsens after activity."

2. A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching? a. Acetaminophen (Tylenol) b. Cyclobenzaprine hydrochloride (Flexeril) c. Hyaluronate (Hyalgan) d. Ibuprofen (Motrin)

a. Acetaminophen (Tylenol) All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug.

3. A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications. What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.) a. Acupuncture b. Stretching c. Supplements d. Tai chi e. Vigorous aerobics

a. Acupuncture b. Stretching d. Tai chi There are many nonpharmacologic means for controlling the symptoms of fibromyalgia, including acupuncture, stretching, tai chi, low-impact aerobics, swimming, biking, strengthening, massage, stress management, and hypnosis. Dietary supplements and vigorous aerobics are not recommended.

6. What action by the perioperative nursing staff is most important to prevent surgical wound infection in a client having a total joint replacement? a. Administer preoperative antibiotic as ordered. b. Assess the clients white blood cell count. c. Instruct the client to shower the night before. d. Monitor the clients temperature postoperatively.

a. Administer preoperative antibiotic as ordered. To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery. Simply taking a shower will not help prevent infection unless the client is told to use special antimicrobial soap. The nother options are processes to monitor for infection, not prevent it.

11. A client with fibromyalgia is in the hospital for an unrelated issue. The client reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? (Select all that apply.) a. Allow the client uninterrupted rest time. b. Assess the clients usual bedtime routine. c. Limit environmental noise as much as possible. d. Offer a massage or warm shower at night. e. Request an order for a strong sleeping pill.

a. Allow the client uninterrupted rest time. b. Assess the clients usual bedtime routine. c. Limit environmental noise as much as possible. d. Offer a massage or warm shower at night. Clients with fibromyalgia often have sleep disturbances, which can be exacerbated by the stress, noise, and unfamiliar environment of the hospital. Allowing uninterrupted rest time, adhering to the clients usual bedtime routine as much as possible, limiting noise and light, and offering massages or warm showers can help. The client does not need a strong sleeping pill unless all other options fail and the client requests something for sleep. At that point a mild sleeping agent can be tried.

5. An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply an abduction pillow to the clients legs. b. Assess the skin under the abduction pillow straps. c. Place pillows under the heels to keep them off the bed. d. Monitor cognition to determine when the client can get up. e. Take and record vital signs per unit/facility policy.

a. Apply an abduction pillow to the clients legs. c. Place pillows under the heels to keep them off the bed. e. Take and record vital signs per unit/facility policy. The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurses responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility.

19. A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best? a. Assess medication records for steroid use. b. Facilitate a consultation with physical therapy. c. Measure the range of motion in both hips. d. Notify the health care provider immediately.

a. Assess medication records for steroid use. Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.

7. The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The clients surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is best? a. Assess neurovascular status in both legs. b. Elevate the affected leg and apply ice. c. Prepare to administer pain medication. d. Try to place the affected leg in abduction.

a. Assess neurovascular status in both legs. This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess the client.

SG 45. The patient with rheumatoid arthritis suffers a subluxation of the first and second vertebrae. What should the nurse do first, before immediately notifying the health care provider? a. Assess respiratory status, and apply oxygen as needed. b. Assess for loss of sensation or loss of movement in the extremities. c. Assess for pain that radiates down the arm and check pulses. d. Assess for change in mental status and orient the patient.

a. Assess respiratory status, and apply oxygen as needed.

24. A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best? a. Assess the client for the presence of subcutaneous nodules or Bakers cysts. b. Inspect the clients feet and hands for podagra and tophi on fingers and toes. c. Prepare to teach the client about an acetaminophen (Tylenol) regimen. d. Reassure the client that the problems will fade as the weather changes again.

a. Assess the client for the presence of subcutaneous nodules or Bakers cysts. Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Bakers cysts. Podagra and tophi are seen in gout. Acetaminophen is not used for rheumatoid arthritis. Telling the client that the symptoms will fade with weather changes is not accurate.

33. A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the condition. What action by the nurse is best? a. Assess the clients culture more thoroughly. b. Discuss options for performing duties. c. See if the client will call a community meeting. d. Suggest the client give up the role of elder.

a. Assess the clients culture more thoroughly. The nurse needs a more thorough understanding of the clients culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions. If the nurse does not understand the consequences of what is suggested, the client may simply be unwilling to listen or participate in problem solving. The other options may be reasonable depending on the outcome of a better cultural understanding.

14. The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met? a. Attends meetings of a book club b. Has a positive outlook on life c. Takes medication as directed d. Uses assistive devices to protect joints

a. Attends meetings of a book club All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met.

SG 40. Although the etiology of rheumatoid arthritis is unknown, it is considered to be what type of disorder? a. Autoimmune disease b. Disease associated with aging c. Genetic disorder d. Trauma disorder

a. Autoimmune disease

2. A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. c. Pregnancy and breast-feeding are not affected by MTX. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects. MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.

23. A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include? a. Avoid large crowds or people who are ill. b. Stay upright for 1 hour after taking this drug. c. This drug may cause your hair to fall out. d. You may double the dose if pain is severe.

a. Avoid large crowds or people who are ill. This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.

10. A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.) a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. c. Step into the bathtub with the affected leg first. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower.

a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower. Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees.

SG 54. The nurse is reviewing the complete blood count results of a patient with rheumatoid arthritis. The results show a low hemoglobin, hematocrit, and red blood cell count. Based on these laboratory results, which intervention is the nurse most likely to implement? a. Encourage rest and ensure rest periods between activities and therapies. b. Instruct the patient to drink extra fluids and to fully consume meals and snacks. c. Instruct unlicensed assistive personnel to handle the patient carefully to prevent bruising. d. Encourage the patient to ambulate in the hall at least three times during the shift.

a. Encourage rest and ensure rest periods between activities and therapies.

SG 69. Patients with ankylosing spondylitis have risk for which condition? a. Compromised respiratory function b. Cardiac arrhythmias c. Hip pain with osteonecrosis d. Dysphagia and decreased gag reflex

a. Compromised respiratory function

37. A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a knee replacement, the health care provider has prescribed morphine sulfate for postoperative pain relief. The client also requests the celecoxib in addition to the morphine. What action by the nurse is best? a. Consult with the health care provider about administering both drugs to the client. b. Inform the client that the celecoxib will be started when he or she goes home. c. Teach the client that, since morphine is stronger, celecoxib is not needed. d. Tell the client he or she should not take both drugs at the same time.

a. Consult with the health care provider about administering both drugs to the client. Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the client may be on other medications for arthritis in other joints. The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain. The nurse should consult the provider about continuing the celecoxib while the client is in the hospital. The other responses are not warranted, as the client should be restarted on this medication postoperatively.

18. The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further? a. Creatinine: 3.9 mg/dL b. Platelet count: 210,000/mm3 c. Red blood cell count: 5.2/mm3 d. White blood cell count: 4400/mm3

a. Creatinine: 3.9 mg/dL Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.

21. A nurse is caring for a client with systemic sclerosis. The clients facial skin is very taut, limiting the clients ability to open the mouth. After consulting with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate? a. Dentist b. Massage therapist c. Occupational therapy d. Physical therapy

a. Dentist With limited ability to open the mouth, dental hygiene may be lacking. The nurse should encourage the client to see a dentist. The other referrals are not related to the mouth.

SG 26. The nurse assesses the patient's surgical hip site and measures the drainage every 4 hours. At 7:00am there is 30mL in the drainage container; at 11:00am there is 10mL; at 3:00pm there is 5mL, and at 7:00pm there is 20mL. What should the nurse do? a. Document the drainage and continue to observe the site and drainage every 4 hours. b. Take vital signs, observe the site for signs of hemorrhage, and notify the surgeon. c. Document the findings but change the assessment frequency to every 2 hours. d. Ask the patient if there is increased pain or decreased sensation on the affected side.

a. Document the drainage and continue to observe the site and drainage every 4 hours.

22. The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate? a. Drink 1 to 2 liters of water each day. b. Have 10 to 12 ounces of juice a day. c. Liver is a good source of iron. d. Never eat hard cheeses or sardines.

a. Drink 1 to 2 liters of water each day. A Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in ash, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not eat organ meats or fish with bones, such as sardines.

6. The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis c. Excess uric acid excretion Gout d. Footdrop and paresthesias Osteoarthritis e. Vasculitis causing organ damage Rheumatoid arthritis

a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis e. Vasculitis causing organ damage Rheumatoid arthritis A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis.

SG 34. Which intervention does the nurse implement to improve mobility for a patient who has undergone a total hip replacement? a. Encourage use of assistive devices such as a walker when ambulating. b. Recommend to quickly decrease rest periods between activities. c. Instruct to flex and extend the hips at least 90 degrees when doing leg exercises. d. Advise to progressively put more weight on the affected side.

a. Encourage use of assistive devices such as a walker when ambulating.

SG 24. Which routine interventions would the nurse perform to prevent the life-threatening complication of venous thromboembolism? Select all that apply. a. Ensure that sequential compression device is in place and functional. b. Administer anticoagulant therapy as ordered. c. Roll and secure top of antiembolic stockings to midcalf area. d. Encourage early ambulation. e. Teach patient about leg exercises. f. Encourage foods that are rich in iron and protein.

a. Ensure that sequential compression device is in place and functional. b. Administer anticoagulant therapy as ordered. d. Encourage early ambulation. e. Teach patient about leg exercises.

15. A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate? a. Giving subcutaneous injections b. Having a chest x-ray once a year c. Taking the medication with food d. Using heat on the injection site

a. Giving subcutaneous injections Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to selfadminister the medication. The other options are not appropriate for etanercept.

9. A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort

a. Grab bars to reach high items b. Long-handled bath scrub brush d. Toothbrush with built-up handle Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.

31. A client is getting out of bed into the chair for the first time after an uncemented hip replacement. What action by the nurse is most important? a. Have adequate help to transfer the client. b. Provide socks so the client can slide easier. c. Tell the client full weight bearing is allowed. d. Use a footstool to elevate the clients leg.

a. Have adequate help to transfer the client. The client with an uncemented hip will be on toe-touch only right after surgery. The nurse should ensure there is adequate help to transfer the client while preventing falls. Slippery socks will encourage a fall. Elevating the leg greater than 90 degrees is not allowed.

28. A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement? a. I always wear long sleeves, pants, and a hat when outdoors. b. I try not to use cosmetics that contain any type of sunblock. c. Since I tend to sweat a lot, I use a lot of baby powder. d. Since I cant be exposed to the sun, I have been using a tanning bed.

a. I always wear long sleeves, pants, and a hat when outdoors. Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, avoiding drying agents such as powder, and avoiding tanning beds.

SG 15. Which treatment modalities might the nurse expect for a patient who is undergoing nonsurgical management of chronic joint pain? Select all that apply. a. Immobilization to promote rest. b. Weight control. c. Exercise balanced with rest. d. Thermal modalities. e. Limit foods and liquids that contain calcium. f. Home traction.

a. Immobilization to promote rest. b. Weight control. c. Exercise balanced with rest. d. Thermal modalities.

36. A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberdens nodules. What assessment technique is correct? a. Inspect the clients distal finger joints. b. Palpate the clients abdomen for tenderness. c. Palpate the clients upper body lymph nodes. d. Perform range of motion on the clients wrists.

a. Inspect the clients distal finger joints. Herberdens nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal joints. To assess for this finding, the nurse inspects the clients distal fingertips. These nodules are not found in the abdomen, lymph nodes, or wrists.

SG 8. The nurse is preparing an educational session for a group of patients newly diagnosed with osteoarthritis. What lifestyle changes does the nurse suggest to help slow joint degeneration? Select all that apply. a. Keep body weight within normal limits. b. Quit smoking. c. Do not participate in outdoor activities. d. Avoid risk-taking behaviors that may result in trauma. e. Avoid high-intensity exercise. f. Avoid direct sunlight and any other type of ultraviolet lightning.

a. Keep body weight within normal limits. b. Quit smoking. d. Avoid risk-taking behaviors that may result in trauma. e. Avoid high-intensity exercise.

SG 67. A patient was prescribed the combination drug of probenecid and colchicine for the treatment of gout. How does the health care team evaluate the effectiveness of the therapy? a. Monitor serum uric acid level. b. Check results of urinalysis. c. Review compliance with a low-purine diet. d. Assess mobility of affected joints.

a. Monitor serum uric acid level.

SG 72. The nurse is assessing a patient with fibromyalgia and identifies the trigger points by palpation. In which specific areas does the nurse expect to elicit pain and tenderness? Select all that apply. a. Neck b. Lips c. Trunk d. Lower back e. Upper abdomen f. Extremities

a. Neck c. Trunk d. Lower back f. Extremities

SG 6. Which patients are at risk for developing osteoarthritis? Select all that apply. a. Obese older woman living alone b. Slender, nonsmoking, middle-aged man c. Middle-aged man who worked construction for 25 years d. Young woman with family history of rheumatoid arthritis e. Middle-aged adult with multiple knee injuries from playing soccer in high school f. Overweight lesbian woman who has experienced discrimination when seeking health care

a. Obese older woman living alone c. Middle-aged man who worked construction for 25 years e. Middle-aged adult with multiple knee injuries from playing soccer in high school f. Overweight lesbian woman who has experienced discrimination when seeking health care

SG 28. Following a total joint arthroplasty, which patients have a higher risk of venous thromboembolism (VTE)? Select all that apply. a. Older patient who has trouble with mobility at baseline. b. Obese patient with chronic pain associated with rheumatoid arthritis. c. Patient with a previous history of VTE related to job as a truck driver. d. Thin patient who needs medication for hyperthyroidism e. Patient with compromised circulation secondary to sickle cell disorder. f. Patient with a history of osteoarthritis pain that is treated with acetaminophen.

a. Older patient who has trouble with mobility at baseline. b. Obese patient with chronic pain associated with rheumatoid arthritis. c. Patient with a previous history of VTE related to job as a truck driver. e. Patient with compromised circulation secondary to sickle cell disorder.

SG 22. The nurse is caring for a patient who had a total joint replacement and administers subcutaneous enoxaparin as ordered. Which outcome statement indicates that the intended goal of the enoxaparin therapy is being met? a. Patient does not show signs or symptoms of venous thromboembolism. b. Prothrombin time and International Normalized Ratio are within normal range. c. Pain is rated at 3/10 within 30 minutes after receiving the medication. d. Would site is free of infection signs and oral temperature is 98.8F (37.1C).

a. Patient does not show signs or symptoms of venous thromboembolism.

SG 2. Which patient is manifesting signs/symptoms that are likely to be associated with connective tissue disease? a. Patient has chronic pain, decreased function, and joint deterioration. b. Patient has cardiac dysthymias and occasional chest pain. c. Patient has acute back pain after exercise and exertion. d. Patient has poor skin turgor and sluggish capillary refill

a. Patient has chronic pain, decreased function, and joint deterioration.

SG 18. Which patient circumstance would be considered a contraindication for total joint arthroplasty? a. Patient is currently being treated for a persistent urinary tract infection. b. Patient reports pain and loss of mobility related to joint dysfunction. c. Patient reports her osteopenia is now considered to be osteoporosis. d. Patient is elderly and has no one to provide postoperative care.

a. Patient is currently being treated for a persistent urinary tract infection.

SG 17. For preoperative care of a patient scheduled for total joint arthroplasty, what does the nurse plan to do? Select all that apply. a. Provide written or videotaped information about the procedure. b. Assess the patient's understanding of the procedure. c. Assess and include the patient's support people or family. d. Obtain the patient's signature on the consent form. e. Assist in scheduling needed dental procedures after the surgery. f. Include interdisciplinary team members, if possible.

a. Provide written or videotaped information about the procedure. b. Assess the patient's understanding of the procedure. c. Assess and include the patient's support people or family. f. Include interdisciplinary team members, if possible.

SG 37. The nurse assesses a postoperative patient who had a total knee replacement for neurovascular compromise. Which assessments must the nurse document? Select all that apply. a. Skin color and temperature. b. Presence or absence of distal peripheral pulses. c. Full range of motion for operative and nonoperative legs. d. Capillary refill of operative leg. e. Comparison of operative leg to nonoperative leg. f. Ability to use extremity compared to baseline.

a. Skin color and temperature. b. Presence or absence of distal peripheral pulses. d. Capillary refill of operative leg. e. Comparison of operative leg to nonoperative leg.

SG 33. The nurse is supervising a nursing student in the postoperative care of a patient who had total knee replacement and has a continuous passive motion (CPM) device. When would the nurse intervene? a. Student applies hot moist compresses to the incisional area. b. Student turns off the CPM while the patient is having a meal in bed. c. Student places a cloth between skin of incisional area and ice packs. d. Student checks to see that the CPM is well padded to protect the skin.

a. Student applies hot moist compresses to the incisional area.

SG 21. Which interventions can the nurse use to prevent or manage infections in patients who have undergone total joint replacement? Select all that apply. a. Use aseptic technique for wound care and emptying of drains. b. Wash hands thoroughly when caring for patients. c. Culture drainage fluid if a change is observed. d. Encourage early ambulation along with leg exercises. e. Monitor the incision every 4 hours for the first 24 and every 8 to 12 hours thereafter. f. Advocate that the patient be placed in a private isolation room.

a. Use aseptic technique for wound care and emptying of drains. b. Wash hands thoroughly when caring for patients. c. Culture drainage fluid if a change is observed. e. Monitor the incision every 4 hours for the first 24 and every 8 to 12 hours thereafter.

SG 23. A patient is reluctant to consider hip surgery because of a fear of blood transfusion reaction. What is the nurse's best response? a. "No one will force you to receive blood if you don't want it." b. "A cell saver can be used to collect your own red blood cells during surgery." c. "It's unlikely that you will need a blood transfusion; please don't worry." d. "Blood products are very safe these days and there are numerous safety protocols."

b. "A cell saver can be used to collect your own red blood cells during surgery."

SG 70. For a patient with Reiter's syndrome, besides asking about joint pain, which additional question would the nurse ask? a. "Is there any chance that you were bitten by an insect?" b. "Are you having pain or burning with urination?" c. "Do you have a family history of arthritis?" d. "Do you get short of breath after minor exertion?"

b. "Are you having pain or burning with urination?"

SG 3. The nurse is working in an ambulatory clinic. Which statement represents the most typical reason for a patient with osteoarthritis (OA) to seek medical care at a clinic? a. "I think that being overweight is putting too much stress on my joints." b. "I am having a lot of joint pain, and I'm frequently taking over-the-counter pain medicine." c. "I noticed that my third finger joint seems to be tilting inward toward my index finger." d. "I have a family history of OA, and I wondered if there is anything I can do to prevent it."

b. "I am having a lot of joint pain, and I'm frequently taking over-the-counter pain medicine."

1. The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.) a. It affects single joints only. b. Antibodies lead to inflammation. c. It consists of an autoimmune process. d. Morning stiffness is rare. e. Permanent damage is inevitable.

b. Antibodies lead to inflammation. c. It consists of an autoimmune process RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.

SG 7. The nurse reads in the documentation that the patient has crepitus associated with osteoarthritis of the right hand. Which assessment would the nurse perform to validate this finding? a. Observe the finger joints for redness and swelling. b. Ask the patient to flex and extend fingers and listen for a grating sound. c. Gently palpate for protruding bony lumps in the finger joints. d. Ask the patient to demonstrate full range of motion of finger joints.

b. Ask the patient to flex and extend fingers and listen for a grating sound.

SG 12. The patient tells the nurse that he has been taking glucosamine for joint pain. Which physical finding is cause for greatest concern? a. Patient is 15lbs overweight. b. Blood pressure is 150/80. c. Resting pulse is 90/min. d. Patient has a light red rash.

b. Blood pressure is 150/80.

SG 36. Although arthritis is not curable, many "cures" are marketed to patients with the disease. What does the nurse encourage the patient to do? a. Avoid alternative and complementary therapies because they are invalid. b. Check with the Arthritis Foundation for appropriate modalities. c. Apply liniments and creams freely, because they are harmless. d. Use herbals and vitamins if they provide subjective relief.

b. Check with the Arthritis Foundation for appropriate modalities.

11. A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client who reports jaw pain when eating b. Client with a red, hot, swollen right wrist c. Client who has a puffy-looking area behind the knee d. Client with a worse joint deformity since the last visit

b. Client with a red, hot, swollen right wrist All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.

7. A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.) a. Allopurinol (Zyloprim) Acute gout b. Colchicine (Colcrys) Acute gout c. Febuxostat (Uloric) Chronic gout d. Indomethacin (Indocin) Acute gout e. Probenecid (Benemid) Chronic gout

b. Colchicine (Colcrys) Acute gout c. Febuxostat (Uloric) Chronic gout d. Indomethacin (Indocin) Acute gout e. Probenecid (Benemid) Chronic gout Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout.

29. A client is scheduled to have a hip replacement. Preoperatively, the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery. What action by the preoperative nurse is most important? a. Administer preoperative medications as prescribed. b. Ensure that a consent for transfusion is on the chart. c. Explain to the client how anemia affects healing. d. Teach the client about foods high in protein and iron.

b. Ensure that a consent for transfusion is on the chart. The preoperative nurse should ensure that all valid consents are on the chart, including one for blood transfusions if this may be needed. Administering preoperative medications is important for all preoperative clients and is not specific to this client. Teaching in the preoperative area should focus on immediate concerns.

SG 13. The nurse is evaluating laboratory results from a patient with osteoarthritis. Which lab results could the nurse expect to find elevated? a. White blood cells, including neutrophils, basophils, macrophages, and eosinophils. b. Erythrocyte sedimentation rate and high-sensitivity C-reactive protein. c. Electrolytes such as potassium, calcium, magnesium, phosphorus, and sodium. d. Partial thromboplastin time and International Normalized Ratio.

b. Erythrocyte sedimentation rate and high-sensitivity C-reactive protein.

4. The nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.) a. Anorexia b. Feltys syndrome c. Joint deformity d. Low-grade fever e. Weight loss

b. Feltys syndrome c. Joint deformity e. Weight loss Late manifestations of RA include Feltys syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease.

3. The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the clients blood glucose readings have been elevated. What question by the nurse is most appropriate? a. Are you compliant with following the diabetic diet? b. Have you been taking glucosamine supplements? c. How much exercise do you really get each week? d. Youre still taking your diabetic medication, right?

b. Have you been taking glucosamine supplements? All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them. Compliant is a word associated with negative images, and the client may deny being noncompliant. Asking how much exercise the client really gets is accusatory. Asking if the client takes his or her medications right? is patronizing.

SG 9. The health care provider informs the nurse that the patient has a joint effusion of the right knee. What is the nurse most likely to find during physical assessment of the knee? a. Hard bony protrusion palpated at the joint space. b. Tightness during flexion and extension of knee. c. Inability to independently stand or walk. d. Dry, red, scaly skin over the knee that itches and flakes.

b. Tightness during flexion and extension of knee.

20. A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family. What action by the nurse is best? a. Explain to the client that SLE is an unpredictable disease. b. Help the client create backup plans to minimize disruption. c. Offer to talk to the family and educate them about SLE. d. Tell the client to remain compliant with treatment plans.

b. Help the client create backup plans to minimize disruption. SLE is an unpredictable disease and acute exacerbations can occur without warning, creating chaos in the family. Helping the client make backup plans for this event not only will decrease the disruption but will give the client a sense of having more control. Explaining facts about the disease is helpful as well but does not engage the client in problem solving. The family may need education, but again this does not help the client to problem-solve. Remaining compliant may

17. A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply? a. Heating pad b. Ice packs c. Splints d. Wax dip

b. Ice packs Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness.

SG 52. The nurse sees an increased number of periungual lesions on a patient with rheumatoid arthritis and reports this vascular change to the health care provider. What is the best rationale for reporting this finding? a. The nurse should always report any unusual findings to the health care provider. b. If arterial involvement is occurring, major organs can become ischemic. c. The brownish spots affect body image but will readily resolve with treatment. d. The lesions will eventually ulcerate and become infected.

b. If arterial involvement is occurring, major organs can become ischemic.

SG 64. A patient with systemic lupus erythematosus is prescribed a relatively new drug, belimumab. Which concept will the nurse use to emphasize important teaching points about this medication? a. Comfort b. Immunity c. Mobility d. Oxygenation

b. Immunity

SG 71. The nurse is interviewing a young patient who seems to be excessively tall, and his hands and feet are elongated. The nurse suspects Marfan syndrome. What is the best rationale for the nurse to alert the health care provider of these findings? a. Patient has a growth disorder that should be monitored. b. In Marfan syndrome, death often occurs in the 30s. c. Patient is likely to experience joint deformity and dysfunction. d. Marfan syndrome is reversible if detected at an early stage.

b. In Marfan syndrome, death often occurs in the 30s.

SG 41. Which assessment finding indicates to the nurse that the patient is experiencing early rheumatoid arthritis? a. Joint deformities b. Joint inflammation c. Weight loss d. Subcutaneous nodules

b. Joint inflammation

31. Every 2 to 4 hours, the nurse assesses a patient who has a continuous femoral nerve blockade for postoperative pain management following a knee joint replacement. What findings prompt the nurse to alert the surgeon about untoward systemic effects of the local anesthesia? a. Patient is unable to detect pain with plantar flexion of the affected foot. b. Patient reports a metallic taste, tinnitus, and a nervous feeling. c. Patient says that the affected foot feels warmer than the unaffected foot. d. Patient reports nausea and mild abdominal discomfort.

b. Patient reports a metallic taste, tinnitus, and a nervous feeling.

SG 63. The nurse is reviewing the laboratory results of a patient with systemic lupus erythematosus. Which test result is most likely to be a false positive? a. Elevated erythrocyte sedimentation rate b. Positive syphilis test c. Positive tuberculosis test d. Increase in components of complete blood count

b. Positive syphilis test

30. An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9 g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate? a. Instruct the client to avoid large crowds. b. Prepare to administer epoetin alfa (Epogen). c. Teach the client about foods high in iron. d. Tell the client that all laboratory results are normal.

b. Prepare to administer epoetin alfa (Epogen). This client is anemic, which needs correction prior to surgery. While eating iron-rich foods is helpful, to increase the clients red blood cells, hemoglobin, and hematocrit within 2 months, epoetin alfa is needed. This colony-stimulating factor will encourage the production of red cells. The clients white blood cell count is normal, so avoiding infection is not the priority.

SG 10. Patients with osteoarthritis that affects the spine are most likely to have what types of symptoms? a. Localized pain at L3-4, bone spurs, stiffness, and muscle atrophy. b. Radiating pain at L3-4 and C4-6, stiffness, muscle spasms, and bone spurs. c. Localized pain at T6-12, inflexibility, and muscle asymmetry. d. Radiating pain throughout the spine, stiffness, and muscle weakness.

b. Radiating pain at L3-4 and C4-6, stiffness, muscle spasms, and bone spurs

SG 58. What can be expected for a patient with recently diagnosed systemic lupus erythematosus? a. Frequent acute inflammatory episodes b. Spontaneous remissions and exacerbations c. Symptoms similar to osteoarthritis d. Frequent infections and reduced immune response

b. Spontaneous remissions and exacerbations

SG 68. A patient comes to the clinic because he thinks he may have Lyme disease. What is the most important question to ask to assist the health care provider in determining if Lyme disease is the correct diagnosis? a. "Have you had flu like symptoms?" b. "Do you notice stiffness in your joints?" c. "Did you notice a bull's-eye-shaped lesion?" d. "Have you had any facial drooping?"

c. "Did you notice a bull's-eye-shaped lesion?"

SG 11. Which response, from a patient with advanced osteoarthritis, alerts the nurse that the patient is having a problem coping with the image and role changes related to disease progression? a. "I used to be a playground assistant; now I work with children who need help with reading." b. "I'm a musician and my instrument is the piano, so I get a lot of enjoyment going to concerts." c. "I used to work in the garden, but my joints are so stiff; I mostly sit and look out the window." d. "I must be getting younger. I used to tie my shoes; now I am using Velcro closures just like my kids."

c. "I used to work in the garden, but my joints are so stiff; I mostly sit and look out the window."

SG 35. What is an important health teaching point for a patient with total joint arthroplasty? a. "Do not use the joint." b. "Stress the joint." c. "Protect the joint." d. "Guard the muscles."

c. "Protect the joint."

SG 48. The patient with rheumatoid arthritis (RA) expresses uncertainty about the disease process and fear of becoming dependent. What is the nurse's best response? a. "You'll be okay. Very few people with RA actually become wheelchair bound." b. "Do you have anyone to help you when you can't take care of yourself?" c. "Tell me what you know about living with RA and the treatment options." d. "So, you are feeling afraid and uncertain. That seems normal to me."

c. "Tell me what you know about living with RA and the treatment options."

SG 14. Which patient statement indicates that the patient knows to take the primary drug of choice for osteoarthritis as recommended by the American Pain Society, American Geriatrics Society, and Osteoarthritis Research Society international? a. "I buy the generic form of ibuprofen because it saves me a lot of money." b. "My daughter is trying to get me a prescription for celecoxib." c. "Usually acetaminophen is sufficient for most painful episodes." d. "I got some of those over-the-counter patches that create a warm sensation."

c. "Usually acetaminophen is sufficient for most painful episodes."

SG 57. The unlicensed assistive personnel (UAP) tells the nurse that the patient with rheumatoid arthritis is increasingly manipulative and demanding and trying to meet the patient's requests is interfering with the care of other patients. What is the best action for the nurse to take? a. Tell the UAP to ignore the demands, complete assigned tasks, and go on to other patients. b. Inform the patient that the UAP has additional duties and has a fixed amount of time per patient. c. Assess patient behaviors and help the patient to focus on realistic goals and coping strategies. d. Temporarily perform the UAP duties until boundaries and expectations are established.

c. Assess patient behaviors and help the patient to focus on realistic goals and coping strategies.

SG 16. When educating a patient about total joint arthroplasty (TJA), what does the nurse do first? a. Ensure that the patient wants the procedure. b. Review instructions and ask the patient to repeat back. c. Assess the patient's knowledge about TJA. d. Ask if the provider has explained the procedure.

c. Assess the patient's knowledge about TJA.

SG 25. The nurse is providing care for a patient scheduled for a total hip arthroplasty. Which medication should the patient receive one hour before the surgical incision in accordance with the Surgical Care Improvement Project Core Measures? a. Low-molecular-weight heparin, such as subcutaneous enoxaparin. b. Fast-acting opioid, such as IV morphine. c. Broad-spectrum antibiotic, such as IV cefazolin. d. Routine daily dose of oral antihypertensive.

c. Broad-spectrum antibiotic, such as IV cefazolin.

SG 44. What is the most common area of involvement of rheumatoid arthritis in the spine? a. Lumbar spine b. Sacral spine c. Cervical spine d. Thoracic spine

c. Cervical spine

SG 30. A patient is on anticoagulant therapy with dalteparin after total joint arthroplasty. Which laboratory test should the nurse monitor? a. Prothrombin time and International Normalized Ratio. b. Oxygen saturation and liver enzymes. c. Complete blood count and platelet count. d. Erythrocyte sedimentation rate and C-reactive protein.

c. Complete blood count and platelet count.

SG 60. The nurse is assessing the skin of a patient with systemic lupus erythematosus. What is the nurse most likely to notice about the skin? a. Small, brownish spots around the nail bed. b. Generalized hardening of the skin. c. Dry, scaly, raised rash on the face. d. Raynaud's phenomenon

c. Dry, scaly, raised rash on the face.

SG 5. The nurse is caring for an obese patient with osteoarthritis (OA). What is the best rationale for encouraging this patient to lose weight? a. An obese person with OA has an increased risk of also developing rheumatoid arthritis. b. Obesity interferes with the metabolism of drugs that are usually prescribed to manage OA. c. Extra weight of obesity increases the degeneration rate of hip and knee joints. d. Obesity has a negative effect on self-esteem and body image of patients with OA.

c. Extra weight of obesity increases the degeneration rate of hip and knee joints.

SG 53. The nurse is teaching a patient about the common side effects of long-term salicylate and nonsteroidal anti-inflammatory therapy. Which body system side effects does the nurse focus on in the teaching plan? a. Central nervous system b. Skin c. Gastrointestinal d. Cardiovascular

c. Gastrointestinal

SG 43. The nurse reads in the documentation that the patient has a Baker's cyst. Which assessment will the nurse perform to validate this finding? a. Check distal lateral ankles for deformities or lumps. b. Observe the wrists bilaterally for abduction. c. Gently palpate the popliteal area behind the knee. d. Ask the patient to flex and extend the Achilles tendon.

c. Gently palpate the popliteal area behind the knee.

26. A nurse is discharging a client after a total hip replacement. What statement by the client indicates good potential for self-management? a. I can bend down to pick something up. b. I no longer need to do my exercises. c. I will not sit with my legs crossed. d. I won't wash my incision to keep it dry.

c. I will not sit with my legs crossed. There are many precautions clients need to take after hip replacement surgery, including not bending more than 90 degrees at the hips, continuing prescribed exercises, not crossing the legs, and washing the incision daily and patting it dry.

SG 62. Then nurse is caring for a patient with systemic lupus erythematosus who is having a flare-up of the condition. Which abnormal vital sign is a classic sign for an exacerbation. a. Increased blood pressure b. Decreased pulse c. Increased temperature d. Decreased respirations

c. Increased temperature

SG 47. The nurse reads in the documentation that the patient with rheumatoid arthritis may have Sjogren's syndrome. Which assessment is the nurse most likely to perform to validate this documentation? a. Weigh the patient and compare weight to baseline. b. Take the temperature and assess for signs of infection. c. Inspect mouth for dry, sticky membranes and eyes for redness. d. Observe for joint contractures and loss of range of motion.

c. Inspect mouth for dry, sticky membranes and eyes for redness.

8. The nurse is caring for a client with systemic sclerosis (SSc). What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Collaborate with a registered dietitian for appropriate foods. b. Inspect the skin and note any areas of ulceration. c. Keep the room at a comfortably warm temperature. d. Place a foot cradle at the end of the bed to lift sheets. e. Remind the client to elevate the head of the bed after eating.

c. Keep the room at a comfortably warm temperature. d. Place a foot cradle at the end of the bed to lift sheets. e. Remind the client to elevate the head of the bed after eating. The client with SSc should avoid cold temperatures, which may lead to vasospasms and Raynauds phenomenon. The UAP can adjust the room temperature for the clients comfort. Keeping the sheets off the feet will help prevent injury; the UAP can apply a foot cradle to the bed to hold the sheets up. Because of esophageal problems, the client should remain in an upright position for 1 to 2 hours after meals. The UAP can remind the client of this once he or she has been taught. The other actions are performed by the registered nurse.

SG 38. The nurse is caring for a patient who underwent a hemiarthroplasty of the right shoulder. The patient arrives on the unit with an abduction immobilizer in place. Which nursing action is correct in the care of the this patient? a. Remove the immobilizer and observe the incision site for infection and inflammation. b. Assess patient's comfort and adjust the position of the immobilizer accordingly. c. Leave the immobilizer in place and perform neurovascular assessments every 4 hours. d. Call the surgeon and ask for an order that specifies when the immobilizer can be removed.

c. Leave the immobilizer in place and perform neurovascular assessments every 4 hours.

1. A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis (OA)? a. Avoid contact sports. b. Get plenty of calcium. c. Lose weight if needed. d. Engage in weight-bearing exercise.

c. Lose weight if needed. Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less common than obesity. Calcium and weight-bearing exercise are both important for osteoporosis.

SG 32. Which outcome statement indicates that the therapeutic goal of continuous passive motion (CPM) therapy is being met? a. Patient has no signs or symptoms of venous thromboembolism. b. Stress and strain on the knee joint are reduced. c. Mobility of the patient's prosthetic knee is maintained. d. Patient uses the CPM device while ambulating.

c. Mobility of the patient's prosthetic knee is maintained.

SG 55. The nurse is caring for a patient with rheumatoid arthritis who just had an arthrocentesis. What is the priority intervention? a. Assess frequently for post procedural pain and ensure optimal pain relief. b. Place the patient in a prone position and elevate the extremity. c. Monitor the insertion site for bleeding or leakage of synovial fluid. d. Teach and encourage leg-, gluteal-, and quadriceps-setting exercises.

c. Monitor the insertion site for bleeding or leakage of synovial fluid.

9. After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the clients pulses are 2+/4+ bilaterally; the skin is pale pink, warm, and dry; and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse perform next? a. Document the findings and monitor as prescribed. b. Increase the frequency of monitoring the client. c. Notify the surgeon or anesthesia provider immediately. d. Palpate the clients bladder or perform a bladder scan.

c. Notify the surgeon or anesthesia provider immediately. With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related.

35. A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? a. Be sure you get enough sleep at night. b. Eat plenty of high-protein, high-iron foods. c. Notify your provider at once if you get a fever. d. Weigh yourself every day on the same scale.

c. Notify your provider at once if you get a fever. Fever is the classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if he or she develops an elevated temperature. Daily weights may or may not be important depending on renal involvement.

SG 46. When a patient has rheumatoid arthritis of the temporamandibular joint, what is the major complaint? a. Toothache on the affected side. b. Headache in the temple area. c. Pain on chewing and opening the mouth. d. Earache on the affected side.

c. Pain on chewing and opening the mouth.

SG 19. A patient with rheumatoid arthritis (RA) may need to undergo general anesthesia for a hip replacement. Which information needs to be brought to the immediate attention of the surgeon before the procedure is scheduled? a. Patient has a previous history of joint surgery on the affected side. b. Patient has been taking vitamin C and nonsteroidal anti-inflammatory drugs for years. c. Patient has cervical spine disease and has not had any recent spinal x-rays. d. Patient fears that the procedure will cause complications because of the RA.

c. Patient has cervical spine disease and has not had any recent spinal x-rays.

SG 27. A patient is postoperative for a total hip arthroplasty and needs to get out of bed for the first time. What should the nurse do? a. Schedule an appointment with physical therapy and wait for the therapist to assist the patient. b. Caution unlicensed assistive personnel about fall prevention and instruct to observe for dizziness. c. Put a gait belt on the patient and stand on the same side of the bed as the affected leg. d. Ask the patient how much assistance is needed to stand and pivot into the chair.

c. Put a gait belt on the patient and stand on the same side of the bed as the affected leg.

8. A client has a continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed? a. Assess the distal circulation in 30 minutes. b. Change the settings based on range of motion. c. Raise the lower siderail on the affected side. d. Remind the client to do quad-setting exercises.

c. Raise the lower siderail on the affected side. Because the clients leg is strapped into the CPM, if it falls off the bed due to movement, the clients leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjusts the CPM settings. Quad-setting exercises are not related to the CPM machine.

4. The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement? a. Needs multiple dental fillings b. Over age 85 c. Severe osteoporosis d. Urinary tract infection

c. Severe osteoporosis Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery.

32. A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best? a. A little sedation will help you get some rest. b. Depression often accompanies fibromyalgia. c. This drug works in the brain to decrease pain. d. You will have more energy after taking this drug.

c. This drug works in the brain to decrease pain. Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate.

34. A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. Lets ask the provider about increasing your pain pills. b. Hold ice bags against your hands before quilting. c. Try a paraffin wax dip 20 minutes before you quilt. d. You need to stop quilting before it destroys your fingers.

c. Try a paraffin wax dip 20 minutes before you quilt. Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a hot or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints.

SG 56. The patient is taking hydroxychloroquine for rheumatoid arthritis. Which patient statement is cause for greatest concern? a. "I seem to have a mild stomach discomfort when I take this medication." b. "I get kind of light headed. I suppose I should stand up a little slowly." c. "Could you give me a Tylenol or something mild? I have some muscle pain." d. "I think I must need new glasses. Lately, my vision is really blurry."

d. "I think I must need new glasses. Lately, my vision is really blurry."

SG 51. What is the best laboratory test to detect early rheumatoid arthritis? a. Rheumatoid factor b. Erythrocyte sedimentation rate c. Complete blood cell count d. Anti-cyclic citrullinated peptide

d. Anti-cyclic citrullinated peptide

SG 50. The nurse is providing teaching for a patient with rheumatoid arthritis who is receiving methotrexate. Which teaching point must the nurse include? a. Medication is taken every morning on an empty stomach. b. Avoid driving or operating heavy machinery. c. Expect some increase in swelling while taking this medication. d. Avoid crowds of people and people who are ill.

d. Avoid crowds of people and people who are ill.

16. The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client taking celecoxib (Celebrex) and ranitidine (Zantac) b. Client taking etanercept (Enbrel) with a red injection site c. Client with a blood glucose of 190 mg/dL who is taking steroids d. Client with a fever and cough who is taking tofacitinib (Xeljanz)

d. Client with a fever and cough who is taking tofacitinib (Xeljanz) Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels.

SG 49. In rheumatoid arthritis, autoantibodies (rheumatoid factors) are formed that attack healthy tissue, especially synovium, causing which condition? a. Nerve pain b. Bone porosity c. Ischemia d. Inflammation

d. Inflammation

SG 20. The nurse is caring for a patient who had a total hip replacement. On assessment, the nurse observes shortening of the affected leg and internal rotation. The patient reports increased pain that is not relieved with medication. What should the nurse do? a. Conduct additional pain assessment and obtain new medication orders. b. Position the leg in an anatomical position and place pillows for support. c. Compare the length of the affected leg to the unaffected leg. d. Keep the patient in bed and immediately notify the surgeon.

d. Keep the patient in bed and immediately notify the surgeon.

SG 1. A rheumatic disease is any condition or disease of which body system? a. Cardiovascular b. Hematopoietic c. Integumentary d. Musculoskeletal

d. Musculoskeletal

12. A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like pins and needles and that the neck is very painful since returning from surgery. What action by the nurse is best? a. Assist the client to change positions. b. Document the findings in the clients chart. c. Encourage range of motion of the neck. d. Notify the provider immediately.

d. Notify the provider immediately. Clients with RA can have cervical joint involvement. This can lead to an emergent situation in which the phrenic nerve is compressed, causing respiratory insufficiency. The client can also suffer a permanent spinal cord injury. The nurse needs to notify the provider immediately. Changing positions and doing range of motion may actually worsen the situation. The nurse should document findings after notifying then provider.

SG 39. What musculoskeletal health problem is often associated with rheumatoid arthritis? a. Paget's disease b. Lyme disease c. Marfan syndrome d. Osteoporosis

d. Osteoporosis

12. A client has a possible connective tissue disease and the nurse is reviewing the clients laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.) a. Elevated antinuclear antibody (ANA) Normal value; no connective tissue disease b. Elevated sedimentation rate Rheumatoid arthritis c. Lowered albumin Indicative only of nutritional deficit d. Positive human leukocyte antigen B27 (HLA-B27) Reiters syndrome or ankylosing spondylitis e. Positive rheumatoid factor Possible kidney disease

d. Positive human leukocyte antigen B27 (HLA-B27) Reiters syndrome or ankylosing spondylitis e. Positive rheumatoid factor Possible kidney disease The HLA-B27 is diagnostic for Reiters syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia. An elevated ANA is indicative of inflammatory CTDs, although a small minority of healthy adults also have this finding. An elevated sedimentation rate indicates inflammation, whether from an infection, an injury, or an autoimmune CTD. Lowered albumin is seen in nutritional deficiencies but also in chronic infection or inflammation.

10. A nurse is discharging a client to a short-term rehabilitation center after a joint replacement. Which action by the nurse is most important? a. Administering pain medication before transport b. Answering any last-minute questions by the client c. Ensuring the family has directions to the facility d. Providing a verbal hand-off report to the facility

d. Providing a verbal hand-off report to the facility As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error. The other options are valid responses but do not take priority.

SG 66. For a patient who is experiencing gout, what is the most likely reason that the patient will seek medical attention? a. Dry, red, scaly rash with butterfly pattern on face. b. Trouble passing urine because of uric acid formation. c. Presence of hard irregular tophi in the outer ear. d. Severe pain in the joint of the great toe.

d. Severe pain in the joint of the great toe.

SG 61. Which laboratory test is the only significant test for diagnosing a patient with discoid lupus? a. Antinuclear antibody b. Serum complement c. Complete blood count d. Skin biopsy

d. Skin biopsy

27. The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP). What action by the UAP warrants intervention by the nurse? a. Checking to see if the machine is working b. Keeping controls in a secure place on the bed c. Placing padding in the machine per request d. Storing the CPM machine under the bed after removal

d. Storing the CPM machine under the bed after removal For infection control (and to avoid tripping on it), the CPM machine is never placed on the floor. The other actions are appropriate.

SG 29. To prevent venous thromboembolism, several types of anticoagulant medications can be ordered. Which drug is most commonly used during hospitalization? a. Oral or parenteral aspirin b. Oral warfarin c. Intravenous tissue plasminogen d. Subcutaneous low-molecular-weight heparin (LMWH)

d. Subcutaneous low-molecular-weight heparin (LMWH)

5. An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury? a. Administer mild sedation. b. Keep all four siderails up. c. Restrain the clients hands. d. Use an abduction pillow.

d. Use an abduction pillow. Older clients often have trouble metabolizing anesthetics and pain medication, leading to confusion or restlessness postoperatively. To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time. Sedation may worsen the clients mental status and should be avoided. Using all four siderails may be considered a restraint. Hand restraints are not necessary in this situation.

25. A nurse is caring for a client after joint replacement surgery. What action by the nurse is most important to prevent wound infection? a. Assess the clients white blood cell count. b. Culture any drainage from the wound. c. Monitor the clients temperature every 4 hours. d. Use aseptic technique for dressing changes.

d. Use aseptic technique for dressing changes. Preventing surgical wound infection is a primary responsibility of the nurse, who must use aseptic technique to change dressings or empty drains. The other actions do not prevent infection but can lead to early detection of an infection that is already present.

13. The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjogrens syndrome? a. Abdominal assessment b. Oxygen saturation c. Renal function studies d. Visual acuity

d. Visual acuity Sjogrens syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjogrens syndrome.