Juvenile Idiopathic Arthritis (JIA) Practice Questions (Test #3, Fall 2020)

Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

1 1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining. 2. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining. 3. NSAIDs do not require a blood level because they are available over the counter. 4. NSAIDs do not interfere with the oral cavity; however, other medications used for JIA cause oral ulcers. TEST-TAKING HINT: The test taker must know what NSAIDs are and that they are available over the counter

The parents of a child just diagnosed with juvenile idiopathic arthritis (JIA) tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What should the nurse include when teaching the parents about the disease? 1.Half of affected children recover without joint deformity. 2.Many affected children go into long remissions but have severe deformities. 3.The disease usually progresses to crippling rheumatoid arthritis. 4.Most affected children recover completely within a few years.

1 In half of the children diagnosed with JIA, recovery occurs without joint deformity. Approximately one-third of the children will continue to have the disease into adulthood, and approximately one-sixth will experience severe, crippling deformities.

Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2 1. JIA is not a type of cancer. 2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA. 3. These medications are not the same as NSAIDs. 4. They are not absorbed into the synovial fluid to treat JIA; they suppress the immune system. TEST-TAKING HINT: There are some drugs that are used for other reasons outside of their usual use, such as chemotherapeutic agents. Many drugs have multiple uses.

The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which of the following responses by the nurse would be most appropriate? 1."It may be difficult for your child to attend school because of the side effects of the medications he will be prescribed." 2."Your child should be encouraged to attend school, but he'll need extra time to work out early morning stiffness." 3."You should keep your child at home from school whenever he experiences discomfort or pain in his joints." 4."Your child will probably need to wear splints and braces so that his joints will be supported properly."

2 Socialization is important for this preschool-age child, and activity is important to maintain function. Because children with JIA commonly experience most problems in the early morning after arising, they need more time to "warm up." Adverse effects may or may not occur. The child's normal routine needs to be maintained as much as possible. Although splints and braces may be needed, they are worn during periods of rest, not activity, to maintain function.

Nonsteroidal anti-inflammatory drugs are the first choice in treating a child with juvenile idiopathic arthritis. Which adverse effects should the nurse include in the teaching plan for the parents? Select all that apply. 1.Weight gain. 2.Abdominal pain. 3.Blood in the stool. 4.Folic acid deficiency. 5.Reduced blood clotting ability.

2,3,5 Adverse effects from nonsteroidal anti-inflammatory drugs include abdominal pain, blood in stool, and reduced clotting ability. Weight gain is common with corticosteroids. Folic acid deficiency is associated with methotrexate therapy

One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

1,2,5 1. Providing pain medication prior to ambulation helps decrease pain during ambulation. 2. Children with JIA need to do range of-motion exercises to prevent joint stiffness. 3. A high-fat diet is not helpful for mobility. 4. Oxygen is usually not necessary with the diagnosis of JIA. 5. Using nonpharmacological methods such as heat helps with flexibility and pain TEST-TAKING HINT: By understanding the disease process of JIA, the test taker will know what interventions are needed to help alleviate pain and disability.

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3 1. Long-term corticosteroid use causes fat deposits, especially in the back, face, and trunk. 2. With the use of corticosteroids, there is adrenal suppression because the exogenous steroid causes the body to lower production of its own steroids. 3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body's attack on itself. 4. Steroids cause hyperglycemia. TEST-TAKING HINT: The test taker must understand how immune system diseases work in order to know how treatments will be helpful. Consider how steroids work and their complications. Each answer listed, except the correct answer, is the opposite of the true side effects

What should the nurse include when developing the teaching plan for the parents of a child with juvenile idiopathic arthritis who is being treated with naproxen (Naprosyn)? 1.Anti-inflammatory effect will occur in approximately 8 weeks. 2.Within 24 hours, the child will have anti-inflammatory relief. 3.The nurse should be called before giving the child any over-the-counter medications. 4.If a dose is forgotten or missed, that dose is not made up.

3 The first group of drugs typically prescribed is the nonsteroidal anti-inflammatory drugs, which include naproxen. Naproxen is included in only a few over-the-counter medications but aspirin is in several. The family should check with the nurse before giving any over-the-counter medications. Once therapy is started, it takes hours or days for relief from pain to occur. However, it takes 3 to 4 weeks for the anti-inflammatory effects to occur, including reduction in swelling and less pain with movement. The missed dose will need to be made up to maintain the serum level and to maintain therapeutic effectiveness of the drug

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated inflammatory response in the joint.

4 1. This is part of the normal breakdown and buildup of bone in the body. 2. This is part of the process for osteoarthritis. 3. This is the pathophysiology of calcium chondrosis. 4. JIA is caused by an immune response by the body on the joint spaces. TEST-TAKING HINT: The test taker must understand JIA is an immune-modulated disorder in which the body attacks itself, causing destruction of the joint spaces

A preschool-age child with juvenile idiopathic arthritis (JIA) has become withdrawn, and the mother asks the nurse what she should do. Which of the following suggestions by the nurse would be most appropriate? 1.Introduce the child to other children her age who also have JIA. 2.Tell the mother to spend extra time with the child and less time with her other children. 3.Recommend that the mother send the child to see a counselor for therapy. 4.Encourage the mother to be supportive and understanding of the child.

4 Because the child is dealing with grief and loss associated with a chronic illness, parents need to be supportive and understanding. The child needs to feel valued and worthwhile. Introducing the child to others of the same age who also have JIA most probably would be ineffective because preschoolers are developmentally egocentric. Although the child needs to feel valued, the mother's spending more time with the child and less time with her other children is inappropriate because the child with JIA may experience secondary gain from the illness if the family interaction patterns are altered. Also, this action reinforces the child's withdrawal behavior. Psychological counseling is not needed at this time because the child's reaction is normal.

The father of a preschool-age child with a tentative diagnosis of juvenile idiopathic arthritis (JIA) asks about a test to definitively diagnose JIA. The nurse's response is based on knowledge of which of the following? 1.The latex fixation test is diagnostic. 2.An increased erythrocyte sedimentation rate is diagnostic. 3.A positive synovial fluid culture is diagnostic. 4.No specific laboratory test is diagnostic.

4 The nurse's response to the father is based on the knowledge that there is no definitive test for JIA. The latex fixation test, which is commonly used to diagnose arthritis in adults, is negative in 90% of children. The erythrocyte sedimentation rate may or may not be increased during active disease. This test identifies the presence of inflammation only. Synovial fluid cultures are done to rule out septic arthritis, not to diagnose JIA.