Rheumatoid Arthritis (RA)
The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is most appropriate? A) Swimming B) Football C) Softball D) Basketball
A) Swimming Rationale: Swimming exercises all the extremities without putting undue stress on joints. In contrast, softball, football, or basketball could all exacerbate joint discomfort.
The nurse is caring for a client who was diagnosed with rheumatoid arthritis (RA) last year. The client has just been prescribed methotrexate as part of his RA treatment regimen. The nurse is teaching the client about use of this medication. Which client statement indicates that this teaching was successful? A) "It's not safe for me to take NSAIDs while on methotrexate therapy." B) "I can help control the side effects of methotrexate by taking folic acid." C) "I should expect to see beneficial results within 3 to 5 days of starting methotrexate therapy." D) "It's important that I take my methotrexate at the same time every day."
B) "I can help control the side effects of methotrexate by taking folic acid." Rationale: Clients who are on methotrexate therapy should be advised to take folic acid, as this can help control side effects such as gastric irritation and stomatitis. Methotrexate is typically taken once per week (not daily), and it can be safely used along with NSAIDs in the treatment of RA. Clients may see beneficial effects of methotrexate therapy is as few as 2-4 weeks (not 3-5 days).
A client diagnosed with Rheumatoid arthritis (RA) reports having trouble doing the prescribed physical therapy exercises because of stiffness. Which intervention should the nurse suggest to help the client follow the prescribed physical therapy program? A) "Wear lightweight clothing when you exercise." B) "Try doing water aerobics at the gym." C) "Try exercising for several hours each day at the gym." D) "Stop exercising for a few weeks."
B) "Try doing water aerobics at the gym." Rationale: Swimming or water aerobics is a good option for individuals with RA because the water supports the body, thus decreasing the amount of stress on the joints. Exercising for several hours each day at the gym, wearing lightweight clothing during exercise, or stopping exercising are not likely to increase mobility.
A client diagnosed with rheumatoid arthritis (RA) is scheduled for surgery to stabilize the client's cervical spine. For which type of surgery should the nurse expect to receive preoperative orders? A) Arthroplasty B) Synovectomy C) Arthrodesis D) Hysterectomy
C) Arthrodesis Rationale: An arthrodesis is a joint fusion surgery. It is performed to stabilize joints such as the cervical vertebrae, wrists, or ankles. A synovectomy is excision of the synovial membrane. It provides temporary relief of inflammation and pain. An arthroplasty is a total joint replacement that is performed in cases of gross deformity and joint destruction. A hysterectomy is the surgical removal of the uterus.
A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). Based on this data, what should the nurse anticipate when providing care to this client? A) A higher risk for preterm delivery B) An increased need for medication C) An acute exacerbation of symptoms D) A continued risk for anemia
D) A continued risk for anemia Rationale: The pregnant client with RA is at continued risk for anemia. Many pregnant clients with RA have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.
A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress checkup. Which of the following statements on the part of the client suggests that she has met a goal of treatment? A) "I sleep for 10 hours a night." B) "I have increased pain in my joints all the time now." C) "I have delegated many household chores to my children and spouse." D) "I don't perform household chores at all anymore."
C) "I have delegated many household chores to my children and spouse." Rationale: One technique for reducing stress on the joints is to delegate household tasks to family members; however, the client does not need to refrain from all household chores. Sleeping for 10 hours at night will not alleviate the need for frequent rest periods during the day. Increased joint pain would indicate that goals have not been met.
The nurse is providing discharge teaching for a client diagnosed with rheumatoid arthritis (RA). Which client statement indicates to the nurse that further teaching is required? A) "I am so glad that this medication will cure my RA in a few weeks." B) "I am looking forward to going to physical therapy so that I can improve my mobility." C) "I understand that the medications I am taking work to reduce inflammation." D) "I will make sure to perform ROM exercises daily."
A) "I am so glad that this medication will cure my RA in a few weeks." Rationale: Rheumatoid arthritis is a chronic disease that has no cure. Treatment is aimed at relieving pain, reducing inflammation, slowing joint damage, and improving the client's well-being. Physical therapy and range-of-motion exercises are often prescribed to improve mobility, and medications are given to reduce inflammation.
The nurse is collecting a health history for a client being seen in an outpatient clinic who complains of joint pain and swelling that have lasted for about 2 months. The client is diagnosed with RA. Which of the following statements made by this client supports the nursing diagnosis of: Activity Intolerance? A) "I seem to get tired early in the day and require a nap." B) "My joints are stiffest at night before I go to sleep." C) "I find it difficult to move when I first get up in the morning." D) "I take ibuprofen for the pain as needed."
A) "I seem to get tired early in the day and require a nap." Rationale: One hallmark symptom of RA is extreme fatigue. The client's statement regarding the need for a nap supports the inclusion of Activity Intolerance in the plan of care. Based on this diagnosis, the nurse would teach the client about the need for frequent rest periods during the day to conserve energy. The joints of RA clients are usually stiffest in the morning, but that would not interfere with activities later in the day. Also, taking ibuprofen for pain does not affect the client's ability to engage in activity.
The nurse instructs a client diagnosed with rheumatoid arthritis about the use of splints to reduce strain on joints. Which instruction is most important for the nurse to include in the teaching? A) "Splints should be made of lightweight materials." B) "The best way to splint your hip is to lie supine on a bed." C) "Be sure to remove the splints twice a week." D) "Splints should be put on only during the day."
A) "Splints should be made of lightweight materials that are easy to remove." Rationale: Splints should be made of lightweight materials that are easy to remove. Splints should be removed once or twice a day to perform range-of-motion (ROM) exercises. Night splints are often used on the hands and wrists. The best way to splint a hip is to lie prone for several hours on a firm bed.
Which nursing diagnosis is appropriate for the nurse to assign to a client diagnosed with rheumatoid arthritis (RA) A) Body image, Disturbed B) Gastrointestinal motility, Dysfunctional C) Pain, Acute D) Gas Exchange, Impaired
A) Body image, Disturbed Rationale: Because of joint deformities, clients diagnosed with RA often have a disturbed body image. RA produces chronic pain, not acute pain. The client will not experience impaired gas exchange or dysfunctional GI motility
A 16-year-old client presents with clinical manifestations of juvenile idiopathic arthritis (JIA). Which diagnostic test should the nurse anticipate being ordered? A) Erythrocyte sedimentation rate (ESR) B) Coagulation tests C) Electrolyte panel D) Urine cultures
A) Erythrocyte sedimentation rate (ESR) Rationale: The diagnosis of JIA is identified based on a combination of diagnostic tests. Erythrocyte sedimentation rate (ESR) is a laboratory test that is used as an inflammatory marker for the diagnosis of arthritis. Urine cultures, coagulation tests, and electrolyte panels are not used for the diagnosis of JIA
Which of the following complications is not associated with a diagnosis of rheumatoid arthritis (RA)? A) Increased risk of cesarean delivery if pregnant B) Increased risk of pleural effusion C) Increased likelihood of uveitis D) Increased risk of anemia
A) Increased risk of cesarean delivery if pregnant Rationale: All individuals with RA are at increased risk of plural effusion and uveitis, although the latter condition is most commonly associated with juvenile RA. Between 25% and 35% of clients with RA have mild anemia. However, pregnant women with RA are no more likely to undergo cesarean delivery than pregnant women without RA
A client with rheumatoid arthritis states, "My disease is normally controlled with a regimen of medications and treatments. However, I'm experiencing a flare-up of the disease in the right knee." Which collaborative intervention should the nurse expect to implement? A) Intra-articular corticosteroid injection B) Sulfasalazine administration C) Hydroxychloroquine administration D) Oral gold salts administration
A) Intra-articular corticosteroid injection Rationale: Intra-articular corticosteroid injections are effective in treating local disease flare-ups without having to change the overall drug regimen. Sulfasalazine is used when the client is not responsive to other medications and is associated with toxic reactions. Hydroxychloroquine requires 3-6 months of therapy to see results; therefore, it is not useful in treating local flare-ups of the disease. Gold salts are better administered by injection; they are used for long-term treatment of RA, not for a local flare-up.
Which form of juvenile idiopathic arthritis (JIA) primarily affects the knees, ankles, and elbows? A) Pauciarticular arthritis B) Polyarticular arthritis C) Systemic arthritis D) Osteoarthritis
A) Pauciarticular arthritis Rationale: There are three types of JIA: pauciarticular, systemic, and polyarticular. Pauciarticular arthritis primarily affects the knees, ankles, and elbows. Systemic arthritis involves high fever, polyarthritis, and rheumatoid rash and also affects internal organs. Polyarticular arthritis affects many joints (five or more), particularly the small joints of the hands and fingers. It also may affect the hips, knees, feet, ankles, and neck. Osteoarthritis is a separate condition, not a form of JIA.
Why are proton pump inhibitors often included as part of the pharmacologic treatment regimen for clients with rheumatoid arthritis (RA)? A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA B) Proton pump inhibitors can dramatically decrease both inflammation and immune reactions and appear to slow the progression of joint destruction in RA C) Proton pump inhibitors help reduce the body's autoimmune response, thereby limiting the effects of the autoimmune process that underlies RA D) Proton pump inhibitors help reduce the risk of retinitis and vision loss in clients who are taking antimalarial agents as part of their therapeutic regimen for RA
A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of meds used in the treatment of RA Rationale: NSAIDs are among the most common dugs used in the treatment of RA, although they may produce unpleasant gastric side effects like stomach lining irritation, erosions, and bleeding ulcers. Concurrent administration of proton pump inhibitors may reduce the risk for GI bleeding due to NSAIDs. Proton pump inhibitors do not affect the inflammation, immune reactions, and joint destruction associated with RA, nor do they reduce the body's autoimmune response. Furthermore, these drugs do not affect the risk of vision problems that accompanies use of antimalarial agents.
The community health nurse is conducting a teaching session for community members on rheumatoid arthritis (RA). Which characteristic should the nurse list as being a risk factor for the development of RA? SATA A) Psychological stressors B) Genetic predisposition C) Family history D) Diet E) Male sex
A, B, C -Psychological stressors -Genetic predisposition -Family hx Rationale: Risk factors for RA include genetic, environmental, reproductive, and hormonal factors. Autoimmune disorders such as RA are more prevalent in women, not men. Diet is not a known risk factor in the development of RA.
The nurse is caring for a client diagnosed with rheumatoid arthritis (RA). Which client outcome leads the nurse to determine that treatment is successful? SATA A) The client maintains joint mobility B) The client maintains a positive body image C) The client uses stress management techniques to cope with the disease D) The client uses pain medication only when the pain is severe E) The client has an active role in managing the disease
A, B, C, E Rationale: The client diagnosed with RA endures chronic pain. Pain medication should be taken regularly and prior to planned activities to remain pain-free. Positive outcomes include maintaining joint mobility, having an active role in managing the disease, maintaining a positive body image, and using stress management techniques to cope with the stress of the disease.
The nurse is caring for a client who was recently diagnosed with rheumatoid arthritis (RA). Which treatment goal should the nurse assign to the client? SATA A) Reducing inflammation B) Preserving function C) Reducing pain D) Curing the disease E) Preventing deformity
A, B, C, E Rationale: The treatment goals for clients with RA are to reduce pain, reduce inflammation, preserve function, and prevent deformity. There is no cure for RA.
Which independent nursing intervention should the nurse implement to treat a client diagnosed with rheumatoid arthritis (RA). SATA A) Instructing the client to alternate periods of rest and activity B) Promoting a well-balanced diet C) Suggesting arthrodesis for joint fusion D) Teaching about low-impact aerobics E) Advising the client to avoid sun exposure
A, B, D Rationale: Independent interventions for clients with rheumatoid arthritis include monitoring and treating chronic pain, preventing fatigue, addressing ineffective role performance, promoting a healthy body image, and providing support related to impaired mobility. Interventions for rheumatoid arthritis include teaching about low-impact aerobics, such as walking and swimming; alternating periods of activity and rest; and promoting a well-balanced diet. Arthrodesis is a surgical intervention used to fuse cervical vertebrae, wrists, and ankles; although it is a treatment for RA, it is not an independent nursing intervention. Avoiding sun exposure is an intervention for systemic lupus erythematosus, not rheumatoid arthritis.
The nurse assessing a client diagnosed with rheumatoid arthritis (RA) notes the presence of joint deformities. Which additional extra-articular manifestation of RA should the nurse look for in the client? SATA A) Subcutaneous nodules B) Splenomegaly C) Hearing loss D) Pericarditis E) Hepatitis
A, B, D Rationale: RA has many systemic effects including subcutaneous nodules, pericarditis, and splenomegaly. These are the result of inflammation or high levels of circulating rheumatoid factors. RA does not cause hearing loss or hepatitis.
The nurse is providing care to a client who is receiving NSAIDs in the treatment of rheumatoid arthritis. When providing care to this client, which actions by the nurse are appropriate? SATA A) Monitoring for signs of an allergic reaction B) Assuring the client that NSAIDs are safe for clients with cardiovascular disease C) Encouraging the client to take NSAIDs with a small snack to help avoid GI distress D) monitoring for signs of renal problems E) Inquire about the use of herbal supplements such as garlic, ginger, or ginkgo
A, C, D, E Rationale: When providing care to a client who is receiving any medication, it is important to monitor for signs of allergic reaction. Taking NSAIDs with food may help reduce symptoms of GI distress that are often associated with these drugs. Clients who are on NSAIDs should be monitored for signs of renal problems, because these medications are potentially nephrotoxic. Clients should also avoid herbal supplements such as feverfew, garlic, ginger, and gingko, as these substances can increase the risk of bleeding associated with NSAID use. Because NSAIDs can cause blood pressure alterations, they may be dangerous for clients with cardiovascular disorders.
A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse to explain the difference is between RA and osteoarthritis (OA). Which responses by the nurse are most appropriate? SATA A) "The onset of OA is gradual, whereas the onset of RA may be rapid." B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time." C) "The affected joints in RA feel cold to the touch, whereas the affected joints in OA are warm or hot to the touch." D) "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions." E) "With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising."
A, D Rationale: The onset of OA is gradual, whereas the onset of RA may be rapid. RA affects multiple joints symmetrically, but OA affects one joint at a time. The affected joints in OA feel cold to the touch, whereas the affected joints in RA are warm or hot to the touch. OA is slowly progressive, whereas RA has exacerbations and remissions. With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising.
A client diagnosed with rheumatoid arthritis (RA) tells the nurse, "Because of my pain and fatigue, I can no longer take care of my family the way I used to. I feel like such a failure." Which intervention is appropriate for the nurse to implement for this client? SATA A) Helping the client to identify strengths and what the client is still able to do for the family B) Encouraging the client to seek physician-centered care C) Instructing the client to remember the family's needs and always put them first D) Encouraging the client to talk about changes brought about by the disease E) Encouraging the client to make decisions about treatment
A, D, E Rationale: As the client becomes unable to fulfill normal familial roles, stress occurs in the family. Talking about the changes, identifying strengths, helping the client realize what they can still do for their family, and encouraging the client to continue to make medical decisions are important for maintaining a sense of self-control and self-esteem. It is not helpful to tell clients to put someone else's needs before their own. Encouraging the client to seek physician-centered care is also inappropriate, because client-centered care helps clients to decrease their dependence on healthcare services and ensures greater safety and efficacy of treatment.
A client newly diagnosed with rheumatoid arthritis (RA) is prescribed therapy with an NSAID. Which side effect of the medication should the nurse list for the client? SATA A) Bleeding ulcers B) Bone marrow depression C) Increased risk of infection D) Stomach lining irritation E) Nephrotoxicity
A, D, E Rationale: The side effects of NSAIDs include: stomach lining irritation, bleeding ulcers, and nephrotoxicity. An increased risk for infection is a side effect of immunosuppressive agents. Bone marrow depression is a side effect of gold salts.
The nurse admits a client to the hospital who is suspected of having rheumatoid arthritis (RA). Which diagnostic test should the nurse expect to be ordered for the client? SATA A) Erythrocyte sedimentation rate (ESR) B) Renal function test C) Kidney biopsy D) Antinuclear antibody test (ANA) E) C-reactive protein (CRP) levels
A, E Rationale: Laboratory tests used to diagnose rheumatoid arthritis include C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), which are nonspecific inflammatory markers. The antinuclear antibody (ANA) test, renal function test, and kidney biopsy are diagnostic tests for systemic lupus erythematosus, not rheumatoid arthritis.
Based on gender and age alone, which of the following clients is most likely to experience the new onset of rheumatoid arthritis (RA)? A) A 31-year-old man B) A 42-year-old woman C) A 65-year-old woman D) An 18-year-old man
B) A 42-year-old woman Rationale: RA is the most common form of autoimmune arthritis, affecting from 1% to 2% of the worldwide population. RA affects three times as many women as men, and while the typical age of onset is between 40 and 60 years, this disease strikes people of all ages.
A client newly diagnosed with rheumatoid arthritis (RA) tells the nurse, "I understand that RA affects my joints. Does it have any other effects on my body that I should know about?" In response, which additional effect of RA should the nurse include? A) Liver failure B) Anemia C) Stomach ulcers D) Headaches
B) Anemia Rationale: RA often causes anemia that is resistant to iron therapy. It does not cause stomach ulcers, headaches, or liver failure.
The nurse is caring for a client recently diagnosed with rheumatoid arthritis (RA). Which clinical manifestations found during the nurse's assessment supports the diagnosis of RA? A) Morning stiffness that lasts for 30 minutes B) Low-grade fever C) Increased energy D) Weight gain over the last several months
B) Low-grade fever Rationale: Clients diagnosed with rheumatoid arthritis often have a low-grade fever. This finding supports the diagnosis of RA. Weight loss, morning stiffness that lasts more than 1 hour, and fatigue are other symptoms that support this diagnosis.
A client with rheumatoid arthritis (RA) complains of pain and discomfort in the hands and knees. Which intervention should the nurse implement to reduce the pain and discomfort that the client is experiencing? SATA A) Providing periods of sun exposure B) Administering prescribed NSAIDs C) Providing periods of exercise D) Administering prescribed corticosteroids E) Providing a balanced diet
B, C, D, E Rationale: NSAIDs are used to treat inflammation and pain in clients with rheumatoid arthritis. Exercise increases muscle strength and preserves function. Low-dose corticosteroids are used to reduce pain and inflammation in clients with rheumatoid arthritis. These medications also slow the development and progression of bone erosion. Improving nutrition promotes a well-balanced diet enhancing overall health in clients. It is also recommended to substitute dietary fat with omega-3 fatty acids in fish oils. Some medications used to treat rheumatoid arthritis cause sun sensitivity. Clients are advised to decrease the amount of time in the sun and to use sunscreen with sun protection when outdoors.
A client is admitted for uncontrolled pain caused by RA. Which ongoing problem should the nurse assess in relation to the RA? SATA A) Weight gain B) Fatigue C) Ineffective role performance D) Chronic Pain E) Poor self-esteem
B, C, D, E Rationale: Ongoing problems related to RA include chronic pain, fatigue, poor self-esteem related to body-image issues, and ineffective role performance. Weight loss, not weight gain, is an issue for clients with RA.
A client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. What information should the nurse include when teaching this client about ways to decrease the likelihood of crippling deformities? SATA A) Ignore pain as a warning signal B) Type instead of hand-writing items if possible. C) Use the strongest joints possible to complete most tasks D) Avoid stress to any current area of deformity E) Stop an activity immediately if it is beyond your ability to perform
B, C, D, E Rationale: The client with RA should never attempt to push a joint beyond its ability. Pain is a warning signal, so the client with RA should immediately stop any activity that causes pain. The client should also use the strongest joints possible to complete tasks, and he or she should avoid activities (like writing) that require a strong grip. In addition, when performing tasks, the client should avoid stress in any current area of deformity to help prevent further deformities.
A client diagnosed with rheumatoid arthritis (RA) states that the pain is controlled with NSAIDs. Which instruction related to the disease process and supportive care should the nurse provide? SATA A) Avoiding exercise B) Taking NSAIDs at regular intervals with food or milk C) Applying heat or cold to relieve pain D) Being aware of the adverse effects of prescribed medications E) Exercising in the pool because it relieves pressure on the joints
B, C, D, E Rationale: The priorities of care for the client with rheumatoid arthritis are supportive care and education. Taking NSAIDs at regular intervals provides continued control of pain and discomfort. Taking NSAIDs with food or milk decreases the incidence of gastrointestinal upset. Clients should consume a well-balanced diet, use the application of heat and cold for pain, exercise in the pool because it supports the client's weight and relieves pressure on the joints, be aware of adverse effects of medications, lose weight if necessary, follow prescribed physical therapy, avoid smoking, and use muscle-strengthening exercises.
A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis (RA) The client reports that her pain is a 3/10 today. Which nonpharmacologic interventions can the nurse provide to enhance the client's comfort? SATA A) Discourage any position changes B) Encourage relaxation techniques C) Immobilize the extremity D) Offer heat and/or cold packs E) Provide distraction activities
B, D, E Rationale: Nonpharmacologic activities for pain relief include relaxation, distraction, and application of heat and cold. Position changes are encouraged along with supportive equipment. Immobilization would likely cause contractures in the joints.
