8.C Rheumatoid Arthritis
A client is admitted for uncontrolled pain caused by rheumatoid arthritis (RA). Which ongoing problem should the nurse assess in relation to the RA? (Select all that apply.) A. Fatigue B. Weight gain C. Poor self-esteem D. Chronic pain E. Ineffective role performance
A, 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 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? (Select all that apply.) A. Administering prescribed corticosteroids B. Providing a balanced diet C. Providing periods of exercise D. Providing periods of sun exposure E. Administering prescribed NSAIDs
A, B, C, 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.
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? (Select all that apply.) A. Pericarditis B. Subcutaneous nodules C. Hepatitis D. Splenomegaly E. Hearing loss
A, B, D Rationale: Rheumatoid arthritis 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 caring for a client who was recently diagnosed with rheumatoid arthritis (RA). Which treatment goal should the nurse assign to the client? (Select all that apply.) A. Preserving function B. Preventing deformity C. Curing the disease D. Reducing inflammation E. Reducing pain
A, B, D, E Rationale: The treatment goals for clients with rheumatoid arthritis are to reduce pain, reduce inflammation, preserve function, and prevent deformity. There is no cure for rheumatoid arthritis.
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? (Select all that apply.) A. Exercising in the pool because it relieves pressure on the joints B. Avoiding exercise C. Being aware of the adverse effects of prescribed medications D. Taking NSAIDs at regular intervals with food or milk E. Applying heat or cold to relieve pain
A, 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.
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? (Select all that apply.) A. Psychological stressors B. Male sex C. Diet D. Genetic predisposition E. Family history
A, D, E 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.
A client newly diagnosed with rheumatoid arthritis (RA) is prescribed therapy with a nonsteroidal anti-inflammatory agent (NSAID). Which side effect of the medication should the nurse list for the client? (Select all that apply.) A. Nephrotoxicity B. Bone marrow depression C. Increased risk for infection D. Bleeding ulcers E. Stomach lining irritation
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.
Which independent nursing intervention should the nurse implement to treat a client diagnosed with rheumatoid arthritis (RA)? (Select all that apply.) A. Advising the client to avoid sun exposure B. Teaching about low-impact aerobics C. Instructing the client to alternate periods of activity and rest D. Promoting a well-balanced diet E. Suggesting arthrodesis for joint fusion
B, C, 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 is caring for a client diagnosed with rheumatoid arthritis (RA). Which client outcome leads the nurse to determine that treatment is successful? (Select all that apply.) A. The client uses pain medication only when pain is severe. B. The client has an active role in managing the disease. C. The client uses stress management techniques to cope with the disease. D. The client maintains a positive body image. E. The client maintains joint mobility.
B, C, D, 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.
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? (Select all that apply.) A. Instructing the client to remember the family's needs and always put them first B. Helping the client to identify strengths and what the client is still able to do for the family C. Encouraging the client to seek physician-centered care D. Encouraging the client to talk about changes brought about by the disease E. Encouraging the client to make decisions about treatment
B, 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.
Which nursing diagnosis is appropriate for the nurse to assign to a client diagnosed with rheumatoid arthritis (RA)? A. Gas Exchange, Impaired B. Body Image, Disturbed C. Pain, Acute D. Gastrointestinal Motility, Dysfunctional
B. Body Image, Disturbed Rationale: Because of the 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 gastrointestinal motility. (NANDA-I ©2014)
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. "Stop exercising for a few weeks." D. "Try exercising for several hours each day at the gym."
B. "Try doing water aerobics at the gym." Rationale: Swimming or water aerobics is a good option for individuals with rheumatoid arthritis 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.
The nurse is caring for a client recently diagnosed with rheumatoid arthritis (RA). Which clinical manifestation found during the nurse's assessment supports the diagnosis of RA? A. Morning stiffness that lasts for 30 minutes B. Low-grade fever C. Weight gain over the last several months D. Increased energy
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.
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? (Select all that apply.) A. Antinuclear antibody (ANA) test B. Kidney biopsy C. C-reactive protein (CRP) levels D. Renal function test E. Erythrocyte sedimentation rate (ESR)
C, 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.
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. Stomach ulcers C. Anemia D. Headaches
C. Anemia Rationale: RA often causes anemia that is resistant to iron therapy. It does not cause stomach ulcers, headaches, or liver failure.
A 16-year-old client presents with clinical manifestations of juvenile idiopathic arthritis (JIA). Which diagnostic test should the nurse anticipate being ordered? A. Urine cultures B. Electrolyte panel C. Erythrocyte sedimentation rate (ESR) D. Coagulation tests
C. 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.
The nurse instructs a client diagnosed with rheumatoid arthritis (RA) 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 put on only during the day." B. "The best way to splint your hip is to lie supine on a bed." C. "Splints should be made of lightweight materials." D. "Be sure to remove the splints twice a week."
C. "Splints should be made of lightweight materials." 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.
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. Hysterectomy C. Synovectomy D. Arthrodesis
D. 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.
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 looking forward to going to physical therapy so that I can improve my mobility." B. "I understand that the medications I am taking work to reduce inflammation." C. "I will make sure to perform range-of-motion exercises daily." D. "I am so glad that this medication will cure my RA in a few weeks."
D. "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.
A client with rheumatoid arthritis (RA) states, "My disease is normally well 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. Hydroxychloroquine administration B. Sulfasalazine administration C. Oral gold salts administration D. Intra-articular corticosteroid injection
D. 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.
