CHAPTER 25

C

The nurse is assessing a patient who received etanercept (Enbrel). What assessment indicates a potential side effect? A) The patient reports fatigue. B) The patient has diarrhea. C) The patient develops wheezing. D) The patient has a heart rate of 100 beats/minute.

B

A 25-year-old woman with rheumatoid arthritis is being treated with acetaminophen and salicylates. The physician has switched her medication regimen to include DMARDs. What is the advantage of DMARDs over salicylates? A) DMARDs control the symptoms of rheumatoid arthritis. B) DMARDs can arrest the progression of rheumatoid arthritis. C) DMARDs have a lower risk of adverse effects. D) DMARDs are more effective with a lower dose.

A

A client is to receive etanercept. What characteristic of the client may contraindicate the use of this medication? A) Fear of injections B) Occasional dysphagia C) Lack of social support D) Employment involving heavy machinery

A

A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving? A) Gold salts B) NSAIDs C) Salicylates D) DMARDs

C

A nurse administers methotrexate (Rheumatrex). What assessment finding is attributable to the effect of this medication? a) Decreased urination b) Increased red blood cell count c) Immunosuppression d) Increased hemoglobin

D

A patient has been diagnosed with rheumatoid arthritis. he patient shows the nurse small nodules on both elbows and hands. What does the nurse understand that these nodules are? A) Lipomas B) Calcification nodules C) Tophi D) Rheumatoid nodules

A

Disease-modifying antirheumatic drugs (DMARDs) are administered to produce which therapeutic effect? A) Stop the progression of the disease. B) Increase the immune response. C) Reverse joint deformity. D) Increase cerebrospinal fluid secretion.

A

Kate, age 32, is being prescribed methotrexate for rheumatoid arthritis. The physician also discussed with Kate the types of birth control available and the effectiveness of each formulation. Why is it essential to discuss contraceptive therapy with Kate? A) Because fetal abnormality has been documented in patients undergoing methotrexate drug therapy B) Because the fetus may also develop rheumatoid arthritis C) Because the fetus' liver and kidneys may not be able to adequately clear the drug D) Because the patient has to undergo extensive renal and hepatic function tests, which could harm the fetus

C

Marge, a 38-year-old woman, is seen in the physician's office for the first time. She complains of fatigue, decreased range of motion in her hands, pain with activities that require her to use her hands, loss of strength in her hands and arms, and a low-grade fever. What is the most likely diagnosis that would explain Marge's symptoms? A) Inflammatory osteoarthritis B) Multiple sclerosis C) Rheumatoid arthritis D) Gouty arthritis

D

Matt, age 35, is being treated with methotrexate for osteosarcoma. He has a history of alcohol abuse, drinking 6 to 10 beers per day. Based on Matt's history, which adverse effects is he at a risk for? A) Methotrexate photosensitivity B) Blood dyscrasias C) Immunosuppression D) Hepatic dysfunction

C

Mr. Gregory is being treated for gout with colchicine. He has been taking the medication for over a year now. What is the main adverse reaction of long-term therapy with this medication? A) GI tract distress B) Renal or hepatic failure C) Depressed bone marrow function D) Paralytic ileus

TRUE

Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction. True False

C

The nurse administers methotrexate (Rheumatrex). What will the nurse determine is a therapeutic effect? A) Decreased blood pressure B) Bradycardia C) Absence of joint pain D) Decreased itching

D

The nurse is administering etanercept (Enbrel). Which administration technique would be considered appropriate? A) The nurse administers the medication orally with other drugs. B) The nurse administers the medication IV. C) The nurse administers the medication topically on the abdomen. D) The nurse administers the medication subcutaneously weekly.

A

The patient is having an acute exacerbation of rheumatoid arthritis. What medication does the nurse anticipate giving as "pulse therapy"? A) Prednisone B) Cyclosporine C) Etanercept D) Remicade

A

What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals? A) Gold salts B) Cox 2 inhibitors C) Propionic Acids D) Fenamates

A

What statement can the nurse make to a patient concerning the administration of a tumor necrosis factor (TNF) inhibitor? A) This new drug therapy is now considered the standard. B) This drug is typically administered alone. C) This medication must be administered daily. D) This medication cannot be administered to patients with kidney disease.

A, B, C, D

Which adverse effects does the nurse attribute to methotrexate (Rheumatrex) therapy for rheumatoid arthritis (RA)? Select all that apply. A) Stomatitis B) Thinning hair C) Fatigue D) Cirrhosis E) Angina

A

Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema? A) Rheumatoid arthritis (RA) B) Systemic lupus erythematosus C) Osteoporosis D) Polymyositis

A

Which is a true statement for the nurse to teach the patient about disease modifying anti-rheumatic drugs (DMARDs)? A) "These medications suppress the immune system." B) "The medications may or may not help you." C) "These medications cause severe depression." D) "The medications are not very strong."

C

A patient being placed on drug therapy for rheumatoid arthritis (RA) asks the nurse why she will have to take methotrexate as well as naprosyn (Naproxyn). What is the best response by the nurse? A) "Methotrexate will work only with a nonsteroidal anti-inflammatory drug (NSAID)." B) "NSAIDs reduce the disease activity more than methotrexate." C) "NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts." D) "NSAIDs begin the immunosuppression until methotrexate takes over."

A, B

A patient has just received etanercept (Enbrel). What medications cannot be administered with this drug? Select all that apply. A) Cyclophosphamide (Cytoxan) B) Imatinib (INN) C) Motrin D) Steroids

B

A patient on methotrexate therapy complains of mouth ulcers. Which treatment does the nurse anticipate the patient will be prescribed? A) Folic acid 1 mg daily by mouth B) Allopurinol 300 mg dissolved in 50 mg of water, swish and spit C) Ibuprofen 400 mg every 6 hours by mouth D) Nystatin oral suspension, swish and swallow

D

A patient sees a physician for pain in the joints of fingers with significant swelling. X-rays reveal extensive joint damage from theumatoid arthritis (RA); laboratory results are definitive. Which medication does the nurse anticipate the patient will receive to decrease the extensive joint damage? A) A nonsteroidal anti-inflammatory medication, such as Ibuprofen B) A glucocorticoid steroid, such as prednisone C) An uricosuric medication, such as Allopurinol D) A disease-modifying antirheumatic drug (DMARD), such as methotrexate

B

Connie, age 43, is being discharged on methotrexate. Which statement by the patient indicates that she understands how the medication will work and how to take the medication? A) "I will start to see an improvement in my symptoms within the week." B) "I should take the medication on an empty stomach to promote absorption of the drug." C) "I should take the drug twice a day as prescribed." D) "I need to limit my fluid intake to prevent excretion of the drug."

B

Danny has been diagnosed with rheumatoid arthritis and begins methotrexate drug therapy. Why should the nurse document the severity of joint inflammation and any restriction in the range of motion when assessing Danny's health status? A) To minimize the adverse effects of methotrexate therapy B) To later compare and assess the efficacy of methotrexate therapy C) To maximize the therapeutic effects of methotrexate therapy D) To identify the signs of hepatic or renal insufficiency

B

The nurse is caring for the patient with chronic gout. The patient has elevated uric acid levels. What medication would the nurse be administering for this patient? A) Colchicine B) Allopurinol C) Nonsteroidal anti-inflammatory medications such as Aleve D) Prednisone

B, D

The nurse is educating the patient about a new diagnosis of rheumatoid arthritis (RA) and reducing the risk of complications that can arise from this disorder. For what complication is the patient with RA at risk? (Select all that apply.) A) Diabetes mellitus B) Stroke C) Hypothyroidism D) Heart attack E) Deep vein thrombosis

C

The nurse is obtaining nutritional information prior to the patient beginning methotrexate therapy for psoriatic arthritis. What information obtained by the nurse would be of greatest concern? A) The patient drinks two glasses of wine once every 2 weeks. B) The patient eats two eggs daily for breakfast. C) The patient drinks six cups of coffee daily. D) The patient eats three fruits per day.

A

The patient informs the nurse that he has been taking methotrexate for 1 week and it is not working to control the rheumatoid arthritis (RA) symptoms. What should the nurse explain to the patient about the onset of action? A) Relief of symptoms should occur within 3-6 weeks. B) Relief of symptoms should occur within 3 days. C) Relief of symptoms should occur within 1 week. D) Relief of symptoms should occur within 2 months.

A, C, D, E

The patient on methotrexate therapy should have lab work performed every 4 to 8 weeks. Which test(s) should be closely monitored at this time? (Select all that apply.) A) Complete blood count B) Rheumatoid factor C) Liver profile D) Serum albumin E) Serum creatinine

A

Which patient is most at risk for adverse effects from disease modifying anti-rheumatic drugs (DMARDs)? A) The patient with hepatic insufficiency B) The patient with supraventricular tachycardia C) The patient with chronic constipation D) The patient with joint pain