Adults Ch 18 Evolve
A patient with fibromyalgia is in the hospital for an unrelated issue. The patient reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? -Allow the patient uninterrupted rest time -Assess the patient's usual bedtime routine -Limit environmental noise as much as possible. -Offer a massage or warm shower at night -Request an order for a strong sleeping pill
Allow the patient uninterrupted rest time, Assess the patient's usual bedtime routine, Limit environmental noise as much as possible, Offer a massage or warn shower at night Patients 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 patient's usual bedtime routine as much as possible, limiting noise and light, and offering massages or warm showers can help. The patient does not need a strong sleeping pill unless all other options fail and the patient requests something for sleep. At that point a mild sleeping agent can be tried.
The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? -It affects single joints only -Antibodies lead to inflammation -It consists of an autoimmune process -Morning stiffness is rare -Permanent damage is inevitable
Antibodies lead to inflammation 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. Patients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.
A patient 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? -Assess medication records for steroid use -Facilitate a consultation with physical therapy -Measure the range of motion in both hips -Notify the health care provider immediately
Assess medication records for steroid use Chronic steroid use is seen in patients with SLE and can lead to osteonecrosis (bone necrosis). The nurse would determine if the patient has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the patient yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.
A patient has been diagnosed with rheumatoid arthritis. The patient 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? -Assess the patient's culture more thoroughly -Discuss options for performing duties -See if the patient will call a community meeting -Suggest the patient give up the role of elder
Assess the patient's culture more thoroughly The nurse needs a more thorough understanding of the patient's 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 patient 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.
The nurse is working with a patient who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the patient. What finding by the nurse indicates goals for this patient problem are being met? -Attends meetings of a book club -Has a positive outlook on life -Takes medication as directed -Uses assistive devices to protect joints
Attends meetings of a book club All of the activities are appropriate for a patient with RA. Patients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this patient problem are being met.
A nurse is teaching a female patient with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? -Avoid acetaminophen in over-the-counter medications -It may take several weeks to become effective on pain." -Pregnancy and breast-feeding are not affected by MTX -Stay away from large crowds and people who are ill -You may find that folic acid, a B vitamin, reduces side effects
Avoid acetaminophen in OTC meds, It may take several weeks to become effective on pain, stay away from large crowds and people who are ill, 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 patient would 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.
A nurse works with several patients who have gout. Which types of gout and their drug treatments are correctly matched? 1. Allopurinol (Zyloprim)—acute gout 2. Colchicine (Colcrys)—acute gout 3. Febuxostat (Uloric)—chronic gout 4. Indomethacin (Indocin)—acute gout 5. Probenecid (Benemid)—chronic gout
Colchicine (colcrys)-acute, Febuxostat (Uloric) chronic, Indomethacin (indocin) -acute, Probenecid (Benemid)-chronic Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout.
The nurse on an inpatient rheumatology unit receives a hand-off report on a patient with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the patient further? -Creatinine: 3.9 mg/dL (345 mcmol/L) -Platelet count: 210,000/mm3 (210 × 109/L) -Red blood cell count: 5.2/mm3 (5.2 × 1012/L) -White blood cell count: 4400/mm3 (4.4 × 109/L)
Creatinine 3.9 mg/dL Lupus nephritis is the leading cause of death in patients 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.
The nurse is working with patients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? -Dry, scaly skin rash—systemic lupus erythematosus (SLE) -Esophageal dysmotility—systemic sclerosis -Excess uric acid excretion—gout -Vasculitis causing organ damage—rheumatoid arthritis -Footdrop and paresthesias—osteoarthritis
Dry scaly skin rash, Esophageal dysmotility, vasculitis 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.
The nurse working in the rheumatology clinic assesses patients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? Anorexia Felty's syndrome Joint deformity Low-grade fever Weight loss
Felty's syndrome, Joint deformity, weight loss Late manifestations of RA include Felty's 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.
A patient is started on etanercept (Enbrel). What teaching by the nurse is most appropriate? -Giving subcutaneous injections -Having a chest x-ray once a year -Taking the medication with food -Using heat on the injection site
Giving subcu injections Etanercept is given as a subcutaneous injection twice a week. The nurse would teach the patient how to self-administer the medication. The other options are not appropriate for etanercept.
A patient has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the patient to maintain independence in activities of daily living (ADLs)? -Grab bars to reach high items -Long-handled bath scrub brush -Soft rocker-recliner chair -Toothbrush with built-up handle -Wheelchair cushion for comfort
Grab bars to reach high items, long-handled bath scrub brush, toothbrush w/ 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 patient with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.
A patient with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The patient 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? -Explain to the patient that SLE is an unpredictable disease. -Help the patient create backup plans to minimize disruption. -Offer to talk to the family and educate them about SLE. -Tell the patient to remain compliant with treatment plans.
Help the patient 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 patient make backup plans for this event not only will decrease the disruption but will give the patient a sense of having more control. Explaining facts about the disease is helpful as well but does not engage the patient in problem solving. The family may need education, but again this does not help the patient to problem-solve. Remaining compliant may help decrease exacerbations, but is not as powerful an intervention as helping the patient plan for such events.
A patient recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the patient practices good self-care when the patient makes which statement? -I always wear long sleeves, pants, and a hat when outdoors -I try not to use cosmetics that contain any type of sunblock -Since I tend to sweat a lot, I use a lot of baby powder -Since I can't be exposed to the sun, I have been using a tanning bed
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
A patient with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What non-pharmacologic treatment does the nurse apply? Heating pad Ice packs Splints Wax dip
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.
A patient with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The patient 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? -Assist the patient to change positions -Document the findings in the patient's chart -Encourage range of motion of the neck -Notify the provider immediately
Notify the provider immediately Patients 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 patient 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 would document findings after notifying the provider
A patient has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? -Be sure you get enough sleep at night -Eat plenty of high-protein, high-iron foods -Notify your provider at once if you get a fever -Weigh yourself every day on the same scale
Notify your provider at once if you get a fever Fever is the classic sign of a lupus flare and would be reported immediately. Rest and nutrition are important but do not take priority over teaching the patient what to do if he or she develops an elevated temperature. Daily weights may or may not be important depending on renal involvement.
The nurse in the rheumatology clinic is assessing patients with rheumatoid arthritis (RA). Which patient would the nurse see first? -Patient taking celecoxib (Celebrex) and ranitidine (Zantac) -Patient taking etanercept (Enbrel) with a red injection site -Patient with a blood glucose of 190 mg/dL (10.6 mmol/L) who is taking steroids -Patient with a fever and cough who is taking abatacept (Orencia)
Patient w/ a fever and a cough that is taking abatacept 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.
A nurse works in the rheumatology clinic and sees patients with rheumatoid arthritis (RA). Which patient would the nurse see first? -Patient who reports jaw pain when eating -Patient with a red, hot, swollen right wrist -Patient who has a puffy-looking area behind the knee -Patient with a worse joint deformity since the last visit
Patient 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 patient first.
A patient has a possible connective tissue disease and the nurse is reviewing the patient's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? 1. Elevated antinuclear antibody (ANA)—normal value; no connective tissue disease 2. Elevated sedimentation rate—rheumatoid arthritis 3. Lowered albumin—indicative only of nutritional deficit 4. Positive human leukocyte antigen B27 (HLA-B27)—Reiter's syndrome or ankylosing spondylitis 5. Positive rheumatoid factor—possible kidney disease
Positive human leukocyte antigen B27 Positive rheumatoid factor The HLA-B27 is diagnostic for Reiter's 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 has 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.
The nurse working in the rheumatology clinic is seeing patients with rheumatoid arthritis (RA). What assessment would be most important for the patient whose chart contains the diagnosis of Sjögren's syndrome? -Abdominal assessment -Oxygen saturation -Renal function studies -Visual acuity
Renal function studies Sjögren's syndrome is seen in patients 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 Sjögren's syndrome.
A patient has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The patient calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best? -A little sedation will help you get some rest -Depression often accompanies fibromyalgia -This drug works in the brain to decrease pain -You will have more energy after taking this drug
This drug works in the brain to decrease pain
A patient has rheumatoid arthritis that especially affects the hands. The patient wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? -Let's ask the provider about increasing your pain pills -Hold ice bags against your hands before quilting -Try a paraffin wax dip 20 minutes before you quilt -You need to stop quilting before it destroys your fingers
Try a paraffin wax dip 20 mins before you quit 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 patient has a "hot" or exacerbated joint. The patient wants to finish her project, so the nurse would not negate its importance by telling the patient it is destroying her joints.