Chapter 25: Drugs Treating Rheumatoid Arthritis and Gout

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

"These medications suppress the immune system."

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? Rheumatoid arthritis (RA) Systemic lupus erythematosus Osteoporosis Polymyositis

Rheumatoid arthritis (RA)

A client with intractable rheumatoid arthritis has been prescribed a gold salt. What medication should the nurse look for on the client's medication administration record? Anakinra Celecoxib Mesalamine Auranofin

Auranofin Auranofin is a gold salt. Celecoxib is a COX-2 inhibitor. Mesalamine is a salicylate. Anakinra is an interleukin-1 receptor antagonist.

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

Immunosuppression

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? "I need to limit my fluid intake to prevent excretion of the drug." "I will start to see an improvement in my symptoms within the week." "I should take the drug twice a day as prescribed." "I should take the medication on an empty stomach to promote absorption of the drug."

"I should take the medication on an empty stomach to promote absorption of the drug."

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? "Methotrexate will work only with a nonsteroidal anti-inflammatory drug (NSAID)." "NSAIDs reduce the disease activity more than methotrexate." "NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts." "NSAIDs begin the immunosuppression until methotrexate takes over."

"NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts."

What should the nurse teach the patient about gold salts therapy? "This therapy can cause excessive bleeding." "This therapy can decrease inflammation." "This is a therapy for pain relief that is similar to opioids." "This therapy is contraindicated in patients with rheumatoid arthritis."

"This therapy can decrease inflammation." Gold salts or chrysotherapy can decrease inflammation. It is not an opioid and is used in rheumatoid arthritis treatment. It is not known to cause excessive bleeding.

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

A disease-modifying antirheumatic drug (DMARD), such as methotrexate

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

A disease-modifying antirheumatic drug (DMARD), such as methotrexate

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

Allopurinol 300 mg dissolved in 50 mg of water, swish and spit

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

Cyclophosphamide (Cytoxan) Imatinib (INN) This medication should not be administered with Cytoxan or imatinib due to the increased risk of myelosuppression. Motrin and steroid therapy should not produce any severe effects if administered with Enbrel.

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? DMARDs control the symptoms of rheumatoid arthritis. DMARDs can arrest the progression of rheumatoid arthritis. DMARDs have a lower risk of adverse effects. DMARDs are more effective with a lower dose.

DMARDs can arrest the progression of rheumatoid arthritis.

What intervention is necessary for the patient who has started supplemental steroid therapy for rheumatoid arthritis? Select all that apply. Diet modification Blood glucose monitoring Daily blood pressure monitoring Hearing tests Reverse isolation

Diet modification Blood glucose monitoring

Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis. True False

False Gold compounds are used for a client with rheumatoid arthritis who does not respond to the usual anti-inflammatory agents and in whom the conditions worsen despite weeks or months of standard pharmacologic treatment.

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

Fear of injections

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Humira Azothiaprine Gold salts Hydroxychloroquine

Gold salts

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

Gold salts

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

Gold salts

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? Blood dyscrasias Hepatic dysfunction Immunosuppression Methotrexate photosensitivity

Hepatic dysfunction

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? Oral Subcutaneous Intramuscular Intravenous

Oral

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

Prednisone Glucocorticoid steroids such as prednisone and prednisolone can be administered as oral or intravenous preparation for systemic effects and as an intra-articular injection for a local effect. They are generally given as "pulse therapy" for an acute exacerbation of rheumatoid arthritis.

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? Relief of symptoms should occur within 3-6 weeks. Relief of symptoms should occur within 3 days. Relief of symptoms should occur within 1 week. Relief of symptoms should occur within 2 months.

Relief of symptoms should occur within 3-6 weeks.

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? Inflammatory osteoarthritis Rheumatoid arthritis Multiple sclerosis Gouty arthritis

Rheumatoid arthritis

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? Rheumatoid arthritis Multiple sclerosis Inflammatory osteoarthritis Gouty arthritis

Rheumatoid arthritis

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

Rheumatoid nodules

A patient has been prescribed cyclophosphamide (Cytoxan) to treat refractory rheumatoid arthritis (RA). What intervention should the nurse teach the patient about this therapy? Stay hydrated and void often. Take stool softeners to prevent constipation. Take aspirin to potentiate the medication. Monitor temperature daily.

Stay hydrated and void often.

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

Stomatitis Thinning hair Fatigue Cirrhosis

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

Stop the progression of the disease.

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

The nurse administers the medication subcutaneously weekly.

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

The patient develops wheezing.

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? The patient eats two eggs daily for breakfast. The patient drinks two glasses of wine once every 2 weeks. The patient eats three fruits per day. The patient drinks six cups of coffee daily.

The patient drinks six cups of coffee daily. Caffeine decreases effectiveness

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

The patient with hepatic insufficiency

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? To minimize the adverse effects of methotrexate therapy To identify the signs of hepatic or renal insufficiency To later compare and assess the efficacy of methotrexate therapy To maximize the therapeutic effects of methotrexate therapy

To later compare and assess the efficacy of methotrexate therapy

What is chrysotherapy? Treatment with gold salts Treatment with DMARDs Treatment with anti-malerials Treatment with salicylates

Treatment with gold salts

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

True