Chapter 4 Evolve Questions

The primary health care provider prescribes epoetin alfa to a patient before knee replacement surgery. What is the resion behind this prescription?

To prevent anemia

The nurse is preparing a patient with OA for hip surgery and instructs the patient to discontinue hormone therapy. What is the rational behind this nursing intervention?

To prevent venous thromboembolism

What is the drug of choice to treat fibromyalgia syndrome (FMS) in a 72-year-old patient with memory impairment?

Trazodone

What causes osteonecrosis?

Use of corticosteroids

The nurse is caring for a patient with lupus erythematosus. What does the nurse teach the patient about skin protection?

Wear a large-brimmed hat when in the sun.

What lab value is most affected by methotrexate?

White blood cell count

Which instructions should the nurse give to ensure safety in a patient with gout who is prescribed febuxostat? Select all that apply.

_"Drink a glass of water after taking each dose." -"Undergo a liver function test every 2 months." -"Have a complete blood count check periodically."

Which finding in the physical assessment may be associated with OA?

impaired mobility

The patient asks the nurse to explain exactly what fibromyalgia is. What is the appropriate response by the nurse?

"Fibromyalgia is a chronic pain symdrome with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by inability to tolerate pain, possibly related to dysfunction in the brain, especially the thalamus and hypothalamus."

Which statement indicates to the nurse that a patient with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms?

"Focusing on the slow stretching movements and my breathing in tai chi helps me relax."

The nurse is teaching a patient about Lyme disease prevention. Which statement made by the patient indicates that further teaching is needed?

"I will dispose of the tick by buring it."

The nurse is teaching a patient with arthritis about exercise. Which statement by the patient indicates that further teaching is needed?

"I will exercise only on good days."

The nurse is teaching a patient about how to decrease recurrences of fibromyalgia. Which statement by the patient indicates that further teaching is needed?

"I will rest whenever I have pain."

The nurse is teaching a patient who has been prescribed methotrexate. Which statement made by the patient indicates that further teaching about methotrexate is needed?

"I will take Vitamin D."

The nurse is teaching a patient with arthritis about joint precautions. Which statement by the patient indicates that further teaching is needed?

"I will turn the doorknob clockwise."

Which statement by the nurse is the most effective when communicating with a patient who was just been diagnosed with fibromyalgia after waiting over 10 years for a diagnosis?

"Tell me what you are feeling after finally getting a diagnosis."

The nurse is caring for an older adult patient diagnosed with OA. Which patient statement indicates to the nurse that the patient is using effective coping strategies?

"The bus is coming to pick me up from the senior center three times a week so I can play cards."

In teaching a patient with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include?

"Weight watchers has healthy meal plans."

A patient with RA is prescribed hydroxychloroquine for joint and muscle pain. Which statements should the nurse include in the teaching?

"You should report any sign of blurred vision or headache."

The student nurse is providing postoperative care to an older adult who has undergone total hip arthroplasty. Which actions of the nurse indicate the need for further teaching? Select all that apply.

- Keeping the patient's heels on the bed -Preventing the patient from getting out of the bed -Using the incentive spirometer every five hours

What instructions for safe drug administration should be given to the patient with RA who is prescribed methotrexate (MTX)? Select all that apply.

-"Avoid crowds." -"Avoid alcohol intake." -"Report any side effects to the primary health care provider."

What teaching should the nurse provide to the elderly patient with OA who is prescribed cyclobenzaprine hydrochloride? Select all that apply.

-"Avoid driving." -"Do not operate heavy machinery."

After teaching self-management measure to a patient with OA, the nurse is evaluating adequate patient education. Which statements by the patient indicates the need for more education? Select all that apply.

-"I should perform passive exercises whenever possible." -"I should not reduce the number of repetitions of exercise though pain is increased."

Which statements made by the patient with Lyme disease indicate ineffective learning about self-management techniques? Select all that apply.

-"I will burn the tick as soon as I find it." -"I will go for a test to check for Lyme disease within 2 weeks after being bitten by a tick."

The nurse is teaching safety meansures to a patient with RA who is on methotrexate therapy. Which statements should the nurse include. Select all that apply.

-"You should avoid crowded places." -"You should avoid alcoholic beverages." -"You should take folic acid supplements."

A patient is diagnosed with systemic sclerosis and esophagitis. What nursing interventions are beneficial? Select all that apply.

-Administering histamine antagonists -Elevating the head of the patient at least 60 degrees starting at the beginning of a meal untul an hour after eating

The nurse is caring for a postoperative patient with total joint arthroplasty. What actions does the nurse take to prevent venous thromboembolism postoperatively. Select all that apply.

-Apply elastic stockings. -Administer antocoagulants.

A patient has joint inflammation. Which interventions should the nurse add to the discharge plan of care? Select all that apply.

-Apply ice packs -Apply heat packs -Ensure adequate rest -Perform daily stretching exercises

What nursing interventions may be performed to prevent dislocation of the hip joint in a patient who has undergone total hip arthroplasty (THA)? Select all that apply.

-Avoid hip flexion beyond 90 degrees -Assess acute pain, rotation, and extremity shortening

After reviewing the medical reports of a patient with systemic sclerosis, the nurse concludes limited cutaneous systemic sclerosis. Which findings would support this conclusion? Select all that apply.

-Calcinosis -Sclerodactyly -Raynaud's phenomenon

Which nutritional supplements are recommended for patients with RA? Select all that apply.

-Calcium -Fish oil capsules -Gamma-linolenic acid

Which complications are associated with Lyme disease? Select all that apply.

-Carditis -Facial paralysis -Meningitis -Peripheral neuritis

While assessing a patient, the nurse concludes that the patient has a severe form of scleroderma. Which symptoms in the patient support the nurse's conclusion? Select all that apply.

-Digit necrosis -Periugual lesions -Sausage-like fingers

Which antibiotics are often used for treating Lyme disease in its earlier stages? Select all that apply.

-Doxycycline -Amoxycyline

When assessing the patient who is diagnosed Lyme disease, which signs or symptoms does the nurse expect the patient to demonstrate? Select all that apply.

-Erythema migrans -Joint stiffness -Muscle pain

The nurse has just provided teaching to a patient who is taking methotrexate. Which side effects does the patient identify to indicate effective teaching? Select all that apply.

-Fever -Dyspnea -Mouth sores -Yellow sclera

During the skin assessment of a patient, the nurse finds a "butterfly" rash. What diagnostic tests would the primary health care provider order to confirm the diagnosis? Select all that apply.

-Immunoglobulins -Serum protein electrophoresis -Erythocyte sedimentation rate (ESR)

Which are the early manifestations of RA? Select all that apply.

-Inflammation -Low-grade fever

The nurse is teaching a patient who has undergone total joint arthroplasty about the measures to be followed at home. During a follow up visit, the nurse finds that the patient has developed complications associated with the surgery. Which actions of the patient may have contributed to the complications? Select all that apply.

-Massaging the legs -Taking very little fluids -Flexing hip beyond 90 degrees

What are the facors that may lead to OA? Select all that apply.

-Obesity -Aging -Genetics

While reviewing the previous records of a patient with a "butterfly" rash, the nurse finds that the patient has been on prednisone therapy for 5 years. Which complications are likely to occur in the patient. Select all that apply.

-Osteonecrisis -Muscle atrophy

The patient with RA complains of cervical pain. What complictions of cervica/spinal column invovement does the nurse monitor for in the patient? Select all that apply.

-Paresthesias -Quadraparesis -Compromised respiratory function

What are the cardiovascular manifestation of systemic erythematosus (SLE)? Select all that apply.

-Pericarditits -Raynaud's phenomenon

Which parameters should be assessed when etanercept and methotrexate are given as combination therapy in patients with RA? Select all that apply.

-Platelet count -Serum bilirubin -Serum creatinine

What are the symptoms of secondary gout? Select all that apply.

-Renal calculi -Hyperuricemia -Altered urination -Occurence of trophi

Which anti-rheumatic drugs are associated with allergic response after administration? Select all that apply.

-Rituximab -Abatacept -Adalimumab

Which parameters should be monitored in an eldery patient with OA who is taking 3500 g of acetaminophen daily? Select all that apply.

-Serum billirubin -Serum albumin -Prothrombin time

What does the nurse expect in the laboratory finding of a patient diagnosed with gout? Select all that apply.

-Serum uric acid of 7 mg/dL -Serum creatinine of 2 mg/dL

What are the clinical manifestations of dermatomyositis? Select all that apply.

-Severe muscle weakness -Eyelid rash -Perioorbital edema

Which assessment findings are associated with psoriatic arthritis? Select all that apply.

-Stiff, painful joints -Scaly, itchy rash -Neck pain -Fingernail pitting

What interventions should be performed for a patient with polymyositis? Select all that apply.

-Teaching about dietary needs -Providing support for physical therapy -Teaching about complications of long-term steroid therapy

Which factors contribute to the difficulty associated with diagnosing chronic fatigue syndrome (CFS)? Select all that apply.

-There is no known cause. -No diagnostic test is available.

Which diseases are associated with arthritis? Select all that apply.

-Tubercolosis -Crohn's disease -Diabetes mellitus -Hyperparathyroidism

A patient who had a total hip arthroplast will be discharged from the hospital shortly. What teaching does the nurse provide for this patient? Select all that apply.

-Use a walker as an ambulatory aid. -Sit up in a firm, supporting chair during the daytime. -Avoid bending the hips more than 90 degrees.

Which instructions for joint protection does the nurse recommend for a patient with a connective tissue disease? Select all that apply.

-Use long-handled devices such as reachers. -Use adaptive devices such as Velcro closures.

Which drugs need to be discontinued before surgery to decrease the risk for venous thromboembolism? Select all that apply.

-Vitamin C -Oral contraceptive drugs -Nonsteroidal anti-inflammatory drugs

The nurse is fiving a presentation to a hiking club regarding self-management techniques for preventing Lyme disease. Which strategies are appropriate for the nurse to include in the teaching? Select all that apply.

-Walking in the center of a hiking trail. -Wearing light clothing when engaging in outdoor activities in wooded areas. -Avoiding areas with thick underbrush, especially in the spring and summer months.

The drug leflunomide is often used for pain management in patients with RA/ What is the drug's initial loading dose?

100 mg

What is the maximum dosage limit of acetaminophen in the treatment of OA?

3000 mg

What is the usual prescribed dose for subcutaneous injection of adalimumab to treat symptoms of inflammatory arthritis?

40 mg

What is the recommended daily dosage of vitamin D for patients taking chronic steroid therapy to prevent osteoporosis?

400 mg

The patient who is diagnosed with severe psoriatic arthritis is scheduled to receive an oral retinoid medication. Which medication will the nurse anticipate administrating to the patient?

Acitretin

The nurse is caring for a patient who is diagnosed with psoriatic arthritis. Which medication does the nurse anticipate will be included in the patient's pharmacologic plan of care?

Alefacept

A patient is prescrived lidocaine 5% patches for knee pain. What does the nurse teach this patient about this therapy?

Apply the patch on clean, intact skin

The nurse is carin for a patient who has undergone total hip arthroplasty. What interventions does the nurse provide to prevent the complication of dislocation?

Assess the patient for extremity shortening.

A patient who has undergone total knee arthroplasty (TKA) is under postoperative care. The primary health care provider advised the patient to use a continuous passive mption (CPM) machine. Which nursing action is most important during use of the CPM machine?

Assessing the patient's response to the machine

The nurse encourages a patient who has undergone total joint arthroplasty to use the incentive spirometer every 2 hours. The nurse also encourages the patient to breathe deeply and cought frequently. Which complication is the nurse seeking to prevent by using this intervention?

Atelectasis

The nurse finds lidocain 5% patche in the prescription of a patient with OA. Upon examination, the nurse finds tha tthe patient is on procainamide therapy, a class I antiarrythmia drug. What is the nurse's appropriate course of action?

Avoid applying lidocain 5% to the patient and tell the primary healthcare provider

The nurse is preparing a patient with OA for self-management. What does the nurse tell the patient about exercising?

Avoid resistive exercises when the joints are inflammed.

Which drug may be administered to a patient undergoing arthroplasty to reduce postoperative pain?

Capsaicin

The nurse is caring for a patient with total knee arthroplasty. What action does the nurse take when the patient is using a continuous passive motion (CPM) machine?

Checks the cycle and ROM settings at least once every 8 hours

During a patient's follow-up visit, the nurse finds that the patient's OA does not improve with the presribed systemic and topical meications. What medication does the nurse anticipate to be beneficial?

Cortisone injection

Which drug is beneficial for a patient with OA who is having painful muscle spasms?

Cyclobenzaprine hydrocloride

A patient with arthritis is prescribed an oral immunosuppressive agent. After 10 days, the patient developed hemorrhagic cystitis. What might be the immunosuppressive agent prescribed to the patient?

Cyclophosphamide

Which metabolic disorder may be responsible for the development of joint degredation in the patient with OA?

Diabetes mellitus

The nurse is caring for a patient who is diagnosed with early-stage Lyme disease. Which medication does the nurse anticipate will be included in the patient's pharmacologic plan of care?

Doxycycline

What is a diagnostic finding of acute gout?

Elevated erythrocyte sedimentation rate (ESR)

After assessing a patient with OA, the nurse suspects crepitus. Which finding supports the nurse's assessment?

Grating heard when the joint is palpated

Assessment findings reveal that an older adult with severe OA of the left hip can no longer perform ADLs and has had several falls in the home over the past month. To which community resource does the nurse refer the patient?

Home health care agency

A patient who is undergoing treatment for OA reports black-colored stools, stomach upset, and difficulty breathing. The patient's blood work reveles abnormal levels of urea and creatinine. The nurse identifies that which medication is the likely cause of the patient's symptoms?

Ibuprofen

The primary health care provider prescrives a medication to a patient with OA. During the follow-up visit, the patient reports dark tarry stools and indigestion. Which medication may be the cause of this finding?

Ibuprofen

Which biological response modifier may cause chest pain and difficulty breathing during infusion?

Inflaximab

A patient with ankylosing spondylitis is being treated with a first-line disease-modifying antirheumatic drug (DMARD). Which DMARD drug does the nurse anticipate will be prescribed for this patient?

Methotrexate

Which statement is true regarding gout?

Multiple myeloma results in gout.

A patient is diagnosed with systemic necrotizing vasculitis. Which assessment finding will the patient demonstrate?

Necrosis of toes

A patient is diagnosed with systemic necrotizing vasculitis. Which statement finding will the patient demonstrate?

Necrosis of toes

A patient reports joint pain, stiffness, and difficulty swallowing. After assessment, the nurse finds diminished peristalsis. Which medication does the nurse suspect to be beneficial to the patient?

Nilotinib

What should the nurse expect the primary health care provider to prescribe to the patient who has chronic back pain, visual disturbances, and weight loss?

Nonsteroidal anti-inflammatory drug and disease-modifying antirheumatic drugs

What should the nurse expect the primary health care provider to prescribe to the patient who has chronic back pain, visual disturbances, and weight loss?

Nonsteroidal anti-inflammatory drugs and disease-modifying artirheumatic drugs

Before administering low-molecular-weight heparin (LMWH) to an older adult patient after total knee arthroplasty, the nurse notes that the patient's platelet count is 50,000 mm^3. What action is most important for the nurse to take?

Notify the health care provider

Which statement is true regarding OA?

Pain is caused by spasms of the surrounding muscles.

After assessing a patient with joint inflammation, the nurse suspects refractory gout. Which medication would be prescribed?

Pegloticase

Which genitourinary manifestation may occur in fibromyalgia syndrome?

Pelvic pain

What medications causes transient lupus-like syndrome?

Procainamide

What is the benefit of prescribing trazodone over other tricycle antidepressants such as amitriptyline to treat fibromyalgia?

Reduce confusion

A patient who has undergone totap hip arthroplasty is advised to do exercises. Which action made by the patient indicates a quadriceps-setting exercise?

Straightening the legs and pushing the back of the knees into the bed

What can lead to organ dysfunction or failure?

Systemic necrotizing vasculitis

What could be the diagnosis of a patient with a headache, slurred speech, and weakness of the left upper limb who has arrived at the hospital?

Systemic necrotizing vasculititis

Which assessment will the nurse perform to detect side effects after administering the drug golimumab?

Temperature