Chapter 64
When reviewing the health record for a new patient with rheumatoid arthritis, the nurse reads that the patient has swan neck deformities. Which deformity will the nurse expect to observe when assessing the patient? Swan Neck Deformity
Swan neck deformity
During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)? a.Sleep disturbances b.Multiple tender points c.Cardiac palpitations and dizziness D.Multi joint inflammation and swelling e.Widespread bilateral, burning musculoskeletal pain
A, B, E
Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication? a.The patient has gained 3 lb. b.The patient has dark-colored stools. c.The patient's pain affects multiple joints. d.The patient uses capsaicin cream (Zostrix).
B
Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)? a.Instruct the patient to purchase a soft mattress. b.Encourage the patient to take a nap in the afternoon. c.Teach the patient to use lukewarm water when bathing. d.Suggest exercise with light weights several times daily.
B
The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement? a."Paraffin baths can be used to help my hands." b."I should lie down for an hour after each meal." c."Lotions will help if I rub them in for a long time." d."I should perform range-of-motion exercises daily."
B
Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone? a.The patient has joint pain and stiffness. b.The patient's blood glucose is 165 mg/dL. c.The patient has experienced a recent 5-pound weight loss. d.The patient's erythrocyte sedimentation rate (ESR) has increased.
B
Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee? a.Presence of Heberden's nodules b.Discomfort with joint movement c.Redness and swelling of the knee joint d.Stiffness that increases with movement
B
Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis? a.Affected joints should not be exercised when pain is present. b.Applying cold packs before exercise may decrease joint pain. c.Exercises should be performed passively by someone other than the patient. d.Walking may substitute for range-of-motion (ROM) exercises on some days.
B
Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about management of the condition? a.Exercise by taking long walks. b.Do daily deep-breathing exercises. c.Sleep on the side with hips flexed. d.Take frequent naps during the day.
B
Which information will the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management? a.Symptoms usually progress as patients become older. b.A gradual increase in daily exercise may help decrease fatigue. c.Avoid use of over-the-counter antihistamines or decongestants. d.A low-residue, low-fiber diet will reduce any abdominal distention.
B
Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis? a.Blood glucose b.C-reactive protein c.Serum electrolytes d.Liver function tests
B
Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma? a.Monitor for difficulty in breathing. b.Document the patient's oral intake. c.Check finger strength and movement. d.Apply capsaicin (Zostrix) cream to hands.
B
Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a.Decreased C-reactive protein (CRP) b.Elevated blood urea nitrogen (BUN) c.Positive antinuclear antibodies (ANA) d.Positive lupus erythematosus cell prep
B
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition? a."I will exercise even if I am tired." b."I will use sunscreen when I am outside." c."I should avoid nonsteroidal antiinflammatory drugs." d."I should take birth control pills to avoid getting pregnant."
B
A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine indicates a need for teaching regarding gout management? a.The patient sleeps 8-10 hours each night. b.The patient usually eats beef once a week. c.The patient takes one aspirin a day to prevent angina. d.The patient usually drinks about 3 quarts water each day.
C
A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate? a.Ask the HCP about discontinuing methotrexate b.Remind the patient that RA is a chronic health condition. c.Suggest the patient use over-the-counter (OTC) artificial tears. d.Teach the patient about adverse effects of the RA medications.
C
Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about a.avoiding concurrent aspirin use. b.symptoms of gastrointestinal (GI) bleeding. c.self-administration of subcutaneous injections. d.taking the medication with at least 8 oz of fluid.
C
The nurse is planning care for a patient with hypertension and gout who has a red, painful right great toe. Which nursing action will be included in the plan of care? a.Gently palpate the toe to assess swelling. b.Use pillows to keep the right foot elevated. c.Use a footboard to hold bedding away from the toe. d.Teach the patient to avoid use of acetaminophen (Tylenol).
C
The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding? a.Palpate the abdomen. b.Auscultate the heart sounds. c.Ask the patient about recent outdoor activities. d.Question the patient about immunization history.
C
The nurse will anticipate the need to teach a patient who has osteoarthritis (OA) about which medication? a.Prednisone B.Adalimumab (Humira) c.Capsaicin cream (Zostrix) d.Sulfasalazine (Azulfidine)
C
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is a."You have the right to refuse to take the methotrexate." b."Methotrexate is less expensive than some of the newer drugs." C."It is important to start methotrexate early to decrease the extent of joint damage." d."Methotrexate is effective and has fewer side effects than some of the other drugs."
C
Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)? a.Rheumatoid factor is positive. b.Fasting blood glucose is 90 mg/dL. c.The white blood cell (WBC) count is 1500/µL. d.The erythrocyte sedimentation rate is elevated.
C
A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with a.methotrexate b.anakinra (Kineret). c.etanercept (Enbrel). d.doxycycline (Vibramycin).
D
A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of a.social isolation. b.activity intolerance c.impaired skin integrity.. d.impaired social interaction.
A
A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately? a.The blood pressure is 86/50 mm Hg. b.The patient says the knee pain is severe. c.The white blood cell count is 11,500/µL. d.The patient is taking ibuprofen (Motrin).
A
A patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of a.sertraline (Zoloft). b.Famotidine (Pepcid). c.hydrochlorothiazide. d.oxycodone (Roxicodone).
A
A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding by the nurse is important to report to the health care provider? a.The patient has painful hematuria. b.Acne is noted on the patient's face. c.Fasting blood glucose is 112 mg/dL. d.The patient has an increased appetite.
A
After the nurse has taught a 28-yr-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management? a."I will need to stop drinking so much coffee and soda." b."I am going to join a soccer team to get more exercise." c."I will call the doctor every time my symptoms get worse." d."I should avoid using over-the-counter medications for pain."
A
The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding a.reduced joint pain. b.increased urine output. c.elevated serum uric acid d.increased white blood cells (WBC).
A
The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should a.avoid activities requiring repetitive use of the same muscles and joints. b.protect the knee joints by sleeping with a small pillow under the knees. c.stand rather than sit when performing daily household and yard chores. d.strengthen small hand muscles by wringing out sponges or washcloths.
A
Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis? a.Advise the patient to sleep on the back with a flat pillow. b.Emphasize that application of heat may worsen symptoms. c.Schedule annual laboratory assessment for the HLA-B27 antigen. d.Assist patient to choose physical activities that involve spinal flexion.
A
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? a.Blurred vision b.Joint tenderness c.Abdominal cramping d.Elevated blood pressure
A
A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate? a.The patient had a history of infectious mononucleosis as a teenager. b.The patient is trying to get pregnant before her disease becomes more severe. c.The patient has a family history of age-related macular degeneration of the retina. d.The patient has been using large doses of vitamins and health foods to treat the RA.
B
A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care? a.Avoid use of capsaicin cream on hands. b.Keep the environment warm and draft free. c.Obtain capillary blood glucose before meals. d.Assist to bathroom every 2 hours while awake.
B
A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. The safety priority for the patient is addressing the a.acute pain. b.risk for aspiration. c.disturbed visual perception. d.risk for impaired skin integrity.
B
A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor a.blood glucose. b.blood pressure. c.erythrocyte count. d.lymphocyte count.
B
A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider? a.Red, scaly patches are noted on the arms. b.Crackles are auscultated in the lung bases. c.Hemoglobin is 11.1g/dL, and hematocrit is 35%. d.Patient has continued pain after first week of etanercept therapy.
B
A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate? a."You need to see a family therapist for some help with stress." b."Tell me more about the situations that are causing you stress." c."Your family should understand the impact of your rheumatoid arthritis." d."Perhaps it would be helpful for your family to be involved in a support group."
B
After the nurse has finished teaching a patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching? a."I can exercise every day to help maintain joint motion." b."I will take 1 g of acetaminophen (Tylenol) every 4 hours." c."I will take a shower in the morning to help relieve stiffness." d."I can use a cane to decrease the pressure and pain in my hip."
B
The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? a.Draw anti-DNA blood titer. b.Administer varicella vaccine. c.Naproxen (Aleve) 200 mg BID. d. Famotidine (Pepcid) 20 mg daily.
B
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a.a brief routine of isometric exercises. b.a warm bath followed by a short rest. c.active range-of-motion (ROM) exercises. d.stretching exercises to relieve joint stiffness.
B
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? a.Rheumatoid factor (RF) b.Antinuclear antibody (ANA) c.Anti-Smith antibody (Anti-Sm) d.Lupus erythematosus (LE) cell prep
C
A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? a.Draw blood for rheumatoid factor analysis. b.Teach the patient about injections for the nodules. c.Assess the nodules for skin breakdown or infection. d.Discuss the need for surgical removal of the nodules.
C
A patient hospitalized with a fever and red, hot, painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient a.had several knee injuries as a teenager. b.recently returned from South America. c.is sexually active with multiple partners. d.has a parent who has rheumatoid arthritis.
C
Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce the risk for osteoarthritis (OA)? a.A 56-yr-old man who has a sedentary office job b.A 38-yr-old man who plays on a summer softball team c.A 56-yr-old woman who works on an automotive assembly line d.A 38-yr-old woman who is newly diagnosed with diabetes mellitus
C
The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed? a.The patient takes a 2-hour nap each day. b.The patient has been taking 16 aspirins each day. c.The patient sits on a stool while preparing meals. d.The patient sleeps with two pillows under the head.
D
The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information requires a discussion with the health care provider about an urgent change in the treatment plan? a.Knee crepitation is noted with normal knee range of motion. b.Patient reports embarrassment about having Heberden's nodes. c.Patient's knee pain while golfing has increased over the last year. d.Laboratory results indicate blood urea nitrogen (BUN) is elevated.
D