Module 3 NUR2214C - Ignatavicius EAQ: Chapter 18

Which drug may help slow the progression of systemic sclerosis? 1 Imatinib 2 Bosentan 3 Abatacept 4 Methotrexate

1

Which is a late manifestation of rheumatoid arthritis? 1 Anorexia 2 Paresthesias 3 Joint inflammation 4 Morning stiffness

1

Which syndrome is associated with leukopenia in a patient with rheumatoid arthritis? 1 Felty's syndrome 2 Caplan's syndrome 3 Sjogren's syndrome 4 Carpal tunnel syndrome

1

Which disease manifests as fever, weight loss, generalized weakness, fatigue, and the inflammation of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands? 1 Rheumatoid arthritis (RA) 2 Fibromyalgia syndrome (FMS) 3 Chronic fatigue syndrome (CFS) 4 Systemic lupus erythematosus (SLE)

1

Which drug is an anticonvulsant medication often used to treat nerve pain in patients with fibromyalgia syndrome? 1 Pregabalin 2 Trazodone 3 Nortriptyline 4 Amitriptyline

1

The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed? 1 "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease." 2 "It is best to walk in the center of the trail." 3 "I should wait 4-6 weeks after being bitten by a tick to be tested for Lyme disease." 4 "I'll wear light-colored clothes with long sleeves, long pants, closed shoes, and a hat when I am walking in the woods."

1

The nurse is caring for a patient with systemic sclerosis. What teaching does the nurse provide to the patient's spouse about nutrition prior to discharge home? 1 Provide small frequent meals throughout the day. 2 Keep the patient's head at 90 degrees during meals. 3 Avoid solid foods and instead provide liquid foods. 4 Choose foods that increase gastric secretion.

1

The primary health care provider prescribes epoetin alfa to a patient before knee replacement surgery. What is the reason behind this prescription? 1 To prevent anemia 2 To prevent infection 3 To prevent vomiting 4 To prevent prosthetic failure

1

What is a cardiovascular manifestation of systemic lupus erythematosus (SLE)? 1 Pericarditis 2 Pleural effusion 3 Interstitial fibrosis 4 Myocardial fibrosis

1

Which diagnostic test is used to detect needle-like crystals in the affected joints of patients with gout? 1 Synovial fluid aspiration 2 Blood urea nitrogen (BUN) 3 Extractable nuclear antigens (ENAs) 4 Venereal disease research laboratory (VDRL) syphilis test

1

A patient diagnosed with exacerbation of systemic sclerosis (SSc) asks the nurse why a foot board and a bed cradle have been placed on the bed. The nurse explains that they are used for what purpose? 1 Inspect skin for lesions or changes 2 Promote comfort from Raynaud's phenomenon 3 Prevent foot drop and contractures 4 Decrease chilling of the extremities

2

A patient has symptoms of rheumatoid arthritis (RA). Which laboratory finding indicates to the nurse that the patient may have RA? 1 Total serum complement, 75 units/mL 2 Positive total antinuclear antibody (ANA) 3 Erythrocyte sedimentation rate (ESR), 20 mm/hr 4 Beta-globulin level, 1.0 g/dL

2

A patient with osteoarthritis asks the nurse about the use of glucosamine as a dietary supplement. What does the nurse teach the patient about taking this supplement? Select all that apply. 1 "Inform the health care provider before starting glucosamine." 2 "Monitor your glucose level daily." 3 "Monitor closely for hypotension." 4 "Use glucosamine with caution if you are also taking chondroitin and anticoagulant therapy." 5 "Discontinue use after a month if no beneficial effect is experienced."

1, 2

Which antibiotics are often used for treating Lyme disease in its earlier stages? Select all that apply. 1 Doxycycline 2 Amoxicillin 3 Cefotaxime 4 Minocycline 5 Ceftriaxone

1, 2

Which medications does the nurse expect to find as prescriptions for a patient with osteoarthritis? Select all that apply. 1 Diclofenac 2 Acetaminophen 3 Methotrexate 4 Leflunomide 5 Azathioprine

1, 2

The nurse just completed discharge teaching to a patient with polymyositis/dermatomyositis. Which statement made by the patient indicates the best understanding of self-management related to this disorder? Select all that apply. 1 "I will watch for signs and symptoms of infection such as fever, sore throat, and congestion." 2 "If swallowing becomes difficult, I will need to see a speech therapist." 3 "I may need a physical therapist to teach me exercises to improve my strength and flexibility." 4 "I will need to include nonpharmacologic strategies to manage chronic back pain." 5 "I may experience pain due to periods of rapid bone growth."

1, 2, 3

What are the stage II complications of Lyme disease? Select all that apply. 1 Meningitis 2 Dysrhythmias 3 Facial paralysis 4 Chronic fatigue 5 Memory problems

1, 2, 3

A patient with acute gout is prescribed colchicine. Which drug is usually added to the prescription? 1 Febuxostat 2 Ibuprofen 3 Allopurinol 4 Probenecid

2

A patient has joint inflammation. Which interventions should the nurse add to the discharge plan of care? Select all that apply. 1 Apply ice packs 2 Apply heat packs 3 Ensure adequate rest 4 Begin a running program 5 Perform daily stretching exercises

1, 2, 3, 5

What are the clinical manifestations of dermatomyositis? Select all that apply. 1 Severe muscle weakness 2 Iritis 3 Eyelid rash 4 Periorbital edema 5 Weight loss

1, 3, 4

A patient who had a total hip arthroplasty will be discharged from the hospital shortly. What teaching does the nurse provide for this patient? Select all that apply. 1 Use a walker as an ambulatory aid. 2 Cleanse the hip incision with antiseptic solution. 3 Sit up in a firm, supporting chair during the daytime. 4 Perform postoperative exercises such as crossing over of the legs. 5 Avoid bending the hips more than 90 degrees.

1, 3, 5

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. 1 Immunoglobulins 2 Serum creatinine levels 3 Blood urea nitrogen (BUN) 4 Serum protein electrophoresis 5 Erythrocyte sedimentation rate (ESR)

1, 4, 5

The nurse is giving 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. 1 Walking in the center of a hiking trail 2 Disposing of a tick by burning it with a match 3 Using tweezers to remove a tick from the skin 4 Wearing light clothing when engaged in outdoor activities in wooded areas 5 Avoiding areas with thick underbrush, especially in the spring and summer months 6 Waiting 2-3 weeks after being bitten by a tick before being tested for Lyme disease

1, 4, 5

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. 1 Avoid hip flexion beyond 90 degrees. 2 Use aseptic technique for wound care. 3 Instruct the patient to do leg exercises. 4 Instruct the patient to wear elastic stockings. 5 Assess acute pain, rotation, and extremity shortening.

1, 5

Which instructions for joint protection does the nurse recommend for a patient with a connective tissue disease? Select all that apply. 1 Use long-handled devices such as a reacher. 2 When getting out of bed, use fingers to push off. 3 Sit in a low-back chair. 4 Bend at the waist while keeping the back straight. 5 Use adaptive devices such as Velcro closures. 6 Turn a doorknob clockwise.

1, 5

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 cough frequently. Which complication is the nurse seeking to prevent by using this intervention? 1 Infections 2 Atelectasis 3 Pressure ulcers 4 Postural hypotension

2

The nurse is providing education for a patient taking amitriptyline for fibromyalgia. Which statement by the patient indicates the need for further teaching? 1 "Taking amitriptyline helps me sleep." 2 "Taking amitriptyline helps my dizziness." 3 "Taking amitriptyline helps decrease my pain." 4 "Taking amitriptyline helps reduce my muscle spasms."

2

The patient asks the nurse to explain exactly what fibromyalgia is. What is the appropriate response by the nurse? 1 "Fibromyalgia is an inflammatory disease with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the thalamus and hypothalamus." 2 "Fibromyalgia is a chronic pain syndrome with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the thalamus and hypothalamus." 3 "Fibromyalgia is an inflammatory disease with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the limbic system and basal ganglia." 4 "Fibromyalgia is a chronic pain syndrome with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the limbic system and basal ganglia."

2

What should be the first intervention for a patient with systemic lupus erythematosus (SLE) when there is severe renal involvement? 1 Prepare the patient for plasmapheresis. 2 Administer immunosuppressants and steroids. 3 Prepare the patient for kidney transplantation. 4 Administer high doses of intravenous glucocorticoids.

2

Which condition is associated with the presence of HLA- B27? 1 Felty's syndrome 2 Reiter's syndrome 3 Sjogren's syndrome 4 Carpal tunnel syndrome

2

Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? 1 Feeling tired and having a temperature that runs about 100° F (37.8° C) during the day 2 Disfiguring and embarrassing rash 3 Peripheral neuropathies and cranial nerve palsies 4 High risk for renal inflammation

2

Which finding in the physical assessment may be associated with osteoarthritis? 1 Depression 2 Impaired mobility 3 Altered body image 4 Decreased quality of life

2

While assessing a patient with acute gout, the nurse finds inflammation of joints of the great toe. Which condition doe the nurse suspect in the patient? 1 Tophi 2 Podagra 3 Calcinosis 4 Periungual lesions

2

While assessing a patient with systemic sclerosis, the nurse finds thickening and hardening of the skin on the fingers. What does the nurse document in the patient's health record? 1 Calcinosis 2 Sclerodactyly 3 Telangiectasia 4 Bilateral carpal tunnel syndrome

2

A patient presents in the emergency department with dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness. Which disease is consistent with these assessment findings? 1 Ankylosing spondylitis 2 Polymyalgia rheumatica 3 Polymyositis/dermatomyositis 4 Reiter's syndrome

3

A patient reports hair loss, swelling, and redness of knees to the nurse. The test reports of the patient reveal inflammation of five joints. Which condition does the nurse suspect in the patient? 1 Gout 2 Scleroderma 3 Lupus erythematosus 4 Raynaud's phenomenon

3

The nurse is teaching a patient about strategies for coping effectively with connective tissue disease. Which statement by the patient indicates that further teaching is needed? Select all that apply. 1 "I will seek support from my friends and family." 2 "I will use ice on my joints whenever I have pain." 3 "I will see my health care provider on a weekly basis." 4 "I will eat a balanced diet and get exercise as my health allows." 5 "I will find out as much as I can about my connective tissue disease."

2, 3

The nurse is teaching safety measures to a patient with rheumatoid arthritis who is on methotrexate therapy. Which statements should the nurse include? Select all that apply. 1 "You should eat a calcium-rich diet." 2 "You should avoid crowded places." 3 "You should avoid alcoholic beverages." 4 "You should take folic acid supplements." 5 "You should have your eyes examined for every 6 months."

2, 3, 4

What interventions should be performed for a patient with polymyositis? Select all that apply. 1 Managing organ dysfunction 2 Teaching about dietary needs 3 Providing support for physical therapy 4 Frequent echocardiography monitoring 5 Teaching about complications of long-term steroid therapy

2, 3, 5

What patient education should be provided to a patient with psoriatic arthritis who is prescribed etanercept? Select all that apply. 1 Etanercept contains a black box warning. 2 Etanercept should be self-administered cautiously. 3 Etanercept cannot be given as combination therapy. 4 Respiratory infections are the common adverse effects of etanercept. 5 Hydrocortisone cream should be used to prevent rash at the etanercept injection site.

2, 4

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. 1 Reorienting the patient frequently 2 Keeping the patient's heels on the bed 3 Encouraging the patient to breathe deeply and cough 4 Preventing the patient from getting out of the bed 5 Using the incentive spirometer every five hours

2, 4, 5

What are the cardiovascular manifestations of systemic lupus erythematosus (SLE)? Select all that apply. 1 CNS lupus 2 Pericarditis 3 Interstitial fibrosis 4 Myocardial fibrosis 5 Raynaud's phenomenon

2, 5

A nurse is reviewing the diagnostic reports for a patient who reports joint swelling and pain along with dryness in the eyes, mouth, and vagina. What does the nurse infer from these findings? 1 Felty's syndrome 2 Reiter's syndrome 3 Sjogren's syndrome 4 Carpal tunnel syndrome

3

Which clinical finding is associated with a diagnosis of early-stage osteoarthritis? 1 Fissures and ulceration 2 Osteophytes in joint space 3 Secondary joint inflammation 4 Opaque and yellowish-brown cartilage

4

Assessment findings reveal that an older adult patient with severe osteoarthritis of the left hip can no longer perform activities of daily living (ADLs) and has had several falls in the home over the past month. To which community resource does the nurse refer the patient? 1 Local senior citizen center 2 Citizens for Better Care 3 Home health care agency 4 Meals on Wheels

3

The patient who is diagnosed with severe psoriatic arthritis is scheduled to receive an oral retinoid medication. Which medication will the nurse anticipate administering to the patient? 1 Alefacept 2 Golimumab 3 Acitretin 4 Ustekinumab

3

What laboratory testing is most important for the patient taking acitretin for psoriatic arthritis? 1 Serum electrolytes 2 Blood urea nitrogen (BUN) 3 Liver enzymes 4 Complete blood count (CBC)

3

What may be the medications provided to prevent osteoporosis in the patient with rheumatoid arthritis who is prescribed long-term steroid therapy? 1 Calcium 750 mg and vitamin D 100 mg daily 2 Calcium 1000 mg and vitamin D 200 mg daily 3 Calcium 1500 mg and vitamin D 400 mg daily 4 Calcium 1800 mg and vitamin D 500 mg daily

3

Which anti-rheumatoid drug may increase the risk of opportunistic infections in patients? 1 Rituximab 2 Tocilizumab 3 Golimumab 4 Hydroxychloroquine

3

Which statement is true regarding systemic sclerosis? 1 It involves pancytopenia. 2 It is characterized by nephritis. 3 It is also called progressive systemic disease. 4 It is also called chronic progressive inflammatory connective tissue disorder.

3

Which statement made by the patient indicates effective learning about self-management of systemic sclerosis? 1 "I will eat three large meals each day." 2 "I will include coffee in my daily diet." 3 "I will not drink large amounts of liquids." 4 "I will take a nap immediately after eating meals."

3

Which type of disorder is fibromyalgia syndrome (FMS)? 1 Autoimmune 2 Inflammatory 3 Chronic pain 4 Connective tissue

3

Which consequence of vasculitis in patients with rheumatoid arthritis would the nurse monitor for? 1 Decrease in WBC count 2 Weakness in all extremities 3 Inflammation of pericardium 4 Ulceration in the lower extremities

4

Which statement describes systemic lupus erythematosus (SLE)? 1 It is nonfatal. 2 It affects men more often than women. 3 It is an acute, nonprogressive disorder. 4 It is characterized by spontaneous remissions and exacerbations.

4

While assessing a patient with systemic sclerosis, the nurse anticipates organ failure. What findings support this anticipation? Select all that apply. 1 Chest pain 2 Abdominal pain 3 Decreased urine output 4 Increased blood pressure 5 Characteristic blue-colored digits

3, 4

Which symptoms does the nurse anticipate in a patient who is in the late stage of rheumatoid arthritis (RA)? Select all that apply. 1 Anorexia 2 Paresthesias 3 Deformities 4 Osteoporosis 5 Severe fatigue 6 Peripheral neuropathy

3, 4, 5, 6

What are the clinical manifestations of temporal arteritis? Select all that apply. 1 Fever 2 Stiffness 3 Headache 4 Weight loss 5 Visual disturbances

3, 5

A patient is diagnosed with polymyalgia rheumatica and given high-dose steroid therapy to achieve remission of the disease. Which statement made by the nursing student regarding the patient's disease needs correction by the precepting nurse? 1 "This therapy causes proximal muscle weakness." 2 "This disorder is an autoimmune, genetic-based disease." Incorrect3 "This disease mostly affects middle-aged and older women." 4 "This is a complex syndrome associated with the HLA-27 allele."

4

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? 1 Abatacept 2 Infliximab 3 Tocilizumab 4 Methotrexate

4

A patient with rheumatoid arthritis with joint swelling had an arthrocentesis. Which post-procedure instruction, provided by the student nurse, needs correction? 1 "You should take acetaminophen if you have pain." 2 "You have to apply ice on the affected joint for 24 hours after the procedure." 3 "You have to immediately notify the health care provider if swelling increases." 4 "You should move the affected joint frequently during the first 24 hours after surgery."

4

The nurse is educating a patient about glucosamine supplements. Which nursing instruction about glucosamine supplements is appropriate? 1 "You should take glucosamine if you are breastfeeding." 2 "You should take glucosamine if you have hypertension." 3 "Be aware that glucosamine can cause constipation." 4 "The recommended dose of glucosamine is based on your body weight."

4

The nurse is providing discharge instructions to a patient who underwent total hip arthroplasty. Which instruction is most beneficial upon discharge of the patient? 1 Twist the body slowly while standing. 2 Bend the hips no more than 110 degrees. 3 Cross the legs beyond the body midline. 4 Use assistive devices for putting on shoes.

4

The nurse is reviewing the medication history for a patient diagnosed with rheumatoid arthritis (RA) who has been ordered to start sulfasalazine therapy. The nurse plans to contact the health care provider if the patient has which condition? 1 Glaucoma 2 Hypertension 3 Hypothyroidism 4 Sulfa allergy

4

The nurse is teaching a patient about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the patient indicates a need for further teaching? 1 "RA is inflammatory. OA is degenerative." 2 "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." 3 "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in patients older than 60 years." 4 "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."

4

The nurse is teaching a patient with arthritis about energy conservation. Which statement made by the patient indicates the need for further teaching? 1 "I will take one or two naps each day." 2 "I will stick to my activity tolerance level." 3 "I will delegate responsibilities and tasks to my family members and friends." 4 "I will determine which activities are most important and save them for last."

4

What can lead to organ dysfunction or failure? 1 Reiter's syndrome 2 Marfan syndrome 3 Polymyalgia rheumatica 4 Systemic necrotizing vasculitis

4

What causes osteonecrosis? 1 Use of capsaicin 2 Use of chondroitin 3 Use of glucosamine 4 Use of corticosteroids

4

What complication is common in both diffuse and limited systemic sclerosis? 1 Telangiectasia 2 Esophageal dysmotility 3 Bilateral carpal tunnel syndrome 4 Gastroesophageal reflux disease (GERD)

4

Which antirheumatic drug acts by inhibiting tyrosine kinase? 1 Infliximab 2 Etanercept 3 Abatacept 4 Tofacitinib

4

The student nurse is preparing medication charts for four patients with inflammatory disorders. Which medication chart needs correction?

Patient 4

Which nursing intervention is being performed in the image?

hip flexion