Arthritis
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? "I can exercise every day to help maintain joint motion." "I will take 1 g of acetaminophen (Tylenol) every 4 hours." "I will take a shower in the morning to help relieve stiffness." "I can use a cane to decrease the pressure and pain in my hip."
"I will take 1 g of acetaminophen (Tylenol) every 4 hours."
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? "I can exercise every day to help maintain joint motion." "I will take 1 g of acetaminophen (Tylenol) every 4 hours.""I will take a shower in the morning to help relieve stiffness.""I can use a cane to decrease the pressure and pain in my hip."
"I will take 1 g of acetaminophen (Tylenol) every 4 hours." No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily to decrease the risk for liver damage. Regular exercise, moist heat, and supportive equipment are recommended for OA management.
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 "You have the right to refuse to take the methotrexate." "Methotrexate is less expensive than some of the newer drugs." "It is important to start methotrexate early to decrease the extent of joint damage." "Methotrexate is effective and has fewer side effects than some of the other drugs."
"It is important to start methotrexate early to decrease the extent of joint damage." Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.
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? "You need to see a family therapist for some help with stress." "Tell me more about the situations that are causing you stress." "Your family should understand the impact of your rheumatoid arthritis." "Perhaps it would be helpful for your family to be involved in a support group."
"Tell me more about the situations that are causing you stress." The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.
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 56-yr-old man who has a sedentary office job A 38-yr-old man who plays on a summer softball team A 56-yr-old woman who works on an automotive assembly line A 38-yr-old woman who is newly diagnosed with diabetes mellitus
A 56-yr-old woman who works on an automotive assembly line OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces the risk for OA. Diabetes is not a risk factor for OA. Sedentary work is not a risk factor for OA.
Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis? Affected joints should not be exercised when pain is present. Applying cold packs before exercise may decrease joint pain. Exercises should be performed passively by someone other than the patient. Walking may substitute for range-of-motion (ROM) exercises on some days.
Applying cold packs before exercise may decrease joint pain. Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.
A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? Draw blood for rheumatoid factor analysis. Teach the patient about injections for the nodules. Assess the nodules for skin breakdown or infection. Discuss the need for surgical removal of the nodules.
Assess the nodules for skin breakdown or infection. Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor, and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? Blurred vision Joint tenderness Abdominal cramping Elevated blood pressure
Blurred vision Plaquenil can cause retinopathy. The medication should be stopped. Other findings are not related to the medication although they will also be reported.
Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis? Blood glucose C-reactive protein Serum electrolytes Liver function tests
C-reactive protein C-reactive protein is a serum marker for inflammation, and a decrease would indicate the corticosteroid therapy was effective. Blood glucose and serum electrolytes will also be monitored to assess for side effects of prednisone. Liver function is not routinely monitored in patients receiving corticosteroids.
Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee? Presence of Heberden's nodules Discomfort with joint movement Redness and swelling of the knee joint Stiffness that increases with movement
Discomfort with joint movement Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is associated with inflammatory arthritis such as rheumatoid arthritis. Stiffness in OA is worse right after the patient rests and decreases with joint movement.
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? Red, scaly patches are noted on the arms. Crackles are auscultated in the lung bases. Hemoglobin is 11.1 g/dL, and hematocrit is 35%. Patient has continued pain after first week of etanercept therapy.
Crackles are auscultated in the lung bases. Because heart failure is a possible adverse effect of etanercept, the medication may need to be discontinued. The other information will also be reported to the health care provider but does not indicate a need for a change in treatment. Red, scaly patches of skin and mild anemia are commonly seen with psoriatic arthritis. Treatment with biologic therapies requires time to improve symptoms.
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? A B C D
D Swan neck deformity involves distal interphalangeal joint hyperflexion and proximal interphalangeal joint hyperextension of the hands. The other deformities are also associated with rheumatoid arthritis: ulnar drift, boutonniere deformity, and hallux vagus.
Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)? Instruct the patient to purchase a soft mattress. Encourage the patient to take a nap in the afternoon. Teach the patient to use lukewarm water when bathing. Suggest exercise with light weights several times daily.
Encourage the patient to take a nap in the afternoon. Adequate rest helps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress. When the disease is stabilized, a therapeutic exercise program is usually developed by a physical therapist to include exercises that improve flexibility and strength of affected joints, as well as the patient's general endurance.
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? Knee crepitation is noted with normal knee range of motion. Patient reports embarrassment about having Heberden's nodes. Patient's knee pain while golfing has increased over the last year. Laboratory results indicate blood urea nitrogen (BUN) is elevated.
Laboratory results indicate blood urea nitrogen (BUN) is elevated. Older patients are at increased risk for renal toxicity caused by nonsteroidal antiinflammatory drugs (NSAIDs) such as naproxen. The other information will also be reported to the health care provider but is consistent with the patient's diagnosis of osteoarthritis and will not require an immediate change in the patient's treatment plan.
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? The blood pressure is 86/50 mm Hg. The patient says the knee pain is severe. The white blood cell count is 11,500/μL. The patient is taking ibuprofen (Motrin).
The blood pressure is 86/50 mm Hg. The low blood pressure suggests the patient may be developing septicemia as a complication of septic arthritis. Immediate blood cultures and initiation of antibiotic therapy are indicated. The other information is typical of septic arthritis and should also be reported to the health care provider, but it does not indicate any immediately life-threatening problems.
Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication? The patient has gained 3 lb. The patient has dark-colored stools. The patient's pain affects multiple joints. The patient uses capsaicin cream (Zostrix).
The patient has dark-colored stools. Dark-colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. The patient's ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
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? The patient had a history of infectious mononucleosis as a teenager. The patient is trying to get pregnant before her disease becomes more severe. The patient has a family history of age-related macular degeneration of the retina. The patient has been using large doses of vitamins and health foods to treat the RA.
The patient is trying to get pregnant before her disease becomes more severe. Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.
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? The patient sleeps 8-10 hours each night. The patient usually eats beef once a week. The patient takes one aspirin a day to prevent angina. The patient usually drinks about 3 quarts water each day.
The patient takes one aspirin a day to prevent angina. Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.
Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone? The patient has joint pain and stiffness. The patient's blood glucose is 165 mg/dL. The patient has experienced a recent 5-pound weight loss. The patient's erythrocyte sedimentation rate (ESR) has increased.
The patient's blood glucose is 165 mg/dL. Corticosteroids have the potential to cause diabetes mellitus. The finding of elevated blood glucose reflects this side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR with no improvement in symptoms would indicate the prednisone was not effective but would not be side effects of the medication.
Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)? Rheumatoid factor is positive. Fasting blood glucose is 90 mg/dL. The white blood cell (WBC) count is 1500/μL. The erythrocyte sedimentation rate is elevated.
The white blood cell (WBC) count is 1500/μL. Bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in RA. The blood glucose is normal.
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? Gently palpate the toe to assess swelling. Use pillows to keep the right foot elevated. Use a footboard to hold bedding away from the toe. Teach the patient to avoid use of acetaminophen (Tylenol).
Use a footboard to hold bedding away from the toe. Because any touch on the area of inflammation may increase pain, bedding should be held away from the toe, and touching the toe should be avoided. Elevation of the foot will not reduce the pain, which is caused by urate crystals. Acetaminophen can be used for pain management.
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a brief routine of isometric exercises. a warm bath followed by a short rest. active range-of-motion (ROM) exercises. stretching exercises to relieve joint stiffness.
a warm bath followed by a short rest. Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.
The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should avoid activities requiring repetitive use of the same muscles and joints. protect the knee joints by sleeping with a small pillow under the knees. stand rather than sit when performing daily household and yard chores. strengthen small hand muscles by wringing out sponges or washcloths.
avoid activities requiring repetitive use of the same muscles and joints. Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase joint stress. Patients are encouraged to position joints in the extended (neutral) position. Sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion.
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 methotrexate anakinra (Kineret). etanercept (Enbrel). doxycycline (Vibramycin).
doxycycline (Vibramycin). Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and requires 3 months of treatment with doxycycline. The other medications are used for chronic inflammatory problems such as rheumatoid arthritis.
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 sertraline (Zoloft). famotidine (Pepcid). hydrochlorothiazide. oxycodone (Roxicodone).
hydrochlorothiazide Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.
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 had several knee injuries as a teenager. recently returned from South America. is sexually active with multiple partners. has a parent who has rheumatoid arthritis.
is sexually active with multiple partners. Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis.
A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about substitution of acetaminophen (Tylenol) for the NSAID. use of enteric-coated NSAIDs to reduce gastric irritation. reasons for using corticosteroids to treat the rheumatoid arthritis. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa. Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis.
Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about avoiding concurrent aspirin use. symptoms of gastrointestinal (GI) bleeding. self-administration of subcutaneous injections. taking the medication with at least 8 oz of fluid.
self-administration of subcutaneous injections. Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued.