Arthritis/Autoimmune Therapy (Ch. 64)

A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding should the nurse report immediately 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. The patient has painful hematuria.

Which information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about managing 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. Do daily deep-breathing exercises.

Which action for the care of a patient who has scleroderma can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? 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. Document the patient's oral intake.

Which result for a patient with systemic lupus erythematosus (SLE) should the nurse identify as most important 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. Elevated blood urea nitrogen (BUN)

Which action should 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. Encourage the patient to take a nap in the afternoon.

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug? A. Avoiding aspirin use. B. Giving subcutaneous injections. C. Taking the medication with water. D. Recognizing gastrointestinal bleeding.

B. Giving subcutaneous injections.

A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action should 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. Keep the environment warm and draft free.

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. What safety priority should the nurse identify for this patient? A. Acute pain B. Risk for aspiration C. Impaired tissue integrity D. Disturbed visual perception

B. Risk for aspiration

The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication? A. The patient has gained 3 pounds. B. The patient has dark-colored stools. C. The patient's pain affects multiple joints. D. The patient uses capsaicin cream (Zostrix)

B. The patient has dark-colored stools.

The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. Which patient statement indicates to the nurse a need for additional teaching? A. "A shower in the morning will help relieve stiffness." B. "I can exercise every day to help maintain joint mobility." C. "I will take 1 gram of acetaminophen (Tylenol) every 4 hours." D. "I can use a cane to decrease the pressure and pain in my hip."

C. "I will take 1 gram of acetaminophen (Tylenol) every 4 hours."

After teaching a 28-yr-old with fibromyalgia about the disease, which patient statement does the nurse determines 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. "I will need to stop drinking so much coffee and soda."

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis should the nurse identify as a likely adverse effect of the medication? A. Blurred vision B. Joint tenderness C. Abdominal cramping D. Elevated blood pressure

A. Blurred vision

Which action should the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis? A. Have the patient sleep on their back with a flat pillow. B. Discuss 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. Have the patient sleep on their back with a flat pillow.

What finding should indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout? A. Reduced joint pain B. Increased urine output C. Elevated serum uric acid D. Increased white blood cells

A. Reduced joint pain

During assessment of the patient with fibromyalgia, the nurse should 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. Multijoint inflammation and swelling E. Widespread bilateral, burning musculoskeletal pain

A. Sleep disturbances B. Multiple tender points E. Widespread bilateral, burning musculoskeletal pain

A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, "I never leave my house because I hate the way I look." Which patient problem should the nurse plan to address? A. Social isolation B. Activity intolerance C. Impaired skin integrity D. Impaired social interaction

A. Social isolation

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding should the nurse report immediately to the health care provider? 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. The blood pressure is 86/50 mm Hg.

The nurse should determine 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. "I should lie down for an hour after each meal."

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands 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. "I will use sunscreen when I am outside."

A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make? 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. "Perhaps it would be helpful for your family to be in a support group." D. "Your family should understand the impact of your rheumatoid arthritis."

B. "Tell me more about the situations that are causing you stress."

Which information should 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. A gradual increase in daily exercise may help decrease fatigue.

How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day? 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 warm bath followed by a short rest

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order should the nurse question? A. Draw anti-DNA blood titer. B. Administer varicella vaccine. C. Naproxen 200 mg twice daily. D. Famotidine (Pepcid) 20 mg daily.

B. Administer varicella vaccine.

Which information should the nurse include when preparing teaching materials for a patient who has 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. Applying cold packs before exercise may decrease joint pain

A patient with gout has a new prescription for losartan (Cozaar). What should the nurse plan to monitor? A. Blood glucose B. Blood pressure C. Erythrocyte count D. Lymphocyte count

B. Blood pressure

Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis? A. Blood glucose B. C-reactive protein C. Serum electrolytes D. Liver function tests

B. C-reactive protein

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 therapy.

B. Crackles are auscultated in the lung bases.

Which finding should 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. Discomfort with joint movement

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider? 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. The patient is trying to get pregnant before her disease becomes more severe.

Which assessment information should indicate to the nurse that 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. The patient's blood glucose is 165 mg/dL.

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." What is the most appropriate response by the nurse? 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. "It is important to start methotrexate early to decrease the extent of joint damage."

A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus? A. Rheumatoid factor (RF) B. Antinuclear antibody (ANA) C. Anti-Smith antibody (Anti-Sm) D. Lupus erythematosus (LE) cell prep

C. Anti-Smith antibody (Anti-Sm)

The nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the clinic reporting chills and muscle aches. Which action should the nurse take to follow up on that finding? A. Auscultate the heart sounds. B. Palpate the abdomen for masses. C. Ask the patient about recent outdoor activities. D. Question the patient about immunization history.

C. Ask the patient about recent outdoor activities.

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should 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. Assess the nodules for skin breakdown or infection.

What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living? A. Protect the knee joints by sleeping with a small pillow under the knees. B. Strengthen small hand muscles by wringing out sponges or washcloths. C. Avoid activities requiring repetitive use of the same muscles and joints. D. Stand rather than sit when performing daily household and yard chores.

C. Avoid activities requiring repetitive use of the same muscles and joints.

The nurse should 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. Capsaicin cream (Zostrix)

Which information from a patient's health history should the nurse identify as a risk factor for septic arthritis? A. Recently visited South America B. Several knee injuries as a teenager C. Sexually active with several partners D. Has a parent who has rheumatoid arthritis.

C. Sexually active with several partners

A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take? 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. Suggest the patient use over-the-counter (OTC) artificial tears.

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 should the nurse understand 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. The patient takes one aspirin a day to prevent angina.

A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider? A. Rheumatoid factor is positive. B. Fasting blood glucose is 90 mg/dL. C. The white blood cell count is 1500/μL. D. The erythrocyte sedimentation rate is increased.

C. The white blood cell count is 1500/μL.

A patient with hypertension and gout has a red, painful right great toe. Which action should the nurse include in the plan of care for this patient? 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 acetaminophen (Tylenol).

C. Use a footboard to hold bedding away from the toe.

A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose? A. sertraline (Zoloft). B. famotidine (Pepcid). C. hydrochlorothiazide. D. oxycodone (Roxicodone).

C. hydrochlorothiazide.

Which patient seen by the nurse in the outpatient clinic is most likely to need 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 38-yr-old woman who is newly diagnosed with diabetes D. A 56-yr-old woman who works on an automotive assembly line

D. A 56-yr-old woman who works on an automotive assembly line

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information should the nurse discuss with the health care provider for 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. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional 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 patient sleeps with two pillows under the head.

A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. What long-term therapy should the nurse plan to explain to the patient? A. methotrexate B. anakinra (Kineret) C. etanercept (Enbrel) D. doxycycline (Vibramycin)

D. doxycycline (Vibramycin)