My Nursing Lab questions on Rheumatoid Arthritis (RA)
d
Mr. Rappaport has been diagnosed with rheumatoid arthritis. He tells you that he is having trouble doing the prescribed physical therapy exercises because of stiffness. What intervention could you suggest to Mr. Rappaport to help him follow the prescribed physical therapy program? a "Try exercising for several hours each day at the gym." b "Wear light-weight clothing when you exercise." c "Stop exercising for a few weeks." d "Try doing your exercises in the shower."
b
A client with RA has Sjogrens syndrome. The nurse can relieve the symptoms of Sjogrens syndrome by: a. providing heat to the joints b. instilling eye drops c. administering pain meds d. providing small frequent meals
a
a client with RA is beginning to develop flexion contracture of the knees. The nurse should tell the client to: a. lie prone and let her feet hang over the mattress edge b. lie supine, with her feet rotated inward c. lie on her right side and point her toes downward d. lie on her left side and allow her feet to remain in a neutral position
a,c,d Increased ESR would indicate presence of inflammation in the joints, which occurs with rheumatoid arthritis. Rheumatoid arthritis may be present with a negative RF. A positive anti-citrulline antibody test indicates the presence of RA in the absence of RF. Positive, not negative, antinuclear antibodies indicate presence of RA. Decreased bone density is found in clients with psoriatic arthritis, not with RA.
A client diagnosed with rheumatoid arthritis (RA) is being seen in an outpatient clinic. Which diagnostic test results would indicate presence of RA? (Select all that apply.) a Increased erythrocyte sedimentation rate (ESR) b Decreased bone density c Positive anti-citrulline antibodies d Negative rheumatoid factor (RF) e Negative antinuclear antibodies
b methotrexate is a folic acid antagonist. multi vitamins contain folic acid
A client has been receiving Rheumatrex (methotrexate) for severe RA. The nurse should tell the client to avoid: a. aspirin b. multivitamins c. omega 3 fish oils d. acetaminophen
a
A client with AIDS has impaired nutrition due to diarrhea. The nurse teaches the client about the need to avoid certain foods. Which diet selection by the client would indicate a need for further teaching? a. tossed salad b. baked chicken c. broiled fish d. steamed rice
a,b,c,e
A client has just recently been diagnosed with rheumatoid arthritis (RA). The client asks the nurse if RA always causes crippling deformities. The nurse tells the client that to decrease the likelihood of deformities, it is important to: Select all that apply. a Stop an activity if it is beyond your ability to perform. b Avoid stress to any current area of deformity. c Type instead of hand-writing items if possible. d Ignore pain as a warning signal. e Use stronger joints for most activity.
a
A clinic nurse is assessing a client with a history of rheumatoid arthritis. The nurse would anticipate which assessment finding? a Progressive joint stiffness and deformation b Intermittent joint pain, mostly in the great toe c Joint stiffness in the spine, hips, and knees d Multiple joints and organs affected, and may have high fever and rheumatoid rash
a,b,c,e Rationale: RA can result in pleural effusion (collection of fluid in the pleural space). Individuals with RA have an increased risk of developing coronary heart disease. RA is a systemic disease of connective tissue that can affect exocrine glands, resulting most frequently in dry eyes and mouth. Properly managed, rheumatoid arthritis is not considered to be a danger for pregnant women or their babies. Patients with RA may suffer from a variety of hematologic disorders, particularly anemia.
A 43-year-old woman, recently diagnosed with RA, asks the nurse whether she might have concerns beyond the problems with her joints. The nurse informs her that RA may also involve: Select all that apply. a The cardiovascular system. b The exocrine system. c The respiratory system. d The reproductive system. e The hematologic system.
a,b,c,e
The client was admitted to an inpatient unit for uncontrolled pain caused by rheumatoid arthritis (RA). Which ongoing problems will the client have in relation to the RA? (Select all that apply.) a Ineffective role performance b Poor self-esteem c Fatigue d Weight gain e Chronic pain
b
The home health nurse is visiting a client with an exacerbation of RA. To prevent deformities of the knee joints the nurse should: a. tell the client to walk without bending the knees b. encourage movement within limits of pain c. instruct the client to only sit in a recliner d. tell the client to remain in bed as long as the joints are painful
a
The nurse is caring for a client with RA. The nurse knows the clients early morning symptoms will be most improved by: a. taking a warm shower upon awakening b. applying ice packs to the joints c. taking two aspirin before going to bed d. going for a early morning walk
c
The nurse is completing a health screening for a school-age child with rheumatoid arthritis. The parents ask the nurse to recommend activities that will promote exercise for their child. Which is an appropriate recommendation by the nurse? a Softball b Basketball c Swimming d Football
a,b,c,e
The nurse is volunteering in one of the local free autoimmune disease clinics. The next client was recently diagnosed with rheumatoid arthritis. What are the goals of care for clients with rheumatoid arthritis? (Select all that apply.) a Prevent deformity b Reduce inflammation c Preserve function d Cure the disease e Reduce pain
a,c RATIONALE: Laboratory tests used to diagnose rheumatoid arthritis include C-reactive protein levels and erythrocyte sedimentation rate. The antinuclear antibody (ANA) test, renal function test, and kidney biopsy are diagnostic tests for systemic lupus erythematosus, not rheumatoid arthritis.
What diagnostic tests are used for rheumatoid arthritis? (Select all that apply.) a Erythrocyte sedimentation rate (ESR) b Antinuclear antibody (ANA) test c C-reactive protein (CRP) d Kidney biopsy e Renal function test
d
Your client, Alexandra Kowalski, is a 16-year-old cross-country runner diagnosed with juvenile idiopathic arthritis. Which diagnostic test does the nurse anticipate will be ordered for Alexandra? a Coagulation tests b Electrolyte panel c Urine cultures d Erythrocyte sedimentation rate
a Rationale: Lying prone and allowing the feet to hang over the end of the mattress will help prevent flexion contractures. The client should be told to do this several times a day. Answers B, C, and D do not help prevent flexion contractures; therefore, they are incorrect.
A client with rheumatoid arthritis is beginning to develop flexion contractures of the knees. The nurse should tell the client to: ❍ A. Lie prone and let her feet hang over the mattress edge ❍ B. Lie supine, with her feet rotated inward ❍ C. Lie on her right side and point her toes downward ❍ D. Lie on her left side and allow her feet to remain in a neutral position
d Rationale: One technique for reducing stress on the joints is to delegate household tasks to family members. The client does not need to refrain from all household chores. Sleeping for 10 hours at night will not alleviate the need for frequent rest periods during the day. Increased joint pain would indicate that goals have not been met.
A client with rheumatoid arthritis is being seen in the outpatient clinic for a progress check-up. The nurse is reviewing the client's plan of care and determines that the client has met a goal of treatment when the client makes which statement? a "I sleep for 10 hours at night." b "I do not perform household chores at all anymore." c "I have increased pain in my joints all the time now." d "I have delegated many household chores to my children and spouse."
c Rationale: RA affects 12% of the total population across all races. It affects women 3 times more than men, and the onset is usually between the ages of 20 and 40 years.
A female client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if the cause of the disease is the fact that her family is of Hispanic descent. Which is the most appropriate response by the nurse to this client? a "RA affects those of German descent most often." b "RA is most prevalent in Caucasian females." c "RA affects all races at the same rate." d "RA is most prevalent in men under the age of 20 years."
a,b Rationale: The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity.
A nurse is caring for a client who has been newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse what the difference is between rheumatoid arthritis and osteoarthritis (OA). The nurse's best response includes: Select all that apply. "The onset of OA is gradual while the onset of RA may be rapid." "OA is slowly progressive while RA is characterized by exacerbations and remissions." "The affected joints in RA feel cold to the touch while the joints affected by OA are warm or hot to the touch." "The pain and stiffness with RA is with activity; OA pain and stiffness is predominant upon arising." "With OA, multiple joints are symmetrically affected; RA affects one joint at a time."
b,d,e
A nurse is caring for a client who has rheumatoid arthritis, which of the following laboratory tests are used to diagnose this disease? SELECT ALL THAT APPLY A. Urinalysis B. ESR C. BUN D. ANA titer E. WBC count
a,d,e
A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis. The client states that her pain is a 3 on a scale from 1 to 10 today. What non-pharmacological interventions can the nurse provide? Select all that apply. a Provide diversion activities. b Immobilize the extremity. c Discourage any position changes. d Massage e Relaxation techniques
c Rationale: The pregnant client with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. The pregnant client with RA that is in remission may stop medication. This client may be anemic as a result of blood loss from salicylate therapy
A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). The nurse understands that this client may: a Not stop medication for RA, even if the client is in remission. b Experience a relapse during pregnancy, often followed by a remission after delivery. c Be anemic as a result of blood loss from salicylate therapy. d Be at higher risk for preterm delivery.
b
A nurse is participating in a community health fair. Which statement made by a participant indicates the teaching about rheumatoid arthritis was understood? a "Rheumatoid arthritis is the most common arthritis in the United States and may affect only one joint." b "Rheumatoid arthritis is an autoimmune disorder and has associated genetic factors." c "Rheumatoid arthritis results in increased uric acid due to impaired purine metabolism." d "Rheumatoid arthritis causes joint inflammation related to a history of joint trauma."
a
A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? a. you can experience morning stiffness when you get out of bed b. you can experience abdominal pain c. you can experience weight gain d. you can experience low blood sugar
a,b,e
A nurse is working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY) a Recent influenza b. Decreased ROM c. Hypersalivation d. Increased BP e. Pain at rest
d Clients diagnosed with rheumatoid arthritis will often have a low-grade fever. This finding supports the client's diagnosis. Weight loss, morning stiffness that lasts more than one hour, and fatigue are other symptoms that support this diagnosis.
The nurse is caring for Ms. Ruiz, a client recently diagnosed with rheumatoid arthritis. Ms. Ruiz is being seen by the primary care provider for a follow-up visit after a recent hospitalization. The nurse prepares to assess Ms. Ruiz. Which clinical manifestation found during the assessment process supports this client's diagnosis? a Morning stiffness that lasts for thirty minutes b Increased energy c Weight gain over the last several months d Low-grade fever
a Rationale Risk factors for RA include a family history of the disease and heavy smoking. Use of herbal remedies, a family history of coronary artery disease, and being underweight do not increase the risk for developing RA.
The nurse is caring for a client recently diagnosed with rheumatoid arthritis (RA). The client states, "I always take care of myself, how could this happen to me?" Which response by the nurse is most appropriate regarding the client's risk for developing RA? a "RA occurs when there is a family history of the disease." b "RA occurs for clients who are underweight." c "RA occurs for clients with a history of using herbal remedies." d "RA occurs when there is a family history of coronary artery disease."
a
The nurse is caring for a client who was diagnosed with rheumatoid arthritis last year. The client has recently been placed on prednisone for treatment. The nurse is teaching the client about safe medication administration. Which client statement indicates that the medication teaching was successful? a "I will take the ordered dose at the same time every day." b "I will not have to limit my consumption of canned vegetables." c "I will take this medication on a full stomach to enhance absorption." d "I will not need to monitor my blood sugar more frequently while on this medication."
b
The nurse is caring for a pregnant client in the obstetrics clinic. The client has a history of rheumatoid arthritis. Which statement by the client would require a follow up by the nurse? a "I need to schedule extra rest periods throughout the day." b "When my joints hurt I can take an aspirin." c "Now that I am in my second trimester, I actually feel good, and my joints are not hurting either." d "I might carry my baby longer than the normal 40 weeks for the pregnancy."
c Rationale: One hallmark of RA is extreme fatigue, and the nurse would plan to teach the client about frequent rest periods during the day to conserve energy. The client with RA will be stiff early in the morning, but that would not interfere with activities later in the day. Joints of the RA client are stiffest in the morning. Taking ibuprofen for pain does not affect the ability for activity.
The nurse is collecting a health history for a client being seen in an outpatient clinic. The client complains of joint pain and swelling that have lasted for about 2 months. The nurse devises a plan of care based on the nursing diagnosis of Activity Intolerance based on which client statement? a "I find it difficult to move when I first get up in the morning." b "I take ibuprofen for the pain as needed." c "I seem to get tired early in the day and require a nap." d "My joints are stiffest at night before I go to sleep."
d Rationale Osteoarthritis, not rheumatoid arthritis, is characterized by pain with activity and stiffness following the activity. Pain and stiffness on arising, lasting more than 1 hour; red, hot swollen joints; and fatigue and weakness are all signs and symptoms of rheumatoid arthritis.
The nurse is performing an assessment on a client who complains of joint pain and stiffness. The client was admitted to the unit with a diagnosis of rheumatoid arthritis. Which reported signs and symptoms from the client interview would NOT be consistent with the clinical manifestations of rheumatoid arthritis? a "I am in so much pain in the morning! It is very hard for me to get out of bed and start my day. I can hardly move my legs; my knees feel like they are frozen." b "Whenever my disease gets worse, my joints get red, hot and swollen." c "I am just tired all the time, and feel very weak." d "I have trouble with walking because of the pain, and when I am finally done with my morning chores and sit down; my knees get so stiff I can hardly get up after I rested."
a,b,d,e Rationale The priorities of care for the client with rheumatoid arthritis are supportive care and education. Taking NSAIDs at regular intervals will provide continued control of pain and discomfort. Taking NSAIDs with food or milk will decrease the incidence of gastrointestinal upset. Clients should consume a well-balanced diet, use the application of heat and cold for pain, exercise in the shower because warm, moist heat promotes mobility; be aware of adverse effects of medications; lose weight if necessary; follow prescribed physical therapy; avoid smoking; and use muscle-strengthening exercises.
The nurse is working in a primary care office. A client diagnosed with rheumatoid arthritis has returned for a follow-up visit. The client states that his pain is controlled on NSAIDs. The nurse would supply what education related to the disease process and supportive care? (Select all that apply.) a Application of heat or cold to relieve pain b Take NSAIDs at regular intervals with food or milk c Avoid exercise d Be aware of the adverse effects of prescribed medications e Exercise in the shower because warm, moist heat promotes mobility
a
The nurse on the inpatient orthopedic unit is preparing the client for surgery. The client was admitted for right knee joint replacement surgery. The nurse wants to use the right teaching handouts for this type of surgery. Which surgical teaching handout is the nurse going to use? a Arthroplasty b Synovectomy c Arthroscopy d Arthrodesis
c
The nursing student is preparing an educational handout for the parents of a client with juvenile idiopathic arthritis (JIA). Based on the etiology, risk factors, and clinical manifestations of the disease, which topic will be addressed in the handout? a Teaching about the symptoms: JIA can affect multiple joints and organs and clients might experience acromegaly. b Teaching about the frequency of the disease: JIA is more frequent in boys than girls. c Teaching about the importance of monitoring growth rates in children. d Teaching about the permanent and progressive nature of the disorder.
a,b,c,e
The nurse, working in an internal medicine practice, prepares to see a client diagnosed with rheumatoid arthritis on the last visit. The client is complaining of pain and discomfort in the hands and knees. Which treatments can be used to reduce the pain and discomfort that the client is experiencing? (Select all that apply.) a Exercising b Taking corticosteroids c Taking NSAIDs d Increasing sun exposure e Eating a balanced diet
c RATIONALE: The abnormal granulation tissue that leads to joint damage in rheumatoid arthritis is called pannus. Uveitis is inflammation of the uvea, the middle layer of the eye, and is a clinical manifestation of juvenile idiopathic arthritis. Synovial membrane is the normal connective tissue that lines the cavity of a joint and produces the synovial fluid. Pleurodesis is a medical procedure in which the pleural space is artificially scarred. It involves the adhesion of the two pleurae. Next Question
What is the clinical term for abnormal tissue that leads to joint damage and immobilization in the pathophysiology of rheumatoid arthritis? a Pleurodesis b Synovial membrane c Pannus d Uveitis
b
Which activity is best suited to the 12- year old with juvenile RA? a. playing video games b. swimming c. working crossword puzzles d. playing slow-pitch softball
a,c,e
Which characteristics are risk factors for the development of rheumatoid arthritis? (Select all that apply.) a Family history b Male sex c Genetic predisposition d Diet e Psychological stressors
C Rationale: Holding a warm cup of coffee provides warmth
Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis? ❍ A. Brushing the teeth ❍ B. Drinking a glass of juice ❍ C. Holding a cup of coffee ❍ D. Brushing the hair
c,d,e
Which independent nursing interventions are used to treat rheumatoid arthritis? (Select all that apply.) a Arthrodesis to fuse cervical vertebrae, wrists, ankles b Promote a well-balanced diet c Alternate periods of activity and rest d Educate about low-impact aerobics e Avoid sun exposure
b
Which of the following instructions should be included in the teaching for a client with RA? a. avoid exercise because it fatigues the joints b. take prescribed anti-inflammatory meds with meals. c. alternate hot and cold packs to affected joints d. avoid weight bearing activity
d
Why are nonsteroidal anti-inflammatory agents (NSAIDs) used to treat rheumatoid arthritis? a To alter the course of the disease b To slow the development and progression of bone erosion c To reduce joint destruction d To reduce inflammation
2 Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching, but does not indicate that methotrexate may be contraindicated for the patient. Focus: Prioritization
You assess a 24-year-old patient with RA who is considering using methotrexate (Rheumatrex) for treatment. Which patient information is most important to communicate to the health care provider? 1. The patient has many concerns about the safety of the drug. 2. The patient has been trying to get pregnant. 3. The patient takes a daily multivitamin tablet. 4. The patient says that she has taken methotrexate in the past.
4 Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications. Focus: Prioritization
Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? 1. RA symptoms are worst in the morning 2. Dry eyes 3. Round and moveable nodules just under the skin 4. Dark-colored stools
4 Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications. Focus: Prioritization
Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? 1. RA symptoms are worst in the morning 2. Dry eyes 3. Round and moveable nodules just under the skin 4. Dark-colored stools