SLE/RA Practice Questions (Test #3, Fall 2020)

The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with SLE who is complaining of chest pain. 2. The client diagnosed with MS who is complaining of pain at a "10." 3. The client diagnosed with myasthenia gravis who has dysphagia. 4. The client diagnosed with GB syndrome who can barely move his toes.

1 1. Chest pain should be considered a priority regardless of the admitting diagnosis. Clients diagnosed with SLE can develop cardiac complications. 2. Pain at a "10" is a priority but not above chest pain. 3. Dysphagia is expected in clients diagnosed with MG. 4. Clients diagnosed with GB syndrome have ascending muscle weakness or paralysis, which could eventually result in the client being placed on a ventilator, but the problem currently is in the distal extremities (the feet) and is not priority over chest pain. TEST-TAKING HINT: When the test taker is deciding on which client has priority, a potentially life-threatening condition is always top priority

The 20-year-old female client diagnosed with advanced unremitting RA is being admitted to receive a regimen of immunosuppressive medications. Which question should the nurse ask during the admission process regarding the medications? 1. "Are you sexually active, and, if so, are you using birth control?" 2. "Have you discussed taking these drugs with your parents?" 3. "Which arm do you prefer to have an IV in for four (4) days?" 4. "Have you signed an informed consent for investigational drugs?"

1 1. Immunosuppressive medications are considered class C drugs and should not be taken while pregnant. These drugs are teratogenic and carcinogenic, and the client is only 20 years old. 2. Any individual older than age 18 years is considered an adult and does not need to discuss treatment with her parents unless she chooses to do so. 3. The medications can be administered on an outpatient basis, but if an inpatient has intravenous therapy, then IV sites are changed every 72 hours and there is no guarantee an IV will last for four (4) days. 4. These are not investigational drugs and are standard therapy approved by the American College of Rheumatology and the Food and Drug Administration. TEST-TAKING HINT: The age of the client and the fact the client is female could give the test taker an idea of the correct answer. This is a client in the childbearing years.

The nurse is preparing to administer morning medications. Which medication should the nurse administer first? 1. The pain medication to a client diagnosed with RA. 2. The diuretic medication to a client diagnosed with SLE. 3. The steroid to a client diagnosed with polymyositis. 4. The appetite stimulant to a client diagnosed with OA.

1 1. Pain medication is important and should be given before the client's pain becomes worse. 2. Unless the client is in a crisis, such as pulmonary edema, this medication can wait. 3. Steroids do not have precedent over pain medication and should be administered with food. 4. Clients diagnosed with OA are usually overweight and do not require appetite stimulants. The nurse should question this medication before administering the medication. TEST-TAKING HINT: When determining priorities, the test taker must employ some criteria to use as a guideline. According to Maslow, pain is a priority.

The nurse is admitting a client diagnosed with R/O SLE. Which assessment data observed by the nurse support the diagnosis of SLE? 1. Pericardial friction rub and crackles in the lungs. 2. Muscle spasticity and bradykinesia. 3. Hirsutism and clubbing of the fingers. 4. Somnolence and weight gain

1 1. SLE can affect any organ. It can cause pericarditis and myocardial ischemia as well as pneumonia or pleural effusions. 2. Muscle spasticity occurs in MS, and bradykinesia occurs in Parkinson's disease. 3. Hirsutism is an overgrowth of hair. Spotty areas of alopecia occur in SLE, and clubbing of the fingers occurs in chronic pulmonary or cardiac diseases. 4. Weight loss and fatigue are experienced by clients diagnosed with SLE. TEST-TAKING HINT: The test taker must know the signs and symptoms of disease processes

The nurse is teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). The nurse evaluates the teaching as effective when the parent states: 1. "The cause is unknown." 2. "There is no genetic involvement." 3. "Drugs are not a trigger for the illness." 4. "Antibodies improve disease outcome."

1 1. SLE is a complex disease; there are many triggers, but how the disease develops is not known. 2. There is some correlation with family history. 3. There are multiple triggers for SLE, including prescription drugs. 4. Antibodies have nothing to do with SLE outcome. TEST-TAKING HINT: Not all diseases have a known cause.

Which signs/symptoms should the nurse expect to assess in the client diagnosed with Sjögren's syndrome? 1. Complaints of dry mouth and eyes. 2. Complaints of peripheral joint pain. 3. Complaints of muscle weakness. 4. Complaints of severe itching

1 1. Sjögren's syndrome is an autoimmune disorder causing inflammation and dysfunction of exocrine glands throughout the body. Dry mouth and eyes are some of the signs/symptoms. 2. Peripheral joint pain may be a symptom of rheumatoid arthritis. 3. Muscle weakness is a symptom of a variety of disease processes and syndromes but not of Sjögren's syndrome. 4. Severe itching is not a symptom of this syndrome.

Which assessment data should the nurse expect for the client diagnosed with RA who is taking sulfasalazine? 1. Orange or yellowish discoloration of the urine. 2. Ulcers and irritation of the mouth. 3. Ecchymosis of the lower extremities. 4. A red, raised skin rash over the back.

1 1. Sulfasalazine (Azulfi dine), an antirheumatic, may cause an orange or yellowish discoloration of urine and the skin. This is expected and is not significant. 2. Stomatitis is not an expected side effect of sulfasalazine (Azulfi dine), an antirheumatic medication, and the HCP should be notified. 3. Ecchymosis (unexplained bleeding) is not an expected side effect of sulfasalazine (Azulfi dine), an antirheumatic, and the HCP should be notified. 4. A rash is not an expected side effect, and the HCP should be notified.

The client diagnosed with RA is taking phenylbutazone. Which statement requires the nurse to question administering this medication? 1. "I have had a sore throat and fever the last few days." 2. "I have not had a bowel movement in more than 3 days." 3. "I can't believe I have gained 3 pounds in the last month." 4. "I have been having trouble sleeping at night."

1 1. The most dangerous adverse reaction to phenylbutazone (Butazolidin), a pyrazoline NSAID, is blood dyscrasias, which are manifested in the client by flu-like symptoms. 2. Constipation is not a side effect of phenylbutazone (Butazolidin), a pyrazoline NSAID. The nurse would not question administering the medication. 3. Weight gain is not a side effect of phenylbutazone (Butazolidin), a pyrazoline NSAID. The nurse would not question administering the medication. 4. Insomnia is not a side effect of phenylbutazone (Butazolidin), a pyrazoline NSAID. The nurse would not question administering the medication. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has fl u-like symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicate the medication has caused a sudden drop in the WBC count, leaving the body defenseless against bacterial invasion.

The client with RA has nontender, movable nodules in the subcutaneous tissue over the elbows and shoulders. Which statement is the scientific rationale for the nodules? 1. The nodules indicate a rapidly progressive destruction of the affected tissue. 2. The nodules are small amounts of synovial fluid that have become crystallized. 3. The nodules are lymph nodes which have proliferated to try to fight the disease. 4. The nodules present a favorable prognosis and mean the client is better

1 1. The nodules may appear over bony prominences and resolve simultaneously. They appear in clients with the rheumatoid factor and are associated with rapidly progressive and destructive disease. 2. There is a proliferation of the synovial membrane in RA, which leads to the formation of pannus and the destruction of cartilage and bone, but synovial fluid does not crystallize to form the nodules. 3. The nodules are not lymph nodes. Lymph nodes may enlarge in the presence of disease, but they do not proliferate (multiply). 4. The nodes indicate a progression of the disease, not an improving prognosis. TEST-TAKING HINT: The test taker can rule out option "3" with knowledge of anatomy or physiology. Lymph nodes do not multiply; they do form chains throughout the body

A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which goal for this client should take priority?. 1.Conserve energy. 2.Adapt self-care skills. 3.Develop coping skills. 4.Adapt body image

1 Based on the information from the client, the nurse should develop a plan with the client that will conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit related to the increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may have difficulty coping or experience changes in body image as the disorder becomes chronic with increasing pain and fatigue, but the current priority is to conserve energy

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate, which of the following statements indicates the need for further teaching?. 1."I will take my vitamins while I'm on this drug." 2."I must not drink any alcohol while I'm taking this drug." 3."I should brush my teeth after every meal." 4."I will continue taking my birth control pills."

1 Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. Methotrexate is considered teratogenic

The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply. 1. Use a sunscreen of SPF 30 or greater when in the sunlight. 2. Notify the HCP immediately when developing a low-grade fever. 3. Some dyspnea is expected and does not need immediate attention. 4. The hands and feet may change color if exposed to cold or heat. 5. Explain the client can be cured with continued therapy

1,2,4 1. Sunlight or UV light exposure has been shown to initiate an exacerbation of SLE, so the client should be taught to protect the skin when in the sun. 2. A fever may be the first indication of an exacerbation of SLE. 3. Dyspnea is not expected and could signal respiratory involvement. 4. Raynaud's phenomenon is a condition in which the digits of the hands and feet turn red, blue, or white in response to heat or cold and stress. It occurs with some immune inflammatory processes. 5. SLE is a chronic disease and there is no known cure. TEST-TAKING HINT: Dyspnea is an uncomfortable sensation of not being able to breathe. Usually clients are not told this is normal regardless of the disease process.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1.Adults between the ages of 20 and 50 years. 2.Adults who have had an infectious disease with the Epstein-Barr virus. 3.Adults who are of the male gender. 4.Adults who possess the genetic link, specifically HLA-DR4. 5.Adults who also have osteoarthritis.

1,2,4 RA affects women three times more often than men between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing RA.

A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythematosus (SLE). On assessment, the nurse expects the child to have which of the following signs and symptoms? Select all that apply. 1. Oral ulcers. 2. Malar rash. 3. Weight gain. 4. Heart failure. 5. Anemia

1,2,5 1. Oral ulcers are a common early symptom. Typically, at least four symptoms must be present for the diagnosis of SLE. 2. The "butterfly," or malar, rash is the most common manifestation of SLE. 3. Weight loss, not weight gain, is a symptom of SLE. 4. Heart failure is not a common manifestation, but it can occur after long-term disease that affects the heart muscle. 5. Anemia is often a presenting symptom of SLE. TEST-TAKING HINT: By understanding the pathophysiology of SLE, the test taker will be able to find the correct answer.

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1."A local anesthetic agent may be injected into the joint site for your comfort." 2."A syringe and needle will be used to withdraw fluid from your joint." 3."The procedure, although not painful, will provide immediate relief." 4."We'll want you to keep your joint active after the procedure to increase blood flow." 5."You will need to wear a compression bandage for several days after the procedure."

1,2,5 An arthrocentesis is performed to aspirate excess synovial fluid, pus, or blood from a joint cavity to relieve pain or to diagnosis inflammatory diseases such as rheumatoid arthritis. A local agent may be used to decrease the pain of the needle insertion through the skin and into the joint cavity. Aspiration of the fluid into the syringe can be very painful because of the size and inflammation of the joint. Usually a steroid medication is injected locally to alleviate the inflammation; a compression bandage is applied to help decrease swelling; and the client is asked to rest the joint for up to 24 hours afterward to help relieve the pain and promote rest to the inflamed joint. The client may experience pain during this time until the inflammation begins to resolve and swelling decreases

A client is in the acute phase of rheumatoid arthritis. In which order of priority should the nurse establish the following goals? 1.Relieving pain. 2.Preserving joint function. 3.Maintaining usual ways of accomplishing tasks. 4.Preventing joint deformity.

1,4,2,3 Pain relief is the highest priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function is the next goal to set, followed by preventing joint deformity during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Maintaining usual ways of accomplishing tasks is the goal with the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks

Which instruction should the nurse discuss with the client diagnosed with RA who is prescribed methotrexate? Select all that apply. 1. "Use a soft-bristled toothbrush when brushing teeth." 2. "Wear warm clothes when it is less than 40°F." 3. "Gargle with mouthwash at least four times a day." 4. "Use a sunscreen with an SPF 15 or lower when outside." 5. "Take NSAIDs only as ordered by the HCP while taking this medication."

1,5 1. Methotrexate, a DMARD, causes bone marrow depression, which may lead to abnormal bleeding; therefore, the client should use a soft-bristled toothbrush. 2. Methotrexate has no effect on the client's response to cold weather. 3. The client is at risk for mouth ulcers and should not use any type of commercially available mouthwash. The client should rinse the mouth with water after eating and drinking. 4. Methotrexate, a DMARD, may increase the sensitivity of the skin to sunlight. The client should use a sunscreen of SPF 30 or higher and wear protective clothing when exposure to the sun is unavoidable. 5. NSAIDs and salicylates taken with methotrexate can cause elevated levels of methotrexate in the blood, leading to toxicity. Careful monitoring of methotrexate levels is required

The client diagnosed with RA is prescribed prednisone for an acute episode of pain. The client asks the nurse, "Why can't I be on this forever since it helps the pain so much?" Which statement is the nurse's best response? 1. "The medication will cause you to have a buffalo hump or moon face." 2. "The medication has long-term side effects, such as osteoporosis." 3. "If you continue taking the medication, it may cause an Addisonian crisis." 4. "There are other medications that can be prescribed to help the pain."

2 1. A buffalo hump and moon face are expected side effects, are not life-threatening, and would not be a problem if the client took the medication forever. These side effects affect body image, but most individuals in severe pain would rather have body-image problems than pain. 2. Prednisone, a glucocorticoid, has serious long-term side effects that can lead to possible life-threatening complications; therefore, the client cannot take prednisone forever. 3. An Addisonian crisis (adrenal insuffi ciency) is a complication that may occur when the patient stops prednisone, a glucocorticoid medication, abruptly, but not if it is tapered off. 4. This response does not answer the client's question; therefore, it is not the best response.

Which statement indicates the female client with systemic lupus erythematosus (SLE) understands the discharge instructions? 1. "I should wear sunscreen with at least a 5 SPF." 2. "I am not going to any activities with large crowds." 3. "I should not get pregnant because I have SLE." 4. "I must avoid using hypoallergenic products."

2 1. A sunscreen with an SPF of at least 15 should be used by the client with SLE. 2. The client with SLE is at risk for infections and should avoid large crowds. 3. Pregnancy is not contraindicated in most women diagnosed with SLE. 4. The client with SLE should use hypoallergenic products and should not use irritating soaps, shampoos, or chemicals

The client diagnosed with RA has developed swan-neck fingers. Which referral is most appropriate for the client? 1. Physical therapy. 2. Occupational therapy. 3. Psychiatric counselor. 4. Home health nurse.

2 1. Physical therapists work with gait training and muscle strengthening. Generally, the physical therapist works on the lower half of the body. 2. The occupational therapist assists the client in the use of the upper half of the body, fine motor skills, and activities of daily living. This is needed for the client with abnormal fingers. 3. A counselor can help the client discuss feelings about body image, loss of function, and role changes, but the best referral is to the occupational therapist. 4. The client may need a home health nurse eventually, but first the client should be assisted to remain as functional as possible. TEST-TAKING HINT: The test taker must be aware of the roles of all the health-care team members. The counselor (option "3") can be ruled out as a possible correct answer because swan-neck fingers are a physical problem.

The 26-year-old female client is complaining of a low-grade fever, arthralgias, fatigue, and a facial rash. Which laboratory tests should the nurse expect the HCP to order if SLE is suspected? 1. Complete metabolic panel and liver function tests. 2. Complete blood count and antinuclear antibody tests. 3. Cholesterol and lipid profile tests. 4. Blood urea nitrogen and glomerular filtration tests.

2 1. SLE can affect any organ system, and these tests are used to determine the possibility of the liver being involved, but they are not used to diagnose SLE. 2. No single laboratory test diagnoses SLE, but the client usually presents with moderate to severe anemia, thrombocytopenia, leukopenia, and a positive antinuclear antibody. 3. Female clients with SLE develop atherosclerosis at an earlier age, but cholesterol and lipid profile tests are not used to diagnose the disease. 4. These tests may be done to determine SLE infiltration in the kidneys but not to diagnose the disease itself. TEST-TAKING HINT: A complete metabolic panel is ordered for many different diseases; cholesterol and lipid panels are usually ordered for atherosclerosis, and BUN and glomerular filtration tests are specific to the kidneys. Options "1," "3," and "4" could be ruled out because they are specific to other diseases or not specific enough.

Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus (SLE)? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Uncovered fluorescent lights offer no danger.

2 1. Sun-protective clothing is important, including hats. 2. Sunscreen helps reduce accelerated burning due to sensitivity. 3. Participating in sports is important for normality and should be encouraged. 4. Protection from uncovered fluorescent lights is as important as protection from ultraviolet A and B light. TEST-TAKING HINT: In general, sunscreen is important for every question regarding sun exposure and photosensitivity

The nurse and a female unlicensed assistive personnel (UAP) are caring for a group of clients on a medical floor. Which action by the UAP warrants immediate intervention by the nurse? 1. The UAP washes her hands before and after performing vital signs on a client. 2. The UAP dons sterile gloves prior to removing an indwelling catheter from a client. 3. The UAP raises the head of the bed to a high Fowler's position for a client about to eat. 4. The UAP uses a fresh plastic bag to get ice for a client's water pitcher

2 1. The UAP should wash the hands before and after client care. 2. The UAP can remove an indwelling catheter with nonsterile gloves. This is a waste of expensive equipment. The nurse is responsible for teaching UAPs appropriate use of equipment and supplies and cost containment. 3. Raising the head of the bed to a 90-degree angle (high Fowler's position) during meals helps to prevent aspiration. 4. Using a clean plastic bag to access the ice machine indicates the assistant is aware of infection control procedures. TEST-TAKING HINT: This is really an "except" question—there will be three (3) options with desire actions and only one (1) needs to change

The client diagnosed with RA who has been prescribed etanercept, a tumor necrosis factor alpha inhibitor, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach? 1. Explain the medication loses its efficacy after a few months. 2. Continue to have checkups and laboratory work while taking the medication. 3. Have yearly magnetic resonance imaging to follow the progress. 4. Discuss the drug is taken for three (3) weeks and then stopped for a week.

2 1. The drug does not lose efficacy, and clients are removed from the drug when the body cannot tolerate the side effects. 2. The drug requires close monitoring to prevent organ damage. 3. MRI scans are not used to determine the progress of RA. 4. There is no "off" period for the drug. TEST-TAKING HINT: If the test taker is not aware of the medication being discussed, option "2," the correct answer, is information which could be said of most medications

The client diagnosed with RA has been taking methotrexate for 2 weeks. Which laboratory data warrants intervention by the nurse? 1. A serum creatinine level of 0.9 mg/dL. 2. A red blood cell (RBC) count of 2.5 million/mm. 3. A WBC count of 9,000 mm. 4. A hemoglobin (Hgb) level of 14.5 g/dL and hematocrit (Hct) level of 43%.

2 1. This is within the normal range of 0.5 to 1.5 mg/dL for serum creatinine. 2. This RBC count indicates anemia (low RBC count and Hgb/Hct resulting from low RBCs), which would warrant intervention by the nurse. The normal RBC is 4.6 to 6.0 million/mm for men and 4.0 to 5.0 million/mm for women. 3. The WBC count is within the normal range of 4,500/mm to 10,000/mm. 4. These are within the normal range—Hgb 13.5 to 18 g/dL in males and 12 to 16 g/dL in females, and Hct 40% to 54% in males and 36% to 46% in females.

The female client diagnosed with SLE reports to the nurse that she has pain, she is stiff when she gets up in the morning, and she takes ibuprofen to help ease the pain and stiffness. Which question is most important for the nurse to ask the client? 1. "How often do you have to take the ibuprofen?" 2. "Do you take the medication on an empty stomach?" 3. "Does the medication help with menstrual cramping too?" 4. "Have you noticed an improvement in the pain and stiffness?"

2 1. This may be asked, but it is not the most important question. 2. This is the most important question. The client reports the pain and stiffness on awakening in the morning. Taking NSAIDs then places the client at risk for developing peptic ulcer disease. The client should be taught to take these medications with food. 3. NSAID medications are frequently taken by female clients to relieve menstrual cramps. This is not the most important question. 4. This is the reason the client is taking the medication. NSAIDs are used to treat the pain and stiffness, but they are also helpful in decreasing the inflammation associated with SLE and in allowing a reduction in the dosage of steroids

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of the left eye. Correct interpretation of this assessment finding indicates which of the following?. 1.Development of a cataract. 2.Possible retinal degeneration. 3.Part of the disease process. 4.A coincidental occurrence.

2 Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

The client has systemic lupus erythematosus and is prescribed azathioprine. Which teaching should the nurse discuss with the client? Select all that apply. 1. Instruct the client on how to use a glucometer. 2. Tell the client to come to the office for lab tests. 3. Explain that low-grade fevers are expected initially. 4. Discuss the need for recording an accurate urinary output. 5. Teach to use sunscreen and protective clothing outdoors.

2,5 1. The client's blood glucose level is not affected by azathioprine (Imuran); therefore, there is no need to monitor the glucose level. 2. Bone marrow depression may occur when taking azathioprine (Imuran). The client must have a CBC and platelet counts every week the first month of therapy, then biweekly for 2 to 3 months, and monthly thereafter. 3. Low-grade fever is not expected and is a sign of infection and must be reported to the HCP. 4. Kidney function is monitored through laboratory tests, not the client's urine output. 5. Azathioprine can increase the risk of skin cancer. The client should be taught to wear sunscreen and protective clothing outdoors and to avoid tanning booths

Which client problem is priority for a client diagnosed with RA? 1. Activity intolerance. 2. Fluid and electrolyte imbalance. 3. Alteration in comfort. 4. Excessive nutritional intake.

3 1. Activity intolerance is an appropriate client problem, but it is not priority over pain. 2. The client with RA does not experience fluid and electrolyte disturbance. 3. The client diagnosed with RA has chronic pain; therefore, alteration in comfort is a priority problem. 4. Clients diagnosed with RA usually experience anorexia and weight loss, unless they are taking long-term steroids. TEST-TAKING HINT: The question is asking for the priority problem, and pain is priority according to Maslow's hierarchy of needs.

The client diagnosed with RA is taking leflunomide. Which comment by the client warrants intervention by the nurse? 1. "I have noticed that I am starting to lose my hair." 2. "I sometimes get dizzy and drowsy." 3. "My spouse and I are trying to start a family." 4. "I will not get any vaccines while taking this medication."

3 1. Alopecia is a common side effect of the DMARD lefl unomide (Arava). This should be discussed with the client before starting the medication, and methods of coping with hair loss should be explored. This comment would not warrant intervention by the nurse. 2. This medication causes dizziness; therefore, this comment would not warrant intervention by the nurse. 3. The DMARD leflunomide (Arava) is teratogenic. Women must undergo the drug-elimination procedure and men must take 8 grams of cholestyramine three times daily for 11 days to minimize any possible risk of harm to the fetus his partner is carrying. 4. The client should avoid vaccinations with live vaccines during and following therapy; therefore, this comment does not require nursing intervention.

The nurse and a licensed practical nurse are caring for clients in a rheumatologist's office. Which task can the nurse assign to the licensed practical nurse? 1. Administer methotrexate, an antineoplastic medication, IV. 2. Assess the lung sounds of a client with RA who is coughing. 3. Demonstrate how to use clothing equipped with Velcro fasteners. 4.Discuss methods of birth control compatible with treatment medications.

3 1. Antineoplastic medications can be administered only by a registered nurse who has been trained in the administration and disposal of these medications. 2. Assessment cannot be assigned to a licensed practical nurse. 3. The licensed practical nurse (LPN) can demonstrate how to use adaptive clothing. 4. This is teaching requiring knowledge of medications and interactions and should not be assigned to an LPN. TEST-TAKING HINT: The nurse cannot assign assessment, evaluation, or teaching or any medication requiring specialized knowledge or skills to administer safely

The client diagnosed with rheumatoid arthritis (RA) is prescribed hydroxychloroquine sulfate. Which statement indicates the client understands the medication teaching? 1. "I will get my eyes checked yearly." 2. "I can only have two beers a week." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks."

3 1. Hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD), can cause pigmentary retinitis and vision loss, so the client should have a thorough vision examination every 6 months; therefore, the client does not understand the medication teaching. 2. Plaquenil may increase the risk of liver toxicity when administered with hepatotoxic drugs, so alcohol use should be eliminated during therapy; therefore, the client does not understand the medication teaching. 3. Hydroxychloroquine sulfate (Plaquenil), a DMARD, should be taken with milk to decrease gastrointestinal upset. This statement indicates the client understands the medication teaching. 4. The medication takes 3 to 6 months to achieve the desired response; therefore, the client needs more medication teaching

The nurse is assessing a client with cutaneous lupus erythematosus. Which intervention should be implemented? 1. Use astringent lotion on the face and skin. 2. Inspect the skin weekly for open areas or rashes. 3. Dry the skin thoroughly by patting. 4. Apply anti-itch medication between the toes.

3 1. Moisturizing lotions, not astringents, are applied. Astringent lotions have an alcohol base, which is drying to the client's skin. 2. The skin should be inspected daily for any breakdown or rashes. 3. The skin should be washed with mild soap, rinsed, and patted dry. Rubbing can cause abrasions and skin breakdown. 4. The stem does not tell the test taker the client is itching, and SLE does not have itching as a symptom. Lotions are not usually applied between the toes because this fosters the development of a fungal infection between the toes. TEST-TAKING HINT: If the test taker did not know what "astringent" meant, then the test taker should skip this option and continue looking for a correct answer. In option "2," the time frame of weekly makes this option wrong

The nurse is discussing autoimmune diseases with a class of nursing students. Which signs and symptoms are shared by rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)? 1. Nodules in the subcutaneous layer and bone deformity. 2. Renal involvement and pleural effusions. 3. Joint stiffness and pain. 4. Raynaud's phenomenon and skin rash

3 1. Nodules and bony deformity are symptoms of RA but not of SLE. 2. Organ involvement occurs in SLE but not RA. 3. Joint stiffness and pain are symptoms occurring in both diseases. 4. Raynaud's phenomenon and skin rashes are associated with SLE. TEST-TAKING HINT: There are a number of illnesses sharing the same symptoms. The test taker must be aware of the symptoms that distinguish one illness from another.

The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for this client? 1. The client will maintain reproductive ability. 2. The client will verbalize feelings of bodyimage changes. 3. The client will have no deterioration of organ function. 4. The client's skin will remain intact and have no irritation

3 1. SLE is frequently diagnosed in young women and reproduction is a concern for these clients, but it is not the most important goal. 2. The client's body image is important, but this is not the most important. 3. SLE can invade and destroy any body system or organ. Maintaining organ function is the primary goal of SLE treatment. 4. Measures are taken to prevent breakdown, but skin breakdown is not life threatening. TEST-TAKING HINT: When the question asks for "priority," the test taker should determine if one of the options has lifethreatening information or could result in a serious complication for the client

The client diagnosed with an acute exacerbation of SLE is prescribed high-dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE? 1. The steroids will increase the body's ability to fight the infection. 2. The steroids will decrease the chance of the SLE spreading to other organs. 3. The steroids will suppress tissue inflammation, which reduces damage to organs. 4. The steroids will prevent scarring of skin tissues associated with SLE.

3 1. Steroid medications mask the development of infections because steroids suppress the immune system's response. 2. SLE does not metastasize, or "spread"; it does invade other organ systems, but steroids do not prevent this from happening. 3. The main function of steroid medications is to suppress the inflammatory response of the body. 4. Steroid medications can delay the healing process, theoretically making scarring worse. TEST-TAKING HINT: Steroids are a frequently administered medication class. The test taker must know the common actions, side effects, adverse effects, and how to administer the medications safely

The client diagnosed with an acute exacerbation of SLE is being discharged with a prescription for an oral steroid which will be discontinued gradually. Which statement is the scientific rationale for this type of medication dosing? 1. Tapering the medication prevents the client from having withdrawal symptoms. 2. So the thyroid gland starts working, because this medication stops it from working. 3. Tapering the dose allows the adrenal glands to begin to produce cortisol again. 4. This is the health-care provider's personal choice in prescribing the medication.

3 1. Steroids are not addicting. 2. The adrenal gland, not the thyroid gland, produces the glucocorticoid cortisol. 3. Tapering steroids is important because the adrenal gland stops producing cortisol, a glucocorticosteroid, when the exogenous administration of steroids exceeds what normally is produced. The functions of cortisol in the body are to regulate glucose metabolism and maintain blood pressure. 4. Tapering the dose is standard medical practice, not a whim of the HCP. TEST-TAKING HINT: Basic knowledge of anatomy and physiology eliminates option "2." Tapering steroid medication is basic knowledge for the nurse administering a steroid.

The nurse is caring for clients on a medical floor. Which client should the nurse assess first? 1. The client diagnosed with RA complaining of pain at a "3" on a 1-to-10 scale. 2. The client diagnosed with SLE who has a rash across the bridge of the nose. 3. The client diagnosed with advanced RA who is receiving antineoplastic drugs IV. 4. The client diagnosed with scleroderma who has hard, waxlike skin near the eyes.

3 1. The client in pain should receive medication as soon as possible to keep the pain from becoming worse, but the client is not at risk for a serious complication. 2. A butterfly rash across the bridge of the nose occurs in approximately 50% of the clients diagnosed with SLE. 3. Antineoplastic drugs can be caustic to tissues; therefore, the client's IV site should be assessed. The client should be assessed for any untoward reactions to the medications first. 4. Scleroderma is a disease characterized by waxlike skin covering the entire body. This is expected for this client. TEST-TAKING HINT: Pain is a priority, but the test taker must determine if there is another client who could experience complications if not seen immediately.

The client recently diagnosed with RA is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication? 1. "I will decrease my dose for a few days if my ears start ringing." 2. "I should take my aspirin with meals, food, milk, or antacids." 3. "I need to take the entire aspirin dose at night before going to bed." 4. "If I have any stomach upset, I will take enteric-coated aspirin."

3 1. This dose of aspirin is just less than the toxic dose that produces tinnitus and hearing loss, but this is the dose needed to treat RA. The client should reduce the dose by two to three tablets per day until the tinnitus resolves. This statement indicates the client does not need more teaching. 2. Gastrointestinal side effects are common with aspirin therapy; therefore, the client should take aspirin with food. This statement indicates the client does not need more teaching. 3. The aspirin should be taken in divided doses (three to four 325-mg tablets four times a day). This statement indicates the client needs more teaching. 4. Enteric-coated aspirin produces less gastric distress than plain, buffered aspirin. The client's statement does not need more teaching

The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits? 1. Perform joint x-rays to determine progression of the disease. 2. Send blood to the laboratory for an erythrocyte sedimentation rate. 3. Recommend the flu and pneumonia vaccines. 4. Assess the client for increasing joint involvement

3 1. This is done, but it will not prevent any disease from occurring. 2. This will follow the progression of the disease of RA, but it is not preventive. 3. RA is a disease with many immunological abnormalities. The clients have increased susceptibility to infectious disease, such as the flu or pneumonia, and, therefore, vaccines, which are preventive, should be recommended. 4. Assessing the client does not address preventive care. TEST-TAKING HINT: The stem requires the test taker to determine what action is preventive care for the client with RA. Only option "3" addresses preventive care.

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit?. 1."I can use heat and cold as often as I want." 2."With heat, I should apply it for no longer than 20 minutes at a time." 3."Heat-producing liniments can be used with other heat devices." "Ten to fifteen minutes per application is the maximum time for cold applications."

3 Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for:. 1.Limited motion of joints. 2.Deformed joints of the hands. 3.Early morning stiffness. 4.Rheumatoid nodules.

3 Initially, most clients with early symptoms of rheumatoid arthritis report early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules

Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus (SLE) and renal involvement? 1. Monitor weight. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine

4 1. For renal impairment due to SLE, monitoring the childs weight is important, but checking the urine is a priority. 2. Uric salts are a normal concentrate of urine. 3. Hypertension, not hypotension, is a problem with renal involvement. 4. Protein in urine is a sign of renal impairment, even in nephrotic syndrome, in which the kidneys are losing protein. TEST-TAKING HINT: The test taker must understand what can happen to the body when organs, such as the kidneys, fail

The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention? 1. The client complains of joint stiffness and the knees feel warm to the touch. 2. The client has experienced one (1)-kg weight loss and is very tired. 3. The client requires a heating pad applied to the hips and back to sleep. 4. The client is crying, has a flat facial affect, and refuses to speak to the nurse

4 1. Joint stiffness and joints warm to the touch are expected in clients diagnosed with RA. 2. Clients diagnosed with RA have bilateral and symmetrical stiffness, edema, tenderness, and temperature changes in the joints. Other symptoms include sensory changes, lymph node enlargement, weight loss, fatigue, and pain. A one (1)-kg weight loss and fatigue are expected. 3. The use of heat is encouraged to provide comfort for a client diagnosed with RA. 4. The client has the signs and symptoms of depression. The nurse should attempt to intervene with therapeutic conversation and discuss these findings with the HCP. TEST-TAKING HINT: The test taker should not automatically assume only physiological data require immediate intervention. There will be times when a psychological need will have priority. Because options "1," "2," and "3" are all expected in a client with RA, the psychological need warrants intervention by the nurse.

Which intervention has the highest priority when caring for a client diagnosed with rheumatoid arthritis? 1. Encourage the client to ventilate feelings about the disease process. 2. Discuss the effects of disease on the client's career and other life roles. 3. Instruct the client to perform most important activities in the morning. 4. Teach the client the proper use of hot and cold therapy to provide pain relief.

4 1. Rheumatoid arthritis is a chronic illness, and verbalization of feelings is helpful in dealing with disease processes, but it is not the highest priority intervention. 2. This helps the client accept the disease process and body changes and helps the client to begin to identify strategies for coping with them, but it is not the highest priority intervention. 3. Helping the client prioritize activities helps the client maintain independence as long as possible. 4. Pain is priority over psychological problems and activity; remember Maslow's hierarchy of needs.

The nurse is planning the care for a client diagnosed with RA. Which intervention should be implemented? 1. Plan a strenuous exercise program. 2. Order a mechanical soft diet. 3. Maintain a keep-open IV. 4. Obtain an order for a sedative.

4 1. The client diagnosed with RA is generally fatigued, and strenuous exercise increases the fatigue, places increased pressure on the joints, and increases pain. 2. The client should be on a balanced diet high in protein, vitamins, and iron for tissue building and repair and should not require a mechanically altered diet. 3. There is no specific reason for the client to be ordered a keep-open IV; the client can swallow needed medications. 4. Sleep deprivation resulting from pain is common in clients diagnosed with RA. A mild sedative can increase the client's ability to sleep, promote rest, and increase the client's tolerance of pain. TEST-TAKING HINT: The test taker should be aware of adjectives leading to an option being eliminated—for example, the word "strenuous" in option "1.

The client diagnosed with RA is taking etodolac. The client is reporting a headache. Which intervention should the nurse implement? 1. Administer two aspirins. 2. Administer an additional dose of etodolac. 3. Administer one oral narcotic analgesic. 4. Administer two acetaminophen tablets.

4 1. The client should not take aspirin, an NSAID, while taking etodolac (Lodine), another NSAID. 2. The client should not receive an additional dose of a routine medication that is being administered for treatment of RA. 3. The nurse should administer a non-narcotic analgesic for a headache, not a narcotic. 4. Acetaminophen, a non-narcotic analgesic, would be the most appropriate medication to give the client who is experiencing a headache and is taking etodolac (Lodine), an NSAID.

The client recently diagnosed with SLE asks the nurse, "What is SLE and how did I get it?" Which statement best explains the scientific rationale for the nurse's response? 1. SLE occurs because the kidneys do not filter antibodies from the blood. 2. SLE occurs after a viral illness as a result of damage to the endocrine system. 3. There is no known identifiable reason for a client to develop SLE. 4. This is an autoimmune disease that may have a genetic or hormonal component.

4 1. The kidneys filter wastes, not antibodies, from the blood. 2. The problem is an overactive immune system, not damage to the endocrine system. There is no research supporting a virus as an initiating factor. 3. SLE is an autoimmune disease characterized by exacerbations and remission. There is empirical evidence indicating hormones may cause the development of the disease, and some drugs can initiate the process. 4. There is evidence for familial and hormonal components to the development SLE. SLE is an autoimmune disease process in which there is an exaggerated production of autoantibodies. TEST-TAKING HINT: The test taker could eliminate options "1" and "2" by referring to basic anatomy and physiology and the function of the kidneys and endocrine system.

The client diagnosed with systemic lupus erythematosus (SLE) is experiencing an acute exacerbation and the HCP has ordered high doses of glucocorticoid medications. Which statement supports the goal of this therapy? 1. To provide a permanent cure for lupus. 2. To allow a peaceful, dignified death. 3. To help enable the client to maintain weight. 4. To prevent permanent damage to the organs

4 1. There is no cure for SLE. The goal of treatment is to prevent or minimize damage to the internal organs. 2. The goal is not death, but to assist the client to live as full a life as possible. 3. The medication may have a side effect of weight gain, but this is not the desired result. 4. The goal of high-dose steroids during an exacerbation is to decrease the inflammatory response in the internal organs and prevent permanent damage.

The client with early-stage RA is being discharged from the outpatient clinic. Which discharge instruction should the nurse teach regarding the use of nonsteroidal antiinflammatory drugs (NSAIDs)? 1. Take with an over-the-counter medication for the stomach. 2. Drink a full glass of water with each pill. 3. If a dose is missed, double the medication at the next dosing time. 4. Avoid taking the NSAID on an empty stomach.

4 1. This is prescribing, and the nurse is not licensed to do this unless the nurse has become a nurse practitioner. 2. NSAIDs do not require a specific amount of water to be effective, unlike bulk laxatives. 3. The medication should be taken in the usual dose when the client realizes a dose has been missed. 4. NSAID medications decrease prostaglandin production in the stomach, resulting in less mucus production, which creates a risk for the development of ulcers. The client should take the NSAID with food. TEST-TAKING HINT: Knowledge of medication administration is a priority for every nurse. It is especially important for the nurse to be familiar with commonly used medications such as NSAIDs, which can be purchased over the counter and may be taken by the client in addition to prescription medications.

The nurse enters the room of a female client diagnosed with SLE and finds the client crying. Which statement is the most therapeutic response? 1. "I know you are upset, but stress makes the SLE worse." 2. "Please explain to me why you are crying." 3. "I recommend going to an SLE support group." 4. "I see you are crying. We can talk if you would like."

4 1. Unless the nurse has SLE and has been through the exact same type of tissue involvement, then the nurse should not tell a client "I know." This does not address the client's feelings. 2. The nurse should never ask the client "why." The client does not owe the nurse an explanation of his or her feelings. 3. Support groups should be recommended, but this is not the best response when the client is crying. 4. The nurse stated a fact, "You are crying," and then offered self by saying "Would you like to talk?" This addresses the nonverbal cue, crying, and is a therapeutic response. TEST-TAKING HINT: The question asks for a therapeutic response, which means a feeling must be addressed. Therapeutic responses do not ask "why," so the test taker could rule out option "2."

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching?. 1.Pushing with palms when rising from a chair. 2.Holding packages close to the body. 3.Sliding objects. 4.Carrying a laundry basket with clinched fingers and fists.

4 Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods?. 1.Proper body alignment. 2.Elevating the part. 3.Prone lying positions. 4.Positions of flexion.

4 Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders"

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate?. 1."You are probably exercising too much. Decrease your exercise to every other day." 2."Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3."Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4."Take a warm tub bath or shower before exercising. This may help with your discomfort."

4 Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate?. 1."It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2."Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3."That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4."Every person is different. What works for one client may not always be effective for another."

4 The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings

The client with rheumatoid arthritis (RA) is prescribed hydroxychloroquine sulfate. Which statements indicate the client needs more teaching concerning the medication? Select all that apply. 1. "I will get my eyes checked every 6 months." 2. "I should not drink alcohol while taking this drug." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks." 5. "It is common to have a loss of balance while taking hydroxychloroquine sulfate."

4,5 1. Hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD), can cause pigmentary retinitis and vision loss, so the client should have a thorough vision examination every 6 months. The client does not need more teaching. 2. Hydroxychloroquine sulfate (Plaquenil), a DMARD, may increase the risk of liver toxicity when administered with hepatotoxic drugs; therefore, alcohol use should be eliminated during therapy. The client does not need more teaching. 3. The medication should be taken with milk to decrease gastrointestinal upset. The client does not need more teaching. 4. The medication hydroxychloroquine sulfate (Plaquenil), a DMARD, takes 3 to 6 months to achieve the desired response, and many clients do not experience signifi cant benefi ts. The client needs more teaching. 5. Loss of balance and coordination is an adverse effect of hydroxychloroquine sulfate (Plaquenil), a DMARD, and the client should notify the HCP. The client needs more teaching. MEDICATION MEMORY JOGGER: Drinking alcohol is always discouraged when taking any prescribed or OTC medication because of potential adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.