Elsevier ch. 64
The nurse is performing neurologic assessments for a patient with systemic lupus erythematosus (SLE) every four hours. After several examinations, the patient asks why this is necessary. What is the nurse's best response?
"Central nervous system (CNS) disorders are common in SLE, so frequent monitoring is important."
A patient voices concerns to the nurse about taking procainamide, stating that a friend was recently hospitalized for drug-induced systemic lupus erythematosus (SLE). What is the nurse's best response?
"Drug-induced SLE generally occurs months to year after continuous use of this drug."
When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement?
"I should try to stay standing all day to keep my joints from becoming stiff."
A patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease?
"I'm hoping that surgery will be an option for me in the future."
A woman with systemic lupus erythematosus (SLE) reports to the clinic that she has been attempting pregnancy for six months without success. What is the nurse's most appropriate response?
"Infertility can result from the SLE or from medications used to treat it."
A patient with systemic lupus erythematosus (SLE) inquires why it is important to have frequent urinalysis done. How should the nurse respond? Select all that apply.
"Kidney damage is very common in people with SLE." "Urinalysis will evaluate for proteinuria, which may be an early sign of renal complications."
The nurse is reinforcing general health teaching for a patient with osteoarthritis of the knees. Which statement by the patient demonstrates correct understanding of osteoarthritis?
"Osteoarthritis is more common with aging, but usually it remains confined to a few joints and does not cause crippling."
A patient with systemic lupus erythematosus (SLE) reports a low-grade fever and malaise. What response by the nurse would be the most appropriate?
"Please schedule a sick visit with the healthcare provider."
A patient with systemic lupus erythematosus (SLE) reports a low-grade fever and malaise. What response by the nurse would be the mostappropriate?
"Please schedule a sick visit with the healthcare provider."
A patient with systemic lupus erythematosus (SLE) is brought to the emergency room by ambulance after a grand mal seizure. The patient's family is visibly distraught, wondering if the patient is going to be diagnosed with another chronic medical disease. What is the nurse's best response?
"Seizures are a common occurrence in SLE but can ideally be managed with oral medications."
The nurse is educating a patient with arthritis in ways to protect the small joints. What should the nurse be sure to include when discussing these interventions? Select all that apply.
"Slide objects instead of picking them up." "Carry your laundry basket with both hands." "Use door knobs that are pushed rather than turned."
During an appointment, a patient with systemic lupus erythematosus (SLE) and suspected lung disease says she is interested in getting pregnant. How should the nurse best counsel the patient?
"Women with advanced SLE should consider alternative family-building options."
A woman with advanced systemic lupus erythematosus (SLE) who suffers from profound kidney and lung dysfunction would like to become pregnant. Based on the nurse's knowledge of SLE, what can the nurse tell the patient?
"Women with profound effects from SLE should not become pregnant."
A patient reports joint pain in six small joints going on for four weeks. There is a high positive rheumatoid factor (RF) and abnormal erythrocyte sedimentation rate (ESR). What is the patient's score according to rheumatoid arthritis classification criteria?
7
Which patient should the nurse expect to be at the highest risk for systemic lupus erythematosus (SLE)?
A 28-year-old Asian American female
The nurse is planning the discharge teaching for a patient with rheumatoid arthritis. Which alternative therapies should the nurse suggest? Select all that apply.
Hypnosis Use of a firm mattress Transcutaneous electrical nerve stimulation
A nurse is assessing a patient with rheumatoid arthritis. What questions should the nurse ask as part of this assessment? Select all that apply.
Are you allergic to aspirin? Do you feel stiffness in your joints? Have you undergone any joint surgery? Are you taking any medications currently?
To diagnose a patient with systemic lupus erythematosus (SLE), the patient must meet how many of the distinct criteria either simultaneously or in sequential evaluation?
Four
A patient is suspected of having systemic lupus erythematosus (SLE). Which would be considered diagnostic for systemic lupus erythematosus?
Anti-Smith antibody
A patient has been taking an antimalarial drug prescribed for systemic lupus erythematosus (SLE) but is unable to tolerate the side effects. What medication does the nurse anticipate educating the patient about that would be an alternate?
Antileprosy drug
What marker is found in a majority of patients diagnosed with systemic lupus erythematosus (SLE)?
Antinuclear antibody (ANA)
The nurse is preparing a patient for serum analysis of uric acid levels. Which condition does the nurse anticipate in the patient?
Gout
A patient newly diagnosed with systemic lupus erythematosus (SLE) is setting care goals with the nurse. What are the most appropriate goals for this patient? Select all that apply.
Adhere to the therapeutic regimen. Have satisfactory pain management. Maintain optimal role function and positive self-image. Demonstrate awareness of an avoid activities that worsen the disease.
A patient with systemic lupus erythematosus (SLE) is experiencing many psychosocial issues. How should the nurse educate the patient to help overcome this problem? Select all that apply.
Advise a consultation with a dermatologist. Counsel the patient that the disease has a good prognosis. Stress the planning of both recreational and occupational activities.
Survival in patients with systemic lupus erythematosus (SLE) is dependent on which factors? Select all that apply.
Age Sex Race Comorbid Conditions
A patient was started on hydralazine for hypertension after a recent hospitalization. The patient is accompanied by a parent who has systemic lupus erythematosus (SLE). What is the best intervention by the nurse?
Alert the healthcare provider to the medication and family history.
What integumentary change does the nurse expect to find in a patient with suspected systemic lupus erythematosus (SLE)?
Alopecia
Which patient diagnosed with systemic lupus erythematous (SLE) is at the highest risk for experiencing health care disparity?
An African American female
A patient has been prescribed diclofenac sodium. What precautions should the nurse inform the patient to take with its use? Select all that apply
Avoid exposure to sunlight. Do not coadminister with oral aspirin Avoid external heat or occlusive dressings.
The nurse is caring for a patient with systemic lupus erythematosus. To prevent an exacerbation of the condition, what should the nurse instruct the patient to avoid?
Becoming fatigued
What feature is characteristic of systemic lupus erythematosus (SLE)?
Butterfly rash
The nurse is performing an assessment for a patient with osteoarthritis (OA). When observing small nodules on the distal interphalangeal joints of the fingers, how does the nurse document these nodules?
Heberden's nodes
A patient with an acute systemic lupus erythematosus (SLE) flare is tearful and anxious. What is the most appropriate action of the nurse?
Hold the patient's hand and provide emotional support.
A nurse is caring for an older adult admitted to the hospital for osteoarthritis. What diagnostic tests will the nurse prepare the patient for that will determine the severity of the disease and plan the course of treatment? Select all that apply.
Computed tomography (CT) scan Magnetic resonance imaging (MRI) Erythrocyte sedimentation rate (ESR) blood test
A patient being treated with medication for systemic lupus erythematosus (SLE) has developed psychosis. Which medication should the nurse suspect may be causing this symptom?
Corticosteroids
Which assessment finding would alert the nurse to the presence of osteoarthritis in a patient admitted to the hospital after a fall?
Crepitus with knee movement
Which is an immunosuppressive agent used to treat lupus nephritis in systemic lupus erythematosus (SLE) patients?
Cyclophosphamide
The nurse is caring for a patient with osteoarthritis. What statement made by the patient demonstrates accurate knowledge of the disorder?
Degeneration of cartilage in synovial joints
A patient has just been given a diagnosis of osteoarthritis. The nurse explains that the associated changes in the joint are the result of what type of process?
Degenerative
The community health nurse is teaching a group of adults about prevention of osteoarthritis (OA). What important teaching points should the nurse include? Select all that apply.
Eat a balanced diet. Avoid cigarette smoking. Maintain a healthy weight.
The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to engage in what activity?
Eat a well-balanced diet to maintain a healthy body weight.
After a patient is diagnosed with systemic lupus erythematosus (SLE), the nurse educates the patient on the effects of sunlight on the disease. What is the best way for the nurse to do this?
Educates the patient on the importance of planning outdoor activities
The nurse is reviewing the laboratory results for a patient to differentiate between rheumatoid arthritis and osteoarthritis. What findings does the nurse anticipate will correlate with both? Select all that apply.
Elevated erythrocyte sedimentation rate Narrowed joint space on x-ray examination
A patient observes discoloration of urine during the course of the treatment for arthritis. What does the nurse infer from this observation? Select all that apply.
Excess medication is excreted in the urine. It will stop once the therapy is discontinued. This is a result of the interaction between the medications with the urine.
A patient has bilateral osteoarthritis of the knees. What should the nurse teach the patient that the most beneficial measure to protect the joints is?
Exercise regularly and maintain a well-balanced diet
A patient is diagnosed with septic arthritis and requires prompt treatment to prevent joint destruction and bone loss. Which nursing interventions would help achieve this goal? Select all that apply.
Explain need of antibiotics to patient. Support the patient who requires operative drainage. Assist in early identification of the causative organism. Assess and monitor joint inflammation, pain, and fever. Suggest use of resting splints to immobilize affected joints.
A patient reports to a rheumatology clinic with a swan neck deformity of the fingers of the left hand and is referred for laboratory testing for systemic lupus erythematosus (SLE). The patient calls back several days later saying, "The healthcare provider must be wrong. This has to be arthritis like my mother has." What is the nurse's best response?
Explain that arthritis is not the only medical condition that can cause joint deformities.
Which findings would the nurse associate with Stage III rheumatoid arthritis (RA)?
Extensive cartilage loss on x-ray
A common diagnostic feature of systemic lupus erythematosus (SLE) is the malar rash, which is characterized by what features?
Fixed erythema, flat or raised, usually in a butterfly pattern
The nurse is caring for a patient with mucocutaneous lesions, urethritis, and conjunctivitis. Which drug therapy does the nurse expect the primary health care provider to prescribe for the patient? Select all that apply.
Ibuprofen Methotrexate Sulfasalazine
A patient with systemic lupus erythematosus (SLE) has comorbid hypertension and hypercholesterolemia. The nurse educates the patient that he or she is at risk for secondary antiphospholipid syndrome, which could have which effect(s)?
Increased risk of stroke, heart attack, and gangrene
A patient with osteoarthritis (OA) is prescribed sulfasalazine and reports an orange discoloration of the urine. What is the most appropriate action for the nurse to take?
Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern.
The nurse is performing an assessment for a pregnant patient with systemic lupus erythematosus (SLE) that has just had an ultrasound. Which complication should the nurse be sure to assess for in this patient?
Intrauterine growth restriction
A pregnant patient is diagnosed with systemic lupus erythematosus (SLE). Which information about associated complications should the nurse give to the patient? Select all that apply.
Intrauterine growth retardation Stillbirth and spontaneous abortion High maternal and fetal risk due to organ involvement
The nurse is caring for a patient diagnosed with Reiter's syndrome. What does the nurse recognize is characteristic of this disease?
It is most often seen in individuals who are positive for HLA-B27.
Which hematologic disorders are frequently associated with systemic lupus erythematosus (SLE)? Select all that apply.
Leukopenia Hemolytic anemia Thrombocytopenia
A patient reports to the primary care clinic after being diagnosed with systemic lupus erythematosus (SLE). The patient's blood pressure is 175/90 mmHg. What does the nurse expect the healthcare provider to recommend? Select all that apply.
Low-sodium diet Complete metabolic panel Aggressive antihypertensive therapy with oral medications
A patient with systemic lupus erythematosus (SLE) arrives at the clinic with a one-month history of a cough. The patient also says, "Sometimes I feel like my heart is racing." What does the nurse suspect the patient may have?
Lung disease
The nurse is assessing a patient that has been bitten by a tick and has a "bulls eye rash" at the site. What disease should the nurse anticipate screening the patient for related to these symptoms?
Lyme disease
What are accurate statements regarding gender differences among patients experiencing OA? Select all that apply.
Men experience hip OA more often than women. Women have a higher incidence of hand OA than do men.
A nurse is instructing a group of caregivers about the home care of a patient with rheumatoid arthritis. What are the instructions that the nurse should include in the teaching? Select all that apply.
Never place pillows below the knees. Perform aquatic exercise in warm water. Use lifts and elevators instead of the stairs.
A patient is newly diagnosed with systemic lupus erythematosus (SLE) and reports joint pain. Which class of medication does the nurse anticipate educating the patient about that can relieve the pain?
Nonsteroidal antiinflammatory drugs (NSAIDs)
A patient is admitted to the hospital for further management of a systemic lupus erythematosus (SLE) flare. What actions does the nurse anticipate performing in the care of this patient? Select all that apply.
Obtain weight daily. Observe and record intake and output. Administer 125 mg methylprednisolone intravenously every six hours. Administer 2 mg hydromorphone intravenously (IV) as needed for pain rated 7 to 10.
An older adult patient is receiving corticosteroid therapy for rheumatoid arthritis. What should the nurse inform the patient a complication of this therapy might be?
Osteopenia
A patient with systemic lupus erythematosus (SLE) arrives at the emergency department with a two-day history of intermittent fever, fatigue, and pain. Which subjective symptoms does the nurse know must be assessed immediately? Select all that apply.
Pain ratings Fever patterns Joint inflammation
A nurse is caring for a patient with systemic lupus erythematosus (SLE) who is taking nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain. Which adverse effects of NSAID therapy should the nurse educate the patient about? Select all that apply.
Pallor Petechiae Tarry stools
A patient with systemic lupus erythematosus has developed osteoporosis related to the disease process. Which drug therapy does the nurse anticipate the patient will be prescribed?
Prasterone
The nurse is reviewing the report of a patient's synovial fluid analysis. Which findings would suggest the presence of rheumatoid arthritis? Select all that apply.
Presence of fibrin flecks Elevated white blood cell (WBC) count Increased matrix metallopeptidase (MMP)-3 enzyme
Which body systems can be affected in patients with systemic lupus erythematosus (SLE) who become pregnant? Select all that apply.
Renal Pulmonary Cardiovascular Central nervous system (CNS)
A patient is experiencing a side effect of antimalarial agent therapy for the treatment of systemic lupus erythematosus (SLE) patients. Which disorder does the nurse educate the patient is reversible when treatment is discontinued?
Retinopathy
A woman with systemic lupus erythematosus (SLE) who is one-month postpartum reports to the emergency room with fever, malaise, and severe pain for two days. She had been discharged from the hospital with similar symptoms one week ago. What is the most likely reason for readmission?
SLE flares are common in the postpartum period.
What environmental factors are believed to contribute to the occurrence of systemic lupus erythematosus (SLE)? Select all that apply.
Stress Viral infections Ultraviolet (UV) light exposure Exposure to chemicals and toxins
A patient is diagnosed with systemic lupus erythematosus (SLE). What neurologic manifestations should the nurse closely monitor for? Select all that apply.
Stroke Seizures Psychosis
A patient with systemic lupus erythematosus (SLE) arrives at a rheumatology clinic with persistent facial lesions, photosensitivity, polyarthralgia, and mild proteinuria. The nurse knows these symptoms constitute which syndrome?
Subacute cutaneous lupus
A patient with suspected systemic lupus erythematosus (SLE) has persistent lesions along with malar rashes, photosensitivity, and mild systemic disease. Which syndrome does the nurse document?
Subacute cutaneous lupus syndrome
The nurse is reviewing laboratory findings for a patient which demonstrate an increased serum creatinine, leukopenia, thrombocytopenia, the presence of anti-DNA antibody, and increased erythrocyte sedimentation rate (ESR). What does the nurse suspect the likely diagnosis may be?
Systemic lupus erythematosus (SLE)
A patient with gout asks the nurse why a low-purine diet is recommended. What explanation should the nurse provide?
The metabolism of purine results in the formation of uric acid.
The nurse is creating a plan of care for a patient with osteoarthritis. What would the nurse plan as an appropriate short-term goal for this patient?
The patient will participate in physical therapy activities
A patient with osteoarthritis of the knees has been taking celecoxib 200 mg every 12 hours. The patient states that the drug does not seem to work as well as it used to in controlling the pain. What does the nurse infer from the patient's statement?
This patient may respond better to an alternate nonsteroidal antiinflammatory drug (NSAID).
A patient asks why they have to continue to take oral prednisone for the treatment of systemic lupus erythematosus (SLE). What is the best response by the nurse? Select all that apply.
To control seizures To treat lupus nephritis
A patient is prescribed an antimalarial agent for the treatment of systemic lupus erythematosus (SLE) and states, "I don't have malaria. Why am I taking this" What is the best response by the nurse? Select all that apply.
To treat fatigue To treat moderate skin and joints disease
A patient with osteoarthritis (OA) is prescribed ibuprofen 800mg every eight hours for pain. What is an important nursing instruction when teaching the patient about safe drug administration?
Try to take ibuprofen with a meal or a snack.
Which diagnostic laboratory studies are utilized in the evaluation of systemic lupus erythematosus (SLE)? Select all that apply.
Urinalysis Serum complement Complete blood cell count (CBC)
A patient has recently been diagnosed with systemic lupus erythematosus (SLE). A nurse is educating the patient about common complications of this disorder, noting that it most commonly affects which body systems? Select all that apply.
Urologic Neurologic Integumentary Musculoskeletal Cardiopulmonary
A 30-year-old female patient with severe rheumatoid arthritis (RA) is prescribed methotrexate for disease management. What should the nurse instruct the patient to do?
Use effective contraception during and three months after treatment with methotrexate.
A nurse caring for a patient with osteoarthritis instructs the patient about the various nonpharmaceutical interventions for the management of pain. Which information should the nurse include in these instructions? Select all that apply.
Use of paraffin baths or hot packs Use of crutches or walker if required Regulation of a normal body mass index (BMI)
