Med Surg - Chapter 18 - Care of Patients with Arthritis and Other Connective Tissue Diseases

What nursing interventions may be performed to prevent dislocation of the hip joint in a patient who has undergone total hip arthroplasty (THA)? Select all that apply. 1 Avoid hip flexion beyond 90 degrees. 2 Use aseptic technique for wound care. 3 Instruct the patient to do leg exercises. 4 Instruct the patient to wear elastic stockings. 5 Assess acute pain, rotation, and extremity shortening.

1 Avoid hip flexion beyond 90 degrees. 5 Assess acute pain, rotation, and extremity shortening. Hip flexion beyond 90 degrees should be avoided because it and may lead to dislocation and also causes pain in the hip. Acute pain, rotation, and extremity shortening should be assessed after a THA. Using aseptic techniques for wound care would help in preventing infections. Instructing the patient to do leg exercises or to wear elastic stockings would help to prevent venous thromboembolism.

What teaching should the nurse provide to the older adult patient with osteoarthritis who is prescribed cyclobenzaprine hydrochloride? Select all that apply. 1 "Avoid driving." 2 "Avoid alcohol intake." 3 "Do not operate heavy machinery." 4 "Do not stand for a prolonged time." 5 "Take the drug before breakfast in the morning."

1 "Avoid driving." 2 "Avoid alcohol intake." 3 "Do not operate heavy machinery." Cyclobenzaprine hydrochloride is a skeletal muscle relaxant used to treat painful muscle spasms. The drug may also cause acute confusion. Patients taking this drug should not drive or operate heavy machinery. Alcohol use with cyclobenzaprine hydrochloride, a CNS depressant, may impair physical or mental abilities. Standing for a prolonged time might increase pain in patients with osteoarthritis, but this is not a teaching related to the cyclobenzaprine hydrochloride prescription. The drug is taken two or three times daily after food.

The primary health care provider prescribes a medication to a patient with osteoarthritis. During the follow-up visit, the patient reports dark tarry stools and indigestion. Which medication may be the cause of this finding? 1 Cortisone 2 Lidoderm 3 Ibuprofen 4 Hyaluronate

3 Ibuprofen Ibuprofen is a non-steroid anti-inflammatory drug that sometimes causes dark tarry stools and indigestion related to bleeding of the gastrointestinal tract. Cortisone is a steroid; overuse can cause osteonecrosis. Lidoderm is a topical medication used to control pain; side effects are skin irritation. Hyaluronate is used to relieve knee and hip pain associated with osteoarthritis. This medication may cause tingling and skin irritation around the knee.

A patient reports hair loss, swelling, and redness of knees to the nurse. The test reports of the patient reveal inflammation of five joints. Which condition does the nurse suspect in the patient? 1 Gout 2 Scleroderma 3 Lupus erythematosus 4 Raynaud's phenomenon

3 Lupus erythematosus Alopecia (hair loss), inflammation of the knees, and polyarthritis (inflammation of five or more joints) indicate lupus erythematosus. Gout is a systemic disease characterized by inflammation of joints due to deposition of urate crystals. Scleroderma or systemic sclerosis is characterized by hardening of the skin. Raynaud's phenomenon (a condition where the fingers turn blue, white, or red due to excess stress or cold conditions) is observed in patients with limited cutaneous systemic sclerosis.

What causes osteonecrosis? 1 Use of capsaicin 2 Use of chondroitin 3 Use of glucosamine 4 Use of corticosteroids

4 Use of corticosteroids Chronic corticosteroid therapy may result in osteonecrosis because these drugs can cause an interruption in blood flow. Capsaicin causes a burning sensation on the skin for a short period. Chondroitin helps to strengthen cartilage. Glucosamine may cause gastrointestinal disturbances.

A patient with rheumatoid arthritis reports pain when chewing and opening the mouth. Which joint involvement does the nurse suspect in this patient? 1 Cervical 2 Temporomandibular 3 Metacarpophalangeal 4 Proximal interphalangeal

2 Temporomandibular The involvement of the temporamandibular joint in rheumatoid arthritis may be manifested with pain when opening the mouth or chewing. The involvement of the cervical joint may cause cervical pain in the patient. Metacarpophalangeal joint involvement results in a slightly reddened, warm, stiff, and swollen arm. The proximal interphalangeal joint is not associated with the mouth.

Which drug is beneficial for a patient with osteoarthritis who is having painful muscle spasms? 1 Diclofenac 2 Hyaluronic acid 3 Acetaminophen 4 Cyclobenzaprine hydrochloride

4 Cyclobenzaprine hydrochloride Cyclobenzaprine hydrochloride is a muscle relaxant used to treat muscle spasms. Diclofenac, hyaluronic acid, and acetaminophen are used to treat pain associated with osteoarthritis but are not used to relieve muscle spasms.

What are the symptoms of secondary gout? Select all that apply. 1 Renal calculi 2 Hyperuricemia 3 Altered urination 4 Joint inflammation 5 Occurrence of tophi

1 Renal calculi 2 Hyperuricemia 3 Altered urination 5 Occurrence of tophi Secondary gout results in the formation of renal calculi, commonly known as kidney stones. It also affects urine output. The most common symptom of secondary gout is the appearance of tophi. The common sites of appearance are the arms and fingers near the joints and in the outer ear. Hyperuricemia and joint inflammation are manifestations of primary gout.

Which statement is associated with minimally invasive surgery? 1 It involves more scarring. 2 It results in a slow recovery. 3 It increases postoperative pain. 4 It enables a shorter hospital stay.

4 It enables a shorter hospital stay. Minimally invasive surgery requires a shorter hospital stay because of reduced muscle cutting. Minimally invasive surgery results in more scarring, a quick recovery, and decreased postoperative pain.

The student nurse is providing dietary instructions to a patient with gout. Which statement made by the student nurse needs correction? 1 "You should eat shellfish." 2 "You should avoid diuretics." 3 "You should avoid organ meats." 4 "You should take alkaline ash foods."

1 "You should eat shellfish." Shellfish contains a high amount of purine, which when ingested leads to increased production of uric acid. This can cause inflammation of joints. Therefore, gout patients should avoid shellfish. Diuretics may raise uric acid in blood; they should be avoided. Intake of organ meat should be avoided because this food results in the formation of urate crystals around the joints. Alkaline ash foods such as citrus fruits and juices will increase the urinary pH, which will subsequently prevent urinary stone formation.

What is the cause of primary osteoarthritis? 1 Aging 2 Obesity 3 Joint injury 4 Heavy manual work

1 Aging Primary osteoarthritis is caused by aging and genetic factors. As people age, proteoglycans, synovial fluid, and water decrease in the joint. Enzymes in the joint break down the articular matrix and the cartilage erodes. Eventually, inflammation will continue to cause deterioration in the joint space. Obesity, joint injury, and heavy manual work are causes of secondary osteoarthritis.

What are the factors that may lead to osteoarthritis (OA)? Select all that apply. 1 Aging 2 Obesity 3 Genetics 4 Rheumatoid arthritis (RA) 5 Systemic lupus erythematosus (SLE)

1 Aging 2 Obesity 3 Genetics OA is a common connective tissue disease characterized by progressive degradation of the cartilage in movable joints. Aging, obesity, and genetic factors are responsible for OA. Aging contributes to a decrease in bone density. Obesity can increase pressure on the joints. Recent studies support genetic changes may contribute to cartilage destruction, osteophyte formation, or the inability of cartilage to repair itself. RA and SLE do not increase the risk for OA; they are inflammatory disorders of the connective tissue.

Which drug is an interleukin-1 (IL-1) receptor antagonist? 1 Anakinra 2 Rituximab 3 Abatacept 4 Tocilizumab

1 Anakinra Anakinra is an IL-1 receptor antagonist. Rituximab is a monoclonal antibody. Abatacept is a selective T-lymphocyte co-stimulator modulator. Tocilizumab is an interleukin-6 (IL-6) inhibitor. These drugs are biological response modifiers (biologics) and are used for rheumatoid arthritis and other connective tissue diseases.

A patient is prescribed lidocaine 5% patches for knee pain. What does the nurse teach this patient about this therapy? 1 Apply the patch on clean, intact skin. 2 Keep the patch in place for 6 hours. 3 Avoid using more than one patch at a time. 4 Obtain a complete blood count before beginning therapy.

1 Apply the patch on clean, intact skin. Lidocaine patches should be placed on clean, intact skin. The patch can be kept in place for 12 hours a day. Three patches may be used at a time. A complete blood count is obtained before the patient begins nonsteroidal anti-inflammatory drug therapy.

What is the pathophysiology of Marfan syndrome? 1 Autosomal dominant disorder resulting from mutations in the fibrillin I gene (FBNI) 2 Complex syndrome associated with the HLA- 27 allele causing a triad of arthritis, conjunctivitis, and urethritis 3 Autoimmune, genetic-based disease affecting middle-aged and older women most often and causing proximal muscle weakness 4 Autoimmune, inflammatory disease affecting the spine and thought to be genetic (strongly associated with specific variations in the HLA- 27 allele on chromosome 6)

1 Autosomal dominant disorder resulting from mutations in the fibrillin I gene (FBNI) Marfan syndrome is an autosomal dominant disorder resulting from mutations in the fibrillin I gene (FBNI). Ankylosing spondylitis is a complex syndrome associated with the HLA- 27 allele causing a triad of arthritis, conjunctivitis, and urethritis. Polymyalgia rheumatica (PMR) is an autoimmune, genetic-based disease that affects middle-aged and older women most often and causes proximal muscle weakness. Ankylosing spondylitis is an autoimmune, inflammatory disease that affects the spine and is thought to be genetic.

Which laboratory and diagnostic tests are used to detect osteoarthritis (OA)? Select all that apply. 1 C-reactive protein assay 2 X-ray studies 3 Rheumatoid factor assay 4 Antinuclear antibody test 5 Magnetic resonance imaging

1 C-reactive protein assay 2 X-ray studies 5 Magnetic resonance imaging Assessment for OA includes serological and imaging studies. The high-sensitivity C-reactive protein (hsCRP) may be slightly elevated when synovial inflammation occurs. Imaging studies of OA include routine x-ray images and magnetic resonance imaging (MRI) to determine structural joint changes. Rheumatoid factor assay and antinuclear antibody testing are used for diagnosing rheumatoid arthritis.

Which drug may be administered to a patient undergoing knee arthroplasty to reduce postoperative pain? 1 Capsaicin 2 Cefazolin 3 Dalteparin 4 Enoxaparin

1 Capsaicin Capsaicin is a product used for reducing postoperative pain following total knee arthroplasty. It binds to C-fiber receptors and facilitates the release of extra calcium to enter the nerve cells. Cephalosporins such as cefazolin are antibiotics given 1 hour prior to surgery to reduce the risk for infection. Dalteparin and enoxaparin are anticoagulants given after surgery to prevent blood clots.

The nurse is caring for a patient who is diagnosed with early-stage Lyme disease. Which medication does the nurse anticipate will be included in the patient's pharmacologic plan of care? 1 Doxycycline 2 Golimumab 3 Pregabalin 4 Febuxostat

1 Doxycycline Doxycycline is prescribed during the uncomplicated stage of Lyme disease for 14 to 21 days. Golimumab is the first biologic that is administered once each month for psoriatic arthritis, not for early-stage Lyme disease. Pregabalin is approved for use in treating neuropathic pain, such as that which occurs with fibromyalgia, as well as for treatment of depression. Febuxostat is the drug of choice for patients with repeated acute episodes or with chronic gout.

When assessing the patient who is diagnosed with Lyme disease, which signs or symptoms does the nurse expect the patient to demonstrate? Select all that apply. 1 Erythema migrans 2 Itchy rash 3 Joint stiffness 4 Muscle pain 5 Podagra

1 Erythema migrans 3 Joint stiffness 4 Muscle pain In the early and localized stage I of Lyme disease, the patient appears with flu-like symptoms, erythema migrans (round or oval, flat or slightly raised rash), and pain and stiffness in the muscles and joints. Itchy rash is an early sign of psoriatic arthritis. Podagra, which is a classic sign of gout, refers to pain and inflammation in one or more small joints (usually the metatarsophalangeal joint of the great toe).

During the skin assessment of a patient, the nurse finds a "butterfly" rash. What diagnostic tests would the primary health care provider order to confirm the diagnosis? Select all that apply. 1 Immunoglobulins 2 Serum creatinine levels 3 Blood urea nitrogen (BUN) 4 Serum protein electrophoresis 5 Erythrocyte sedimentation rate (ESR)

1 Immunoglobulins 4 Serum protein electrophoresis 5 Erythrocyte sedimentation rate (ESR) Dry, scaly, raised rash on the face of patients with lupus erythematosus is known as a "butterfly" rash. Immunoglobulin tests, serum protein electrophoresis, and erythrocyte sedimentation rate (ESR) are laboratory tests used to diagnose lupus erythematosus. Serum creatinine levels and blood urea nitrogen (BUN) are kidney function tests, which are used to diagnose gout.

What are the stage II complications of Lyme disease? Select all that apply. 1 Meningitis 2 Dysrhythmias 3 Facial paralysis 4 Chronic fatigue 5 Memory problems

1 Meningitis 2 Dysrhythmias 3 Facial paralysis Meningitis, dysrhythmias, and facial paralysis are stage II complications, or early disseminated complications, of Lyme disease. These occur if Lyme disease is not treated or if the treatment is not successful 2-12 weeks after the tick bite. Chronic fatigue and memory problems are stage III complications that occur months to years after the tick bite if the disease is not treated.

Which statements may be used to describe osteoarthritis (OA)? Select all that apply. 1 Obesity is a risk factor. 2 It is an autoimmune disorder. 3 Its disease process is degenerative. 4 It usually affects the upper extremities first. 5 Its disease pattern is bilateral and symmetric.

1 Obesity is a risk factor. 3 Its disease process is degenerative. Osteoarthritis is the progressive deterioration and loss of cartilage in a joint. Obesity is a risk factor for osteoarthritis, and it is a degenerative disease process. Osteoarthritis occurs due to aging and may or may not be genetic, but it is not an autoimmune disorder. Osteoarthritis affects weight-bearing joints and hands, and it may be unilateral.

Which drug is an anticonvulsant medication often used to treat nerve pain in patients with fibromyalgia syndrome? 1 Pregabalin 2 Trazodone 3 Nortriptyline 4 Amitriptyline

1 Pregabalin Pregabalin is a gabapentin-like anticonvulsant medication used to treat nerve pain associated with fibromyalgia syndrome (FMS). Trazodone, nortriptyline, and amitriptyline are antidepressant medications often used to promote sleep and reduce pain or muscle spasm for patients with FMS.

What assessment finding helps the nurse to identify rheumatoid arthritis in a patient with joint pain? 1 Presence of bilateral joint swelling 2 Pain in weight-bearing joints 3 Crepitus may be felt or heard 4 Joint stiffness after inactivity

1 Presence of bilateral joint swelling Rheumatoid arthritis can be identified by the presence of bilateral joint swelling. It follows a bilateral, symmetric pattern affecting multiple joints. The patient with osteoarthritis manifests pain in weight-bearing joints. Crepitus may be felt or heard when the joints are put through range-of-motion exercises. Joint stiffness usually lasts less than 30 minutes after a period of inactivity.

The urinary analysis reports of a patient reveal the excretion of 850 mg of uric acid in 24 hours. Which medication would be beneficial to the patient? 1 Probenecid 2 Methotrexate 3 Imatinib mesylate 4 Hydroxychloroquine

1 Probenecid Excretion of uric acid greater than 750 mg uric acid in 24 hours indicates hyperuricemia, which is a sign of gout. Probenecid is a uricosuric medication that inhibits the renal excretion of organic anions and decreases the tubular reabsorption of urate. Methotrexate is an immunosuppressive agent used to treat lupus erythematosus. Imatinib mesylate is an oral tyrosine kinase inhibitor used to treat systemic sclerosis. Hydroxychloroquine is an anti-malarial medication used to reduce the risk of skin infections in patients with lupus erythematosus.

Which anti-rheumatic drugs are associated with allergic response after administration? Select all that apply. 1 Rituximab 2 Abatacept 3 Tocilizumab 4 Golimumab 5 Adalimumab

1 Rituximab 2 Abatacept 5 Adalimumab Rituximab may cause infusion reactions. Therefore, infusion reactions such as dyspnea, wheezing, flushing, and itching should be carefully monitored for by the nurse. Abatacept may also be associated with mild to moderate allergic reactions. Adalimumab may cause site reactions, which indicate local allergic response. Tocilizumab may cause a decrease in WBC platelet count and is not specifically associated with allergic reactions. Golimumab may cause serious opportunistic infections. It is not associated with allergic reactions.

What are the clinical manifestations of dermatomyositis? Select all that apply. 1 Severe muscle weakness 2 Iritis 3 Eyelid rash 4 Periorbital edema 5 Weight loss

1 Severe muscle weakness 3 Eyelid rash 4 Periorbital edema Dermatomyositis is an inflammatory disease of skeletal muscle that causes symmetric weakness and atrophy and has an accompanying rash. Patients with this disease typically have severe muscle weakness, dysphagia, periorbital edema, and lilac eyelid rash. Malignant neoplasms are seen in older patients. Weight loss and malaise are seen in ankylosing spondylitis.

In order to provide emotional support, which referrals should the nurse include in the plan of care for a patient? Select all that apply. 1 Spiritual leader 2 Anesthesiologist 3 Physical therapist 4 Religious leader 5 Psychological counselor

1 Spiritual leader 4 Religious leader 5 Psychological counselor When planning emotional support for a patient, the nurse should include referrals for a spiritual leader, religious leader, and/or a psychological counselor. Referrals to an anesthesiologist (for pain management) and physical therapist (to promote range of movement) are often necessary for the nurse to include in the physiological, not psychosocial, plan of care.

The primary health care provider prescribes epoetin alfa to a patient before knee replacement surgery. What is the reason behind this prescription? 1 To prevent anemia 2 To prevent infection 3 To prevent vomiting 4 To prevent prosthetic failure

1 To prevent anemia Epoetin alfa is a recombinant human erythropoietin that is essential for developing red blood cells. Epoetin alfa is prescribed to patients before surgery to prevent anemia. Epoetin alfa is not prescribed to prevent infection, vomiting, or prosthetic failure.

Which instructions for joint protection does the nurse recommend for a patient with a connective tissue disease? Select all that apply. 1 Use long-handled devices such as a reacher. 2 When getting out of bed, use fingers to push off. 3 Sit in a low-back chair. 4 Bend at the waist while keeping the back straight. 5 Use adaptive devices such as Velcro closures. 6 Turn a doorknob clockwise.

1 Use long-handled devices such as a reacher. 5 Use adaptive devices such as Velcro closures. Use of long-handled devices such as a reacher and other adaptive devices like Velcro closures help to protect the joints. When getting out of bed, the patient should not push off with fingers but use the entire palm of both hands. Patients with connective tissue disease should sit in a chair that has a high, straight back and should bend at the knees while keeping the back straight. Doorknobs should be turned counterclockwise to avoid twisting the arm and promoting ulnar deviation.

Which drugs need to be discontinued before surgery to decrease the risk for venous thromboembolism? Select all that apply. 1 Vitamin C 2 Vitamin K 3 Antianginal drugs 4 Oral contraceptive drugs 5 Nonsteroidal anti-inflammatory drugs

1 Vitamin C 4 Oral contraceptive drugs 5 Nonsteroidal anti-inflammatory drugs Vitamin C, oral contraceptive drugs, and nonsteroidal anti-inflammatory drugs increase the risk of bleeding and clotting, which results in venous thromboembolism. Therefore, these drugs should be discontinued about a week before surgery. Vitamin K is a coagulant that does not increase the risk of bleeding. Antianginal drugs do not increase the risk of bleeding.

After assessing a patient with osteoarthritis, the nurse suspects crepitus. Which finding supports the nurse's assessment? 1 Inflammation near the joint 2 Grating heard when the joint is palpated 3 Enlarged joint with bone hypertrophy 4 Bony nodules at the distal interphalangeal joint

2 Grating heard when the joint is palpated Crepitus is a condition in which the cartilage disintegrates and pieces of bone and cartilage float in the diseased joint. A grating sound can be heard because of loosened bone and cartilage in the joint. Secondary synovitis occurs if inflammation is present near the joint. An enlarged joint with bone hypertrophy indicates an advanced stage of the disease. Bony nodules at the distal interphalangeal joint indicate Heberden's nodes.

The nurse is caring for an older adult patient diagnosed with osteoarthritis. Which patient statement indicates to the nurse that the patient is using effective coping strategies? 1 "I do not know how long my wife will be able to take care of me at home." 2 "The bus is coming to pick me up from the senior center three times a week so I can play cards." 3 "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." 4 "I do not know how much longer my neighbor can continue to help clean my house."

2 "The bus is coming to pick me up from the senior center three times a week so I can play cards." Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support. Caregiving responsibilities can be a source of stress; the patient worrying about his wife's caregiving abilities does not indicate that the patient is effectively coping. Routine tasks like doing dishes and laundry need to be reassigned, or effective pain management should be instituted before activities are undertaken to demonstrate effective coping. Neighbors are not reliable resources for in-home needs, and asking a neighbor to help does not indicate that the patient is coping effectively.

The student nurse is preparing a patient with osteoarthritis for home care self-management. Which nursing instruction needs correction? 1 "Do not bend at your waist." 2 "Turn doorknobs clockwise." 3 "Use a small pillow under your head." 4 "Use utensils with an extended handle for eating."

2 "Turn doorknobs clockwise." Patients with osteoarthritis should turn doorknobs counterclockwise to avoid twisting the arm, which promotes ulnar deviation. Patients should bend at the knees and not the waist because the back should be kept straight. A small pillow should be used under the head to support the neck. Utensils with an extended handle should be used to assist with eating.

While assessing a patient with fever, pain, and fatigue, the nurse notices joint inflammation and myositis. Which medication does the nurse anticipate will be prescribed? 1 Topical cortisone 2 Acetaminophen 3 Methotrexate 4 Hydroxychloroquine

2 Acetaminophen Fever, fatigue, joint inflammation, and myositis are symptoms of systemic lupus erythematosus (SLE). Therefore, the patient may be prescribed acetaminophen as this medication is used to treat joint and muscle pain and inflammation. Topical cortisone promotes fading of skin lesions. Methotrexate may be useful in patients with renal or central nervous system lupus. Hydroxychloroquine helps decrease the risk for skin lesions by decreasing the absorption of ultraviolet light by the skin.

What should be the first intervention for a patient with systemic lupus erythematosus (SLE) when there is severe renal involvement? 1 Prepare the patient for plasmapheresis. 2 Administer immunosuppressants and steroids. 3 Prepare the patient for kidney transplantation. 4 Administer high doses of intravenous glucocorticoids.

2 Administer immunosuppressants and steroids. Immunosuppressants and steroids are administered as the first choice of therapy when there is severe renal involvement in a patient with SLE. Plasmapheresis is a process of separating plasma from the cells. Patients who do not respond to immunosuppressants and steroid therapy would be scheduled for plasmapheresis. Kidney transplantation might be performed if the patient does not respond to drug therapies. A high dose of intravenous glucocorticoids might be administered if the patient does not respond to immunosuppressant and steroid therapy.

A patient is diagnosed with systemic sclerosis and esophagitis. What nursing interventions are beneficial? Select all that apply. 1 Providing liquids in the diet 2 Administering histamine antagonists 3 Providing three large meals each day 4 Providing little amount of caffeine in the diet 5 Elevating the head of the patient at least 60 degrees starting at the beginning of a meal until an hour after eating

2 Administering histamine antagonists 5 Elevating the head of the patient at least 60 degrees starting at the beginning of a meal until an hour after eating Administering histamine antagonists will help to reduce and neutralize gastric acid. The patient's head should be elevated 60 degrees from the start of a meal to an hour after eating to discourage reflux. A patient with systemic sclerosis and esophagitis should take small, frequent meals rather than three large meals per day. Caffeine increases the gastric secretion and should be avoided.

Which medication would the nurse expect to be prescribed for the patient with Lyme disease? 1 Allopurinol 2 Amoxicillin 3 Colchicine 4 Ustekinumab

2 Amoxicillin Antibiotic therapy, such as doxycycline or amoxicillin, is prescribed during the uncomplicated stage of Lyme disease for 14 to 21 days. Allopurinol and colchicine are both drugs used to treat gout. Ustekinumab targets the cytokines interleukin (IL)-12 and IL-23 to decrease inflammation and is used to treat psoriatic arthritis.

While reviewing the medical reports of a patient, the nurse finds that the patient has class IV pulmonary arterial hypertension. Which medication would be prescribed? 1 Nilotinib 2 Bosentan 3 Probenicid 4 Febuxostat

2 Bosentan Bosentan is an endothelin receptor antagonist that promotes the narrowing of the blood vessels causing high blood pressure, or hypertension. Nilotinib is an oral tyrosine kinase inhibitor that treats systemic sclerosis. Probenicid and febuxostat are used to treat gout.

Which syndrome is characterized by the presence of rheumatoid nodules in the lungs? 1 Felty's syndrome 2 Caplan's syndrome 3 Sjogren's syndrome 4 Carpal tunnel syndrome

2 Caplan's syndrome Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs. Felty's syndrome is characterized by leukopenia and hepatosplenomegaly. Dryness of the eyes, mouth, and vagina is a characteristic feature of Sjogren's syndrome. Carpal tunnel syndrome is caused by the compression of the median nerve in the wrist.

Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? 1 Feeling tired and having a temperature that runs about 100° F (37.8° C) during the day 2 Disfiguring and embarrassing rash 3 Peripheral neuropathies and cranial nerve palsies 4 High risk for renal inflammation

2 Disfiguring and embarrassing rash Skin lesions are common to SLE and DLE. Fatigue and fever are common only to SLE. Neurologic manifestations and inflammation of the kidneys are common in SLE.

Which finding in the physical assessment may be associated with osteoarthritis? 1 Depression 2 Impaired mobility 3 Altered body image 4 Decreased quality of life

2 Impaired mobility Impaired mobility is a clinical manifestation in a patient with osteoarthritis. It occurs due to pain and inflammation in the joints. Depression, altered body image, and decreased quality of life are psychosocial changes associated with osteoarthritis.

Which syndrome is characterized by symptoms such as scoliosis and excessive height with elongated hands and feet? 1 Reiter's syndrome 2 Marfan syndrome 3 Fibromyalgia syndrome 4 Chronic fatigue syndrome

2 Marfan syndrome Marfan syndrome is an autosomal dominant disorder that occurs due to a mutation of the fibrillin I gene (FBNI). Fibrillin helps in limiting the stretch of elastic connective tissues and in allowing them to return to their original shape. Due to a mutation in this gene, there is elongation of the hands and feet, excessive height, and an abnormal curving of the spine (scoliosis). Reiter's syndrome is associated with joint pain, eye infection, and burning infection. Fibromyalgia syndrome is associated with pain, stiffness, and tenderness in upper chest, trunk, and lower extremities. Chronic fatigue syndrome is associated with sore throat, memory impairment, and muscle pain.

Which element is a risk factor for osteoarthritis (OA)? 1 Thin build 2 Obesity 3 Non-smoker 4 Male

2 Obesity Being obese, not thin, places an individual at higher risk for slow joint degeneration and the development of OA. Smoking leads to knee cartilage loss, especially in patients with a family history of knee OA. Women tend to develop OA more than men, and it is believed that obesity may be a contributing factor; as women age and have children, they tend to gain more weight than men.

Which genitourinary manifestation may occur in fibromyalgia syndrome? 1 Dyspnea 2 Pelvic pain 3 Constipation 4 Abdominal pain

2 Pelvic pain Fibromyalgia is a chronic pain syndrome characterized by stiffness and tenderness in back of the neck, lower back, and extremities. Genitourinary manifestations are characterized by pelvic pain, dysuria, and urinary frequency and urgency. Dyspnea is a cardiovascular manifestation of fibromyalgia syndrome. Constipation and abdominal pain are gastrointestinal manifestations.

While assessing a patient with acute gout, the nurse finds inflammation of joints of the great toe. Which condition doe the nurse suspect in the patient? 1 Tophi 2 Podagra 3 Calcinosis 4 Periungual lesions

2 Podagra Severe pain and inflammation in one or more small joints of the great toe indicates podagra. Tophi are the deposition of sodium urate crystals in the fingers; this condition occurs in patients with chronic gout. Calcinosis is deposition of calcium, which occurs in patients with systemic sclerosis. Periungual lesions are vasculitic lesions around the nail beds of patients with systemic sclerosis.

The nurse is assisting a patient who had a right total hip arthroplasty with getting up from bed. What action does the nurse take? 1 Stands on the left side of the bed when assisting patient 2 Reminds the patient to stand on the left leg after getting out of bed 3 Lifts the patient and assists the patient to stand 4 Asks the patient to pivot on the right side to sit in the chair

2 Reminds the patient to stand on the left leg after getting out of bed The nurse should remind the patient to stand on the left leg after getting out of bed, which prevents the patient from putting undue pressure on the right leg. The nurse should stand on the same side of the bed as the patient's affected side to provide support. The nurse should not lift the patient and assist the patient to stand. The patient should pivot on the stronger left side to sit in the chair.

Systemic necrotizing vasculitis is characterized by ischemia. What are the clinical manifestations observed with cerebral ischemia? Select all that apply. 1 Vertigo 2 Severe pain 3 Skin lesions 4 Necrosis of fingers or toes 5 Visual changes

2 Severe pain 4 Necrosis of fingers or toes Necrotizing vasculitis is a term for a group of diseases whose primary manifestation is arteritis (inflammation of arterial walls), which causes ischemia in the tissues usually supplied by the involved vessels. Clinical manifestations of peripheral arterial disease are severe pain and necrosis of toes or fingers. Vertigo and visual changes would be seen with cerebral vasculitis. Hypersensitivity vasculitis is characterized by skin lesions as an allergic response to drugs, infections, or tumors. Malignant neoplasms are often observed in patients with dermatomyositis.

What interventions should be performed for a patient with polymyositis? Select all that apply. 1 Managing organ dysfunction 2 Teaching about dietary needs 3 Providing support for physical therapy 4 Frequent echocardiography monitoring 5 Teaching about complications of long-term steroid therapy

2 Teaching about dietary needs 3 Providing support for physical therapy 5 Teaching about complications of long-term steroid therapy Health teaching about dietary needs, providing support for physical therapy, and teaching about long-term steroid therapy are the interventions performed for a patient with polymyositis. Management of organ dysfunction is an intervention performed for a patient with systemic necrotizing vasculitis. Frequent echocardiography monitoring is an intervention performed for patients with Marfan syndrome.

What is the drug of choice to treat fibromyalgia syndrome (FMS) in a 72-year-old patient with memory impairment? 1 Tramadol 2 Trazodone 3 Amitriptyline 4 Nortriptyline

2 Trazodone Trazodone is preferred to treat fibromyalgia syndrome in elderly patients because it has minimal side effects and it can be used in patients with memory impairment. Tramadol is an opioid analgesic used to relieve pain and helps in the management of FMS. Amitriptyline and nortriptyline are tricyclic antidepressants. They cause confusion and orthostatic hypotension and are therefore used cautiously in elderly patients with FMS.

A patient diagnosed with rheumatoid arthritis (RA) is started on methotrexate. Which statement made by the patient indicates to the nurse that further teaching is needed regarding drug therapy? 1 "Drinking alcoholic beverages should be avoided." 2 "The health care provider should be notified 3 months before a planned pregnancy." 3 "Any side effects of this drug will be mild." 4 "I will avoid any live vaccines."

3 "Any side effects of this drug will be mild." Methotrexate can have devastating side effects and toxic effects, and the patient should be carefully monitored when taking this drug; this statement indicates the patient needs further clarification. Alcoholic beverages increase the risk for hepatotoxicity and should be avoided. Strict birth control is recommended for any patient of childbearing age because of the possibility of birth defects. Severe reactions may occur when live vaccines are given because of the immunosuppressive effect of methotrexate.

Which instructions should the nurse give to ensure drug safety in a patient with gout who is prescribed febuxostat? Select all that apply. 1 "Take the drug before meals." 2 "Have your blood pressure checked regularly." 3 "Drink a glass of water after taking each dose." 4 "Undergo a liver function test every 2 months." 5 "Have a complete blood count check periodically."

3 "Drink a glass of water after taking each dose." 4 "Undergo a liver function test every 2 months." 5 "Have a complete blood count check periodically." Febuxostat causes an increase in serum creatinine levels. Drinking a glass of water after taking the drug helps in preventing renal dysfunction. Liver function tests should be performed every 2 months because liver enzymes should be monitored. A complete blood count check should be performed periodically because the drug causes bone marrow depression. The drug should be taken after meals. Having blood pressure checked regularly is good for health maintenance but is not related to taking febuxostat.

The nurse is teaching a patient about taking etanercept for psoriatic arthritis. Which statement by the patient indicates that further teaching is needed? 1 "I'm comfortable self-administering etanercept." 2 "I will not take etanercept if I have an infection." 3 "I can use heat at the injection site if an itchy rash develops." 4 "If I get a respiratory infection, I will seek immediate care."

3 "I can use heat at the injection site if an itchy rash develops." Ice, not heat, and hydrocortisone 1% cream should be applied if a red, itchy rash develops at the injection site. The patient will self-administer etanercept injections. The patient should discontinue use of etanercept and seek immediate care if an infection develops.

Which statement by the patient indicates a need for further teaching about self-management of systemic lupus erythematosus? 1 "I will use moisturizers." 2 "I will pat my skin dry after showers." 3 "I will use sunblock with sun protection factor (SPF) 15." 4 "I will wear long sleeves and cover my legs when going out in the sunlight."

3 "I will use sunblock with sun protection factor (SPF) 15." Sunblock with SPF of 30 or higher should be used. Sunblock with SPF of 15 is not strong enough to protect the skin from sunlight. Moisturizers should be used to keep the skin moist and should be applied on dry skin areas. Rubbing should be avoided; instead, the skin should be patted dry. Pants or long dresses with long sleeves to protect the skin should be worn when going out in the sunlight.

The nurse is caring for a middle-aged patient diagnosed with rheumatoid arthritis. Which patient statement requires further assessment for unproductive coping strategies? 1 "I'm letting my husband do most of the cooking, but I help plan the menus." 2 "Since I started taking etanercept, I can walk up and down the stairs of my home easier." 3 "My husband is getting used to having sex only once a month." 4 "I worry about what's going to happen to me if my husband cannot take care of me, but he says he'll hire someone if he must."

3 "My husband is getting used to having sex only once a month." The patient's comment that her husband is getting used to sex only once a month could indicate negative body image or depression; additional open-ended questions by the nurse are required. Being involved in the meal process is a productive coping strategy. The patient's statement about the positive effects of etanercept therapy indicates productive coping because it describes improved mobility. Expressing concerns about the future but then identifying a plan is a productive coping strategy.

A patient is diagnosed with osteoarthritis (OA). Which medication is considered the primary drug of choice for treatment? 1 Methotrexate (MTX) 2 Adalimumab 3 Acetaminophen 4 Leflunomide

3 Acetaminophen Drug therapy in OA is used for reducing pain caused by cartilage damage. The American Pain Society recommends acetaminophen as the primary choice of drug for osteoarthritis. Methotrexate, adalimumab, and leflunomide are drugs used in the treatment of rheumatoid arthritis (RA).

The patient who is diagnosed with severe psoriatic arthritis is scheduled to receive an oral retinoid medication. Which medication will the nurse anticipate administering to the patient? 1 Alefacept 2 Golimumab 3 Acitretin 4 Ustekinumab

3 Acitretin Acitretin is an oral retinoid given for patients with severe psoriatic arthritis. Golimumab is the first biological response modifier (biologic) that is administered only once each month for psoriatic arthritis. Ustekinumab, which is also a biologic, targets the cytokines interleukin (IL)-12 and IL-23 to decrease inflammation. Alefacept is an IV immunosuppressive drug.

Which medication treats chronic gout? 1 Colchicine 2 Pegloticase 3 Allopurinol 4 Indomethacin

3 Allopurinol Allopurinol is a xanthine oxidase inhibitor that is used in the treatment of chronic gout. Colchicine is used in the treatment of acute gout. Pegloticase is used in the treatment of refractory gout. Indomethacin is used in the treatment of acute gout.

A patient who recently underwent total hip arthroplasty and is on anticoagulants is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the patient and caregiver? 1 Use an abduction pillow between the legs. 2 Keep heels off the bed. 3 Avoid using a straight razor. 4 Reorient frequently.

3 Avoid using a straight razor. The patient will be on anticoagulants for 4-6 weeks at home and should avoid injury to the skin, including when shaving. Using an abduction pillow between the legs is usually done immediately after surgery, especially if the patient is confused or restless and cannot maintain proper joint positioning. Keeping the heels off the bed prevents pressure ulcers during the in-hospital postoperative period. Changes in mental status can occur immediately after surgery as a result of anesthesia.

What medication treats central nervous system (CNS) lupus? 1 Nilotinib 2 Bosentan 3 Azathioprine 4 Acetaminophen

3 Azathioprine Azathioprine is an immunosuppressant used to treat central nervous system (CNS) or renal lupus. Nilotinib is an oral tyrosine kinase inhibitor that is used to treat systemic sclerosis. Bosentan is an endothelin receptor antagonist, which is used to treat systemic sclerosis. Acetaminophen is a non-steroidal anti-inflammatory drug that is used to treat joint pain, muscle pain, and inflammation.

What may be the medications provided to prevent osteoporosis in the patient with rheumatoid arthritis who is prescribed long-term steroid therapy? 1 Calcium 750 mg and vitamin D 100 mg daily 2 Calcium 1000 mg and vitamin D 200 mg daily 3 Calcium 1500 mg and vitamin D 400 mg daily 4 Calcium 1800 mg and vitamin D 500 mg daily

3 Calcium 1500 mg and vitamin D 400 mg daily Osteoporosis is a complication of glucocorticoid therapy; therefore, adequate calcium and vitamin D should be taken to prevent osteoporosis. Calcium 1500 mg and vitamin D 400 mg are recommended for patients receiving glucocorticoid therapy. Calcium 750 mg and vitamin D 100 mg and calcium 1000 mg and vitamin D 200 mg are not sufficient to prevent osteoporosis. Calcium 1800 mg and vitamin D 500 mg are higher doses than are required for patients receiving glucocorticoid therapy.

Which dietary supplements may be prescribed specifically to a patient with osteoarthritis (OA)? Select all that apply. 1 Iron 2 Garlic 3 Chondroitin 4 Glucosamine 5 Niacin

3 Chondroitin 4 Glucosamine The intake of dietary supplements can replace traditional drug therapy for decreasing OA pain and repairing cartilage. Chondroitin strengthens cartilage, and glucosamine decreases inflammation. Iron, garlic, and niacin are not used specifically to manage OA.

Which type of disorder is fibromyalgia syndrome (FMS)? 1 Autoimmune 2 Inflammatory 3 Chronic pain 4 Connective tissue

3 Chronic pain Fibromyalgia syndrome is a chronic pain syndrome that specifically affects the trigger points of the back of the neck, upper chest, trunk, low back, and extremities. It is not accurately described as an autoimmune, inflammatory, or connective tissue disorder.

Which metabolic disorder may be responsible for the development of joint degradation in the patient with osteoarthritis (OA)? 1 Aging 2 Hemophilia 3 Diabetes mellitus 4 Sickle cell disease

3 Diabetes mellitus Diabetes mellitus causes reduced insulin production which results in an elevated blood glucose level. This can lead to an inflammatory state resulting in OA. Aging is not a metabolic disorder. Hemophilia and sickle cell disease are blood disorders that may also cause joint degeneration.

What are the clinical manifestations of temporal arteritis? Select all that apply. 1 Fever 2 Stiffness 3 Headache 4 Weight loss 5 Visual disturbances

3 Headache 5 Visual disturbances Temporal arteritis is commonly known as giant cell arteritis and is seen in 20% of patients with polymyalgia rheumatic (PMR). The clinical manifestations of temporal arteritis are headache and visual disturbances. Fever and weight loss are systemic manifestations of temporal arteritis. Stiffness is a myalgic manifestation of the disease if the patient also has PMR.

A patient with suspected rheumatoid arthritis had an arthrocentesis. Which components present in the synovial fluid would indicate rheumatoid arthritis? Select all that apply. 1 Platelets 2 Red blood cells 3 Immune complex 4 Inflammatory cells 5 Rheumatoid factor

3 Immune complex 4 Inflammatory cells 5 Rheumatoid factor Arthrocentesis is an invasive procedure that aspirates synovial fluid. The fluid is analyzed for immune complexes, inflammatory cells, and rheumatoid factor. Platelets may not be found in the synovial fluid of a patient with rheumatoid arthritis. The patient's red blood cell count is not a measure associated with rheumatoid arthritis.

Which statement is true regarding systemic sclerosis? 1 It involves pancytopenia. 2 It is characterized by nephritis. 3 It is also called progressive systemic disease. 4 It is also called chronic progressive inflammatory connective tissue disorder.

3 It is also called progressive systemic disease. Systemic sclerosis was formerly called progressive systemic disease. Systemic sclerosis does not involve pancytopenia; it involves arthralgia and dysphagia. The disease is not characterized by nephritis, but it is involved with kidney failure. Systemic sclerosis is an uncommon, inflammatory, autoimmune connective tissue disorder, which may not always be progressive.

Which antirheumatic drug acts by inhibiting tyrosine kinase? 1 Infliximab 2 Etanercept 3 Abatacept 4 Tofacitinib

4 Tofacitinib Tofacitinib is a tyrosine kinase inhibitor (TKI). Tyrosine kinases usually facilitate cytokine-mediated (e.g., interleukin) signals that promote the inflammatory process. Infliximab inhibits the tumor necrosis factor—alpha (TNFA). Etanercept also produces the desired effects in rheumatoid arthritis by inhibiting TNFA. Abatacept inhibits T-lymphocyte co-stimulator modulator.

While reviewing the previous medical records of a patient with a "butterfly" rash, the nurse finds that the patient has been on prednisone therapy for 5 years. Which complications are likely to occur in the patient? Select all that apply. 1 Pancreatitis 2 Organ failure 3 Osteonecrosis 4 Muscle atrophy 5 Mesentric arteritis

3 Osteonecrosis 4 Muscle atrophy A "butterfly" rash is a dry, scaly, raised rash on the face of patients with systemic lupus erythematosus. Prednisone is a corticosteroid whose chronic use results in osteonecrosis. Long-term exposure to corticosteroids results in muscle wasting, which is known as muscle atrophy. Pancreatitis results from arteritis of the pancreatic artery. Organ failure occurs due to vasculitis affecting any major or small vessels. Arteritis of the pancreatic artery will cause mesentric arteritis.

A patient presents in the emergency department with dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness. Which disease is consistent with these assessment findings? 1 Ankylosing spondylitis 2 Polymyalgia rheumatica 3 Polymyositis/dermatomyositis 4 Reiter's syndrome

3 Polymyositis/dermatomyositis Dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness along with malignant neoplasms in an older patient are signs and symptoms of polymyositis/dermatomyositis. Ankylosing spondylitis, polymyalgia rheumatic, and Reiter's syndrome do not produce all these symptoms.

After reviewing the prescription list of a patient with rheumatoid arthritis, the nurse advises calcium supplements. Which drug on the patient's prescription list requires calcium supplements to prevent side effects? 1 Infliximab 2 Abatacept 3 Prednisone 4 Methotrexate

3 Prednisone Prednisone is associated with the risk of osteoporosis, so calcium supplementation is recommended for patients on prednisone therapy. Infliximab, abatacept, and methotrexate do not cause osteoporosis; therefore, calcium supplementation is not needed.

What is the benefit of prescribing trazodone over other tricycle antidepressants such as amitriptyline to treat fibromyalgia? 1 Reduce pain 2 Promote sleep 3 Reduce confusion 4 Reduce muscle spasms

3 Reduce confusion Tricyclic antidepressants, such as amitriptyline or nortriptyline, can cause confusion and orthostatic hypotension, especially in the older population. Trazodone may be preferred for this population because of its minimal side effects. Trazodone promotes sleep and reduces pain and muscle spasms, as do the other tricyclic antidepressants.

While assessing a patient with systemic lupus erythematosus, the nurse finds that the patient has chest pain. Which is the appropriate nursing intervention? 1 Administering analgesics 2 Providing comfort measures 3 Reporting to the primary health care provider 4 Notifying to primary health care provider as a common observation

3 Reporting to the primary health care provider Chest pain in patients with systemic lupus erythematosus occurs as a result of pericarditis, which is a cardiovascular manifestation. The nurse should immediately notify the primary health care provider if the patient complains of chest pain. The nurse should administer analgesics only on the order of the primary health care provider. Providing comfort measures may provide relief, but it is not the appropriate intervention. Chest pain is not a common observation.

A patient with rheumatoid arthritis says to the nurse, "My eyes feel gritty." Further assessment reveals that the patient also has redness in the eyes and no tears. What does the nurse suspect in this patient? 1 Felty's syndrome 2 Caplan's syndrome 3 Sjogren's syndrome 4 Carpel tunnel syndrome

3 Sjogren's syndrome The patients with Sjogren's syndrome may have dry eyes and experience a gritty sensation. Felty's syndrome is characterized by leukopenia and hepatosplenomegaly. Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs. Carpal tunnel syndrome is caused by the compression of the median nerve in the wrist.

A construction worker who reports pain in the vertebral column and hips is diagnosed with secondary osteoarthritis (OA). What does the nurse tell the patient may have been the cause? 1 Aging 2 Genetic changes 3 Trauma or abuse 4 Obesity

3 Trauma or abuse Secondary OA occurs from trauma to the joints due to excessive use or abuse. Heavy manual occupations such as construction work causes high-intensity or repetitive stress to the joints. Primary OA may be triggered by aging, genetic changes, or obesity.

What is the dosage limit of acetaminophen in the treatment of osteoarthritis (OA)?___ mg

3000 mg Acetaminophen may cause liver disorders if the patient takes more than 3000 mg daily of acetaminophen. Liver enzymes must be monitored in patients with OA who are regularly taking acetaminophen.

Which statement given by the patient would make the nurse suspect a diagnosis of Raynaud's phenomenon? 1 "I have difficulty swallowing." 2 "I find red-colored lesions around my nail beds." 3 "I find redness and swelling on my great toe." 4 "I have severe pain in my fingers, and they turn blue in cold conditions."

4 "I have severe pain in my fingers, and they turn blue in cold conditions." Raynaud's phenomenon is associated with reduced blood flow in response to emotional stress or the cold. It is characterized by severe pain and fingers that turn blue, red, or white in cold or stressed conditions. Difficulty swallowing is known as dysphagia. Red lesions around the nail bed are called periungual lesions. Podagra is a manifestation observed in gout, which is characterized by swelling and redness of the great toe.

Which assessment will the nurse perform to detect side effects after administering the drug golimumab? 1 Blood pressure 2 Pedal pulses 3 Serum electrolytes 4 Temperature

4 Temperature Golimumab is the first biologic that is administered only once each month for psoriatic arthritis, which can cause opportunistic pathogens. Therefore, the temperature is taken because if it is elevated, it indicates the person has a fever, which is an early sign of infection. Other assessment for infection is important. Teach patients that this drug has a black box warning for serious infections that may lead to hospitalization or death from opportunistic pathogens. The other possible answers are not signs of opportunistic pathogens.

The nurse is teaching a patient about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the patient indicates a need for further teaching? 1 "RA is inflammatory. OA is degenerative." 2 "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." 3 "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in patients older than 60 years." 4 "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."

4 "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints." OA is unilateral and usually affects a single joint, whereas RA is bilateral and affects multiple joints; this statement by the patient indicates the need for further teaching. RA is indeed an inflammatory process, while OA is a degenerative process. Research is being done to find a possible genetic cause for OA, but age, trauma, obesity, and occupation are the main causes of degeneration. RA occurs most often in women, usually between 35 and 45 years of age, whereas older age is a cause of OA.

Which statement describes systemic lupus erythematosus (SLE)? 1 It is nonfatal. 2 It affects men more often than women. 3 It is an acute, nonprogressive disorder. 4 It is characterized by spontaneous remissions and exacerbations.

4 It is characterized by spontaneous remissions and exacerbations. SLE is characterized by spontaneous remissions and exacerbations. It is fatal, but patients with SLE can lead a productive life. It affects women 10 times more often than men. It is not an acute, progressive disorder, but it is a chronic, progressive disorder.

A patient with ankylosing spondylitis is being treated with a first-line disease-modifying antirheumatic drug (DMARD). Which DMARD drug does the nurse anticipate will be prescribed for this patient? 1 Abatacept 2 Infliximab 3 Tocilizumab 4 Methotrexate

4 Methotrexate Methotrexate is a first-line disease-modifying antirheumatic drug, which is an immunosuppressive medication. Abatacept, infliximab, and tocilizumab are biological response modifiers (BRMs) (also called biologics), which are one of the newest classes of DMARDs that neutralizes the biologic activity of tumor necrosis factor—alpha (TNFA), interleukins (IL), T-lymphocytes, or tyrosine kinase (TK) to decrease immune response and inflammation; abatacept is a selective T-lymphocyte co-stimulator modulator (T-cell inhibitor), infliximab is a TNFA inhibitor, and tocilizumab is an IL-6 inhibitor.

Which is a late manifestation of rheumatoid arthritis? 1 Anorexia 2 Paresthesias 3 Joint inflammation 4 Morning stiffness

4 Morning stiffness Late manifestations of rheumatoid arthritis include morning stiffness. Symptoms such as anorexia, paresthesias, and inflammation are early manifestations of rheumatoid arthritis.

While caring for a patient with rheumatoid arthritis, the nurse finds that the patient has a single hot, swollen, and painful wrist joint. Which is the best nursing intervention for this patient? 1 Applying ice immediately 2 Administering analgesics immediately 3 Administering antibiotics immediately 4 Notifying the primary health care provider

4 Notifying the primary health care provider The single, hot, swollen and painful wrist joint indicates the joint is infected. The primary health care provider (PHP) should be notified immediately. Ice should be applied only if the PHP advises it. The nurse should not administer analgesics or antibiotics unless the PHP prescribes them.

Which clinical finding is associated with a diagnosis of early-stage osteoarthritis? 1 Fissures and ulceration 2 Osteophytes in joint space 3 Secondary joint inflammation 4 Opaque and yellowish-brown cartilage

4 Opaque and yellowish-brown cartilage In the early stage of osteoarthritis, the cartilage changes from a bluish-white translucent color to an opaque and yellowish-brown appearance. As the disease progresses, fissures and ulceration are observed. Osteophytes are formed in the later stages of osteoarthritis. Secondary joint inflammation occurs in the late stage of osteoarthritis.

What class of medication decreases inflammation and slows down the progression of systemic sclerosis? 1 Immunosuppressants 2 Histamine antagonists 3 Endothelin receptor antagonists 4 Oral tyrosine kinase inhibitors (TKIs)

4 Oral tyrosine kinase inhibitors (TKIs) Oral tyrosine kinase inhibitors (TKIs) such as nilotinib and imatinib mesylate reduce inflammation and slow the progression of systemic sclerosis. Immunosuppressants are used to treat renal or central nervous system lupus. Histamine antagonists are used to treat gastroesophageal reflux disease and esophageal symptoms that occur in systemic sclerosis. Endothelin receptor antagonists, such as bosentan, are prescribed to patients with class III or class IV pulmonary arterial hypertension.

Which statement is true regarding osteoarthritis? 1 Pain worsens after rest in early stage of the disease. 2 Pain is caused by the nerve supply to the cartilage. 3 Pain diminishes after activity in early stage of the disease. 4 Pain is caused by spasms of the surrounding muscles.

4 Pain is caused by spasms of the surrounding muscles. Because cartilage does not have a nerve supply, the pain is caused by joint and soft tissue involvement and by spasms of the surrounding muscles. The pain diminishes after rest in the early stage of the disease. Pain will increase after activity in the early stages of the disease.

An older patient with rheumatoid arthritis reports a burning and tingling sensation in the legs. Further assessment reveals foot drop in the patient. Which condition does the nurse suspect as a clinical manifestation of vasculitis present in rheumatoid arthritis? 1 Quadriplegia 2 Osteoporosis 3 Caplan's syndrome 4 Peripheral neuropathy

4 Peripheral neuropathy Peripheral neuropathy associated with decreased blood circulation may cause foot drop and paresthesias in patients with rheumatoid arthritis. Quadriplegia is paralysis and may occur in patients with rheumatoid arthritis who are also suffering from cervical disease. Osteoporosis is one of the systemic complications of rheumatoid arthritis that may increase the risk of fractures but does not manifest as tingling and burning in the legs. Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs.

Which is the first symptom that occurs in a patient with the diffuse form of systemic sclerosis (SSc)? 1 Calcinosis 2 Sclerodactyly 3 Esophageal dysmotility 4 Symmetric, pitting edema

4 Symmetric, pitting edema The first symptom that occurs in the diffuse form of SSc is symmetric, pitting edema. Calcium deposits in the soft tissue of skin are called calcinosis. Sclerodactyly is scleroderma of the digits, which refers to hardening of the skin. Esophageal dysmotility causes difficulty in swallowing, which is one of the symptoms of both the diffuse form and limited form of SSc.

The nurse encourages a patient who has undergone total hip joint arthroplasty to drink fluids and instructs the patient's caregivers not to massage the leg. The nurse also observes for signs of redness, swelling, and pain in the patient's leg. Which complication is the nurse seeking to avoid with these interventions? 1 Dislocation 2 Infection 3 Hypotension 4 Venous thromboembolism

4 Venous thromboembolism A patient with venous thromboembolism may show redness, swelling, and pain in the region that underwent surgery. The patient should drink a high amount of fluids and avoid massaging the region of surgery in order to decrease the risk of venous thromboembolism. To avoid dislocation of the joint, the nurse checks the patient's position and instructs the patient to keep the leg slightly abducted. To avoid infections, the nurse uses aseptic techniques and washes hands thoroughly while caring for the patient. The nurse observes the patient's vital signs every 4 hours to avoid the risk of hypotension.

The nurse is developing a teaching plan for a patient diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? 1 Begin a running program. 2 Take up knitting to slow down joint degeneration. 3 Eat at least two cups of yogurt per day. 4 Wear supportive shoes.

4 Wear supportive shoes. Wearing supportive shoes will help prevent falls and damage to foot joints, especially metatarsal joints. Running promotes stress on joints and should be avoided. Repetitive stress activities such as knitting or typing should be avoided for prolonged periods. No single food can cure OA; a well-balanced diet is recommended.