My Nursing Lab questions on Rheumatoid Arthritis (RA)

Ace your homework & exams now with Quizwiz!

d

Mr. Rappaport has been diagnosed with rheumatoid arthritis. He tells you that he is having trouble doing the prescribed physical therapy exercises because of stiffness. What intervention could you suggest to Mr. Rappaport to help him follow the prescribed physical therapy​ program? ​a "Try exercising for several hours each day at the​ gym." b ​"Wear light-weight clothing when you​ exercise." ​c "Stop exercising for a few​ weeks." ​d "Try doing your exercises in the​ shower."

b

A client with RA has Sjogrens syndrome. The nurse can relieve the symptoms of Sjogrens syndrome by: a. providing heat to the joints b. instilling eye drops c. administering pain meds d. providing small frequent meals

a

a client with RA is beginning to develop flexion contracture of the knees. The nurse should tell the client to: a. lie prone and let her feet hang over the mattress edge b. lie supine, with her feet rotated inward c. lie on her right side and point her toes downward d. lie on her left side and allow her feet to remain in a neutral position

a,c,d Increased ESR would indicate presence of inflammation in the​ joints, which occurs with rheumatoid arthritis. Rheumatoid arthritis may be present with a negative RF. A positive​ anti-citrulline antibody test indicates the presence of RA in the absence of RF. ​Positive, not​ negative, antinuclear antibodies indicate presence of RA. Decreased bone density is found in clients with psoriatic​ arthritis, not with RA.

A client diagnosed with rheumatoid arthritis​ (RA) is being seen in an outpatient clinic. Which diagnostic test results would indicate presence of​ RA? ​(Select all that​ apply.) a Increased erythrocyte sedimentation rate​ (ESR) b Decreased bone density c Positive​ anti-citrulline antibodies d Negative rheumatoid factor​ (RF) e Negative antinuclear antibodies

b methotrexate is a folic acid antagonist. multi vitamins contain folic acid

A client has been receiving Rheumatrex (methotrexate) for severe RA. The nurse should tell the client to avoid: a. aspirin b. multivitamins c. omega 3 fish oils d. acetaminophen

a

A client with AIDS has impaired nutrition due to diarrhea. The nurse teaches the client about the need to avoid certain foods. Which diet selection by the client would indicate a need for further teaching? a. tossed salad b. baked chicken c. broiled fish d. steamed rice

a,b,c,e

A client has just recently been diagnosed with rheumatoid arthritis​ (RA). The client asks the nurse if RA always causes crippling deformities. The nurse tells the client that to decrease the likelihood of​ deformities, it is important​ to: Select all that apply. a Stop an activity if it is beyond your ability to perform. b Avoid stress to any current area of deformity. c Type instead of​ hand-writing items if possible. d Ignore pain as a warning signal. e Use stronger joints for most activity.

a

A clinic nurse is assessing a client with a history of rheumatoid arthritis. The nurse would anticipate which assessment​ finding? a Progressive joint stiffness and deformation b Intermittent joint​ pain, mostly in the great toe c Joint stiffness in the​ spine, hips, and knees d Multiple joints and organs​ affected, and may have high fever and rheumatoid rash

a,b,c,e ​Rationale: RA can result in pleural effusion​ (collection of fluid in the pleural​ space). Individuals with RA have an increased risk of developing coronary heart disease. RA is a systemic disease of connective tissue that can affect exocrine​ glands, resulting most frequently in dry eyes and mouth. Properly​ managed, rheumatoid arthritis is not considered to be a danger for pregnant women or their babies. Patients with RA may suffer from a variety of hematologic​ disorders, particularly anemia.

A​ 43-year-old woman, recently diagnosed with​ RA, asks the nurse whether she might have concerns beyond the problems with her joints. The nurse informs her that RA may also​ involve: Select all that apply. a The cardiovascular system. b The exocrine system. c The respiratory system. d The reproductive system. e The hematologic system.

a,b,c,e

The client was admitted to an inpatient unit for uncontrolled pain caused by rheumatoid arthritis​ (RA). Which ongoing problems will the client have in relation to the​ RA? ​(Select all that​ apply.) a Ineffective role performance b Poor​ self-esteem c Fatigue d Weight gain e Chronic pain

b

The home health nurse is visiting a client with an exacerbation of RA. To prevent deformities of the knee joints the nurse should: a. tell the client to walk without bending the knees b. encourage movement within limits of pain c. instruct the client to only sit in a recliner d. tell the client to remain in bed as long as the joints are painful

a

The nurse is caring for a client with RA. The nurse knows the clients early morning symptoms will be most improved by: a. taking a warm shower upon awakening b. applying ice packs to the joints c. taking two aspirin before going to bed d. going for a early morning walk

c

The nurse is completing a health screening for a​ school-age child with rheumatoid arthritis. The parents ask the nurse to recommend activities that will promote exercise for their child. Which is an appropriate recommendation by the​ nurse? a Softball b Basketball c Swimming d Football

a,b,c,e

The nurse is volunteering in one of the local free autoimmune disease clinics. The next client was recently diagnosed with rheumatoid arthritis. What are the goals of care for clients with rheumatoid​ arthritis? ​(Select all that​ apply.) a Prevent deformity b Reduce inflammation c Preserve function d Cure the disease e Reduce pain

a,c RATIONALE: Laboratory tests used to diagnose rheumatoid arthritis include​ C-reactive protein levels and erythrocyte sedimentation rate. The antinuclear antibody​ (ANA) test, renal function​ test, and kidney biopsy are diagnostic tests for systemic lupus​ erythematosus, not rheumatoid arthritis.

What diagnostic tests are used for rheumatoid​ arthritis? ​(Select all that​ apply.) a Erythrocyte sedimentation rate​ (ESR) b Antinuclear antibody​ (ANA) test ​c C-reactive protein​ (CRP) d Kidney biopsy e Renal function test

d

Your​ client, Alexandra​ Kowalski, is a​ 16-year-old cross-country runner diagnosed with juvenile idiopathic arthritis. Which diagnostic test does the nurse anticipate will be ordered for​ Alexandra? a Coagulation tests b Electrolyte panel c Urine cultures d Erythrocyte sedimentation rate

a Rationale: Lying prone and allowing the feet to hang over the end of the mattress will help prevent flexion contractures. The client should be told to do this several times a day. Answers B, C, and D do not help prevent flexion contractures; therefore, they are incorrect.

A client with rheumatoid arthritis is beginning to develop flexion contractures of the knees. The nurse should tell the client to: ❍ A. Lie prone and let her feet hang over the mattress edge ❍ B. Lie supine, with her feet rotated inward ❍ C. Lie on her right side and point her toes downward ❍ D. Lie on her left side and allow her feet to remain in a neutral position

d ​Rationale: One technique for reducing stress on the joints is to delegate household tasks to family members. The client does not need to refrain from all household chores. Sleeping for 10 hours at night will not alleviate the need for frequent rest periods during the day. Increased joint pain would indicate that goals have not been met.

A client with rheumatoid arthritis is being seen in the outpatient clinic for a progress​ check-up. The nurse is reviewing the​ client's plan of care and determines that the client has met a goal of treatment when the client makes which​ statement? ​a "I sleep for 10 hours at​ night." ​b "I do not perform household chores at all​ anymore." ​c "I have increased pain in my joints all the time​ now." ​d "I have delegated many household chores to my children and​ spouse."

c ​Rationale: RA affects​ 12% of the total population across all races. It affects women 3 times more than​ men, and the onset is usually between the ages of 20 and 40 years.

A female client who was recently diagnosed with rheumatoid arthritis​ (RA) asks the nurse if the cause of the disease is the fact that her family is of Hispanic descent. Which is the most appropriate response by the nurse to this​ client? ​a "RA affects those of German descent most​ often." ​b "RA is most prevalent in Caucasian​ females." c ​"RA affects all races at the same​ rate." ​d "RA is most prevalent in men under the age of 20​ years."

a,b ​Rationale: The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in​ OA, which is with activity.

A nurse is caring for a client who has been newly diagnosed with rheumatoid arthritis​ (RA). The client asks the nurse what the difference is between rheumatoid arthritis and osteoarthritis​ (OA). The​ nurse's best response​ includes: Select all that apply. ​"The onset of OA is gradual while the onset of RA may be​ rapid." ​"OA is slowly progressive while RA is characterized by exacerbations and​ remissions." ​"The affected joints in RA feel cold to the touch while the joints affected by OA are warm or hot to the​ touch." ​"The pain and stiffness with RA is with​ activity; OA pain and stiffness is predominant upon​ arising." ​"With OA, multiple joints are symmetrically​ affected; RA affects one joint at a​ time."

b,d,e

A nurse is caring for a client who has rheumatoid arthritis, which of the following laboratory tests are used to diagnose this disease? SELECT ALL THAT APPLY A. Urinalysis B. ESR C. BUN D. ANA titer E. WBC count

a,d,e

A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis. The client states that her pain is a 3 on a scale from 1 to 10 today. What​ non-pharmacological interventions can the nurse​ provide? Select all that apply. a Provide diversion activities. b Immobilize the extremity. c Discourage any position changes. d Massage e Relaxation techniques

c Rationale: The pregnant client with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. The pregnant client with RA that is in remission may stop medication. This client may be anemic as a result of blood loss from salicylate therapy

A nurse is caring for a pregnant client who has rheumatoid arthritis​ (RA). The nurse understands that this client​ may: a Not stop medication for​ RA, even if the client is in remission. b Experience a relapse during​ pregnancy, often followed by a remission after delivery. c Be anemic as a result of blood loss from salicylate therapy. d Be at higher risk for preterm delivery.

b

A nurse is participating in a community health fair. Which statement made by a participant indicates the teaching about rheumatoid arthritis was​ understood? ​a "Rheumatoid arthritis is the most common arthritis in the United States and may affect only one​ joint." ​b "Rheumatoid arthritis is an autoimmune disorder and has associated genetic​ factors." c ​"Rheumatoid arthritis results in increased uric acid due to impaired purine​ metabolism." ​d "Rheumatoid arthritis causes joint inflammation related to a history of joint​ trauma."

a

A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? a. you can experience morning stiffness when you get out of bed b. you can experience abdominal pain c. you can experience weight gain d. you can experience low blood sugar

a,b,e

A nurse is working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY) a Recent influenza b. Decreased ROM c. Hypersalivation d. Increased BP e. Pain at rest

d Clients diagnosed with rheumatoid arthritis will often have a​ low-grade fever. This finding supports the​ client's diagnosis. Weight​ loss, morning stiffness that lasts more than one​ hour, and fatigue are other symptoms that support this diagnosis.

The nurse is caring for Ms.​ Ruiz, a client recently diagnosed with rheumatoid arthritis. Ms. Ruiz is being seen by the primary care provider for a​ follow-up visit after a recent hospitalization. The nurse prepares to assess Ms. Ruiz. Which clinical manifestation found during the assessment process supports this​ client's diagnosis? a Morning stiffness that lasts for thirty minutes b Increased energy c Weight gain over the last several months ​d Low-grade fever

a Rationale Risk factors for RA include a family history of the disease and heavy smoking. Use of herbal​ remedies, a family history of coronary artery​ disease, and being underweight do not increase the risk for developing RA.

The nurse is caring for a client recently diagnosed with rheumatoid arthritis​ (RA). The client​ states, "I always take care of​ myself, how could this happen to​ me?" Which response by the nurse is most appropriate regarding the​ client's risk for developing​ RA? ​a "RA occurs when there is a family history of the​ disease." b ​"RA occurs for clients who are​ underweight." c ​"RA occurs for clients with a history of using herbal​ remedies." d ​"RA occurs when there is a family history of coronary artery​ disease."

a

The nurse is caring for a client who was diagnosed with rheumatoid arthritis last year. The client has recently been placed on prednisone for treatment. The nurse is teaching the client about safe medication administration. Which client statement indicates that the medication teaching was​ successful? a ​"I will take the ordered dose at the same time every​ day." ​b "I will not have to limit my consumption of canned​ vegetables." ​c "I will take this medication on a full stomach to enhance​ absorption." ​d "I will not need to monitor my blood sugar more frequently while on this​ medication."

b

The nurse is caring for a pregnant client in the obstetrics clinic. The client has a history of rheumatoid arthritis. Which statement by the client would require a follow up by the​ nurse? a ​"I need to schedule extra rest periods throughout the​ day." b ​"When my joints hurt I can take an​ aspirin." ​c "Now that I am in my second​ trimester, I actually feel​ good, and my joints are not hurting​ either." d ​"I might carry my baby longer than the normal 40 weeks for the​ pregnancy."

c ​Rationale: One hallmark of RA is extreme​ fatigue, and the nurse would plan to teach the client about frequent rest periods during the day to conserve energy. The client with RA will be stiff early in the​ morning, but that would not interfere with activities later in the day. Joints of the RA client are stiffest in the morning. Taking ibuprofen for pain does not affect the ability for activity.

The nurse is collecting a health history for a client being seen in an outpatient clinic. The client complains of joint pain and swelling that have lasted for about 2 months. The nurse devises a plan of care based on the nursing diagnosis of Activity Intolerance based on which client​ statement? a ​"I find it difficult to move when I first get up in the​ morning." ​b "I take ibuprofen for the pain as​ needed." c ​"I seem to get tired early in the day and require a​ nap." d ​"My joints are stiffest at night before I go to​ sleep."

d Rationale ​Osteoarthritis, not rheumatoid​ arthritis, is characterized by pain with activity and stiffness following the activity. Pain and stiffness on​ arising, lasting more than 1​ hour; red, hot swollen​ joints; and fatigue and weakness are all signs and symptoms of rheumatoid arthritis.

The nurse is performing an assessment on a client who complains of joint pain and stiffness. The client was admitted to the unit with a diagnosis of rheumatoid arthritis. Which reported signs and symptoms from the client interview would NOT be consistent with the clinical manifestations of rheumatoid​ arthritis? ​a "I am in so much pain in the​ morning! It is very hard for me to get out of bed and start my day. I can hardly move my​ legs; my knees feel like they are​ frozen." b ​"Whenever my disease gets​ worse, my joints get​ red, hot and​ swollen." ​c "I am just tired all the​ time, and feel very​ weak." d ​"I have trouble with walking because of the​ pain, and when I am finally done with my morning chores and sit​ down; my knees get so stiff I can hardly get up after I​ rested."

a,b,d,e Rationale The priorities of care for the client with rheumatoid arthritis are supportive care and education. Taking NSAIDs at regular intervals will provide continued control of pain and discomfort. Taking NSAIDs with food or milk will decrease the incidence of gastrointestinal upset. Clients should consume a​ well-balanced diet, use the application of heat and cold for​ pain, exercise in the shower because​ warm, moist heat promotes​ mobility; be aware of adverse effects of​ medications; lose weight if​ necessary; follow prescribed physical​ therapy; avoid​ smoking; and use​ muscle-strengthening exercises.

The nurse is working in a primary care office. A client diagnosed with rheumatoid arthritis has returned for a​ follow-up visit. The client states that his pain is controlled on NSAIDs. The nurse would supply what education related to the disease process and supportive​ care? ​(Select all that​ apply.) a Application of heat or cold to relieve pain b Take NSAIDs at regular intervals with food or milk c Avoid exercise d Be aware of the adverse effects of prescribed medications e Exercise in the shower because​ warm, moist heat promotes mobility

a

The nurse on the inpatient orthopedic unit is preparing the client for surgery. The client was admitted for right knee joint replacement surgery. The nurse wants to use the right teaching handouts for this type of surgery. Which surgical teaching handout is the nurse going to​ use? a Arthroplasty b Synovectomy c Arthroscopy d Arthrodesis

c

The nursing student is preparing an educational handout for the parents of a client with juvenile idiopathic arthritis​ (JIA). Based on the​ etiology, risk​ factors, and clinical manifestations of the​ disease, which topic will be addressed in the​ handout? a Teaching about the​ symptoms: JIA can affect multiple joints and organs and clients might experience acromegaly. b Teaching about the frequency of the​ disease: JIA is more frequent in boys than girls. c Teaching about the importance of monitoring growth rates in children. d Teaching about the permanent and progressive nature of the disorder.

a,b,c,e

The​ nurse, working in an internal medicine​ practice, prepares to see a client diagnosed with rheumatoid arthritis on the last visit. The client is complaining of pain and discomfort in the hands and knees. Which treatments can be used to reduce the pain and discomfort that the client is​ experiencing? ​(Select all that​ apply.) a Exercising b Taking corticosteroids c Taking NSAIDs d Increasing sun exposure e Eating a balanced diet

c RATIONALE: The abnormal granulation tissue that leads to joint damage in rheumatoid arthritis is called pannus. Uveitis is inflammation of the​ uvea, the middle layer of the​ eye, and is a clinical manifestation of juvenile idiopathic arthritis. Synovial membrane is the normal connective tissue that lines the cavity of a joint and produces the synovial fluid. Pleurodesis is a medical procedure in which the pleural space is artificially scarred. It involves the adhesion of the two pleurae. Next Question

What is the clinical term for abnormal tissue that leads to joint damage and immobilization in the pathophysiology of rheumatoid​ arthritis? a Pleurodesis b Synovial membrane c Pannus d Uveitis

b

Which activity is best suited to the 12- year old with juvenile RA? a. playing video games b. swimming c. working crossword puzzles d. playing slow-pitch softball

a,c,e

Which characteristics are risk factors for the development of rheumatoid​ arthritis? ​(Select all that​ apply.) a Family history b Male sex c Genetic predisposition d Diet e Psychological stressors

C Rationale: Holding a warm cup of coffee provides warmth

Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis? ❍ A. Brushing the teeth ❍ B. Drinking a glass of juice ❍ C. Holding a cup of coffee ❍ D. Brushing the hair

c,d,e

Which independent nursing interventions are used to treat rheumatoid​ arthritis? ​(Select all that​ apply.) a Arthrodesis to fuse cervical​ vertebrae, wrists, ankles b Promote a​ well-balanced diet c Alternate periods of activity and rest d Educate about​ low-impact aerobics e Avoid sun exposure

b

Which of the following instructions should be included in the teaching for a client with RA? a. avoid exercise because it fatigues the joints b. take prescribed anti-inflammatory meds with meals. c. alternate hot and cold packs to affected joints d. avoid weight bearing activity

d

Why are nonsteroidal​ anti-inflammatory agents​ (NSAIDs) used to treat rheumatoid​ arthritis? a To alter the course of the disease b To slow the development and progression of bone erosion c To reduce joint destruction d To reduce inflammation

2 Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching, but does not indicate that methotrexate may be contraindicated for the patient. Focus: Prioritization

You assess a 24-year-old patient with RA who is considering using methotrexate (Rheumatrex) for treatment. Which patient information is most important to communicate to the health care provider? 1. The patient has many concerns about the safety of the drug. 2. The patient has been trying to get pregnant. 3. The patient takes a daily multivitamin tablet. 4. The patient says that she has taken methotrexate in the past.

4 Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications. Focus: Prioritization

Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? 1. RA symptoms are worst in the morning 2. Dry eyes 3. Round and moveable nodules just under the skin 4. Dark-colored stools

4 Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications. Focus: Prioritization

Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? 1. RA symptoms are worst in the morning 2. Dry eyes 3. Round and moveable nodules just under the skin 4. Dark-colored stools


Related study sets

Chapter 13: Planning & Implementing Change-Oriented Strategies

View Set

Chapter 21: The Cardiovascular System-Blood Vessels and Hemodynamics

View Set

Unit 14: physical exams: physical exams; positions and draping

View Set

Biology Chapter 7 Smartbook questions

View Set

Reading 27 Financial Analysis Techniques

View Set

Grade: 8th / Subject: History / Unit: Crash Course Video On The South & Slavery

View Set

OB PrepU Ch. 2: Family Centered Community Based Care

View Set