Rheumatic quiz (chapter 39)
A patient is admitted with an acute attack of gout. What interventions are essential for this patient? Select all that apply
Corticosteroid therapy Probenecid (Benemid) Pain medications Serum uric acid level Steroids may be used in patients who have not had a response to other therapy. They have been shown to decrease inflammation and pain in attacks of gout. Probenecid will assist in the excretion of uric acid, the causative agent. Serum uric acid levels will guide therapy and treatment. A dietary consult can wait until the patient is over the acute, painful period. (ch 39, p. 1079)
The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)
Decreased ventilation owing to lung scarring Dyspnea owing to fibrotic cardiac tissue Dysphagia owing to hardening of the esophagus The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur. (ch 39, p. 1073)
The nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnoses will most likely apply to this patient's care? Select all that apply
Fluid and electrolyte imbalance Alteration in self-concept Fatigue Pain Patients with rheumatic diseases, which typically involve joints and muscles, cause problems with mobility, fatigue, and pain. Due to limitations of the disease, the patients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases. (ch 39, p. 1054)
A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.
Intestinal cramping Diarrhea Nausea and vomiting Colchicine is administered every 1 or 2 hours until the pain subsides or nausea, vomiting, intestinal cramping, and diarrhea develop. When one or more of these symptoms occurs, the drug should be stopped temporarily. Tingling in the arms and increase in pain are not normal adverse reactions that are seen with this drug. (ch 39, p. 1080)
Which of the following medications are used in the treatment of gout? Select all that apply.
Probenecid (Benemid) Febuxostat (Uloric) Allopurinol (Zyloprim) Benemid, Zyloprim, and Uloric are used in the treatment of gout. Plaquenil and Azulfidine are useful in the treatment of rheumatoid arthritis. (ch 39, p. 1080)
A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply.
The importance of vigilant skin care Managing Raynaud's-type symptoms Smoking cessation Patient teaching for the patient with scleroderma focuses on management of Raynaud's phenomenon, smoking cessation, and meticulous skin care. Surgical treatment options do not exist and weight loss is not a central concern. (ch 39, p. 1074)
Diagnosis of osteoarthritis is complicated because initial joint changes occur without symptoms. Therefore, a combination of physical assessment and X-ray review is necessary for a diagnosis. Select two signs that, when combined, are sensitive indicators of OA.
Osteophytes Joint space narrowing Standard X-rays of affected joints show osteophytes, the most characteristic feature of OA, and in more advanced disease, joint space narrowing and sclerosis. When these two are combined, a diagnosis of OA is established. (ch 39, p. 1076
Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply.
Provide opportunities for the client to verbalize feelings. Provide diversional activities. Support joints with splints and pillows. To manage pain, the nurse maintains normal alignment of extremities as much as possible by supporting the joints with splints and pillows. Diversional activities distract the client's focus from the pain. Providing opportunities for the client to verbalize feelings facilitates coping with pain. Assistive devices for self-feeding help the client meet nutritional needs independently. Assisting the client in developing a sleep routine promotes rest and minimizes fatigue. (ch 39, p. 1063)
Which of the following classifications are considered antiarthritic drugs? Select all that apply.
Glucocorticoids Anti-inflammatory Disease-modifying antirheumatics (DMARDs) Antiarthritic drugs fall into three major groups: nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and glucocorticoids. Diuretics and muscle relaxants are not antiarthritic drugs. (ch 39, p. 1056)
A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.)
Positive C-reactive protein (CRP) Red blood cell (RBC) count of <4.0 million/mcL Positive antinuclear antibody (ANA) Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focus on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive. (ch 39, p. 1066)
