Nokea
A 40-year-old woman was diagnosed with Raynauds phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are stiff, like the skin is being stretched from all directions. The nurse should recognize the need for medical referral for the assessment of what health problem?
- A. Giant cell arteritis (GCA)
- B. Fibromyalgia (FM)
- C. Rheumatoid arthritis (RA)
- D. Scleroderma
Correct Answer: D
Rationale: Scleroderma starts insidiously with Raynauds phenomenon and swelling in the hands. Later, the skin and the subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures. This progression of symptoms is inconsistent with GCA, FM, or RA.
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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.
- A. Surgical treatment options
- B. The importance of weight loss
- C. Managing Raynauds-type symptoms
- D. Smoking cessation
- E. The importance of vigilant skin care
Correct Answer: C,D,E
Rationale: Patient teaching for the patient with scleroderma focuses on management of Raynauds phenomenon, smoking cessation, and meticulous skin care. Surgical treatment options do not exist and weight loss is not a central concern.
A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patients adherence to her medication regimen?
- A. Encourage the patient to store the bottles with their tops removed.
- B. Have a trusted family member take over the management of the patients medication regimen.
- C. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.
- D. Have the patient approach her primary care provider to explore medication alternatives.
Correct Answer: C
Rationale: The patients pharmacy will likely be able to facilitate a practical solution that preserves the patients independence while still fostering adherence to treatment. There should be no need to change medications, and storing open medication containers is unsafe. Delegating medications to a family member is likely unnecessary at this point and promotes dependence.
A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care?
- A. Fatigue Related to Anemia
- B. Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism
- C. Acute Confusion Related to Increased Serum Ammonia Levels
- D. Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit
Correct Answer: A
Rationale: Patients with SLE nearly always experience fatigue, which is partly attributable to anemia. Ammonia levels are not affected and hematocrit is typically low, not high. VTE is not one of the central complications of SLE.
Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings?
- A. Hyperuricemia
- B. Increased erythrocyte sedimentation rate
- C. Elevated serum creatinine
- D. Decreased platelets
Correct Answer: D
Rationale: Thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.
A patient with SLE asks the nurse why she has to come to the office so often for check-ups. What would be the nurses best response?
- A. Taking care of you in the best way involves seeing you face to face.
- B. Taking care of you in the best way involves making sure you are taking your medication the way it is ordered.
- C. Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working.
- D. Taking care of you in the best way involves drawing blood work every month.
Correct Answer: C
Rationale: The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy. Management of SLE involves regular monitoring to assess disease activity and therapeutic effectiveness. Stating the benefit of face-to-face interaction does not answer the patients question. Blood work is not necessarily drawn monthly and assessing medication adherence is not the sole purpose of visits.