Nokea
A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the client's condition. What action by the nurse is best?
- A. Assess the client's culture more thoroughly
- B. Assess options for performing duties
- C. Suggest the client attend a community meeting
- D. Suggest the client give up the role of elder
Correct Answer: A
Rationale: The nurse needs a more thorough understanding of the client's culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions.
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The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further?
- A. Creatinine: 3.9 mg/dL
- B. Red blood cell count: 5.2 million/µL
- C. White blood cell count: 4000/µL
- D. Platelet count: 200,000/µL
Correct Answer: A
Rationale: Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.
A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching?
- A. Acetaminophen
- B. Cyclobenzaprine hydrochloride (Flexeril)
- C. Hydrocortisone (Hylan)
- D. Ibuprofen
Correct Answer: A
Rationale: All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hydrocortisone is a synthetic joint fluid implant. Ibuprofen is a non-steroidal anti-inflammatory drug.
A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important?
- A. Be sure you get enough sleep at night
- B. Eat plenty of high-protein, high-iron foods
- C. Notify your provider at once if you get a fever
- D. Weigh yourself every day on your home scale
Correct Answer: C
Rationale: A fever is a classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if they develop an elevated temperature.
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first?
- A. Client who reports jaw pain when eating
- B. Client with a red, hot, swollen right wrist
- C. Client who has a puffy-looking area behind the knee
- D. Client with a worse joint deformity since the last visit
Correct Answer: B
Rationale: All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen than other joints may indicate infection. The nurse needs to see this client first.
A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) for disease control. What information does the nurse include? (Select all that apply.)
- A. Avoid acetaminophen or over-the-counter medication
- B. It may take several weeks to become effective
- C. Pregnancy and breast-feeding are not affected by MTX
- D. You may find that folic acid, a B vitamin, reduces side effects
- E. Avoid crowds and sick people
Correct Answer: A,B,D,E
Rationale: MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take weeks to effectively treat RA. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.