A client has rheumatoid arthritis that especially affects th...

A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best?

A. Let's ask the provider about increasing your pain pills
B. Hold ice bags against your hands before quilting
C. Try a paraffin wax dip 20 minutes before you quilt
D. You need to stop quilting before it destroys your fingers

Correct Answer: C

Rationale: Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure.

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A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include?

A. Avoid large crowds or people who are ill
B. Stay upright for 1 hour after taking this drug
C. This drug may cause your hair to fall out
D. You may double the dose if pain is severe

Correct Answer: A

Rationale: This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.

The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)

A. It affects single joints only
B. Antibodies lead to inflammation
C. It consists of an autoimmune process
D. Morning stiffness is common
E. Permanent damage is inevitable

Correct Answer: B,C

Rationale: RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Permanent damage is not inevitable with aggressive, early treatment.

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.

The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate?

A. Are you compliant with following the diabetic diet?
B. Have you been taking glucosamine supplements?
C. How much exercise do you really get each week?
D. You're still taking your diabetic medication, right?

Correct Answer: B

Rationale: All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them.

Which clinical manifestations are seen in clients with connective tissue diseases? (Select all that apply.)

A. Dry, scaly skin rash: Systemic lupus erythematosus
B. Esophageal motility problems: Systemic sclerosis
C. Vasculitis leading to organ damage: Rheumatoid arthritis
D. Foot drop and paresthesias: Rheumatoid arthritis
E. Gout caused by hyperuricemia

Correct Answer: A,B,C,D,E

Rationale: A dry, scaly skin rash is common in SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Foot drop and paresthesias occur in rheumatoid arthritis. Gout is caused by hyperuricemia.