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A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be appropriate?
- A. Keep shifting weight from one foot to the other.
- B. Perform aerobic exercises.
- C. Maintain complete bed rest.
- D. Maintain good posture.
Correct Answer: D
Rationale: The nurse needs to remind the client with degenerative joint disease to maintain good posture to avoid unusual stress on a joint. Although the client need not maintain complete bed rest, performing aerobic exercises is not advisable because it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.
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The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?
- A. Methotrexate
- B. Celecoxib
- C. Methylprednisolone
- D. Mercaptopurine azathioprine
Correct Answer: A
Rationale: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.
A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What symptom(s) should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.
- A. Diarrhea
- B. Tingling in the arms
- C. Intestinal cramping
- D. Increase in pain in the affected extremity
- E. Nausea and vomiting
Correct Answer: A,C,E
Rationale: 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.
A nurse is caring for a client with gout. Which of the following would the nurse encourage the client to limit?
- A. Fluid intake
- B. Protein-rich foods
- C. Purine-rich foods
- D. Carbohydrates
Correct Answer: C
Rationale: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.
The nurse is planning care in the home for a client with rheumatoid arthritis. What instruction(s) should the nurse include in the plan of care? Select all that apply.
- A. Collaborate with occupational therapists for specialized equipment.
- B. Identify the exercise regimen planned by physical therapist.
- C. Provide nursing assistance for ADLs.
- D. Teach the nursing assistant to allow extra time in the evening for hygiene or other procedures.
- E. Ensure the home environment is safe.
Correct Answer: A,B,C,E
Rationale: The nurse should collaborate with occupational therapists for specialized equipment, identify the exercise regimen planned by physical therapist, provide nursing assistance for ADLs, and ensure the home environment is safe. The nurse should teach the nursing assistant to allow extra time in the morning, not the evening, for hygiene or other procedures.
A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease?
- A. Diffuse purplish lesions on the trunk
- B. Butterfly-shaped rash on the face over the bridge of the nose and cheeks
- C. Fluid-filled vesicles clustered on the cheeks, chin, and forehead
- D. Pustules scattered on the chest and back
Correct Answer: B
Rationale: A prominent sign for about half of the clients with SLE is a red, butterfly-shaped rash known as malar rash, on the face over the bridge of the nose and the cheeks. The word lupus means 'wolf.' The term may have been used as a description for the facial rash that, to some, resembled the mask of reddish-brown fur on a wolf. The other choices are not routinely seen with SLE.