Nokea
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.
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A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved?
- A. Angiography
- B. Myelography
- C. Paracentesis
- D. Arthrocentesis
Correct Answer: D
Rationale: Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through the abdominal wall under sterile conditions.
A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem?
- A. Rheumatoid arthritis (RA)
- B. Systemic lupus erythematosus
- C. Osteoporosis
- D. Polymyositis
Correct Answer: A
Rationale: In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.
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.
A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following?
- A. Hydromorphone (Dilaudid)
- B. Methotrexate (Rheumatrex)
- C. Allopurinol (Zyloprim)
- D. Prednisone
Correct Answer: B
Rationale: In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that treatment with the non-biologic DMARDs begin within 3 months of disease onset. Allopurinol is used to treat gout. Opioids are not indicated in early RA. Prednisone is used in unremitting RA.
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.