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A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor?
- A. The patient has a 30 pack-year smoking history.
- B. The patients body mass index is 34 (obese).
- C. The patient has primary hypertension.
- D. The patient is 58 years old.
Correct Answer: B
Rationale: Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly heightened risk.
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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 planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this womans care needs?
- A. Ineffective Role Performance Related to Pain
- B. Risk for Impaired Skin Integrity Related to Myalgia
- C. Risk for Infection Related to Tissue Alterations
- D. Unilateral Neglect Related to Neuropathic Pain
Correct Answer: A
Rationale: Typically, patients with fibromyalgia have endured their symptoms for a long period of time. The neuropathic pain accompanying FM can often impair a patients ability to perform normal roles and functions. Skin integrity is unaffected and the disease has no associated infection risk. Activity limitations may result in neglect, but not of a unilateral nature.
A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection?
- A. Petechiae
- B. Butterfly rash
- C. Jaundice
- D. Skin sloughing
Correct Answer: B
Rationale: An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin sloughing.
A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse emphasize the need for continued adherence to the prescribed medication?
- A. To avoid complications such as venous thromboembolism
- B. To avoid the progression to osteoporosis
- C. To avoid the progression of GCA to degenerative joint disease
- D. To avoid complications such as blindness
Correct Answer: D
Rationale: The nurse must emphasize to the patient the need for continued adherence to the prescribed medication regimen to avoid complications of giant cell arteritis, such as blindness. VTE, OP, and degenerative joint disease are not among the most common complications for GCA.
A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA?
- A. Cool joints with decreased range of motion
- B. Signs of systemic infection
- C. Joint stiffness, especially in the morning
- D. Visible atrophy of the knee and shoulder joints
Correct Answer: C
Rationale: In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning. Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often warm rather than cool.