Nokea
A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients care, what goal should the nurse include?
- A. The patient will express satisfaction with her ability to perform ADLs.
- B. The patient will recover from OA within 6 months.
- C. The patient will adhere to the prescribed plan of care.
- D. The patient will deny signs or symptoms of OA.
Correct Answer: A
Rationale: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care.
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A patient with polymyositis is experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action?
- A. Initiate a program of passive range of motion exercises
- B. Facilitate referrals to occupational and physical therapy
- C. Administer skeletal muscle relaxants as ordered
- D. Encourage a progressive program of weight-bearing exercise
Correct Answer: B
Rationale: Patients with polymyositis may have symptoms similar to those of other inflammatory diseases. However, proximal muscle weakness is characteristic, making activities such as hair combing, reaching overhead, and using stairs difficult. Therefore, use of assistive devices may be recommended, and referral to occupational or physical therapy may be warranted. The muscle weakness is a product of the disease process, not lack of exercise. Skeletal muscle relaxants are not used in the treatment of polymyositis.
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 nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug?
- A. I have this ringing in my ears that just wont go away.
- B. I feel so foggy in the mornings and it takes me so long to wake up.
- C. When I eat a meal thats high in fat, I get really nauseous.
- D. I seem to have lost my appetite, which is unusual for me.
Correct Answer: A
Rationale: Tinnitus is associated with salicylate therapy. Salicylates do not normally cause drowsiness, intolerance of high-fat meals, or anorexia.
A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following?
- A. Autoimmune processes in the joints
- B. Chronic metabolic acidosis
- C. Increased uric acid levels
- D. Unstable serum calcium levels
Correct Answer: C
Rationale: Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an autoimmune disease and it does not result from metabolic acidosis or unstable serum calcium levels.
A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply.
- A. Erythrocyte count
- B. Erythrocyte sedimentation rate
- C. Creatinine clearance
- D. C-reactive protein
- E. D-dimer
Correct Answer: B,D
Rationale: Simultaneous elevation in the ESR and CRP have a sensitivity of 88% and a specificity of 98% in making the diagnosis of GCA when coupled with clinical findings. Erythrocyte counts, creatinine clearance, and D-dimer are not diagnostically useful.