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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.
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A nurse is providing care for a patient who has a rheumatic disorder. The nurses comprehensive assessment includes the patients mood, behavior, LOC, and neurologic status. What is the patients most likely diagnosis?
- A. Osteoarthritis (OA)
- B. Systemic lupus erythematosus (SLE)
- C. Rheumatoid arthritis (RA)
- D. Gout
Correct Answer: B
Rationale: SLE has a high degree of neurologic involvement, and can result in central nervous system changes. The patient and family members are asked about any behavioral changes, including manifestations of neurosis or psychosis. Signs of depression are noted, as are reports of seizures, chorea, or other central nervous system manifestations. OA, RA, and gout lack this dimension.
A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. Which of the following is the most appropriate action?
- A. Arrange a family meeting in order to explore assisted living options.
- B. Refer the patient to a support group.
- C. Arrange for the patient to be assessed in her home environment.
- D. Refer the patient to social work.
Correct Answer: C
Rationale: Assessment in the patients home setting can often reveal more meaningful data than an assessment in the health care setting. There is no indication that assisted living is a pressing need or that the patient would benefit from social work or a support group.
A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurses response to the patient?
- A. New evidence shows CAM to be as effective as medical treatment.
- B. CAM therapies negate many of the benefits of medications.
- C. CAM therapies typically do more harm than good.
- D. Evidence shows minimal benefits from most CAM therapies.
Correct Answer: D
Rationale: A recent systematic review of complementary and alternative medicine (CAM) examined the efficacy of herbal medicine, acupuncture, Tai chi and biofeedback for the treatment of rheumatoid arthritis and osteoarthritis. Although acupuncture treatment for pain management showed some promise, in all modalities the evidence was ambiguous. There is not enough evidence of the effectiveness of CAM and more rigorous research is needed.
A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?
- A. OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
- B. OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees.
- C. OA originates with an infection. RA is a result of your bodys cells attacking one another.
- D. OA is associated with impaired immune function; RA is a consequence of physical damage.
Correct Answer: A
Rationale: OA is a degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints, with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. The diseases are not distinguished by the joints affected and neither has an infectious etiology.
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.