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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.
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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.
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 patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications?
- A. Corticosteroids
- B. Gold-containing compounds
- C. Antimalarials
- D. Salicylate therapy
Correct Answer: B
Rationale: Stomatitis is an adverse effect that is associated with gold therapy. Steroids, antimalarials, and salicylates do not normally have this adverse effect.
A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make?
- A. Ensuring adequate rest
- B. Limiting exposure to sunlight
- C. Limiting intake of alcohol
- D. Smoking cessation
Correct Answer: C
Rationale: Alcohol and red meat can precipitate an acute exacerbation of gout. Each of the other listed actions is consistent with good health, but none directly addresses the factors that exacerbate gout.
A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential adverse effect?
- A. Infection
- B. Acute confusion
- C. Sedation
- D. Malignant hyperthermia
Correct Answer: A
Rationale: When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression and infection. Confusion and sedation are atypical adverse effects. Malignant hyperthermia is a surgical complication and not a possible adverse effect.