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A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect?
- A. Tinnitus
- B. Visual changes
- C. Stomatitis
- D. Hirsutism
Correct Answer: B
Rationale: Antimalarials may cause visual changes; regular ophthalmologic examinations are necessary. Tinnitus is associated with salicylate therapy, stomatitis is associated with gold therapy, and hirsutism is associated with corticosteroid therapy.
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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 patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize?
- A. Take OTC calcium supplements consistently.
- B. Restrict consumption of foods high in purines.
- C. Ensure fluid intake of at least 4 liters per day.
- D. Restrict weight-bearing on right foot.
Correct Answer: B
Rationale: Although severe dietary restriction is not necessary, the nurse should encourage the patient to restrict consumption of foods high in purines, especially organ meats. Calcium supplementation is not necessary and activity should be maintained as tolerated. Increased fluid intake is beneficial, but it is not necessary for the patient to consume more than 4 liters daily.
A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses anger and irritation when her call bell isnt answered immediately. What would be the most appropriate response?
- A. You seem like youre feeling angry. Is that something that we could talk about?
- B. Try to remember that stress can make your symptoms worse.
- C. Would you like to talk about the problem with the nursing supervisor?
- D. I can see youre angry. Ill come back when youve calmed down.
Correct Answer: A
Rationale: The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care, as well as sensitivity to the psychological reactions of the patient. Offering to listen to the patient express anger can help the nurse and the patient understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the patient to calm down doesn't acknowledge her feelings. Ignoring the patients feelings suggests that the nurse has no interest in what the patient has said. Offering to get the nursing supervisor also does not acknowledge the patients feelings.
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.