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A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize?
- A. Assessment for subtle signs of bleeding disorders
- B. Assessment of the metatarsal joints and phalangeal joints
- C. Assessment for thoracic pain that is exacerbated by activity
- D. Assessment for headaches and jaw pain
Correct Answer: D
Rationale: Assessment of the patient with GCA focuses on musculoskeletal tenderness, weakness, and decreased function. Careful attention should be directed toward assessing the head (for changes in vision, headaches, and jaw claudication). There is not a particular clinical focus on the potential for bleeding, hand and foot pain, or thoracic pain.
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A patient with SLE asks the nurse why she has to come to the office so often for check-ups. What would be the nurses best response?
- A. Taking care of you in the best way involves seeing you face to face.
- B. Taking care of you in the best way involves making sure you are taking your medication the way it is ordered.
- C. Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working.
- D. Taking care of you in the best way involves drawing blood work every month.
Correct Answer: C
Rationale: The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy. Management of SLE involves regular monitoring to assess disease activity and therapeutic effectiveness. Stating the benefit of face-to-face interaction does not answer the patients question. Blood work is not necessarily drawn monthly and assessing medication adherence is not the sole purpose of visits.
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 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 clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patients adherence to her medication regimen?
- A. Encourage the patient to store the bottles with their tops removed.
- B. Have a trusted family member take over the management of the patients medication regimen.
- C. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.
- D. Have the patient approach her primary care provider to explore medication alternatives.
Correct Answer: C
Rationale: The patients pharmacy will likely be able to facilitate a practical solution that preserves the patients independence while still fostering adherence to treatment. There should be no need to change medications, and storing open medication containers is unsafe. Delegating medications to a family member is likely unnecessary at this point and promotes dependence.
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.