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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.
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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 nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor?
- A. The patient has a 30 pack-year smoking history.
- B. The patients body mass index is 34 (obese).
- C. The patient has primary hypertension.
- D. The patient is 58 years old.
Correct Answer: B
Rationale: Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly heightened risk.
A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment?
- A. The patient will need daily blood testing for the duration of treatment.
- B. The patient must stop all other drugs 72 hours before starting prednisone.
- C. The drug should be used at the highest dose the patient can tolerate.
- D. The drug should be used for as short a time as possible.
Correct Answer: D
Rationale: Corticosteroids are used for shortest duration and at lowest dose possible to minimize adverse effects. Daily blood work is not necessary and the patient does not need to stop other drugs prior to using corticosteroids.
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 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.