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A nurses plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals?
- A. Maximize range of motion while minimizing exertion
- B. Increase joint size and strength
- C. Limit energy output in order to preserve strength for healing
- D. Preserve and increase range of motion while limiting joint stress
Correct Answer: D
Rationale: Exercise is vital to the management of rheumatic disorders. Goals should be preserving and promoting mobility and joint function while limiting stress on the joint and possible damage. Cardiovascular exertion should remain within age-based limits and individual ability, but it is not a goal to minimize exertion. Increasing joint size is not a valid goal.
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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 has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply.
- A. PMR has an association with the genetic marker HLA-DR4.
- B. Immunoglobulin deposits occur in PMR.
- C. PMR is considered to be a wear-and-tear disease.
- D. Foods high in purines exacerbate the biochemical processes that occur in PMR.
- E. PMR occurs predominately in Caucasians.
Correct Answer: A,B,E
Rationale: The underlying mechanism involved with polymyalgia rheumatica is unknown. This disease occurs predominately in Caucasians and often in first-degree relatives. An association with the genetic marker HLA-DR4 suggests a familial predisposition. Immunoglobulin deposits in the walls of inflamed temporal arteries also suggest an autoimmune process. Purines are unrelated and it is not a result of physical degeneration.
The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome?
- A. Raynauds phenomenon
- B. Thyroid dysfunction
- C. Esophageal varices
- D. Osteopenia
Correct Answer: A
Rationale: The R in CREST stands for Raynauds phenomenon. Thyroid dysfunction, esophageal varices, and osteopenia are not associated with scleroderma.
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 newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient?
- A. Impaired Urinary Elimination Related to Neuropathy
- B. Altered Nutrition Related to Impaired Absorption
- C. Disturbed Sleep Pattern Related to CNS Stimulation
- D. Fatigue Related to Pain
Correct Answer: D
Rationale: Fibromyalgia is characterized by fatigue, generalized muscle aching, and stiffness. Impaired urinary elimination is not a common manifestation of the disease. Altered nutrition and disturbed sleep pattern are potential nursing diagnoses, but are not the priority.