Nokea
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.
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A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement?
- A. Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels.
- B. Ill try to be as physically active as possible between flare-ups.
- C. Ill make sure to monitor my body temperature on a regular basis.
- D. Ill stop taking my steroids when I get relief from my symptoms.
Correct Answer: C
Rationale: Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the patient.
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.
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 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 community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patients health should the nurse focus most closely during the visit?
- A. The patients understanding of rheumatoid arthritis
- B. The patients risk for cardiopulmonary complications
- C. The patients social support system
- D. The patients functional status
Correct Answer: D
Rationale: The patients functional status is a central focus of home assessment of the patient with RA. The nurse may also address the patients understanding of the disease, complications, and social support, but the patients level of function and quality of life is a primary concern.