Nokea
A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care?
- A. Fatigue Related to Anemia
- B. Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism
- C. Acute Confusion Related to Increased Serum Ammonia Levels
- D. Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit
Correct Answer: A
Rationale: Patients with SLE nearly always experience fatigue, which is partly attributable to anemia. Ammonia levels are not affected and hematocrit is typically low, not high. VTE is not one of the central complications of SLE.
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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 nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply.
- A. Erythrocyte count
- B. Erythrocyte sedimentation rate
- C. Creatinine clearance
- D. C-reactive protein
- E. D-dimer
Correct Answer: B,D
Rationale: Simultaneous elevation in the ESR and CRP have a sensitivity of 88% and a specificity of 98% in making the diagnosis of GCA when coupled with clinical findings. Erythrocyte counts, creatinine clearance, and D-dimer are not diagnostically useful.
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.
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 patient with polymyositis is experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action?
- A. Initiate a program of passive range of motion exercises
- B. Facilitate referrals to occupational and physical therapy
- C. Administer skeletal muscle relaxants as ordered
- D. Encourage a progressive program of weight-bearing exercise
Correct Answer: B
Rationale: Patients with polymyositis may have symptoms similar to those of other inflammatory diseases. However, proximal muscle weakness is characteristic, making activities such as hair combing, reaching overhead, and using stairs difficult. Therefore, use of assistive devices may be recommended, and referral to occupational or physical therapy may be warranted. The muscle weakness is a product of the disease process, not lack of exercise. Skeletal muscle relaxants are not used in the treatment of polymyositis.