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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.
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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.
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 nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients care, what goal should the nurse include?
- A. The patient will express satisfaction with her ability to perform ADLs.
- B. The patient will recover from OA within 6 months.
- C. The patient will adhere to the prescribed plan of care.
- D. The patient will deny signs or symptoms of OA.
Correct Answer: A
Rationale: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care.
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 patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved?
- A. Angiography
- B. Myelography
- C. Paracentesis
- D. Arthrocentesis
Correct Answer: D
Rationale: Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through the abdominal wall under sterile conditions.