Nokea
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.
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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.
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 patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem?
- A. Rheumatoid arthritis (RA)
- B. Systemic lupus erythematosus
- C. Osteoporosis
- D. Polymyositis
Correct Answer: A
Rationale: In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.
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.
A patient with SLE has come to the clinic for a routine check-up. When auscultating the patients apical heart rate, the nurse notes the presence of a distinct scratching sound. What is the nurses most appropriate action?
- A. Reposition the patient and auscultate posteriorly.
- B. Document the presence of S3 and monitor the patient closely.
- C. Inform the primary care provider that a friction rub may be present.
- D. Inform the primary care provider that the patient may have pneumonia.
Correct Answer: C
Rationale: Patients with SLE are susceptible to developing a pericardial friction rub, possibly associated with myocarditis and accompanying pleural effusions; this warrants prompt medical follow-up. This finding is not characteristic of pneumonia and does not constitute S3. Posterior auscultation is unlikely to yield additional meaningful data.