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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.
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A nurse is planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this womans care needs?
- A. Ineffective Role Performance Related to Pain
- B. Risk for Impaired Skin Integrity Related to Myalgia
- C. Risk for Infection Related to Tissue Alterations
- D. Unilateral Neglect Related to Neuropathic Pain
Correct Answer: A
Rationale: Typically, patients with fibromyalgia have endured their symptoms for a long period of time. The neuropathic pain accompanying FM can often impair a patients ability to perform normal roles and functions. Skin integrity is unaffected and the disease has no associated infection risk. Activity limitations may result in neglect, but not of a unilateral nature.
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.
A nurse is providing care for a patient who has a rheumatic disorder. The nurses comprehensive assessment includes the patients mood, behavior, LOC, and neurologic status. What is the patients most likely diagnosis?
- A. Osteoarthritis (OA)
- B. Systemic lupus erythematosus (SLE)
- C. Rheumatoid arthritis (RA)
- D. Gout
Correct Answer: B
Rationale: SLE has a high degree of neurologic involvement, and can result in central nervous system changes. The patient and family members are asked about any behavioral changes, including manifestations of neurosis or psychosis. Signs of depression are noted, as are reports of seizures, chorea, or other central nervous system manifestations. OA, RA, and gout lack this dimension.
A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize?
- A. Assessment for subtle signs of bleeding disorders
- B. Assessment of the metatarsal joints and phalangeal joints
- C. Assessment for thoracic pain that is exacerbated by activity
- D. Assessment for headaches and jaw pain
Correct Answer: D
Rationale: Assessment of the patient with GCA focuses on musculoskeletal tenderness, weakness, and decreased function. Careful attention should be directed toward assessing the head (for changes in vision, headaches, and jaw claudication). There is not a particular clinical focus on the potential for bleeding, hand and foot pain, or thoracic pain.
A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA?
- A. Cool joints with decreased range of motion
- B. Signs of systemic infection
- C. Joint stiffness, especially in the morning
- D. Visible atrophy of the knee and shoulder joints
Correct Answer: C
Rationale: In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning. Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often warm rather than cool.