Nokea
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.
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A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?
- A. OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
- B. OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees.
- C. OA originates with an infection. RA is a result of your bodys cells attacking one another.
- D. OA is associated with impaired immune function; RA is a consequence of physical damage.
Correct Answer: A
Rationale: OA is a degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints, with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. The diseases are not distinguished by the joints affected and neither has an infectious etiology.
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.
A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect?
- A. Tinnitus
- B. Visual changes
- C. Stomatitis
- D. Hirsutism
Correct Answer: B
Rationale: Antimalarials may cause visual changes; regular ophthalmologic examinations are necessary. Tinnitus is associated with salicylate therapy, stomatitis is associated with gold therapy, and hirsutism is associated with corticosteroid therapy.
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 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.