Nokea
A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement?
- A. Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels.
- B. Ill try to be as physically active as possible between flare-ups.
- C. Ill make sure to monitor my body temperature on a regular basis.
- D. Ill stop taking my steroids when I get relief from my symptoms.
Correct Answer: C
Rationale: Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the patient.
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A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make?
- A. Ensuring adequate rest
- B. Limiting exposure to sunlight
- C. Limiting intake of alcohol
- D. Smoking cessation
Correct Answer: C
Rationale: Alcohol and red meat can precipitate an acute exacerbation of gout. Each of the other listed actions is consistent with good health, but none directly addresses the factors that exacerbate gout.
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.
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 patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment?
- A. The patient will need daily blood testing for the duration of treatment.
- B. The patient must stop all other drugs 72 hours before starting prednisone.
- C. The drug should be used at the highest dose the patient can tolerate.
- D. The drug should be used for as short a time as possible.
Correct Answer: D
Rationale: Corticosteroids are used for shortest duration and at lowest dose possible to minimize adverse effects. Daily blood work is not necessary and the patient does not need to stop other drugs prior to using corticosteroids.
A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurses response to the patient?
- A. New evidence shows CAM to be as effective as medical treatment.
- B. CAM therapies negate many of the benefits of medications.
- C. CAM therapies typically do more harm than good.
- D. Evidence shows minimal benefits from most CAM therapies.
Correct Answer: D
Rationale: A recent systematic review of complementary and alternative medicine (CAM) examined the efficacy of herbal medicine, acupuncture, Tai chi and biofeedback for the treatment of rheumatoid arthritis and osteoarthritis. Although acupuncture treatment for pain management showed some promise, in all modalities the evidence was ambiguous. There is not enough evidence of the effectiveness of CAM and more rigorous research is needed.