Nokea
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.
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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.
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.
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 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 40-year-old woman was diagnosed with Raynauds phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are stiff, like the skin is being stretched from all directions. The nurse should recognize the need for medical referral for the assessment of what health problem?
- A. Giant cell arteritis (GCA)
- B. Fibromyalgia (FM)
- C. Rheumatoid arthritis (RA)
- D. Scleroderma
Correct Answer: D
Rationale: Scleroderma starts insidiously with Raynauds phenomenon and swelling in the hands. Later, the skin and the subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures. This progression of symptoms is inconsistent with GCA, FM, or RA.