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The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which of the following assessments made by the nurse indicates that more patient teaching is needed?
- A. The patient requires a 2-hour midday nap.
- B. The patient has been taking 9 Aspirins daily.
- C. The patient sits on a stool when preparing meals.
- D. The patient sleeps with two pillows under the head.
Correct Answer: D
Rationale: The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.
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A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which of the following actions should the nurse take?
- A. Draw blood for rheumatoid factor analysis.
- B. Teach the patient about injection of the nodule.
- C. Assess the nodules for skin breakdown or infection.
- D. Discuss the need for surgical removal of the nodule.
Correct Answer: C
Rationale: Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.
The nurse is teaching a patient diagnosed with progressive systemic sclerosis about health maintenance activities. Which of the following patient statements indicates the need for additional instruction?
- A. I should lie down for an hour after meals.
- B. Paraffin baths can be used to help my hands.
- C. Lotions will help if I rub them in for a long time.
- D. I should perform range-of-motion exercises daily.
Correct Answer: A
Rationale: Because of the esophageal scarring, patients should sit up for 2 hours after eating. The other patient statements are correct and indicate that the teaching has been effective.
The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine for systemic lupus erythematosus. Which of the following orders should the nurse question?
- A. Draw anti-DNA blood titre.
- B. Administer varicella vaccine.
- C. Use naproxen 200 mg BID.
- D. Take famotidine 20 mg daily.
Correct Answer: B
Rationale: Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
The nurse is assessing a patient with fibromyalgia. Which of the following symptoms should the nurse expect the patient to report? (Select all that apply.)
- A. Sleep disturbances
- B. Multiple tender points
- C. Cardiac palpitations and dizziness
- D. Multijoint pain with inflammation and swelling
- E. Widespread bilateral, burning musculoskeletal pain
Correct Answer: A,B,E
Rationale: These symptoms are commonly described by patients with fibromyalgia. Cardiac involvement and joint inflammation are not typical of fibromyalgia.
Which of the following information should the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?
- A. Affected joints should not be exercised when pain is present.
- B. Application of cold packs before exercise may decrease joint pain.
- C. Exercises should be performed passively by someone other than the patient.
- D. Walking may substitute for range-of-motion (ROM) exercises on some days.
Correct Answer: B
Rationale: Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is persistent, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.