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The home health nurse is visiting a patient who has rheumatoid arthritis (RA) and tells the nurse about having persistently dry eyes. Which of the following actions by the nurse is most appropriate?
- A. Reassure the patient that dry eyes are a common problem with RA.
- B. Provide more health teaching about adverse effects of the RA medications.
- C. Suggest that the patient start using over-the-counter (OTC) artificial tears.
- D. Ask the health care provider about lowering the methotrexate dose.
Correct Answer: C
Rationale: The patient's dry eyes are consistent with Sjögren syndrome, a common extra-articular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not an adverse effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.
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The nurse is conducting patient teaching with a patient who has systemic lupus erythematosus and is prescribed hydroxychloroquine. Which of the following information should the nurse include in the teaching plan?
- A. Has a rapid therapeutic response.
- B. Vision assessment every 6-12 months
- C. Does not prevent flare-ups of symptoms.
- D. Can only be administered intravenously.
Correct Answer: B
Rationale: Fundoscopic and visual field examinations must be performed by an ophthalmologist every 6-12 months when patients are on hydroxychloroquine. Hydroxychloroquine is often used to treat fatigue and moderate skin and joint problems. Unlike the rapid response noted with corticosteroids, effects of antimalarial therapy may not be noticed for several months. Flares may also be prevented with these drugs.
The nurse has completed the health history with a female patient who is taking methotrexate to treat rheumatoid arthritis. Which of the following information about the patient is most important for the nurse to report to the health care provider?
- A. The patient had a history of infectious mononucleosis as a teenager.
- B. The patient is trying to have a baby before her disease becomes more severe.
- C. The patient has a family history of age-related macular degeneration of the retina.
- D. The patient has been using large doses of vitamins and health foods to treat the RA.
Correct Answer: B
Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy and up to 3 months after therapy. The other information will not impact the choice of methotrexate as therapy.
The nurse is caring for a patient who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the following responses by the nurse is most appropriate?
- A. You may need to see a family therapist for some help.
- B. Tell me more about the situations that are causing stress.
- C. Perhaps it would be helpful for you and your family to get involved in a support group.
- D. Your family may need some help to understand the impact of your rheumatoid arthritis.
Correct Answer: B
Rationale: The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.
The nurse is caring for a patient with polymyositis and has joint pain, an erythematous facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?
- A. Acute pain related to biological injury agent (inflammation)
- B. Risk for aspiration as evidenced by barrier to elevating upper body
- C. Risk for impaired skin integrity as evidenced by excretions
- D. Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)
Correct Answer: B
Rationale: The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses also are appropriate but are not as high a priority as the maintenance of the patient's airway.
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.