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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.
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The nurse is caring for a young adult patient with urethritis and knee pain who has been diagnosed with reactive arthritis. Which of the following medications should the nurse include in the teaching plan?
- A. Anakinra
- B. Etanercept
- C. Doxycycline
- D. Methotrexate
Correct Answer: C
Rationale: Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and treatment with doxycycline. The other medications are used for persistent inflammatory problems such as rheumatoid arthritis.
The nurse is assessing a patient who is taking hydroxychloroquine to treat rheumatoid arthritis. Which of the following findings is most important to report to the health care provider?
- A. Abdominal cramping
- B. Complaint of blurry vision
- C. Phalangeal joint tenderness
- D. Blood pressure 170/84 mm Hg
Correct Answer: B
Rationale: Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.
The nurse is caring for a patient with gout and takes losartan for control of the condition. Which of the following laboratory results should the nurse plan to monitor in the patient?
- A. Blood glucose
- B. Blood pressure
- C. Erythrocyte count
- D. Lymphocyte count
Correct Answer: B
Rationale: Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.
The nurse is teaching a patient with osteoarthritis (OA) of the left hip and knee about management of OA. Which of the following patient statements indicate a need for further education?
- A. I can take glucosamine to help decrease my knee pain.
- B. I will take 1 g of acetaminophen every 4 hours.
- C. I will take a shower in the morning to help relieve stiffness.
- D. I can use a cane to decrease the pressure and pain in my hip.
Correct Answer: B
Rationale: No more than 4 g of acetaminophen should be taken daily to avoid liver toxicity. The other patient statements are correct and indicate good understanding of OA management.
The nurse is caring for a patient with a new diagnosis of rheumatoid arthritis. Which of the following actions should the nurse include in the plan of care?
- A. Instruct the patient to purchase a soft mattress.
- B. Teach patient to use lukewarm water when bathing.
- C. Suggest that the patient take a nap in the afternoon.
- D. Suggest exercise with light weights several times daily.
Correct Answer: C
Rationale: Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid arthritis. Patients are taught to avoid stressing joints, to use warm baths to relieve stiffness, and to use a firm mattress.