Nokea
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.
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The nurse is teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living. Which of the following information should the nurse include in the teaching plan?
- A. Stand rather than sit when performing household chores.
- B. Avoid activities that require continuous use of the same muscles.
- C. Strengthen small hand muscles by wringing sponges or washcloths.
- D. Protect the knee joints by sleeping with a small pillow under the knees.
Correct Answer: B
Rationale: Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position and sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion (ROM).
The nurse is caring for a patient with an exacerbation of rheumatoid arthritis (RA) and is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication?
- A. The patient's blood glucose is 9.2 mmol/L.
- B. The patient has no improvement in symptoms.
- C. The patient has experienced a recent 2 kg weight loss.
- D. The patient's erythrocyte sedimentation rate (ESR) has increased.
Correct Answer: A
Rationale: Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this adverse effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be adverse effects of the medication.
The nurse is caring for a patient who has systemic sclerosis manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) syndrome. Which of the following actions should the nurse include in the plan of care?
- A. Avoid use of capsaicin cream on hands.
- B. Keep patient's room warm and draft free.
- C. Obtain capillary blood glucose before meals.
- D. Assist to bathroom every 2 hours while awake.
Correct Answer: B
Rationale: Keeping the room warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose levels or to assist the patient to the bathroom every 2 hours.
While working at a clinic at a summer camp, the nurse sees a camper complaining of chills and muscle aches. Upon examination, the nurse notes a circular lesion with a red border and a clear centre on the camper's right arm. Which of the following actions should the nurse take next?
- A. Palpate the abdomen.
- B. Auscultate the heart sounds.
- C. Ask the patient about recent outdoor activities.
- D. Question the patient about immunization history.
Correct Answer: C
Rationale: The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.
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.