Nokea
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.
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The nurse is caring for a patient with an acute attack of gout in the left great toe and has a new prescription for probenecid. Which of the following information about the patient's home routine indicates a need for teaching regarding gout management?
- A. The patient sleeps about 8-10 hours every night.
- B. The patient usually eats beef once or twice a week.
- C. The patient generally drinks about 3 L of juice and water daily.
- D. The patient takes one Aspirin a day prophylactically to prevent angina.
Correct Answer: D
Rationale: Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.
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.
The nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE). Which of the following results is most important to communicate to the health care provider?
- A. Decreased C-reactive protein (CRP)
- B. Mild proteinuria
- C. Positive antinuclear antibodies (ANA)
- D. Positive lupus erythematosus cell prep
Correct Answer: B
Rationale: The mild proteinuria indicates possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.
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).
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.