Nokea
The nurse is caring for a patient who has rheumatoid arthritis (RA) and is prescribed anakinra. Which of the following information should the nurse include when teaching the patient about this drug?
- A. Self-administration of subcutaneous injections
- B. Take the medication with at least 240 mL of fluid
- C. Avoid concurrently taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- D. Symptoms of gastrointestinal (GI) irritation or bleeding
Correct Answer: A
Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not an adverse effect of this medication. Because the medication is injected, instructions to take it with 240 mL of fluid would not be appropriate. The patient is likely to be concurrently taking Aspirin or NSAIDs, and these should not be discontinued.
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Which of the following patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)?
- A. A 56-year-old man who is a member of a construction crew
- B. A 24-year-old man who participates in a summer softball team
- C. A 49-year-old woman who works on an automotive assembly line
- D. A 36-year-old woman who is newly diagnosed with diabetes mellitus
Correct Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky.
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.
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 young adult patient suspected of having septic arthritis, is hospitalized with a fever and red, hot, painful knees. Which of the following information obtained during the nursing history indicates a risk factor for septic arthritis?
- A. Has a parent who has reactive arthritis.
- B. Is sexually active and has multiple partners.
- C. Recently returned from a trip to South America.
- D. Had several sports-related knee injuries as a teenager.
Correct Answer: B
Rationale: Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis.
The nurse is caring for a patient with gout and has a red, painful left great toe. Which of the following nursing actions should be included in the plan of care?
- A. Gently palpate the toe to assess swelling.
- B. Use pillows to keep the left foot elevated.
- C. Use a footboard to hold bedding away from the toe.
- D. Teach patient to avoid use of acetaminophen.
Correct Answer: C
Rationale: Since any touch on the area of inflammation may increase pain, bedding should be held away from the toe and touching the toe will be avoided. Elevation of the foot will not reduce the pain, which is caused by the urate crystals. Acetaminophen can be used for pain relief.