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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.
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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 planning care for a patient who has osteoarthritis. Which of the following medications should the nurse anticipate being prescribed for the patient?
- A. Adalimumab
- B. Prednisone
- C. Capsaicin cream
- D. Sulphasalazine
Correct Answer: C
Rationale: Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA.
The nurse is caring for a patient with an acute exacerbation of rheumatoid arthritis and is prescribed prednisone. Which of the following laboratory results should the nurse monitor to determine whether the medication has been effective?
- A. Blood glucose test
- B. Liver function tests
- C. C-reactive protein level
- D. Serum electrolyte levels
Correct Answer: C
Rationale: C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels also will be monitored to check for adverse effects of prednisone. Liver function is not routinely monitored for patients receiving steroids.
A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which of the following actions should the nurse take?
- A. Draw blood for rheumatoid factor analysis.
- B. Teach the patient about injection of the nodule.
- C. Assess the nodules for skin breakdown or infection.
- D. Discuss the need for surgical removal of the nodule.
Correct Answer: C
Rationale: Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.
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.