Nokea
The nurse is caring for a patient with an acute attack of gout and is being treated with colchicine. Which of the following assessment data indicates the effectiveness of this medication?
- A. Relief of joint pain
- B. Increased urine output
- C. Elevated serum uric acid
- D. Decreased white blood cells
Correct Answer: A
Rationale: Colchicine produces pain relief in 24-48 hours by decreasing inflammation. The recommended increase in fluid intake of 2-3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in pain.
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The nurse is caring for a patient in a long-term care facility who takes multiple medications and has developed acute gouty arthritis. Which of the following medications should not be given until the health care provider has been consulted?
- A. Serratiopeptidase
- B. Famotidine
- C. Oxycodone
- D. Hydrochlorothiazide
Correct Answer: D
Rationale: Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.
Which of the following information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?
- A. Exercise by taking long walks.
- B. Do daily deep-breathing exercises.
- C. Sleep on the side with hips flexed.
- D. Take frequent naps during the day.
Correct Answer: B
Rationale: Deep-breathing exercises are used to decrease the risk for pulmonary complications that may occur with the reduced chest expansion that can occur with ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.
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 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.
The nurse is caring for a patient with polymyositis and has joint pain, an erythematous facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?
- A. Acute pain related to biological injury agent (inflammation)
- B. Risk for aspiration as evidenced by barrier to elevating upper body
- C. Risk for impaired skin integrity as evidenced by excretions
- D. Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)
Correct Answer: B
Rationale: The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses also are appropriate but are not as high a priority as the maintenance of the patient's airway.