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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.
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Which of the following findings should the nurse expect when assessing an older-adult patient who has osteoarthritis (OA) of the left knee?
- A. Heberden nodules
- B. Pain upon joint movement
- C. Redness and swelling of the knee joint
- D. Stiffness that increases with movement
Correct Answer: B
Rationale: Initial symptoms of OA include pain with joint movement. Heberden nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA), and stiffness in OA is worse right after the patient rests and decreases with joint movement.
The nurse is caring for a patient who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the following responses by the nurse is most appropriate?
- A. You may need to see a family therapist for some help.
- B. Tell me more about the situations that are causing stress.
- C. Perhaps it would be helpful for you and your family to get involved in a support group.
- D. Your family may need some help to understand the impact of your rheumatoid arthritis.
Correct Answer: B
Rationale: The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.
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.
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.
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.