Nokea
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.
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Which of the following statements by a young adult female patient with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about management of the condition?
- A. I will use a sunscreen whenever I am outside.
- B. I will try to keep exercising even if I am tired.
- C. I should take birth control pills to keep from getting pregnant.
- D. I should not take Aspirin or nonsteroidal anti-inflammatory drugs.
Correct Answer: A
Rationale: Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal anti-inflammatory drugs are used to treat the musculoskeletal manifestations of SLE.
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.
The nurse is caring for a patient with an exacerbation of rheumatoid arthritis (RA) and is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication?
- A. The patient's blood glucose is 9.2 mmol/L.
- B. The patient has no improvement in symptoms.
- C. The patient has experienced a recent 2 kg weight loss.
- D. The patient's erythrocyte sedimentation rate (ESR) has increased.
Correct Answer: A
Rationale: Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this adverse effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be adverse effects of the medication.
The home health nurse is visiting a patient who has rheumatoid arthritis (RA) and tells the nurse about having persistently dry eyes. Which of the following actions by the nurse is most appropriate?
- A. Reassure the patient that dry eyes are a common problem with RA.
- B. Provide more health teaching about adverse effects of the RA medications.
- C. Suggest that the patient start using over-the-counter (OTC) artificial tears.
- D. Ask the health care provider about lowering the methotrexate dose.
Correct Answer: C
Rationale: The patient's dry eyes are consistent with Sjögren syndrome, a common extra-articular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not an adverse effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.
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.