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The nurse is caring for a patient with dermatomyositis who is receiving long-term prednisone therapy. Which of the following findings is most important to report to the health care provider?
- A. The blood glucose is 6.2 mmol/L.
- B. The patient has painful hematuria.
- C. The patient has an increased appetite.
- D. Acne is noted on the back and face.
Correct Answer: B
Rationale: Corticosteroid use is associated with increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne also are adverse effects of corticosteroid use, but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.
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The nurse is conducting patient teaching with a patient who has systemic lupus erythematosus and is prescribed hydroxychloroquine. Which of the following information should the nurse include in the teaching plan?
- A. Has a rapid therapeutic response.
- B. Vision assessment every 6-12 months
- C. Does not prevent flare-ups of symptoms.
- D. Can only be administered intravenously.
Correct Answer: B
Rationale: Fundoscopic and visual field examinations must be performed by an ophthalmologist every 6-12 months when patients are on hydroxychloroquine. Hydroxychloroquine is often used to treat fatigue and moderate skin and joint problems. Unlike the rapid response noted with corticosteroids, effects of antimalarial therapy may not be noticed for several months. Flares may also be prevented with these drugs.
The nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE). Which of the following results is most important to communicate to the health care provider?
- A. Decreased C-reactive protein (CRP)
- B. Mild proteinuria
- C. Positive antinuclear antibodies (ANA)
- D. Positive lupus erythematosus cell prep
Correct Answer: B
Rationale: The mild proteinuria indicates possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.
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 assessing a patient who is taking hydroxychloroquine to treat rheumatoid arthritis. Which of the following findings is most important to report to the health care provider?
- A. Abdominal cramping
- B. Complaint of blurry vision
- C. Phalangeal joint tenderness
- D. Blood pressure 170/84 mm Hg
Correct Answer: B
Rationale: Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.
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.