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The nurse is caring for a patient with gout and has a red, painful left great toe. Which of the following nursing actions should be included in the plan of care?
- A. Gently palpate the toe to assess swelling.
- B. Use pillows to keep the left foot elevated.
- C. Use a footboard to hold bedding away from the toe.
- D. Teach patient to avoid use of acetaminophen.
Correct Answer: C
Rationale: Since any touch on the area of inflammation may increase pain, bedding should be held away from the toe and touching the toe will be avoided. Elevation of the foot will not reduce the pain, which is caused by the urate crystals. Acetaminophen can be used for pain relief.
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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 rheumatoid arthritis who refuses to take the prescribed methotrexate, telling the nurse 'That drug has too many adverse effects. My arthritis isn't that bad yet.' Which of the following responses is most appropriate?
- A. You have the right to refuse to take the methotrexate.
- B. Methotrexate is less expensive than some of the newer drugs.
- C. It is important to start methotrexate early to decrease the extent of joint damage.
- D. Methotrexate is effective and has fewer adverse effects than some of the other drugs.
Correct Answer: C
Rationale: Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.
The nurse is teaching a patient diagnosed with progressive systemic sclerosis about health maintenance activities. Which of the following patient statements indicates the need for additional instruction?
- A. I should lie down for an hour after meals.
- B. Paraffin baths can be used to help my hands.
- C. Lotions will help if I rub them in for a long time.
- D. I should perform range-of-motion exercises daily.
Correct Answer: A
Rationale: Because of the esophageal scarring, patients should sit up for 2 hours after eating. The other patient statements are correct and indicate that the teaching has been effective.
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.
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.