Nokea
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.
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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 with gout and takes losartan for control of the condition. Which of the following laboratory results should the nurse plan to monitor in the patient?
- A. Blood glucose
- B. Blood pressure
- C. Erythrocyte count
- D. Lymphocyte count
Correct Answer: B
Rationale: Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.
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.
Which of the following assessment findings about a patient who has been using naproxen for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?
- A. The patient has dark-coloured stools.
- B. The patient's pain has not improved.
- C. The patient is using capsaicin cream.
- D. The patient has gained 3 pounds over 3 weeks.
Correct Answer: A
Rationale: Dark-coloured stools may indicate that the patient is experiencing gastrointestinal bleeding caused by the naproxen. The information about the patient's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment or counselling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
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.