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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.
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The nurse is reviewing laboratory data for a patient who is taking methotrexate to treat rheumatoid arthritis. Which of the following information is most important to communicate to the health care provider?
- A. The blood glucose is 4.2 mmol/L.
- B. The rheumatoid factor is positive.
- C. The white blood cell (WBC) count is 1.5 x 10^9/L.
- D. The erythrocyte sedimentation rate is elevated.
Correct Answer: C
Rationale: Bone marrow suppression is a possible adverse effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in rheumatoid arthritis. The blood glucose is normal.
The nurse is planning care for a patient who has osteoarthritis. Which of the following medications should the nurse anticipate being prescribed for the patient?
- A. Adalimumab
- B. Prednisone
- C. Capsaicin cream
- D. Sulphasalazine
Correct Answer: C
Rationale: Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA.
The nurse is caring for a patient in a long-term care facility who takes multiple medications and has developed acute gouty arthritis. Which of the following medications should not be given until the health care provider has been consulted?
- A. Serratiopeptidase
- B. Famotidine
- C. Oxycodone
- D. Hydrochlorothiazide
Correct Answer: D
Rationale: Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.
A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which of the following actions should the nurse take?
- A. Draw blood for rheumatoid factor analysis.
- B. Teach the patient about injection of the nodule.
- C. Assess the nodules for skin breakdown or infection.
- D. Discuss the need for surgical removal of the nodule.
Correct Answer: C
Rationale: Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.
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.