Nokea
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.
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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.
To determine whether a patient with joint swelling and pain has systemic lupus erythematosus, which test will be most useful for the nurse to review?
- A. Rheumatoid factor (RF)
- B. Antinuclear antibody (ANA)
- C. Anti-Smith antibody (Anti-Sm)
- D. Lupus erythematosus (LE) cell prep
Correct Answer: C
Rationale: The anti-Sm is an antibody found almost exclusively in SLE. The other blood tests also are used in screening but are not as specific to SLE.
Which of the following information should the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?
- A. Affected joints should not be exercised when pain is present.
- B. Application of cold packs before exercise may decrease joint pain.
- C. Exercises should be performed passively by someone other than the patient.
- D. Walking may substitute for range-of-motion (ROM) exercises on some days.
Correct Answer: B
Rationale: Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is persistent, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.
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 caring for a patient who has systemic sclerosis manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) syndrome. Which of the following actions should the nurse include in the plan of care?
- A. Avoid use of capsaicin cream on hands.
- B. Keep patient's room warm and draft free.
- C. Obtain capillary blood glucose before meals.
- D. Assist to bathroom every 2 hours while awake.
Correct Answer: B
Rationale: Keeping the room warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose levels or to assist the patient to the bathroom every 2 hours.