Nokea
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.
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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.
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 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.
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.
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.