Nokea
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.
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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.
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.
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.
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.