Nokea
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.
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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.
The nurse has completed the health history with a female patient who is taking methotrexate to treat rheumatoid arthritis. Which of the following information about the patient is most important for the nurse to report to the health care provider?
- A. The patient had a history of infectious mononucleosis as a teenager.
- B. The patient is trying to have a baby before her disease becomes more severe.
- C. The patient has a family history of age-related macular degeneration of the retina.
- D. The patient has been using large doses of vitamins and health foods to treat the RA.
Correct Answer: B
Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy and up to 3 months after therapy. The other information will not impact the choice of methotrexate as therapy.
The nurse is assisting a patient with rheumatoid arthritis (RA) to plan a daily routine. Which of the following information should the nurse include when discussing the most helpful way to start the day?
- A. A warm bath followed by a short rest
- B. A short routine of isometric exercises
- C. Active range-of motion (ROM) exercises
- D. Stretching exercises to relieve joint stiffness
Correct Answer: A
Rationale: Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.
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.
The nurse is caring for a patient with an acute attack of gout in the left great toe and has a new prescription for probenecid. Which of the following information about the patient's home routine indicates a need for teaching regarding gout management?
- A. The patient sleeps about 8-10 hours every night.
- B. The patient usually eats beef once or twice a week.
- C. The patient generally drinks about 3 L of juice and water daily.
- D. The patient takes one Aspirin a day prophylactically to prevent angina.
Correct Answer: D
Rationale: Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.