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The nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE). Which of the following results is most important to communicate to the health care provider?
- A. Decreased C-reactive protein (CRP)
- B. Mild proteinuria
- C. Positive antinuclear antibodies (ANA)
- D. Positive lupus erythematosus cell prep
Correct Answer: B
Rationale: The mild proteinuria indicates possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.
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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.
While working at a clinic at a summer camp, the nurse sees a camper complaining of chills and muscle aches. Upon examination, the nurse notes a circular lesion with a red border and a clear centre on the camper's right arm. Which of the following actions should the nurse take next?
- A. Palpate the abdomen.
- B. Auscultate the heart sounds.
- C. Ask the patient about recent outdoor activities.
- D. Question the patient about immunization history.
Correct Answer: C
Rationale: The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.
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.
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.
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.