Nokea
The nurse is teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living. Which of the following information should the nurse include in the teaching plan?
- A. Stand rather than sit when performing household chores.
- B. Avoid activities that require continuous use of the same muscles.
- C. Strengthen small hand muscles by wringing sponges or washcloths.
- D. Protect the knee joints by sleeping with a small pillow under the knees.
Correct Answer: B
Rationale: Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position and sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion (ROM).
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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 caring for a patient who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the following responses by the nurse is most appropriate?
- A. You may need to see a family therapist for some help.
- B. Tell me more about the situations that are causing stress.
- C. Perhaps it would be helpful for you and your family to get involved in a support group.
- D. Your family may need some help to understand the impact of your rheumatoid arthritis.
Correct Answer: B
Rationale: The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.
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.
Which of the following actions should the nurse implement for a patient with septic arthritis?
- A. Hot compress on affected area tid
- B. Active ROM exercises qid
- C. Monitor BP q4h
- D. Passive ROM exercises bid
Correct Answer: A
Rationale: Local hot compresses can also help relieve pain associated with septic arthritis. Only gentle ROM exercises are advocated. The temperature should be monitored often but the BP does not need to be assessed q4h.
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.