Nokea
The nurse is teaching a patient with osteoarthritis (OA) of the left hip and knee about management of OA. Which of the following patient statements indicate a need for further education?
- A. I can take glucosamine to help decrease my knee pain.
- B. I will take 1 g of acetaminophen every 4 hours.
- C. I will take a shower in the morning to help relieve stiffness.
- D. I can use a cane to decrease the pressure and pain in my hip.
Correct Answer: B
Rationale: No more than 4 g of acetaminophen should be taken daily to avoid liver toxicity. The other patient statements are correct and indicate good understanding of OA management.
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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.
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.
The nurse is caring for a patient with polymyositis and has joint pain, an erythematous facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?
- A. Acute pain related to biological injury agent (inflammation)
- B. Risk for aspiration as evidenced by barrier to elevating upper body
- C. Risk for impaired skin integrity as evidenced by excretions
- D. Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)
Correct Answer: B
Rationale: The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses also are appropriate but are not as high a priority as the maintenance of the patient's airway.
The nurse is caring for a patient with an acute attack of gout and is being treated with colchicine. Which of the following assessment data indicates the effectiveness of this medication?
- A. Relief of joint pain
- B. Increased urine output
- C. Elevated serum uric acid
- D. Decreased white blood cells
Correct Answer: A
Rationale: Colchicine produces pain relief in 24-48 hours by decreasing inflammation. The recommended increase in fluid intake of 2-3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in pain.
The nurse is caring for a patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia who tells the nurse, 'I hate the way I look! I never go anywhere except here to the health clinic.' Which of the following is an appropriate nursing diagnosis for the patient?
- A. Activity intolerance related to immobility
- B. Impaired social interaction related to insufficient knowledge about how to enhance mutuality
- C. Impaired skin integrity related to excretions
- D. Social isolation related to difficulty establishing relationships (embarrassment about the effects of SLE)
Correct Answer: D
Rationale: The patient's statement about not going anywhere because they hate the way they look supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.