Nokea
The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)
- A. It affects single joints only
- B. Antibodies lead to inflammation
- C. It consists of an autoimmune process
- D. Morning stiffness is common
- E. Permanent damage is inevitable
Correct Answer: B,C
Rationale: RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Permanent damage is not inevitable with aggressive, early treatment.
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A client has a possible connective tissue disease and the nurse is reviewing the client's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.)
- A. Elevated antinuclear antibody (ANA): Normal value: no connective tissue disease
- B. Elevated sedimentation rate: Rheumatoid arthritis
- C. Elevated albumin: Indicative only of rheumatoid deficit
- D. Positive human leukocyte antigen B27 (HLA-B27): Reiter's syndrome or ankylosing spondylitis
- E. Positive rheumatoid factor: Possible kidney disease
Correct Answer: D,E
Rationale: The HLA-B27 is diagnostic for Reiter's syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia.
A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement?
- A. I always wear long sleeves, pants, and a hat when outdoors
- B. I try not to use concentrate that contains any type of sunblock
- C. Since I tend to sweat a lot, I use a lot of baby powder
- D. Since I can be exposed to the sun, I have been using a tanning bed
Correct Answer: A
Rationale: Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, and avoiding drying agents such as powder and tanning beds.
A client with rheumatoid arthritis (RA) is having difficulty completing activities of daily living (ADLs). What devices can the nurse suggest to increase the client's independence? (Select all that apply.)
- A. Grab bars
- B. Long-handled bath brushes
- C. Rocker-recliner
- D. Toothbrushes with built-up handles
- E. Wheelchair cushion
Correct Answer: A,B,D
Rationale: Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.
A nurse is teaching a client with rheumatoid arthritis (RA) who is prescribed etanercept (Enbrel). What information is most important for the nurse to teach this client?
- A. Administer the medication via subcutaneous injection twice a week
- B. Use heat on the injection site to reduce pain
- C. Avoid large crowds or people who are ill
- D. Monitor for signs of infection daily
Correct Answer: A
Rationale: Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.
A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best?
- A. Assess for the presence of subcutaneous nodules or Baker's cysts
- B. Inspect the client's feet and hands for podagra and tophi on fingers and toes
- C. Assess for the correlation of osteoarthritis to weather changes
- D. Reassure the client that the problems will fade when the weather changes again
Correct Answer: A
Rationale: Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Inspecting for podagra and tophi is more relevant for gout. Reassuring the client about weather changes is inaccurate.