Nokea
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.
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The nurse is assessing a patient who is taking hydroxychloroquine to treat rheumatoid arthritis. Which of the following findings is most important to report to the health care provider?
- A. Abdominal cramping
- B. Complaint of blurry vision
- C. Phalangeal joint tenderness
- D. Blood pressure 170/84 mm Hg
Correct Answer: B
Rationale: Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.
Which of the following information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?
- A. Exercise by taking long walks.
- B. Do daily deep-breathing exercises.
- C. Sleep on the side with hips flexed.
- D. Take frequent naps during the day.
Correct Answer: B
Rationale: Deep-breathing exercises are used to decrease the risk for pulmonary complications that may occur with the reduced chest expansion that can occur with ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.
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 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 exacerbation of rheumatoid arthritis (RA) and is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication?
- A. The patient's blood glucose is 9.2 mmol/L.
- B. The patient has no improvement in symptoms.
- C. The patient has experienced a recent 2 kg weight loss.
- D. The patient's erythrocyte sedimentation rate (ESR) has increased.
Correct Answer: A
Rationale: Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this adverse effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be adverse effects of the medication.