Nokea
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.
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The nurse is assessing a patient with fibromyalgia. Which of the following symptoms should the nurse expect the patient to report? (Select all that apply.)
- A. Sleep disturbances
- B. Multiple tender points
- C. Cardiac palpitations and dizziness
- D. Multijoint pain with inflammation and swelling
- E. Widespread bilateral, burning musculoskeletal pain
Correct Answer: A,B,E
Rationale: These symptoms are commonly described by patients with fibromyalgia. Cardiac involvement and joint inflammation are not typical of fibromyalgia.
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.
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 health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine for systemic lupus erythematosus. Which of the following orders should the nurse question?
- A. Draw anti-DNA blood titre.
- B. Administer varicella vaccine.
- C. Use naproxen 200 mg BID.
- D. Take famotidine 20 mg daily.
Correct Answer: B
Rationale: Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
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.