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Which of the following information should the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?
- A. Affected joints should not be exercised when pain is present.
- B. Application of cold packs before exercise may decrease joint pain.
- C. Exercises should be performed passively by someone other than the patient.
- D. Walking may substitute for range-of-motion (ROM) exercises on some days.
Correct Answer: B
Rationale: Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is persistent, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.
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The nurse is reviewing laboratory data for a patient who is taking methotrexate to treat rheumatoid arthritis. Which of the following information is most important to communicate to the health care provider?
- A. The blood glucose is 4.2 mmol/L.
- B. The rheumatoid factor is positive.
- C. The white blood cell (WBC) count is 1.5 x 10^9/L.
- D. The erythrocyte sedimentation rate is elevated.
Correct Answer: C
Rationale: Bone marrow suppression is a possible adverse effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in rheumatoid arthritis. The blood glucose is normal.
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.
The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which of the following assessments made by the nurse indicates that more patient teaching is needed?
- A. The patient requires a 2-hour midday nap.
- B. The patient has been taking 9 Aspirins daily.
- C. The patient sits on a stool when preparing meals.
- D. The patient sleeps with two pillows under the head.
Correct Answer: D
Rationale: The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.
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 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.