Nokea
Which of the following statements by a young adult female patient with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about management of the condition?
- A. I will use a sunscreen whenever I am outside.
- B. I will try to keep exercising even if I am tired.
- C. I should take birth control pills to keep from getting pregnant.
- D. I should not take Aspirin or nonsteroidal anti-inflammatory drugs.
Correct Answer: A
Rationale: Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal anti-inflammatory drugs are used to treat the musculoskeletal manifestations of SLE.
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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 caring for a patient with dermatomyositis who is receiving long-term prednisone therapy. Which of the following findings is most important to report to the health care provider?
- A. The blood glucose is 6.2 mmol/L.
- B. The patient has painful hematuria.
- C. The patient has an increased appetite.
- D. Acne is noted on the back and face.
Correct Answer: B
Rationale: Corticosteroid use is associated with increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne also are adverse effects of corticosteroid use, but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.
The nurse is teaching a patient diagnosed with progressive systemic sclerosis about health maintenance activities. Which of the following patient statements indicates the need for additional instruction?
- A. I should lie down for an hour after meals.
- B. Paraffin baths can be used to help my hands.
- C. Lotions will help if I rub them in for a long time.
- D. I should perform range-of-motion exercises daily.
Correct Answer: A
Rationale: Because of the esophageal scarring, patients should sit up for 2 hours after eating. The other patient statements are correct and indicate that the teaching has been effective.
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 rheumatoid arthritis (RA) and is prescribed anakinra. Which of the following information should the nurse include when teaching the patient about this drug?
- A. Self-administration of subcutaneous injections
- B. Take the medication with at least 240 mL of fluid
- C. Avoid concurrently taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- D. Symptoms of gastrointestinal (GI) irritation or bleeding
Correct Answer: A
Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not an adverse effect of this medication. Because the medication is injected, instructions to take it with 240 mL of fluid would not be appropriate. The patient is likely to be concurrently taking Aspirin or NSAIDs, and these should not be discontinued.