OA, SLE
&
FIBROMYALGIA
&
FIBROMYALGIA
During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (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
ANS A, B, E
These symptoms are commonly described by patients with fibromyalgia. Cardiac involvement and joint inflammation are not typical of fibromyalgia.
The nurse correlates which clinical manifestations to the diagnosis of rheumatoid arthritis? Select all that apply.
a. Bouchard’s nodes
b. Boutonniere deformity
c. Swan-neck deformity
d. Tophi
e. Ulnar deviation
ANS B, C, & E
B. Rheumatoid arthritis leads to irreversible joint damage and disability. Common joint deformities include swan-neck deformity caused by hyperextension of the proximal interphalangeal joints, boutonnière deformity caused by abnormal flexion of the proximal interphalangeal joints, and ulnar deviation caused by the lateral deviation of the phalanges.
C. Rheumatoid arthritis leads to irreversible joint damage and disability. Common joint deformities include swan-neck deformity caused by hyperextension of the proximal interphalangeal joints, boutonnière deformity caused by abnormal flexion of the proximal interphalangeal joints, and ulnar deviation caused by the lateral deviation of the phalanges.
E. Rheumatoid arthritis leads to irreversible joint damage and disability. Common joint deformities include swan-neck deformity caused by hyperextension of the proximal interphalangeal joints, boutonnière deformity caused by abnormal flexion of the proximal interphalangeal joints, and ulnar deviation caused by the lateral deviation of the phalanges.
The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.)
a. Dry, scaly skin rash – Systemic lupus erythematosus (SLE)
b. Esophageal dysmotility – Systemic sclerosis
c. Excess uric acid excretion – Gout
d. Footdrop and paresthesias – Osteoarthritis
e. Vasculitis causing organ damage – Rheumatoid arthritis
ANS: A ,B & E
A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis.
A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.)
a. Allopurinol (Zyloprim) – Acute gout
b. Colchicine (Colcrys) – Acute gout
c. Febuxostat (Uloric) – Chronic gout
d. Indomethacin (Indocin) – Acute gout
e. Probenecid (Benemid) – Chronic gout
ANS: B,C,D, & E
Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout.
The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further?
a. Creatinine: 3.9 mg/dL
b. Platelet count: 210,000/mm3
c. Red blood cell count: 5.2/mm3
d. White blood cell count: 4400/mm3
ANS: A
Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.
The nurse is caring for a patient who has recently been diagnosed with fibromyalgia. The nurse correlates which prescriptions as part of the patient’s treatment plan? Select all that apply.
a. Ibuprofen (Advil)
b. Aerobic exercise
c. Pregabalin (Lyrica)
d. Fentanyl (Sublimaze)
e. Cognitive behavioral therapy
ANS A,B,C & E
Pharmacological treatments for fibromyalgia may include NSAIDs such as ibuprofen for pain, antidepressants (such as duloxetine, milnacipran, amitriptyline, and fluoxetine) to help with pain and sleep, and anti-seizure medications (Pregabalin, for example) to reduce pain.
2 This is correct. Nonpharmacological therapy for fibromyalgia may include physical therapy, strength training, aerobic exercise, cognitive behavioral therapy, education, and self-management. Physical therapy is helpful in maintaining strength and function.
Pharmacological treatments for fibromyalgia may include antidepressants (such as duloxetine, milnacipran, amitriptyline, fluoxetine) to help with pain and sleep, and anti-seizure medications (pregabalin, for example) to reduce pain.
Nonpharmacological therapy for fibromyalgia may include physical therapy, strength training, aerobic exercise, cognitive behavioral therapy, education, and self-management. Physical therapy is helpful in maintaining strength and function.
The nurse is providing care to a patient who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of rheumatoid arthritis. When providing care to this patient, which actions by the nurse are appropriate? Select all that apply.
a. Assessing for an allergic reaction
b. Monitoring for signs of renal problems
c. Advising against abrupt discontinuation of drugs
d. Assuring the patient that there is no relationship between NSAIDs and heart disease
e. Encouraging the patient to take NSAIDs with water, milk, or a small snack to help avoid stomach distress
ANS: A,B C, & E
A. When providing care to a patient who is receiving any medication, it is important to monitor the patient for signs of an allergic reaction.
B. If you take NSAIDs in high doses, the reduced blood flow can permanently damage the kidneys, and it can eventually lead to kidney failure and require dialysis.
C. Abrupt discontinuation can have serious side effects.
E. Taking NSAIDs with food may help reduce irritation of the stomach and prevent an ulcer.
An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
a. Apply an abduction pillow to the client’s legs.
b. Assess the skin under the abduction pillow straps.
c. Place pillows under the heels to keep them off the bed.
d. Monitor cognition to determine when the client can get up.
e. Take and record vital signs per unit/facility policy.
ANS: A C, & E
The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurse’s responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility.
A patient with an acute attack of gout in the right great toe has a new prescription for probenecid (Benemid). Which information about the patient’s home routine indicates a need for teaching regarding gout management?
a. The patient sleeps about 8 to 10 hours every night.
b. The patient usually eats beef once or twice a week.
c. The patient takes one aspirin a day to prevent angina.
d. The patient usually drinks about 3 quarts water daily.
ANS: C
Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient’s sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.
Which laboratory data is important to communicate to the health care provider for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis?
a. The blood glucose is 90 mg/dL.
b. The rheumatoid factor is positive.
c. The white blood cell (WBC) count is 1500/µL.
d. The erythrocyte sedimentation rate is elevated.
ANS; C
Bone marrow suppression is a possible side 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 who has recently been diagnosed with fibromyalgia. Which medications does the nurse anticipate will be prescribed as part of the patient’s treatment plan? Select all that apply.
a. Ibuprofen
b. Aerobic exercise
c. Pregabalin (Lyrica)
d. Zolpidem (Ambien)
e. Tenormin (Atenolol)
ANS; A,B & C
A. Treatment for fibromyalgia may include NSAIDs such as ibuprofen for pain, pregabalin (Lyrica), and aerobic exercise.
B. Treatment for fibromyalgia may include NSAIDs such as ibuprofen for pain, pregabalin (Lyrica), and aerobic exercise.
C. Treatment for fibromyalgia may include NSAIDs such as ibuprofen for pain, pregabalin (Lyrica), and aerobic exercise
A patient recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. Which teaching topics will the nurse include as ways to decrease the likelihood of crippling deformities? Select all that apply.
a. Ignore pain as a warning signal
b. Use stronger joints for most activity
c. Avoid stress to any current area of deformity
d. Type instead of handwriting items if possible
e. Stop an activity if it is beyond your ability to perform
ANS: B, C D, & E
B. Using a stronger joint or part of the body, such as the palm, to carry items is preferable to grasping.
C. When performing a task, the patient should avoid stress in the area of the deformity to help prevent further deformities.
D. Writing requires using a strong grip, so typing is preferable.
E. The patient with RA should never attempt to push a joint beyond its ability.
The nurse provides education to a patient with rheumatoid arthritis who is prescribed methotrexate by the health-care provider. Which patient statement indicates to the nurse a need for additional teaching?
a. “I can have a glass of wine each night with dinner.”
b. “I will take folic acid each day to decrease my risk of mouth ulcers.”
c. “I will continue to take my oral contraception to prevent pregnancy.”
d. “I didn’t have to decrease my medication dose because my kidney tests came back okay.”
ANS: A
This patient statement indicates a need for additional teaching. The patient is taught to avoid alcohol while taking this medication because of the risk of hepatotoxicity.
Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)?
a. The patient has joint pain and stiffness.
b. The patient’s blood glucose is 165 mg/dL.
c. The patient has experienced a recent 5-pound weight loss.
d. The patient’s erythrocyte sedimentation rate (ESR) has increased.
ANS: B
Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this side 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 side effects of the medication.
Which result for a 30-year-old patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider?
a. Decreased C-reactive protein (CRP)
b. Elevated blood urea nitrogen (BUN)
c. Positive antinuclear antibodies (ANA)
d. Positive lupus erythematosus cell prep
ANS: B
The elevated BUN and creatinine levels indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.
The nurse monitors for which of the following clinical manifestations in the patient diagnosed with systemic lupus erythematosus? Select all that apply.
a. Alopecia
b. Fever
c. Elevated uric acid
d. Thrombocytosis
e. Leukopenia
ANS A, B, & E
A. Systemic lupus erythematosus is an autoimmune disease mostly characterized by fatigue, fever, rash, photosensitivity, oral and nasal ulcers, alopecia, arthralgia, and myalgia.
B. Systemic lupus erythematosus is an autoimmune disease mostly characterized by fatigue, fever, rash, photosensitivity, oral and nasal ulcers, alopecia, arthralgia, and myalgia.
E. Laboratory values in patients with SLE include a complete blood count (CBC) to check for leukopenia (decreased white blood cell count), thrombocytopenia (decreased platelet count), and anemia (decreased red blood cells).
A patient, recently diagnosed with rheumatoid arthritis (RA), asks the nurse whether RA will affect her in other ways. When responding to the patient, which systems will the nurse include as possibly being affected by the diagnosis? Select all that apply.
a. Exocrine
b. Respiratory
c. Hematologic
d. Reproductive
e. Cardiovascular
ANS: A,B,C & E
A. RA can affect the respiratory system with pleural effusion (collection of fluid in the pleural space); the cardiovascular system with coronary heart disease; the exocrine glands, resulting in dry eyes and mouth; and the hematologic system with a variety of disorders, particularly anemia.
B. RA can affect the respiratory system with pleural effusion (collection of fluid in the pleural space); the cardiovascular system with coronary heart disease; the exocrine glands, resulting in dry eyes and mouth; and the hematologic system with a variety of disorders, particularly anemia.
C. RA can affect the respiratory system with pleural effusion (collection of fluid in the pleural space); the cardiovascular system with coronary heart disease; the exocrine glands, resulting in dry eyes and mouth; and the hematologic system with a variety of disorders, particularly anemia.
E. RA can affect the respiratory system with pleural effusion (collection of fluid in the pleural space); the cardiovascular system with coronary heart disease; the exocrine glands, resulting in dry eyes and mouth; and the hematologic system with a variety of disorders, particularly anemia.
The nurse provides care for a patient who is admitted to the cardiac care unit for a coronary artery bypass graft (CABG). The patient has a history of osteoarthritis. Which medication does the nurse question if prescribed by the health-care provider?
a. Ibuprofen (Advil)
b. Fentanyl (Duragesic)
c. Morphine (MS Contin)
d. Acetaminophen (Tylenol)
ANS; A
Nonsteroidal anti-inflammatory drug (NSAIDs) (e.g., ibuprofen) may cause an increased risk of serious cardiovascular thrombotic events such as myocardial infarction, stroke, and renal insufficiency, especially in a “stressed” kidney (a patient with preexisting risk factors such as dehydration, or a patient with already compromised renal function), and serious GI-adverse events including bleeding, ulceration, and perforation of the stomach. They are contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft surgery and patients in renal failure.
The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question?
a. Draw anti-DNA blood titer.
b. Administer varicella vaccine.
c. Naproxen (Aleve) 200 mg BID.
d. Famotidine (Pepcid) 20 mg daily.
ANS: B
Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?
a. Rheumatoid factor (RF)
b. Antinuclear antibody (ANA)
c. Anti-Smith antibody (Anti-Sm)
d. Lupus erythematosus (LE) cell prep
ANS: C
The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.
Which clinical manifestations does the nurse assess for in the patient diagnosed with gout? Select all that apply.
a. Presence of tophi
b. Raynaud’s phenomenon
c. Reports of severe pain in the great toe
d. Redness and swelling of great toe
e. Ulnar deviation
ANS A C. D
A. Chronic tophaceous gout is characterized by repeated attacks of many years, leading to the production of tophi (uric acid deposits or nodules in the joint) and joint destruction.
C. Clinical manifestations of gout are related to pain and decreased function caused by the accumulation of urate crystals and tophi nodules in the affected joints.
D. Clinical manifestations of gout are related to pain and decreased function caused by the accumulation of urate crystals and tophi nodules in the affected joints.
A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.)
a. Buy and install an elevated toilet seat.
b. Install grab bars in the shower and by the toilet.
c. Step into the bathtub with the affected leg first.
d. Remove all throw rugs throughout the house.
e. Use a shower chair while taking a shower.
ANS: A,B, D & E
Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees.
The nurse is caring for a patient who was diagnosed with rheumatoid arthritis (RA) last year. The patient has recently been placed on prednisone for treatment. Which patient statement indicates that the medication teaching was successful?
a. “I will not have to limit my consumption of canned vegetables.”
b. “I will take this medication on a full stomach to enhance absorption.”
c. “I will not need to monitor my blood sugar more frequently while on this medication.”
d. “I will take the ordered dose at the same time every day.”
ANS: D
Steroid therapy is usually done as part of a tapered-dose treatment plan. It is important to take the medication at the same time each day.
A 71-year-old patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of
a. sertraline (Zoloft).
b. famotidine (Pepcid).
c. oxycodone (Roxicodone).
d. hydrochlorothiazide (HydroDIURIL).
ANS: D
Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.
Which laboratory result will the nurse monitor to determine whether prednisone (Deltasone) has been effective for a 30-year-old patient with an acute exacerbation of rheumatoid arthritis?
a. Blood glucose test
b. Liver function tests
c. C-reactive protein level
d. Serum electrolyte levels
ANS: C
C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored in patients receiving corticosteroids.
Which subjective findings should the nurse anticipate when assessing a patient diagnosed with gout? Select all that apply.
a. Presence of tophi
b. Tenderness on palpation
c. Reports of severe pain in the great toe
d. Patient states, “I cannot move my joint.”
e. Soft tissue swelling accompanied by warmth
ANS: C & D
C. This is a subjective assessment finding for a patient diagnosed with gout.
D. This is a subjective assessment finding for a patient diagnosed with gout.
A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.)
a. Grab bars to reach high items
b. Long-handled bath scrub brush
c. Soft rocker-recliner chair
d. Toothbrush with built-up handle
e. Wheelchair cushion for comfort
ANS: A, B, & D
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 client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best?
a. “A little sedation will help you get some rest.”
b. “Depression often accompanies fibromyalgia.”
c. “This drug works in the brain to decrease pain.”
d. “You will have more energy after taking this drug.”
ANS: C
Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate.
The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding
a. relief of joint pain.
b. increased urine output.
c. elevated serum uric acid.
d. increased white blood cells (WBC).
ANS: A
Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but would not increase.
The nurse is caring for a patient who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the patient’s lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which is a priority nursing diagnosis for this patient?
a. Risk for Infection
b. Ineffective Individual Coping
c. Risk for Impaired Skin Integrity
d. Ineffective Health Maintenance
ANS: A
All identified diagnoses are appropriate for a patient with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection. Therefore, the priority diagnosis is Risk for Infection
The nurse monitors for which of the following clinical manifestations in the patient diagnosed with osteoarthritis? Select all that apply.
a. Bouchard’s nodes
b. Butterfly rash
c. Crepitus
d. Heberden’s nodes
e. Raynaud’s phenomenon
ANS: A C, & D
A. Osteophytes are projections of new cartilage and bone growth that form along joint lines, contributing to pain in the joint and decreased range of motion. Osteophyte formations on the proximal interphalangeal joints and distal interphalangeal joints are referred to as Bouchard’s nodes and Heberden’s nodes, respectively.
C. Crepitus, a crackling, grating sound or feeling caused by air or gas under the skin, may be present in patients with osteoarthritis. This is due to cartilage breakdown in the joint.
D. Osteophytes are projections of new cartilage and bone growth that form along joint lines, contributing to pain in the joint and decreased range of motion. Osteophyte formations on the proximal interphalangeal joints and distal interphalangeal joints are referred to as Bouchard’s nodes and Heberden’s nodes, respectively.
The nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.)
a. Anorexia
b. Felty’s syndrome
c. Joint deformity
d. Low-grade fever
e. Weight loss
ANS: B,C & E
Late manifestations of RA include Felty’s syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease.
An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9 g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate?
a. Instruct the client to avoid large crowds.
b. Prepare to administer epoetin alfa (Epogen).
c. Teach the client about foods high in iron.
d. Tell the client that all laboratory results are normal.
ANS: B
This client is anemic, which needs correction prior to surgery. While eating iron-rich foods is helpful, to increase the client’s red blood cells, hemoglobin, and hematocrit within 2 months, epoetin alfa is needed. This colony-stimulating factor will encourage the production of red cells. The client’s white blood cell count is normal, so avoiding infection is not the priority.
nakinra (Kineret) is prescribed for a 49-year-old patient who has rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about
a. avoiding concurrently taking aspirin.
b. symptoms of gastrointestinal (GI) bleeding.
c. self-administration of subcutaneous injections.
d. taking the medication with at least 8 oz of fluid.
ANS; C
Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued.
After the nurse has finished teaching a 68-year-old patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?
a. “I can take glucosamine to help decrease my knee pain.”
b. “I will take 1 g of acetaminophen (Tylenol) 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.”
ANS: B
No more than 4 g of acetaminophen should be taken daily to avoid liver damage. The other patient statements are correct and indicate good understanding of OA management.
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 cosmetics that contain any type of sunblock.”
c. “Since I tend to sweat a lot, I use a lot of baby powder.”
d. “Since I can’t be exposed to the sun, I have been using a tanning bed.”
ANS: A
Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, avoiding drying agents such as powder, and avoiding tanning beds.
A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.)
a. “Avoid acetaminophen in over-the-counter medications.”
b. “It may take several weeks to become effective on pain.”
c. “Pregnancy and breast-feeding are not affected by MTX.”
d. “Stay away from large crowds and people who are ill.”
e. “You may find that folic acid, a B vitamin, reduces side effects.”
ANS: A,B,D & E
MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.
A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate?
a. Giving subcutaneous injections
b. Having a chest x-ray once a year
c. Taking the medication with food
d. Using heat on the injection site
ANS: A
Iggy P. 323 Table 18-9
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 nurse is caring for a patient with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). When providing care for this patient, the nurse monitors for which adverse effect associated with the prescribed medication?
a. Renal toxicity
b. Retinal toxicity
c. Cushingoid effects
d. Pulmonary fibrosis
ANS: B
Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness.
The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client’s blood glucose readings have been elevated. What question by the nurse is most appropriate?
a. “Are you compliant with following the diabetic diet?”
b. “Have you been taking glucosamine supplements?”
c. “How much exercise do you really get each week?”
d. “You’re still taking your diabetic medication, right?”
ANS: B
All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them. “Compliant” is a word associated with negative images, and the client may deny being “noncompliant.” Asking how much exercise the client “really” gets is accusatory. Asking if the client takes his or her medications “right?” is patronizing.
The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which patient statement indicates an appropriate understanding of the plan of care?
a. “I will take birth control pills while I am taking cytotoxic medications.”
b. “I do not need to contact the doctor if I develop a fever or rash.”
c. “I plan to go to the movies this weekend so that I get out of the house.”
d. “I can take aspirin as indicated for pain.”
ANS A
Treatment for SLE can include cytotoxic drugs. The patient is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects.
The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests that they
a. stand rather than sit when performing household and yard chores.
b. strengthen small hand muscles by wringing sponges or washcloths.
c. protect the knee joints by sleeping with a small pillow under the knees.
d. avoid activities that require repetitive use of the same muscles and joints.
ANS: D
Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position, and sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion (ROM).
A 31-year-old woman is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which information from the patient’s health history is important for the nurse to report to the health care provider about the methotrexate?
a. The patient had a history of infectious mononucleosis as a teenager.
b. The patient is trying to get pregnant 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.
ANS: B
Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.
A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply?
a. Heating pad
b. Ice packs
c. Splints
d. Wax dip
ANS: B
Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness.
The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first?
a. Client taking celecoxib (Celebrex) and ranitidine (Zantac)
b. Client taking etanercept (Enbrel) with a red injection site
c. Client with a blood glucose of 190 mg/dL who is taking steroids
d. Client with a fever and cough who is taking tofacitinib (Xeljanz)
ANS: D
Iggy P 323 tABLE 18-9
Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels.