What Am I?
Classic S/S
Nursing Care
DMARDS
Surprise!
100
This degenerative joint disease is caused by mechanical “wear and tear,” commonly affecting weight-bearing joints like the hips and knees and causing brief morning stiffness.
What is Osteoarthritis (OA)?
100
When assessing the client with OA of the knees and fingers, the nurse expects these manifestations (list three.)
Joint pain that worsens with activity and improves with rest
Brief morning stiffness (typically less than 30 minutes)
Bony enlargements of finger joints (Heberden’s nodes at DIP joints or Bouchard’s nodes at PIP joints)
100
This vascular condition seen in RA and SLE causes fingers to turn white or blue in response to cold or stress due to vasospasm.
What is Raynaud’s phenomenon?
100
This DMARD is considered potentially teratogenic.
What is methotrexate?
***Infliximab is not considered teratogenic, but pregnant patients who take it should avoid breast feeding, and infants exposed to infliximab in utero should wait at least 6 months before any live vaccine; may be at increased r/f infection***
100
Clients taking this medication for lupus require routine eye exams due to retinal toxicity.
What is Hydroxychloroquine?
200
This pediatric autoimmune disorder can affect bone growth and may cause uveitis.
What is Juvenile Rheumatoid Arthritis (JRA)?
200
This hallmark lupus skin manifestation appears as a red rash across the cheeks and bridge of the nose.
What is the malar (butterfly) rash?
200
This therapy is recommended for RA clients experiencing morning stiffness, helping improve joint mobility.
What is heat therapy (warm shower or warm compress)?
200
This adverse effect of hydroxychloroquine results in the rash pictured below. It may result in flares and a prolonged course of recovery. 
What is drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome?
200
This class of medication used for inflammatory flares should never be stopped abruptly due to risk of adrenal insufficiency.
What are corticosteroids (prednisone)?
300
This multisystem autoimmune disease causes immune complexes to deposit in tissues such as the kidneys, skin, lungs, and heart.
What is Systemic Lupus Erythematosus (SLE)?
300
This inflammatory marker is commonly elevated in RA and lupus and reflects systemic inflammation.
What is ESR (erythrocyte sedimentation rate)?
Alternative answer: CRP (C-Reactive Protein)
300
Clients taking immunosuppressants for RA or SLE should avoid this type of vaccine.
What are live vaccines?
300
A client taking cyclophosphamide is instructed to increase fluid intake to prevent this severe bladder complication.
What is hemorrhagic cystitis?
300
The nurse is concerned an adolescent client with RA is developing a side effect of methotrexate and recommends this test as a priority to monitor.
What is a complete blood count (CBC)?
400
This test is positive in more than 90% of clients with lupus and is the most sensitive screening test.
What is ANA (antinuclear antibody)?
400
This rheumatoid deformity occurs due to chronic synovial inflammation leading to lateral displacement of the fingers.
What is ulnar deviation (ulnar drift)?
400
This leading cause of death in systemic lupus erythematosus occurs when immune complexes damage the kidneys.
What is Lupus nephritis?
400
This drug is the first-line DMARD of choice...
List 3 things to monitor for during this therapy.
What is methotrexate?
Bone marrow suppression
Monitor CBC for decreased WBCs, platelets, or anemia
Hepatotoxicity
Monitor liver function tests (AST, ALT, bilirubin)
Educate patient to avoid alcohol
Signs of infection or immunosuppression
Fever, sore throat, fatigue, or unusual illness due to immune suppression
400
This biologic monoclonal antibody used in RA suppresses TNF and requires screening for tuberculosis before initiation.
What is Infliximab?
500
Cloudy synovial fluid with fibrin flecks and elevated WBCs is commonly seen in this inflammatory joint disorder.
What is Rheumatoid Arthritis?
500
An x-ray showing joint space narrowing and osteophyte formation most strongly supports this diagnosis.
What is Osteoarthritis?
500
A nurse caring for a client with lupus should closely monitor this lab finding to detect early lupus nephritis.
What is protein in the urine (proteinuria)?
Alternative answer: Hematuria
500
The nurse is teaching a client prescribed methotrexate; they will be sure to include these points in their teaching (list five.)
1) Drink fluids to prevent acute renal failure
2) This medication suppresses the immune system; Report s/s of infection
4) Take folic acid supplement to reduce mouth ulcers
5) Avoid alcohol (increased risk of hepatotoxicity)
500
A client with RA taking long-term corticosteroids should be monitored for this bone complication.
What is osteoporosis?