Question 1

A client with systemic lupus erythematosus (SLE)was recently discharged from the hospital after an acute exacerbation.The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family.What action by the nurse is best?

Accepted Answer

A)  Explain to the client that SLE is an unpredictable disease. 
B)  Help the client create backup plans to minimize disruption. 
C)  Offer to talk to the family and educate them about SLE. 
D)  Tell the client to remain compliant with treatment plans.

Question 2

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?

Accepted Answer

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."

Question 3

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems.Which statement by the nurse is most appropriate?

Accepted Answer

A)  "Drink 1 to 2 liters of water each day." 
B)  "Have 10 to 12 ounces of juice a day." 
C)  "Liver is a good source of iron." 
D)  "Never eat hard cheeses or sardines."

Question 4

A client with fibromyalgia is in the hospital for an unrelated issue.The client reports that sleep,which is always difficult,is even harder now.What actions by the nurse are most appropriate? (Select all that apply.)

Accepted Answer

A)  Allow the client uninterrupted rest time. 
B)  Assess the client's usual bedtime routine. 
C)  Limit environmental noise as much as possible. 
D)  Offer a massage or warm shower at night. 
E)  Request an order for a strong sleeping pill.

Question 5

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.)

Accepted Answer

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

Question 6

The nurse is caring for a client using a continuous passive motion (CPM)machine and has delegated some tasks to the unlicensed assistive personnel (UAP).What action by the UAP warrants intervention by the nurse?

Accepted Answer

A)  Checking to see if the machine is working 
B)  Keeping controls in a secure place on the bed 
C)  Placing padding in the machine per request 
D)  Storing the CPM machine under the bed after removal

Question 7

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.)

Accepted Answer

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.

Question 8

The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA).Which client should the nurse see first?

Accepted Answer

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)

Question 9

After a total knee replacement,a client is on the postoperative nursing unit with a continuous femoral nerve blockade.On assessment,the nurse notes the client's pulses are 2+/4+ bilaterally; the skin is pale pink,warm,and dry; and the client is unable to dorsiflex or plantarflex the affected foot.What action does the nurse perform next?

Accepted Answer

A)  Document the findings and monitor as prescribed. 
B)  Increase the frequency of monitoring the client. 
C)  Notify the surgeon or anesthesia provider immediately. 
D)  Palpate the client's bladder or perform a bladder scan.

Question 10

A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA)about drugs used to treat the disease.For which medication does the nurse plan primary teaching?

Accepted Answer

A)  Acetaminophen (Tylenol) 
B)  Cyclobenzaprine hydrochloride (Flexeril) 
C)  Hyaluronate (Hyalgan) 
D)  Ibuprofen (Motrin)

Question 11

A client is started on etanercept (Enbrel).What teaching by the nurse is most appropriate?

Accepted Answer

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

Question 12

A client comes to the family medicine clinic and reports joint pain and stiffness.The nurse is asked to assess the client for Heberden's nodules.What assessment technique is correct?

Accepted Answer

A)  Inspect the client's distal finger joints. 
B)  Palpate the client's abdomen for tenderness. 
C)  Palpate the client's upper body lymph nodes. 
D)  Perform range of motion on the client's wrists.

Question 13

A nurse is discharging a client after a total hip replacement.What statement by the client indicates good potential for self-management?

Accepted Answer

A)  "I can bend down to pick something up." 
B)  "I no longer need to do my exercises." 
C)  "I will not sit with my legs crossed." 
D)  "I won't wash my incision to keep it dry."

Question 14

A client takes celecoxib (Celebrex)for chronic osteoarthritis in multiple joints.After a knee replacement,the health care provider has prescribed morphine sulfate for postoperative pain relief.The client also requests the celecoxib in addition to the morphine.What action by the nurse is best?

Accepted Answer

A)  Consult with the health care provider about administering both drugs to the client. 
B)  Inform the client that the celecoxib will be started when he or she goes home. 
C)  Teach the client that, since morphine is stronger, celecoxib is not needed. 
D)  Tell the client he or she should not take both drugs at the same time.

Question 15

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?

Accepted Answer

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?"

Question 16

A client is scheduled to have a hip replacement.Preoperatively,the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery.What action by the preoperative nurse is most important?

Accepted Answer

A)  Administer preoperative medications as prescribed. 
B)  Ensure that a consent for transfusion is on the chart. 
C)  Explain to the client how anemia affects healing. 
D)  Teach the client about foods high in protein and iron.

Question 17

A nurse works with several clients who have gout.Which types of gout and their drug treatments are correctly matched? (Select all that apply.)

Accepted Answer

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

Question 18

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?

Accepted Answer

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.

Question 19

A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications.What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.)

Accepted Answer

A)  Acupuncture 
B)  Stretching 
C)  Supplements 
D)  Tai chi 
E)  Vigorous aerobics

Question 20

A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA).Which client should the nurse see first?

Accepted Answer

A)  Client who reports jaw pain when eating 
B)  Client with a red, hot, swollen right wrist 
C)  Client who has a puffy-looking area behind the knee 
D)  Client with a worse joint deformity since the last visit

Exam 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation.The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family.What action by the nurse is best?

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?

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems.Which statement by the nurse is most appropriate?

A client with fibromyalgia is in the hospital for an unrelated issue.The client reports that sleep,which is always difficult,is even harder now.What actions by the nurse are most appropriate? (Select all that apply.)

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.)

The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP) .What action by the UAP warrants intervention by the nurse?

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.)

The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA) .Which client should the nurse see first?

A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease.For which medication does the nurse plan primary teaching?

A client is started on etanercept (Enbrel) .What teaching by the nurse is most appropriate?

A client comes to the family medicine clinic and reports joint pain and stiffness.The nurse is asked to assess the client for Heberden's nodules.What assessment technique is correct?

A nurse is discharging a client after a total hip replacement.What statement by the client indicates good potential for self-management?

A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints.After a knee replacement,the health care provider has prescribed morphine sulfate for postoperative pain relief.The client also requests the celecoxib in addition to the morphine.What action by the nurse is best?

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 client is scheduled to have a hip replacement.Preoperatively,the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery.What action by the preoperative nurse is most important?

A nurse works with several clients who have gout.Which types of gout and their drug treatments are correctly matched? (Select all that apply.)

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 client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications.What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.)

A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA) .Which client should the nurse see first?