Question 1

Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?

Accepted Answer

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. B

Question 2

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anywhere except here to the health clinic." An appropriate nursing diagnosis for the patient is

Accepted Answer

A)   activity intolerance related to fatigue and inactivity.
B)   impaired social interaction related to lack of social skills.
C)   impaired skin integrity related to itching and skin sloughing.
D)   social isolation related to embarrassment about the effects of SLE. D

Question 3

To determine whether a patient with joint swelling and pain has systemic lupus erythematosus, which test will be most useful for the nurse to review?

Accepted Answer

A)   Rheumatoid factor ( RF ) 
B)   Antinuclear antibody ( ANA ) 
C)   Anti-Smith antibody ( Anti-Sm ) 
D)   Lupus erythematosus ( LE )  cell prep C

Question 4

A patient with an acute attack of gout in the left 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?

Accepted Answer

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 generally drinks about 3 quarts of juice and water daily.
D)   The patient takes one aspirin a day prophylactically to prevent angina.

Question 5

A home health patient with rheumatoid arthritis ( RA ) complains to the nurse about having chronically dry eyes. Which action by the nurse is most appropriate?

Accepted Answer

A)   Reassure the patient that dry eyes are a common problem with RA.
B)   Teach the patient more about adverse affects of the RA medications.
C)   Suggest that the patient start using over-the-counter ( OTC )  artificial tears.
D)   Ask the health care provider about lowering the methotrexate ( Rheumatrex )  dose.

Question 6

After obtaining the health history from a 28-year-old woman who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis, which information about the patient is most important for the nurse to report to the health care provider?

Accepted Answer

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.

Question 7

A patient who had arthroscopic surgery of the left knee 5 days ago is admitted with a red, swollen, and hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

Accepted Answer

A)   The blood pressure is 88/46 mm Hg.
B)   The white blood cell count is 14,200/µL.
C)   The patient is taking ibuprofen (Motrin) .
D)   The patient says the knee is very painful.

Question 8

Which of these patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis ( OA )?

Accepted Answer

A)   A 56-year-old man who is a member of a construction crew
B)   A 24-year-old man who participates in a summer softball team
C)   A 49-year-old woman who works on an automotive assembly line
D)   A 36-year-old woman who is newly diagnosed with diabetes mellitus

Question 9

When teaching a patient who has rheumatoid arthritis ( RA ) about how to manage activities of daily living, the nurse instructs the patient to

Accepted Answer

A)   stand rather than sit when performing household chores.
B)   avoid activities that require continuous use of the same muscles.
C)   strengthen small hand muscles by wringing sponges or washcloths.
D)   protect the knee joints by sleeping with a small pillow under the knees.

Question 10

When caring for a patient with a new diagnosis of rheumatoid arthritis, which action will the nurse include in the plan of care?

Accepted Answer

A)   Instruct the patient to purchase a soft mattress.
B)   Teach patient to use lukewarm water when bathing.
C)   Suggest that the patient take a nap in the afternoon.
D)   Suggest exercise with light weights several times daily.

Question 11

Which assessment finding about a patient who has been using naproxen (Naprosyn) for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?

Accepted Answer

A)   The patient has dark colored stools.
B)   The patient's pain has not improved.
C)   The patient is using capsaicin cream (Zostrix) .
D)   The patient has gained 3 pounds over 3 weeks.

Question 12

A patient with dermatomyositis is receiving long-term prednisone (Deltasone) therapy. Which assessment finding by the nurse is most important to report to the health care provider?

Accepted Answer

A)   The blood glucose is 112 mg/dL.
B)   The patient has painful hematuria.
C)   The patient has an increased appetite.
D)   Acne is noted on the back and face.

Question 13

During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (select all that apply)?

Accepted Answer

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.

Question 14

When caring for a patient who has osteoarthritis, the nurse will anticipate the need to teach the patient about which of these medications?

Accepted Answer

A)   Adalimumab ( Humira ) 
B)   Prednisone ( Deltasone ) 
C)   Capsaicin cream ( Zostrix ) 
D)   Sulfasalazine ( Azulfidine )

Question 15

After teaching a patient diagnosed with progressive systemic sclerosis about health maintenance activities, the nurse determines that additional instruction is needed when the patient says,

Accepted Answer

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."

Question 16

Which statement by a 24-year-old woman with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about management of the condition?

Accepted Answer

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."

Question 17

A patient has systemic sclerosis manifested by CREST ( calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia ) syndrome. Which action will the nurse include in the plan of care?

Accepted Answer

A)   Avoid use of capsaicin cream on hands.
B)   Keep patient's room warm and draft free.
C)   Obtain capillary blood glucose before meals.
D)   Assist to bathroom every 2 hours while awake.

Question 18

When caring for a patient with gout and a red and painful left great toe, which nursing action will be included in the plan of care?

Accepted Answer

A)   Gently palpate the toe to assess swelling.
B)   Use pillows to keep the left foot elevated.
C)   Use a footboard to hold bedding away from the toe.
D)   Teach patient to avoid use of acetaminophen (Tylenol) .

Question 19

A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will plan to monitor

Accepted Answer

A)   blood glucose.
B)   blood pressure.
C)   erythrocyte count.
D)   lymphocyte count.

Question 20

A patient with an acute attack of gout is treated with colchicine. The nurse determines that the drug is effective upon finding

Accepted Answer

A)   relief of joint pain.
B)   increased urine output.
C)   elevated serum uric acid.
D)   decreased white blood cells ( WBC ) .

Exam 65: Nursing Management: Arthritis and Connective Tissue Diseases