Question 1

Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?

Accepted Answer

A)  Exercise by taking long walks. 
B)  Do daily deep breathing exercises. 
C)  Sleep on the side with hips flexed. 
D)  Take frequent naps during the day.

Question 2

While working at a summer camp, the nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the camp clinic complaining of chills and muscle aches. Which action should the nurse take next?

Accepted Answer

A)  Palpate the abdomen. 
B)  Auscultate the heart sounds. 
C)  Ask the patient about recent outdoor activities. 
D)  Question the patient about immunization history.

Question 3

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective?

Accepted Answer

A)  Blood glucose test 
B)  Liver function tests 
C)  C-reactive protein level 
D)  Serum electrolyte levels

Question 4

A long-term care patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of

Accepted Answer

A)  sertraline ( Zoloft ). 
B)  famotidine ( Pepcid ). 
C)  oxycodone ( Roxicodone ). 
D)  hydrochlorothiazide ( HydroDIURIL ).

Question 5

After the nurse has finished teaching a patient with osteoarthritis ( OA ) of the left hip and knee about how to manage the OA, which patient statement indicates a need for more education?

Accepted Answer

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."

Question 6

A patient hospitalized with polymyositis has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is

Accepted Answer

A)  acute pain related to inflammation. 
B)  risk for aspiration related to dysphagia. 
C)  risk for impaired skin integrity related to scratching. 
D)  disturbed visual perception related to eyelid swelling.

Question 7

Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis ( OA ) of the left knee?

Accepted Answer

A)  Heberden's nodules 
B)  Pain upon joint movement 
C)  Redness and swelling of the knee joint 
D)  Stiffness that increases with movement

Question 8

The nurse obtains this information when assessing a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis. Which symptom is most important to report to the health care provider?

Accepted Answer

A)  Abdominal cramping 
B)  Complaint of blurry vision 
C)  Phalangeal joint tenderness 
D)  Blood pressure 170/84 mm Hg

Question 9

When helping a patient with rheumatoid arthritis ( RA ) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with

Accepted Answer

A)  a warm bath followed by a short rest. 
B)  a short routine of isometric exercises. 
C)  active range-of-motion ( ROM ) exercises. 
D)  stretching exercises to relieve joint stiffness.

Question 10

Anakinra ( Kineret ) is prescribed for a patient who has rheumatoid arthritis ( RA ). When teaching the patient about this drug, the nurse will include information about

Accepted Answer

A)  self-administration of subcutaneous injections. 
B)  taking the medication with at least 8 oz of fluid. 
C)  avoiding concurrently taking aspirin or nonsteroidal antiinflammatory drugs ( NSAIDs ). 
D)  symptoms of gastrointestinal ( GI ) irritation or bleeding.

Question 11

A 26-year-old patient with urethritis and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with

Accepted Answer

A)  anakinra (Kineret). 
B)  etanercept (Enbrel). 
C)  doxycycline (Vibramycin). 
D)  methotrexate (Rheumatrex).

Question 12

When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus ( SLE ), which result is most important to communicate to the health care provider?

Accepted Answer

A)  Decreased C-reactive protein ( CRP ) 
B)  Elevated blood urea nitrogen ( BUN ) 
C)  Positive antinuclear antibodies ( ANA ) 
D)  Positive lupus erythematosus cell prep

Question 13

When the nurse is reviewing laboratory data for a patient who is taking methotrexate ( Rheumatrex ) to treat rheumatoid arthritis, which information is most important to communicate to the health care provider?

Accepted Answer

A)  The blood glucose is 75 mg/dL. 
B)  The rheumatoid factor is positive. 
C)  The white blood cell ( WBC ) count is 1500/mL. 
D)  The erythrocyte sedimentation rate is elevated.

Question 14

A 22-year-old patient hospitalized with a fever and red, hot, and painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient

Accepted Answer

A)  has a parent who has reactive arthritis. 
B)  is sexually active and has multiple partners. 
C)  recently returned from a trip to South America. 
D)  had several sports-related knee injuries as a teenager.

Question 15

A patient with an exacerbation of rheumatoid arthritis ( RA ) is taking prednisone ( Deltasone ) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication?

Accepted Answer

A)  The patient's blood glucose is 165 mg/dL. 
B)  The patient has no improvement in symptoms. 
C)  The patient has experienced a recent 5-pound weight loss. 
D)  The patient's erythrocyte sedimentation rate ( ESR ) has increased.

Question 16

A patient with rheumatoid arthritis refuses to take the prescribed methotrexate (Rheumatrex), telling the nurse "That drug has too many side effects. My arthritis isn't that bad yet." The most appropriate response by the nurse is

Accepted Answer

A)  "You have the right to refuse to take the methotrexate." 
B)  "Methotrexate is less expensive than some of the newer drugs." 
C)  "It is important to start methotrexate early to decrease the extent of joint damage." 
D)  "Methotrexate is effective and has fewer side effects than some of the other drugs."

Question 17

A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which action will the nurse take?

Accepted Answer

A)  Draw blood for rheumatoid factor analysis. 
B)  Teach the patient about injection of the nodule. 
C)  Assess the nodules for skin breakdown or infection. 
D)  Discuss the need for surgical removal of the nodule.

Question 18

The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis ( RA ). Which assessment made by the nurse indicates that more patient teaching is needed?

Accepted Answer

A)  The patient requires a 2-hour midday nap. 
B)  The patient has been taking 16 aspirins daily. 
C)  The patient sits on a stool when preparing meals. 
D)  The patient sleeps with two pillows under the head.

Question 19

A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis ( RA ) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate?

Accepted Answer

A)  "You may need to see a family therapist for some help." 
B)  "Tell me more about the situations that are causing stress." 
C)  "Perhaps it would be helpful for you and your family to get involved in a support group." 
D)  "Your family may need some help to understand the impact of your rheumatoid arthritis."

Question 20

The health care provider has prescribed the following collaborative interventions for a 49-year-old who is taking azathioprine ( Imuran ) for systemic lupus erythematosus. Which order will the nurse question?

Accepted Answer

A)  Draw anti-DNA blood titer. 
B)  Administer varicella vaccine. 
C)  Use naproxen ( Aleve ) 200 mg BID. 
D)  Take famotidine ( Pepcid ) 20 mg daily.

Exam 65: Nursing Management: Arthritis and Connective Tissue Diseases