Question 1

The nurse has completed the health history with a female client who is taking methotrexate to treat rheumatoid arthritis. Which of the following information about the client is most important for the nurse to report to the health care provider?

Accepted Answer

A) The client had a history of infectious mononucleosis as a teenager. 
B) The client is trying to have a baby before her disease becomes more severe. 
C) The client has a family history of age-related macular degeneration of the retina. 
D) The client has been using large doses of vitamins and health foods to treat the RA.

Question 2

The nurse is caring for a client with gout and takes losartan for control of the condition. Which of the following laboratory results should the nurse plan to monitor in the client?

Accepted Answer

A) Blood glucose 
B) Blood pressure 
C) Erythrocyte count 
D) Lymphocyte count

Question 3

The nurse is caring for a young adult client hospitalized with a fever and red, hot, painful knees and is suspected of having septic arthritis. Which of the following information obtained during the nursing history indicates a risk factor for septic arthritis?

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 4

The nurse is assessing a client with fibromyalgia. Which of the following symptoms should the nurse expect the client 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 musculo-skeletal pain

Question 5

The nurse is caring for a client with dermatomyositis who is receiving long-term prednisone therapy. Which of the following findings is most important to report to the health care provider?

Accepted Answer

A) The blood glucose is 6.2 mmol/L. 
B) The client has painful hematuria. 
C) The client has an increased appetite. 
D) Acne is noted on the back and face.

Question 6

The nurse is reviewing laboratory results for a client with systemic lupus erythematosus (SLE). Which of the following results is most important to communicate to the health care provider?

Accepted Answer

A) Decreased C-reactive protein (CRP) 
B) Mild proteinuria 
C) Positive antinuclear antibodies (AN
A)  
D) Positive lupus erythematosus cell prep

Question 7

The nurse is caring for a client who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The client tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the followingresponses 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 8

Which of the following clients 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

The nurse is assisting a client with rheumatoid arthritis (RA) to plan a daily routine. Which of the following information should the nurse include when discussing the most helpful way to start the day?

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

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

Accepted Answer

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

Question 11

The nurse is teaching a client diagnosed with progressive systemic sclerosis about health maintenance activities. Which of the following client statements indicates the need for additional instruction?

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 12

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

Accepted Answer

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

Question 13

Which of the following statements by a young adult female client with systemic lupus erythematosus (SLE) indicates that the client 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 14

The nurse is caring for a client who has systemic sclerosis manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) syndrome. Which of the following actions should the nurse include in the plan of care?

Accepted Answer

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

Question 15

The nurse is teaching a client who has rheumatoid arthritis (RA) about how to manage activities of daily living. Which of the following information should the nurse include in the teaching plan?

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 16

The nurse is reviewing laboratory data for a client who is taking methotrexate to treat rheumatoid arthritis. Which of the following information is most important to communicate to the health care provider?

Accepted Answer

A) The blood glucose is 4.2 mmol/L. 
B) The rheumatoid factor is positive. 
C) The white blood cell (WB
C)  count is 1.5 * 109/L. 
D) The erythrocyte sedimentation rate is elevated.

Question 17

The nurse is caring for a client with polymyositis and has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?

Accepted Answer

A) Acute pain related to biological injury agent (inflammation) 
B) Risk for aspiration as evidenced by barrier to elevating upper body 
C) Risk for impaired skin integrity as evidenced by excretions 
D) Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)

Question 18

To determine whether a client 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 (AN
A)  
C) Anti-Smith antibody (Anti-Sm) 
D) Lupus erythematosus (L
E)  cell prep

Question 19

The nurse is conducting client teaching with a client who has systemic lupus erythematosus and is prescribed hydroxychloroquine. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

A) Has a rapid therapeutic response 
B) Vision assessment every 6-12 months 
C) Does not prevent flare-ups of symptoms 
D) Can only be administered intravenously

Question 20

Which of the following assessment findings about a client who has been using naproxen for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?

Accepted Answer

A) The client has dark-coloured stools. 
B) The client's pain has not improved. 
C) The client is using capsaicin cream. 
D) The client has gained 3 pounds over 3 weeks.

Exam 67: Nursing Management Arthritis and Connective Tissue Diseases