Chapter 64 Arthritis and Connective Tissue Diseases PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter64:ArthritisandConnectiveTissueDiseases TestBank MULTIPLECHOICE 1.Whichfindingwillthenurseexpectwhenassessinga58-year-oldpatientwhohasosteoarthritis(OA)ofthe knee? a.

Discomfortwithjointmovement

b.

HeberdensandBouchardsnodes

c.

Rednessandswellingofthekneejoint

d.

Stiffnessthatincreaseswithmovement

ANS:A InitialsymptomsofOAincludepainwithjointmovement.Heberdensnodulesoccuronthefingers.Rednesso thejointismorestronglyassociatedwithrheumatoidarthritis(RA).StiffnessinOAisworserightafterthe patientrestsanddecreaseswithjointmovement. DIF:CognitiveLevel:Understand(comprehension)REF:1518 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.Whichassessmentfindingaboutapatientwhohasbeenusingnaproxen(Naprosyn)for6weekstotreat osteoarthritisismostimportantforthenursetoreporttothehealthcareprovider? a.

Thepatienthasgained3pounds.

b.

Thepatienthasdark-coloredstools.

c.

Thepatientspainhasbecomemoresevere.

d.

Thepatientisusingcapsaicincream(Zostrix).

ANS:B Dark-coloredstoolsmayindicatethatthepatientisexperiencinggastrointestinalbleedingcausedbythe naproxen.Theinformationaboutthepatientsongoingpainandweightgainalsowillbereportedandmay indicateaneedforadifferenttreatmentand/orcounselingaboutavoidingweightgain,butthesearenotas largeaconcernasthepossibilityofgastrointestinalbleeding.Useofcapsaicincreamwithoralmedicationsis appropriate. DIF:CognitiveLevel:Apply(application)REF:1521 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 3.Afterthenursehasfinishedteachinga68-year-oldpatientwithosteoarthritis(OA)oftherighthipabout howtomanagetheOA,whichpatientstatementindicatesaneedformoreteaching?

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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.

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ANS:B Nomorethan4gofacetaminophenshouldbetakendailytoavoidliverdamage.Theotherpatientstatements arecorrectandindicategoodunderstandingofOAmanagement. DIF:CognitiveLevel:Apply(application)REF:1520 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 4.Thenursewillanticipatetheneedtoteacha57-year-oldpatientwhohasosteoarthritis(OA)aboutwhich medication? a.

Adalimumab(Humira)

b.

Prednisone(Deltasone)

c.

Capsaicincream(Zostrix)

d.

Sulfasalazine(Azulfidine)

ANS:C CapsaicincreamblocksthetransmissionofpainimpulsesandishelpfulforsomepatientsintreatingOA.The othermedicationswouldbeusedforpatientswithRA. DIF:CognitiveLevel:Apply(application)REF:1520 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 5.Apatientwithrheumatoidarthritisbeingseenintheclinichasrheumatoidnodulesontheelbows.Which actionwillthenursetake? a.

Drawbloodforrheumatoidfactoranalysis.

b.

Teachthepatientaboutinjectionsforthenodules.

c.

Assessthenodulesforskinbreakdownorinfection.

d.

Discusstheneedforsurgicalremovalofthenodules.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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ANS:C Rheumatoidnodulescanbreakdownorbecomeinfected.Theyarenotassociatedwithchangesinrheumatoid factor,andinjectionisnotneeded.Rheumatoidnodulesareusuallynotremovedsurgicallybecauseofahigh probabilityofrecurrence. DIF:CognitiveLevel:Apply(application)REF:1527 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 6.Whichactionwillthenurseincludeintheplanofcarefora33-year-oldpatientwithanewdiagnosisof rheumatoidarthritis? a.

Instructthepatienttopurchaseasoftmattress.

b.

Suggestthatthepatienttakeanapintheafternoon.

c.

Teachthepatienttouselukewarmwaterwhenbathing.

d.

Suggestexercisewithlightweightsseveraltimesdaily.

ANS:B Adequateresthelpsdecreasethefatigueandpainthatareassociatedwithrheumatoidarthritis.Patientsare taughttoavoidstressingjoints,tousewarmbathstorelievestiffness,andtouseafirmmattress.When stabilized,atherapeuticexerciseprogramisusuallydevelopedbyaphysicaltherapisttoincludeexercisesthat improvetheflexibilityandstrengthoftheaffectedjoints,andthepatientsoverallendurance. DIF:CognitiveLevel:Apply(application)REF:1531 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 7.Apatientwithrheumatoidarthritis(RA)complainstotheclinicnurseabouthavingchronicallydryeyes. Whichactionbythenurseismostappropriate? a.

TeachthepatientaboutadverseeffectsoftheRAmedications.

b.

Suggestthatthepatientuseover-the-counter(OTC)artificialtears.

c.

ReassurethepatientthatdryeyesareacommonproblemwithRA.

d.

Askthehealthcareprovideraboutdiscontinuingmethotrexate(Rheumatrex).

ANS:B ThepatientsdryeyesareconsistentwithSjgrenssyndrome,acommonextraarticularmanifestationofRA. SymptomatictherapysuchasOTCeyedropsisrecommended.Dryeyesarenotasideeffectofmethotrexate. AlthoughdryeyesarecommoninRA,itismorehelpfultoofferasuggestiontorelievethesesymptomsthan toofferreassurance.ThedryeyesarenotcausedbyRAtreatment,butbythediseaseitself. DIF:CognitiveLevel:Apply(application)REF:1546

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 8.Whichinformationwillthenurseincludewhenpreparingteachingmaterialsforpatientswithexacerbations ofrheumatoidarthritis? 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.

ANS:B ColdapplicationishelpfulinreducingpainduringperiodsofexacerbationofRA.Becausethejointpainis chronic,patientsareinstructedtoexerciseevenwhenjointsarepainful.ROMexercisesareintendedto strengthenjointsandimproveflexibility,sopassiveROMaloneisnotsufficient.Recreationalexerciseis encouragedbutisnotareplacementforROMexercises. DIF:CognitiveLevel:Apply(application)REF:1531 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 9.Whichlaboratoryresultwillthenursemonitortodeterminewhetherprednisone(Deltasone)hasbeen effectivefora30-year-oldpatientwithanacuteexacerbationofrheumatoidarthritis? a.

Bloodglucosetest

b.

Liverfunctiontests

c.

C-reactiveproteinlevel

d.

Serumelectrolytelevels

ANS:C C-reactiveproteinisamarkerforinflammation,andadecreasewouldindicatethatthecorticosteroidtherapy waseffective.Bloodglucoseandserumelectrolytelevelswillalsobemonitoredtocheckforsideeffectsof prednisone.Liverfunctionisnotroutinelymonitoredinpatientsreceivingcorticosteroids. DIF:CognitiveLevel:Apply(application)REF:1527 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 10.Thenurseteachingasupportgroupofwomenwithrheumatoidarthritis(RA)abouthowtomanage activitiesofdailylivingsuggeststhatthey a.

standratherthansitwhenperforminghouseholdandyardchores.

b.

strengthensmallhandmusclesbywringingspongesorwashcloths.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

protectthekneejointsbysleepingwithasmallpillowundertheknees.

d.

avoidactivitiesthatrequirerepetitiveuseofthesamemusclesandjoints.

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ANS:D Patientsareadvisedtoavoidrepetitiousmovements.Sittingduringhouseholdchoresisrecommendedto decreasestressonjoints.Wringingwateroutofspongeswouldincreasethejointstress.Patientsare encouragedtopositionjointsintheextendedposition,andsleepingwithapillowbehindthekneeswould decreasetheabilityofthekneetoextendandalsodecreasekneerangeofmotion(ROM). DIF:CognitiveLevel:Apply(application)REF:1530 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 11.Thenursesuggeststhatapatientrecentlydiagnosedwithrheumatoidarthritis(RA)plantostarteachday with 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.

ANS:A Takingawarmshowerorbathisrecommendedtorelievejointstiffness,whichisworseinthemorning. Isometricexerciseswouldplacestressonjointsandwouldnotberecommended.StretchingandROMshould bedonelaterintheday,whenjointstiffnessisdecreased. DIF:CognitiveLevel:Apply(application)REF:1531 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 12.Anakinra(Kineret)isprescribedfora49-year-oldpatientwhohasrheumatoidarthritis(RA).When teachingthepatientaboutthisdrug,thenursewillincludeinformationabout a.

avoidingconcurrentlytakingaspirin.

b.

symptomsofgastrointestinal(GI)bleeding.

c.

self-administrationofsubcutaneousinjections.

d.

takingthemedicationwithatleast8ozoffluid.

ANS:C

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Anakinraisadministeredbysubcutaneousinjection.GIbleedingisnotasideeffectofthismedication. Becausethemedicationisinjected,instructionstotakeitwith8ozoffluidwouldnotbeappropriate.The patientislikelytobeconcurrentlytakingaspirinornonsteroidalantiinflammatorydrugs(NSAIDs),andthese shouldnotbediscontinued. DIF:CognitiveLevel:Apply(application)REF:1529 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 13.A37-year-oldpatientwith2school-agechildrenwhohasrecentlybeendiagnosedwithrheumatoid arthritis(RA)tellsthenursethathomelifeisverystressful.Whichresponsebythenurseismostappropriate? a.

Tellmemoreaboutsituationsthatarecausingyoustress.

b.

Youneedtoseeafamilytherapistforsomehelpwithstress.

c.

Yourfamilyshouldunderstandtheimpactofyourrheumatoidarthritis.

d.

Perhapsitwouldbehelpfulforyourfamilytobeinvolvedinasupportgroup.

ANS:A Theinitialactionbythenurseshouldbefurtherassessment.Theotherthreeresponsesmightbeappropriate basedontheinformationthenurseobtainswithfurtherassessment. DIF:CognitiveLevel:Apply(application)REF:1530 TOP:NursingProcess:ImplementationMSC:NCLEX:PsychosocialIntegrity 14.Whichinformationwillthenurseincludewhenteachinga38-year-oldmalepatientwithnewlydiagnosed ankylosingspondylitis(AS)aboutthemanagementofthecondition? 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.

ANS:B Deep-breathingexercisesareusedtodecreasetheriskforpulmonarycomplicationsthatmayoccurwiththe reducedchestexpansionthatcanoccurwithankylosingspondylitis(AS).Patientsshouldsleeponthebackand avoidflexedpositions.Prolongedstandingandwalkingshouldbeavoided.Thereisnoneedforfrequentnaps. DIF:CognitiveLevel:Apply(application)REF:1537 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 15.A19-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

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thepatient a.

hadseveralkneeinjuriesasateenager.

b.

recentlyreturnedfromSouthAmerica.

c.

issexuallyactivewithmultiplepartners.

d.

hasaparentwhohasrheumatoidarthritis.

ANS:C Neisseriagonorrhoeaeisthemostcommoncauseforsepticarthritisinsexuallyactiveyoungadults.Theother informationdoesnotpointtoanyriskforsepticarthritis. DIF:CognitiveLevel:Understand(comprehension)REF:1535 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 16.Thenursenoticesacircularlesionwitharedborderandclearcenteronthearmofan18-year-oldsummer campcounselorwhoisinthecampcliniccomplainingofchillsandmuscleaches.Whichactionshouldthe nursetakenext? a.

Palpatetheabdomen.

b.

Auscultatetheheartsounds.

c.

Askthepatientaboutrecentoutdooractivities.

d.

Questionthepatientaboutimmunizationhistory.

ANS:C ThepatientsclinicalmanifestationssuggestpossibleLymedisease.Ahistoryofrecentoutdooractivitiessuch ashikeswillhelpconfirmthediagnosis.Thepatientssymptomsdonotsuggestcardiacorabdominalproblems orlackofimmunization. DIF:CognitiveLevel:Apply(application)REF:1534 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 17.A29-year-oldpatientreportingpainfulurination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 a.

anakinra(Kineret).

b.

etanercept(Enbrel).

c.

doxycycline(Vibramycin).

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d.

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methotrexate(Rheumatrex).

ANS:C ReactivearthritisassociatedwithurethritisisusuallycausedbyinfectionwithChlamydiatrachomatisand requires3monthsoftreatmentwithdoxycycline.Theothermedicationsareusedforchronicinflammatory problemssuchasrheumatoidarthritis. DIF:CognitiveLevel:Apply(application)REF:1537 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 18.Thenursedeterminesthatcolchicinehasbeeneffectiveforapatientwithanacuteattackofgoutupon finding a.

reliefofjointpain.

b.

increasedurineoutput.

c.

elevatedserumuricacid.

d.

increasedwhitebloodcells(WBC).

ANS:A Colchicineproducespainreliefin24to48hoursbydecreasinginflammation.Therecommendedincreasein fluidintakeof2to3L/daywouldincreaseurineoutputbutwouldnotindicatetheeffectivenessofcolchicine. Elevateduricacidlevelswouldresultinincreasedsymptoms.TheWBCcountmightdecreasewithdecreased inflammation,butwouldnotincrease. DIF:CognitiveLevel:Understand(comprehension)REF:1533 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 19.Apatientwithgouthasanewprescriptionforlosartan(Cozaar)tocontrolthecondition.Thenursewill plantomonitor a.

bloodglucose.

b.

bloodpressure.

c.

erythrocytecount.

d.

lymphocytecount.

ANS:B Losartan,anangiotensinIIreceptorantagonist,willlowerbloodpressure.Itdoesnotaffectbloodglucose,red bloodcell(RBC)count,orlymphocytes. DIF:CognitiveLevel:Apply(application)REF:1534

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844

TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 20.A71-year-oldpatientwhotakesmultiplemedicationsdevelopsacutegoutyarthritis.Thenursewillconsul withthehealthcareproviderbeforegivingtheprescribeddoseof a.

sertraline(Zoloft).

b.

famotidine(Pepcid).

c.

oxycodone(Roxicodone).

d.

hydrochlorothiazide(HydroDIURIL).

ANS:D Diureticuseincreasesuricacidlevelsandcanprecipitategoutattacks.Theothermedicationsaresafeto administer. DIF:CognitiveLevel:Apply(application)REF:1532 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 21.Whichstatementbyapatientwithsystemiclupuserythematosus(SLE)indicatesthatthepatienthas understoodthenursesteachingaboutthecondition? a.

IwillexerciseevenifIamtired.

b.

IwillusesunscreenwhenIamoutside.

c.

Ishouldtakebirthcontrolpillstokeepfromgettingpregnant.

d.

Ishouldavoidaspirinornonsteroidalantiinflammatorydrugs.

ANS:B SevereskinreactionscanoccurinpatientswithSLEwhoareexposedtothesun.Patientsshouldavoidfatigue bybalancingexercisewithrestperiodsasneeded.Oralcontraceptivescanexacerbatelupus.Aspirinand nonsteroidalantiinflammatorydrugsareusedtotreatthemusculoskeletalmanifestationsofSLE. DIF:CognitiveLevel:Apply(application)REF:1542 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 22.A25-year-oldfemalepatientwithsystemiclupuserythematosus(SLE)whohasafacialrashandalopecia tellsthenurse,IneverleavemyhousebecauseIhatethewayIlook.Anappropriatenursingdiagnosisforthe patientis a.

activityintolerancerelatedtofatigueandinactivity.

b.

impairedsocialinteractionrelatedtolackofsocialskills.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

impairedskinintegrityrelatedtoitchingandskinsloughing.

d.

socialisolationrelatedtoembarrassmentabouttheeffectsofSLE.

845

ANS:D Thepatientsstatementaboutnotgoinganywherebecauseofhatingthewayheorshelookssupportsthe diagnosisofsocialisolationbecauseofembarrassmentabouttheeffectsoftheSLE.Activityintoleranceisa possibleproblemforpatientswithSLE,buttheinformationaboutthispatientdoesnotsupportthisasa diagnosis.T...