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Lewis Medical Surgical Nursing Chap 69: Arthritis and Connective Tissue Disorders exam
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Lewis Medical Surgical Nursing Chap 69: Arthritis and Connective Tissue Disorders exam
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Lewis Medical Surgical Nursing Chap 69: Arthritis andConnective Tissue Disorders exam 2024-2025
A patient who takes multiple medications develops acute gout arthritis. Which medication
would the nurse discuss with the health care provider before administering?
a. sertraline (Zoloft)
b. famotidine (Pepcid)
c. hydrochlorothiazide
d. oxycodone (Roxicodone) - answer>>>ANS: C Diuretic use increases uric acid levels and can
precipitate gout attacks. The other medications are safe to administer.
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient
understands the nurse's 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 avoid nonsteroidal antiinflammatory drugs.‖
d. ―I should take birth control pills to avoid getting pregnant.‖ - answer>>>ANS: B Severe skin
reactions can occur in patients with SLE who are exposed to the sun. Patients would 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.
A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and
alopecia. She tells the nurse, ―I never leave my house because I hate the way I look.‖ Which
patient problem would the nurse plan to address?
a. Activity intolerance
b. Impaired socialization
c. Impaired tissue integrity
d. Impaired communication - answer>>>ANS: B The patient's statement about not going
anywhere because of hating the way he or she looks expresses impaired socialization, an
insufficient quantity of human Interaction, 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. The rash with SLE does not impair tissue integrity. There is no
evidence of impaired communication ability for this patient.
. A new clinic patient with joint swelling and pain is having diagnostic tests. Which test would
the nurse identify as specific to systemic lupus erythematosus?
a. Rheumatoid factor (RF)
b. Antinuclear antibody (ANA)
c. Anti-Smith antibody (Anti-Sm)
d. Lupus erythematosus (LE) cell prep - answer>>>ANS: C The anti-Sm is antibody found almost
exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.
A patient with hypertension and gout has a red, painful right great toe. Which action would the
nurse include in the plan of care for this patient?
a. Use a footboard to hold up the bedding.
b. Gently palpate the toe to assess swelling.
c. Use pillows to keep the right foot elevated.
d. Teach the patient to avoid acetaminophen (Tylenol). - answer>>>ANS: A Because any touch
on the area of inflammation may increase pain, bedding should be held away from the toe, and
touching the toe should be avoided. Elevation of the foot will not reduce the pain, which is
caused by urate crystals. Acetaminophen can be used for pain management.
The health care provider has prescribed the following interventions for a patient who is taking
azathioprine (Imuran) for systemic lupus erythematosus. Which order would the nurse
question?
a. Draw anti-DNA blood titer.
b. Administer varicella vaccine.
c. Naproxen 200 mg twice daily.
d. Famotidine (Pepcid) 20 mg daily. - answer>>>ANS: B Live virus vaccines, such as varicella, are
contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate
for the patient.
, A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon,
esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action would the
nurse include in the plan of care?
a. Avoid use of capsaicin cream on hands
b. . b. Keep the environment warm and draft free.
c. c. Obtain capillary blood glucose before meals
d. . d. Assist to bathroom every 2 hours while awake. - answer>>>ANS: B Keeping the room
warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST
syndrome. Capsaicin cream may be used to improve circulation and decrease pain.
There is no need to obtain blood glucose or to assist the patient to the bathroom every
2 hours.
The nurse would determine additional instruction is needed when a patient diagnosed with
scleroderma makes which statement?
a. ―Paraffin baths can be used to help my hands.‖
b. ―I should lie down for an hour after each meal.‖
c. ―Lotions will help if I rub them in for a long time.‖ d. ―I should perform range-of-motion
exercises daily.‖ - answer>>>ANS: B Because of the esophageal scarring and to reduce
heartburn with reflux, patients should sit up for 2 hours after eating rather than lying down.
Paraffin baths, lotions, and range of motion are helpful in managing the symptoms and would
indicate good understanding of the teaching.
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses
the prescribed methotrexate. The patient tells the nurse, ―My arthritis isn't that bad yet. The
side effects of methotrexate are worse than the arthritis.‖ Which information would be most
important for the nurse to provide?
a. ―Methotrexate is less expensive than some of the newer drugs.‖
b. ―It will take 4-6 weeks to see the therapeutic effects of the methotrexate.‖
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.‖ -
answer>>>ANS: C Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to
prevent the joint degeneration that occurs as soon as the first year with RA. The other
statements are accurate, but the most important point for the patient to understand is that it is
important to start DMARDs as quickly as possible.
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