65MD

Question 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. Heberden’s and Bouchard’s nodes
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement

Answer 1

a. Discomfort with joint movement

Question 2

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 patient’s pain has become more severe.
   d. The patient is using capsaicin cream (Zostrix).

Answer 2

b. The patient has dark-colored stools.

Question 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?

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.”

Answer 3

b. “I will take 1 g of acetaminophen (Tylenol) every 4 hours.”

Question 4

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)

Answer 4

c. Capsaicin cream (Zostrix)

Question 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.

Answer 5

c. Assess the nodules for skin breakdown or infection

Question 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.

Answer 6

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

Question 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) .

Answer 7

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

Question 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.

Answer 8

b. Application of cold packs before exercise may decrease joint pain

Question 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

Answer 9

c. C-reactive protein level

Question 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.
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.

Answer 10

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

Question 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.

Answer 11

a. a warm bath followed by a short rest.

Question 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.

Answer 12

c. self-administration of subcutaneous injections.

Question 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.”

Answer 13

a. “Tell me more about situations that are causing you stress.”

Question 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.

Answer 14

b. Do daily deep-breathing exercises.

Question 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 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.

Answer 15

c. is sexually active with multiple partners.

Question 16

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 take next?
    a. Palpate the abdomen.
    b. Auscultate the heart sounds.
    c. Ask the patient about recent outdoor activities.
    d. Question the patient about immunization history.

Answer 16

c. Ask the patient about recent outdoor activities.

Question 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).
d. methotrexate (Rheumatrex).

Answer 17

c. doxycycline (Vibramycin).

Question 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).

Answer 18

a. relief of joint pain.

Question 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.

Answer 19

b. blood pressure.

Question 20

A 71-year-old patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of

a. sertraline (Zoloft).
b. famotidine (Pepcid).
c. oxycodone (Roxicodone).
d. hydrochlorothiazide (HydroDIURIL).

Answer 20

d. hydrochlorothiazide (HydroDIURIL).

Question 21

Which statement by a patient with systemic lupus erythematosus (SLE) indicates that the patient has understood 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 take birth control pills to keep from getting pregnant.”
d. “I should avoid aspirin or nonsteroidal antiinflammatory drugs.”

Answer 21

b. “I will use sunscreen when I am outside.”

Question 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.
c. impaired skin integrity related to itching and skin sloughing.
d. social isolation related to embarrassment about the effects of SLE.

Answer 22

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

Question 23

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?

a. Rheumatoid factor (RF)
b. Antinuclear antibody (ANA)
c. Anti-Smith antibody (Anti-Sm)
d. Lupus erythematosus (LE) cell prep

Answer 23

c. Anti-Smith antibody (Anti-Sm)

Question 24

The nurse is planning care for a patient with hypertension and gout who has a red and painful right great toe. Which nursing action will be included in the plan of care?

a. Gently palpate the toe to assess swelling.
b. Use pillows to keep the right foot elevated.
c. Use a footboard to hold bedding away from the toe.
d. Teach patient to avoid use of acetaminophen (Tylenol).

Answer 24

c. Use a footboard to hold bedding away from the toe.

Question 25

The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Naproxen (Aleve) 200 mg BID. d. Famotidine (Pepcid) 20 mg daily.

Answer 25

b. Administer varicella vaccine.

Question 26

A 40-year-old African American patient has scleroderma manifested by CREST (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care? a. Avoid use of capsaicin cream on hands. b. Keep environment warm and draft free. c. Obtain capillary blood glucose before meals. d. Assist to bathroom every 2 hours while awake.

Answer 26

b. Keep environment warm and draft free.

Question 27

The nurse determines that additional instruction is needed when a patient diagnosed with scleroderma says which of the following? 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 27

b. “I should lie down for an hour after each meal.”

Question 28

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate (Rheumatrex). The patient tells the nurse, “My arthritis isn’t that bad yet. The side effects of methotrexate are worse than the arthritis.” The most appropriate response by the nurse is 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.”

Answer 28

c. “It is important to start methotrexate early to decrease the extent of joint damage.”

Question 29

Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)? a. The patient has joint pain and stiffness. b. The patient’s blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient’s erythrocyte sedimentation rate (ESR) has increased.

Answer 29

b. The patient’s blood glucose is 165 mg/dL.

Question 30

30. The home health nurse is doing a follow-up visit to a 41-year-old patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? a. The patient takes a 2-hour nap each day. b. The patient has been taking 16 aspirins daily. c. The patient sits on a stool while preparing meals. d. The patient sleeps with two pillows under the head.

Answer 30

d. The patient sleeps with two pillows under the head.

Question 31

A patient with an acute attack of gout in the right 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? 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 takes one aspirin a day to prevent angina. d. The patient usually drinks about 3 quarts water daily.

Answer 31

c. The patient takes one aspirin a day to prevent angina.

Question 32

Which result for a 30-year-old patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep

Answer 32

b. Elevated blood urea nitrogen (BUN)

Question 33

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure

Answer 33

a. Blurred vision

Question 34

A 31-year-old woman is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which information from the patient’s health history is important for the nurse to report to the health care provider about the methotrexate? a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to get pregnant 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.

Answer 34

b. The patient is trying to get pregnant before her disease becomes more severe.

Question 35

Which laboratory data is important to communicate to the health care provider for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis? a. The blood glucose is 90 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/µL. d. The erythrocyte sedimentation rate is elevated.

Answer 35

c. The white blood cell (WBC) count is 1500/µL

Question 36

36. A patient who had arthroscopic surgery of the right knee 7 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? a. The blood pressure is 86/50 mm Hg. b. The white blood cell count is 11,500/µL. c. The patient is taking ibuprofen (Motrin). d. The patient says the knee pain is severe.

Answer 36

a. The blood pressure is 86/50 mm Hg

Question 37

A 63-year-old patient hospitalized with polymyositis has joint pain, an erythematosus facial rash, eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is a. risk for aspiration related to dysphagia. b. disturbed visual perception related to swelling. c. acute pain related to generalized inflammation. d. risk for impaired skin integrity related to scratching.

Answer 37

a. risk for aspiration related to dysphagia.

Question 38

A 46-year-old male 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? a. The blood glucose is 112 mg/dL. b. The patient has painful hematuria. c. Acne is noted on the patient's face. d. The patient has an increased appetite.

Answer 38

b. The patient has painful hematuria

Question 39

Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? a. A 38-year-old man who plays on a summer softball team b. A 56-year-old man who is a member of a construction crew c. A 56-year-old woman who works on an automotive assembly line d. A 49-year-old woman who is newly diagnosed with diabetes mellitus

Answer 39

c. A 56-year-old woman who works on an automotive assembly line

Question 40

Which action will the nurse include in the plan of care for a 40-year-old with newly diagnosed ankylosing spondylitis? a. Advise the patient to sleep on the back with a flat pillow. b. Emphasize that application of heat may worsen symptoms. c. Schedule annual laboratory assessment for the HLA-B27 antigen. d. Assist patient to choose physical activities that allow the spine to flex.

Answer 40

a. Advise the patient to sleep on the back with a flat pillow.

Question 41

After the nurse has taught a 28-year-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management? a. “I am going to join a soccer team to get more exercise.” b. “I will need to stop drinking so much coffee and soda.” c. “I will call the doctor every time my symptoms get worse.” d. “I should avoid using over-the-counter medications for pain.”

Answer 41

b. “I will need to stop drinking so much coffee and soda.”

Question 42

Which information will the nurse include when teaching a patient with newly diagnosed chronic fatigue syndrome about self-management? a. Avoid use of over-the-counter antihistamines or decongestants. b. A low-residue, low-fiber diet will reduce any abdominal distention. c. A gradual increase in your daily exercise may help decrease fatigue. d. Chronic fatigue syndrome usually progresses as patients become older.

Answer 42

c. A gradual increase in your daily exercise may help decrease fatigue

Question 43

After the nurse assesses a 78-year-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management, which information is most important to report to the health care provider? a. Knee crepitation is noted with normal knee range of motion. b. Patient reports embarrassment about having Heberden’s nodes. c. Patient’s knee pain while golfing has increased over the last year. d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

Answer 43

d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

Question 44

A 28-year-old with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider? a. Crackles are heard in both lung bases. b. Red, scaly patches are noted on the arms. c. Hemoglobin level is 11.1g/dL and hematocrit is 35%. d. Patient reports continued back pain after a week of etanercept therapy.

Answer 44

a. Crackles are heard in both lung bases.

Question 45

Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma? a. Monitor for difficulty in breathing. b. Document the patient’s oral intake. c. Check finger strength and movement. d. Apply capsaicin (Zostrix) cream to hands.

Answer 45

b. Document the patient’s oral intake.