Rheumatoid Arthritis: Complications, Treatment, and Management, Exams of Nursing

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Rheumatoid Arthritis Midterm Exam

Questions And All Correct Answers.

1. Which of the following complications is not associated with a diagnosis of rheumatoid arthritis (RA)? A) Increased risk of cesarean delivery B) Increased risk of pleural effusion C) Increased likelihood of uveitis D) Increased risk of anemia - Answer Answer: A Explanation: A) All individuals with RA are at increased risk of plural effusion and uveitis, although the latter condition is most commonly associated with juvenile RA. Between 25% and 35% of clients with RA have mild anemia. However, pregnant women with RA are no more likely to undergo cesarean delivery than pregnant women without RA. ) A client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. What information should the nurse include when teaching this client about ways to decrease the likelihood of crippling deformities? Select all that apply. A) Ignore pain as a warning signal. B) Type instead of hand-writing items if possible. C) Use the strongest joints possible to complete most tasks. D) Avoid stress to any current area of deformity. E) Stop an activity immediately if it is beyond your ability to perform. - Answer Answer: B, C, D, E Explanation: The client with RA should never attempt to push a joint beyond its ability. Pain is a warning signal, so the client with RA should immediately stop any activity that causes pain. The client should also use the strongest joints possible to complete tasks, and he or she should avoid activities (like writing) that require a strong grip. In addition, when performing tasks, the client should avoid stress in any current area of deformity to help prevent further deformities.
2. Based on gender and age alone, which of the following clients is most likely to experience the new onset of rheumatoid arthritis (RA)? A) A 31-year-old man B) A 42-year-old woman C) A 65-year-old woman

D) An 18-year-old man - Answer Answer: B Explanation: RA is the most common form of autoimmune arthritis, affecting from 1% to 2% of the worldwide population. RA affects three times as many women as men, and while the typical age of onset is between 40 and 60 years, this disease strikes people of all ages.

4. The nurse is collecting a health history for a client being seen in an outpatient clinic who complains of joint pain and swelling that have lasted for about 2 months. The client is diagnosed with rheumatoid arthritis (RA). Which of the following statements made by this client supports the nursing diagnosis of Activity Intolerance? A) "I seem to get tired early in the day and require a nap." B) "My joints are stiffest at night before I go to sleep." C) "I find it difficult to move when I first get up in the morning." D) "I take ibuprofen for the pain as needed." - Answer Answer: A Explanation: A) One hallmark symptom of RA is extreme fatigue. The client's statement regarding the need for a nap supports the inclusion of Activity Intolerance in the plan of care. Based on this diagnosis, the nurse would teach the client about the need for frequent rest periods during the day to conserve energy. The joints of RA clients are usually stiffest in the morning, but that would not interfere with activities later in the day. Also, taking ibuprofen for pain does not affect the client's ability to engage in activity.
5. The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is most appropriate? A) Swimming B) Football C) Softball D) Basketball - Answer Answer: A Explanation: A) Swimming exercises all the extremities without putting undue stress on joints. In contrast, softball, football, or basketball could all exacerbate joint discomfort.
6. A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress checkup. Which of the following statements on the part of the client suggests that she has met a goal of treatment? A) "I sleep for 10 hours at night."

B) "I have increased pain in my joints all the time now." C) "I have delegated many household chores to my children and spouse." D) "I do not perform household chores at all anymore." - Answer Answer: C Explanation: One technique for reducing stress on the joints is to delegate household tasks to family members; however, the client does not need to refrain from all household chores. Sleeping for 10 hours at night will not alleviate the need for frequent rest periods during the day. Increased joint pain would indicate that goals have not been met.

7. The nurse is caring for a client who was diagnosed with rheumatoid arthritis (RA) last year. The client has just been prescribed methotrexate as part of his RA treatment regimen. The nurse is teaching the client about use of this medication. Which client statement indicates that this teaching was successful? A) "It's not safe for me to take nonsteroidal anti-inflammatory drugs (NSAIDs) while on methotrexate therapy." B) "I can help control the side effects of methotrexate by taking folic acid." C) "I should expect to see beneficial results within 3 to 5 days of starting methotrexate therapy." D) "It's important that I take my methotrexate at the same time every day." - Answer Answer: B Explanation: Clients who are on methotrexate therapy should be advised to take folic acid, as this can help control side effects such as gastric irritation and stomatitis. Methotrexate is typically taken once per week (not daily), and it can be safely used along with NSAIDs in the treatment of RA. Clients may see beneficial effects of methotrexate therapy is as few as 2-4 weeks (not 3-5 days).
8. A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis (RA). The client reports that her pain is a 3 on a scale from 0 (none) to 10 (high) today. Which nonpharmacologic interventions can the nurse provide to enhance the client's comfort? Select all that apply. A) Discourage any position changes. B) Encourage relaxation techniques. C) Immobilize the extremity. D) Offer heat and/or cold packs. E) Provide distraction activities. Answer: B, D, E - Answer Explanation: Nonpharmacologic activities for pain relief include relaxation, distraction, and application of heat and cold. Position changes are encouraged along with supportive equipment. Immobilization would likely cause contractures in the joints.

9. A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). Based on this data, what should the nurse anticipate when providing care to this client? A) A higher risk for preterm delivery B) An increased need for medication C) An acute exacerbation of symptoms D) A continued risk for anemia - Answer Answer: D Explanation: The pregnant client with RA is at continued risk for anemia. Many pregnant clients with RA have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. Due to remission, a decrease in medication is often necessitated.
10. A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse to explain the difference is between RA and osteoarthritis (OA). Which responses by the nurse are most appropriate? Select all that apply. A) "The onset of OA is gradual, whereas the onset of RA may be rapid." B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time." C) "The affected joints in RA feel cold to the touch, whereas the affected joints in OA are warm or hot to the touch." D) "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions." E) "With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising." - Answer Answer: A, D Explanation: A) The onset of OA is gradual, whereas the onset of RA may be rapid. RA affects multiple joints symmetrically, but OA affects one joint at a time. The affected joints in OA feel cold to the touch, whereas the affected joints in RA are warm or hot to the touch. OA is slowly progressive, whereas RA has exacerbations and remissions. With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising.
11. The nurse is providing care to a client who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis. When providing care to this client, which actions by the nurse are appropriate? Select all that apply. A) Monitoring for signs of allergic reaction B) Assuring the client that NSAIDs are safe for clients with cardiovascular disease C) Encouraging the client to take NSAIDs with a small snack to help avoid GI distress D) Monitoring for signs of renal problems

E) Inquire about the use of herbal supplements such as feverfew, garlic, ginger, or ginkgo - Answer Answer: A, C, D, E Explanation: A) When providing care to a client who is receiving any medication, it is important to monitor for signs of allergic reaction. Taking NSAIDs with food may help reduce symptoms of GI distress that are often associated with these drugs. Clients who are on NSAIDs should be monitored for signs of renal problems, because these medications are potentially nephrotoxic. Clients should also avoid herbal supplements such as feverfew, garlic, ginger, and gingko, as these substances can increase the risk of bleeding associated with NSAID use. Because NSAIDs can cause blood pressure alterations, they may be dangerous for clients with cardiovascular disorders.

12. Which form of juvenile idiopathic arthritis (JIA) primarily affects the knees, ankles, and elbows? A) Pauciarticular arthritis B) Polyarticular arthritis C) Systemic arthritis D) Osteoarthritis - Answer Answer: A Explanation: A) There are three types of JIA: pauciarticular, systemic, and polyarticular. Pauciarticular arthritis primarily affects the knees, ankles, and elbows. Systemic arthritis involves high fever, polyarthritis, and rheumatoid rash and also affects internal organs. Polyarticular arthritis affects many joints (five or more), particularly the small joints of the hands and fingers. It also may affect the hips, knees, feet, ankles, and neck. Osteoarthritis is a separate condition, not a form of JIA.
13. Why are proton pump inhibitors often included as part of the pharmacologic treatment regimen for clients with rheumatoid arthritis (RA)? A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA. B) Proton pump inhibitors can dramatically decrease both inflammation and immune reactions and appear to slow the progression of joint destruction in RA. C) Proton pump inhibitors help reduce the body's autoimmune response, thereby limiting the effects of the autoimmune disease process that underlies RA. D) Proton pump inhibitors help reduce the risk of retinitis and vision loss in clients who are taking antimalarial agents as part of their therapeutic regimen for RA. - Answer Answer: A Explanation: A) NSAIDs are among the most common dugs used in the treatment of RA, although they may produce unpleasant gastric side effects like stomach lining irritation, erosions, and bleeding ulcers. Concurrent administration of proton pump inhibitors may reduce the risk for GI bleeding due to NSAIDs. Proton pump inhibitors do not affect the inflammation, immune reactions, and joint destruction

associated with RA, nor do they reduce the body's autoimmune response. Furthermore, these drugs do not affect the risk of vision problems that accompanies use of antimalarial agents.