Rheumatoid Arthritis: Comprehensive Care and Management, Exams of Nursing

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NUR200 Rheumatoid Arthritis Final

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1. A 43-year-old woman, recently diagnosed with RA, asks the nurse whether she might have concerns beyond the problems with her joints. The nurse informs her that RA may also involve: Select all that apply. A) The respiratory system. B) The cardiovascular system. C) The exocrine system. D) The reproductive system. E) The hematologic system. - Answer Answer: A, B, C, E Explanation: A) RA can result in pleural effusion (collection of fluid in the pleural space). Individuals with RA have an increased risk of developing coronary heart disease. RA is a systemic disease of connective tissue that can affect exocrine glands, resulting most frequently in dry eyes and mouth. Properly managed, rheumatoid arthritis is not considered to be a danger for pregnant women or their babies. Patients with RA may suffer from a variety of hematologic disorders, particularly anemia. Page Ref: 495 Cognitive Level: Analyzing Client Need: Physiological Integrity Nursing Process: Analysis Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of rheumatoid arthritis (RA).
2. A client has just recently been diagnosed with rheumatoid arthritis (RA). The client asks the nurse if RA always causes crippling deformities. The nurse tells the client that to decrease the likelihood of deformities, it is important to: Select all that apply. A) Ignore pain as a warning signal. B) Type instead of hand-writing items if possible.

C) Use stronger joints for most activity. D) Avoid stress to any current area of deformity. E) Stop an activity if it is beyond your ability to perform. - Answer Answer: B, C, D, E Explanation: A) The client with RA should never attempt to push a joint beyond its ability. Writing requires using a strong grip, so typing is preferable. Using a stronger joint or part of the body, such as the palm, to carry items is preferable to grasping. Pain is a warning signal, and the client with RA should stop any activity that causes pain. When performing a task, the client should avoid stress in the area of the deformity to help prevent further deformities. Page Ref: 505 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 2. Identify risk factors and prevention methods associated with RA.

3. A female client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if the cause of the disease is the fact that her family is of Hispanic descent. Which is the most appropriate response by the nurse to this client? A) "RA affects those of German descent most often." B) "RA is most prevalent in Caucasian females." C) "RA is most prevalent in men under the age of 20 years." D) "RA affects all races at the same rate." - Answer Answer: D Explanation: A) RA affects 12% of the total population across all races. It affects women 3 times more than men, and the onset is usually between the ages of 20 and 40 years. Page Ref: 496 Cognitive Level: Applying Client Need: Psychosocial Integrity Nursing Process: Implementation Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with rheumatoid arthritis.

4. The nurse is collecting a health history for a client being seen in an outpatient clinic. The client complains of joint pain and swelling that have lasted for about 2 months. The nurse devises a plan of care based on the nursing diagnosis of Activity Intolerance based on which client statement? 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 of RA is extreme fatigue, and the nurse would plan to teach the client about frequent rest periods during the day to conserve energy. The client with RA will be stiff early in the morning, but that would not interfere with activities later in the day. Joints of the RA client are stiffest in the morning. Taking ibuprofen for pain does not affect the ability for activity. Page Ref: 505 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with rheumatoid arthritis.
5. The nurse is completing a health screening for a school-age child with rheumatoid arthritis. The parents ask the nurse to recommend activities that will promote exercise for their child. Which is an appropriate recommendation by the nurse? A) Swimming B) Football C) Softball D) Basketball - Answer Answer: A Explanation: A) Swimming exercises all the extremities without putting undue stress on joints. Softball, football, or basketball could exacerbate joint discomfort. Page Ref: 504 Cognitive Level: Applying Client Need: Health Promotion and Maintenance Nursing Process: Implementation

Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with RA.

6. A client with rheumatoid arthritis is being seen in the outpatient clinic for a progress check-up. The nurse is reviewing the client's plan of care and determines that the client has met a goal of treatment when the client makes which statement? 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: A) One technique for reducing stress on the joints is to delegate household tasks to family members. 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. Page Ref: 507 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 7. Evaluate expected outcomes for an individual with RA.
7. The nurse is caring for a client who was diagnosed with rheumatoid arthritis last year. The client has recently been placed on prednisone for treatment. The nurse is teaching the client about safe medication administration. Which client statement indicates that the medication teaching was successful? A) "I will not have to limit my consumption of canned vegetables." B) "I will take this medication on a full stomach to enhance absorption." C) "I will not need to monitor my blood sugar more frequently while on this medication." D) "I will take the ordered dose at the same time every day." - Answer Answer: D Explanation: A) Steroid therapy is usually done as part of a tapered-dose treatment plan. It is important to take the medication at the same time each day. Steroids are taken with food to minimize GI distress, not to enhance absorption. Steroids can cause fluid retention, so sodium intake should be limited. A hidden source of sodium is canned vegetables. Steroids also increase blood sugar, so blood sugar may need to be monitored more frequently while on the medication regimen.

Page Ref: 502 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with RA.

8. A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis. The client states that her pain is a 3 on a scale from 1 to 10 today. What non-pharmacological interventions can the nurse provide? Select all that apply. A) Discourage any position changes. B) Relaxation techniques C) Immobilize the extremity. D) Massage E) Provide diversion activities. - Answer Answer: B, D, E Explanation: A) Non-pharmacological activities for pain relief include massage, relaxation, and diversion. Position changes are encouraged along with supportive equipment. Immobilization would likely cause contractures in the joints. Page Ref: 504 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 6. Plan evidence-based care for an individual with RA and his or her family in collaboration with other members of the healthcare team.
9. A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). The nurse understands that this client may: A) Be at higher risk for preterm delivery. B) Not stop medication for RA, even if the client is in remission. C) Experience a relapse during pregnancy, often followed by a remission after delivery. D) Be anemic as a result of blood loss from salicylate therapy. - Answer Answer: D Explanation: A) The pregnant client with RA may have prolonged gestations and often experience a remission during pregnancy and relapse after delivery. The pregnant client with RA that is in remission may stop medication. This client may be anemic as a result of blood loss from salicylate therapy. Page Ref: 497 Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance

Nursing Process: Planning Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with RA.

10. A nurse is caring for a client who has been newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse what the difference is between rheumatoid arthritis and osteoarthritis (OA). The nurse's best response includes: Select all that apply. A) "The onset of OA is gradual while 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 while the joints affected by OA are warm or hot to the touch." D) "OA is slowly progressive while RA is characterized by exacerbations and remissions." E) "The pain and stiffness with RA is with activity; OA pain and stiffness is predominant upon arising." - Answer Answer: A, D Explanation: A) The onset of OA is gradual while the onset of RA may be rapid. RA affects multiple joints symmetrically while OA affects one joint at a time. The affected joints in OA feel cold to the touch while the joints affected by RA are warm or hot to the touch. OA is slowly progressive while RA has exacerbations and remissions. Pain associated with RA is predominant upon arising versus the pain in OA, which is with activity. Page Ref: 495 Cognitive Level: Understanding Client Need: Physiological Integrity Nursing Process: Assessment Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of rheumatoid arthritis (RA).

1. A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation

D. Increased blood pressure E. Pain at rest - Answer 1. A. CORRECT: Exacerbating factors, such as a recent illness like influenza, are indicative in clients who have RA. B. CORRECT: A decrease in range of motion is indicative in clients who have RA. C. Clients who have RA can experience xerostomia, not hypersalivation. D. Increased blood pressure is not indicative of RA. E. CORRECT: Pain at rest is indicative of RA. NCLEX® Connection: Physiological Adaptation, Pathophysiology

2. A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A. "You can experience morning stiffness when you get out bed." B. "You can experience abdominal pain." C."You can experience weight gain." D."You can experience low blood sugar." - Answer 2. A. CORRECT: The nurse should include in the teaching that the client who has RA can experience stiffness in her joints upon rising. B. The client who has RA can experience pleuritic pain upon inspiration, not abdominal pain. C. The client who has RA can experience weight loss, not weight gain. D. The client who has RA does not experience a low blood sugar. NCLEX® Connection: Physiological Adaptation, Illness Management
3. A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply.) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count - Answer 3. A. A urinalysis is not a laboratory test used to diagnose RA. This test can used for detecting kidney failure. B. CORRECT: ESR is a laboratory test used to diagnose RA. This laboratory test will show an elevated result in clients who have RA.

C. A BUN is not a laboratory test used to diagnose RA. This test can be used for detecting kidney failure. D. CORRECT: ANA titer is a laboratory test used to diagnose RA. This laboratory test will show a positive result in clients who have RA. E. CORRECT: WBC count is a laboratory test used to diagnose RA. This laboratory test will show a decreased result in clients who have RA. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests PRACTICE Active Learning Scenario A nurse is providing information about the adverse effects of prednisone to a client who has rheumatoid arthritis. Use the ATI Active Learning Template: Medication and the ATI Pharmacology Review Module to complete this item. COMPLICATIONS: Identify three adverse effects of this medication, as well as related client education. - Answer PRACTICE Answer Using the ATI Active Learning Template: Medication COMPLICATIONS ● Risk of infection (fever and/or sore throat): Advise clients to notify the provider immediately if symptoms occur. ● Osteoporosis: Advise clients to take calcium supplements, vitamin D, and/or bisphosphonate. ● Fluid retention: Monitor for signs of fluid excess, such as crackles, weight gain, and edema. ● Adrenal suppression ◯ Advise clients to observe for symptoms and to notify the provider if symptoms occur. ◯ Administer fluids such as normal saline, salt, and ● GI discomfort ◯ Advise clients to observe for symptoms and to notify the provider if symptoms occur. ◯ H2 antagonists can be used prophylactically.

● Hyperglycemia: Monitor blood glucose level. Clients who have diabetes mellitus can need to adjust hypoglycemic agent. ● Hypokalemia hydrocortisone IV. ◯ Advise clients to report ◯◯ Advise clients not to discontinue the medication suddenly. symptoms of GI bleeding (coffee-ground emesis; black, tarry stools). ◯ ◯ Monitor serum potassium levels. Advise clients to eat potassium-rich foods. Administer potassium supplements. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration