AMERICAN RIVER COLLEGE: EXAM 2, RHEUMATOID ARTHRITIS
QUESTIONS & ANSWERS
The nurse obtains a history from a 46-yr-old woman with rheumatoid arthritis. The nurse
should follow up on which patient statement?
A. "I perform range of motion exercises at least twice a day."
B. "I use a heating pad for 20 minutes to reduce morning stiffness."
C. "I take a 20-minute nap in the afternoon even if I sleep 9 hours at night."
D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."
D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."
Methotrexate can affect renal function. Patients should be well hydrated to prevent
nephropathy. Heat application, range of motion, and rest are appropriate interventions
to manage rheumatoid arthritis.
A 24-yr-old female patient with systemic lupus erythematosus (SLE) tells the nurse she
wants to have a baby and is considering getting pregnant. Which response by the nurse
is most appropriate?
A. "Infertility can result from some medications used to control your disease."
B. "Temporary remission of your signs and symptoms is common during pregnancy."
C. "Autoantibodies transferred to the baby during pregnancy will cause heart defects."
D. "The baby is at high risk for neonatal lupus erythematosus being diagnosed at birth."
A. "Infertility can result from some medications used to control your disease."
Infertility may be caused by renal involvement and the previous use of high-dose
corticosteroid and chemotherapy drugs. Neonatal lupus erythematosus rarely occurs in
infants born to women with SLE. Exacerbation is common after pregnancy during the
postpartum period. Spontaneous abortion, stillbirth, and intrauterine growth retardation
are common problems with pregnancy related to deposits of immune complexes in the
placenta and because of inflammatory responses in the placental blood vessels. There
is not an increased risk for heart defects.
A female patient's complex symptomatology over the past year has led to a diagnosis of
systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need
for further teaching about the disease?
A. "I'll try my best to stay out of the sun this summer."
B. "I know that I have a high chance of getting arthritis."
C. "I'm hoping surgery will be an option for me in the future."
D. "I understand I'm going to be vulnerable to getting infections."
C. "I'm hoping surgery will be an option for me in the future."
,Surgery is not a key treatment modality for SLE, so this indicates a need for further
teaching. SLE carries an increased risk of infection, sun damage, and arthritis.
The public health nurse is providing community education to increase the number of
people who seek care after a tick bite. What priority information should the nurse
provide to people at risk for tick bites?
A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Surveillance is necessary during the summer months only.
D. Antibiotics will prevent Lyme disease if taken for 10 days.
B. Check for an enlarging reddened area with a clear center.
After a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that
usually occurs in 3 to 30 days. Flu-like symptoms and migrating joint and muscle pain
also may be present. Active lesions are treated with oral antibiotics for 2 to 3 weeks;
doxycycline is effective in preventing Lyme disease when given within 3 days after the
bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although
ticks are most prevalent during summer months, residents of high-risk areas should
check for ticks whenever they are outdoors. No vaccine is available.
A nurse assesses a 38-yr-old patient with joint pain and stiffness who was diagnosed
with stage III rheumatoid arthritis (RA). Which additional characteristics should the
nurse expect (select all that apply.)?
A. Presence of nodules
B. Consistent muscle strength
C. Localized disease symptoms
D. No destructive changes on x-ray
E. Subluxation of joints without fibrous ankyloses
F. Joint space narrowing and formation of osteophytes
A, E
In stage III severe RA, extraarticular soft tissue lesions or nodules may be present along
with subluxation without fibrous or bony ankylosis. Muscle strength is decreased
because of extensive muscle atrophy. Manifestations are systemic rather than localized.
There is x-ray evidence of cartilage and bone destruction in addition to osteoporosis.
Joint space narrowing with osteophytes is consistent with osteoarthritis.
Name the dermatologic problems with SLE
Skin lesions, butterfly rash, oral/nasal ulcers
Name musculoskeletal problems with SLE
,Morning stiffness, arthritis, increased risk of bone fx
Name cardiopulmonary problems with SLE
tachypnea, cough, dysrhythmias, pericarditis
Name renal problems with SLE
proteinuria, scarring leads to ESRD
Name nervous system problems with SLE
seizures, peripheral neuropathy, cognitive dysfunction, psychiatric disorders
Name hematologic problems with SLE
formation of antibodies against blood cells (anemia, leukopenia, thrombocytopenia,
coagulation disorders)
Name a major cause of death in patients with SLE
infection (increased susceptibility)
What 5 drugs/classes used as drug therapy for SLE?
1. NSAIDs
2. Antimalarials
3. Steroid-sparing drugs
4. Corticosteroids
5. Immunosuppressives
What effect on pregnancy do SLE drugs have?
They may cause infertility.
What increases the risk of rheumatoid arthritis in patients genetically predisposed?
Smoking
Stage I Rheumatoid Arthritis
-synovitis
-xray: soft tissue swelling
Stage II Rheumatoid Arthritis
-increased joint inflammation
-gradual destruction in joint cartilage
-narrowing joint space
Stage III Rheumatoid Arthritis
-synovial pannus
-xray: extensive cartilage loss, erosion at joint margins, possible deformity
Stage IV Rheumatoid Arthritis
, -inflammatory response subsides
-loss of joint function
-subcutaneous nodules
Four clinical manifestations of Rheumatoid Arthritis
fatigue, anorexia, weight loss, generalized stiffness
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.
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.
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 patient's overall endurance.
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 patient's dry eyes are consistent with Sjögren's 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
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.
QUESTIONS & ANSWERS
The nurse obtains a history from a 46-yr-old woman with rheumatoid arthritis. The nurse
should follow up on which patient statement?
A. "I perform range of motion exercises at least twice a day."
B. "I use a heating pad for 20 minutes to reduce morning stiffness."
C. "I take a 20-minute nap in the afternoon even if I sleep 9 hours at night."
D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."
D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."
Methotrexate can affect renal function. Patients should be well hydrated to prevent
nephropathy. Heat application, range of motion, and rest are appropriate interventions
to manage rheumatoid arthritis.
A 24-yr-old female patient with systemic lupus erythematosus (SLE) tells the nurse she
wants to have a baby and is considering getting pregnant. Which response by the nurse
is most appropriate?
A. "Infertility can result from some medications used to control your disease."
B. "Temporary remission of your signs and symptoms is common during pregnancy."
C. "Autoantibodies transferred to the baby during pregnancy will cause heart defects."
D. "The baby is at high risk for neonatal lupus erythematosus being diagnosed at birth."
A. "Infertility can result from some medications used to control your disease."
Infertility may be caused by renal involvement and the previous use of high-dose
corticosteroid and chemotherapy drugs. Neonatal lupus erythematosus rarely occurs in
infants born to women with SLE. Exacerbation is common after pregnancy during the
postpartum period. Spontaneous abortion, stillbirth, and intrauterine growth retardation
are common problems with pregnancy related to deposits of immune complexes in the
placenta and because of inflammatory responses in the placental blood vessels. There
is not an increased risk for heart defects.
A female patient's complex symptomatology over the past year has led to a diagnosis of
systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need
for further teaching about the disease?
A. "I'll try my best to stay out of the sun this summer."
B. "I know that I have a high chance of getting arthritis."
C. "I'm hoping surgery will be an option for me in the future."
D. "I understand I'm going to be vulnerable to getting infections."
C. "I'm hoping surgery will be an option for me in the future."
,Surgery is not a key treatment modality for SLE, so this indicates a need for further
teaching. SLE carries an increased risk of infection, sun damage, and arthritis.
The public health nurse is providing community education to increase the number of
people who seek care after a tick bite. What priority information should the nurse
provide to people at risk for tick bites?
A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Surveillance is necessary during the summer months only.
D. Antibiotics will prevent Lyme disease if taken for 10 days.
B. Check for an enlarging reddened area with a clear center.
After a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that
usually occurs in 3 to 30 days. Flu-like symptoms and migrating joint and muscle pain
also may be present. Active lesions are treated with oral antibiotics for 2 to 3 weeks;
doxycycline is effective in preventing Lyme disease when given within 3 days after the
bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although
ticks are most prevalent during summer months, residents of high-risk areas should
check for ticks whenever they are outdoors. No vaccine is available.
A nurse assesses a 38-yr-old patient with joint pain and stiffness who was diagnosed
with stage III rheumatoid arthritis (RA). Which additional characteristics should the
nurse expect (select all that apply.)?
A. Presence of nodules
B. Consistent muscle strength
C. Localized disease symptoms
D. No destructive changes on x-ray
E. Subluxation of joints without fibrous ankyloses
F. Joint space narrowing and formation of osteophytes
A, E
In stage III severe RA, extraarticular soft tissue lesions or nodules may be present along
with subluxation without fibrous or bony ankylosis. Muscle strength is decreased
because of extensive muscle atrophy. Manifestations are systemic rather than localized.
There is x-ray evidence of cartilage and bone destruction in addition to osteoporosis.
Joint space narrowing with osteophytes is consistent with osteoarthritis.
Name the dermatologic problems with SLE
Skin lesions, butterfly rash, oral/nasal ulcers
Name musculoskeletal problems with SLE
,Morning stiffness, arthritis, increased risk of bone fx
Name cardiopulmonary problems with SLE
tachypnea, cough, dysrhythmias, pericarditis
Name renal problems with SLE
proteinuria, scarring leads to ESRD
Name nervous system problems with SLE
seizures, peripheral neuropathy, cognitive dysfunction, psychiatric disorders
Name hematologic problems with SLE
formation of antibodies against blood cells (anemia, leukopenia, thrombocytopenia,
coagulation disorders)
Name a major cause of death in patients with SLE
infection (increased susceptibility)
What 5 drugs/classes used as drug therapy for SLE?
1. NSAIDs
2. Antimalarials
3. Steroid-sparing drugs
4. Corticosteroids
5. Immunosuppressives
What effect on pregnancy do SLE drugs have?
They may cause infertility.
What increases the risk of rheumatoid arthritis in patients genetically predisposed?
Smoking
Stage I Rheumatoid Arthritis
-synovitis
-xray: soft tissue swelling
Stage II Rheumatoid Arthritis
-increased joint inflammation
-gradual destruction in joint cartilage
-narrowing joint space
Stage III Rheumatoid Arthritis
-synovial pannus
-xray: extensive cartilage loss, erosion at joint margins, possible deformity
Stage IV Rheumatoid Arthritis
, -inflammatory response subsides
-loss of joint function
-subcutaneous nodules
Four clinical manifestations of Rheumatoid Arthritis
fatigue, anorexia, weight loss, generalized stiffness
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.
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.
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 patient's overall endurance.
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 patient's dry eyes are consistent with Sjögren's 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
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.
