NURS 111 Rheumatoid Arthritis with Joint Arthroplasty Exam Questions with Answers

Rheumatoid Arthritis with Joint Arthroplasty Instructions Meet the Client: Terry Barnes Terry Barnes, a 35-year-old mother of three young children, visits the healthcare clinic. She reports experiencing increasing bilateral joint pain, especially in her hands, wrists, and knees. She also reports increasing fatigue and a weight loss of 5 pounds over the last 2 months. She states she has been taking a couple of aspirins a day, but the joint pain is increasing, and she is hesitant to take more medication without a medical evaluation. She appears tense and anxious, and states that she is upset because it is becoming increasingly more difficult to do all the little things necessary to care for her three children. She states, "I'm too young to have arthritis. That's something you get when you're old." Terry's initial medical diagnosis is rheumatoid arthritis, and she is scheduled for diagnostic evaluation. Diagnostic Evaluation Terry is scheduled for a CBC (complete blood count), RF (rheumatoid factor), ESR (erythrocyte sedimentation rate), joint x-rays, and a bone scan. Additional diagnostic tests, which may be performed to help diagnose rheumatoid arthritis, include MRI and synovial fluid analysis, or synovial biopsy. 1. Which nursing intervention related to the scheduled bone scan is most important to implement? A) Ask the client if she has any internal metal devices. INCORRECT This is an important measure prior to an MRI, because the magnetic force may cause movement of internal metal devices. B) Assess the joint puncture site for signs of inflammation. INCORRECT This is an important intervention after synovial joint fluid analysis. Joint fluid for analysis is obtained using sterile procedure, but the client should be monitored carefully after the procedure for any signs of bleeding or infection at the site of the needle insertion. C) Advise the client that the test requires lying still in an enclosed cylinder. INCORRECT This is an important intervention prior to an enclosed MRI, since clients with claustrophobia may have difficulty in an enclosed space. D) Instruct Terry to increase fluid intake after the test. CORRECT Increasing fluid intake after a bone scan will help with elimination of the injected radioisotope. Terry should also be instructed that because the dose of radioisotope is minimal, no special precautions are necessary. Etiology/Risk Factors Terry's test results confirm the diagnosis of rheumatoid arthritis. Her CBC shows normochromic anemia, her RF is positive, and her ESR is elevated. The x-rays and bone scan show evidence of rheumatoid arthritis. Terry is told of her diagnosis of rheumatoid arthritis (RA). She expresses confusion, and states, "How did I get this? What is it? How long will I be like this?" The nurse provides the following explanation: Rheumatoid arthritis is an autoimmune disease affecting not only joints, but organ systems as well. The symptoms of this inflammatory disease can often be controlled, but the disease itself cannot be cured. It is a chronic, progressive disease that seems to affect women more often than men.