Evolve HESI PN Rheumatoid Arthritis – Flashcards

A. Notify the RN and HCP about this contraindication to the scheduled procedure. INCORRECT This action is not indicated. B. Explain that the bone scan is a simple procedure involving fluid collection from a joint. INCORRECT Synovial joint fluid analysis is a sterile procedure in which fluid is collected, but this does not describe a bone scan. C. Offer assurance that bone scan will not affect the client's metal implants. CORRECT A bone scan involves the injection of a radioisotope. This has no impact on metal implants and the presence of metal implants is not a contraindication to this procedure. D. Clarify the type of metal device implanted before cancelling the scheduled appointment. INCORRECT While it may be useful to document the type of metal device implanted, the scheduled appointment does not need to be cancelled.

A. Low white blood cell count (WBC). INCORRECT Because of the inflammatory nature of RA, the WBC may be elevated during periods of active disease and not decreased. B. Decreased platelet count. INCORRECT Thrombocytosis, an elevated platelet count, reflects active RA, not a decreased platelet count. C. Elevated red blood cell count (RBC). INCORRECT Ineffective erythropoiesis with active RA is reflected in a decreased RBC (anemia) not an increase of red blood cells. D. Increased erythrocyte sedimentation rate (ESR). CORRECT Because of the inflammatory process and tissue destruction with RA, the ESR is increased. Elevations of ESR are associated with progressive joint damage. June'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.

A. Thrombosis. INCORRECT With RA, thrombosis is not the cause of pain in the joints. B. Bleeding. INCORRECT With RA, bleeding is not the cause of pain in the joints. Bleeding into the joints causes pain with sickle cell anemia. C. Inflammation. CORRECT With RA, joint pain is the result of synovitis, an inflammation of the synovial membranes. D. Infection. INCORRECT With RA, infection is not the cause of pain in the joints.

A. Increasing age. INCORRECT The onset of rheumatoid arthritis (RA) occurs primarily between the ages of 35 and 45, although it can occur at any age. B. Genetic predisposition. CORRECT Because the incidence of RA in persons with a positive family history is significantly greater that for the general population, genetic predisposition is probably a significant etiologic factor. In addition, increased stress has been linked to RA, and viral infections are believed to be a trigger for the onset of this autoimmune disease. C. Environmental exposure to carcinogens. INCORRECT Although environmental factors may be involved, there is no clear evidence to link specific exposure to carcinogens to the onset of RA. D. History of osteoarthritis. INCORRECT Osteoarthritis is a degenerative joint disease, and although it is not related to RA as an etiologic factor, persons with RA may develop secondary degenerative joint disease.

A. Finger tophi. INCORRECT Finger tophi are typically seen in the client with gout, although joint deformities and subcutaneous nodules are common in advanced RA. B. Drooling. INCORRECT The client is likely to experience hallmark symptoms of RA: dry mouth and dry eyes. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness. Of the several syndromes associated with advance RA, Sjogren's syndrome is the most common. C. Butterfly rash. INCORRECT A butterfly rash on the face is a classic manifestations of systemic lupus erythematosus (SLE) rather than RA. D. Fever. CORRECT A persistent low-grade fever is a common early manifestation of this inflammatory disease. Remember, RA is both a local and systemic inflammatory disease with many generalized symptoms such as fever, fatigue, and weakness, along with multiple lung, cardiac, and renal manifestations.

A. Limited motion. CORRECT Joint motion is limited because of the inflammation. B. Stiffness with activity. INCORRECT Joint stiffness with inactivity is common with RA, especially in the morning. C. Pain relief with movement. INCORRECT Because affected joints with RA are inflamed, movement causes pain, rather than relieving pain. D. Unilateral involvement. INCORRECT RA is usually symmetric, with joints on both sides of the body affected.

A. Anti-infective. INCORRECT Aspirin is not an anti-infective. B. Analgesic. CORRECT Aspirin is an analgesic and helps control joint pain. C. Antiemetic. INCORRECT Aspirin is not an antiemetic. D. Anti-platelet. INCORRECT Although aspirin helps prevent platelet aggregation (clumping), this action does not help reduce the joint pain associated with RA.

A. Crush the tablets to avoid gastrointestinal irritation. INCORRECT B. Be sure to take enteric-coated aspirin tablets. CORRECT Enteric-coated tablets pass through the stomach before they dissolve in the intestines. This action helps prevent stomach irritation. C. Use sunscreen when outside because skin burns quicker. INCORRECT D. Wear sunglasses both indoors and outdoors. INCORRECT

A. Anemia. INCORRECT B. Thrombocytopenia. INCORRECT C. Neutropenia. CORRECT Decreased levels of neutrophils place the client at high risk for infection. The client with neutropenia should be instructed to institute measures to avoid infections. D. Alopecia. INCORRECT

A. Offer the client assurance that the medication may be discontinued at any time. INCORRECT B. Explain to the client that the medication should not be discontinued abruptly. CORRECT Corticosteroids should not be discontinued abruptly because of the potential for an adrenal crisis. The dosage should be gradually tapered down, as prescribed by the HCP. C. Encourage the client to take the medication until her RA symptoms are resolved. INCORRECT D. Call the RN back to the exam room to respond to the client's statement. INCORRECT

3. Dose ordered=Tablets required Dose on hand Dose on hand=2.5 mg tabs Desired dose=7.5 mg 7.5 mg=3 tablets ---------- 2.5

A. Do your children understand why you will have to take so many pills now? INCORRECT B. Do you expect that your health care provider will pay for your prescriptions? INCORRECT C. Do you plan to teach your children about the side effects you may experience? INCORRECT D. Do you have a plan for where and how you will store you medications? CORRECT The PN needs to ensure that the client has a plan for the safe storage of medication out of reach of small children. June's prescribed medication could cause serious harm if swallowed by young children.

A. Instruct the client to discuss her concerns with her HCP. INCORRECT B. Explain that the medications are not working because the client is too anxious. INCORRECT C. Clarify that it may take up to 6 months for the medications to relieve symptoms. CORRECT June's medications may take up to 6 months to relieve symptoms. D. Advise the client that she is probably not taking the medications correctly. INCORRECT

A. Instruct June to minimize contact with her children to reduce stress. INCORRECT B. Advise June not to burden others with her concerns. INCORRECT C. Encourage June to allow her husband to make all major decisions. INCORRECT D. Help June practice problem-solving techniques. CORRECT This is an important nursing intervention. Clients experiencing a high level of stress may need guidance to solve even simple problems. In addition, support groups are often beneficial for clients coping with chronic disease.

A. Quit your job to get more rest. INCORRECT B. Use relaxation techniques. CORRECT C. Avoid wearing high heeled shoes. CORREcT D. Rest in bed as much as possible. INCORRECT E. Eat several small meals a day. CORRECT

A. Increased stiffness can occur with periods of inactivity. CORRECT B. Plan and eat well balanced meals in order to maintain a healthy weight. CORRECT C. Exercise the weakest joints to avoid misuse. INCORRECT D. Continue to take all medication as prescribed. CORRECT E. Plan activities that can be stopped immediately if needed. CORRECT

A. Drink extra fluids with meals. INCORRECT B. Eat low calorie snacks. INCORRECT C. Choose iron-rich foods. CORRECT Persons with RA often have anemia. A diet containing iron-rich foods (liver, oysters, clams, organ meat, lean meat, whole grains, legumes, and leafy green vegetables) is recommended to decrease anemia. D. Select foods high in fats. INCORRECT

A. Make a notation in the medical record that the client's blood pressure could not be measured due to tinnitus. INCORRECT B. Provide emotional support as the client learns to cope with these symptoms of her disease process. INCORRECT C. Offer assurance that symptoms such as tinnitus will diminish as soon as her medications become effective. INCORRECT D. Gather information about any other recent changes and report the findings to the health care provider. CORRECT Both aspirin and paquenil can cause symptoms of toxicity such as tinnitus and confusion. Since the client reported the onset of tinnitus and confusion, the PN should gather any other related information and report the findings to the HCP.

A. Auscultate the client's breath sounds. INCORRECT B. Measure and record the vital signs. CORRECT The PN did not complete the vital sign measurement earlier and should obtain that information now. Additionally, since the client may be exhibiting symptoms of drug toxicity, vital sign measurement may provide useful information about related symptoms of medication toxicity. C. Ask the client to obtain a urine sample. INCORRECT D. Check the pupillary response to light. INCORRECT

A. Provide brief, concise instructions about the needed supplies to the UAP. INCORRECT B. Confront the UAP about interrupting the PN's conversation with the client. INCORRECT C. Step outside the exam room briefly to confer with the UAP about the supplies. CORRECT Stepping outside the exam room allows the PN to confer in private with the UAP and yet remain in close proximity to the client while awaiting the arrival of the HCP. D. Ask the UAP to remain with the client while the PN gathers the needed supplies. INCORRECT

A. Write up a description of the UAP's behavior and give it to the RN in charge. INCORRECT B. Meet privately with the UAP to discuss the identified concerns about privacy. CORRECT Meeting privately with the UAP allows the PN to discuss the concerns and teach the UAP the importance of maintaining client privacy in the future. C. Confront the UAP and insist that the UAP submit a written incident report. INCORRECT D. Ignore the UAP's behaviors unless a further breach of privacy is observed. INCORRECT

A. Apply moist warm packs to affected joints. CORRECT heat applications will increase blood supply to the joints, decrease pain, and increase mobility. Cold applications may also be used, primarily for acute pain flare-ups. B. Be realistic and expect to always experience pain. INCORRECT C. Keep the affected extremities elevated. INCORRECT D. Exercise joints to the point of pain 4 times a day. INCORRECT

A. Soak in a hot tub before bedtime to prevent morning stiffness. INCORRECT B. Consult a physical therapist regarding crutch-walking techniques. INCORRECT C. Resting during the daytime prevents effective sleep at night, increasing fatigue. INCORRECT D. Use joint splints for joint support and to help maintain good alignment. CORRECT Joint splints provide rest and support for the joints while maintaining good anatomical alignment.

A. "You seem very overwhelmed right now." CORRECT Clarification of June's feelings is a therapeutic technique that will encourage further communication. B. "We will discuss this when you are not so depressed." INCORRECT C. "If i were in your situation, i'd be depressed too." INCORRECT D. "I will call the clinic chaplain to talk to you." INCORRECT

A. "Since you are so depressed right now, you should reduce your dose of pain medication." INCORRECT B. "Have you considered speaking with the healthcare provider about surgical joint replacement?" CORRECT Making a client-focused suggestion offers June an alternative without being confrontational or belittling. C. "You will feel better if you focus on positive things rather than negative things." INCORRECT D. "I'm sure your husband is really very glad to be able to do things for you." INCORRECT

A. Artificial joints will replace both knee joints during surgery. CORRECT This answers the question so June can understand it. Arthroplasty is the term used for total joint replacement. Hip replacement is the most common joint arthroplasty, followed by knee replacement. Clients with rheumatoid arthritis may also benefit from elbow, wrist, or finger arthroplasty. B. The surgical excision of the synovial membrane of both knee joints. INCORRECT C. Observation of both knee joints through a scope. INCORRECT D. Both knee joints will be surgically immobilized. INCORRECT