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Adaptive Quizzing CH 18 D. A patient presents in the emergency department with dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness. Which disease is consistent with the... se assessment findings? Ankylosing spondylitis Polymyalgia rheumatica Polymyositis/dermatomyositis Reiter's syndrome Rationale Dysphagia,periorbitaledema,lilaceyelidrash(DM),andseveremuscleweakness alongwithmalignantneoplasmsinanolderpatientaresignsandsymptomsof polymyositis/dermatomyositis.Ankylosingspondylitis,polymyalgiarheumatic,and Reiter'ssyndromedonotproducealthesesymptoms. p.334 The patient who is diagnosed with severe psoriatic arthritis is scheduled to receive an oral retinoid medication. Which medication will the nurse anticipate administering to the patient? Alefacept Golimumab Acitretin Ustekinumab Rationale Acitretinisanoralretinoidgivenforpatientswithseverepsoriaticarthritis.Golimumabis thefirstbiologicalresponsemodifier(biologic)thatisadministeredonlyonceeach monthforpsoriaticarthritis.Ustekinumab,whichisalsoabiologic,targetsthecytokines interleukin(IL)-12andIL-23todecreaseinflammation.AlefaceptisanIV immunosup ressivedrug.p.333 Fibromyalgia syndrome (FMS) is which type of disorder? Autoimmune Inflammatory Chronic pain Connective tissue Rationale Fibromyalgiasyndromeisachronicpaindisorderthatspecificalyaffectsthetriger pointsofthebackoftheneck,up erchest,trunk,lowback,andextremities.Itisnot acuratelydescribedasanautoimmune,inflammatory,orcon ectivetissuedisorder.p. 333 Which genitourinary manifestation may occur in fibromyalgia syndrome? Dyspnea Pelvic pain Constipation Abdominal pain Rationale Fibromyalgiaisachronicpainsyndromecharacterizedbystiffnessandtendernessin backoftheneck,lowerback,andextremities.Genitourinarymanifestationsare characterizedbypelvicpain,dysuria,andurinaryfrequencyandurgency.Dyspneaisa cardiovascularmanifestationoffibromyalgiasyndrome.Constipationandabdominal painaregastrointestinalmanifestations.p.333 Systemic necrotizing vasculitis is characterized by ischemia. What are the clinical manifestations observed with cerebral ischemia? Selectallthatapply. Vertigo Severe pain Skin lesions Necrosis of fingers or toes Visual changes Rationale Necrotizingvasculitisisaterm foragroupofdiseaseswhoseprimarymanifestationis arteritis(inflammationofarterialwals),whichcausesischemiainthetissuesusualy sup liedbytheinvolvedvessels.Clinicalmanifestationsofperipheralarterialdisease areseverepainandnecrosisoftoesorfingers.Vertigoandvisualchangeswouldbe se nwithcerebralvasculitis.Hypersensitivityvasculitisischaracterizedbyskinlesions asanalergicresponsetodrugs,infections,ortumors.Malignantneoplasmsareoften observedinpatientswithdermatomyositis.p.334 Which syndrome is characterized by symptoms such as scoliosis and excessive height with elongated hands and feet? Reiter's syndrome Marfan syndrome Fibromyalgia syndrome Chronic fatigue syndrome Rationale Marfansyndromeisanautosomaldominantdisorderthatocursduetoamutationof thefibrillinIgene(FBNI).Fibrilinhelpsinlimitingthestretchofelasticcon ective tissuesandinalowingthem toreturntotheiroriginalshape.Duetoamutationinthis gene,thereiselongationofthehandsandfe t,excessiveheight,andanabnormal curvingofthespine(scoliosis).Reiter'ssyndromeisassociatedwithjointpain,eye infection,andburninginfection.Fibromyalgiasyndromeisassociatedwithpain, stiffness,andtendernessinup erchest,trunk,andlowerextremities.Chronicfatigue syndromeisassociatedwithsorethroat,memoryimpairment,andmusclepain.p.334 What is the drug of choice to treat fibromyalgia syndrome (FMS) in a 72-year-old patient with memory impairment? Tramadol Trazodone Amitriptyline Nortriptyline Rationale Trazodoneispreferredtotreatfibromyalgiasyndromeinelderlypatientsbecauseithas minimalsideeffectsanditcanbeusedinpatientswithmemoryimpairment.Tramadolis anopioidanalgesicusedtorelievepainandhelpsinthemanagementofFMS. Amitriptylineandnortriptylinearetricyclicantidepressants.Theycauseconfusionand orthostatichypotensionandarethereforeusedcautiouslyinelderlypatientswithFMS. p.334 The nurse is caring for a patient who is diagnosed with early-stage Lyme disease. Which medication does the nurse anticipate will be included in the patient's pharmacologic plan of care? Doxycycline Golimumab Pregabalin Febuxostat Rationale DoxycyclineisprescribedduringtheuncomplicatedstageofLymediseasefor14to21 days.Golimumabisthefirstbiologicthatisadministeredonceeachmonthforpsoriatic arthritis,notforearly-stageLymedisease.Pregabalinisap rovedforuseintreating neuropathicpain,suchasthatwhichocurswithfibromyalgia,aswelasfortreatmentof depression.Febuxostatisthedrugofchoiceforpatientswithrepeatedacuteepisodes orwithchronicgout. pp.332-333 The nurse is teaching a patient about taking etanercept for psoriatic arthritis. Which statement by the patient indicates that further teaching is needed? "I'm comfortable self-administering etanercept." "I will not take etanercept if I have an infection." "I can use heat at the injection site if an itchy rash develops." "If I get a respiratory infection, I will seek immediate care." Ice,notheat,andhydrocortisone1% cream shouldbeap liedifared,itchyrash developsatheinjectionsite.Thepatientwilself-administeretanerceptinjections.The patientshoulddiscontinueuseofetanerceptandse kimmediatecareifaninfection develops.p.333 What are the clinical manifestations of dermatomyositis? Selectallthatapply. Severe muscle weakness Iritis Eyelid rash Periorbital edema Weight loss Rationale Dermatomyositisisaninflammatorydiseaseofskeletalmusclethatcausessymmetric weaknessandatrophyandhasanacompanyingrash.Patientswiththisdisease typicalyhaveseveremuscleweakness,dysphagia,periorbitaledema,andlilaceyelid rash.Malignantneoplasmsarese ninolderpatients.Weightlossandmalaisearese n inankylosingspondylitis.p.334 What interventions should be performed for a patient with polymyositis? Selectallthat apply. Managing organ dysfunction Teaching about dietary needs Providing support for physical therapy Frequent echocardiography monitoring Teaching about complications of long-term steroid therapy Rationale Healthteachingaboutdietaryne ds,providingsup ortforphysicaltherapy,and teachingaboutlong-term steroidtherapyaretheinterventionsperformedforapatient withpolymyositis.Managementoforgandysfunctionisaninterventionperformedfora patientwithsystemicnecrotizingvasculitis.Frequentechocardiographymonitoringisan interventionperformedforpatientswithMarfansyndrome.p.334 When assessing the patient who is diagnosed with Lyme disease, which signs or symptoms does the nurse expect the patient to demonstrate? Selectallthatapply. Erythema migrans Itchy rash Joint stiffness Muscle pain Podagra IntheearlyandlocalizedstageIofLymedisease,thepatientap earswithflu-like symptoms,erythemamigrans(roundoroval,flatorslightlyraisedrash),andpainand stiffnessinthemusclesandjoints.Itchyrashisanearlysignofpsoriaticarthritis. Podagra,whichisaclassicsignofgout,referstopainandinflammationinoneormore smaljoints(usualythemetatarsophalangealjointofthegreatoe).p.332 Which assessment will the nurse perform to detect side effects after administering the drug golimumab? Blood pressure Pedal pulses Serum electrolytes Temperature Rationale Golimumabisthefirstbiologicthatisadministeredonlyonceeachmonthforpsoriatic arthritis,whichcancauseop ortunisticpathogens.Therefore,thetemperatureistaken becauseifitiselevated,itindicatesthepersonhasafever,whichisanearlysignof infection.Otherassessmentforinfectionisimportant.Teachpatientsthathisdrughas ablackboxwarningforseriousinfectionsthatmayleadtohospitalizationordeathfrom op ortunisticpathogens.Theotherpossibleanswersarenotsignsofop ortunistic pathogens. p.333 Which antidepressant drug is often used to treat nerve pain in patients with fibromyalgia syndrome? Pregabalin Trazodone Nortriptyline Amitriptyline Rationale Pregabalinisanantidepressantdrugusedinthetreatmentofnervepaininthepatient withfibromyalgiasyndrome.Itpromotesthereleaseofserotoninandnorepinephrine, neurotransmitersinthebrain.Trazodone,nortriptyline,andamitriptylinearedrugsused topromotesle pandreducegeneralizedpainormusclespasm andarenotaseffective intreatingnervepain.p.333 Which action is appropriate for a patient managing osteoarthritis with prescribed exercises? Maintain the usual number of repetitions when inflammation is severe. Substitute prescribed exercises with household tasks. Use passive and active-assist rather than active exercises whenever possible. Avoid resistive exercises when joints are severely inflamed. Thepatientshouldavoidresistiveexerciseswhenhisorherjointsareseverelyinflamed. Thepatientmayreducethenumberofrepetitionswheninflammationandpainare severe.Thepatientshouldnotsubstitutehouseholdtasksforprescribedexercises.The patientshoulduseactiveratherthanpassiveandactive-assistexerciseswhenever possible.p.317 Which statement indicates to the nurse that a patient with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms? "My Thera-Band really helps me loosen up my arms." "The brace on my lower leg is helping me walk better." "Focusing on the slow stretching movements and my breathing in tai chi helps me relax." "Water aerobic exercises have helped me sleep better." Rationale Taichisanalternativeorcomplementarytherapythatfocusesonslowandgentle stretchingmovementsandbreathing.Thera-Bandexercisesareusedinphysical therapy.Splintsorbracesareusedinocupationaltherapy.Wateraerobicsisan exampleofalow-impactexercise,notalternativetherapy.p.334 The nurse provides discharge planning to a patient who has been prescribed methotrexate (MTX). Which vitamin is included to help decrease some of the side effects of MTX? Niacin Folic acid Vitamin D Vitamin K Rationale Folicacid,oneoftheBvitamins,isoftengiventopatientswhoaretakingMTXtohelp decreasesomeofthedrug'ssideeffectsincludingGIproblems,suchasnauseaand vomiting,andoralproblems,suchasmouthsores.NiacinandvitaminsDandKdonot haveanysignificantimpactonthesideeffectsofmethotrexate. p.322 What should the nurse expect the primary health care provider to prescribe to the patient who has chronic back pain, visual disturbances, and weight loss? Antibiotics and disease-modifying antirheumatic drugs Nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs Nonsteroidal anti-inflammatory drugs, steroid therapy, and disease modifying antirheumatic drugs Nonsteroidal anti-inflammatory drugs, analgesics, antibiotics, and disease modifying antirheumatic drugs Chronicbackpain,visualdisturbances,andweightlossareclinicalmanifestationsof ankylosingspondylitis.Thisisacon ectivetissuedisorder,whichisautoimmuneand inflammatory.Ankylosingspondylitisistreatedwithnonsteroidalanti-inflammatorydrugs (NSAIDs)anddisease-modifyingantirheumaticdrugs(DMARDs).Antibioticsand DMARDswouldonlyhelpintreatinginfectionsandspondylitis.Steroidtherapydoesnot helptotreatankylosingspondylitis.Antibioticsdonothelptotreatankylosing spondylitis. p.334 What patient education should be provided to a patient with psoriatic arthritis who is prescribed etanercept? Selectallthatapply. Etanercept contains a black box warning. Etanercept should be self-administered cautiously. Etanercept cannot be given as combination therapy. Respiratory infections are the common adverse effects of etanercept. Hydrocortisone cream should be used to prevent rash at the etanercept injection site. Rationale Thepatientshouldbetaughtabouthecaretakenwhileself-administeringthedrugto preventinjection-sitereactions.Respiratoryinfectionsarecommonadverseeffectsof etanercept.Thedrugdoesn'tcontainablackboxwarning.Etanerceptcanbeusedin combinationwithotherbiologicstotreatarthritis.Hydrocortisonecream isusedtotreat rednessanditchingdevelopedatheinjectionsiteafteradministrationofthedrug.p. 323 Which assessment findings are associated with psoriatic arthritis? Selectallthatapply. Stiff, painful joints Blurred vision Abdominal pain Scaly, itchy rash Neck pain Fingernail pitting Rationale Psoriaticarthritis(PsA)affectssomepeoplewhohavepsoriasis—askincondition characterizedbyascaly,itchyrash,usualyontheelbows,kne s,andscalp.Fingernail andtoenailiftingandpitingmayalsoocur.Thejointpainassociatedwithpsoriasis oftenincludesstiffness,especialyinthemorning.Neckandbackpainareparticularly common,butvariousformsofthediseasecancausesmaljointarthritisorinvolvement ofthesacroiliacjointsofthespine.Bluredvisionandabdominalpainaresymptomsof fibromyalgia.p.332 The nurse is teaching a patient with systemic lupus erythema (SLE) about self-management. Which statement by the patient indicates effective teaching? "I will avoid sunlight." "I will avoid Ivory soap." "I will use clotrimazole on any skin lesions." "I will use powder on any moist skin areas." Rationale PatientswithSLEshouldbeinstructedtoavoidsunlightandanyothertypeofultraviolet lighting,includingtan ingbeds,astheycancauseexacerbationsofthedisease.Using amildsoap,suchasIvory,isgentleontheskin.Topicalcortisonepreparation,not clotrimazole(atopicalantifungal),helpsreduceinflammationandpromotefadingofskin lesions.Avoidpowderandotherdryingagents,suchasrub ingalcohol,duetothe dryingproperties.p.326 The patient asks the nurse to explain exactly what fibromyalgia is. What is the appropriate response by the nurse? "Fibromyalgia is an inflammatory disease with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the thalamus and hypothalamus." "Fibromyalgia is a chronic pain syndrome with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the thalamus and hypothalamus." "Fibromyalgia is an inflammatory disease with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the limbic system and basal ganglia." "Fibromyalgia is a chronic pain syndrome with symptoms of stiffness, tenderness, and pain located at specific sites. Increased muscle tenderness may be caused by the inability to tolerate pain, possibly related to dysfunction in the brain, especially the limbic system and basal ganglia." Rationale Fibromyalgiasyndrome(FMS),alsoreferedtoassimplyfibromyalgia,isachronicpain syndrome,notaninflammatorydisease.However,arthritisandothercomorbiditiesare commonlypresentinpatientsdiagnosedwithFMS.Increasedmuscletendernessmay becausedbytheinabilitytotoleratepain,possiblyrelatedtodysfunctioninthebrain, especialythethalamusandhypothalamus,nothelimbicsystem orthebasalganglia. pp.333-334 What laboratory testing is mostimportant for the patient taking acitretin for psoriatic arthritis? Serum electrolytes Blood urea nitrogen (BUN) Liver enzymes Complete blood count (CBC) Rationale Acitretinisanoralretinoidgiventopatientswithseverepsoriaticarthritis.Thedrughas asignificanteffectontheliver,somonitoringliverenzymesisthepriority.Blo durea nitrogen(BUN)isreflectiveofrenalfunctionanddoesnotmeasureliverfunction.Serum electrolytesdonotreflectliverfunction.Completeblo dcount(CBC)doesnotdirectly measureliverfunction.p.333 Which antibiotics are often used for treating Lyme disease in its earlier stages? Selectallthat apply. Doxycycline Amoxicillin Cefotaxime Minocycline Ceftriaxone Rationale DoxycyclineandamoxicilinaretheantibioticsofchoicefortreatingLymediseaseinits earlier,uncomplicatedstage.MinocyclineisusedinthetreatmentofReiter'ssyndrome. Cefotaximeandceftriaxoneareusedinthelater,complicatedstagesofLymedisease. p.332 The nurse is teaching the patient about taking acitretin for psoriatic arthritis. Which statement indicates the bestunderstanding by the patient? "I will take acitretin daily with food." "I will take acitretin daily at bedtime." "I will take acitretin daily after I wake up." "I will take acitretin daily without food." Rationale Acitretinisanoralretinoidthatshouldbetakendailywithameal.Thereisnospecific timeofdaywhenacitretinmustbetaken,aslongasitistakenwithameal.Acitretin shouldnotbetakenwithoutfo d.p.333 The nurse is teaching a patient with arthritis about energy conservation. Which statement made by the patient indicates the need for further teaching? "I will take one or two naps each day." "I will stick to my activity tolerance level." "I will delegate responsibilities and tasks to my family members and friends." "I will determine which activities are most important and save them for last." Rationale Energyconservationisimportantintheself-managementofarthritis.Thepatientshould beinstructedtodeterminewhichactivitiesaremostimportantanddothem first,notlast. Setingprioritiesisnecessarysothepatientdoesnotover-exert.Thiscanbedoneby balancingactivitywithrest,whichisbestdonebytakingoneortwonapseachday. Energyconservationisalsoachievedbyteachingthepatientolearnhisorheractivity tolerancelevelandnotexce dingitopreventexacerbations.Finaly,delegating responsibilitytofamilyandfriendshelpsconservethepatient'senergy,alowingforthe patientodoimportantactivities.p.324 The nurse is giving a presentation to a hiking club regarding self-management techniques for preventing Lyme disease. Which strategies are appropriatefor the nurse to include in the teaching? Selectallthatapply. Walking in the center of a hiking trail Disposing of a tick by burning it with a match Using tweezers to remove a tick from the skin Wearing light clothing when engaged in outdoor activities in wooded areas Avoiding areas with thick underbrush, especially in the spring and summer months Waiting 2-3 weeks after being bitten by a tick before being tested for Lyme disease Rationale Lymediseaseisspreadviainfectedde rticks;wearinglighter-coloredclothingmakesit easiertospotatick.Walkinginthecenterofahikingtrailreducestheriskof encounteringatick.Avoidingheavilywo dedareasorareaswiththickunderbrush reducestheriskforencounteringticks,especialyinthespringandsummermonths whenticksaremoreprevalent.Disposingofatickbyburningitcouldspreadinfection; instead,disposeofthetickbyflushingitdownthetoilet.Folowingatickbite,an individualshouldwait4-6we ksbeforebeingtestedforLymedisease,astestingbefore thistimeisnotreliable.Ticksshouldbegentlyremovedfrom theskinwithtwezersor withfingerscoveredwithtissueorgloves. p.333 Which medication would be beneficial to the patient with fibromyalgia syndrome who develops nerve pain? Tramadol Pregabalin Amitriptyline Nortriptyline Rationale Pregabalinisanantidepressantdrugap rovedfortreatingnervepaininpatientswith fibromyalgiasyndrome.Itactsbyincreasingthereleaseofserotoninandnorepinephrine inthebrain.Tramadolisanopioidanalgesicusedfortreatingpain,butnotspecificaly nervepain,associatedwithfibromyalgiasyndrome.Amitriptylineandnortriptylineare tricyclicantidepressantsthathelpinreducingpainandmusclespasms. p.333 The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed? "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease." "It is best to walk in the center of the trail." "I should wait 4-6 weeks after being bitten by a tick to be tested for Lyme disease." "I'll wear light-colored clothes with long sleeves, long pants, closed shoes, and a hat when I am walking in the woods." Rationale BurningaLymedisease-carryingtickcouldspreadinfection,soflushingitdownthe toiletistherecommendeddisposalmethod;thisstatementindicatesthatfurther instructionisne ded.Walkinginthecenterofthetrailisaprotectivemeasureagainst Lymedisease.Ifbiten,testingisnotreliableuntil4-6we kslater.Wearinglight-colored clothes,longpants,longsleves,closedshoes,andhatareap ropriateskinprotection measuresagainstLymedisease.p.332 Which diseases are associated with arthritis? Selectallthatapply. Tuberculosis Crohn's disease Diabetes mellitus Hyperparathyroidism Congestive heart failure Chronic obstructive pulmonary disease Rationale Thediseasesthatarerelatedtoarthritisaretuberculosis,Crohn'sdisease,diabetes melitus,andhyperparathyroidism.Congestiveheartfailureandchronicobstructive pulmonarydiseasearenotassociatedwitharthritis.p.333 The nurse is caring for a patient who is diagnosed with psoriatic arthritis. Which medication does the nurse anticipate will be included in the patient's pharmacologic plan of care? Alefacept Indomethacin Imatinib mesylate Nilotinib Rationale Alefacept is an IV immunosuppressive drug (T-cell blocker) that is reserved for moderate to severe disease. Indomethacin is an NSAID that is prescribed in combination with colchicine for acute gout. New oral tyrosine kinase inhibitors (TKIs), including nilotinib and imatinib mesylate, are being tested for use for patients with systemic sclerosis. p.333 A patient is diagnosed with polymyalgia rheumatica and given high-dose steroid therapy to achieve remission of the disease. Which statement made by the nursing student regarding the patient's disease needs correction by the precepting nurse? "This therapy causes proximal muscle weakness." "This disorder is an autoimmune, genetic-based disease." "This disease mostly affects middle-aged and older women." "This is a complex syndrome associated with the HLA-27 allele." Rationale Weaknessintheshoulder,neck,pelvis,andhip,orstiffness,jointaches,low-grade fever,fatigue,andweightlosscausedbyinflammationaresymptomsofpolymyalgia rheumatica.High-dosesteroidtherapymaybeusedtoachieveremissionofthedisease. Polymyalgiarheumaticacausesproximalmuscleweakness;itisanautoimmune, genetic-baseddiseaseandaffectsmid le-agedandolderwomenmostoften.Reiter syndrome,notpolymyalgiarheumatica,isacomplexsyndromeassociatedwiththe HLA-27alele. p.334 The nurse is providing discharge instructions to a patient who underwent total hip arthroplasty. Which instruction is mostbeneficial upon discharge of the patient? Twist the body slowly while standing. Bend the hips no more than 110 degrees. Cross the legs beyond the body midline. Use assistive devices for putting on shoes. Rationale Thepatientshouldbeinstructedtouseassistivedevicestoputonshoesandsocksto avoidfaling.Thepatientshouldnotwisthebodyatalwhenstanding.Thepatient shouldnotbendthehipsmorethan90degre stoavoidinjury.Thepatientshouldbe instructednotocrossthelegsbeyondthemidlineofthebodytopreventblo dclot formationathesurgicalsite.p.312 The nurse is teaching a patient who likes going camping about Lyme disease. Which patient statements indicate effective learning? Selectallthatapply. "I'll check my pets for ticks." "I'll burn any tick as soon as I find it." "I'll avoid wearing dark-colored clothes." "I'll go for a test to check for Lyme disease within two weeks after being bitten by a tick." "I'll report to the primary health care provider if I see any rash or redness around a bitten area." Rationale Lymediseaseisaninfectiousilnesscausedbythebiteofade rtickcarryingthe causativeorganism.Petsshouldbecheckedforticksregularly.Wearinglight-colored clotheshelpsrevealtickseasily.Telingtheprimaryhealthcareprovideraboutanyrash se naroundabitenareaaidsinearlymanagementofthedisease.Theremaining statementsrequirefurtherteaching.Burningthetickmayincreasetheriskofspreading infection,sothepatientshouldflushthetickinsteadofburningit.Afterbeingbitenbya tick,thepatientshouldgetestedforLymediseaseafterfourtosixwe ks;beforethat, theinfectioncan otbedetected. p.333 A patient is diagnosed with systemic necrotizing vasculitis. Which assessment finding will the patient demonstrate? Severe muscle weakness Necrosis of toes Difficulty swallowing Periorbital edema Rationale Systemicnecrotizingvasculitisisassociatedwithseverepainandnecrosisoftoesand fingers.Severemuscleweakness,difficultyswalowing,andperiorbitaledemaare manifestationsofpolymyositis/dermatomyositis.p.334 The nurse is providing discharge instructions to a patient with chronic back pain, compromised respiratory function, visual disturbances, joint pain and aching, malaise, and weight loss. Which order in the patient's plan of care would the nurse question? Send to physical therapy Prescription for ibuprofen Prescription for allopurinol Teach deep breathing exercises Rationale Alopurinolisusedforpatientswithchronicgoutopromoteuricacidexcretion. Treatmentforankylosingspondylitisincludesphysicalandocupationaltherapyto maintainfunctionandminimizedeformity.Adailyexerciseprogram helpsreduce stiffness,strengthenthemusclesaroundthejoints,andpreventorminimizetheriskof disability.De pbreathingexercisesmayhelpke pthechestcageflexible.Drugtherapy includesNSAIDs,suchasibuprofen,andDMARDs,suchasmethotrexateandbiologic responsemodifiers.pp.331-332 Which statement by the nurse is the mosteffective when communicating with a patient who was just been diagnosed with fibromyalgia after waiting for over 10 years for a diagnosis? "You must be so happy to finally have a diagnosis." "Now that you finally have a diagnosis, things will be easier." "Tell me what you are feeling after finally getting a diagnosis." "If I were you, I would be so thankful that you finally got a diagnosis." Rationale Patientswithfibromyalgiaandchronicfatiguesyndromeareoftenfrustratedbecause theyhavenotbe ndiagnosedorhavebe nmisdiagnosed.Whenthenursesays,"Tel mewhatyouarefe lingafterfinalygetingadiagnosis,"itisatherapeuticresponse thatgivesthepatientheop ortunitytosharefre lyonasubject.Non-therapeutic responsessuchas,"Youmustbesohapytofinalyhaveadiagnosis"limitreflectionby thepatientandimplyane dforpatientstohavethenurse'ssup ortandap roval.The nurseisgivingfalsereassurancewhensaying,"Nowthatyoufinalyhaveadiagnosis thingswilbeeasier,"whichdiscountsthepatient'sfe lingsandcutsoffconversation aboutlegitimateconcernsofthepatient.Thenurseisgivingadvicewhensaying,"IfI wereyou,Iwouldbesothankfulthatyoufinalygotadiagnosis,"whichtendstolimithe patient'sabilitytoexplorealternativesolutionstoissuesthatne dtobefaced. pp.333- 334 What can lead to organ dysfunction or failure? Reiter's syndrome Marfan syndrome Polymyalgia rheumatica Systemic necrotizing vasculitis Rationale Systemicnecrotizingvasculitisisagroupofautoimmunediseasesthatresultinarteritis (inflammationofarterialwals),causingischemiainthetissuesororgansthatare sup liedbythearteries.Itcanaffectperipheralarterialdiseasecausingseverepainand necrosisoftoesorfingersorcancauseorgandysfunctionorfailure,suchaskidneyor heartfailure;itcanalsocausestroke-likesymptoms.Reiter'ssyndrome,Marfan syndrome,andpolymyalgiarheumaticdonotcauseorganfailure. p.334 When caring for a patient who takes methotrexate, which laboratory data is mostimportant for the nurse to monitor? Glucose Potassium Complete blood count (CBC) White blood cells (WBCs) Rationale DecreasingWBCsandplatelets(asaresultofbonemarrowsup ression)shouldbe monitoredinpatientstakingmethotrexate;aCBCprovidesdataonredblo dcels, hemoglobin,hematocrit,platelets,andwhiteblo dcelcount.Glucoseandpotassium arenotaffectedbymethotrexate. p.322 What could be the diagnosis of a patient with a headache, slurred speech, and weakness of the left upper limb who has arrived at the hospital? Polymyositis Ankylosing spondylitis Polymyalgia rheumatica Systemic necrotizing vasculitis Rationale Headache,slurredspe ch,andweaknessofleftup erlimbarethesymptomsofstroke. Thesemayocurinsystemicnecrotizingvasculitis.Systemicnecrotizingvasculitisisa groupofautoimmunediseases,anditmayleadtomultipleorgandysfunctionand strokes.Polymyositisisanautoimmuneinflammatorydiseasethatcausessymmetric muscleatrophy.Ankylosingspondylitisisanautoimmuneinflammatorydiseasethat affectsthespine.Polymyalgiarheumaticaisanautoimmune,geneticdiseasethat causesproximalmuscleweakness.p.334 The nurse is teaching a patient with arthritis about exercise. Which statement by the patient indicates that further teaching is needed? "I will exercise only on good days." "I will do the exercises prescribed for me." "I will do active exercises whenever possible." "I will do my exercises in addition to my normal activities." Rationale Exercisesshouldbeconsistentlydoneonbothgo ddaysandbaddaystomaintainor increasemobilityandreducepain.Thepatientshouldfolowtheexercisesspecificaly prescribedbythehealthcareprovider.Activeexercises,ratherthanactive-assistor passiveexercises,aredonewheneverpossibleasthisenhancesself-este m.Patients ne dtobetaughtnotosubstitutenormalactivitiesorhouseholdtasksforthe prescribedexercisestomaintainindependenceaswelasincreasemobilityandreduce pain.pp.317,324 The nurse is teaching a patient about Lyme disease prevention. Which statement made by the patient indicates that further teaching is needed? "I will dispose of the tick by burning it." "I will wear closed shoes or boots and a hat or cap." "I will bathe immediately after being in an infested area and inspect my body for ticks." "After removing a tick, I will clean the tick area with an antiseptic such as rubbing alcohol." Rationale Lymediseaseisspreadbyticks.Ticksshouldbedisposedofbyflushingthem downthe toilet;burningatickcouldspreadinfection.OtherprecautionstopreventgetingLyme diseaseincludewearingclosedshoesorbotsandahatorcaptoke ptheticksoffthe skin;bathingimmediatelyafterbeinginaninfestedareaandinspectingthebodyfor ticks;andafteremovingthetick,cleaningthetickareawithanantisepticsuchas rub ingalcohol. p.333 The nurse just completed discharge teaching to a patient with polymyositis/dermatomyositis. Which statement made by the patient indicates the bestunderstanding of self-management related to this disorder? Selectallthatapply. "I will watch for signs and symptoms of infection such as fever, sore throat, and congestion." "If swallowing becomes difficult, I will need to see a speech therapist." "I may need a physical therapist to teach me exercises to improve my strength and flexibility." "I will need to include nonpharmacologic strategies to manage chronic back pain." "I may experience pain due to periods of rapid bone growth." Rationale Toprovideself-managementforpolymyositis/dermatomyositis,thepatientmustbeable toverbalizewhathesignsandsymptomsareforinfectionsuchasfever,sorethroat, andcongestion.Thepatientmustse aspe chtherapistolearnhowtocompensate withthechangesthatocurwithdifficultyswalowing.Toimprovestrengthandflexibility, physicaltherapywilbene ded.Neitherchronicbackpainnorperiodsofrapidbone growtharecommonlyassociatedwithpolymyositis/dermatomyositis.p.334 A patient has joint inflammation. Which interventions should the nurse add to the discharge plan of care? Selectallthatapply. Apply ice packs Apply heat packs Ensure adequate rest Begin a running program Perform daily stretching exercises Rationale Adequaterest,properpositioning,andiceandheatap licationsareimportantinpain management.Ifacuteinflammationispresent,icepacksmaybeap liedto"hot"joints forpainreliefuntiltheinflammationlessens.Theicepackshouldnotbeto heavy.At home,thepatientcanuseasmalbagofrozenpeasorcornasanicepack.Daily stretchingexercisesandgentlelow-impactexerciseslikewalkingandswimming(not run ing)helpimprovesymptoms. pp.308 Which statements made by the patient with Lyme disease indicate ineffective learning about self- management techniques? Selectallthatapply. "I will burn the tick as soon as I find it." "I will inspect for ticks after being in an infested area." "I will wear closed shoes or boots when going into heavily wooded areas." "I will go for a test to check for Lyme disease within 2 weeks after being bitten by a tick." "I will report to the primary health care provider if any rash or redness is seen in the bitten area." Rationale Burningthetickmightincreasetheriskofspreadinginfection.So,insteadofburningthe tick,itisrecommendedtoflushit.Afterbeingbitenbyatick,goforatestodetect Lymediseaseafter4to6we ks,becausebeforethatheinfectioncan otbedetected. Inspectingfortheticksafterbeinginaninfestedareahelpspreventickbites.Wearing closedshoesorbo tswhengoingintoheavilywo dedareasalsohelpspreventick bites.Reportingtotheprimaryhealthcareproviderifanyrashisse ninthebitenarea isrecommendedbecauseitmayhelpinearlyidentificationofthedisease. p.333 The nurse is teaching a patient about strategies for coping effectively with connective tissue disease. Which statement by the patient indicates that further teaching is needed? Selectall thatapply. "I will seek support from my friends and family." "I will use ice on my joints whenever I have pain." "I will see my health care provider on a weekly basis." "I will eat a balanced diet and get exercise as my health allows." "I will find out as much as I can about my connective tissue disease." Rationale Whenthepatienthasjointpain,heatisthebestmethodtodecreasepain,notice.The exceptionisifthereisanacuteinjury,iceshouldbeusedforthefirst24hours.The patientshouldse thehealthcareproviderathefrequencyordered,whichisoften every3monthsunlessthereisanexacerbationorthepatient'shealthstatus deterioratestowarrantmorefrequentvisits.Socialsup ortfrom friendsandfamilyhelps thepatientocopewiththestressofmixedcon ectivetissuedisease;thehealthcare providershouldalsoprovideinformationaboutlocalsup ortgroups.Ke pingthebody healthywithdietandexercisemakesiteasiertodealwiththestressoflivingwitha chronicilnessandbeterpreparesthepatientocopewiththenextexacerbation.The patientfindingoutasmuchaspossibleabouthediseasemakesiteasiertounderstand what'shap eningtohisbody.p.323 A patient reports burning and gnawing pain in the back of the neck, upper chest, trunk, low back, and extremities. The patient also experiences mild to severe fatigue and sleep disturbances. Which other symptoms may be seen in such patients? Selectallthatapply. Numbness or tingling in the extremities Multiple joint pain with redness or swelling Neurologic problems such as forgetfulness Substantial impairment in short-term memory Postexertional malaise lasting more than 24 hours Rationale Burningandgnawingpaininthebackoftheneck,up erchest,trunk,lowback,and extremities;mild-to-severefatigue;andsle pdisturbancesaresymptomsoffibromyalgia syndrome(FMS).Suchpatientsreportnumbnessortinglingintheirextremities.They mayalsohaveneurologicproblemssuchasforgetfulness.Multiplejointpainwith rednessorsweling,substantialimpairmentinshort-term memory,postexertional malaiselastingmorethan24hoursaresymptomsofchronicfatiguesyndrome(CFS). p.333 The nurse is teaching a patient about how to decrease recurrences of fibromyalgia. Which statement by the patient indicates that further teaching is needed? "I will try to avoid my triggers." "I will rest whenever I have pain." "I will establish a regular sleep pattern." "I will find healthy ways to cope with stress." Rationale Individualswithfibromyalgiamustexerciseregularly,notstrictlywhentheyexperience pain.Homeexerciseshouldincludestretching,strengthening,andlow-impactaerobic exercise.Walking,swimming,rowing,biking,andwaterexercisearego dexamplesof low-impactexercise.Patientsshouldbetaughtoavoidorlimitexposuretotrigersor stressors,toestablisharegularsle ppatern,andtoreducestressbyfindinghealthy waystocopewithstress. pp.333-334 The nurse has just provided teaching to a patient who is taking methotrexate. Which side effects does the patient identify to indicate effective teaching? Selectallthatapply. Fever Dyspnea Dysphagia Mouth sores Constipation Yellow sclera Patientstakingmethotrexateareatriskforinfectionwithafeverasasymptom.Patients shouldbeinstructedtoavoidalcoholicbeverageswhiletakingMTXtopreventliver toxicitywithyelowscleraasasymptom.Patientsshouldalsobetaughtoobserveand reportothersideandtoxiceffects,includingmouthsoresandacutedyspneafrom pneumonitis.ConstipationanddysphagiaarenotsideeffectsofMTX.p.322 Which medication would the nurse expect to be prescribed for the patient with Lyme disease? Allopurinol Amoxicillin Colchicine Ustekinumab Rationale Antibiotictherapy,suchasdoxycyclineoramoxicilin,isprescribedduringthe uncomplicatedstageofLymediseasefor14to21days.Alopurinolandcolchicineare bothdrugsusedtotreatgout.Ustekinumabtargetsthecytokinesinterleukin(IL)-12and IL-23todecreaseinflammationandisusedtotreatpsoriaticarthritis. p.332 What are the clinical manifestations of temporal arteritis? Selectallthatapply. Fever Stiffness Headache Weight loss Visual disturbances Rationale Temporalarteritisiscommonlyknownasgiantcellarteritisandisse nin20% of patientswithpolymyalgiarheumatic(PMR).Theclinicalmanifestationsoftemporal arteritisareheadacheandvisualdisturbances.Feverandweightlossaresystemic manifestationsoftemporalarteritis.Stiffnessisamyalgicmanifestationofthediseaseif thepatientalsohasPMR.p.334 What are the stage II complications of Lyme disease? Selectallthatapply. Meningitis Dysrhythmias Facial paralysis Chronic fatigue Memory problems Meningitis,dysrhythmias,andfacialparalysisarestage Icomplications,orearly disseminatedcomplications,ofLymedisease.TheseocurifLymediseaseisnot treatedorifthetreatmentisnotsucesful2-12we ksafterthetickbite.Chronicfatigue andmemoryproblemsarestage Icomplicationsthatocurmonthstoyearsafterthe tickbiteifthediseaseisnotreated.p.332 [Show More]

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