Chapter 67: Nursing Management: Arthritis and Connective Tissue Diseases
Lewis: Medical-Surgical Nursing In Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. Which of the following findings should the nurse expect when assessing an older-adult
client who has osteoarthritis (OA) of the left knee?
a. Heberden nodules
b. Pain upon joint movement
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement
ANS: B
Initial symptoms of OA include pain with joint movement. Heberden nodules occur on the
fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA),
and stiffness in OA is worse right after the client rests and decreases with joint movement.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. Which of the following assessment findings about a client who has been using naproxen
for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health
care provider?
a. The client has dark-coloured stools.
b. The client’s pain has not improved.
c. The client is using capsaicin cream.
d. The client has gained 3 pounds over 3 weeks.
ANS: A
Dark-coloured stools may indicate that the client is experiencing gastrointestinal bleeding
caused by the naproxen. The information about the client’s ongoing pain and weight gain
also will be reported and may indicate a need for a different treatment or counselling about
avoiding weight gain, but these are not as large a concern as the possibility of
gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is teaching a client with osteoarthritis (OA) of the left hip and knee about how
to manage the OA. Which of the following client statements indicates a need for more
education?
a. “I can take glucosamine to help decrease my knee pain.”
b. “I will take 1 g of acetaminophen every 4 hours.”
c. “I will take a shower in the morning to help relieve stiffness.”
d. “I can use a cane to decrease the pressure and pain in my hip.”
ANS: B
No more than 4 g of acetaminophen should be taken daily to avoid liver toxicity. The other
client statements are correct and indicate good understanding of OA management.
, DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
4. The nurse is planning care for a client who has osteoarthritis. Which of the following
medications should the nurse anticipate being prescribed for the client?
a. Adalimumab
b. Prednisone
c. Capsaicin cream
d. Sulphasalazine
ANS: C
Capsaicin cream blocks the transmission of pain impulses and is helpful for some clients
in treating OA. The other medications would be used for clients with RA.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
5. A client who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes
that rheumatoid nodules are present on the client’s elbows. Which of the following actions
should the nurse take?
a. Draw blood for rheumatoid factor analysis.
b. Teach the client about injection of the nodule.
c. Assess the nodules for skin breakdown or infection.
d. Discuss the need for surgical removal of the nodule.
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.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. The nurse is caring for a client with a new diagnosis of rheumatoid arthritis. Which of the
following actions should the nurse include in the plan of care?
a. Instruct the client to purchase a soft mattress.
b. Teach client to use lukewarm water when bathing.
c. Suggest that the client take a nap in the afternoon.
d. Suggest exercise with light weights several times daily.
ANS: C
Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid
arthritis. Clients are taught to avoid stressing joints, to use warm baths to relieve stiffness,
and to use a firm mattress.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. The home health nurse is visiting a client who has rheumatoid arthritis (RA) and tells the
nurse about having chronically dry eyes. Which of the following actions by the nurse is
most appropriate?
a. Reassure the client that dry eyes are a common problem with RA.
Lewis: Medical-Surgical Nursing In Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. Which of the following findings should the nurse expect when assessing an older-adult
client who has osteoarthritis (OA) of the left knee?
a. Heberden nodules
b. Pain upon joint movement
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement
ANS: B
Initial symptoms of OA include pain with joint movement. Heberden nodules occur on the
fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA),
and stiffness in OA is worse right after the client rests and decreases with joint movement.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. Which of the following assessment findings about a client who has been using naproxen
for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health
care provider?
a. The client has dark-coloured stools.
b. The client’s pain has not improved.
c. The client is using capsaicin cream.
d. The client has gained 3 pounds over 3 weeks.
ANS: A
Dark-coloured stools may indicate that the client is experiencing gastrointestinal bleeding
caused by the naproxen. The information about the client’s ongoing pain and weight gain
also will be reported and may indicate a need for a different treatment or counselling about
avoiding weight gain, but these are not as large a concern as the possibility of
gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is teaching a client with osteoarthritis (OA) of the left hip and knee about how
to manage the OA. Which of the following client statements indicates a need for more
education?
a. “I can take glucosamine to help decrease my knee pain.”
b. “I will take 1 g of acetaminophen every 4 hours.”
c. “I will take a shower in the morning to help relieve stiffness.”
d. “I can use a cane to decrease the pressure and pain in my hip.”
ANS: B
No more than 4 g of acetaminophen should be taken daily to avoid liver toxicity. The other
client statements are correct and indicate good understanding of OA management.
, DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
4. The nurse is planning care for a client who has osteoarthritis. Which of the following
medications should the nurse anticipate being prescribed for the client?
a. Adalimumab
b. Prednisone
c. Capsaicin cream
d. Sulphasalazine
ANS: C
Capsaicin cream blocks the transmission of pain impulses and is helpful for some clients
in treating OA. The other medications would be used for clients with RA.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
5. A client who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes
that rheumatoid nodules are present on the client’s elbows. Which of the following actions
should the nurse take?
a. Draw blood for rheumatoid factor analysis.
b. Teach the client about injection of the nodule.
c. Assess the nodules for skin breakdown or infection.
d. Discuss the need for surgical removal of the nodule.
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.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. The nurse is caring for a client with a new diagnosis of rheumatoid arthritis. Which of the
following actions should the nurse include in the plan of care?
a. Instruct the client to purchase a soft mattress.
b. Teach client to use lukewarm water when bathing.
c. Suggest that the client take a nap in the afternoon.
d. Suggest exercise with light weights several times daily.
ANS: C
Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid
arthritis. Clients are taught to avoid stressing joints, to use warm baths to relieve stiffness,
and to use a firm mattress.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. The home health nurse is visiting a client who has rheumatoid arthritis (RA) and tells the
nurse about having chronically dry eyes. Which of the following actions by the nurse is
most appropriate?
a. Reassure the client that dry eyes are a common problem with RA.
