Lewis Medical Surgical Nursing Chap 69: Arthritis and Connective
Tissue Disorders
1. Which finding would the nurse expect when assessing a patient who has
osteoarthritis (OA) of the knee?
a. Presence of Heberden's nodules
b. Discomfort with 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's nodules occur on the fingers.
Redness of the joint is associated with inflammatory arthritis such as rheumatoid
arthritis. Stiffness in OA is worse right after the patient rests and decreases with
joint movement.
e. 2. The nurse is assessing a patient with osteoarthritis who uses naproxen
(Naprosyn) for pain management. Which assessment finding would the
nurse recognize as likely to require a change in medication? a. The patient
has gained 3 pounds.
b. The patient has dark-colored stools.
c. The patient's pain affects multiple joints.
d. The patient uses capsaicin cream (Zostrix).: ANS: B Dark-colored stools may
indicate the patient is experiencing gastrointestinal bleeding caused by the
naproxen. The patient's ongoing pain and weight gain will also be reported and
may indicate a need for a different treatment and/or counseling about avoiding
weight gain, but these are not as large a concern as the possibility of
gastrointestinal bleeding.
Capsaicin cream is often used along with oral medications.
3. The nurse teaches a patient with osteoarthritis (OA) of the hip about how to
manage the OA. Which patient statement a need for additional teaching? a. A
shower in the morning will help relieve stiffness.
b. I can exercise every day to help maintain joint mobility.
c. I will take 1 gram of acetaminophen (Tylenol) every 4 hours.
d. I can use a cane to decrease the pressure and pain in my hip joint.: ANS:
C No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily
to decrease the risk for liver damage. Regular exercise, moist heat, and
supportive equipment are recommended for OA management.
4. The nurse would anticipate the need to teach a patient who has
osteoarthritis (OA) about which medication? a. Prednisone
b. Adalimumab (Humira)
c. Capsaicin cream (Zostrix)
, Lewis Medical Surgical Nursing Chap 69: Arthritis and Connective
Tissue Disorders
d. Sulfasalazine (Azulfidine): ANS: C Capsaicin cream blocks the transmission of
pain impulses and is helpful for some patients in treating OA. The other
medications would be used for patients with rheumatoid arthritis.
5. A patient being seen in the clinic has rheumatoid nodules on the elbows.
Which action would 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.
6. Which action would the nurse include in the plan of care for a patient with
a new diagnosis of rheumatoid arthritis (RA)?
a. Instruct the patient to purchase a soft mattress.
b. Teach the patient to use cool water when bathing.
c. Encourage the patient to 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 associated with RA. Patients are taught
to avoid stressing joints, use warm baths to relieve stiffness, and use a firm
mattress. When the disease is stabilized, a physical therapist usually develops a
therapeutic exercise program that includes exercises that improve flexibility and
strength of affected joints, as well as the patient's general endurance
7. A patient with rheumatoid arthritis (RA) tells the clinic nurse about
having chronically dry eyes. Which action would the nurse take? a. Ask the
HCP about discontinuing methotrexate.
b. Suggest the patient use preservative free artificial tears.
c. Remind the patient that RA is a chronic health condition.
d. Teach the patient about adverse effects of the RA medications.: ANS: B The
patient's dry eyes are consistent with Sjögren's syndrome, a common
manifestation of RA. Symptomatic therapy such as artificial tears eyedrops is
recommended. Dry eyes are not a side effect of methotrexate. A focus on the
prognosis for RA is not helpful. The dry eyes are not caused by RA treatment but
by the disease itself.
8. Which information would the nurse include when teaching a patient who
has an exacerbation of rheumatoid arthritis?
Tissue Disorders
1. Which finding would the nurse expect when assessing a patient who has
osteoarthritis (OA) of the knee?
a. Presence of Heberden's nodules
b. Discomfort with 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's nodules occur on the fingers.
Redness of the joint is associated with inflammatory arthritis such as rheumatoid
arthritis. Stiffness in OA is worse right after the patient rests and decreases with
joint movement.
e. 2. The nurse is assessing a patient with osteoarthritis who uses naproxen
(Naprosyn) for pain management. Which assessment finding would the
nurse recognize as likely to require a change in medication? a. The patient
has gained 3 pounds.
b. The patient has dark-colored stools.
c. The patient's pain affects multiple joints.
d. The patient uses capsaicin cream (Zostrix).: ANS: B Dark-colored stools may
indicate the patient is experiencing gastrointestinal bleeding caused by the
naproxen. The patient's ongoing pain and weight gain will also be reported and
may indicate a need for a different treatment and/or counseling about avoiding
weight gain, but these are not as large a concern as the possibility of
gastrointestinal bleeding.
Capsaicin cream is often used along with oral medications.
3. The nurse teaches a patient with osteoarthritis (OA) of the hip about how to
manage the OA. Which patient statement a need for additional teaching? a. A
shower in the morning will help relieve stiffness.
b. I can exercise every day to help maintain joint mobility.
c. I will take 1 gram of acetaminophen (Tylenol) every 4 hours.
d. I can use a cane to decrease the pressure and pain in my hip joint.: ANS:
C No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily
to decrease the risk for liver damage. Regular exercise, moist heat, and
supportive equipment are recommended for OA management.
4. The nurse would anticipate the need to teach a patient who has
osteoarthritis (OA) about which medication? a. Prednisone
b. Adalimumab (Humira)
c. Capsaicin cream (Zostrix)
, Lewis Medical Surgical Nursing Chap 69: Arthritis and Connective
Tissue Disorders
d. Sulfasalazine (Azulfidine): ANS: C Capsaicin cream blocks the transmission of
pain impulses and is helpful for some patients in treating OA. The other
medications would be used for patients with rheumatoid arthritis.
5. A patient being seen in the clinic has rheumatoid nodules on the elbows.
Which action would 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.
6. Which action would the nurse include in the plan of care for a patient with
a new diagnosis of rheumatoid arthritis (RA)?
a. Instruct the patient to purchase a soft mattress.
b. Teach the patient to use cool water when bathing.
c. Encourage the patient to 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 associated with RA. Patients are taught
to avoid stressing joints, use warm baths to relieve stiffness, and use a firm
mattress. When the disease is stabilized, a physical therapist usually develops a
therapeutic exercise program that includes exercises that improve flexibility and
strength of affected joints, as well as the patient's general endurance
7. A patient with rheumatoid arthritis (RA) tells the clinic nurse about
having chronically dry eyes. Which action would the nurse take? a. Ask the
HCP about discontinuing methotrexate.
b. Suggest the patient use preservative free artificial tears.
c. Remind the patient that RA is a chronic health condition.
d. Teach the patient about adverse effects of the RA medications.: ANS: B The
patient's dry eyes are consistent with Sjögren's syndrome, a common
manifestation of RA. Symptomatic therapy such as artificial tears eyedrops is
recommended. Dry eyes are not a side effect of methotrexate. A focus on the
prognosis for RA is not helpful. The dry eyes are not caused by RA treatment but
by the disease itself.
8. Which information would the nurse include when teaching a patient who
has an exacerbation of rheumatoid arthritis?
