CH. 39 TEST Q'S RA, SYSTEMIC LUPUS,
ERYTHEMATOSOUS, SCLERODERMIA,
OA, DEGENERATIVE JOINT DZ,
FIBROMYALGIA, GOUT QUESTIONS
WITH COMPLETE ANSWERS
A ccpatient ccis ccsuspected ccof cchaving ccrheumatoid ccarthritis ccand ccher ccdiagnostic
ccregimen ccincludes ccaspiration ccof ccsynovial ccfluid ccfrom ccthe ccknee ccfor cca
ccdefinitive ccdiagnosis. ccThe ccnurse ccknows ccthat ccwhich ccof ccthe ccfollowing
ccprocedures ccwill ccbe ccinvolved?
A)
Angiography
B)
Myelography
C)
Paracentesis
D)
Arthocentesis cc- ccAnswer ccAnswer: ccD
cc
Arthrocentesis ccinvolves ccneedle ccaspiration ccof ccsynovial ccfluid. ccAngiography ccis
ccan ccx-ray ccstudy ccof cccirculation ccwith cca cccontrast ccagent ccinjected ccinto cca
ccselected ccartery. ccMyelography ccis ccan ccx-ray ccof ccthe ccspinal ccsubarachnoid
ccspace cctaken ccafter ccthe ccinjection ccof cca cccontrast ccagent ccinto ccthe ccspinal
ccsubarachnoid ccspace ccthrough cca cclumbar ccpuncture. ccParacentesis ccis ccremoval
ccof ccfluid cc(ascites) ccfrom ccthe ccperitoneal cccavity ccthrough cca ccsmall ccsurgical
ccincision ccor ccpuncture ccmade ccthrough ccthe ccabdominal ccwall ccunder ccsterile
ccconditions.
,A ccnurse ccis ccproviding cccare ccfor cca ccpatient ccwho cchas ccjust ccbeen ccdiagnosed ccas
ccbeing ccin ccthe ccearly ccstage ccof ccrheumatoid ccarthritis. ccThe ccnurse ccshould
ccanticipate ccthe ccadministration ccof ccwhich ccof ccthe ccfollowing?
A)
Hydromorphone cc(Dilaudid)
B)
Methotrexate cc(Rheumatrex)
C)
Allopurinol cc(Zyloprim)
D)
Prednisone cc- ccAnswer ccAnswer: ccB
cc
In ccthe ccpast, cca ccstep-wise ccapproach ccstarting ccwith ccNSAIDs ccwas ccstandard ccof
cccare. ccHowever, ccevidence ccclearly ccdocumenting ccthe ccbenefits ccof ccearly ccDMARD
cc(methotrexate cc[Rheumatrex], ccantimalarials, ccleflunomide cc[Arava], ccor
ccsulfasalazine cc[Azulfidine]) cctreatment cchas ccchanged ccnational ccguidelines ccfor
ccmanagement. ccNow ccit ccis ccrecommended ccthat cctreatment ccwith ccthe ccnon-biologic
ccDMARDs ccbegin ccwithin cc3 ccmonths ccof ccdisease cconset. ccAllopurinol ccis ccused ccto
cctreat ccgout. ccOpioids ccare ccnot ccindicated ccin ccearly ccRA. ccPrednisone ccis ccused ccin
ccunremitting ccRA.
A ccnurse ccis ccperforming ccthe ccinitial ccassessment ccof cca ccpatient ccwho cchas cca
ccrecent ccdiagnosis ccof ccsystemic cclupus ccerythematosus cc(SLE). ccWhat ccskin
ccmanifestation ccwould ccthe ccnurse ccexpect ccto ccobserve ccon ccinspection?
A)
Petechiae
B)
Butterfly ccrash
C)
Jaundice
D)
Skin ccsloughing cc- ccAnswer ccAnswer: ccB
An ccacute cccutaneous cclesion ccconsisting ccof cca ccbutterfly-shaped ccrash ccacross ccthe
ccbridge ccof ccthe ccnose ccand cccheeks ccoccurs ccin ccSLE. ccPetechiae ccare ccpinpoint
ccskin cchemorrhages, ccwhich ccare ccnot cca ccclinical ccmanifestation ccof ccSLE. ccPatients
ccwith ccSLE ccdo ccnot cctypically ccexperience ccjaundice ccor ccskin ccsloughing.
, A ccclinic ccnurse ccis cccaring ccfor cca ccpatient ccwith ccsuspected ccgout. ccWhile
ccexplaining ccthe ccpathophysiology ccof ccgout ccto ccthe ccpatient, ccthe ccnurse ccshould
ccdescribe ccwhich ccof ccthe ccfollowing?
A)
Autoimmune ccprocesses ccin ccthe ccjoints
B)
Chronic ccmetabolic ccacidosis
C)
Increased ccuric ccacid cclevels
D)
Unstable ccserum cccalcium cclevels cc- ccAnswer ccAnswer: ccC
Gout ccis cccaused ccby cchyperuricemia cc(increased ccserum ccuric ccacid). ccGout ccis ccnot
cccategorized ccas ccan ccautoimmune ccdisease ccand ccit ccdoes ccnot ccresult ccfrom
ccmetabolic ccacidosis ccor ccunstable ccserum cccalcium cclevels.
A ccnurse ccis ccplanning ccthe cccare ccof cca ccpatient ccwho cchas cca cclong cchistory ccof
ccchronic ccpain, ccwhich cchas cconly ccrecently ccbeen ccdiagnosed ccas ccfibromyalgia.
ccWhat ccnursing ccdiagnosis ccis ccmost cclikely ccto ccapply ccto ccthis ccwoman's cccare
ccneeds?
A)
Ineffective ccRole ccPerformance ccRelated ccto ccPain
B)
Risk ccfor ccImpaired ccSkin ccIntegrity ccRelated ccto ccMyalgia
C)
Risk ccfor ccInfection ccRelated ccto ccTissue ccAlterations
D)
Unilateral ccNeglect ccRelated ccto ccNeuropathic ccPain cc- ccAnswer ccAnswer: ccA
Typically, ccpatients ccwith ccfibromyalgia cchave ccendured cctheir ccsymptoms ccfor cca
cclong ccperiod ccof cctime. ccThe ccneuropathic ccpain ccaccompanying ccFM cccan ccoften
ccimpair cca ccpatient's ccability ccto ccperform ccnormal ccroles ccand ccfunctions. ccSkin
ccintegrity ccis ccunaffected ccand ccthe ccdisease cchas ccno ccassociated ccinfection ccrisk.
ccActivity cclimitations ccmay ccresult ccin ccneglect, ccbut ccnot ccof cca ccunilateral ccnature.
A ccpatient's ccdecreased ccmobility ccis ccultimately ccthe ccresult ccof ccan ccautoimmune
ccreaction ccoriginating ccin ccthe ccsynovial cctissue, ccwhich cccaused ccthe ccformation ccof
ccpannus. ccThis ccpatient cchas ccbeen ccdiagnosed ccwith ccwhat cchealth ccproblem?
ERYTHEMATOSOUS, SCLERODERMIA,
OA, DEGENERATIVE JOINT DZ,
FIBROMYALGIA, GOUT QUESTIONS
WITH COMPLETE ANSWERS
A ccpatient ccis ccsuspected ccof cchaving ccrheumatoid ccarthritis ccand ccher ccdiagnostic
ccregimen ccincludes ccaspiration ccof ccsynovial ccfluid ccfrom ccthe ccknee ccfor cca
ccdefinitive ccdiagnosis. ccThe ccnurse ccknows ccthat ccwhich ccof ccthe ccfollowing
ccprocedures ccwill ccbe ccinvolved?
A)
Angiography
B)
Myelography
C)
Paracentesis
D)
Arthocentesis cc- ccAnswer ccAnswer: ccD
cc
Arthrocentesis ccinvolves ccneedle ccaspiration ccof ccsynovial ccfluid. ccAngiography ccis
ccan ccx-ray ccstudy ccof cccirculation ccwith cca cccontrast ccagent ccinjected ccinto cca
ccselected ccartery. ccMyelography ccis ccan ccx-ray ccof ccthe ccspinal ccsubarachnoid
ccspace cctaken ccafter ccthe ccinjection ccof cca cccontrast ccagent ccinto ccthe ccspinal
ccsubarachnoid ccspace ccthrough cca cclumbar ccpuncture. ccParacentesis ccis ccremoval
ccof ccfluid cc(ascites) ccfrom ccthe ccperitoneal cccavity ccthrough cca ccsmall ccsurgical
ccincision ccor ccpuncture ccmade ccthrough ccthe ccabdominal ccwall ccunder ccsterile
ccconditions.
,A ccnurse ccis ccproviding cccare ccfor cca ccpatient ccwho cchas ccjust ccbeen ccdiagnosed ccas
ccbeing ccin ccthe ccearly ccstage ccof ccrheumatoid ccarthritis. ccThe ccnurse ccshould
ccanticipate ccthe ccadministration ccof ccwhich ccof ccthe ccfollowing?
A)
Hydromorphone cc(Dilaudid)
B)
Methotrexate cc(Rheumatrex)
C)
Allopurinol cc(Zyloprim)
D)
Prednisone cc- ccAnswer ccAnswer: ccB
cc
In ccthe ccpast, cca ccstep-wise ccapproach ccstarting ccwith ccNSAIDs ccwas ccstandard ccof
cccare. ccHowever, ccevidence ccclearly ccdocumenting ccthe ccbenefits ccof ccearly ccDMARD
cc(methotrexate cc[Rheumatrex], ccantimalarials, ccleflunomide cc[Arava], ccor
ccsulfasalazine cc[Azulfidine]) cctreatment cchas ccchanged ccnational ccguidelines ccfor
ccmanagement. ccNow ccit ccis ccrecommended ccthat cctreatment ccwith ccthe ccnon-biologic
ccDMARDs ccbegin ccwithin cc3 ccmonths ccof ccdisease cconset. ccAllopurinol ccis ccused ccto
cctreat ccgout. ccOpioids ccare ccnot ccindicated ccin ccearly ccRA. ccPrednisone ccis ccused ccin
ccunremitting ccRA.
A ccnurse ccis ccperforming ccthe ccinitial ccassessment ccof cca ccpatient ccwho cchas cca
ccrecent ccdiagnosis ccof ccsystemic cclupus ccerythematosus cc(SLE). ccWhat ccskin
ccmanifestation ccwould ccthe ccnurse ccexpect ccto ccobserve ccon ccinspection?
A)
Petechiae
B)
Butterfly ccrash
C)
Jaundice
D)
Skin ccsloughing cc- ccAnswer ccAnswer: ccB
An ccacute cccutaneous cclesion ccconsisting ccof cca ccbutterfly-shaped ccrash ccacross ccthe
ccbridge ccof ccthe ccnose ccand cccheeks ccoccurs ccin ccSLE. ccPetechiae ccare ccpinpoint
ccskin cchemorrhages, ccwhich ccare ccnot cca ccclinical ccmanifestation ccof ccSLE. ccPatients
ccwith ccSLE ccdo ccnot cctypically ccexperience ccjaundice ccor ccskin ccsloughing.
, A ccclinic ccnurse ccis cccaring ccfor cca ccpatient ccwith ccsuspected ccgout. ccWhile
ccexplaining ccthe ccpathophysiology ccof ccgout ccto ccthe ccpatient, ccthe ccnurse ccshould
ccdescribe ccwhich ccof ccthe ccfollowing?
A)
Autoimmune ccprocesses ccin ccthe ccjoints
B)
Chronic ccmetabolic ccacidosis
C)
Increased ccuric ccacid cclevels
D)
Unstable ccserum cccalcium cclevels cc- ccAnswer ccAnswer: ccC
Gout ccis cccaused ccby cchyperuricemia cc(increased ccserum ccuric ccacid). ccGout ccis ccnot
cccategorized ccas ccan ccautoimmune ccdisease ccand ccit ccdoes ccnot ccresult ccfrom
ccmetabolic ccacidosis ccor ccunstable ccserum cccalcium cclevels.
A ccnurse ccis ccplanning ccthe cccare ccof cca ccpatient ccwho cchas cca cclong cchistory ccof
ccchronic ccpain, ccwhich cchas cconly ccrecently ccbeen ccdiagnosed ccas ccfibromyalgia.
ccWhat ccnursing ccdiagnosis ccis ccmost cclikely ccto ccapply ccto ccthis ccwoman's cccare
ccneeds?
A)
Ineffective ccRole ccPerformance ccRelated ccto ccPain
B)
Risk ccfor ccImpaired ccSkin ccIntegrity ccRelated ccto ccMyalgia
C)
Risk ccfor ccInfection ccRelated ccto ccTissue ccAlterations
D)
Unilateral ccNeglect ccRelated ccto ccNeuropathic ccPain cc- ccAnswer ccAnswer: ccA
Typically, ccpatients ccwith ccfibromyalgia cchave ccendured cctheir ccsymptoms ccfor cca
cclong ccperiod ccof cctime. ccThe ccneuropathic ccpain ccaccompanying ccFM cccan ccoften
ccimpair cca ccpatient's ccability ccto ccperform ccnormal ccroles ccand ccfunctions. ccSkin
ccintegrity ccis ccunaffected ccand ccthe ccdisease cchas ccno ccassociated ccinfection ccrisk.
ccActivity cclimitations ccmay ccresult ccin ccneglect, ccbut ccnot ccof cca ccunilateral ccnature.
A ccpatient's ccdecreased ccmobility ccis ccultimately ccthe ccresult ccof ccan ccautoimmune
ccreaction ccoriginating ccin ccthe ccsynovial cctissue, ccwhich cccaused ccthe ccformation ccof
ccpannus. ccThis ccpatient cchas ccbeen ccdiagnosed ccwith ccwhat cchealth ccproblem?
