RA

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of
rheumatoid arthritis. The nurse should anticipate the administration of which of the following?

A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol (Zyloprim) D) Prednisone

A nurse is performing the health history and physical assessment of a patient who has a diagnosis
of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical
presentation of RA?
A) Cool joints with decreased range of motion B) Signs of systemic infection C) Joint stiffness,
especially in the morning D) Visible atrophy of the knee and shoulder joints

A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now
prescribed cyclophosphamide (Cytoxan) Immunosuppressants. The nurses subsequent
assessments should address what potential adverse effect?
A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia

A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the
patient should further assess the patient for the adverse effects of what medications? A)
Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy

A nurse is planning patient education for a patient being discharged home with a diagnosis of
rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows
to teach the patient to self-monitor for what adverse effect?
A) Tinnitus B) Visual changes C) Stomatitis D) Hirsutism

A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy.
What statement would indicate that the patient is experiencing adverse effects of this drug?
A) I have this ringing in my ears that just wont go away. B) I feel so foggy in the mornings and it takes me
so long to wake up. C) When I eat a meal thats high in fat, I get really nauseous. D) I seem to have lost
my appetite, which is unusual for me

A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line

treatments and the primary care provider has added prednisone to the patients drug
regimen. What principle will guide this aspect of the patients treatment? A) The patient
will need daily blood testing for the duration of treatment. B) The patient must stop all
other drugs 72 hours before starting prednisone. C) The drug should be used at the highest
dose the patient can tolerate. D) The drug should be used for as short a time as possible
 A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of
his right great toe and is eventually diagnosed with gout. When planning teaching for this
patient, what management technique should the nurse emphasize? A) Take OTC calcium
supplements consistently. B) Restrict consumption of foods high in purines. C) Ensure fluid
intake of at least 4 liters per day. D) Restrict weight-bearing on right

A nurses plan of care for a patient with rheumatoid arthritis includes several exercise-based
interventions. Exercises for patients with rheumatoid disorders should have which of the following
goals?
A) Maximize range of motion while minimizing exertion B) Increase joint size and strength C) Limit
energy output in order to preserve strength for healing D) Preserve and increase range of motion while
limiting joint stress

A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On
assessment the nurse notes that the patient appears to have lost some of her ability to
function since her last office visit. Which of the following is the most appropriate action?
A) Arrange a family meeting in order to explore assisted living options. B) Refer the patient
to a support group. C) Arrange for the patient to be assessed in her home environment. D)
Refer the patient to social work.

You are providing education to a patient, who was recently diagnosed with rheumatoid
arthritis, about physical exercise. Which statement made by the patient is correct?

A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my
routine, such as running and aerobics."
B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a
weekly regime of range of motion exercises along with walking and riding a stationary bike."
C. "It is important I perform range of motion exercises during joint flare-ups and
incorporate low-impact exercises into my daily routine."
D. "Physical exercise should be limited to only range of motion exercises to prevent further
joint damage."
The nurse is performing an assessment on a client who complains of joint pain and
stiffness. The client was admitted to the unit with a diagnosis of rheumatoid arthritis.
Which reported signs and symptoms from the client interview would NOT be consistent
with the clinical manifestations of rheumatoid arthritis?

a "I am in so much pain in the morning! It is very hard for me to get out of bed and start my
day. I can hardly move my legs; my knees feel like they are frozen."

b "Whenever my disease gets worse, my joints get red, hot and swollen."

c "I am just tired all the time, and feel very weak."

d "I have trouble with walking because of the pain, and when I am finally done with my
morning chores and sit down; my knees get so stiff I can hardly get up after I rested."

he nurse is caring for Ms. Ruiz, a client recently diagnosed with rheumatoid arthritis. Ms.
Ruiz is being seen by the primary care provider for a follow-up visit after a recent
hospitalization. The nurse prepares to assess Ms. Ruiz. Which clinical manifestation found
during the assessment process supports this client's diagnosis?

a Morning stiffness that lasts for thirty minutes

b Increased energy

c Weight gain over the last several months

d Low-grade fever

r. Rappaport has been diagnosed with rheumatoid arthritis. He tells you that he is having
trouble doing the prescribed physical therapy exercises because of stiffness. What
intervention could you suggest to Mr. Rappaport to help him follow the prescribed
physical therapy program?

a "Try exercising for several hours each day at the gym."

b "Wear light-weight clothing when you exercise."

c "Stop exercising for a few weeks."

d "Try doing your exercises in the shower."

A clinic nurse is assessing a client with a history of rheumatoid arthritis. The nurse would
anticipate which assessment finding?

a Progressive joint stiffness and deformation

b Intermittent joint pain, mostly in the great toe

c Joint stiffness in the spine, hips, and knees

d Multiple joints and organs affected, and may have high fever and rheumatoid rash

The nurse is caring for a pregnant client in the obstetrics clinic. The client has a history of
rheumatoid arthritis. Which statement by the client would require a follow up by the
nurse?

a "I need to schedule extra rest periods throughout the day."

b "When my joints hurt I can take an aspirin."

c "Now that I am in my second trimester, I actually feel good, and my joints are not hurting
either."

d "I might carry my baby longer than the normal 40 weeks for the pregnancy."

A client with rheumatoid arthritis is beginning to develop flexion

contractures of the knees. The nurse should tell the client to:
❍ A. Lie prone and let her feet hang over the mattress edge
❍ B. Lie supine, with her feet rotated inward
❍ C. Lie on her right side and point her toes downward
❍ D. Lie on her left side and allow her feet to remain in a
neutral position

Which early morning activity helps to reduce the symptoms associated

with rheumatoid arthritis?
❍ A. Brushing the teeth
❍ B. Drinking a glass of juice
❍ C. Holding a cup of coffee
❍ D. Brushing the hair

Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and
naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most
 important to communicate to the health care provider?
1. RA symptoms are worst in the morning
2. Dry eyes
3. Round and moveable nodules just under the skin
4. Dark-colored stools ( NASID)

You assess a 24-year-old patient with RA who is considering using methotrexate

(Rheumatrex) for treatment. Which patient information is most important to communicate
to the health care provider?
1. The patient has many concerns about the safety of the drug.
2. The patient has been trying to get pregnant.
3. The patient takes a daily multivitamin tablet.
4. The patient says that she has taken methotrexate in the past.

The nurse is completing a health screening for a school-age child with rheumatoid
arthritis. The parents ask the nurse to recommend activities that will promote exercise for
their child. Which is an appropriate recommendation by the nurse?

a Softball

b Basketball

c Swimming

d Football

Which of the following instructions should be included in the teaching for a client with
RA?
a. avoid exercise because it fatigues the joints
b. take prescribed anti-inflammatory meds with meals.
c. alternate hot and cold packs to affected joints
d. avoid weight bearing activity

client has been receiving Rheumatrex (methotrexate) for severe RA. The nurse should tell
the client to avoid:
a. aspirin
b. multivitamins
c. omega 3 fish oils
d. acetaminophen

b
methotrexate is a folic acid antagonist. multi vitamins contain folic acid
The nurse is caring for a client with RA. The nurse knows the clients early morning symptoms will be
most improved by:
a. taking a warm shower upon awakening
b. applying ice packs to the joints
c. taking two aspirin before going to bed
d. going for a early morning walk

A client with RA has Sjogrens syndrome. The nurse can relieve the symptoms of Sjogrens syndrome by:
a. providing heat to the joints
b. instilling eye drops
c. administering pain meds
d. providing small frequent meals

A client newly diagnosed with rheumatoid arthritis (RA) tells the nurse, "I understand that
RA affects my joints. Does it have any other effects on my body that I should know
about?" In response, which additional effect of RA should the nurse include?
A) Liver failure
B) Anemia
C) Stomach ulcers
D) Headaches

The nurse is collecting a health history for a client being seen in an outpatient clinic who
complains of joint pain and swelling that have lasted for about 2 months. The client is
diagnosed with RA. Which of the following statements made by this client supports the
nursing diagnosis of: Activity Intolerance?
A) "I seem to get tired early in the day and require a nap."
B) "My joints are stiffest at night before I go to sleep."
C) "I find it difficult to move when I first get up in the morning."
D) "I take ibuprofen for the pain as needed."

A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress
checkup. Which of the following statements on the part of the client suggests that she has
met a goal of treatment?
A) "I sleep for 10 hours a night."
B) "I have increased pain in my joints all the time now."
C) "I have delegated many household chores to my children and spouse."
D) "I don't perform household chores at all anymore.

The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care
should the nurse include in the regularly scheduled clinic visits?

1. Perform joint x-rays to determine progression of the disease.

2. Send blood to the lab for an erythrocyte sedimentation rate.
3. Recommend the flu and pneumonia vaccines.
4. Assess the client for increasing joint involvement
 The client diagnosed with RA who has been prescribed etanercept, a tumor necrosis
factor alpha inhibitor, shows marked improvement. Which instruction regarding the use
of this medication should the nurse teach?

1. Explain the medication loses its efficacy after a few months.

2. Continue to have checkups and lab work while taking the medication.
3. Have yearly magnetic resonance imaging to follow the progress.
4. Discuss the drug is taken for three (3) weeks and then stopped for a week.

The nurse is planning the care for a client diagnosed with RA. Which intervention should
be implemented?

1. Plan a strenuous exercise program.

2. Order a mechanical soft diet.
3. Maintain a keep-open IV.
4. Obtain an order for a sedative.

The 20-year-old female client diagnosed with advanced unremitting RA is being admitted
to receive a regimen of immunosuppressive medications. Which question should the
nurse ask during the admission process regarding the medications?

1. "Are you sexually active, and, if so, are you using birth control?"
2. "Have you discussed taking these drugs with your parents?"
3. "Which arm do you prefer to have an IV in for four (4) days?"
4. "Have you signed an informed consent for investigational drugs?"

The client recently diagnosed with RA is prescribed aspirin, an NSAID medication. Which
comment by the client would warrant immediate intervention by the nurse?

1. "I always take the aspirin with food"

2. "If I have dark stools, I will call my HCP"
3. "Aspirin will not cure my arthritis"
4. "I am having some ringing in my ears"

Which intervention has the highest priority when caring for a client diagnosed with RA?

1. Encourage the client to ventilate feelings about the disease process

2. Discuss the effects of disease on the client's career and other life roles
3. Instruct the client to perform most important activities in the morning
4. Teach the client the proper use of hot and cold therapy to provide pain relief