1. Which of the following
clinical manifestations Which of the following
should the healthcare
provider anticipate
observing in a patient
diagnosed with
rheumatoid arthritis
(RA)? Select all that
apply.
a) Bone spurs noted on
X-ray
b) Ulnar deviation
c) Decreased synovial
fluid
d) Low-grade fever
e) Increased C-
reactive protein
(CRP)
2. A patient with a history
of osteoarthritis (OA)
and repeated intra-
articular corticosteroid
injections is admitted to
the medical unit with
acute swelling of the left
knee. The patient
experiences pain on
active or passive
movement. The joint is
warm to the touch and
the patient has a low- 4. While assessing a client
grade fever. Which of
these additional
assessment findings
support a diagnosis of
septic arthritis? Select
all that apply.
a) Positive anti-CCP
antibody (CCP)
b) Cloudy synovial
fluid
c) Decreased serum
neutrophil count
d) Elevated 5. Which care plan item
erythrocyte
sedimentation rate
(ESR)
e) Positive serum
rheumatoid factor
(RF)
3. The healthcare provider
is teaching a patient
diagnosed with
rheumatoid arthritis (RA)
how to safely use heat
and cold therapy on
their affected joints.
will be included in the
teaching for this
patient? Select all that
apply.
a) Dry heat is prefered 6. The nurse knows
because it is more
effective than moist
heat.
b) Apply either heat or
cold to your joint for
30 - 60 minutes each
day.
c) If there is
swelling, use cold
first before
applying heat.
d) For best results,
apply your ice pack
directly to the skin of
the affected joint.
e) It is sometimes
helpful to use an
electric heating pad
during sleep.
f) Heat relaxes the
joints and helps
improve range of
motion.
recently diagnosed with
rheumatoid arthritis, the
nurse should focus the
assessment on the
severity of:
a) Deformed joints of
the hands
b) Early morning
stiffness
c) Limited motion of the
joints
d) Rheumatoid nodules
would be the lowest
priority for a client in
the active stages of
rheumatoid arthritis?
a) Maintaining
normal task
procedures
b) Preserving joint
function
c) Relieving pain
d) Preventing joint
deformity
additional teaching is
needed when the client
taking methotrexate
(Rheumatrex) makes
which statement?
a) My vitamins will
be fine to take
with my
medication.
b) I need to avoid
alcohol.
c) Brushing my teeth
after every meal is
recommended.
d) I will continue taking
my birth control pills
as prescribed.
7. A client with
osteoarthritis states that
her friend with
rheumatoid arthritis
takes steroid pills for his
condition, and asks why
she is not prescribed
these pills. Which of the
following would be the
best explanation by the
nurse?
a) Oral corticosteroids
can be used for
osteoarthritis
b) Osteoarthritis is
treated by using a
systemic effect
c) Osteoarthritis and
rheumatoid arthritis
are similar conditions
d) Intra-articular
corticosteroid
injections are used
to treat
osteoarthritis

8. When educating a client
with osteoarthritis about
using capsaicin (Zostrix)
cream, the nurse would
instruct the client to:
a) Wrap the site with a
bandage after applying
the cream
b) Store the cream above
the stove in the kitchen
c) Wash hands
immediately after
applying the cream
d) Keep the cream handy
for reducing the pain of
cuts and burns
1. Mr. Alcasid asks the nurse,
"What is osteoarthritis?"
Which response from the
nurse is correct?
a) your bones are inflamed
b) your weight bearing
joints are inflamed
c) you have inflammation
in your joints
d) there is shortening of
your long bones
2. Which of the following
guidelines should a nurse
include in the teaching
plan for a patient who has
osteoarthritis?
a) achieve ideal body
weight
b) increase daily calcium
intake to 1500 mg
c) maintain a high fiber
diet
d) sleep at least 10 hours
each day
Situation: Maco, a newly
registered nurse, works as a
private duty nurse of a 55 year
old female Canadian national
who has gout.
therapy should be advised by
3. Which of the following the nurse to:
nursing diagnoses is a priority
for a patient with gout? a) limit carbohydrates in the
diet
a) Pain b) take the medication on an
b) fatigue empty stomach
c) risk for infection c) avoid individuals who
d) risk for peripheral have infections
neurovascular dysfunction d) stop the medication when
symptoms have subsided
4. The nurse would instruct the
Situation: Karen, a 32 year old
patient which of the following
vendor, is admitted to the hospital
to minimize complications?
with diagnosis of Rheumatoid
Arthritis.
a) drinking a minimum of
3000 ml of fluid per day
9. Which type of exercise should
b) eating a minimum of 2500
the nurse recommend to Cindy?
calories per day
c) walking at least three miles
a) jogging
per day
b) swimming
d) resting at least three hours
c) bicycling
per day
d) skating
5. Foods allowed in the diet of
10. Before discharge, the nurse
gout patient include:
tells Karen that she should pace
her activities. An example of
a) cheese
pacing activities would be:
b) beef
c) sardines
a) doing all her household chores
d) liver
in the morning and resting in the
afternoon
6. The patient is placed on
b) taking a nap before going
allopurinol (Zyloprim) therapy.
shopping
To monitor effectiveness of the
c) hiring a helper to do the
therapy, the nurse will monitor
housework
which the following serum
laboratory values?
11. Which type of medication is
most commonly used to treat
a) uric acid
rheumatoid arthritis?
b) fasting blood glucose
c) serum calcium
a) glucocorticoids
d) alkaline phosphatase
b) non-steroidal ant-
inflammatory drugs (NSAIDs)
c) antimalarial drugs
d) gold salts
7. A patient with rheumatoid
12. Which assessment findings
arthritis asks the nurse why
should the nurse expect for Karen?
she is taking Prednisone
(Deltasone) the nurse best
a) an asymmetrical pattern of
response would be that it:
affected joints
b) a positive rheumatoid factor
a) enhance the immune
titer
system
c) the presence of Herberden's
b) increase bone density
nodes
c) decrease inflammation
d) a positive antinuclear antibody
d) reduce peripheral edema
titer
8. A patient under steroid
13. The nurse discussed to Karen
the nature of RA. Which of the
following statements by indicate a
correct understanding of disease
process?
a) the nodules under my skin
behind my forehead is part of
RA
b) I have to be careful because my
bones have become brittle
c) I have been working very hard
lifting heavy things while selling in
the market
d) my disease is a normal aspect
of my aging
20. Which of the following will
contribute to the development
of primary gout?
a) beer and wine
b) eggs and milk
c) vegetables and meat
d) butter and fruits
21. Which of the following nursing
interventions will best help
alleviate the discomfort of the
patient with rheumatoid arthritis?
a) walking a mile each morning
b) active range-of-motion
exercises of joints
c) application of hot or cold
packs on the joints
d) splinting the joint during waking
hours
29. Which of the following is the
primary reason for splinting the
hands and wrists of client
with rheumatoid arthritis?
a) to improve the strength of the
hands and wrists
b) to prevent contractures
c) to relieve muscle spasm
d) to relieve pain
39. Which non-pharmacologic
intervention should the nurse
include in the care plan for a
patient who has
moderate rheumatoid arthritis?
a) massaging inflamed joints
b) avoiding range of motion
c) selecting clothing that have
Velcro fasteners
d) using assistive devices at meal
times
42. A nurse has conducted
preoperative teaching for a client
scheduled for surgery in 1 week.
The client has a history of arthritis
and has been taking acetylsalicylic
acid (aspirin). The nurse
determines that the client needs
additional teaching if the client
states:
a) aspirin can cause bleeding after
surgery
b) aspirin can cause my ability to
clot blood to abnormal
c) I need to discontinue the aspirin
48 hours before the scheduled
surgery
d) I need to continue to take
aspirin until the day of surgery
On a visit to the clinic, a
client reports the onset of
early symptoms of
rheumatoid arthritis. The
nurse should conduct a
focused assessment for:
1. Limited motion of joints.
2. Deformed joints of the
hands.
3. Early morning
stiffness.
4. Rheumatoid nodules.
2. A client with rheumatoid
arthritis states, "I can't do
my household chores
without becoming tired. My
knees hurt whenever I
walk." Which nursing
diagnosis would be most
appropriate?
1. Activity intolerance
related to fatigue and
pain.
2. Self-care deficit related
to increasing joint pain.
3. Ineffective coping related
to chronic pain.
4. Disturbed body image
related to fatigue and joint
pain.
A client is in the acute
phase of rheumatoid
arthritis. Which of the
following should the nurse
identify as lowest priority in
the plan of care?
1. Relieving pain.
2. Preserving joint function.
3. Maintaining usual
ways of accomplishing
tasks.
4. Preventing joint
deformity.
The nurse teaches a client
about heat and cold
treatments to manage
arthritis pain. Which of the
following client statements
indicates that the client still
has a knowledge deficit?
1. "I can use heat and cold
as often as I want."
2. "With heat, I should
apply it for no longer than
20 minutes at a time."
3. "Heat-producing
liniments can be used
with other heat
devices."
4. "Ten to 15 minutes per
application is the maximum
time for cold applications."
The client with rheumatoid
arthritis tells the nurse, "I
have a friend who took gold
shots and had a wonderful
response. Why didn't my
physician let me try that?"
Which of the following
responses by the nurse
would be most appropriate?
1. "It's the physician's
prerogative to decide how
to treat you. The physician
has chosen what is best for
your situation."
2. "Tell me more about your
friend's arthritic condition.
Maybe I can answer that
question for you."
3. "That drug is used for
cases that are worse than
yours. It wouldn't help you,
so don't worry about it."
4. "Every person is
different. What works
for one client may not
always be effective for
another."
The teaching plan for the
client with rheumatoid
arthritis includes rest
promotion. Which of the
following would the nurse
expect to instruct the client
to avoid during rest
periods?
1. Proper body alignment.
2. Elevating the part.
3. Prone lying positions.
4. Positions of flexion.
After teaching the client
with rheumatoid arthritis
about measures to
conserve energy in
activities of daily living
involving the small joints,
which of the following, if
stated by the client, would
indicate the need for
additional teaching? 1.
Pushing with palms when
rising from a chair.
2. Holding packages close
to the body.
3. Sliding objects.
4. Carrying a laundry
basket with clinched
fingers and fists.
After teaching the client
with severe rheumatoid
arthritis about prescribed
methotrexate
(Rheumatrex), which of the
following statements
indicates the need for
further teaching?
1. "I will take my
vitamins while I'm on
this drug."
2. "I must not drink any
alcohol while I'm taking this
drug." 3. "I should brush my
teeth after every meal."
4. "I will continue taking my
birth control pills."
A 25-year-old client taking
hydroxychloroquine
(Plaquenil) for rheumatoid
arthritis reports difficulty
seeing out of her left eye.
Correct interpretation of
this assessment finding
indicates which of the
following?
1. Development of a
cataract.
2. Possible retinal
degeneration.
3. Part of the disease
process.
4. A coincidental
occurrence.
A client with rheumatoid
arthritis tells the nurse, "I
know it is important to
exercise my joints so that I
won't lose mobility, but my
joints are so stiff and
painful that exercising is
difficult." Which of the
following responses by the
nurse would be most
appropriate?
1. "You are probably
exercising too much.
Decrease your exercise to
every other day."
2. "Tell the physician about
your symptoms. Maybe
your analgesic medication
can be increased."
3. "Stiffness and pain are
part of the disease. Learn to
cope by focusing on
activities you enjoy."
4. "Take a warm tub bath
or shower before
exercising. This may
help with your
discomfort."
Which of the following
statements should the
nurse include in the
teaching session when
preparing a client for
arthrocentesis? Select all
that apply.
1. "A local anesthetic
agent may be injected
into the joint site for
your comfort."
2. "A syringe and needle
will be used to withdraw
fluid from your joint."
3. "The procedure, although
not painful, will provide
immediate relief."
4. "We'll want you to keep
your joint active after the
procedure to increase blood
flow."
5. "You will need to wear
a compression bandage
for several days after
the procedure."
A client with osteoarthritis
will undergo an
arthrocentesis on his
painful edematous knee.
What should be included in
the nursing plan of care?
Select all that apply.
1. Explain the
procedure.
2. Administer preoperative
medication 1 hour before
surgery.
3. Instruct the client to
immobilize the knee for 2
days after the surgery.
4. Assess the site for
bleeding.
5. Offer pain medication.
A postmenopausal client is
scheduled for a bone-
density scan. To plan for the
client's test, what should
the nurse communicate to
the client?
1. Request that the
client remove all metal
objects on the day of the
scan.
2. Instruct the client to
consume foods and
beverages with a high
content of calcium for 2
days before the test.
3. Inform the client that she
will need to ingest 600 mg
of calcium gluconate by
mouth for 2 weeks before
the test.
4. Tell the client that she
should report any
significant pain to her
physician at least 2 days
before the test.
A physician orders a
lengthy X-ray examination
for a client with
osteoarthritis. Which of the
following actions by the
nurse would demonstrate
client advocacy?
1. Contact the X-ray
department and ask the
technician if the lengthy
session can be divided
into shorter sessions.
2. Contact the physician to
determine if an alternative
examination could be
scheduled.
3. Provide a dose of
acetaminophen (Tylenol).
4. Cancel the examination
because of the hard X-ray
table.
Which of the following
should the nurse assess
when completing the
history and physical
examination of a client
diagnosed with
osteoarthritis?
1. Anemia.
2. Osteoporosis.
3. Weight loss.
4. Local joint pain.
A client with osteoporosis
needs education about diet
and ways to increase bone
density. Which of the
following should be
included in the teaching
plan? Select all that apply.
1. Maintain a diet with
adequate amounts of
vitamin D, as found in
fortified milk and
cereals.
2. Choose good calcium
sources, such as figs,
broccoli, and almonds.
3. Use alcohol in
moderation because a
moderate intake has no
known negative effects.
4. Try swimming as a good
exercise to maintain bone
mass. 5. Avoid the use of
high-fat foods, such as
avocados, salad dressings,
and fried foods.
Which of the following
statements indicates that
the client with osteoarthritis
understands the effects of
capsaicin (Zostrix) cream?
1. "I always wash my
hands right after I apply
the cream."
2. "After I apply the cream, I
wrap my knee with an
elastic bandage."
3. "I keep the cream in the
cabinet above the stove in
the kitchen."
4. "I also use the same
cream when I get a cut or a
burn."
At which of the following
times should the nurse
instruct the client to take
ibuprofen (Motrin),
prescribed for left hip pain
secondary to osteoarthritis,
to minimize gastric mucosal
irritation?
1. At bedtime.
2. On arising.
3. Immediately after a
meal.
4. On an empty stomach.
The client diagnosed with
osteoarthritis states, "My
friend takes steroid pills for
her rheumatoid arthritis.
Why don't I take steroids for
my osteoarthritis?" Which
of the following is the best
explanation?
1. Intra-articular
corticosteroid injections
are used to treat
osteoarthritis.
2. Oral corticosteroids can
be used in osteoarthritis.
3. A systemic effect is
needed in osteoarthritis.
4. Rheumatoid arthritis and
osteoarthritis are two
similar diseases.
After teaching a group of
clients with osteoarthritis
about using regular
exercise, which of the
following client statements
indicates effective
teaching?
1. "Performing range-of-
motion exercises will
increase my joint mobility."
2. "Exercise helps to
drive synovial fluid
through the cartilage."
3. "Joint swelling should
determine when to stop
exercising."
4. "Exercising in the
outdoors year-round
promotes joint relaxation."
1. The client diagnosed with
OA is a resident in a long
term care facility. The
resident is refusing to bathe
because she is hurting.
Which instruction should
the nurse give the
unlicensed nursing
assistant?
a. Allow the client to stay in
bed until the pain becomes
bearable
b. Tell the assistant to give
the client a bed bath this
morning
c. Try to encourage the
client to get up and go
to the shower
d. Notify the family that the
client is refusing to be
bathed
2. The client has been
diagnosed with OA for the
last 7 years and has tried
multiple medical
treatments and alternative
treatments but still has
significant joint pain. Which
psychosocial client problem
would the nurse identify?
a. Severe pain
b. Body-image disturbance
c. Knowledge deficit
d. Depression
. Which member of the
health care team should the
nurse refer the client
diagnosed with OA who is
complaining of not being
able to get in and out of the
bathtub?
a. Physiatrist
b. Social worker
c. Physical therapist
d. Counselor
4. The occupational health
nurse is teaching a class on
the risk factors for
developing OA. Which is a
modifiable risk for
developing OA?
a. Being overweight
b. Increasing age
c. Previous joint damage
d. Genetic susceptibility
5. The client is diagnosed
with osteoarthritis. Which
sign/symptom would the
nurse expect the client to
exhibit?
a. Severe bone deformity
b. Joint stiffness
c. Waddling gait
d. Swan neck fingers
6. Which client goal would
be most appropriate for a
client diagnosed with OA?
a. Perform passive range-of-
motion exercises
b. Maintain optimal
functional ability
c. Client will walk three
miles a day
d. Client will join a health
club
7. The client is complaining
of joint stiffness, especially
in the morning. Which
diagnostic tests would the
nurse expect the HCP to
order to R/O OA?
a. Full body MRI scan
b. Serum studies for
synovial fluid amount
c. X-ray of the affected
joints
d. Serum erythrocyte
sedimentation rate (ESR)
8. The client diagnosed with
OA is prescribed a NSAID.
Which instruction should
the nurse teach the client?
a. Take the medication on
an empty stomach
b. Make sure the client
tapers the medication when
discontinuing
c. Apply the medication
topically over the affected
joints
d. Notify the HCP if
vomiting blood
9. The HCP prescribes
glucosamine and
chondroitin for a client
diagnosed with OA. What is
the scientific rationale for
prescribing this medication?
a. It will help decrease the
inflammation in the joints
b. It improves tissue
function and may
decrease breakdown of
cartilage
c. It is a potent medication
that decreases the client's
joint pain
d. It increases the
production of synovial fluid
in the joint
10. The nurse is admitting
the client with OA to the
medical floor. Which
statement by the client
indicates a complementary
form of treatment for OA?
a. "I take medication every
two hours for my pain"
b. "I use a heating pad
when I go to bed at night"
c. "I wear a copper
bracelet to help with my
OA"
d. "I always wear my ankle
splints when I sleep"
11. The client diagnosed
with RA is receiving care
through a nurse practitioner
clinic. Which preventive
care should the nurse
include in the regularly
scheduled clinic visits?
a. Perform joint x-rays to
determine progression of
the disease
b. Send blood to the lab for
an erythrocyte
sedimentation rate (ESR)
c. Recommend the flu
and pneumonia vaccines
d. Assess the client for
increasing joint
involvement
12. The nurse is assessing a
client diagnosed with RA.
Which assessment findings
warrant immediate
intervention?
a. The client complains of
joint stiffness and the knees
feel warm to the touch
b. The client has
experienced one kg weight
loss and is very tired
c. The client requires a
heating pad applied to the
hips and back to sleep
d. The client is crying,
has a flat facial affect,
and refuses to speak to
the nurse
13. The client diagnosed
with RA has developed
swan-neck fingers. Which
referral would be the most
appropriate for the client?
a. Physical therapy
b. Occupational therapy
c. Psychiatric counselor
d. Home health nurse
14. Which client problem is
priority for a client
diagnosed with RA?
a. Activity intolerance
b. Fluid and Electrolyte
balance
c. Alteration in comfort
d. Excessive nutritional
intake
15. The nurse is caring for
clients on a medical floor.
Which client should the
nurse assess first?
a. The client diagnosed with
RA who is complaining of
pain at a "3" on a 1-10
scale
b. The client diagnosed with
Systemic Lupus
Erythematosus who has a
rash across the bridge of
the nose
c. The client diagnosed
with advanced RA who is
receiving antineoplastic
drugs IV
d. The client diagnosed with
scleroderma who has hard,
waxylike skin near the eyes
16. Which intervention has
the highest priority when
caring for a client
diagnosed with RA?
a. Encourage the client to
ventilate feelings about the
disease process
b. Discuss the effects of
disease on the client's
career and other life roles
c. Instruct the client to
perform most important
activities in the morning
d. Teach the client the
proper use of hot and
cold therapy to provide
pain relief
17. Which psychosocial
problem would be priority
for a client diagnosed with
RA?
a. Alteration in comfort
b. Ineffective coping
c. Anxiety
d. Altered body image
18. The client with RA has
nontender movable nodules
in subcutaneous tissue over
the elbows and shoulders.
Which statement is the best
explanation for the
nodules?
a. The nodules indicate a
rapidly progressive
destruction of the
affected tissue
b. The nodules are small
amounts of synovial fluid
that have become
crystallized
c. The nodules are lymph
nodes that have
proliferated to try to fight
the disease
d. The nodules present a
favorable prognosis and
mean the client is better
19. The client diagnosed
with RA who has been
prescribed Plaquenil, shows
marked improvement.
Which instruction regarding
the use of this medication
should the nurse teach?
a. Explain that the less
medication loses its efficacy
after a few months
b. Continue to have regular
eye exams while taking the
medication
c. Have yearly MRIs to
follow the progress
d. Discuss that the drug is
taken for 3 weeks and then
stopped for a week
20. 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?
a. "Are you sexually
active, and if so, are you
using birth control?"
b. "Have you discussed
taking these drugs with
your parents?"
c. "Which arm do you prefer
to have an IV in for 4
days?"
d. "Have you signed an
informed consent for
investigational drugs?"
21. The client with early-
stage RA is being
discharged from the
outpatient clinic. Which
discharge instructions
should the nurse teach
regarding the use of
NSAIDs?
a. Take an over-the-counter
medication for the stomach
b. Drink a full glass of water
with each pill
c. If a dose is missed,
double the medication at
the next dosing time
d. Avoid taking the
NSAID on an empty
stomach
22. The nurse is preparing
to administer morning
medications. Which
medication should the
nurse administer first?
a. The pain medication
to a client diagnosed
with RA
b. The diuretic medication
to a client diagnosed with
Lupus (SLE)
c. The steroid to a client
diagnosed with
polymyositis
d. The appetite stimulant to
a client diagnosed with OA
23. The client recently
diagnosed with RA is
prescribed aspirin, an
NSAID medication. Which
comment by the client
would warrant immediate
intervention by the nurse
a. "I always take the aspirin
with food"
b. "If I have dark stools, I
will call my HCP"
c. "Aspirin will not cure my
arthritis"
d. "I am having some
ringing in my ears"
A client diagnosed with
rheumatoid arthritis (RA) is
prescribed prednisone.
Which client statement
indicates to the nurse that
medication teaching was
successful?
"I will take the specific
dose ordered at the same
time every day."
"I do not need to limit my
sodium intake."
"I will take the medication on
an empty stomach to
maximize absorption."
"I will not have to adjust my
insulin regimen."
"I will take the specific dose
ordered at the same time
every day."
The nurse, assessing a client
with suspected rheumatoid
arthritis (RA), would observe
which of the following joint
changes in the client?
Charcot's joints
Heberden's and Bouchard's
nodes
Swan-neck deformity and
ulnar deviation
Tophi
.
Which of the following should
the nurse provide when
explaining therapeutic
measures to a client
prescribed methotrexate
(Rheumatrix) for rheumatoid
arthritis (RA)?
Fluids are restricted to
prevent formation of edema
in the joints.
Drug doses will be
adjusted for optimum
effect at the lowest dose
once relief has been
established.
Six months of therapy will be
adequate to stop disease
progression.
Relief of symptoms will be
assessed within 1 week of
starting medication.
Medication instructions for a
client with rheumatoid
arthritis (RA) should include
which of the following
teaching points?
Penicillamine may be safely
used during pregnancy.
NSAIDS, acetaminophen,
and aspirin may be used
interchangeably to decrease
inflammation.
Injection of gold salts
requires monitoring for
anaphylactic shock every
half-hour.
Treatment with sulfasalazine
requires fluid restriction to
avoid nausea and vomiting.
The nurse, caring for a 10-
year-old client with
symptoms of juvenile
rheumatoid arthritis (JRA),
should include which of the
following when teaching the
family about the child's
illness?
The child will grow normally.
About 80% of children
experience a spontaneous
remission.
Symptoms are different for
children and adults.
The child will need
hospitalization.
The nurse, caring for a
middle-age adult client who
is employed in a stressful job
and newly diagnosed with
rheumatoid arthritis, would
select which of the following
nursing diagnoses for this
client? (Select all that apply.)
Caregiver Role Strain
Anxiety
Ineffective Coping
Risk for Disuse Syndrome
Risk for Confusion
Ineffective Coping
Which of the following
observations by the nurse
warrants further investigation
to determine if the client has
rheumatoid arthritis (RA)?
Complaints of pain with
movement
Negative family history
Complaints of prolonged
morning stiffness lasting
for 1 hour
Which of the following is a
major factor in the
susceptibility and severity of
rheumatoid arthritis (RA)?
Diabetes mellitus
Infectious agents
Frequent use of chemicals in
pools
Genetic predisposition
The focus of treatment for
rheumatoid arthritis is related
directly to joint damage that
is caused by:
Vasculitis.
Sjgren's syndrome.
Felty's syndrome.
Pannus.
Which nonpharmacologic
interventions should a nurse
include in the care plan for a
client who has moderate
rheumatoid arthritis? Select
all that apply.
massaging inflamed joints
avoiding range-of-motion
exercises
applying splints to
inflamed joints
using assistive devices at all
times
selecting clothing that has
hook-and-loop (Velcro)
fasteners
applying moist heat to
joints
Which of the following
instructions should be
included in the teaching for
the client with rheumatoid
arthritis?
a. Avoid exercise because it
fatigues the joints.
b. Take prescribed anti-
inflammatory medications
with meals.
c. Alternate hot and cold
packs to affected joints.
d. Avoid weight-bearing
activity.
When the first class of drugs
prescribed for rheumatoid
arthritis fails, the
nurse
anticipates which category of
drugs will be prescribed?
A.
Nonsteroidal anti-
inflammatory
B. Disease modifying
antirheumatic
C. Salicylates
D. Biologic response
modulators
D:
Disease modifying
antirheumatic drugs
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
2. send blood to the lab for
ESR
3. recommend the flu and
pneumonia
4. assess the client for
increasing joint involvement
The client with RA has
nontender, movable nodules
in the subcutaneous tissue
over the elbow and
shoulders. which statement
is the scientific rationale for
the nodules?
1. the nodules indicate a
rapidly progressive
destruction of affected
tissue
2. the nodules are small
amounts of synovial fluid that
have become crystallized
3. the nodules are lymph
nodes which have
proliferated to try to fight
infection
4. the nodules present
favorable prognosis and
mean the client is better
The nurse is assessing a
client diagnosed with RA.
which assessment findings
warrant immediate
intervention?
1. the client c/o joint stiffness
and knees feel warm to
touch
2. the client has experienced
1-kg weight loss and is very
tired
3. the client requires heat
pad applied to hips and back
to sleep
4. the client is crying, has
flat facial affect, and
refuses to speak to nurse
The client diagnosed with RA
who has been prescribed
entanercept, a tumor
necrosis factor alpha
inhibitor, shows marked
improvement. which
instructions regarding the
use of this medication should
the nurse teach?
1. explain med loses it
efficacy after a month
2. continue to have
checkup and lab work
while on med
3. have yearly magnetic
resonance imaging
4. discuss the drug is taken 3
weeks and then stopped for
a week
Prednisone (Deltasone) is
prescribed for a patient with
an acute exacerbation of
rheumatoid arthritis. When
the patient has a follow-up
visit 1 month later, the nurse
recognizes that the patient's
response to the treatment
may be best evaluated by
a. blood glucose testing.
b. liver function tests.
c. serum electrolyte levels.
d. C-reactive protein level.

When teaching a patient who
has rheumatoid arthritis (RA)
about how to manage
activities of daily living, the
nurse instructs the patient to
a. stand rather than sit when
performing household
chores.
b. avoid activities that
require continuous use of
the same muscles.
c. strengthen small hand
muscles by wringing
sponges or washcloths.
d. protect the knee joints by
sleeping with a small pillow
under the knees.
When helping a patient with
rheumatoid arthritis (RA)
plan a daily routine, the
nurse informs the patient that
it is most helpful to start the
day with
a. a warm bath followed by
a short rest.
b. a 10-minute routine of
isometric exercises.
c. stretching exercises to
relieve joint stiffness.
d. active range-of-motion
(ROM) exercises.
.A 35-year-old patient with
three school-age children
who has recently been
diagnosed with rheumatoid
arthritis (RA) tells the nurse
that the inability to be
involved in many family
activities is causing stress at
home. Which response by
the nurse is most
appropriate?"
a. "Your family may need
some help to understand the
impact of your rheumatoid
arthritis."
b. "You may need to see a
family therapist for some
help."
c. "Perhaps it would be
helpful for you and your
family to get involved in a
support group."
d. "Tell me more about the
situations that are causing
stress."
1) A 43-year-old woman,
recently diagnosed with RA,
asks the nurse whether she
might have concerns
beyond the problems with
her joints. The nurse
informs her that RA may
also involve:
Select all that apply.
A) The respiratory
system.
B) The cardiovascular
system.
C) The exocrine system.
D) The reproductive
system.
E) The hematologic
system.
2) A client has just recently
been diagnosed with
rheumatoid arthritis (RA).
The client asks the nurse if
RA always causes crippling
deformities. The nurse tells
the client that to decrease
the likelihood of
deformities, it is important
to:
Select all that apply.
A) Ignore pain as a warning
signal.
B) Type instead of hand-
writing items if possible.
C) Use stronger joints
for most activity.
D) Avoid stress to any
current area of
deformity.
E) Stop an activity if it is
beyond your ability to
perform.
3) A female client who was
recently diagnosed with
rheumatoid arthritis (RA)
asks the nurse if the cause
of the disease is the fact
that her family is of
Hispanic descent. Which is
the most appropriate
response by the nurse to
this client?
A) "RA affects those of
German descent most
often."
B) "RA is most prevalent in
Caucasian females."
C) "RA is most prevalent in
men under the age of 20
years."
D) "RA affects all races
at the same rate."
4) The nurse is collecting a
health history for a client
being seen in an outpatient
clinic. The client complains
of joint pain and swelling
that have lasted for about 2
months. The nurse devises
a plan of care based on the
nursing diagnosis of Activity
Intolerance based on which
client statement?
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."
5) 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) Swimming
B) Football
C) Softball
D) Basketball
6) A client with rheumatoid
arthritis is being seen in the
outpatient clinic for a
progress check-up. The
nurse is reviewing the
client's plan of care and
determines that the client
has met a goal of treatment
when the client makes
which statement?
A) "I sleep for 10 hours at
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 do not perform
household chores at all
anymore."
7) The nurse is caring for a
client who was diagnosed
with rheumatoid arthritis
last year. The client has
recently been placed on
prednisone for treatment.
The nurse is teaching the
client about safe
medication administration.
Which client statement
indicates that the
medication teaching was
successful?
A) "I will not have to limit
my consumption of canned
vegetables."
B) "I will take this
medication on a full
stomach to enhance
absorption."
C) "I will not need to
monitor my blood sugar
more frequently while on
this medication."
D) "I will take the
ordered dose at the
same time every day."
8) A nurse is caring for a
client who was admitted to
the hospital with an
exacerbation of rheumatoid
arthritis. The client states
that her pain is a 3 on a
scale from 1 to 10 today.
What non-pharmacological
interventions can the nurse
provide?
Select all that apply.
A) Discourage any position
changes.
B) Relaxation techniques
C) Immobilize the extremity.
D) Massage
E) Provide diversion
activities.
9) A nurse is caring for a
pregnant client who has
rheumatoid arthritis (RA).
The nurse understands that
this client may:
A) Be at higher risk for
preterm delivery.
B) Not stop medication for
RA, even if the client is in
remission.
C) Experience a relapse
during pregnancy, often
followed by a remission
after delivery.
D) Be anemic as a result
of blood loss from
salicylate therapy.
10) A nurse is caring for a
client who has been newly
diagnosed with rheumatoid
arthritis (RA). The client
asks the nurse what the
difference is between
rheumatoid arthritis and
osteoarthritis (OA). The
nurse's best response
includes:
Select all that apply.
A) "The onset of OA is
gradual while the onset
of RA may be rapid."
B) "With OA, multiple joints
are symmetrically affected;
RA affects one joint at a
time."
C) "The affected joints in RA
feel cold to the touch while
the joints affected by OA
are warm or hot to the
touch."
D) "OA is slowly
progressive while RA is
characterized by
exacerbations and
remissions."
E) "The pain and stiffness
with RA is with activity; OA
pain and stiffness is
predominant upon arising."
1. A nurse working in an
outpatient clinic is
assessing a client who has
rheumatoid arthritis (RA).
The client reports increased
joint tenderness and
swelling. Which of the
following findings should
the nurse expect? (Select
all that apply.)
A. Recent influenza
B. Decreased range of
motion
C. Hypersalivation
D. Increased blood pressure
E. Pain at rest
2. A nurse is teaching a
client who has a new
diagnosis of rheumatoid tests are used to diagnose
arthritis. Which of the this disease? (Select all that
following statements should apply.)
the nurse include in the
A. Urinalysis
teaching?
B. Erythrocyte
A. "You can experience
sedimentation rate
morning stiffness when
(ESR)
you get out bed."
C. BUN
B. "You can experience
abdominal pain." D. Antinuclear antibody
(ANA) titer
C."You can experience
weight gain." E. WBC count
D."You can experience low
blood sugar."
3. A nurse is caring for a
client who has rheumatoid
arthritis. Which of the
following laboratory