Chapter 065

Lewis: Medical-Surgical Nursing, 7th Edition
Test Bank
Chapter 65: Nursing Management: Arthritis and Connective Tissue Diseases
MULTIPLE CHOICE
1. A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse
would expect to be present on examination of the patient’s knee is
a. Heberden’s nodules.
b. redness and swelling of the knee joint.
c. pain upon joint movement.
d. stiffness that increases with movement.
Correct Answer: C
Rationale: Initial symptoms of OA include pain with joint movement. Heberden’s
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 patient rests and
decreases with joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694

Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening patients at a community center, the nurse will plan to teach ways to
reduce risk factors for osteoarthritis to a
a. 24-year-old man who participates in a summer softball team.
b. 36-year-old woman who is newly diagnosed with diabetes mellitus.
c. 49-year-old woman who works on an automotive assembly line.
d. 56-year-old man who is a member of a construction crew.
Correct Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at
menopause and in individuals whose work involves repetitive movements and lifting.
Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for
OA. Working on a construction crew would involve nonrepetitive work and thus would
not be as risky.
Cognitive Level: Application Text Reference: p. 1694

Nursing Process: Planning NCLEX: Physiological Integrity
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

3. The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient
with osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use
that the drug does not seem to be effective in controlling the pain. The nurse should
teach the patient that

Test Bank 65-3
a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated

because of variations in individual response to the drugs.
b. it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood.
c. if NSAIDs are not effective in controlling symptoms, corticosteroids are the next
drug of choice.
d. adding a twice-daily aspirin to the naproxen may improve the effectiveness of the
drug.
Correct Answer: A
Rationale: Individual responses to NSAIDs can vary, so the health care provider may
prescribe a different NSAID. Full effectiveness of NSAIDs occurs in 2 to 3 weeks.
Corticosteroids are usually reserved for use in RA. Patients are instructed to avoid aspirin
when taking NSAIDs because of the increased risk for bleeding and gastrointestinal
irritation.

Nursing Process: Implementation NCLEX: Physiological Integrity
4. When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar
vertebrae about management of the condition, the nurse determines that additional
instruction is needed when the patient says,
a. “I can use a cane if I find it helpful in relieving the pressure on my back and hip.”
b. “A warm shower in the morning will help relieve the stiffness I have when I get
up.”
c. “I should try to stay active throughout the day to keep my joints from becoming
stiff.”
d. “I should take no more than 1 g of acetaminophen four times a day to control the
pain.”
Correct Answer: C
Rationale: Protection and avoidance of joint stressors are recommended for patients with
OA, so this patient should alternate periods of rest with necessary activity. The other
patient statements indicate that teaching has been effective.
Cognitive Level: Application Text Reference: pp. 1696, 1701

Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance
5. A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and
feet. The patient tells the nurse, “I am afraid that I will be hopelessly crippled in just a
few years!” The best response by the nurse is that
a. progression of OA can be prevented with a regimen of exercise, diet, and drugs.
b. OA is an inflammatory process with periods of exacerbation and remission.
c. joint degeneration with pain and deformity occurs with OA by age 60 to 70.

Test Bank 65-4
d. OA is common with aging, but usually it is localized and does not cause deformity.
Correct Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although
exercise, diet, and drugs can help to decrease symptoms and slow disease progression,
they will not prevent progression of the disease. OA is progressive and does not have
exacerbations and remissions, which are typical of RA. Joint degeneration and pain occur
later in OA; joint deformity is not a common symptom.

6. A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to
teach the patient about the use of
a. prednisone (Deltasone).
b. capsaicin cream (Zostrix).
c. sulfasalazine (Azulfidine).
d. doxycycline (Vibramycin).
Correct Answer: B
Rationale: 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 RA.

7. A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse
teaches the patient that the most beneficial measure to protect the joints is to
a. use a wheelchair to avoid walking as much as possible.
b. sit in chairs that do not cause the hips to be lower than the knees.
c. use a walker for ambulation to relieve the pressure on the hips.
d. eat according to a weight-reduction diet to obtain a healthy body weight.
Correct Answer: D
Rationale: Because the patient’s major risk factor is obesity, the nurse should teach the
patient that weight loss is the best way to reduce stress on the hips. Avoiding activity by
sitting in a wheelchair would likely increase the patient’s weight; moderate activity is
recommended for patients with OA. Sitting with the hips higher than the knees and using
a walker would be recommended but are not as helpful as weight loss for this obese
patient.


Test Bank 65-5
8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old

woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health
history from the patient, the most important information for the nurse to communicate
to the health care provider is that the patient has
a. a history of infectious mononucleosis as a teenager.
b. a family history of age-related macular degeneration of the retina.
c. been trying to have a baby before her disease becomes more severe.
d. been using large doses of vitamins and health foods to treat the RA.
Correct Answer: C
Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives
during methotrexate therapy. The other information will not impact the choice of
methotrexate as therapy.

9. A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain
and inflammation of the fingers, wrists, and feet with swelling, redness, and limited
movement of the joints. When developing the plan of care, the nurse recognizes that
the most appropriate patient outcome at this time is to
a. maintain a positive self-image.
b. perform activities of daily living independently.
c. achieve satisfactory control of pain.
d. make a successful adjustment to disease progression.
Correct Answer: C
Rationale: The focus during an acute exacerbation of RA is to manage pain effectively.
The other outcomes are appropriate long-term outcomes.

Nursing Process: Planning
10. A home health patient with rheumatoid arthritis (RA) complains to the nurse about
having chronically dry eyes and a dry mouth. Which action by the nurse is most
appropriate?
a. Have the patient withhold the daily methotrexate (Rheumatrex) until talking with
the health care provider.
b. Reassure the patient that dry eyes and mouth are very common with RA.
c. Teach the patient to use an antiseptic mouth wash tid.
d. Suggest that the patient start using over-the-counter (OTC) artificial tears.

Test Bank 65-6
Correct Answer: D
Rationale: The patient’s dry eyes and oral mucous membranes are consistent with
Sjögren’s syndrome, a common extraarticular manifestation of RA. Symptomatic therapy
such as OTC eye drops is recommended. Dry eyes and mouth are not side effects of
methotrexate. Although dry eyes and mouth are common in RA, it is more helpful to offer
a suggestion to relieve these symptoms than to offer reassurance. Rinsing the mouth to
decrease oral dryness is appropriate, but the frequent use of antiseptic mouthwashes is not
appropriate unless the patient has oral symptoms that require this.

11. When teaching range-of-motion exercises to a patient who is having an acute

exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both hands,
the nurse teaches the patient that
a. affected joints should not be exercised when pain is present.
b. cold applications before exercise will decrease joint pain.
c. exercises should be performed passively by someone other than the patient.
d. regular walking may substitute for range-of-motion (ROM) exercises on some
days.
Correct Answer: B
Rationale: Cold application is helpful in reducing pain during periods of exacerbation of
RA. Because the joint pain is chronic, patients are instructed to exercise even when joints
are painful. ROM exercises are intended to strengthen joints as well as improve
flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged
but is not a replacement for ROM exercises.

12. 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.
Correct Answer: D
Rationale: C-reactive protein is a marker for inflammation, and a decrease would
indicate that the corticosteroid therapy was effective. Blood glucose and serum
electrolyte levels will also be monitored to check for side effects of prednisone. Liver
function is not routinely monitored for patients receiving steroids.

Test Bank 65-7
Cognitive Level: Application Text Reference: pp. 1698-1699

Nursing Process: Evaluation NCLEX: Physiological Integrity
13. 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.
Correct Answer: B
Rationale: Patients are advised to avoid repetitious movements. Sitting during household
chores is recommended to decrease stress on joints. Wringing water out of sponges would
increase the joint stress. Patients are encouraged to position joints in the extended
position, and sleeping with a pillow behind the knees would decrease the ability of the
knee to extend and also decrease knee ROM.

Nursing Process: Implementation
14. When the nurse is reviewing laboratory data for a patient who is taking methotrexate
(Rheumatrex), which information is most important to communicate to the health care
provider?
a. The platelet count is 130,000/ml.
b. The white blood cell count (WBC) is 1500/ml.
c. The blood glucose is 130 mg/dl.
d. The potassium is 5.2 mEq/L.
Correct Answer: B
Rationale: Bone marrow suppression is a possible side effect of methotrexate, and the
patient’s low WBC count places the patient at high risk for infection. The other laboratory
values are also abnormal but are not far from normal values and would not have any
immediate serious consequences.

15. 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.

Test Bank 65-8
c. stretching exercises to relieve joint stiffness.

d. active range-of-motion (ROM) exercises.
Correct Answer: A
Rationale: Taking a warm shower or bath is recommended to relieve joint stiffness,
which is worse in the morning. Isometric exercises would place stress on joints and
would not be recommended. Stretching and ROM should be done later in the day, when
joint stiffness is decreased.

16. The biologic agent anakinra (Kineret) is prescribed for a patient who has moderately
severe rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse
will include information about
a. symptoms of gastrointestinal (GI) irritation or bleeding.
b. self-administration of subcutaneous injections.
c. taking the medication with at least 8 oz of fluid.
d. avoiding concurrently taking aspirin or NSAIDs.
Correct Answer: B
Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not a side
effect of this medication. Because the medication is injected, instructions to take it with 8
oz of fluid would not be appropriate. The patient is likely to be concurrently taking
aspirin or NSAIDs and these should not be discontinued.
Cognitive Level: Application Text Reference: pp. 1700, 1705-1706

17. 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.”
Correct Answer: D
Rationale: The initial action by the nurse should be further assessment. The other three
responses might be appropriate based on the information the nurse obtains with further
assessment.

Test Bank 65-9

18. In teaching a patient with ankylosing spondylitis (AS) about the management of the
condition, the nurse instructs the patient to
a. sleep on the side with hips flexed.
b. take slow, long walks as a form of exercise.
c. perform daily deep-breathing exercises.
d. take frequent naps during the day.
Correct Answer: C
Rationale: Deep-breathing exercises are used to decrease the risk for pulmonary
complications that may occur with the reduced chest expansion that can occur with
ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions.
Prolonged standing and walking should be avoided. There is no need for frequent naps.

19. A patient who had arthroscopic surgery of the left knee 5 days previously is admitted
with a red, swollen, and hot-to-touch knee. Which of these assessment data obtained
by the nurse should be reported to the health care provider immediately?
a. The white blood cell count is 14,200/ml.
b. The patient rates the knee pain at 9 on a 10-point pain scale.
c. The patient has recently taken ibuprofen (Motrin).
d. The oral temperature is 104.1° F degrees.
Correct Answer: D
Rationale: The elevated temperature suggests that the patient may have an infection and
be in danger of developing septicemia as a complication of septic arthritis. Immediate
blood cultures and initiation of antibiotic therapy are indicated. The other information is
typical of septic arthritis and should also be reported to the health care provider, but it
does not indicate any immediately life-threatening problems.

20. A 22-year-old patient hospitalized with severe pain in the knees and a fever and
shaking chills is suspected of having septic arthritis. Information obtained during the
nursing history that indicates a risk factor for septic arthritis is that the patient
a. has a parent who has reactive arthritis.

Test Bank 65-10
b. recently returned from a trip to South America.

c. is sexually active and has multiple partners.
d. had several sports-related knee injuries as a teenager.
Correct Answer: C
Rationale: Neisseria gonorrhoeae is the most common cause for septic arthritis in
sexually active young adults. The other information does not point to any risk for septic
arthritis.

21. A concerned parent who lives in an area endemic for Lyme disease asks the nurse
what precautions should be taken for the disease. The nurse will teach the parent that
a. early treatment of the infection with antiviral agents can prevent the development
of cardiac and neurologic manifestations.
b. if Lyme disease is transmitted by a tick, symptoms of nausea, vomiting, and
diarrhea occur before the onset of joint pain.
c. transmission of the disease can be prevented by covering ticks attached to the skin
with oil to suffocate them.
d. an early sign of Lyme disease is a lesion at the bite site that increases in size and
has a red border and clear center.
Correct Answer: D
Rationale: Erythema migrans is the typical early lesion associated with a tick bite
causing Lyme disease. Treatment with antibiotics can prevent the later stages of Lyme
disease. The initial symptoms are headache, chills, stiff neck, fatigue, and joint and
muscle pain. Ticks should be removed with tweezers.

22. A patient is hospitalized with an acute attack of primary gout, which is affecting the
left great toe and ankle. The outcome that the nurse determines as most important is
that the patient
a. maintains a purine-free diet.
b. experiences no evidence of tophi.
c. expresses satisfactory pain relief.
d. has minimal functional loss in joints.
Correct Answer: C

Test Bank 65-11
Rationale: The priority patient outcome for an acute attack of gout is to control pain. A
low-purine diet would be encouraged, but a purine-free diet is not the most important
patient outcome during an acute attack. Lack of development of tophi and minimal
function loss are also long-term outcomes, but they are not as important as pain control
during an acute attack.

23. A patient with an acute attack of gout is treated with colchicine. The nurse determines
that the drug is effective upon finding
a. relief of joint pain.
b. increased urine output.
c. elevated serum uric acid.
d. decreased white blood cells (WBC).
Correct Answer: A
Rationale: Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation.
The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but
would not indicate the effectiveness of colchicine. Elevated uric acid levels would result
in increased symptoms. The WBC might decrease with decreased inflammation, but this
would not be as useful in determining the effectiveness of colchicine as a decrease in
pain.

24. A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the
condition. The nurse will need to monitor
a. blood pressure.
b. blood glucose.
c. erythrocyte count.
d. lymphocyte count.
Correct Answer: A
Rationale: Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It
does not affect blood glucose, red blood cell count (RBC), or lymphocytes.


Test Bank 65-12
25. A 26-year-old woman has been diagnosed with early systemic lupus erythematosus
(SLE) involving her joints. In teaching the patient about the disease, the nurse
includes the information that SLE is a(n)
a. hereditary disorder of women but usually does not show clinical symptoms unless
a woman becomes pregnant.
b. autoimmune disease of women in which antibodies are formed that destroy all
nucleated cells in the body.
c. disorder of immune function, but it is extremely variable in its course, and there is
no way to predict its progression.
d. disease that causes production of antibodies that bind with cellular estrogen
receptors, causing an inflammatory response.
Correct Answer: C
Rationale: SLE has an unpredictable course, even with appropriate treatment. Women
are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms
may worsen during pregnancy but are not confined to pregnancy or the perinatal period.
All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in
SLE is not caused by antibody binding to cellular estrogen receptors.
Cognitive Level: Comprehension Text Reference: pp. 1717, 1719

26. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is

hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria.
The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which
nursing action should be included in the plan of care?
a. Institute seizure precautions.
b. Reorient to time and place PRN.
c. Monitor intake and output.
d. Place on cardiac monitor.
Correct Answer: C
Rationale: Lupus nephritis is a common complication of SLE, and when the patient is
taking corticosteroids, it is especially important to monitor renal function. There is no
indication that the patient is experiencing any nervous system or cardiac problems with
the SLE.

27. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia
tells the nurse, “I hate the way I look! I never go anyplace except here to the health
clinic.” An appropriate nursing diagnosis for the patient is
a. activity intolerance related to fatigue and inactivity.

Test Bank 65-13
b. impaired skin integrity related to itching and skin sloughing.

c. social isolation related to embarrassment about the effects of SLE.
d. impaired social interaction related to lack of social skills.
Correct Answer: C
Rationale: The patient’s statement about not going anyplace because of hating the way
he or she looks supports the diagnosis of social isolation because of embarrassment about
the effects of the SLE. Activity intolerance is a possible problem for patients with SLE,
but the information about this patient does not support this as a diagnosis. The rash with
SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

Nursing Process: Diagnosis NCLEX: Psychosocial Integrity
28. A patient with polyarthralgia with joint swelling and pain is being evaluated for
systemic lupus erythematosus (SLE). The nurse knows that the serum test result that
is the most specific for SLE is the presence of
a. rheumatoid factor.
b. anti-Smith antibody (Anti-Sm).
c. antinuclear antibody (ANA).
d. lupus erythematosus (LE) cell prep.
Correct Answer: B
Rationale: The anti-Sm is antibody found almost exclusively in SLE. The other blood
tests are also used in screening but are not as specific to SLE.
Cognitive Level: Comprehension Text Reference: pp. 1718-1719

29. Following instruction for a patient with newly diagnosed systemic lupus
erythematosus (SLE), the nurse determines that teaching about the disease has been
effective when the patient says,
a. “I should expect to have a low fever all the time with this disease.”
b. “I need to restrict my exposure to sunlight to prevent an acute onset of symptoms.”
c. “I should try to ignore my symptoms as much as possible and have a positive
outlook.”
d. “I can expect a temporary improvement in my symptoms if I become pregnant.”
Correct Answer: B

Test Bank 65-14
Rationale: Sun exposure is associated with SLE exacerbation, and patients should use
sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00
PM. Low-grade fever may occur with an exacerbation but should not be expected all the
time. A positive attitude may decrease the incidence of SLE exacerbations, but patients
are taught to self-monitor for symptoms that might indicate changes in the disease
process. Symptoms may worsen during pregnancy and especially during the postpartum
period.

30. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus
erythematosus has a check-up before leaving home for college. The health care
provider writes all of these orders. Which one should the nurse question?
a. Naproxen (Aleve) 200 mg BID
b. Give measles-mumps-rubella (MMR) immunization
c. Draw anti-DNA titer
d. Famotidine (Pepcid) 20 mg daily
Correct Answer: B
Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking
immunosuppressive drugs. The other orders are appropriate for the patient.

Nursing Process: Implementation NCLEX: Psychosocial Integrity
31. A patient has systemic sclerosis manifested by the CREST syndrome. During
assessment of the patient, the nurse would expect to find
a. bony ankylosis of the small joints in the feet.
b. a recent history of significant weight gain.
c. burning, itching, and photosensitivity of the eyes.
d. a history of numbness and tingling in the fingers.
Correct Answer: D
Rationale: Raynaud’s phenomenon is one aspect of the CREST syndrome. Bony
ankylosis is not a symptom of systemic sclerosis, which does not affect bone. Weight loss
occurs with CREST syndrome as a result of esophageal scarring. Burning, itching, and
photosensitivity of the eyes are not associated with systemic sclerosis.


Test Bank 65-15
32. The nurse teaches a patient diagnosed with progressive systemic sclerosis about
health maintenance activities. The nurse determines that additional instruction is
needed when the patient says,
a. “I should lie down for an hour after meals.”
b. “Lotions will help if I rub them in for a long time.”
c. “I should perform range-of-motion exercises daily.”
d. “Paraffin baths can be used to help my hands.”
Correct Answer: A
Rationale: Because of the esophageal scarring, patients should sit up for 2 hours after
eating. The other patient statements are correct and indicate that the teaching has been
effective.

33. A patient hospitalized for IV corticosteroid therapy to treat polymyositis has joint
pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The
priority nursing diagnosis for the patient is
a. risk for aspiration related to dysphagia.
b. acute pain related to inflammation.
c. risk for impaired skin integrity related to scratching.
d. disturbed visual perception related to eyelid swelling.
Correct Answer: A
Rationale: The patient’s vocal weakness and hoarseness indicate weakness of the
pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses are also
appropriate but are not as high a priority as the maintenance of the patient’s airway.

Nursing Process: Diagnosis NCLEX: Physiological Integrity
34. A patient is hospitalized for onset of diffuse erythema of the upper body with
periorbital edema. The health care provider suspects dermatomyositis. In planning
care for the patient, the nurse anticipates that the collaborative care of the patient will
involve
a. instillation of artificial tears.
b. local steroid injections of skin lesions.
c. administration of high-dose corticosteroids.
d. electromyelographic (EMG) evaluation for meningeal inflammation.
Correct Answer: C

Test Bank 65-16
Rationale: Dermatomyositis is initially treated with high-dose steroids. Eye dryness is

not a manifestation of dermatomyositis and artificial tears are not routinely needed.
Topical corticosteroids may be used to treat the skin rash. EMG evaluation is done
because this disease involves muscle changes, not neurologic changes.

35. A patient with fibromyalgia syndrome (FMS) tells the nurse, “I don’t know why the
doctor has prescribed amitriptyline (Elavil) for me. I don’t feel depressed, just tired
and achy.” The most appropriate response by the nurse is, “The Elavil
a. is ordered to prevent depression from occurring.”
b. will improve the quality of your sleep at night.”
c. relaxes your muscles and helps prevent spasm.”
d. has antiinflammatory actions to reduce joint pain.”
Correct Answer: B
Rationale: Elavil is ordered to improve sleep, to decrease stress and fatigue, and as an
adjuvant medication for pain control. It would not be ordered to prevent depression,
although it might be ordered to treat depression in a patient with FMS. Elavil is not a
muscle relaxant or an antiinflammatory drug, although medications from these categories
are used in treating FMS.

36. A patient who has had fatigue and muscle weakness for several years is diagnosed
with chronic fatigue syndrome. The patient expresses anger at the health care
professional for not offering relief of the symptoms and also anger at family members
for saying “snap out of it and get busy.” Based on the patient’s statements, the nurse
identifies a nursing diagnosis of
a. activity intolerance related to fatigue.
b. powerlessness related to lack of control over illness.
c. altered family process related to illness of family member.
d. situational low self-esteem related to inability to meet role expectation.
Correct Answer: B
Rationale: The patient’s statements support the problem and etiology of powerlessness
related to lack of control. The patient does not complain about activity intolerance.
Although the patient may have risk for altered family process, but there are not enough
data to support this diagnosis. The patient is not expressing low self-esteem or feelings of
inadequacy regarding meeting role expectations.

Test Bank 65-17
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity
37. The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient
with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, “That
drug has too many side effects; I would rather wait until my joint problems are worse
before beginning any drugs.” The most appropriate response by the nurse is
a. “You should tell the doctor how you feel so the two of you can make a decision
together.”
b. “It is important to start methotrexate early in order to decrease the joint damage.”
c. “Methotrexate is not expensive and will be cheaper to take than other possible
drugs.”
d. “Methotrexate is very effective and has no more side effects than the other
available drugs.”
Correct Answer: B
Rationale: Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed early to
prevent the joint degeneration that occurs as soon as the first year with RA. The other
statements are accurate, but the most important point for the patient to understand is that
it is important to start DMARDs as quickly as possible.

38. A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone

(Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse
indicate that the patient is experiencing a side effect of the medication?
a. The patient has experienced a recent 5-pound weight loss.
b. The patient’s erythrocyte sedimentation rate (ESR) has increased.
c. The patient’s blood glucose is 166 mg/dl.
d. The patient has no improvement in symptoms.
Correct Answer: C
Rationale: Hyperglycemia is a side effect of prednisone. Corticosteroids increase
appetite and lead to weight gain. An elevated ESR and no improvement in symptoms
would indicate that the prednisone was not effective but would not be side effects of the
medication.

39. The home health nurse is doing a follow-up visit to a patient with recently diagnosed
rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more
patient teaching is needed?

Test Bank 65-18
a. The patient sleeps with two pillows under the head.

b. The patient has been taking 16 aspirins daily.
c. The patient requires a 2 hour midday nap.
d. The patient sits on a stool when preparing meals.
Correct Answer: A
Rationale: The joints should be maintained in an extended position to avoid contractures,
so patients should use a small, flat pillow for sleeping. The other information is
appropriate for a patient with RA and indicates that teaching has been effective.
Cognitive Level: Application Text Reference: pp. 1708-1709

40. A patient with an acute attack of gout in the left great toe has a new prescription for
probenecid (Benemid). Which information about the patient’s home routine indicates
a need for teaching regarding gout management?
a. The patient takes one aspirin a day prophylactically to prevent angina.
b. The patient sleeps about 8 to 10 hours every night.
c. The patient generally drinks about 3 quarts of juice and water daily.
d. The patient usually eats beef once or twice a week.
Correct Answer: A
Rationale: Aspirin interferes with the effectiveness of probenecid and should not be
taken when the patient is taking probenecid. The patient’s sleep pattern will not affect
gout management. Drinking 3 quarts of water and eating beef only once or twice a week
are appropriate for the patient with gout.

41. When the nurse is reviewing laboratory results for a patient with systemic lupus
erythematosus (SLE), which result is most important to communicate to the health
care provider?
a. Elevated blood urea nitrogen (BUN) and creatinine
b. Positive lupus erythematosus cell prep
c. Positive antinuclear antibodies (ANA)
d. Decreased C-reactive protein (CRP)
Correct Answer: A
Rationale: The elevated BUN and creatinine levels indicate possible lupus nephritis and
a need for a change in therapy to avoid further renal damage. The positive LE cell prep
and ANA would be expected in a patient with SLE. A drop in CRP shows an
improvement in the inflammatory process.

Test Bank 65-19

MULTIPLE RESPONSE
1. During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would
expect the patient to report (Select all that apply.)
a. sleep disturbances.
b. multiple tender points.
c. urinary frequency and urgency.
d. cardiac palpitations and dizziness.
e. multijoint pain with inflammation and swelling.
f. widespread bilateral, burning musculoskeletal pain.
Correct Answer: A, B, C, F
Rationale: These symptoms are commonly described by patients with FMS. Cardiac
involvement and joint inflammation are not typical of FMS.


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Lewis: Medical-Surgical Nursing, 7th Edition

Chapter 65: Nursing Management: Arthritis and Connective Tissue Diseases

Cognitive Level: Comprehension Text Reference: p. 1694

Cognitive Level: Application Text Reference: p. 1694

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated

Cognitive Level: Application Text Reference: p. 1697

Cognitive Level: Application Text Reference: pp. 1696, 1701

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: pp. 1701, 1704

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8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old

Cognitive Level: Application Text Reference: p. 1699

Cognitive Level: Application Text Reference: p. 1707

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 1726

11. When teaching range-of-motion exercises to a patient who is having an acute

Cognitive Level: Application Text Reference: pp. 1707, 1710

12. Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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c. stretching exercises to relieve joint stiffness.

Cognitive Level: Comprehension Text Reference: p. 1708

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Cognitive Level: Application Text Reference: p. 1711

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Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

b. recently returned from a trip to South America.

Cognitive Level: Application Text Reference: p. 1713

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Cognitive Level: Comprehension Text Reference: pp. 1717, 1719

26. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is

Cognitive Level: Application Text Reference: pp. 1718, 1720

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b. impaired skin integrity related to itching and skin sloughing.

Cognitive Level: Application Text Reference: p. 1722

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Rationale: Dermatomyositis is initially treated with high-dose steroids. Eye dryness is

Cognitive Level: Application Text Reference: p. 1725

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Cognitive Level: Application Text Reference: p. 1729

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Nursing Process: Diagnosis NCLEX: Psychosocial Integrity