Chapter 72: Drug Therapy of Rheumatoid Arthritis

Chapter 72: Drug Therapy of Rheumatoid Arthritis

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1. The nurse is teaching a class on the pathophysiology of rheumatoid arthritis to a group of nurses. The nurse asks the group, “Which clinical manifestations would you expect to see with rheumatoid arthritis?” The group correctly names which of the following? (Select all that apply.)

ANS:   A, B, E

Rheumatoid arthritis is manifested by joint injury (stiffness, swelling, and pain) and systemic manifestations such as fever, weakness, fatigue, weight loss, thinning of the skin, scleritis, corneal ulcers, vasculitis, and nodules under the skin and periosteum.

Patients experience weight loss rather than weight gain.

Patients experience thinning of the skin rather than thickening.

DIF:    Cognitive Level: Application             REF:    p. 856

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

2. The nurse is providing education for a patient starting therapy on hydroxychloroquine (Plaquenil). Before giving the first dose of medication, the nurse should arrange

ANS:   C

Retinal damage is the most serious toxicity of hydroxychloroquine. Patients should have a thorough ophthalmologic exam prior to treatment and every 6 months thereafter.

Thyroid function tests are not indicated, because hydroxychloroquine does not affect thyroid function.

A glucose tolerance test is unnecessary, because hydroxychloroquine does not affect blood glucose levels.

A bone density test is not needed, because hydroxychloroquine does not affect bone density.

DIF:    Cognitive Level: Application             REF:    p. 860

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is caring for a patient who is to be discharged from the hospital on etanercept (Enbrel). Which of the following instructions should the nurse include in the patient teaching?

ANS:   B

The nurse should tell the patient to avoid live vaccines. Because etanercept neutralizes tumor necrosis factor (a contributor to the pathophysiology of rheumatoid arthritis), the drug may increase the patient’s risk of acquiring or transmitting infection if vaccinated with a live vaccine.

Eating a high-fat diet does not enhance absorption of the medication.

Alcohol is not contraindicated with etanercept therapy.

The patient should be encouraged to perform active, not passive, range of motion exercises.

DIF:    Cognitive Level: Application             REF:    p. 861

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A female patient with rheumatoid arthritis has taken leflunomide (Arava) for 1 year. She telephones the clinic nurse and says that a home pregnancy test showed a positive result. The nurse should

ANS:   A

Leflunomide is contraindicated during pregnancy, because it is teratogenic and embryotoxic. The medication should be discontinued immediately, and the prescriber should be notified.

The medication should not be taken under any circumstances, to prevent injury to the fetus.

The medication should not be taken at all during pregnancy and should be cleared from the body before becoming pregnant.

DIF:    Cognitive Level: Application             REF:    p. 859

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies