TEST BANK Feedback: In RA, the autoimmune reaction results in
Chapter 38: Assessment and Management of Patients
With Rheumatic Disorders
1. A patient is suspected of having rheumatoid arthritis and
her diagnostic regimen includes aspiration of synovial fluid
from the knee for a definitive diagnosis. The nurse knows
which of the following procedures will be involved?
A) Angiography
B) Myelography
C) Paracentesis
D) Arthrocentesis
Feedback: Arthrocentesis involves needle aspiration of
synovial fluid. Angiography is an x-ray study of circulation
with a contrast agent injected into a selected artery.
Myelography is an x-ray of the spinal subarachnoid space
taken after the injection of a contrast agent into the spinal
subarachnoid space through a lumbar puncture.
Paracentesis is removal of fluid (ascites) from the peritoneal
cavity through a small surgical incision or puncture made
through the abdominal wall under sterile conditions.
2. 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
Feedback: In the past, a step-wise approach starting with
NSAIDs was standard of care. However, evidence clearly
documenting the benefits of early DMARD (methotrexate
[Rheumatrex], antimalarials, leflunomide [Arava], or
sulfasalazine [Azulfidine]) treatment has changed national
guidelines for management. Now it is recommended that
treatment with the non-biologic DMARDs begin within 3
months of disease onset. Allopurinol is used to treat gout.
Opioids are not indicated in early RA. Prednisone is used in
unremitting RA.
3. A nurse is performing the initial assessment of a patient
who has a recent diagnosis of systemic lupus erythematosus
(SLE). What skin manifestation would the nurse expect to
observe on inspection?
A) Petechiae
B) Butterfly rash
C) Jaundice
D) Skin sloughing
Feedback: An acute cutaneous lesion consisting of a
butterfly-shaped rash across the bridge of the nose and
cheeks occurs in SLE. Petechiae are pinpoint skin
hemorrhages, which are not a clinical manifestation of SLE.
Patients with SLE do not typically experience jaundice or
skin sloughing.
4. A clinic nurse is caring for a patient with suspected gout.
While explaining the pathophysiology of gout to the patient,
the nurse should describe which of the following?
A) Autoimmune processes in the joints
B) Chronic metabolic acidosis
C) Increased uric acid levels
D) Unstable serum calcium levels
Feedback: Gout is caused by hyperuricemia (increased
serum uric acid). Gout is not categorized as an autoimmune
disease and it does not result from metabolic acidosis or
unstable serum calcium levels.
5. A nurse is planning the care of a patient who has a long
history of chronic pain, which has only recently been
diagnosed as fibromyalgia. What nursing diagnosis is most
likely to apply to this woman's care needs?
A) Ineffective Role Performance Related to Pain
B) Risk for Impaired Skin Integrity Related to
Myalgia
C) Risk for Infection Related to Tissue Alterations
D) Unilateral Neglect Related to Neuropathic Pain
Feedback: Typically, patients with fibromyalgia have
endured their symptoms for a long period of time. The
neuropathic pain accompanying FM can often impair a
patient's ability to perform normal roles and functions. Skin
integrity is unaffected and the disease has no associated
infection risk. Activity limitations may result in neglect, but
not of a unilateral nature.
6. A patient's decreased mobility is ultimately the result of an
autoimmune reaction originating in the synovial tissue, which
caused the formation of pannus. This patient has been
diagnosed with what health problem?
A) Rheumatoid arthritis (RA)
B) Systemic lupus erythematosus
C) Osteoporosis
D) Polymyositis
phagocytosis, producing enzymes within the joint that break
down collagen, cause edema and proliferation of the
synovial membrane, and ultimately form pannus. Pannus
destroys cartilage and bone. SLE, osteoporosis, and
polymyositis do not involve pannus formation.
7. 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
Feedback: In addition to joint pain and swelling, another
classic sign of RA is joint stiffness, especially in the morning.
Joints are typically swollen, not atrophied, and systemic
infection does not accompany the disease. Joints are often
warm rather than cool.
8. A patient has a diagnosis of rheumatoid arthritis and the
primary care provider has now prescribed cyclophosphamide
(Cytoxan). The nurse's subsequent assessments should
address what potential adverse effect?
A) Infection
B) Acute confusion
C) Sedation
D) Malignant hyperthermia
Feedback: When administering immunosuppressives such
as Cytoxan, the nurse should be alert to manifestations of
bone marrow suppression and infection. Confusion and
sedation are atypical adverse effects. Malignant
hyperthermia is a surgical complication and not a possible
adverse effect.
9. A clinic nurse is caring for a patient newly diagnosed with
fibromyalgia. When developing a care plan for this patient,
what would be a priority nursing diagnosis for this patient?
A) Impaired Urinary Elimination Related to
Neuropathy
B) Altered Nutrition Related to Impaired Absorption
C) Disturbed Sleep Pattern Related to CNS
Stimulation
D) Fatigue Related to Pain
Feedback: Fibromyalgia is characterized by fatigue,
generalized muscle aching, and stiffness. Impaired urinary
elimination is not a common manifestation of the disease.
Altered nutrition and disturbed sleep patterns are potential
nursing diagnoses, but are not the priority.
10. A nurse is assessing a patient for risk factors known to
contribute to osteoarthritis. What assessment finding would
the nurse interpret as a risk factor?
A) The patient has a 30 pack-year smoking history.
B) The patient's body mass index is 34 (obese).
C) The patient has primary hypertension.
D) The patient is 58 years old.
Feedback: Risk factors for osteoarthritis include obesity and
previous joint damage. Risk factors of OA do not include
smoking or hypertension. Incidence increases with age, but
a patient who is 58 would not yet face a significantly
heightened risk.
11. A patient is undergoing diagnostic testing to determine
the etiology of recent joint pain. The patient asks the nurse
about the difference between osteoarthritis (OA) and
rheumatoid arthritis (RA). What is the best response by the
nurse?
A) OA is considered a noninflammatory joint
disease. RA is characterized by inflamed, swollen
joints.
B) OA and RA are very similar. OA affects the
smaller joints such as the fingers, and RA affects
the larger, weight-bearing joints like the knees.
C) OA originates with an infection. RA is a result of
your body's cells attacking one another.
D) OA is associated with impaired immune
function; RA is a consequence of physical
damage.
Feedback: OA is a degenerative arthritis with a
noninflammatory etiology, characterized by the loss of
cartilage on the articular surfaces of weight-bearing joints,
with spur development. RA is characterized by inflammation
of synovial membranes and surrounding structures. The
diseases are not distinguished by the joints affected and
neither has an infectious etiology.
12. A patient with systemic lupus erythematosus (SLE) is
preparing for discharge. The nurse knows that the patient
has understood health education when the patient makes
what statement?
A) I'll make sure I get enough exposure to sunlight
to keep up my vitamin D levels.
 B) I'll try to be as physically active as possible
between flare-ups.
C) I'll make sure to monitor my body temperature
on a regular basis.
D) I'll stop taking my steroids when I get relief from
my symptoms.
Feedback: Fever can signal an exacerbation and should be
reported to the physician. Sunlight and other sources of
ultraviolet light may precipitate severe skin reactions and
exacerbate the disease. Fatigue can cause a flare-up of
SLE. Patients should be encouraged to pace activities and
plan rest periods. Corticosteroids must be gradually tapered
because they can suppress the function of the adrenal gland.
As well, these drugs should not be independently adjusted
by the patient.
13. medical unit. The nurse observes that the patient
expresses anger and irritation when her call bell isn't. A
patient with an exacerbation of systemic lupus
erythematosus (SLE) has been hospitalized immediately.
What would be the most appropriate response?
A) “You seem like you're feeling angry. Is that
something that we could talk about?”
B) “Try to remember that stress can make your
symptoms worse.”
C) “Would you like to talk about the problem with
the nursing supervisor?”
D) “I can see you're angry. I'll come back when
you've calmed down.”
Feedback: The changes and the unpredictable course of
SLE necessitate expert assessment skills and nursing care,
as well as sensitivity to the psychological reactions of the
patient. Offering to listen to the patient express anger can
help the nurse and the patient understand its cause and
begin to deal with it. Although stress can exacerbate the
symptoms of SLE, telling the patient to calm down doesn't
acknowledge her feelings. Ignoring the patient's feelings
suggests that the nurse has no interest in what the patient
has said. Offering to get the nursing supervisor also does not
acknowledge the patient's feelings.
14. A nurse is caring for a 78-year-old patient with a history
of osteoarthritis (OA). When planning the patient's care, what
goal should the nurse include?
A) The patient will express satisfaction with her
ability to perform ADLs.
B) The patient will recover from OA within 6
months.
C) The patient will adhere to the prescribed plan of
care.
D) The patient will deny signs or symptoms of OA.
Feedback: Pain management and optimal functional ability
are major goals of nursing interventions for OA. Cure is not a
possibility and it is unrealistic to expect a complete absence
of signs and symptoms. Adherence to the plan of care is
highly beneficial, but this is not the priority goal of care.
15. A patient who has been newly diagnosed with systemic
lupus erythematosus (SLE) has been admitted to the
medical unit. Which of the following nursing diagnoses is the
most plausible inclusion in the plan of care?
A) Fatigue Related to Anemia
B) Risk for Ineffective Tissue Perfusion Related to
Venous Thromboembolism
C) Acute Confusion Related to Increased Serum
Ammonia Levels
D) Risk for Ineffective Tissue Perfusion Related to
Increased Hematocrit
Feedback: Patients with SLE nearly always experience
fatigue, which is partly attributable to anemia. Ammonia
levels are not affected and hematocrit is typically low, not
high. VTE is not one of the central complications of SLE.
16. The nurse is preparing to care for a patient who has
scleroderma. The nurse refers to resources that describe
CREST syndrome. Which of the following is a component of
CREST syndrome?
A) Raynaud's phenomenon
B) Thyroid dysfunction
C) Esophageal varices
D) Osteopenia
Feedback: The R in CREST stands for Raynaud's
phenomenon. Thyroid dysfunction, esophageal varices, and
osteopenia are not associated with scleroderma.
17. Allopurinol (Zyloprim) has been ordered for a patient
receiving treatment for gout. The nurse caring for this patient
knows to assess the patient for bone marrow suppression,
which may be manifested by which of the following
diagnostic findings?
A) Hyperuricemia
B) Increased erythrocyte sedimentation rate
C) Elevated serum creatinine
D) Decreased platelets
Feedback: Thrombocytopenia occurs in bone marrow
suppression. Hyperuricemia occurs in gout, but is not caused
by bone marrow suppression. Increased erythrocyte
sedimentation rate may occur from inflammation associated
with gout, but is not related to bone marrow suppression. An
elevated serum creatinine level may indicate renal damage,
but this is not associated with the use of allopurinol.
18. 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
Feedback: Stomatitis is an adverse effect that is associated
with gold therapy. Steroids, antimalarials, and salicylates do
not normally have this adverse effect.
19. 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
Feedback: Antimalarials may cause visual changes; regular
ophthalmologic examinations are necessary.Tinnitus is
associated with salicylate therapy, stomatitis is associated
with gold therapy, and hirsutism is associated with
corticosteroid therapy.
20. 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 that's high in fat, I get really
nauseous.
D) I seem to have lost my appetite, which is
unusual for me.
Feedback: Tinnitus is associated with salicylate therapy.
Salicylates do not normally cause drowsiness, intolerance of
high-fat meals, or anorexia.
21. A patient has been admitted to a medical unit with a
diagnosis of polymyalgia rheumatica (PMR). The nurse
should be aware of what aspects of PMR? Select all that
apply.
A) PMR has an association with the genetic
marker HLA-DR4.
B) Immunoglobulin deposits occur in PMR.
C) PMR is considered to be a wear-and-tear
disease.
D) Foods high in purines exacerbate the
biochemical processes that occur in PMR.
E) PMR occurs predominantly in Caucasians.
Feedback: The underlying mechanism involved with
polymyalgia rheumatica is unknown. This disease occurs
predominantly in Caucasians and often in first-degree
relatives. An association with the genetic marker HLA-DR4
suggests a familial predisposition. Immunoglobulin deposits
in the walls of inflamed temporal arteries also suggest an
autoimmune process. Purines are unrelated and it is not a
result of physical degeneration.
22. A nurse is providing care for a patient who has a recent
diagnosis of giant cell arteritis (GCA). What aspect of
physical assessment should the nurse prioritize?
A) Assessment for subtle signs of bleeding
disorders
B) Assessment of the metatarsal joints and
phalangeal joints
C) Assessment for thoracic pain that is
exacerbated by activity
D) Assessment for headaches and jaw pain
Feedback: Assessment of the patient with GCA focuses on
musculoskeletal tenderness, weakness, and decreased
function. Careful attention should be directed toward
assessing the head (for changes in vision, headaches, and
jaw claudication). There is not a particular clinical focus on
the potential for bleeding, hand and foot pain, or thoracic
pain.
23. A nurse is educating a patient with gout about lifestyle
modifications that can help control the signs and symptoms
of the disease. What recommendation should the nurse
make?
 A) Ensuring adequate rest
B) Limiting exposure to sunlight
C) Limiting intake of alcohol
D) Smoking cessation
Feedback: Alcohol and red meat can precipitate an acute
exacerbation of gout. Each of the other listed actions is
consistent with good health, but none directly addresses the
factors that exacerbate gout.
24. A patient's 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 patient's
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.
Feedback: Corticosteroids are used for the shortest duration
and at lowest dose possible to minimize adverse effects.
Daily blood work is not necessary and the patient does not
need to stop other drugs prior to using corticosteroids.
25. A nurse is caring for a patient who is suspected of having
giant cell arteritis (GCA). What laboratory tests are most
useful in diagnosing this rheumatic disorder? Select all that
apply.
A) Erythrocyte count
B) Erythrocyte sedimentation rate
C) Creatinine clearance
D) C-reactive protein
E) D-dimer
Feedback: Simultaneous elevation in the ESR and CRP
have a sensitivity of 88% and a specificity of 98% in making
the diagnosis of GCA when coupled with clinical findings.
Erythrocyte counts, creatinine clearance, and D-dimer are
not diagnostically useful.
26. A patient with SLE has come to the clinic for a routine
check-up. When auscultating the patient's apical heart rate,
the nurse notes the presence of a distinct scratching sound.
What is the nurse's most appropriate action?
A) Reposition the patient and auscultate
posteriorly.
B) Document the presence of S3 and monitor the
patient closely.
C) Inform the primary care provider that a friction
rub may be present.
D) Inform the primary care provider that the patient
may have pneumonia.
Feedback: Patients with SLE are susceptible to developing
a pericardial friction rub, possibly associated with myocarditis
and accompanying pleural effusions; this warrants prompt
medical follow-up. This finding is not characteristic of
pneumonia and does not constitute S3. Posterior
auscultation is unlikely to yield additional meaningful data.
27. A community health nurse is performing a visit to the
home of a patient who has a history of rheumatoid arthritis
(RA). On what aspect of the patient's health should the nurse
focus most closely during the visit?
A) The patients understanding of rheumatoid
arthritis
B) The patient's risk for cardiopulmonary
complications
C) The patients social support system
D) The patient's functional status
Feedback: The patient's functional status is a central focus
of home assessment of the patient with RA. The nurse may
also address the patient's understanding of the disease,
complications, and social support, but the patient's level of
function and quality of life is a primary concern.
28. A 21-year-old male has just been diagnosed with
spondyloarthropathy. What will be a priority nursing
intervention for this patient?
A) Referral for assistive devices
B) Teaching about symptom management
C) Referral to classes to stop smoking
D) Setting up an exercise program
Feedback: Major nursing interventions in the
spondyloarthropathies are related to symptom management
and maintenance of optimal functioning. This is a priority
over the use of assistive devices, smoking cessation, and
exercise programs, though these topics may be of
importance for some patients.
29. A patient with SLE asks the nurse why she has to come
to the office so often for check-ups. What would be the
nurse's best response?
A) Taking care of you in the best way involves
seeing you face to face.
B) Taking care of you in the best way involves
making sure you are taking your medication the
way it is ordered.
C) Taking care of you in the best way involves
monitoring your disease activity and how well the
prescribed treatment is working.
D) Taking care of you in the best way involves
drawing blood work every month.
Feedback: The goals of treatment include preventing
progressive loss of organ function, reducing the likelihood of
acute disease, minimizing disease-related disabilities, and
preventing complications from therapy. Management of SLE
involves regular monitoring to assess disease activity and
therapeutic effectiveness. Stating the benefit of face-to-face
interaction does not answer the patient's question. Blood
work is not necessarily drawn monthly and assessing
medication adherence is not the sole purpose of visits.
30. The patient will stop taking the medication as soon as he
starts to feel better. Why must the nurse? A patient is
diagnosed with giant cell arteritis (GCA) and is placed on
corticosteroids. A concern for this emphasizes the need for
continued adherence to the prescribed medication?
A) To avoid complications such as venous
thromboembolism
B) To avoid the progression to osteoporosis
C) To avoid the progression of GCA to
degenerative joint disease
D) To avoid complications such as blindness
Feedback: The nurse must emphasize to the patient the
need for continued adherence to the prescribed medication
regimen to avoid complications of giant cell arteritis, such as
blindness. VTE, OP, and degenerative joint disease are not
among the most common complications for GCA.
31. A patient with polymyositis is experiencing challenges
with activities of daily living as a result of proximal muscle
weakness. What is the most appropriate nursing action?
A) Initiate a program of passive range of motion
exercises
B) Facilitate referrals to occupational and physical
therapy
C) Administer skeletal muscle relaxants as
ordered
D) Encourage a progressive program of
weight-bearing exercise
Feedback: Patients with polymyositis may have symptoms
similar to those of other inflammatory diseases. However,
proximal muscle weakness is characteristic, making activities
such as hair combing, reaching overhead, and using stairs
difficult. Therefore, use of assistive devices may be
recommended, and referral to occupational or physical
therapy may be warranted. The muscle weakness is a
product of the disease process, not lack of exercise. Skeletal
muscle relaxants are not used in the treatment of
polymyositis.
32. A nurse is creating a teaching plan for a patient who has
a recent diagnosis of scleroderma. What topics should the
nurse address during health education? Select all that apply.
A) Surgical treatment options
B) The importance of weight loss
C) Managing Raynaud's-type symptoms
D) Smoking cessation
E) The importance of vigilant skin care
Feedback: Patient teaching for the patient with scleroderma
focuses on management of Raynaud's phenomenon,
smoking cessation, and meticulous skin care. Surgical
treatment options do not exist and weight loss is not a
central concern.
33. A 40-year-old woman was diagnosed with Raynaud's
phenomenon several years earlier and has sought care
because of a progressive worsening of her symptoms. The
patient also states that many of her skin surfaces are stiff,
like the skin is being stretched from all directions. The nurse
should recognize the need for medical referral for the
assessment of what health problem?
A) Giant cell arteritis (GCA)
B) Fibromyalgia (FM)
C) Rheumatoid arthritis (RA)
D) Scleroderma
Feedback: Scleroderma starts insidiously with Raynaud's
phenomenon and swelling in the hands. Later, the skin and
the subcutaneous tissues become increasingly hard and
rigid and cannot be pinched up from the underlying
structures. This progression of symptoms is inconsistent with
GCA, FM, or RA.
34. 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 the right foot.
Feedback: Although severe dietary restriction is not
necessary, the nurse should encourage the patient to restrict
consumption of foods high in purines, especially organ
meats. Calcium supplementation is not necessary and
activity should be maintained as tolerated. Increased fluid
intake is beneficial, but it is not necessary for the patient to
consume more than 4 liters daily.
35. that she has not been taking her medication because she
usually cannot remove the childproof A clinic nurse is caring
for a patient diagnosed with rheumatoid arthritis (RA). The
patient tells the nurse medication lids. How can the nurse
best facilitate the patient's adherence to her medication
regimen?
A) Encourage the patient to store the bottles with
their tops removed.
B) Have a trusted family member take over the
management of the patient's medication regimen.
C) Encourage her to have her pharmacy replace
the tops with alternatives that are easier to open.
D) Have the patient approach her primary care
provider to explore medication alternatives.
Feedback: The patients pharmacy will likely be able to
facilitate a practical solution that preserves the patients
independence while still fostering adherence to treatment.
There should be no need to change medications, and storing
open medication containers is unsafe. Delegating
medications to a family member is likely unnecessary at this
point and promotes dependence.
C) Arrange for the patient to be assessed in her
home environment.
D) Refer the patient to social work.
Feedback: Assessment in the patient's home setting can
often reveal more meaningful data than an assessment in
the health care setting. There is no indication that assisted
living is a pressing need or that the patient would benefit
from social work or a support group.
40. A nurse is assessing a patient with rheumatoid arthritis.
The patient expresses his intent to pursue complementary
and alternative therapies. What fact should underlie the
nurse's response to the patient?
A) New evidence shows CAM to be as effective as
medical treatment.
B) CAM therapies negate many of the benefits of
medications.
C) CAM therapies typically do more harm than
good.
D) Evidence shows minimal benefits from most
CAM therapies.
Feedback: A recent systematic review of complementary
and alternative medicine (CAM) examined the efficacy of
herbal medicine, acupuncture, Tai chi and biofeedback for
the treatment of rheumatoid arthritis and osteoarthritis.
Although acupuncture treatment for pain management
showed some promise, in all modalities the evidence was
ambiguous. There is not enough evidence of the
effectiveness of CAM and more rigorous research is needed.

36. A nurse's 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
Feedback: Exercise is vital to the management of rheumatic
disorders. Goals should be preserving and promoting
mobility and joint function while limiting stress on the joint
and possible damage. Cardiovascular exertion should
remain within age-based limits and individual ability, but it is
not a goal to minimize exertion. Increasing joint size is not a
valid goal.

37. A patient has just been told by his physician that he has
scleroderma. The physician tells the patient that he is going
to order some tests to assess for systemic involvement. The
nurse knows that priority systems to be assessed include
what?
A) Hepatic
B) Gastrointestinal
C) Genitourinary
D) Neurologic
Feedback: Assessment of systemic involvement with
scleroderma requires a systems review with special attention
to gastrointestinal, pulmonary, renal, and cardiac systems.
Liver, GU, and neurologic functions are not central priorities.

38. A nurse is providing care for a patient who has a

rheumatic disorder. The nurse's comprehensive assessment
includes the patient's mood, behavior, LOC, and neurologic
status. What is this patient's most likely diagnosis?
A) Osteoarthritis (OA)
B) Systemic lupus erythematosus (SLE)
C) Rheumatoid arthritis (RA)
D) Gout
Feedback: SLE has a high degree of neurologic
involvement, and can result in central nervous system
changes. The patient and family members are asked about
any behavioral changes, including manifestations of neurosis
or psychosis. Signs of depression are noted, as are reports
of seizures, chorea, or other central nervous system
manifestations. OA, RA, and gout lack this dimension.

39. 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.