1. 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.

3. Initially, most clients with early symptoms of rheumatoid arthritis report early morning stiffness or 

stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint 

range of motion; deformed joints, especially of the hand; and 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 goal for this client should take priority?.

1. Conserve energy.

2. Adapt self-care skills.

3. Develop coping skills.

4. Adapt body image.

1. Based on the information from the client, the nurse should develop a plan with the client that will 

conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit 

related to the increasing joint pain, the client is voicing concerns about household chores and 

difficulty around the house and yard, not self-care issues. Over time, the client may have difficulty 

coping or experience changes in body image as the disorder becomes chronic with increasing pain and 

fatigue, but the current priority is to conserve energy.

3. Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all

that apply.

1. Adults between the ages of 20 and 50 years.

2. Adults who have had an infectious disease with the Epstein-Barr virus.

3. Adults who are of the male gender.

4. Adults who possess the genetic link, specifically HLA-DR4.

5. Adults who also have osteoarthritis.

1, 2, 4 RA affects women three times more often than men between the ages of 20 and 55 years. 

Research has determined that RA occurs in clients who have had infectious disease, such as the 

Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with 

RA. People with osteoarthritis are not necessarily at risk for developing RA.

4. A client is in the acute phase of rheumatoid arthritis. In which order of priority should the

nurse establish the following goals?

1. Relieving pain.

2. Preserving joint function.

3. Maintaining usual ways of accomplishing tasks.

4. Preventing joint deformity.

1, 4, 2, 3 Pain relief is the highest priority during the acute phase because pain is typically severe and 

interferes with the client's ability to function. Preserving joint function is the next goal to set, followed 

by preventing joint deformity during the acute phase to promote an optimal level of functioning and 

reduce the risk of contractures. Maintaining usual ways of accomplishing tasks is the goal with the 

lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of 

accomplishing routine tasks.

5. 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 fifteen minutes per application is the maximum time for cold applications."

3. Heat-producing liniment can produce a burn if used with other heat devices that could intensify the 

heat reaction. Heat and cold can be used as often as the client desires.

However, each application of heat should not exceed 20 minutes, and each application of cold should 

not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended 

effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction 

with cold.

6. 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."

4. The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic 

communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain 

truthfully that each client is different and that there are various forms of arthritis and arthritis 

treatment. To state that it is the physician's prerogative to decide how to treat the client implies that 

the client is not a member of his or her own health care team and is not a participant in his or her care. 

The statement also is defensive, which serves to block any further communication or questions from 

the client about the physician. Asking the client to tell more about the friend presumes that the client 

knows correct and complete information, which is not a valid assumption to make. The nurse does not 

know about the client's friend and should not make statements about another client's condition. Stating 

that the drug is for cases that are worse than the client's demonstrates that the nurse is making 

assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores 

the underlying emotions associated with the question, totally discounting the client's feelings.

7. 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.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper 

body alignment during rest periods is encouraged to maintain correct muscle and joint placement. 

Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation 

of the shoulders.

8. 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.

4. Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of 

small joints. The laundry basket should be held with both hands opened as wide as possible and with 

outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a 

chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of 

the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and 

wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. 

This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid 

with the palm of the hand, which distributes weight over the larger area of the palms instead of 

stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

9. After teaching the client with severe rheumatoid arthritis about prescribed methotrexate, 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."

1. Because some over-the-counter vitamin supplements contain folic acid, the client should avoid selfmedication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is 

hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for 

hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for 

infection. Therefore, meticulous mouth

care is essential to minimize the risk of infection. Contraception should be used during methotrexate 

therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. 

Methotrexate is considered teratogenic.