NSG 555 - Nurse Practitioners

NSG 555 - Nurse Practitioners in Primary Care II

Exam 4

Question:

Which are symptoms of rheumatoid arthritis (RA) that distinguish it from osteoarthritis (OA)? (Select all that apply.)

• Extra-articular inflammatory signs
• History of injury to affected joints
• Morning stiffness of at least 1 hour
• Symmetric tender, swollen joints
• Unilateral joint involvement

Answer:

ANS: A, C, D

The clinical presentation of RA includes extra-articular symptoms, morning stiffness lasting at least 1 hour, and symmetric, bilateral joint involvement.OA often has a history of previous injury and is usually asymmetric and may be unilateral.

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Question:

A patient is diagnosed with ankylosing spondylitis and begins taking a COX-

• inhibitor with minimal pain and inflammation relief. What will the

provider order initially to manage this patient's symptoms?

• A trial of sulfasalazine and methotrexate
• Biologic anti-tumor necrosis factor agents
• Changing to a COX-1 inhibitor medication
• Corticosteroid injections every 3 months

Answer:

ANS: C

NSAIDs have been shown to reduce pain and stiffness and reduce progression of structural damage if administered continuously. Patients should try at least two NSAIDs before other medications are attempted.Sulfasalazine and methotrexate have not been shown to be significantly effective for axial disease. Biologic anti-tumor necrosis factor medications are given only after failure of two NSAIDs. Corticosteroid injections are not indicated.

Question:

A patient is treated for a urinary tract infection and, 3 weeks later, presents with pain and swelling of one knee and in one hand, along with inflammation in both eyes. What will the provider suspect as the cause of these symptoms?

• Ankylosing spondylitis
• Infectious arthritis
• Psoriatic arthritis
• Reactive arthritis

Answer:

ANS: D 2 / 3

Reactive arthritis can cause arthritis, urethritis, and inflammation of the eyes

• to 6 weeks after a prior infection. Ankylosing spondylitis generally presents

with lower back inflammation. Psoriatic arthritis is associated with psoriasis.Reactive arthritis is not related to infection in the involved joints.

Question:

A patient reports a history of recurrent lower back pain for 6 months. The patient describes the pain as a deep ache and stiffness that is worse upon awakening and improves after walking. Which findings will the examiner elicit to help make a clinical diagnosis of ankylosing spondylitis? (Select all that apply.)

• Assessment of the degree of lumbar lordosis
• Evaluation of lateral thoracic spine flexion
• Measurement of chest expansion
• Noting the degree of cervical kyphosis
• Observation for scapular asymmetry

Answer:

ANS: A, B, C

Examination of the spine will show loss of the normal lumbar lordosis, decreased thoracic spine flexion, and diminished chest expansion. Cervical kyphosis is not assessed. Scapular asymmetry evaluates for scoliosis.

Question:

A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient?

• Dialysis only
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