Chapter 39 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition


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Chapter 39  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition



Complete Chapter Questions And Answers

Sample Questions


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 that which of the following procedures will be involved?

  1. A)  Angiography
  2. B)  Myelography
  3. C)  Paracentesis
  4. D)  Arthocentesis

Ans: D


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?

  1. A)  Hydromorphone (Dilaudid)
  2. B)  Methotrexate (Rheumatrex)
  3. C)  Allopurinol (Zyloprim)
  4. D)  Prednisone

Ans: B


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.

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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?

  1. A)  Petechiae
  2. B)  Butterfly rash
  3. C)  Jaundice
  4. D)  Skin sloughing

Ans: B


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?

  1. A)  Autoimmune processes in the joints
  2. B)  Chronic metabolic acidosis
  3. C)  Increased uric acid levels
  4. D)  Unstable serum calcium levels

Ans: C


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?

  1. A)  Ineffective Role Performance Related to Pain
  2. B)  Risk for Impaired Skin Integrity Related to Myalgia
  3. C)  Risk for Infection Related to Tissue Alterations
  4. D)  Unilateral Neglect Related to Neuropathic Pain

Ans: A


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.

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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?

  1. A)  Rheumatoid arthritis (RA)
  2. B)  Systemic lupus erythematosus
  3. C)  Osteoporosis
  4. D)  Polymyositis

Ans: A


In RA, the autoimmune reaction results in 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.

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