Which lab test would the nurse review for a client suspected to have rheumatoid arthritis?

This is a quiz that contains NCLEX review questions for rheumatoid arthritis. As a nurse providing care to a patient with rheumatoid arthritis, it is important to know the signs and symptoms, pathophysiology, nursing management, patient education, and treatment for this condition.

In the previous NCLEX review series, I explained about other musculoskeletal disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.

Don’t forget to watch the rheumatoid arthritis lecture before taking this quiz.

Rheumatoid Arthritis NCLEX questions

This quiz will test your knowledge on rheumatoid arthritis in preparation for the NCLEX exam.

• 1. During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply:*
  • A. "Does the pain and stiffness tend to be the worst before bedtime?"
  • B. "Are you experiencing fatigue and fever as well?"
  • C. "Is your pain and stiffness symmetrical on the body?"
  • D. "Is your pain and stiffness aggravated by extreme temperature changes?"

• 2. True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60.*
  • True
  • False

• 3. Identify the correct sequence in how rheumatoid arthritis develops:*
  • A. Development of pannus, synovitis, ankylosis
  • B. Anklyosis, development of pannus, synovitis
  • C. Synovitis, development of pannus, anklyosis
  • D. Synovitis, anklyosis, development of pannus

• 4. A patient with severe rheumatoid arthritis is scheduled for a procedure called an arthrodesis. The nursing student you are precepting asks what type of procedure this is. Your response is:*
  • A. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together."
  • B. "It is a procedure that involves replacing the joint with an artificial one."
  • C. "It is a procedure where the surgeon goes in with a scope and cleans out the affected joint."
  • D. "It is a procedure where the synovium is completely removed within the joint, which helps decrease inflammation of the joint.

• 5. A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While assisting the patient with her morning routine, the patient verbalizes a pain rating of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing interventions can you provide to this patient to help alleviate pain and stiffness? Select-all-that-apply:*
  • A. Exercise the affected joints
  • B. Assist the patient with a warm shower or bath
  • C. Perform deep massage therapy to the wrist joints
  • D. Assist the patient with applying wrist splints

• 6. You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct?*
  • A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics."
  • B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike."
  • C. "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine."
  • D. "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

• 7. Disease-modifying antirheumatic drugs (DMARDS) are used to treat rheumatoid arthritis. Select-all-the drugs below that are DMARDS:*
  • A. Dexamethasone (Decadron)
  • B. Hydroxychloroquine (Plaquenil)
  • C. Teriparatide (Forteo)
  • D. Calcitonin
  • E. Leflunomide (Arava)
  • F. Methotrexate (Trexall)

• 8. A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage?*
  • A. Hydroxychloroquine (Plaquenil)
  • B. Lefluomide (Arava)
  • C. Sulfasalazine (Azulfidine)
  • D. Methylprednisolone (Medrol)

• 9. You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis?*
  • A. Potassium 3.2 mEq/L
  • B. Hemoglobin 7 g/dL
  • C. Sodium 135 mEq/L
  • D. WBC count 6,500

• 10. A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply:*
  • A. Rheumatoid factor
  • B. Uric acid level
  • C. Erythrocyte sedimentation
  • D. Dexa-Scan
  • E. X-ray imaging

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1. During a routine health check-up visit a patient states, “I’ve been experiencing severe pain and stiffness in my joints lately.” As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply:

A. “Does the pain and stiffness tend to be the worst before bedtime?”

B. “Are you experiencing fatigue and fever as well?”

C. “Is your pain and stiffness symmetrical on the body?”

D. “Is your pain and stiffness aggravated by extreme temperature changes?”

The answers are B and C. Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued…remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

2. True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60.

False: Yes, RA tends to affect women more than men BUT it can affect all ages…most commonly 20-60 years old.

3. Identify the correct sequence in how rheumatoid arthritis develops:

A. Development of pannus, synovitis, ankylosis

B. Anklyosis, development of pannus, synovitis

C. Synovitis, development of pannus, anklyosis

D. Synovitis, anklyosis, development of pannus

The answer is C. The body attacks (specifically the WBCs) the synovium of the joint. The synovium becomes inflamed and this process is called synovitis. The inflammation of the synovium leads to thickening and the formation of a pannus, which is a layer of vascular fibrous tissue. The pannus will grow so large it will damage the bone and cartilage within the joint. The space in between the joints will disappear and anklyosis will develop, which is the fusion of the bone.

4. A patient with severe rheumatoid arthritis is scheduled for a procedure called an arthrodesis. The nursing student you are precepting asks what type of procedure this is. Your response is:

A. “It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together.”

B. “It is a procedure that involves replacing the joint with an artificial one.”

C. “It is a procedure where the surgeon goes in with a scope and cleans out the affected joint.”

D. “It is a procedure where the synovium is completely removed within the joint, which helps decrease inflammation of the joint.

The answer is A. An arthrodesis (also called joint fusion) is where the affected joint is removed and the bones within it are fused together. Option B describes a joint replacement. Option C is known as a surgical cleaning. Option D is known as a synovectomy.

5. A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While assisting the patient with her morning routine, the patient verbalizes a pain rating of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing interventions can you provide to this patient to help alleviate pain and stiffness? Select-all-that-apply:

A. Exercise the affected joints

B. Assist the patient with a warm shower or bath

C. Perform deep massage therapy to the wrist joints

D. Assist the patient with applying wrist splints

The answers are B and D. During flare-ups of RA the joint should be rested (not exercised) and should not be deep massaged because this can further damage the joint (in addition cause the patient more pain). Heat therapy, like a warm shower or bath, will help alleviate the stiffness. Furthermore, cold therapy can be used to reduce the inflammation along with splinting the affected joints to protect and rest them.

6. You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct?

A. “It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics.”

B. “I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike.”

C. “It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine.”

D. “Physical exercise should be limited to only range of motion exercises to prevent further joint damage.”

The answer is B. During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient’s energy level along with muscle strength and maintain joint health.

7. Disease-modifying antirheumatic drugs (DMARDS) are used to treat rheumatoid arthritis. Select-all-the drugs below that are DMARDS:

A. Dexamethasone (Decadron)

B. Hydroxychloroquine (Plaquenil)

C. Teriparatide (Forteo)

D. Calcitonin

E. Leflunomide (Arava)

F. Methotrexate (Trexall)

The answers are B, E, and F. These are DMARDs that can be prescribed for RA. Option A is a corticosteroid. Option C and D are sometimes prescribed in osteoporosis.

8. A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient’s medication list can cause retinal damage?

A. Hydroxychloroquine (Plaquenil)

B. Lefluomide (Arava)

C. Sulfasalazine (Azulfidine)

D. Methylprednisolone (Medrol)

The answer is A. This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

9. You’re providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient’s overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says “I’m so tired. I can’t even get out of this bed without getting short of breath.” Which finding on the patient’s morning lab work may confirm a complication that can be experienced with rheumatoid arthritis?

A. Potassium 3.2 mEq/L

B. Hemoglobin 7 g/dL

C. Sodium 135 mEq/L

D. WBC count 6,500

The answer is B. Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient’s signs and symptoms above are classic findings in anemia.

10. A physician suspects a patient may have rheumatoid arthritis due to the patient’s presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply:

A. Rheumatoid factor

B. Uric acid level

C. Erythrocyte sedimentation

D. Dexa-Scan

E. X-ray imaging

The answers are A, C, and E. These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis.

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