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Quizzes > Health & Medicine > Diseases & Conditions

NCLEX Rheumatoid Arthritis Questions: Take the 10-Question Quiz!

Conquer NCLEX questions on rheumatoid arthritis and prove your RA expertise!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art showing inflamed hand joints and quiz text for a free 10 question RA NCLEX skills test on a sky blue background

Use this 10-question quiz to practice rheumatoid arthritis NCLEX questions and spot gaps before the exam. You'll work through key points on assessment, diagnosis, meds, and nursing care. For more focused review, try this RA practice quiz after you play.

Which of the following best describes rheumatoid arthritis?
A metabolic bone disorder
An infectious arthritis caused by bacteria
An autoimmune inflammatory disorder affecting synovial joints
A degenerative cartilage disease
Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the immune system attacks synovial membranes, leading to inflammation and joint destruction. It contrasts with osteoarthritis, which is primarily a degenerative cartilage disease. RA often presents symmetrically in small joints and may involve systemic symptoms.
How long does morning stiffness typically last in rheumatoid arthritis?
5 to 10 minutes
Less than 15 minutes
30 to 60 minutes
More than 1 hour
Morning stiffness lasting longer than one hour is characteristic of rheumatoid arthritis due to prolonged synovial inflammation. Shorter durations are more typical of osteoarthritis. This prolonged stiffness helps differentiate RA from other joint disorders.
Which pattern of joint involvement is characteristic of rheumatoid arthritis?
Axial spine involvement
Symmetric small joints of hands and wrists
Asymmetric weight-bearing joints
Distal interphalangeal joints
RA classically presents as a symmetric arthritis affecting small joints of the hands and wrists. Distal interphalangeal joints are more commonly involved in osteoarthritis. Axial spine involvement is uncommon in RA except in the cervical spine.
Which physical deformity is most characteristic of advanced rheumatoid arthritis?
Swan-neck deformity
Boutonniere deformity
Bouchard's nodes
Heberden's nodes
Swan-neck deformity, with hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint, is a hallmark of chronic RA joint damage. Heberden's and Bouchard's nodes are seen in osteoarthritis. Boutonniere deformity is less common than swan-neck in RA.
Which laboratory test is traditionally used to monitor general inflammation in rheumatoid arthritis?
Erythrocyte sedimentation rate
Anti-CCP antibody
Rheumatoid factor
Antinuclear antibody
The erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation often elevated in active RA. While rheumatoid factor and anti-CCP help with diagnosis, ESR and CRP are used to track disease activity. ANA is not specific for RA.
Which medication class provides the fastest symptomatic pain relief in rheumatoid arthritis?
Disease-modifying antirheumatic drugs (DMARDs)
Sulfasalazine
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Gold salts
NSAIDs reduce inflammation and pain rapidly but do not alter the underlying disease process. DMARDs and other agents take weeks to months to show benefit. Sulfasalazine and gold salts are DMARDs with slower onset.
Which class of drugs is considered first-line disease-modifying therapy in early rheumatoid arthritis?
Biologic agents
NSAIDs
Disease-modifying antirheumatic drugs (DMARDs)
Corticosteroids
Conventional DMARDs, such as methotrexate, are the cornerstone of early RA management to slow disease progression. NSAIDs and corticosteroids provide symptomatic relief but do not alter long-term outcomes. Biologics are typically added if response to DMARDs is inadequate.
Which self-care intervention can help reduce morning stiffness in rheumatoid arthritis?
Hot shower or warm compress before activity
Cold packs applied before rising
Ultrasound therapy first thing in the morning
Vigorous full-body exercise immediately upon waking
Applying warmth via a hot shower or warm compress increases joint blood flow and reduces stiffness. Cold therapy is more helpful after activity to reduce inflammation. Vigorous exercise may aggravate inflamed joints, and ultrasound therapy is not practical for daily home use.
Methotrexate is effective in rheumatoid arthritis primarily by what mechanism?
Tumor necrosis factor-alpha inhibition
Folate antagonist inhibiting dihydrofolate reductase
Interleukin-6 receptor blockade
T-cell costimulation inhibition
Methotrexate inhibits dihydrofolate reductase, reducing folate availability and suppressing DNA synthesis in rapidly dividing immune cells. This mechanism reduces synovial inflammation in RA. TNF inhibitors and IL-6 blockers are used but have different targets.
Hydroxychloroquine therapy for rheumatoid arthritis requires regular monitoring of which organ system due to toxicity risk?
Renal function
Ocular health
Hepatic enzymes
Gastrointestinal mucosa
Hydroxychloroquine can cause retinopathy with prolonged use, so baseline and periodic ophthalmologic exams are essential. Renal and hepatic monitoring are less critical for this drug. GI side effects are possible but not the primary concern.
Which biologic agent targets tumor necrosis factor-alpha in rheumatoid arthritis treatment?
Tocilizumab
Rituximab
Anakinra
Etanercept
Etanercept is a fusion protein that binds TNF-alpha, preventing its inflammatory effects in RA. Rituximab targets CD20 on B cells; tocilizumab blocks IL-6 receptors; anakinra blocks IL-1.
Which laboratory test should be monitored monthly in a patient receiving methotrexate for RA?
Complete blood count
Blood glucose
Thyroid-stimulating hormone
Serum calcium
Methotrexate can cause bone marrow suppression, so monthly complete blood counts are recommended. Liver function tests are also monitored regularly. Blood glucose, calcium, and TSH are not directly affected by methotrexate therapy.
For an acute RA flare, which corticosteroid regimen is appropriate to minimize long-term side effects?
Low-dose oral prednisone for a short duration
Intramuscular triamcinolone monthly
Daily intra-articular steroid injections in all affected joints
High-dose oral prednisone for 6 months
A short course of low-dose oral prednisone helps control flares while reducing risks of osteoporosis, weight gain, and adrenal suppression. Long-term high-dose therapy is avoided. Intramuscular or multiple intra-articular injections are reserved for specific cases.
Which combination of findings suggests Felty's syndrome in a patient with longstanding RA?
Hepatomegaly and anemia
Splenomegaly and neutropenia
Leukocytosis and pulmonary fibrosis
Thrombocytosis and lymphadenopathy
Felty's syndrome is characterized by the triad of RA, splenomegaly, and neutropenia. It increases infection risk. Hepatomegaly with anemia and other blood count changes may occur but are not diagnostic.
Which nonpharmacologic intervention is recommended to preserve joint function in RA?
Aquatic exercise
High-impact aerobics
Prolonged immobilization
Heavy weightlifting
Aquatic exercise provides low-impact resistance that maintains muscle strength and joint mobility without overstressing inflamed joints. High-impact or heavy weightlifting can exacerbate joint damage. Prolonged immobilization leads to stiffness and muscle atrophy.
Why is folinic acid given with methotrexate in RA therapy?
To increase renal clearance of methotrexate
To prevent bone marrow suppression and mucositis
To enhance methotrexate's anti-inflammatory effect
To reduce hepatic enzyme elevations
Folinic acid (leucovorin) rescues healthy cells by bypassing the inhibited dihydrofolate reductase, reducing methotrexate-induced mucositis and bone marrow suppression. It does not enhance anti-inflammatory effects directly. Renal clearance and liver enzyme effects are not significantly altered.
Leflunomide treats rheumatoid arthritis primarily by inhibiting which process?
B-cell antibody class switching
Pyrimidine synthesis
Leukotriene production
T-cell receptor signaling
Leflunomide inhibits dihydroorotate dehydrogenase, an enzyme in pyrimidine synthesis, leading to reduced lymphocyte proliferation. This targeted mechanism helps control RA inflammation. It does not directly affect leukotriene synthesis or antibody class switching.
Prior to initiating a TNF-alpha inhibitor, patients should be screened for which latent infection?
Human immunodeficiency virus
Hepatitis C
Cytomegalovirus
Tuberculosis
TNF-alpha inhibitors increase the risk of reactivating latent tuberculosis, so a PPD or interferon-gamma release assay is required before therapy. HIV and hepatitis screening may be considered but are not mandatory for TNF inhibitors. CMV reactivation is not a primary concern.
Rituximab, used in refractory RA, acts by depleting which cell type?
CD8+ T lymphocytes
Natural killer cells
CD4+ T lymphocytes
CD20+ B lymphocytes
Rituximab is a monoclonal antibody targeting CD20 on B cells, leading to B-cell depletion and reduced autoantibody production. It does not directly target T cells or NK cells. This mechanism is useful in RA patients who fail to respond to TNF inhibitors.
Which deformity involves flexion at the proximal interphalangeal joint and hyperextension at the distal interphalangeal joint in RA?
Heberden's deformity
Boutonniere deformity
Swan-neck deformity
Mallet finger
Boutonniere deformity is characterized by flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint due to extensor tendon injury. Swan-neck is the opposite pattern. Heberden's nodes are in OA, and mallet finger is a different tendon injury.
Which ocular complication is most closely associated with rheumatoid arthritis?
Cataract formation
Glaucoma
Scleritis
Anterior uveitis
Scleritis, inflammation of the sclera, is a serious extra-articular manifestation of RA and can threaten vision. Anterior uveitis is more common in other autoimmune diseases. Cataracts and glaucoma are not directly caused by RA but may develop from steroid therapy.
Which extra-articular manifestation suggests rheumatoid vasculitis?
Rheumatoid nodules
Anemia of chronic disease
Osteoporosis
Skin ulcerations and mononeuritis multiplex
Rheumatoid vasculitis involves small- and medium-sized vessels, leading to skin ulcerations and neuropathies such as mononeuritis multiplex. Rheumatoid nodules and anemia of chronic disease are common RA findings but not indicative of vasculitis.
Which radiographic finding is classic in established rheumatoid arthritis?
Osteophyte formation
Bone cysts
Subchondral sclerosis
Joint space narrowing with marginal erosions
RA typically shows symmetrical joint space narrowing and marginal bone erosions due to pannus formation. Osteophytes and subchondral sclerosis are osteoarthritis features. Bone cysts are less characteristic than erosions.
What does CCP stand for in the anti-CCP antibody test for RA?
Cyclical collagen peptide
Citrate calcium protein
Cellular cytoplasmic peptide
Cyclic citrullinated peptide
Anti-CCP antibodies target cyclic citrullinated peptides and are highly specific for RA. The presence of anti-CCP can predict disease severity. Other peptide names are incorrect expansions.
Before starting azathioprine for RA, testing for which enzyme deficiency is recommended to reduce the risk of severe toxicity?
Dihydropyrimidine dehydrogenase
Thiopurine methyltransferase (TPMT)
Methylenetetrahydrofolate reductase
Glucose-6-phosphate dehydrogenase
Azathioprine is metabolized by TPMT, and deficiency in this enzyme can lead to accumulation of toxic metabolites and severe bone marrow suppression. Screening for TPMT activity helps dose adjustment and prevents life-threatening cytopenias. Other enzyme deficiencies are not primary concerns with azathioprine.
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Study Outcomes

  1. Identify Clinical Manifestations of RA -

    Recognize key signs and symptoms of rheumatoid arthritis, including joint stiffness, swelling, and systemic features. This outcome ensures accurate identification of RA presentations on exam scenarios.

  2. Interpret Diagnostic Data -

    Analyze laboratory results and imaging findings such as rheumatoid factor, anti-CCP antibodies, and radiographic joint changes. This skill enhances your ability to confirm RA diagnoses on the NCLEX.

  3. Evaluate Pharmacologic Interventions -

    Assess the appropriate use of DMARDs, NSAIDs, corticosteroids, and biologics in managing RA. You will learn to prioritize medication choices based on patient presentation and side effect profiles.

  4. Apply Nursing Interventions for RA Management -

    Implement evidence-based nursing actions to reduce pain, maintain joint function, and monitor for complications. This outcome equips you to carry out effective care plans for RA patients.

  5. Educate Patients on Self-Care Strategies -

    Develop patient teaching plans that cover joint protection techniques, exercise recommendations, and medication adherence. This skill fosters improved long-term outcomes and patient empowerment.

Cheat Sheet

  1. Pathophysiology & Clinical Presentation -

    Understanding RA's autoimmune attack on synovial joints is key for rheumatoid arthritis nclex questions. Patients typically report symmetrical joint pain with morning stiffness lasting over an hour; remember the MORSE mnemonic (Morning stiffness, Oligoarthritis, Rheumatoid nodules, Systemic signs, Extra-articular).

  2. Diagnostic Criteria & Lab Markers -

    In nclex rheumatoid arthritis questions, recalling lab values improves accuracy: rheumatoid factor is positive in about 70% of cases, while anti-CCP antibodies offer 90% specificity. Elevated ESR and CRP support active inflammation, and the ACR/EULAR 2010 criteria assign points for joint involvement, serology, acute phase reactants, and symptom duration.

  3. Pharmacologic Management with DMARDs and Biologics -

    For ra nclex questions, remember Methotrexate is the first-line DMARD and must be paired with folic acid to minimize cytotoxic effects, with monthly CBC and LFT monitoring. NSAIDs and low-dose corticosteroids provide symptomatic relief, while biologic agents like TNF inhibitors (etanercept, adalimumab) target the underlying immune cascade.

  4. Nursing Interventions & Joint Protection -

    Effective nursing care in NCLEX questions rheumatoid arthritis scenarios includes pacing activities, using assistive devices, and alternating heat or cold therapy to reduce pain and swelling. Encourage range-of-motion exercises and occupational therapy referrals to maintain function and prevent joint deformity.

  5. Patient Education & Safety Considerations -

    When studying ra nclex questions, emphasize infection prevention due to immunosuppression: ensure up-to-date vaccinations and teach strict hand hygiene. Educate on potential methotrexate teratogenicity, the importance of regular lab monitoring, and prompt reporting of signs like fever or sore throat.

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