Ch. 44 PrepU Quiz

Juvenile dermatomyositis (JDMS)

The health care provider is assessing a child and suspects an inflammatory myopathy. The assessment data include muscle weakness and a characteristic rash, primarily involving the skin and muscle. The health care provider would document this as:

Positive anti-DNA antibody test.

Which of the following assessment findings best confirms the diagnosis of systemic lupus erythematosis (SLE)?

Joint stiffness Finger and hand pain Wrist pain Limited joint mobility

Which of the following assessment findings will help the nurse to confirm the diagnosis of rheumatoid arthritis? Select all that apply.

• Vitamin D supplements • Regular exposure to sunlight

Which of the following intervention should the nurse recommend to best minimize the risk of nutritional rickets in an infant whose culture supports long-term breast feeding without the introduction of foods? Select all that apply.

Loss of motion in the spinal column and eventual kyphosis.

Which of the following pathophysiological phenomena would be most indicative of ankylosing spondylitis?

Synovial fluid

Which of the following substances helps maintain a smooth surface in joint cartilage?

Generalized stunted growth can occur.

Which statement is true regarding the development of juvenile idiopathic arthritis?

• Evidence of nail changes • Characteristic skin changes are evident

Which symptoms are required for a diagnosis of psoriatic arthritis? Select all that apply.

Synovial fluid aspiration indicates the presence of monosodium urate crystals.

While reviewing the following diagnostic findings on a group of patients with joint complaints, which finding would be a priority for further investigation and possible medical intervention?

Anemia

A nurse is teaching the patient about extra-articular manifestations of rheumatoid arthritis (RA). Which of the following will the nurse include in the teaching plan?

"Genetic predisposition is very likely."

A patient has been diagnosed with rheumatoid arthritis (RA). Which of the following will the nurse tell the patient about this disorder's etiology?

Raynaud's phenomenon

A patient has been diagnosed with scleroderma. Which of the following assessment findings does the nurse expect?

Assessing the patient's pain and history

A patient presents with arthralgia and arthritis. Which of the following is the priority nursing action?

Muscle-strengthening exercises to support joints

A patient presents with joint pain and suspected rheumatoid arthritis (RA). Which of the following is the appropriate nursing action?

"More women than men are affected by lupus."

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which of the following statements does the nurse is likely to make?

Biologic response modifiers are beneficial in controlling the disease.

A nurse is teaching a patient with psoriatic arthritis about treatment. Which of the following statements should be included?

Immune response

A 16 year-old boy has been diagnosed with ankylosing spondylitis. Which of the following etiologies is responsible for his health problem?

Immune response

A 30-year-old man has been diagnosed with ankylosing spondylitis. Which etiology is responsible for his health problem?

"The worst part of this so far has been learning that there aren't any treatments for scleroderma."

A 36 year-old female who has experienced diverse symptoms for several years has finally had her health problems attributed to scleroderma (systemic sclerosis), and has committed herself to learning as much about the disease as she can. Which of her following statements would her nurse want to correct or clarify?

Paget Disease

A 42-year-old client is admitted to the hospital with severe back pain, intermittent tinnitus, constant headache, and vertigo. He states that the back pain has been a problem for a number of years, but the other symptoms are quite new. Upon further examination, it is noted that he has unexplained hearing loss, and his femur and tibia have begun to bow. What condition does this client most likely have?

Antiplatelet aggregators

A 44 year-old woman who has a longstanding diagnosis of SLE has been able to control her symptoms with lifestyle modifications for several years, but has presented to her care provider due to recent exacerbation. Which of the following pharmacological treatment options is her care provider most likely to rule out first?

the axial skeleton and an abnormal autoimmune response.

A 56-year-old male has been dealing with chronic back pain his entire life. In recent months, the pain has begun to involve his shoulder as well. The client has been subsequently diagnosed with a seronegative spondyloarthropathy. When describing this disease to the client, the nurse should describe the involvement of:

"I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."

A 64 year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the affects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which of the following statements by the client would necessitate further teaching?

• Inflammatory response • Interaction between rheumatoid factor (RF) and IgG • T-cell mediated immune response • Pannus invasion • Destruction of articular cartilage

A 68 year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options.

Dowager hump

A 70-year-old female client tells the health care provider she is concerned because she is getting shorter and her posture is not as good as it used to be. The provider completes an assessment of her spine and notes a loss of height in the vertebral column and kyphosis. This assessment would be recognized as:

Osteoporosis

A 75-year-old Caucasian female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely?

Further testing is needed before a diagnosis of gout can be made.

A client has undergone extensive diagnostic testing following several months of worsening joint pain and reduced range of motion. The client's results indicate hyperuricemia. What is the nurse's best interpretation of this finding?

Serum uric acid levels

A client is experiencing an episode of gout. The nurse recognizes that the condition is a result of:

• Treatment goals • Education • Posture • Physical rest • Therapeutic use of heat and cold

A client newly diagnosed with rheumatoid arthritis is crying and tells the nurse she does not know how to manage the disease. Select the most important information for the nurse to provide. Select all that apply.

"Losing some weight and reducing your alcohol intake will likely be beneficial."

A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client?

Reactive arthritis

A client was diagnosed with Salmonella 1 week ago and is now experiencing joints that are warm, swollen, and tender. The client also reports experiencing fever and weight loss. The health care provider would interpret these manifestations as:

Brisk walking three times per week on a flat surface

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

inhibiting prostaglandin synthesis.

A client with osteoarthritis states that every morning "it gets harder and harder to loosen up". The client's main therapy to this point is the use of over-the-counter nonsteroidal anti-inflammatories (NSAIDs). These drugs reduce the client's pain by:

The client reports being "really sensitive to sunshine." The client states that she is highly prone to mouth sores. The client is known to have arthritis in her knees. The client has elevated creatinine and blood urea nitrogen (BUN) levels.

A client's presentation and recent health history are suggestive of systemic lupus erythematosus (SLE). Which findings would support this diagnosis? Select all that apply.

Intestinal absorption slows as a natural aging process

A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that:

Fever

A nurse is caring for a child with systemic-onset juvenile idiopathic arthritis (JIA). On which of following symptoms should the nurse focus?

Systemic lupus erythematosus

A nurse is caring for a patient admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which of the following disease processes?

Hyperuricemia.

A nurse is caring for a patient undergoing antineoplastic chemotherapy for acute leukemia. Which of these diagnostic studies does the nurse monitor to detect the consequences of the rapid lysis of cancer cells?

Ulcers of the lower extremities

A nurse is caring for a patient who has developed vasculitis as a result of a rheumatology disorder. Which of the following factors does the nurse expect to uncover in assessing this patient?

"To prevent cartilage atrophy, slowly and gradually resume exercising."

A nurse is caring for a patient with a fractured elbow. Which of the following instructions is important to give the patient to prevent cartilage degeneration while the elbow is immobilized?

Kyphosis

A nurse is caring for a patient with ankylosing spondylitis. For which of these associated symptoms does the nurse assess?

Integumentary assessment

A nurse is caring for a patient with discoid lupus. Which of the following systems does the nurse set as a priority for the nursing assessment?

RA has an autoimmune and genetic predisposition.

A nurse is caring for a patient with rheumatoid arthritis (RA) who states she "caught" this from her mother. Which of the following statements is the correct explanation of how this type of arthritis develops?

"Extra-articular manifestations may include anemia and deformities of the affected joints."

A patient recently diagnosed with rheumatoid arthritis (RA) tells the nurse she is glad there is nothing "really wrong with her" but some joint swelling. Which of the following information should the nurse tell the patient about RA?

• Assist the client to ambulate in the morning. • Medicate the client for muscle spasms. Provide nonsteroidal anti-inflammatory medications.

A patient who has had ankylosing spondylitis for several years is admitted to the hospital. Which of the following interventions will best assist this patient while in the hospital? (Select all that apply.)

• The client has a "butterfly rash" on her nose and cheeks. • She complains of intermittent joint pain. • The client has been hospitalized twice in the past for pleural effusions. • Blood work indicates low red cells, white cells and platelets.

A physician is attempting a differential diagnosis of a 30 year-old female who is suspected of having systemic lupus erythematosus (SLE). Which of the following aspects of the physician's assessment and the client's history would be considered potentially indicative of SLE? Select all that apply.

• Fatigue • Loss of appetite • Aching • Stiffness

A rheumatology nurse is teaching a patient about extra-articular signs and symptoms of rheumatoid arthritis (RA). Which of the following does the nurse include in the teaching session? Select all that apply.

Etanercept

A seronegative inflammatory arthropathy is psoriatic arthritis. What drug has been found to be beneficial in controlling both the psoriasis and the arthritis in these clients?

Aluminum-sparing antacids

Adult rickets can result from several disorders. It can also have a pharmacologic basis for its onset. Which medication can cause rickets in an adult?

weight and nutritional status.

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should recognize the need to monitor the client's:

Serum phosphorus level of 0.55 mmol/l (normal 1.0 to 1.5 mmol/l) Serum calcium level of 1.4 mmol/l (normal 2.1 to 2.6 mmol/l) 25-hydroxy vitamin D level of 10.1 nmol/l (normal 19.4 to 137 nmol/l)

An older adult's primary care provider has deemed the client to be at a high risk for developing osteomalacia. What current laboratory findings would support this conclusion? Select all that apply.

Worse when lying

Ankylosing spondylitis is a disease that typically manifests in late adolescence and early adulthood. What is the characteristic of the pain in ankylosing spondylitis?

Spine

The health care provider is assessing a client with a history of ankylosing spondylitis, to note progression of the disease. The most important area for the provider to assess would be:

Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself.

Due to her progressing osteoarthritis (OA), an 80 year-old woman is no longer able to perform her activities of daily living without assistance. Which of the following phenomena most likely underlies the woman's situation?

Corticosteroids

Juvenile dermatomyositis is a chronic inflammatory myopathy that commonly manifests systemically. What is the treatment of choice for this myopathy?

"Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."

Following a progressive onset of fatigue, aching and joint stiffness over the last two years, a 69 year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which of the following teaching points should his primary care physician include during the office visit in which this diagnosis is communicated to the client?

Polymalgia rheumatica

Giant cell arteritis is a comorbid condition of which of the following?

Finding of monosodium urate crystals in the synovial fluid

Gout, or gouty arthritis, cannot be diagnosed on the basis of hyperuricemia. What is the diagnostic criterion for gout?

Increasing dietary consumption of vitamin D

In a patient diagnosed with osteomalacia, which of the following would be recommended to aid with improvement of the condition?

False

In general, children are not affected by rheumatic diseases, such as arthritis, that occur in adults.

Neutrophils, macrophages, and lymphocytes arrive Immune complexes phagocytized, releasing lysosomal enzymes Destructive changes in joint cartilage Inflammatory response Reactive hyperplasia of synovial cells and subsynovial tissues Vasodilation and joint swelling

Joint destruction in rheumatoid arthritis occurs by an obscure process. The cellular changes, however, have been documented. Place the process in the correct order.

Vitamin D-rich diet and exposure to midday sun

Osteomalacia is a bone disease caused by one of two reasons: inadequate calcium absorption or phosphate deficiency. In the elderly, what is the least expensive and most effective long-term treatment for osteomalacia?

Dual-energy x-ray absorptiometry (DXA or DEXA) of the spine and hip

Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?

false

Rheumatoid arthritis is a chronic autoimmune system disease that affects a single joint.

The formation of autoantibodies and immune complexes (type III hypersensitivity)

Select the statement that best describes systemic lupus erythematosus (SLE). SLE is characterized by which of the following?

Bisphosphonates Selective estrogen receptor modulators (SERMs) Calcitonin RANKL inhibitor denosumab Recombinant parathyroid hormone

The health care provider has evaluated a client diagnosed with osteoporosis and determined that pharmacological therapy will benefit the client. Select the medication options that the provider may prescribe. Select all that apply.

Arthritis

Systemic lupus erythematosus has been called the great imitator because it can affect many different body systems. What is among the most commonly occurring symptoms in the early stages of SLE?

spine

The health care provider is assessing a client with a history of ankylosing spondylitis, to note progression of the disease. The most important area for the provider to assess would be:

History and physical examination, x-ray studies, and laboratory findings that exclude other diseases

The client with a suspected diagnosis of osteoarthritis asks the health care provider how the diagnosis will be confirmed. The best response would be:

Sleeplessness

The elderly population needs special consideration in the treatment of the arthritic diseases. The NSAIDs, a first-line group of drugs used in the general population for arthritic diseases, may not be well tolerated by the elderly. What side effects of NSAIDs might be seen in the elderly?

A T-cell mediated response to an immunologic trigger, such as a microbial agent

The health care provider has determined that a client has developed rheumatoid arthritis. The provider is aware that the client may experience joint inflammation that involves of immunologic mediation triggered by:

Raynaud's phenomenon

The nurse assessing a patient with scleroderma with CREST variant would include an assessment for which of the following?

Rickets

The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for which of the following?

"Men are more likely to have osteoarthritis than women."

The nurse determines further teaching is necessary when a client diagnosed with osteoarthritis states:

"When I have an exacerbation of my symptoms, a glass of red wine will be helpful."

The nurse determines that additional patient education is needed when a patient with gout makes which one of the following statements?

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client states:

Lower back pain

The nurse is assessing a patient with ankylosing spondylitis (AS). Which of the following does the nurse expect to find?

Erythema Swelling Warmth Tenderness

The nurse is assessing a patient with rheumatoid arthritis. Which of the following would the nurse expect to find? Select all that apply.

"OA is a disease of the weight-bearing joints."

The nurse is caring for a patient diagnosed with osteoarthritis (OA). Which of the following does the nurse teach the patient about the disease?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse is caring for a patient with newly diagnosed systemic lupus erythematosus (SLE). Which of the following over-the-counter medications does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis?

Proteinuria Periorbital edema

The nurse is caring for a patient with systemic lupus erythematosus who has developed interstitial nephritis. Which of the following assessment findings is consistent with lupus nephritis? Select all that apply.

Smoking, high protein diet, alcoholism, and excessive caffeine intake.

The nurse is conducting a community education class on prevention of osteoporosis. The nurse concludes that the participants are understanding the information when the participants identify which of the following as risk factors? Select all that apply

Obesity is a strong risk factor for developing OA.

The nurse is conducting a health promotion class on osteoarthitis (OA). Which of the following statements should the nurse include?

bone density testing on a scheduled basis.

The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for:

The injections will be given only 3-4 times per year because they can increase joint destruction.

The nurse is providing patient education related to intra-articular corticosteroid injections. Which of the following should the nurse include?

A 60-year-old female taking prednisone for asthma

The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.

Increasing dietary consumption of vitamin D

The nurse is teaching a client diagnosed with osteomalacia about treatments to improve the condition. The best information for the nurse to provide would be:

Vascular granulation tissue that destroys cartilage and bone

The nurse is teaching a patient with rheumatoid arthritis about pannus, which develops in the affected joint area. Which of the following does the nurse include to describe pannus?

"Children can be affected with almost all of the rheumatic diseases that occur in adults."

The parents of a child diagnosed with rheumatic disease are shocked by the diagnosis and tell the nurse that they did not think children could acquire the disease. The best response would be:

TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL functions.

The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a rheumatoid arthritis patient. Which of the following statements is accurate about the advantages of using a TNF inhibitor?

The woman complains of aching and morning stiffness in her neck, shoulder and pelvis.

Though the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82 year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem?

Elevated anti-nuclear antibodies (ANA)

Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?

Juvenile dermatomyositis

Which disease presents with an inflammatory myopathy primarily involving skin and muscle with a characteristic rash?

• Rheumatoid arthritis • Postraumatic disorders • Metabolic disorders • Collagen disorders

Which of the following are potential causes of osteoarthritis? (Select all that apply.)

• Joint involvement • Serology • Acute phase reactants • Duration of symptoms

What are the criteria categories required for the diagnosis of rheumatoid arthritis (RA)? Select all that apply.

Adalimumab

When a nurse is administering medications to a patient with rheumatoid arthritis (RA), which of the following medications interferes with tumor necrosis factor (TNF)-alpha?

• Aching diffuse pain in the involved area • Grating sensation palpated upon movement • Presence of Heberden nodes

When a nurse is assessing a patient with osteoarthritis, which of the following does the nurse note are consistent with this disorder? Select all that apply.

obesity

When a nurse is assessing a patient with osteoarthritis, which of the following factors poses a risk factor for the disease?

Avoiding ultraviolet light (UV)

When a nurse is caring for a patient newly diagnosed with systemic lupus erythematosus (SLE), which of these behaviors will best help prevent exacerbations of the disease?

Autoimmune process

When a nurse is caring for a patient who has systemic lupus erythematosis (SLE), which of the following causes the disease?

• "Corticosteroids do not prevent joint destruction." • "Pain is relieved with use of corticosteroid medications." • "These drugs are for short-term use."

When administering a corticosteroid to a patient with rheumatoid arthritis, a nurse includes which of the following in educating the patient about the medication? Select all that apply.

• Headaches • Intermittent tinnitus • Vertigo • Hearing loss

When assessing a patient diagnosed with Paget disease focused in the skull, the nurse should anticipate which of the following findings?

• Redness and swelling of the affected joint • Pain and swelling in one joint • Intake of alcohol

When assessing a patient with gout, for which of these signs and symptoms does the nurse assess? Select all that apply.

Flat with one pillow

When caring for a patient with ankylosing spondylitis, in which position does the nurse place the patient for sleep?

Gentle exercise

When caring for a patient with ankylosing spondylitis, the nurse tells the patient that stiffness may be relieved by which of the following interventions?

"Try to balance your rest and exercise." "Using heat or cold to relieve pain may be helpful." "Losing weight or maintaining your ideal weight reduces stress on your joints." "A walker may be helpful to avoid excess pressure on your hips."

When planning care for the client with severe osteoarthritis (OA) of the hip, the nurse includes which of the following in a teaching session with the patient?

Elderly individuals Older women Obese people

When teaching a community education class on osteoarthritis (OA), the nurse should include which of the following in discussing which individuals are at risk for this problem? Select all that apply.

Risk for falls

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which of the following important differences when caring for the older adult?

Metatarsals Instep Heel

When teaching a patient about areas of the body typically affected by gout, the nurse should include which of the following areas? Select all that apply.

Ultraviolet light (UV)

When teaching a patient recently diagnosed with systemic lupus erythematosus (SLE), which of the following does the nurse teach the client to avoid to prevent exacerbations?

Autologous antibodies

When teaching a patient with rheumatoid arthritis (RA), which of the following factors does the nurse explain is an underlying cause of this disease?

Aspiration, risk for related to swallowing impairments.

When working with a patient with diffuse scleroderma who is exhibiting a 'stone face' expression, the nurse should consider which of the following to be a priority nursing diagnosis for this patient?