CH 50 Disorders of Musculoskeletal Function: Rheumatic Disorders

The nurse is creating a teaching plan on self-management for a client with moderate rheumatoid arthritis. What should the nurse include in the teaching plan? Select all that apply.

- Use of heat or cold on joints - Use of assistive devices - Techniques to reduce joint use

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 phenomenon most likely underlies the woman's situation?

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

An 8-year-old child has been diagnosed with juvenile idiopathic arthritis (JIA). The parents ask the nurse about the prognosis for this condition. What is the nurse's best response?

The prognosis is dependent on the type of JIA with which your child has been diagnosed.

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?

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

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 effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which statement by the client would necessitate further teaching?

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

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 teaching point should his primary care physician include during the office visit in which this diagnosis is communicated to the client?

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

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 statement would her nurse want to correct or clarify?

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

A client with rheumatoid arthritis ha been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory result(s) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply.

- Absolute neutrophil count of 500/uL (0.50x10^9/L) - Red blood cell count of 8.0x10^6/uL (8.0x10^12/L) - Platelet count 10,000/uL (100x10^9/L)

A male client has just been diagnosed with hyperuricemia following multiple flare-ups of his metatarsophalangeal joint associated with severe pain and swelling that is affecting his sleep. The nurse should anticipate that which medications may be prescribed for this client? Select all that apply.

- Allopurinol to decrease uric acid levels. - Sulfinpyrazone to increase excretion of urate.

The nurse is planning care for a client with ankylosing spondylitis (AS). Which interventions should the nurse include in the plan of care? Select all that apply.

- Application of heat to involved joints - Physiotherapy consult - Administration of analgesics

A health care provider is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which assessment and history findings correlate with SLE? Select all that apply.

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

A client returns to the clinic for review of previous laboratory values. A diagnose of ankylosing spondylitis (AS) is made, based on laboratory results and manifestations of low back pain which worsens when resting, thigh like that of sciatica, and morning stiffness. Which educational teaching would be appropriate for the nurse to provide? Select all that apply.

- Muscle-strengthening exercises for extensor muscle group - Proper posture - Use of firm mattress with one small pillow

When educating the client with ankylosing spondylitis, the nurse should emphasize which treatment interventions? Select all that apply.

- Try using the heating pad prior to exercise to help stretching and improve movement. - Encourage sleeping supine on an extra firm mattress if possible.

During assessment of a client with systemic lupus erythematous (SLE), the nurse hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the nurse document in the medical records and report to the health care provider?

Pericarditis

Which individual is most likely to develop a form of reactive arthritis?

A 24-year-old male who completed treatment for a chlamydia infection 1 year ago.

A new client arrives at the clinic. The physician is suspecting the client may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and history of pleural effusions. The nurse should anticipate which diagnostic test will be a priority to facilitate with the diagnosis?

Anti-DNA antibody test

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

Immune response

Which pathophysiologic phenomenon would be most indicative of ankylosing spondylitis?

Loss of motion in the spinal column and eventual kyphosis.

While speaking to a senior citizen club about osteoarthritis (OA), which facts are accurate to share?

Obesity in women has been correlated to having OA in the knees.

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

Risk for aspiration related to swallowing impairments.

A child has just been diagnosed with systemic lupus erythematosus (SLE). Which assessment finding would be considered the most accurate prognostic indicator of the extent/seriousness of the disease?

Rust/blood-colored urine.

A nurse is working on a health care cost analysis related to total knee arthroplasty in the treatment of osteoarthritis. What should the nurse cite as a priority reason to reduce surgery wait times for clients requiring joint replacement?

Stress placed on joints while awaiting surgery can increase the need for additional surgeries.

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

Synovial fluid aspiration indicates the presence of monosodium urate crystals.

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

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

A client being investigated for systemic lupus erythematosus (SLE) has an elevated antinuclear antibody result and asks the nurse what this means. What is the nurse's best response?

This is a nonspecific marker for autoimmune activity, so you will require additional tests.