Ch. 64 - Arthritis & Connective Tissue Diseases

The nurse should teach the patient with ankylosing spondylitis the importance of... a. regularly exercising and maintaining proper posture b. avoiding extremes in environmental temperatures c. maintaining patient's usual physical activity during flares d. applying hot and cool compresses for relief of local symptoms

a. regularly exercising and maintaining proper posture Rationale: Patients with ankylosing spondylitis (AS) should exercise after pain and stiffness are managed. Postural control is important for minimizing spinal deformity. The exercise regimen should include back, neck, and chest stretches. Teach the patient with AS about regular exercise and attention to posture, local moist-heat applications, and knowledgeable use of drugs. Discourage excessive physical exertion during periods of active flare-up of the disease. Proper positioning at rest is essential. The mattress should be firm and the patient should sleep on the back with a flat pillow, avoiding positions that encourage flexion deformity. Postural training emphasizes avoiding spinal flexion (e.g., leaning over a desk), heavy lifting, and prolonged walking, standing, or sitting.

Teach the patient with fibromyalgia the importance of limiting intake of which foods? (select all that apply) a. sugar b. alcohol c. caffeine d. red meat c. root vegetables

a. sugar b. alcohol c. caffeine Rationale: Dietitians often urge patients with fibromyalgia to limit their intake of sugar, caffeine, and alcohol because these substances have been shown to be muscle irritants.

When administering medications to the patietn with chronic gout, the nurse would recognize which drug is used as a treatment for this disease? a. Colchicine b. Febuxostat c. Sulfasalazine d. Cyclosporine

b. Febuxostat Rationale: Febuxostat (Uloric), a selective inhibitor of xanthine oxidase, is given for long-term management of hyperuricemia in persons with chronic gout. An acute episode of gout is treated with colchicine and nonsteroidal antiinflammatory drugs (NSAIDs).

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes... a. are often red, swollen, and tender b. indicate osteophyte formation at the PIP joints c. are the result of pannus formation at the DIP joints d. occur from deterioration of cartilage by proteolytic enzymes

b. indicate osteophyte formation at the PIP joints Rationale: Bouchard's nodes are bony deformities of the proximal interphalangeal joints that indicate osteophyte formation and loss of joint space in osteoarthritis.

A patient with rheumatoid arthritis is experiencing articular involvement. The nurse recognizes these characteristic changes include... (select all that apply) a. bamboo-shaped fingers b. metatarsal head dislocation in feet c. noninflammatory pain in large joints d. asymmetric involvement of small joints e. morning stiffness lasting 60 minutes or more

b. metatarsal head disclocation in feet e. morning stiffness lasting 60 minutes or more Rationale: Morning stiffness may last from 60 minutes to several hours or more, depending on disease activity. Metatarsal head dislocation and subluxation in the feet may cause pain and walking disability. Joint symptoms occur symmetrically and frequently affect the small joints of the hands (proximal interphalangeal [PIP] and metacarpophalangeal [MCP] joints) and feet (metatarsophalangeal [MTP] joints). Larger peripheral joints such as the wrists, elbows, shoulders, knees, hips, ankles, and jaw may also be involved. Rheumatoid arthritis (RA) is an inflammatory disorder. In early disease, the fingers may become spindle-shaped from synovial hypertrophy and thickening of the joint capsule.

In teaching a patient with Sjogren's syndrome about drug therapy for this disorder, the nurse includes instruction on use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis) Rationale: Cyclosporine (Restasis) ophthalmic drops can be used to treat the chronic dry eye associated with Sjögren's syndrome.

In teaching a patient with SLE about the disorder, the nurse knows the pathophysiology of SLE includes... a. circulating immune complexes formed from IgG autoantibodies reacting with IgG b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles d. the production of a variety of autoantibodies directed against components of the cell nucleus

d. the production of a variety of autoantibodies directed against components of the cell nucleus Rationale: Systemic lupus erythematosus (SLE) is marked by production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions (antinuclear antibodies [ANA]) are typically directed against constituents of the cell nucleus, especially DNA.