Chapter 34- Rheumatic Disorders

A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening?

Lung sounds are diminished in the apical area.

A client cringes in pain when the nurse places the stethoscope over the upper back to assess breath sounds. On which condition will the nurse focus when assessing this client?

Fibromyalgia

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?

minimizing damage

The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan?

t'ai chi

A client seeks medical attention for the development of red scaly lesions over the surface of both knees. Which question will the nurse ask to determine if the client is experiencing polymyositis?

"Have you had a change in the strength of your legs?"

An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client?

"Look at the cane as maintaining your independence."

A client with early stage rheumatoid arthritis asks the nurse what to do to help ease the symptoms of the disease. What would be the best response by the nurse?

"The health care provider could prescribe anti-inflammatory drugs."

Which client is most likely to develop systemic lupus erythematosus (SLE)?

A 27-year-old Black female

Which of the following refers to fixation of a joint?

Ankylosis

Which term refers to fixation or immobility of a joint?

Ankylosis

The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful?

Clients may develop Heberden nodes.

Which finding is consistent with the diagnosis of rheumatoid arthritis?

Cloudy synovial fluid

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)

Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?

It is suggestive of rheumatoid arthritis.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?

age

Which drug is not used in the treatment of rheumatoid arthritis?

allopurinol

A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects?

aspirin

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining?

celecoxib

A client is being placed on a purine-restricted diet. What foods will the nurse include in the client's diet plan?

dairy products

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?

hydroxychloroquine

The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. What should the nurse include in the teaching plan?

Protect the hands and feet from cold.

During a home visit, the nurse notes that a client with polymyositis has difficulty combing the hair and putting on socks and shoes. Which referrals will the nurse recommend for this client? Select all that apply.

Physical therapy Occupational therapy

A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

Heberden nodes

A client is experiencing symptoms of giant cell arteritis (GCA). Which action will be taken to definitively diagnose this condition?

Obtain the results of a temporal artery biopsy.

The nurse is assessing a client with rheumatoid arthritis. The nurse knows that prolonged inflammation can cause compression of nerves. Which symptoms would accompany this level of involvement?

Paresthesias of both hands

A client with systemic lupus erythematosus is prescribed belimumab. For which reason will the nurse question giving the client this medication?

Received a live vaccination a week ago

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply.

Weight loss Decreasing alcohol intake Avoiding purine-rich foods

A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply.

Use relaxation exercises. Establish a set time to sleep every night. Avoid caffeine before bedtime. Create a quiet sleep environment.

A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis?

Boney erosions on x-ray

The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis?

Clients may develop Heberden nodes.

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment

Joint pain, crepitus, Heberden's nodes

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment?

Joint pain, crepitus, Heberden's nodes

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)?

Limited passive movement

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?

Muscle biopsy

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

Scleroderma

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?

Sicca syndrome

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply.

Support joints with splints and pillows. Provide diversional activities. Provide opportunities for the client to verbalize feelings.

The nurse is gathering objective data for a client at the clinic reporting arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

Swan neck deformity

Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?

Systemic lupus erythematous (SLE)

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication?

Take the medication with food to avoid stomach upset.

The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse?

The fluid will be milky, cloudy, and dark yellow.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?

colchicine

A client with Sjogren's syndrome is experiencing xerostomia. Which information will the nurse provide to help alleviate this client's problem? Select all that apply.

Avoid smoking Eat small frequent meals Omit spicy and salty foods Limit the intake of alcohol

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. What medication might be prescribed?

Etanercept

The nurse is creating a plan to assist an older adult to manage rheumatoid arthritis. Which areas will the nurse include in this plan? Select all that apply.

Exercise Medication Psychological support Modification of daily activities

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Widespread chronic pain

A client has been living with rheumatoid arthritis (RA) for several years. Which diagnostic test will the nurse prepare the client for to determine the progression of the disease?

X-ray

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

Safe exercise Medication dosages and side effects Assistive devices

A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response?

Hand and finger deformities are associated with the development of rheumatoid arthritis.

A client with systemic lupus erythematosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term should the nurse use to describe this characteristic pattern?

Butterfly rash

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects

The nurse is conducting a health history with an older client. Which information indicates to the nurse that the client may be experiencing polymyalgia rheumatica (PMR)? Select all that apply.

Anorexia Sore neck muscles Aching shoulder muscles Body stiffness in the morning

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply.

Fatigue Pain Alteration of self-concept

A client with rheumatoid arthritis (RA) is taking methotrexate. Which assessment findings indicate to the nurse that the client is experiencing side effects of this medication? Select all that apply.

Hair loss Skin rash Gastric distress Frequent infections

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?

If you have problems with a medication, you may stop it until your next physician visit.

The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities?

Inflammation

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury?

Install safety devices in the home.

A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease?

Review the client's medical record

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease?

Review the client's medical record.