Chapter 38: Assessment and Management of Patients With Rheumatic Disorders Prep-U

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 complete bed rest. Keep shifting weight from one foot to the other. Perform aerobic exercises. Maintain good posture.

Maintain good posture. Explanation: The nurse needs to remind the client with degenerative joint disease to maintain good posture. While the client need not maintain complete bed rest, performing aerobic exercises is not advisable as it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? patchy hair loss on the scalp low back pain red, butterfly-shaped facial rash increased urine output

low back pain Explanation: The most common symptoms of ankylosing spondylitis are low back pain and stiffness. A red, butterfly-shaped rash on the face and a patchy loss of hair are associated with systemic lupus erythematosus. Ankylosing spondylitis does not affect urine output.

A client is experiencing symptoms of giant cell arteritis (GCA). Which action will be taken to definitively diagnose this condition? Evaluate the erythrocyte sedimentation rate. Obtain the results of a temporal artery biopsy. Monitor the response to corticosteroids. Measure the C-reactive protein level.

Obtain the results of a temporal artery biopsy. Explanation: The diagnosis of GCA can be difficult because of the lack of specificity of tests. However, in the case of GCA, biopsy of the temporal artery is the definitive diagnostic tool. The C-reactive protein can be used to diagnose GCA if other clinical findings are present. The response to corticosteroids may be considered as diagnostic for GCA and polymyalgia rheumatica. A markedly high erythrocyte sedimentation rate is a screening test but is not definitive for GCA.

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? Crepitus when moving major joints Restricted movement in tendons Limited motion in the wrists Paresthesias of both hands

Paresthesias of both hands Explanation: The rheumatoid arthritis inflammatory process has been implicated in other disease processes. The nervous system is affected as synovial inflammation can compress adjacent nerves, causing neuropathies and paresthesias. Limited motion in the wrists and restricted movement in the tendons is caused by a breakdown of collagen and pannus formation which destroys cartilage and erodes the bone. This causes a loss of articular surfaces and joint motion and tendon and ligament elasticity and contractility is lost. Rheumatoid arthritis does not cause crepitus with movement.

The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply. inflammation autoantibodies immune complexes susceptibility damage abnormal innate and adaptive immune responses

susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." "OA is more common in women. RA is more common in men." "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA affects joints on both sides of the body. RA is usually unilateral."

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.

Which client is most likely to develop systemic lupus erythematosus (SLE)? A 25-year-old Jewish female A 25-year-old White male A 35-year-old Hispanic male A 27-year-old Black female

A 27-year-old Black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more Black women than white women; its incidence is about 1 in every 250 Black women, compared to 1 in every 700 white women.

The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? Clients will develop boutonniere deformity. Clients will have an ulnar deviation. Clients may develop Heberden nodes. Clients may have swan neck deformity.

Clients may develop Heberden nodes. Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? Behavioral changes Decreased cognitive ability Hypertension Chest pain

Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? Reiter's syndrome Sjögren's syndrome Raynaud's phenomenon Ankylosing spondylitis

Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.

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? Observe the client's gait. Review the client's medical record. Auscultate the client's lung sounds. Inspect the client's mouth.

Review the client's medical record. Explanation: The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.

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 straw colored. The amount of fluid will be scant in volume. The fluid will be milky, cloudy, and dark yellow. The fluid will be clear and pale.

The fluid will be milky, cloudy, and dark yellow. Explanation: An arthrocentesis shows abnormal synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach? "Do you think you are too old to exercise?" "Does exercise usually work for you?" "What types of exercise were you doing?" "Why do you think the exercise didn't work?"

"What types of exercise were you doing?" Explanation: In an older adult with rheumatoid arthritis, exercise programs may not be instituted or may be ineffective because the client expects results too quickly or fails to appreciate the effectiveness of a program of exercise. Strength training is encouraged in the older adult with chronic diseases. The other questions will not help the nurse understand what type of exercise was used and what it was not effective for the client.

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal? Hyperproteinuria Glucosuria Hyperuricemia Ketonuria

Hyperuricemia Explanation: Gout is caused by hyperuricemia (increased serum uric acid).

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 Episcleritis Cataracts Glaucoma

Sicca syndrome Explanation: Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye.

Which of the following disorders is characterized by an increased autoantibody production? Systemic lupus erythematosus (SLE) Polymyalgia rheumatic Scleroderma Rheumatoid arthritis (RA)

Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Joint effusion Pannus Subchondral bone Tophi

Tophi Explanation: Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity.

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? MRI CT scan Ultrasound X-ray

X-ray Explanation: Plain x-ray is the most common radiographic study used to track disease progression as it is inexpensive, reliable, and reproducible. MRI may be used to detect erosions not visible on x-ray or ultrasound. CT scan is not routinely used to track the progression of RA. Ultrasound might be used to establish a baseline for joint evaluation however is not used to track progression of the condition.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? obesity congenital deformity age trauma

age Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

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? azathioprine cyclophosphamide diclofenac hydroxychloroquine

hydroxychloroquine Explanation: The DMARD hydroxychloroquine is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmologic examinations every 6-12 months. Azathioprine, diclofenac, and cyclophosphamide do not have visual changes as a side effect.

The nurse teaches the client that osteoarthritis: requires early treatment because most of the damage appears to occur early in the course of the disease. affects the cartilaginous joints of the spine and surrounding tissues. affects young males. is the most common and frequently disabling of joint disorders.

is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues and is usually diagnosed in the second or third decade of life.

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? A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. It's impossible to determine at the time of diagnosis how the disease will progress. The client should discuss this concern with the health care provider. Hand and finger deformities are associated with the development of rheumatoid arthritis.

Hand and finger deformities are associated with the development of rheumatoid arthritis. Explanation: The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease.

A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client? "Be sure to wear nonslip footwear for safety." "Don't go if your joints are inflamed." "Have someone check your blood pressure before exercising." "That's not the best activity for misaligned joints."

"Be sure to wear nonslip footwear for safety." Explanation: Appropriate programs of exercise have been shown to decrease pain and improve function in rheumatoid arthritis. Pool exercises provide a buoyant medium for performance of dynamic or aerobic exercise and the water supports movement while warm water provides muscle relaxation. The client should be reminded to wear nonslip footwear for safety and comfort. Range of motion exercises should not be done if the joints are inflamed. Dynamic exercise is not the best for unstable or misaligned joints. Blood pressure should be checked before engaging in isometric exercises.

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 diagnostic for systemic lupus erythematosus. It is suggestive of rheumatoid arthritis. It is diagnostic for Sjögren's syndrome. It is specific for rheumatoid arthritis.

It is suggestive of rheumatoid arthritis. Explanation: Rheumatoid factor is present in about 70% to 80% of patients with rheumatoid arthritis, but its presence alone is not diagnostic of rheumatoid arthritis, and its absence does not rule out the diagnosis. The antinuclear antibody (ANA) test is used to diagnose Sjögren's syndrome and systemic lupus erythematosus.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Mercaptopurine azathioprine Celecoxib Methotrexate Methylprednisolone

Methotrexate Explanation: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? Rheumatoid arthritis Polymyalgia rheumatic Scleroderma Systemic lupus erythematosus

Scleroderma Explanation: Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

The nurse is caring for a client with ankylosing spondylitis. Which educational information will the nurse provide to this client? Use of cough supressants Use of laxatives Use of diuretics Use of analgesics

Use of analgesics Explanation: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine. Back pain is the characteristic feature. AS affects the cartilaginous joints of the spine and surrounding tissues, making them rigid, decreasing mobility, and leading to kyphosis or a stooped position. Constipation, chronic cough, and peripheral edema are not symptoms associated with AS.

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. Limiting exercise Restricting the intake of water Avoiding purine-rich foods Weight loss Decreasing alcohol intake

Weight loss Decreasing alcohol intake Avoiding purine-rich foods Explanation: Management between the attacks of gout include lifestyle changes to include weight loss, decreasing alcohol intake, and avoiding purine-rich foods. Exercise does not need to be limited and water does not need to be restricted.

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? celecoxib hydroxychloroquine aspirin methotrexate

aspirin Explanation: Salicylates like aspirin may have side effects such as tinnitus, gastric intolerance and bleeding. While celecoxib, methotrexate, and hydroxychloroquine have GI upset effects, the tinnitus is unique to aspirin.

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? loading-dose schedule dietary restrictions common adverse effects activity restrictions

common adverse effects Explanation: The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of? citrus fruits fresh fish organ meats green vegetables

organ meats Explanation: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, chocolate, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with gouty arthritis.

A client is being placed on a purine-restricted diet. What foods will the nurse include in the client's diet plan? dairy products organ meats shellfish alcohol

dairy products Explanation: Purines are chemical compounds found in high concentrations in certain foods, particularly shellfish, organ meats, and some alcoholic beverages (e.g., beer, distilled liquors). Purines are implicated in gout. Another reason that clients with gout are advised to avoid alcohol is that alcohol of any kind may increase the free fatty acid concentrations that can exacerbate gout.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? early morning stiffness subcutaneous nodules joint pain that increases with rest small joint involvement

early morning stiffness Explanation: Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of: infection. degeneration. inflammation. gout.

gout. Explanation: The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications disease-modifying antirheumatic drug therapy prevention of joint deformity strategies for remaining active

strategies for remaining active Explanation: The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

Which is the leading cause of disability and pain in the elderly? Systemic lupus erythematosus (SLE) Scleroderma Rheumatoid arthritis (RA) Osteoarthritis (OA)

Osteoarthritis (OA) Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? Antibiotics Oral corticosteroids Anticoagulants Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: NSAIDs are the first-line therapy for treating all spondyloarthropathies. Antibiotics and anticoagulants are not used to treat AS. Corticosteroid injections may be used for periodic flares; however, oral and long-term use of steroids is not recommended.

A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? "There might be some difficulties with your plan and fasting." "Try combining the fasting with moderate exercise." "Make sure to eat some fat occasionally with all that exercise." "The fasting is okay, but make sure you drink fluids when exercising."

"There might be some difficulties with your plan and fasting." Explanation: Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.

The nurse is providing education for a client with a new diagnosis of rheumatoid arthritis (RA). Which statement will the nurse include in the discussion with the client? Select all that apply. "You can expected warmth in your joints." "A symptom of RA will be joint pain on both sides." "Redness can occur in the skin at the joints." "Swelling of the joints will occur, causing pain." "A rash of the joints is common with rheumatoid arthritis."

"Swelling of the joints will occur, causing pain." "You can expected warmth in your joints." "Redness can occur in the skin at the joints." "A symptom of RA will be joint pain on both sides." Explanation: The initial clinical manifestations of RA include symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic symptoms. A rash is not a symptom of RA.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? Bone scan Computed tomography (CT) Magnetic resonance imaging (MRI) Muscle biopsy

Muscle biopsy Explanation: As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity.

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client? "Have you increased your intake of fat-soluble vitamins?" "Have you reduced the amount of daily exercise?" "Are you taking the medication as prescribed?" "Are you taking frequent rest periods throughout the day?"

"Are you taking the medication as prescribed?" Explanation: Medication adherence is critical but poor among clients prescribed urate lowering therapies for gout. Between acute episodes, the client feels well and may abandon medications and preventive behaviors, which may result in an acute attack. Asking about medication adherence is the appropriate. Exercise, fat-soluble vitamins, and rest periods will not increase the risk of having an attack of gout.

Which of the following procedures involves a surgical fusion of the joint? Osteotomy Arthrodesis Tenorrhaphy Synovectomy

Arthrodesis Explanation: An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Performing meticulous skin care Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware Administering ordered analgesics and monitoring their effects

Administering ordered analgesics and monitoring their effects Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) Acupuncture Cold therapy An exercise routine that includes range-of-motion (ROM) exercises

An exercise routine that includes range-of-motion (ROM) exercises Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain.

Which term refers to fixation or immobility of a joint? Arthroplasty Hemarthrosis Ankylosis Diarthrodial

Ankylosis Explanation: Ankylosis is the fixation or immobility of a joint. It may result from a disease process or from scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

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? Wear worn, comfortable shoes. Get help when lifting objects. Install safety devices in the home. Wear protective devices when exercising.

Install safety devices in the home. Explanation: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises.

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? Rheumatoid arthritis Systemic lupus erythematosus Fibromyalgia Scleroderma

Rheumatoid arthritis Explanation: Palindromic rheumatism is an uncommon variety of recurring and acute arthritis and periarthritis that in some may progress to rheumatoid arthritis (RA) but is characterized by symptom-free periods of days to months. Because of this, the nurse should plan care that would be similar to the client with RA. The symptoms of palindromic rheumatism are not similar to those of scleroderma, fibromyalgia, or systemic lupus erythematosus

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

colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack? frequently ingesting salicylates frequently drinking coffee high carbohydrate intake eating organ meats and sardines

eating organ meats and sardines Explanation: During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. The other listed factors do not worsen attacks.

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care? ability to perform activities of daily living (ADL) a weight gain of 2 pounds increased fatigue decreased joint pain

increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? reddened tender to the touch located over bony prominence nonmovable

located over bony prominence Explanation: Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? weakness stiffness pain joint swelling

pain Explanation: The symptom that most commonly causes a person to seek medical attention is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? prednisone methotrexate colchicine penicillamine

colchicine Explanation: Colchicine is prescribed for the treatment of an acute attack of gout.

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? "Corticosteroids may be stopped when symptoms are relieved." "There are no activity limitations between flare-ups." "Exposure to sunlight will help control skin rashes." "Monitor your body temperature."

"Monitor your body temperature." Explanation: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) Butterfly-shaped rash on the face Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue Decreased ventilation owing to lung scarring Productive cough

Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue Explanation: The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? Assess for gastrointestinal complications associated with COX-2 inhibitors Avoid the use of topical analgesics Encourage weight loss and an increase in aerobic activity Provide an analgesic after exercise

Encourage weight loss and an increase in aerobic activity Explanation: Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methyl salicylate may be used for pain management.