Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders
The health care provider is assessing a client with a history of ankylosing spondylitis to note progression of the disease. On which area of the body will the provider focus the assessment? Spine Ankles Elbows All joints (polyarticular)
Spine
A client with ankylosing spondylitis wants to begin an exercise program. Which sport would the nurse recommend? Jogging Swimming Bowling Golfing
Swimming
The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include? - The injections will be given only 3 to 4 times per year because they can increase joint destruction. - There will be minimal discomfort because the injections are placed in the subcutaneous tissue. - The client or a family member will be taught to administer the injections daily. - There will be immediate relief with one injection and daily running can be resumed.
The injections will be given only 3 to 4 times per year because they can increase joint destruction.
When teaching a client recently diagnosed with systemic lupus erythematosus (SLE), what does the nurse teach the client to avoid to prevent exacerbations? Raw or undercooked shellfish Ultraviolet light (UV) Corticosteroid medications Calcium supplements
Ultraviolet light (UV)
When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease? - Sedentary life style - Obesity - Smoking - Hypertension
Obesity
When teaching a client about areas of the body typically affected by gout, the nurse would include which locations? Select all that apply. Heart Metatarsals Instep Hip Heel
Metatarsals Instep Heel
The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find? Joint contractures Facial butterfly rash Lower back pain Bruises on the lower extremities
Lower back pain
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: - "Children can be affected with almost all of the rheumatic diseases that occur in adults." - "Children who acquire rheumatic diseases are more likely to have a higher intelligence level." - "Do not worry; a course of antibiotic therapy will cure the child." - "Your child will not be restricted with any activities and will have a normal lifestyle."
"Children can be affected with almost all of the rheumatic diseases that occur in adults."
Which assessment finding best confirms the diagnosis of systemic lupus erythematosus (SLE)? joint pain facial rash positive anti-DNA antibody test elevated antinuclear antibodies (ANA) levels
positive anti-DNA antibody test
Despite differences in onset, involvement, and symptomatology, all of the spondyloarthropathies involve which pathogenesis etiology? sacroiliitis calcinosis excessive bone turnover destruction of chondrocytes
sacroiliitis
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: inhibiting prostaglandin synthesis. agonizing opioid receptors. increasing blood flow to sites of inflammation. stimulating the release of pain-reducing cytokines.
inhibiting prostaglandin synthesis.
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 makes which statement? - "Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular." - "Rheumatoid arthritis is a chronic autoimmune system disease that affects a single joint." - "Only upper extremity diarthrodial joint can be involved." - "The disease will not fluctuate in occurrence."
"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."
A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed." "To prevent cartilage atrophy, slowly and gradually resume exercising." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster."
"To prevent cartilage atrophy, slowly and gradually resume exercising."
While explaining the physiology behind systemic sclerosis (scleroderma), the nurse would mention which development as a hallmark of this disease? Activation of fibroblasts, resulting in fibrosis Development of thin, fragile skin Development of a collagen deficiency Avascular necrosis of the femoral head
Activation of fibroblasts, resulting in fibrosis
The nurse is assessing a client's risk for osteoarthritis. Which factor places the client at greatest risk for this condition? Age Injury Social status Exposure to smoke
Age
When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease? Immunocompromised host Tissue necrosis Autologous antibodies Lysosomes
Autologous antibodies
Juvenile dermatomyositis is a chronic inflammatory myopathy that commonly manifests systemically. What is the treatment of choice for this myopathy? Muscle relaxants Corticosteroids IgG Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
The nurse is teaching a client with rheumatoid arthritis about pannus, which develops in the affected joint area. What does the nurse include to describe pannus? Muscles in the area that atrophy from disuse Vascular granulation tissue that destroys cartilage and bone Microorganisms that attack the joint space causing stiffness Reversible calcium deposits affecting the joints
Vascular granulation tissue that destroys cartilage and bone
An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects? Weight and nutritional status Cognition and coping skills Sodium and potassium levels Oxygenation and respiratory status
Weight and nutritional status
Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)? elevated anti-nuclear antibodies (ANA) abnormal serum SLE assay decreased rheumatoid factor low red blood cell (RBC) count
elevated anti-nuclear antibodies (ANA)
A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply. "I'm having a hard time opening doors since it hurts so bad." "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands." "Look how my hand is deformed. My doctor calls it hyperextension." "Just look at my face. It looks like I have varicose veins on my cheeks." "Every time I get something out of the freezer, my hands turn reddish purple in color."
"I'm having a hard time opening doors since it hurts so bad." "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands." "Look how my hand is deformed. My doctor calls it hyperextension."
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? - "Your doctor will likely prescribe acetaminophen with codeine to manage your pain." - "Losing some weight and reducing your alcohol intake will likely be beneficial." - "In a lot of cases, clients with gout are able to control their symptoms through physiotherapy." - "It's important that you have your bloodwork drawn weekly and that you adjust your diet."
"Losing some weight and reducing your alcohol intake will likely be beneficial."
A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make? "Lupus is a disease of older individuals." "More women than men are affected by lupus." "Lupus is more common in white people." "Drug-induced lupus requires lifelong treatment."
"More women than men are affected by lupus."
The nurse is caring for a client diagnosed with osteoarthritis (OA). What does the nurse teach the client about the disease? "OA is a disease of the weight-bearing joints." "OA typically occurs in clients between 20 and 40 years of age." "OA is an autoimmune disorder." "OA is a genetic disorder."
"OA is a disease of the weight-bearing joints."
The nurse determines that additional client education is needed when a client with gout makes which statement? - "When I have an exacerbation of my symptoms, a glass of red wine will be helpful." - "Increasing my intake of water each day will help stop the symptoms." - "I will plan to eat more white meat rather than red meat." - "I should avoid eating shellfish to decrease the risk of an episode."
"When I have an exacerbation of my symptoms, a glass of red wine will be helpful."
A client with rheumatoid arthritis (RA) tells the nurse that the disease-modifying antirheumatic drug (DMARD) methotrexate does not seem to be working anymore. Which other antirheumatic medication category can the nurse relay that may be prescribed following DMARD failure? Corticosteroids Anti-TNFs like infliximab Gold salts Nonsteroidal anti-inflammatory drugs
Anti-TNFs like infliximab
When a nurse is teaching a client with ankylosing spondylitis about an exercise regimen, which suggestion does the nurse make to reduce pain with movement? Sleeping with the head of the bed elevated Application of a heating pad prior to exercise Strengthening flexor muscles Keeping a journal, noting frequency of morning stiffness
Application of a heating pad prior to exercise
A client presents with arthralgia and arthritis. Which is the priority nursing intervention? Assessing the client's pain and history of treating it Assessing the client's vital signs Assessing the client's electrocardiogram Performing range-of-motion exercises
Assessing the client's pain and history of treating it
Gout, or gouty arthritis, cannot be diagnosed on the basis of hyperuricemia. What is the diagnostic criterion for gout? Finding of tophaceous deposits Finding of monosodium urate crystals in the synovial fluid Finding of leukocyte crystals in the tissues Finding of calcium crystal deposits in the synovial fluid
Finding of monosodium urate crystals in the synovial fluid
Which statement is true regarding the development of juvenile idiopathic arthritis? Generalized stunted growth can occur. A diagnosis will be made when two joints are affected. The condition will resolve in adulthood. Surgical intervention can stop the decline associated with the arthritis.
Generalized stunted growth can occur.
When caring for a client with ankylosing spondylitis, the nurse tells the client that stiffness may be relieved by which intervention? Bed rest Gentle exercise Calcium supplements Acetaminophen
Gentle exercise
A 30-year-old client has been diagnosed with ankylosing spondylitis. Which etiology is responsible for this health problem? Infection Friction between bones Immune response Inappropriate bone remodeling
Immune response
A 55-year-old client has reported joint pain in the feet. Which laboratory result should prompt further testing to rule out primary gout? Increased C-reactive protein (CRP) Increased serum uric acid Increased polymorphonuclear leukocytes Increased serum cortisol
Increased serum uric acid
A nurse is caring for a client with discoid lupus. Which system does the nurse set as a priority for the nursing assessment? Integumentary assessment Hematologic assessment Peripheral vascular assessment Rheumatologic assessment
Integumentary assessment
The nurse is reviewing laboratory results and notes an elevated uric acid level on a client. Which action should the nurse take first? Interview the client about current or past joint or urinary symptoms Educate the client about avoiding foods that are high in purines Take no action; elevated uric acid levels are a benign laboratory finding Notify the health care provider of the elevated uric acid
Interview the client about current or past joint or urinary symptoms
A client has developed signs and symptoms of systemic lupus erythematosus (SLE). The nurse reviews the client's medication record for which medications that are associated with drug-induced lupus? Select all that apply. Hydralazine Ramipril Digoxin Isoniazid Procainamide
Isoniazid Procainamide Hydralazine
Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)? Chronic nausea and vomiting that is unresponsive to antiemetics Joint pain and proteinuria A history of thromboembolic events and varicose veins Dysmenorrhea and recent spontaneous abortion
Joint pain and proteinuria
The nurse is caring for a client with newly diagnosed systemic lupus erythematosus (SLE). Which over-the-counter medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis? - Nonsteroidal anti-inflammatory drugs (NSAIDs) - Hydroxychloroquine - Cyclophosphamide - Belimumab
Nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse is conducting a health promotion class on osteoarthritis (OA). Which statement should the nurse include? - Obesity is a strong risk factor for developing OA. - Young women have a higher risk than young men of developing OA. - There is no hereditary link to the development of OA. - Eating a diet low in calcium is the only contributing risk factor to OA.
Obesity is a strong risk factor for developing OA.
The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate? Physical examination and x-ray studies Aspiration of the joint with biopsy sent to laboratory Bone marrow aspiration of the pelvis Exercise trials to monitor angle of joint movements
Physical examination and x-ray studies
A young adult client presents with "stiffening of the spine." Which diagnostic laboratory result leads the health care worker to diagnose ankylosing spondylitis? Elevated serum calcium level of 15.1 mg/dL (3.77 mmol/L) Increased production of antibodies against self and non-self antigens Presence of HLA-B27 allele marker Elevated serum uric acid level
Presence of HLA-B27 allele marker
The nurse assessing a client with scleroderma with CREST variant would include an assessment for: Raynaud's phenomenon. thrombocytopenia. leukocytosis. butterfly rash.
Raynaud's phenomenon.
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: inhibiting prostaglandin synthesis. agonizing opioid receptors. increasing blood flow to sites of inflammation. stimulating the release of pain-reducing cytokines.
inhibiting prostaglandin synthesis.
A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology? "Environment is the biggest contributing factor to the development of RA." "Exposure to workplace chemicals is a causative agent." "Genetic predisposition is very likely." "The disease is most common in those under 30."
"Genetic predisposition is very likely."
A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology? - "Environment is the biggest contributing factor to the development of RA." - "Exposure to workplace chemicals is a causative agent." - "Genetic predisposition is very likely." - "The disease is most common in those under 30."
"Genetic predisposition is very likely."
In general, how are children affected by a rheumatic disease such as juvenile idiopathic arthritis (JIA)? It's characterized by synovitis and can influence epiphyseal growth, resulting in stunted growth. It usually is a single disease affecting primarily the long bones. It is primarily a joint problem with few, if any, systemic symptoms. It may eventually attack the cardiac muscle resulting in the need for valve replacement.
It's characterized by synovitis and can influence epiphyseal growth, resulting in stunted growth.
Which assessment findings will help the nurse to confirm the diagnosis of rheumatoid arthritis? Select all that apply. Asymmetrical joint involvement Joint stiffness Finger and hand pain Wrist pain Limited joint mobility
Joint stiffness Finger and hand pain Wrist pain Limited joint mobility
Which disease in children presents with an inflammatory myopathy primarily involving skin and muscle with a heliotrope rash around the eyes? Juvenile dermatomyositis Juvenile spondyloarthropathies Systematic lupus erythematous Juvenile arthritis
Juvenile dermatomyositis
A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess? Tremors Kyphosis Syndactyly Tachycardia
Kyphosis
A client presents with joint pain and suspected rheumatoid arthritis (RA). Which intervention is appropriate for the nurse to implement? Increase in the client's activity to provide sufficient joint stress Muscle-strengthening exercises to support joints Intravenous opioid to control pain Admission to the intensive care unit for cardiac monitoring
Muscle-strengthening exercises to support joints
Giant cell arteritis is a comorbid condition of: Polymyalgia rheumatica Pseudogout Gout Systemic lupus erythematosus
Polymyalgia rheumatica
A client diagnosed with arthritis had a recent infection. Which intervention is necessary to determine if the client has bacterial arthritis? Decrease in symptoms with steroid administration Assessment of vital signs for fever Administration of antibiotics with relief of symptoms Positive culture of synovial fluid
Positive culture of synovial fluid
A client has been diagnosed with scleroderma. Which assessment finding does the nurse expect? Facial rash Increased blood pressure Raynaud phenomenon Cardiac dysrhythmias
Raynaud phenomenon
A nurse is teaching a client with psoriatic arthritis about treatment. Which statement should be included? Antibiotics are administered early in the disease diagnosis. Biologic response modifiers are beneficial in controlling the disease. A medication to decrease uric acid levels is often effective The only medication therapy that is effective are nonsteroidal anti-infective agents.
Biologic response modifiers are beneficial in controlling the disease.
When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider would include which statement? Blocks the production of uric acid by the body Increases elimination of uric acid by the kidneys Prevents flare-up during the first few months of starting medication Can be given intravenously to rapidly decrease serum uric acid levels
Blocks the production of uric acid by the body
An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health? - A mismatch between bone resorption and remodeling - Immunologically mediated joint inflammation - Excessive collagen production and deposition - Cytokine release following mechanical joint injury
Immunologically mediated joint inflammation
Joint destruction in rheumatoid arthritis occurs by an obscure process. The cellular changes, however, have been documented. Place the process in the correct order. Inflammatory response Immune complexes phagocytized, releasing lysosomal enzymes Reactive hyperplasia of synovial cells and subsynovial tissues Vasodilation and joint swelling Neutrophils, macrophages, and lymphocytes arrive Destructive changes in joint cartilage
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
An older adult reports waking up in the morning with pain/stiffness in the neck/shoulders. Laboratory work reveals an elevated erythrocyte sedimentation rate (ESR). Following a short trial of prednisone with significant improvement, the health care provider likely will diagnose which disorder? - Polymyalgia rheumatica - Psoriatic arthritis - Reiter syndrome - Ankylosing spondylitis
Polymyalgia rheumatica
A client reports increasing pain at the back of the ankle over the past 2 weeks. The client states being generally healthy, despite having just completed a course of antibiotics for an infection 6 weeks prior for Chlamydia trachomatis. This client is likely experiencing which type of reaction? Systemic sclerosis Ankylosing spondylitis Osteoarthritis Reactive arthritis
Reactive arthritis
When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which important differences when caring for the older adult? Need for pain relief Stiffness in the morning Risk for falls Muscle weakness
Risk for falls
When a nurse is caring for a client with gout, which diagnostic study supporting the presence of the disease does the nurse monitor? - Monosodium urate levels - Uric acid levels - Amyloid levels - Calcium levels
Uric acid levels