Med Surg I Prep U Chapter 38: Assessment and Management of Patients With Rheumatic Disorders
The nurse is gathering objective data for a client at the clinic complaining of 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
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?
An exercise routine that includes range-of-motion (ROM) exercises
Which client is most likely to develop systemic lupus erythematosus (SLE)?
A 27-year-old black female
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
Administering ordered analgesics and monitoring their effects
Which term refers to fixation or immobility of a joint?
Ankylosis
Which of the following procedures involves a surgical fusion of the joint?
Arthrodesis
The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about?
Celecoxib (Celebrex)
The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?
Chronic fatigue, generalized muscle aching, and stiffness
A nurse should expect to administer which medication to a client with gout?
Colchicine
The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins.
Colchicine
When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?
Colchicine
A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. An appropriate nursing diagnosis for the client is:
Disturbed body image
Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis?
Early morning stiffness
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?
Elevated erythrocyte sedimentation rate
Which is an appropriate nursing intervention in the care of the client with osteoarthritis?
Encourage weight loss and an increase in aerobic activity
A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response?
Hand and finger deformities are associated with the development of rheumatoid arthritis.
Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement?
Hypertension
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 findings best correlate with a diagnosis of osteoarthritis?
Joint stiffness that decreases with activity
Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)?
Limited passive movement
The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. What foods should the nurse encourage the patient to avoid?
Liver
A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?
Located over bony prominence
Which condition is the leading cause of disability and pain in the elderly?
Osteoarthritis (OA)
Which is the leading cause of disability and pain in the elderly?
Osteoarthritis (OA)
Which of the following is the most common cause for a patient to seek medical attention for arthritis?
Pain
What intervention is a priority for a client diagnosed with osteoarthritis?
Physical therapy and exercise
A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?
Positive Anti-dsDNA antibody test
The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. Which of the following should the nurse include in the teaching plan?
Protect the hands and feet from cold.
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?
Raynaud's phenomenon
The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?
Reports increased fatigue
A nurse is providing care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?
Risk for impaired skin integrity
Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues?
Scleroderma
In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on:
Strategies for remaining active
A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result?
Suggestive of RA
Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?
Systemic lupus erythematosus (SLE)
Which of the following disorders is characterized by an increased autoantibody production?
Systemic lupus erythematosus (SLE)
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?
Tophi
A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:
age.
A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?
applications of ice
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?
eating organ meats and sardines
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
The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective?
"I should avoid prolonged sun exposure."
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?
"It will get better and worse again."
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
"Monitor your body temperature."
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?
"My finger joints are oddly shaped."
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
Which of the following classifications are considered antiarthritic drugs? Select all that apply.
* Anti-inflammatory * Disease-modifying antirheumatics (DMARDs) * Glucocorticoids
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 nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?
Facial erythema, pericarditis, pleuritis, fever, and weight loss
After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?
The belief is that it is an autoimmune disorder with an unknown trigger.
A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?
"Pace yourself and rest frequently, especially after activities."
A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?
"The diagnosis won't be based on the findings of a single test but by combining all data found."
A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis?
"Client will exhibit no signs or symptoms of aspiration."
A client with gout has been advised to lose weight. She informs the nurse that she 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."
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?
Assess diet and activity at home
Which of the following is a plasma protein associated with the immunologic reaction?
Complement
A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication?
Take the medication with food to avoid stomach upset.
The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout?
colchicine
The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?
After the client has had a warm paraffin hand bath
A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?
Degenerative joint disease
The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client?
Fatigue
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?
Hyperuricemia
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include 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.
Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis?
Imbalanced nutrition: greater than body requirements
When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?
Impaired skin integrity
Which of the following statements is accurate regarding osteoarthritis?
It is a noninflammatory disorder and the most common and frequently disabling of joint disorders.
Which points should be included in the medication teaching plan for a client taking adalimumab?
It is important to monitor for injection site reactions.
Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?
Low back pain
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.
Which joint is most commonly affected in gout?
Metatarsophalangeal
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?
Methotrexate (Rheumatrex)
An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically:
Milky, cloudy, and dark yellow.
A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:
organ meats
The nurse teaches the client that osteoarthritis is
the most common and frequently disabling of joint disorders.
A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:
weight loss will reduce uric acid levels and reduce stress on joints.
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?
Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?
Muscle biopsy
A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?
Nonsteroidal anti-inflammatory drugs
Osteoarthritis is known as a disease that
is the most common and frequently disabling of joint disorders.
Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia
may feel as if their symptoms are not taken seriously.