NURS 309 Quiz 14 Connective Tissue

Methylprednisolone 60 mg IV is prescribed for a patient who is experiencing a systemic lupus erythematosus (SLE) exacerbation. Based on the label for the medication below, the nurse will administer how many mL? Label: 125 mg/2mL

-0.96 mL

Although the etiology of rheumatoid arthritis is unknown, it is considered to be what type of disorder? A. Autoimmune disease B. Disease associated with aging C. Genetic disorder D. Trauma disorder

A. Autoimmune disease

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? SATA A. Nausea B. Joint pain C. Blood in the stool D. Ringing in the ears E. Increased urine output

C. Blood in the stool D. Ringing in the ears

When a patient has rheumatoid arthritis of the temporomandibular joint, what is the major complaint? A. Toothache on the affected side B. Headache in the temple area C. Pain on chewing and opening the mouth D. Earache on the affected side

C. Pain on chewing and opening the mouth

Which patient reported symptom(s) would typify early rheumatoid arthritis? A. "I feel tired and weak" B. "I feel like my hands are burning" C. "I have severe stiffness in the morning" D. "I have gained a lot of weight"

A. "I feel tired and weak"

A nurse plans care to prevent deformities in a client with rheumatoid arthritis. Which intervention should be alternated with periods of rest? A. Active exercise B. Passive massage C. Bracing of joints D. Isometric exercises

A. Active exercise

Which medication should the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? A. Aspirin B. Codeine C. Meperidine D. Alprazolam

A. Aspirin

A nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? SATA A. Butterfly facial rash B. Firm skin fixed to tissue C. Inflammation of the joints D. Muscle mass degeneration E. Inflammation of small arteries

A. Butterfly facial rash C. Inflammation of the joints

An 18-year-old college student with an exacerbation of systemic lupus erythematosus (SLE) has been receiving prednisone 20 mg/day for 4 days. Which action prescribed by the healthcare provider is most important for the nurse to question? A. Discontinue prednisone after today's dose B. Give a "catch-up" dose of varicella vaccine C. Check the patient's C-reactive protein level D. Administer ibuprofen 800 mg PO TID

B. Give a "catch-up" dose of varicella vaccine

The patient with rheumatoid arthritis (RA) expresses uncertainty about the disease process and fear of becoming dependent. What is the nurse's best response? A. "You will be okay. Very few people with RA actually become wheelchair bound" B. "Do you have anyone to help you when you can't take care of yourself?" C. "Tell me what you know about living with RA and the treatment options" D. "So, you are feeling afraid and uncertain. That seems normal to me."

C. "Tell me what you know about living with RA and the treatment options"

A patient is prescribed amitriptyline for the diagnosis of fibromyalgia. What is the classification of this medication? A. Anti-inflammatory B. Antirheumatic C. Antidepressant D. Antipsychotic

C. Antidepressant

A nurse is caring for a client with rheumatoid arthritis. Based on the client's diagnosis, the nurse should review the result of which laboratory test? A. Pancreatic lipase B. Bence Jones protein C. Antinuclear antibody D. Alkaline phosphatase

C. Antinuclear antibody

In rheumatoid arthritis, autoantibodies (rheumatoid factors) are formed that attack healthy tissue, especially synovium, causing which condition? A. Nerve pain B. Bone porosity C. Ischemia D. Inflammation

D. Inflammation

What can be expected for a patient with recently diagnosed systemic lupus erythematosus? A. Frequent acute inflammatory episodes B. Spontaneous remissions and exacerbations C. Symptoms similar to osteoarthritis D. Frequent infections and reduced immune response

B. Spontaneous remissions and exacerbations

The patient with rheumatoid arthritis suffers a subluxation of the first and second vertebrae. What should the nurse do first, before immediately notifying the health care provider? A. Assess respiratory status, and apply oxygen as needed B. Assess for loss of sensation or loss of movement in the extremities C. Assess for pain that radiates down the arm and check pulses D. Assess for change in mental status and orient the patient

A. Assess respiratory status, and apply oxygen as needed

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). What recommendations are essential for the nurse to include? SATA A. Eat foods high in vitamin C B. Take your temperature daily C. Balance periods of rest and activity D. Use a strong soap when washing the skin E. Expose the skin to the sun as often as possible

A. Eat foods high in vitamin C B. Take your temperature daily C. Balance periods of rest and activity

The nurse is caring for a patient with rheumatoid arthritis who is taking naproxen twice a day to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? A. Joint pain worse in the morning B. Dry eyes bilaterally C. Round and moveable nodules under the skin D. Dark-colored stools

D. Dark-colored stools

Initiation of subcutaneous etanercept for a patient with rheumatoid arthritis is being considered. Which patient information is most important for the nurse to communicate to the health care provider? A. The patient is currently taking methotrexate B. The patient has a positive tuberculin skin test result C. The patient has had type 2 diabetes for 5 years D. The patient is anxious about having to self-inject

B. The patient has a positive tuberculin skin test result

Based on the nurse's knowledge of the most common cause of death for patients with systemic lupus erythematosus, which laboratory tests will the nurse closely monitor when caring for these patients? A. Cardiac enzymes and sedimentation rate B. Blood urea nitrogen and creatinine C. Complete blood cell count and platelet count D. Liver enzymes and cholesterol levels

B. Blood urea nitrogen and creatinine

What is the primary consideration when caring for a client with rheumatoid arthritis? A. Surgery B. Comfort C. Education D. Motivation

B. Comfort

The patient is taking hydroxychloroquine for rheumatoid arthritis. Which patient statement is cause for greatest concern? A. "I seem to have a mild stomach discomfort when I take this medication" B. "I get kind of light headed. I suppose I should stand up a little slowly" C. "Could you give me a Tylenol or something mild? I have some muscle pain." D. "I think I must need new glasses. Lately, my vision is really blurry"

D. "I think I must need new glasses. Lately, my vision is really blurry"

A client with arthritis reports receiving the following dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? A. Wheat germ and yeast B. Yogurt and blackstrap molasses C. Multiple vitamin supplements in large doses D. Adequate foods in a variety of different food groups

D. Adequate foods in a variety of different food groups

What is the best laboratory test to detect early rheumatoid arthritis? A. Rheumatoid factor B. Erythrocyte sedimentation rate C. Complete blood cell count D. Anti-cyclic citrullinated peptide

D. Anti-cyclic citrullinated peptide

The nurse is providing teaching for a patient with rheumatoid arthritis who is receiving methotrexate. Which teaching point must the nurse include? A. Medication is taken every morning on an empty stomach B. Avoid driving or operating heavy machinery C. Expect some increase in swelling while taking this medication D. Avoid crowds of people who are all ill

D. Avoid crowds of people who are all ill

A client with type-2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? A. Decrease the daily dose of NSAIDs B. Limit fluid intake to one quart a day C. Take the medication on an empty stomach D. Monitor blood glucose levels more frequently

D. Monitor blood glucose levels more frequently

What musculoskeletal health problems is often associated with rheumatoid arthritis? A. Paget's disease B. Lyme disease C. Marfan syndrome D. Osteoporosis

D. Osteoporosis

A nurse is caring for a client attending a community-based health center and reviews the client's medical record. Progress note: Client has stage III rheumatoid arthritis, which is progressively causing more joint deformity, stiffness, and pain. Nurse's physical assessment: Client has ulnar drift of both hands and hallux valgus deformity of both feet. Client reports pain when walking and joint stiffness for several hours in the morning, particularly the small joints of the hands and feet. Joints of the hands reflects signs and symptoms of inflammation. Lab results: WBC: 13,000, Rheumatoid factor: 1:70 (positive for rheumatoid arthritis), ESR: 40 mm/hour, CRP: 20 mg/dL. What should the nurse encourage the client to do? A. Wring a sponge repeatedly when washing dishes B. Install faucets that require turning rather than pushing C. Engage in a sewing project several hours each morning D. Push with the palms rather than the fingers when rising from a chair

D. Push with the palms rather than the fingers when rising from a chair

What should the nurse take into consideration when planning nursing care for a client experiencing an acute episode of rheumatoid arthritis? A. Inflammation of the synovial membrane rarely occurs B. Bony ankylosis of a joint is irreversible and causes immobility C. Complete immobility is desired during the acute phase of inflammation D. Redness and swelling of a joint signify irreversible damage has occurred

B. Bony ankylosis of a joint is irreversible and causes immobility

A client is admitted with acute gouty arthritis. Which medication does the nurse anticipate the health care provider may prescribe to prevent and treat an acute attack of gout? A. Ibuprofen (Motrin) B. Colchicine (Colsalide) C. Probenecid (Benemid) D. Hydrocortisone (Cortef)

B. Colchicine (Colsalide)

When preparing an individualized teaching plan for a client with rheumatoid arthritis, which topic should the nurse omit from the generalized plan for clients with arthritis? A. Ulnar drift B. Heberden nodes C. Swan neck deformity D. Boutonniere deformity

B. Heberden nodes

The nurse sees an increased number of periungual lesions on a patient with rheumatoid arthritis and reports this vascular change to the health care provider. What is the best rationale for reporting this finding? A. The nurse should always report any unusual findings to the health care provider B. If arterial involvement is occurring, major organs can become ischemic C. The brownish spots affect body image but will readily resolve with treatment D. The lesions will eventually ulcerate and become infected

B. If arterial involvement is occurring, major organs can become ischemic

A patient with systemic lupus erythematosus is prescribed a relatively new drug, belimumab. Which concept will the nurse use to emphasize important teaching points about this medication? A. Comfort B. Immunity C. Mobility D. Oxygenation

B. Immunity

Which assessment finding indicates to the nurse that the patient is experiencing early rheumatoid arthritis? A. Joint deformities B. Joint inflammation C. Weight loss D. Subcutaneous nodules

B. Joint inflammation

Which foods should the nurse teach a client with gout to avoid to limit painful attacks? SATA A. Eggs B. Liver C. Cheese D. Salmon E. Shellfish

B. Liver E. Shellfish

The nurse is reviewing the laboratory results of a patient with systemic lupus erythematosus. Which test result is most likely to be a false positive? A. Elevated erythrocyte sedimentation rate B. Positive syphilis test C. Positive tuberculosis test D. Increase in components of complete blood count

B. Positive syphilis test

The unlicensed assistive personnel (UAP) tells the nurse that the patient with rheumatoid arthritis is increasingly manipulative and demanding and trying to meet the patient's requests is interfering with the care of other patients. What is the best action for the nurse to take? A. Tell the UAP to ignore the demands, complete the assigned tasks, and go on to other patients B. Inform the patient that the UAP has additional duties and has a fixed amount of time per patient C. Assess the patient's behaviors and help the patient to focus on realistic goals and coping strategies D. Temporarily perform the UAp duties until boundaries and expectations are established

C. Assess the patient's behaviors and help the patient to focus on realistic goals and coping strategies

What should the nurse consider as the goal of therapy when administering allopurinol (Zyloprim) to a client with gout? A. Increased bone density B. Decrease synovial swelling C. Decrease uric acid production D. Prevent crystallization of uric acid

C. Decrease uric acid production

The nurse is assessing the skin of a patient with systemic lupus erythematosus. What is the nurse most likely to notice about the skin? A. Small, brownish spots around the nail bed B. Generalized hardening of the skin C. Dry, scaly, raised rash on the face D. Raynaud's phenomenon

C. Dry, scaly, raised rash on the face

The nurse questions a client with rheumatoid arthritis about pain. When should the nurse expect the client to experience increased pain and limited movement of the joints? A. After assistive exercise B. When the room is cool C. In the morning on awakening D. When the latex fixation test is positive

C. In the morning on awakening

The nurse is caring for a patient with systemic lupus erythematosus who is having a flare-up of the condition. Which abnormal vital sign is a classic sign for exacerbation? A. Increased blood pressure B. Decreased pulse C. Increased temperature D. Decreased respirations

C. Increased temperature

The nurse reads in the documentation that the patient with rheumatoid arthritis may have Sjogren's syndrome. Which assessment is the nurse most likely to perform to validate this documentation? A. Weigh the patient and compare weight to baseline B. Take the temperature and assess for signs of infection C. Inspect mouth for dry, sticky membranes and eyes for redness D. Observe for joint contractures and loss of range of motion

C. Inspect mouth for dry, sticky membranes and eyes for redness

The nurse is caring for a patient with rheumatoid arthritis who just had an arthrocentesis. What is the priority intervention? A. Assess frequently for post procedural pain and ensure optimal pain relief B. Place the patient in a prone position and elevate the extremity C. Monitor the insertion site for bleeding or leakage of synovial fluid D. Teach and encourage leg-, gluteal-, and quadriceps-setting exercises

C. Monitor the insertion site for bleeding or leakage of synovial fluid

A client with rheumatoid arthritis has severe pain and swelling of the joints in both hands. Range-of-motion exercises for this client should be: A. passively performed by the nurse B. avoided if the client reports discomfort C. preceded by the application of heat or cold D. gradually increased to improve mobility and independence

C. preceded by the application of heat or cold

A client who has intermittently been having painful, swollen knee and wrist joints during the past 3 months is diagnosed with rheumatoid arthritis. What type of diet should the nurse expect the health care provider to order? A. Salt-free, low-fiber diet B. High-calorie, low-cholesterol diet C. High-protein diet with minimal calcium D. Regular diet with vitamins and minerals

D. Regular diet with vitamins and minerals

For a patient who is experiencing gout, what is the most likely reason that the patient will seek medical attention? A. Dry, red, scaly rash with butterfly pattern on face B. Trouble passing urine because of uric acid formation C. Presence of hard irregular tophi in the outer ear D. Severe pain in the joint of the great toe

D. Severe pain in the joint of the great toe

A client with rheumatoid arthritis has been talking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client? A. Decreased white blood cells B. Increased C-reactive protein C. Increased sedimentation rate D. Decreased serum glucose levels

A. Decreased white blood cells

A patient with systemic lupus erythematosus (SLE) is admitted to the hospital with acute joint inflammation. Which information obtained in the laboratory testing will be of highest concern to the nurse? A. Elevated blood urea nitrogen level B. Increased C-reactive protein level C. Positive antinuclear antibody test result D. Positive lupus erythematosus cell preparation

A. Elevated blood urea nitrogen level

What should the nurse do to prevent deformities of the knee in a client with an exacerbation of arthritis? SATA A. Encourage motion of the joint B. Maintain a knee brace on the leg C. Keep the client on a regimen of bed rest D. Maintain joints in functional alignment when resting E. Immobilize the joint with pillows until pain subsides

A. Encourage motion of the joint D. Maintain joints in functional alignment when resting

The nurse is reviewing the complete blood count results of a patient with rheumatoid arthritis. The results show a low hemoglobin, hematocrit, and red blood cell count. Based on these laboratory results, which interventions is the nurse most likely to implement? A. Encourage rest and ensure rest periods between activities and therapies B. Instruct the patient to drink extra fluids and to fully consume meals and snacks C. Instruct the unlicensed assistive personnel to handle the patient carefully to prevent bruising D. Encourage the patient to ambulate in the hall at least three times during the shift

A. Encourage rest and ensure rest periods between activities and therapies

The nurse is assessing a patient with fibromyalgia and identifies the trigger points by palpation. In which specific areas does the nurse expect to elicit pain and tenderness? A. Neck B. Lips C. Trunk D. Lower back E. Upper abdomen F. Extremities

A. Neck C. Trunk D. Lower back F. Extremities

A client is newly diagnosed with scleroderma states, "Where did I get this from?" The nurse's best response is "Although no cause has been determined for scleroderma, it is through to be the result of: A. autoimmunity" B. ocular motility" C. increased amino acid metabolism" D. defective sebaceous gland formation"

A. autoimmunity"

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? A. Lubricate the joint B. Reduce inflammation C. Provide physiotherapy D. Prevent ankylosis of the joint

B. Reduce inflammation

The nurse assesses a 24-year-old patient with rheumatoid arthritis who is considering using methotrexate for treatment. Which patient information is most important to communicate to the health care provider? A. The patient has many concerns about the safety of the drug B. The patient has been trying to get pregnant C. The patient takes a daily multivitamin tablet D. The patient says that she has taken methotrexate in the past

B. The patient has been trying to get pregnant

For a patient in the early phase of scleroderma, the nurse is most likely to observe which signs/symptoms during the physical examination? A. Digit necrosis with severe pain B. Localized hardening of the skin C. Arthralgia and joint stiffness D. Dysphagia and esophagitis

C. Arthralgia and joint stiffness

What is the most common area of involvement of rheumatoid arthritis in the spine? A. Lumbar spine B. Sacral spine C. Cervical spine D. Thoracic spine

C. Cervical spine

A nurse is assessing a client with the diagnosis of scleroderma for the signs of CREST syndrome. What clinical indicators should the nurse expect to identify? SATA A. Joint pain B. Mask-like facies C. Esophageal reflux D. Spider-like hemangiomas E. Episodic blanching of the fingers

C. Esophageal reflux D. Spider-like hemangiomas E. Episodic blanching of the fingers

The nurse is teaching a patient about the common side effects of long-term salicylate and nonsteroidal anti-inflammatory therapy. Which body system side effects does the nurse focus on in the teaching plan? A. Central nervous system B. Skin C. Gastrointestinal D. Cardiovascular

C. Gastrointestinal

The nurse reads in the documentation that the patient has Baker's cysts. Which assessment will the nurse perform to validate this finding? A. Check distal lateral ankles for deformities or lumps B. Observe the wrist bilaterally for abduction C. Gently palpate the popliteal area behind the knee D. Ask the patient to flex and extend the Achilles tendon

C. Gently palpate the popliteal area behind the knee

A regimen of rest, exercise, and physical therapy is ordered for a client with rheumatoid arthritis. What should the nurse explain is the intended purpose of this regimen? A. Prevent arthritic pain B. Halt the inflammatory process C. Help prevent the crippling effects of this disease D. Provide for the return of joint motion after prolonged loss

C. Help prevent the crippling effects of this disease

Which laboratory test is the only significant test for diagnosing a patient with discoid lupus? A. Antinuclear antibody B. Serum complement C. Complete blood count D. Skin biopsy

D. Skin biopsy