Patho Final - Ch 50

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?

Joint pain and proteinuria

Which disease in children presents with an inflammatory myopathy primarily involving skin and muscle with a heliotrope rash around the eyes?

Juvenile dermatomyositis

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess?

Kyphosis

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

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"

A client recently diagnosed with rheumatoid arthritis (RA) tells the nurse she is glad there is nothing "really wrong with her" besides some joint swelling. Which information should the nurse tell the client about RA?

"Extra-articular manifestations may include anemia and deformities of the affected joints"

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 shirts 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?

"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?

"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"

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?

"To prevent cartilage atrophy, slowly and gradually resume exercising"

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"

A client who has developed rheumatoid arthritis can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response?

A T-cell-mediated response to an immunologic trigger, such as a microbial agent

The nurse is caring for a client with acute gout. The nurse reviews the client's medical history for what possible contributors to secondary gout? Select all that apply.

A decreased glomerular filtration rate - Diagnosed with a hemolytic anemia - Has been taking a cytotoxic medication

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

A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?

Autoimmune process

When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease?

Autologous antibodies

When a nurse is caring for a client newly diagnosed with systemic lupus erythematosus (SLE), which behavior will best help prevent exacerbations of the disease?

Avoiding ultraviolet light (UV)

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

A nurse is caring for an adolescent female who is undergoing diagnostic studies for systemic lupus erythematosus (SLE). Which assessment findings does the nurse recognize as being consistent with childhood SLE? Select all that apply.

Child is between 8 and 15 years of age - Child is fatigued and generally feels "under the weather" - Child has increased serum creatinine

Which clients with rheumatoid arthritis (RA) will the nurse prioritize to assess first?

Client with systemic lupus erythematosus (SLE) and chest pain

A client with a history of polymyalgia rheumatica is admitted with a suspected stroke and is permitted nothing by mouth (NPO). Given this client's prescribed medications, what parenteral medication will the nurse prioritize as most important to request from the health care provider?

Corticosteroid

Juvenile dermatomyositis is a chronic inflammatory myopathy that commonly manifests systemically. What is the treatment of choice for this myopathy?

Corticosteroids

Osteoarthritis is the most common cause of arthritis and a significant cause of disability in older adults. What joint changes occur in osteoarthritis? Select all that apply.

Creation of spurs, loss of articular cartilage, synovitis

The nurse performing a musculoskeletal assessment of a client with osteoarthritis would evaluate the presence of which finding as being a normal expectation?

Crepitus and grinding

When a nurse assesses a client with scleroderma (systemic sclerosis), which manifestation does the nurse recognize is part of the CREST variant syndrome rather than the systemic type of this disorder?

Dermal thickening proximal to wrists

Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?

Elevated anti-nuclear antibodies (ANA)

Which statement is true regarding the development of juvenile idiopathic 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?

Gentle exercise

When teaching a client about areas of the body typically affected by gout, the nurse would include which locations? Select all that apply.

Heel, Metatarsals, Heel

A client who has recently been diagnosed with polymyositis asks the nurse how this problem arose. The nurse tells the client that the underlying cause of this disorder is:

Inflammation and immune mechanisms

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

An otherwise healthy 35-year-old client has been admitted for treatment of active systemic lupus erythematosus (SLE) and is prescribed cyclophosphamide. What should the nurse include in the plan of care? Select all that apply.

Inspecting oral mucosa, avoiding invasive procedures, monitoring urine output

When assessing a client with rheumatoid arthritis, which statement about joint involvement is most accurate?

Involvement is symmetric and polyarticular, initially starting in the fingers, hands, and wrists

In general, how are children affected by a rheumatic disease such as juvenile idiopathic arthritis (JIA)?

It is characterized by synovitis and can influence epiphyseal growth, resulting in stunted growth

The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find?

Lower back pain

A client presents with joint pain and suspected rheumatoid arthritis (RA). Which intervention is appropriate for the nurse to implement?

Muscle-strengthening exercises to support joints

Which assessment finding best confirms the diagnosis of systemic lupus erythematosus (SLE)?

Negative anti-DNA antibody test

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)

When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease?

Obesity

A client presents with a "spur" on the joint. The client asks, "Why did this happen? I guess I just did not exercise enough." Which pathophysiologic mechanism of osteoarthritis (OA) should the nurse explain to this client?

Osteophyte formation and erosion of cartilage

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

Which type of joint manifestations would the nurse anticipate finding in a client with rheumatoid arthritis?

Polyarticular

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

Giant cell arteritis is a comorbid condition of:

Polymyalgia rheumatica

A client diagnosed with arthritis had a recent infection. Which intervention is necessary to determine if the client has bacterial arthritis?

Positive culture of synovial fluid

The nurse assessing a client with scleroderma with CREST variant would include an assessment for:

Raynaud's phenomenon

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?

Reactive arthritis

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which important differences when caring for the older adult?

Risk for falls

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

Which substance helps maintain a smooth surface in joint cartilage?

Synovial fluid

A nurse is caring for a client admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which disease process?

Systemic lupus erythematosus (SLE)

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

A nurse is caring for a client who has developed vasculitis as a result of a rheumatology disorder. Which factor does the nurse expect to uncover in assessing this client?

Ulcers of the lower extremities

When a nurse is caring for a client with gout, which diagnostic study supporting the presence of the disease does the nurse monitor?

Uric acid levels

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?

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

The nurse is caring for a client who has a history of dermatomyositis. Which objective is a priority for this client?

Preventing long-term muscle, joint, and organ damage