PrepU Chapter 39: Assessment and Management of Patients With Rheumatic Disorders

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."

What should the nurse teach the patient about the diagnosis of osteoarthritis?

"It is the most common and frequently disabling of joint disorders."

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? Glucosuria Hyperuricemia Hyperproteinuria Ketonuria

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

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

50 the client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose.

The side effect of bone marrow depression may occur with which medication used to treat gout?

Allopurinol (Zyloprim)

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 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.

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursing diagnosis isn't the priority. Clients with scleroderma are at risk for Imbalanced nutrition: Less than body requirements. The client with advanced scleroderma, not newly diagnosed scleroderma, is at increased risk for developing respiratory complications.

Scleroderma typically begins with which system involvement?

Integumentary

Fibromyalgia is a common condition that

Involves chronic fatigue, generalized muscle aching, and stiffness

Which of the following statements is accurate regarding osteoarthritis?

It is a noninflammatory disorder and the most common and frequently disabling of joint

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?

SLE

During a home health visit you are helping a patient with gout identify foods in their pantry they should avoid eating. Select all the foods below the patient should avoid: A. Sardine B. Whole wheat bread C. Sweetbreads D. Crackers E. Craft beer F. Bananas

Sardine - Sweetbreads - Craft beer A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer).

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis? a) Imbalanced nutrition: greater than body requirements b) Impaired physical mobility c) Deficient knowledge: symptom management d) Chronic pain

a) Imbalanced nutrition: greater than body requirements

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound? a) Inhibits DNA synthesis b) Inhibits lysosomal enzymes c) Inhibits T- and B-cell activity d) Inhibits platelet aggregation

c) Inhibits T- and B-cell activity Gold sodium thiolmalate (Myochrysine) inhibits T- and B-cell activity, thereby suppressing synovitis during the active stage of rheumatoid disease. pg.1060

A client comes to the clinic and reports pain in the right great toe which is worse at night. Assessment reveals tophi. What does the nurse suspect? a. reactive arthritis b. rheumatoid arthritis c. gouty arthritis d. osteoarthritis

c. gouty arthritis Gout results from the inability to metabolize purines. This condition is most commonly seen in men and usually affects the legs, feet, and knees. Osteoarthritis is caused by degeneration of the joints. Rheumatoid arthritis is a systemic disorder more common in women of childbearing age. Reactive arthritis is seen with infections and is most common in young adult males.

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

combat inflammation.

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

gout. The presence of crystals is indicative of gout, and the presence of bacteria is indicative of infective arthritis.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to:

install safety devices in the home.

Which of the following would a nurse encourage a client with gout to limit? fluid intake protein-rich foods purine-rich foods carbohydrates

purine-rich foods Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan? jogging running on a treadmill t'ai chi weight lifting

t'ai chi T'ai chi is low impact, so this is the best exercise for low joint impact. Jogging, weight lifting, and running on a treadmill are high-impact, jarring types of exercise.