A2 EX.4 CH.38 PREP U Musculoskeletal

The nurse notes that a client is being treated for fibromyalgia. For which additional rheumatic conditions will the nurse analyze the client's health history? Select all that apply. Ankylosing spondylitis Systemic lupus erythematosus Ostearthritis Rheumatoid arthritis Psoriatic arthritis

Ankylosing spondylitis Rheumatoid arthritis Systemic lupus erythematosus

A client with rheumatoid arthritis asks what can be used to control pain besides taking pain medication. Which recommendations will the nurse suggest to this client? Select all that apply. Assistive walking devices Warm tub bath Warm moist compresses Splints Transcutaneous nerve stimulator

Assistive walking devices Warm tub bath Warm moist compresses Splints

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? high carbohydrate intake frequently ingesting salicylates eating organ meats and sardines frequently drinking coffee

eating organ meats and sardines High-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops

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 Celecoxib Mercaptopurine azathioprine Methylprednisolone

Methotrexate

The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the most common finding associated with fibromyalgia? Heberden nodes widespread chronic pain jaw locking butterfly facial rash

widespread chronic pain

A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? "Try combining the fasting with moderate exercise." "The fasting is okay, but make sure you drink fluids when exercising." "Make sure to eat some fat occasionally with all that exercise." "There might be some difficulties with your plan and fasting."

"There might be some difficulties with your plan and fasting." void fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion

As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. 3.2 mg/dL (0.19mmol/L) 4.0 mg/dL (0.24 mmol/L) 5.4 mg/dL (0.32 mmol/L) 6.8 mg/dL (0.40 mmol/L)

6.8 mg/dL (0.40 mmol/L)

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? Chest pain Decreased cognitive ability Behavioral changes Hypertension

Hypertension

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? Ankylosing spondylitis Reiter's syndrome Sjögren's syndrome Raynaud's phenomenon

Raynaud's phenomenon

A client with rheumatoid arthritis wants to try nonpharmacologic approaches to control the pain and stiffness. Which approaches will the nurse suggest that might improve the client's comfort and mobility? Select all that apply. Self-hypnosis Massage Imagery Chiropractic adjustments Golfing

Self-hypnosis Massage Imagery chiropractic adj.

Tophi

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Joint effusion Tophi Subchondral bone Pannus

Tophi

Hyperuricemia.

a serum uric acid concentration above 6.8 mg/dL (0.40 mol/L) can cause urate crystal deposition which can lead to gout.

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? eradicating pain promoting sleep minimizing damage eliminating deformities

minimizing damage

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? "The belief is that it is an autoimmune disorder with an unknown trigger." "This disorder is more common in men in their thirties and forties than in women." "The symptoms are primarily localized to the skin but may involve the joints." "SLE has very specific manifestations that make diagnosis relatively easy."

The belief is that it is an autoimmune disorder with an unknown trigger.

What intervention is a priority for a client diagnosed with osteoarthritis? Colchicine Hydrotherapy Physical therapy and exercise Allopurinol

Physical therapy and exercise

the nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? penicillamine colchicine prednisone methotrexate

colchicine

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? fever and malaise joint stiffness that increases with activity anorexia and weight loss erythema and edema over the affected joint

joint stiffness that increases with activity

The nurse is caring for a client with ankylosing spondylitis. Which educational information will the nurse provide to this client? Use of analgesics Use of cough supressants Use of diuretics Use of laxatives

Use of analgesics

A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of? citrus fruits green vegetables organ meats fresh fish

organ meats

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? Acupuncture Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) Cold therapy An exercise routine that includes range-of-motion (ROM) exercises

An exercise routine that includes range-of-motion (ROM) exercises Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain

Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Systemic lupus erythematous (SLE) Polymyositis Scleroderma Rheumatoid arthritis (RA)

Systemic lupus erythematous (SLE)

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. Weight loss Limiting exercise Decreasing alcohol intake Avoiding purine-rich foods Restricting the intake of water

Weight loss Decreasing alcohol intake Avoiding purine-rich foods

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? "It will never get any better than it is right now." "When it clears up, it will never come back." "It will get better and worse again." "I'll definitely need surgery for this."

"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? "Exposure to sunlight will help control skin rashes." "Corticosteroids may be stopped when symptoms are relieved." "There are no activity limitations between flare-ups." "Monitor your body temperature."

"Monitor your body temperature." fever can signal an exacerbation and should be reported to the physician.

The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? "You are not immune to the disease causing the symptoms." "You have inherited your parent's immunity to the disease." "You have antigens to the disease, but they do not prevent the disease." "Your symptoms are a result of your body attacking itself."

"Your symptoms are a result of your body attacking itself."

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Administering ordered analgesics and monitoring their effects Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes Performing meticulous skin care

Administering ordered analgesics and monitoring their effects

autoimmune disease

a disease in which the immune system attacks the organism's own cells

ankylosing spondylitis

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

Hyperuricemia (gout)

a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation

Osteoarthritis

inflammation of the bone and joint

Which condition is the leading cause of disability and pain in the elderly? Scleroderma Systemic lupus erythematous (SLE) Rheumatoid arthritis (RA) Osteoarthritis (OA)

Osteoarthritis (OA)

The nurse is providing medication teaching to a client with rheumatoid disease. What common actions are seen with diclofenac and aspirin? Select all that apply. antispasmodic analgesic antipyretic anti-inflammatory antiplatelet

analgesic antipyretic anti-inflammatory antiplatelet

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

gout.

Pannus

proliferation of newly formed synovial tissue infiltrated with inflammatory cells

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? "This disorder is more common in men in their thirties and forties than in women." "The belief is that it is an autoimmune disorder with an unknown trigger." "SLE has very specific manifestations that make diagnosis relatively easy." "The symptoms are primarily localized to the skin but may involve the joints."

"The belief is that it is an autoimmune disorder with an unknown trigger."

A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? "The test will determine how long you will have the rash." "It is a routine test done on everyone." "The medication you take can affect your bladder." "The lupus can affect your kidney function."

"The lupus can affect your kidney function." Nephritis as a result of SLE, also referred to as lupus nephritis, occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons.

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased albumin levels Elevated erythrocyte sedimentation rate Increased red blood cell count Increased C4 complement

Elevated erythrocyte sedimentation rate

A client with rheumatoid arthritis is discharging to home following an exacerbation of joint pain. Which type of referral will be the priority for the client? Home health nurse Physical therapy Social services Occupational therapy

Home health nurse

Which joint is most commonly affected in gout? Ankle Metatarsophalangeal Knee Tarsal area

Metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra

Primary gout is often caused by an inherited disorder in which type of metabolism? Fat Purine Carbohydrate Glucose

Purine

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care? a weight gain of 2 pounds increased fatigue decreased joint pain ability to perform activities of daily living (ADL)

increased fatigue

Fibromyalgia is a common condition that involves diminished vision, chronic fatigue, and reduced appetite. generalized muscle aching, mood swings, and loss of balance. chronic fatigue, generalized muscle aching, and stiffness. pain, viral infection, and tremors.

chronic fatigue, generalized muscle aching, and stiffness

The nurse is caring for a client with a new onset of gout. What medication does the nurse anticipate will be ordered by the health care provider? anturane colchicine allopurinol probenecid

colchicine