Brunner Review Ch. 34

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply. a. Pain b. Alteration of self-concept c. Fluid volume deficit d. Fluid and electrolyte imbalance e. Fatigue

A, B, & E Rationale: Clients with rheumatic diseases, which typically involve joints and muscles, experience problems with mobility, fatigue, and pain. Because of the limitations of the disease, clients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases

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

C Rationale: The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? a. Place client on bed rest b. Increase fluids c. Insert a Foley catheter d. Assess diet and activity at home

D Rationale: Clients with gout need to be educated about dietary restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a client with this problem.

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a. Systemic lupus erythematosus b. Polymyalgia rheumatic c. Rheumatoid arthritis d. Scleroderma

D Rationale: Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

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

D Rationale: The most familiar manifestation of SLE is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and the cheeks. This type of rash does not characterize RA, scleroderma, or polymyositis

Which joint is most commonly affected in gout? a. Knee b. Metatarsophalangeal c. Tarsal area d. Ankle

B Rationale: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. a. Dressing changes b. Medication dosages and side effects c. Narcotic safety d. Assistive devices e. Safe exercise

B, D, & E Rationale: The client with rheumatoid arthritis who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints, walkers, and canes, may assist the client to perform safe self-care. Narcotics are not commonly used, and there would be no reason for dressings.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? a. Assess for gastrointestinal complications associated with COX-2 inhibitors b. Avoid the use of topical analgesics c. Encourage weight loss and an increase in aerobic activity d. Provide an analgesic after exercise

C Rationale: Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methyl salicylate may be used for pain management.

Which points should be included in the medication teaching plan for a client taking adalimumab? a. The medication is given at room temperature. b. The client should continue taking the medication if fever occurs. c. The medication is administered intramuscularly. d. It is important to monitor for injection site reactions.

D Rationale: It is important to monitor for injection site reactions when taking adalimumab. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.

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

D Rationale: Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity.

The side effect of bone marrow depression may occur with which medication used to treat gout? a. Allopurinol b. Prednisone c. Colchicine d. Probenecid

A Rationale: A client taking allopurinol needs to be monitored for the side effects of bone marrow depression, vomiting, and abdominal pain.

A client is admitted with an acute attack of gout. What interventions are essential for this client? Select all that apply. a. Pain medication b. Probenecid c. Dietary consult d. Serum uric acid concentration e. Corticosteroid therapy

All of the above Rationale: Steroids may be used in clients who have not responded to other therapies. They have been shown to decrease inflammation and pain in attacks of gout. Probenecid will assist in the excretion of uric acid, the causative agent. Serum uric acid concentrations will guide therapy and treatment. A dietary consult can wait until the client the acute, painful period is over but will be a necessary nursing intervention for a client experiencing gout.

Which term refers to fixation or immobility of a joint? a. Arthroplasty b. Ankylosis c. Hemarthrosis d. Diarthrodial

B Rationale: Ankylosis is the fixation or immobility of a joint. It may result from a disease process or from scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process? a. Infection b. Degeneration c. Gout d. Inflammation

C Rationale: The presence of crystals is indicative of gout; the presence of bacteria is indicative of infective arthritis

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

A Rationale: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown, and no pathological characteristics specific for the condition have been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals.

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis? a. Uric acid b. Red blood cell count c. ESR d. Creatinine

B Rationale: Clients diagnosed with rheumatic diseases have a decreased red blood cell count. ESR is increased in inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.

Which finding is consistent with the diagnosis of rheumatoid arthritis? a. Decreased ESR b. Cloudy synovial fluid c. Increased C4 complement component d. Increased red blood cell count

B Rationale: In a client with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.

A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client? a. Surgery b. Nonsteroidal anti-inflammatory drugs c. Opioid therapy d. Ice packs

B Rationale: Nonsteroidal anti-inflammatory drugs are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat, rather than ice packs, is used to relieve pain. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional; it is not an intervention specific to relieving pain.

Which is the leading cause of disability and pain in the elderly? a. Scleroderma b. Osteoarthritis (OA) c. Rheumatoid arthritis (RA) d. Systemic lupus erythematosus (SLE)

B Rationale: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

Osteoarthritis is known as a disease that... a. affects the cartilaginous joints of the spine and surrounding tissues. b. is the most common and frequently disabling of joint disorders. c. affects young males. d. requires early treatment because most of the damage seems to occur early in the course of the disease.

B Rationale: The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.

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

C Rationale: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other statements do not explain autoimmunity.

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia... a. will eventually lose their ability to walk. b. rarely respond to treatment. c. all have the same type of symptoms. d. may feel as if their symptoms are not taken seriously.

D Rationale: Because clients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose them. Clients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from client to client and respond to different treatments. Clients do not lose their ability to walk.

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms? a. Generalized muscle aching, mood swings, and loss of balance b. Diminished vision, chronic fatigue, and reduced appetite c. Pain, viral infection, and tremors d. Chronic fatigue, generalized muscle aching, and stiffness

D Rationale: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown, and no pathologic characteristics specific for the condition have been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals.

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns? a. Tricyclic antidepressants b. Range-of-motion exercise before sleeping c. Administering opioids at bed time d. Increasing activity during the day

A Rationale: Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in clients with fibromyalgia. Increasing activity during the day or using range-of-motion exercises will not increase the client's ability to sleep. Narcotics are generally not needed for pain control with this disorder.