Ch. 38: Assessment/Mgmt of Pts w/ Rheumatic Disorders
The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan? jogging running on a treadmill t'ai chi weight lifting
t'ai chi Explanation: 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.
What intervention is a priority for a client diagnosed with osteoarthritis? Physical therapy and exercise Hydrotherapy Colchicine Allopurinol
Physical therapy and exercise
The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse? The fluid will be clear and pale. The fluid will be milky, cloudy, and dark yellow. The amount of fluid will be scant in volume. The fluid will be straw colored.
The fluid will be milky, cloudy, and dark yellow. Explanation: An arthrocentesis shows abnormal synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.
A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce purine levels. Weight loss will reduce inflammation. Weight loss will increase uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints.
Weight loss will reduce uric acid levels and reduce stress on joints. Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.
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 methotrexate prednisone colchicine
colchicine
A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate? Keep shifting weight from one foot to the other. Perform aerobic exercises. Maintain complete bed rest. Maintain good posture.
Maintain good posture. Explanation: The nurse needs to remind the client with degenerative joint disease to maintain good posture. While the client need not maintain complete bed rest, performing aerobic exercises is not advisable as it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.
A nurse is managing the care of a client who has gout. Which medication would be prescribed as the drug of choice to prevent tophi formation and promote tophi regression? Probenecid Sulfinpyrazone Febuxostat Allopurinol
Allopurinol Explanation: Allopurinol (Zyloprim), a xanthine oxidase inhibitor, is considered the drug of choice for preventing the precipitation of an attack, preventing tophi formation, and promoting the regression of existing tophi. Uricosuric agents, such as probenecid (Benemid), correct hyperuricemia and dissolve deposited urate.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased red blood cell count Increased C4 complement Elevated erythrocyte sedimentation rate Increased albumin levels
Elevated erythrocyte sedimentation rate Explanation: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.
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 An exercise routine that includes range-of-motion (ROM) exercises Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) Cold therapy
An exercise routine that includes range-of-motion (ROM) exercises Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain.
A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response? A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. It's impossible to determine at the time of diagnosis how the disease will progress. The client should discuss this concern with the health care provider. Hand and finger deformities are associated with the development of rheumatoid arthritis.
Hand and finger deformities are associated with the development of rheumatoid arthritis. Explanation: The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease.
A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse? "If you don't take your medication, you will become very ill." "Be sure to let the physician know after you stop your medications." "It is important that you continue to take your medication to avoid an acute exacerbation." "As long as you are not having symptoms, you can take a medication vacation."
"It is important that you continue to take your medication to avoid an acute exacerbation."
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 of the following refers to fixation of a joint? Ankylosis Synovitis Pannus Articulations
Ankylosis Explanation: Fixation of a joint, called ankylosis, eliminates friction, but at the drastic cost of immobility. Inflammation is manifested in the joints as synovitis. Pannus has a destructive effect on the adjacent cartilage and bone. Articulations are joints.
Which of the following procedures involves a surgical fusion of the joint? Arthrodesis Synovectomy Tenorrhaphy Osteotomy
Arthrodesis Explanation: An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint.
The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? Ibuprofen Celecoxib Piroxicam Tolmetin sodium
Celecoxib
Which finding is consistent with the diagnosis of rheumatoid arthritis? Decreased ESR Cloudy synovial fluid Increased red blood cell count Increased C4 complement component
Cloudy synovial fluid Explanation: 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.
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 Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.
Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? Limited passive movement Joint enlargement Joint instability Limb shortening
Limited passive movement
Which joint is most commonly affected in gout? Metatarsophalangeal Tarsal area Ankle Knee
Metatarsophalangeal
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? Bone scan Computed tomography (CT) Magnetic resonance imaging (MRI) Muscle biopsy
Muscle biopsy Explanation: As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity.
Which condition is the leading cause of disability and pain in the elderly? Osteoarthritis (OA) Rheumatoid arthritis (RA) Systemic lupus erythematous (SLE) Scleroderma
Osteoarthritis (OA) Explanation: OA 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.
Which is the leading cause of disability and pain in the elderly? Osteoarthritis (OA) Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Scleroderma
Osteoarthritis (OA) Explanation: 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.
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 Raynaud's phenomenon Reiter's syndrome Sjögren's syndrome
Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Subchondral bone Pannus Joint effusion Tophi
Tophi
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? colchicine probenecid anturane allopurinol
colchicine
The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? small joint involvement joint pain that diminishes with rest subcutaneous nodules early morning stiffness
early morning stiffness Explanation: Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.
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? ability to perform activities of daily living (ADL) decreased joint pain increased fatigue a weight gain of 2 pounds
increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.
The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? pain joint swelling stiffness weakness
pain
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications strategies for remaining active disease-modifying antirheumatic drug therapy prevention of joint deformity
strategies for remaining active Explanation: The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Facial erythema, pericarditis, pleuritis, fever, and weight loss Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Weight gain, hypervigilance, hypothermia, and edema of the legs Hypothermia, weight gain, lethargy, and edema of the arms
Facial erythema, pericarditis, pleuritis, fever, and weight loss
A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities? prone semi-Fowler's position side-lying with pillows supporting the shoulders and legs supine with pillows under the knees
prone
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 comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? Degenerative joint disease Muscular dystrophy Scoliosis Paget's disease
Degenerative joint disease Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease.
A nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach the about for osteoarthritis? administration of opioids for pain control. administration of nonsteroidal anti-inflammatory drugs (NSAIDs) administration of monthly intra-articular injections of corticosteroids. vigorous physical therapy for the joints.
administration of nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? joint stiffness that decreases with activity erythema and edema over the affected joint anorexia and weight loss fever and malaise
joint stiffness that decreases with activity Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? "My legs feel weak." "My finger joints are oddly shaped." "I have pain in my hands." "I have trouble with my balance."
"My finger joints are oddly shaped." Explanation: Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.
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." "There are no activity limitations between flare-ups." "Monitor your body temperature." "Corticosteroids may be stopped when symptoms are relieved."
"Monitor your body temperature."
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men."
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
Which client is most likely to develop systemic lupus erythematosus (SLE)? A 25-year-old white male A 25-year-old Jewish female A 27-year-old black female A 35-year-old Hispanic male
A 27-year-old black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women.
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? "You have inherited your parent's immunity to the disease." "Your symptoms are a result of your body attacking itself." "You have antigens to the disease, but they do not prevent the disease." "You are not immune to the disease causing the symptoms."
"Your symptoms are a result of your body attacking itself." Explanation: 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.
The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? First thing in the morning when the client wakes After cool compresses have been applied to the hands After the client has had a warm paraffin hand bath After the client has a diagnostic test
After the client has had a warm paraffin hand bath Explanation: Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises.
A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply. Diarrhea Tingling in the arms Intestinal cramping Increase in pain in the affected extremity Nausea and vomiting
Diarrhea Intestinal cramping Nausea and vomiting Explanation: Colchicine is administered every 1 or 2 hours until the pain subsides or nausea, vomiting, intestinal cramping, and diarrhea develop. When one or more of these symptoms occurs, the drug should be stopped temporarily. Tingling in the arms and increase in pain are not normal adverse reactions that are seen with this drug.
Which is an appropriate nursing intervention in the care of the client with osteoarthritis? Provide an analgesic after exercise Encourage weight loss and an increase in aerobic activity Assess for gastrointestinal complications associated with COX-2 inhibitors Avoid the use of topical analgesics
Encourage weight loss and an increase in aerobic activity Explanation: 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 methylsalicylate may be used for pain management.
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease? If you have problems with a medication, you may stop it until your next physician visit. Avoid sunlight and ultraviolet radiation. Pace activities. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
If you have problems with a medication, you may stop it until your next physician visit.
Which points should be included in the medication teaching plan for a client taking adalimumab? The medication is administered intramuscularly. The client should continue taking the medication if fever occurs. The medication is given at room temperature. It is important to monitor for injection site reactions.
It is important to monitor for injection site reactions. Explanation: 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.
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 (Rheumatrex) Etanercept (Enbrel) Methylprednisolone (Medrol) Infliximab (Remicade)
Methotrexate (Rheumatrex)
A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client? Opioid therapy Ice packs Surgery Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs Explanation: 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.
A client is admitted with an acute attack of gout. What interventions are essential for this client? Select all that apply. Dietary consult Probenecid Corticosteroid therapy Pain medication Serum uric acid concentration
Probenecid Corticosteroid therapy Pain medication Serum uric acid concentration Explanation: Steroids may be used in clients who have not responsed 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.
A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease? Observe the client's gait. Review the client's medical record. Inspect the client's mouth. Auscultate the client's lung sounds.
Review the client's medical record. Explanation: The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.
Which of the following disorders is characterized by an increased autoantibody production? Systemic lupus erythematosus (SLE) Scleroderma Rheumatoid arthritis (RA) Polymyalgia rheumatic
Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. 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. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.
A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Take the medication on an empty stomach in order to increase effectiveness. Since the medication is able to be obtained over the counter, it has few side effects. Take the medication with food to avoid stomach upset. Inform the health care provider if there is ringing in the ears.
Take the medication with food to avoid stomach upset. Explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. Ibuprofen is available over the counter, but it still has side effects. Aspirin is known to cause ringing in the ears, not NSAIDs.
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? eating organ meats and sardines frequently drinking coffee high carbohydrate intake frequently ingesting salicylates
eating organ meats and sardines
Osteoarthritis is known as a disease that is the most common and frequently disabling of joint disorders. affects young males. requires early treatment because most of the damage seems to occur early in the course of the disease. affects the cartilaginous joints of the spine and surrounding tissues.
is the most common and frequently disabling of joint disorders. Explanation: 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.
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? tender to the touch reddened nonmovable located over bony prominence
located over bony prominence
The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? low back pain increased urine output red, butterfly-shaped facial rash patchy hair loss on the scalp
low back pain
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 Explanation: 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.
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? Assess diet and activity at home Place client on bed rest Increase fluids Insert a Foley catheter
Assess diet and activity at home Explanation: 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.
A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? congenital deformity age trauma obesity
age Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.
The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. Safe exercise Narcotic safety Medication dosages and side effects Dressing changes Assistive devices
Safe exercise Medication dosages and side effects Assistive devices Explanation: 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.
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? "The fasting is okay, but make sure you drink fluids when exercising." "Make sure to eat some fat occasionally with all that exercise." "Try combining the fasting with moderate exercise." "There might be some difficulties with your plan and fasting."
"There might be some difficulties with your plan and fasting." Explanation: Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.