Ch 50

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 shirt 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."

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

A feature of rheumatoid arthritis that differentiates it from other forms of inflammatory arthritis is the development of which physiologic abnormality?

Pannus tissue

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

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 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 has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology?

"Genetic predisposition is very likely."

The nurse is teaching a client about osteoarthritis. The nurse corrects the client when the client makes which inaccurate statement?

"Older men are more likely to have osteoarthritis than older women."

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client makes which statement?

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."

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."

The nurse is caring for several clients on an orthopedic unit. Place the clients listed in the order in which the nurse should assess them. Use all options.

77-year-old with osteoarthritis who has just returned from total knee arthroplasty. 56-year-old with rheumatoid arthritis with a temperature of 101.3°F (38.5°C). 24-year-old with ankylosing spondylitis with acute pain radiating from spine to thigh. 89-year-old with polymyalgia rheumatica who currently has corticosteroids infusing.

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 assessing a client's risk for osteoarthritis. Which factor places the client at greatest risk for this condition?

Age

A nurse is teaching the client about extra-articular manifestations of rheumatoid arthritis (RA). Which topic will the nurse include in the teaching plan?

Anemia

The nurse is reviewing a laboratory report that documents the presence of HLA-B27 antigen. The nurse interprets this as being linked to which disorder?

Ankylosing spondylitis

A 44 year-old woman who has a longstanding diagnosis of SLE has been able to control her symptoms with lifestyle modifications for several years, but has presented to her care provider due to recent exacerbation. Which pharmacologic treatment option is her care provider most likely to rule out first?

Antiplatelet aggregators

The nurse is teaching the client with rheumatoid arthritis (RA) about the role of corticosteroid therapy in disease management. What information does the nurse include about the use of corticosteroids in RA? Select all that apply.

Are reserved for poorly controlled, systemic symptoms Can increase the risk for opportunistic infections Do not affect disease process or prevent joint damage

A client presents with arthralgia and arthritis. Which is the priority nursing intervention?

Assessing the client's pain and history of treating it

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

A nurse is teaching a client with psoriatic arthritis about treatment. Which statement should be included?

Biologic response modifiers are beneficial in controlling the disease.

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 has increased serum creatinine. Child is fatigued and generally feels "under the weather."

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

Corticosteroids

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 is caring for a client with systemic sclerosis (scleroderma), which condition does the nurse instruct the client causes symptoms of the disease?

Deposits of collagen in the skin and organs

A rheumatology nurse is teaching a client about extra-articular signs and symptoms of rheumatoid arthritis (RA). Which item does the nurse include in the teaching session? Select all that apply.

Fatigue Temperature 99.3°F (37.4°C) Loss of appetite

Which assessment findings will help the nurse to confirm the diagnosis of rheumatoid arthritis? Select all that apply.

Finger and hand pain Joint stiffness Wrist pain Limited joint mobility

When caring for a client with ankylosing spondylitis, in which position does the nurse place the client for sleep?

Flat with one pillow

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 Instep Metatarsals

A client has developed signs and symptoms of systemic lupus erythematosus (SLE). The nurse reviews the client's medication record for which medications that are associated with drug-induced lupus? Select all that apply.

Hydralazine Isoniazid Procainamide

An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health?

Immunologically mediated joint inflammation

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 nurse is caring for a client with discoid lupus. Which system does the nurse set as a priority for the nursing assessment?

Integumentary assessment

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

It's characterized by synovitis and can influence epiphyseal growth, resulting in stunted growth.

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

The health care provider suspects a child has developed an inflammatory myopathy based on muscle weakness and a characteristic rash. Which diagnosis correlates to the findings?

Juvenile dermatomyositis (JDMS)

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

Kyphosis

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

Lower back pain

The relative of a client with osteoarthritis asks how to avoid developing the condition. Which response by the nurse is most accurate?

Maintain your weight near ideal.

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

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

An adult client has osteoarthritis in his left ankle that has been attributed to an old sports injury. When he plays on the weekends now, residual changes in the joint cause him significant pain. Which cause is most likely?

Osteophytes

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

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 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

A client has been diagnosed with scleroderma. Which assessment finding does the nurse expect?

Raynaud phenomenon

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

Raynaud's phenomenon.

A client was diagnosed with Salmonella 1 week ago and is now experiencing joints that are warm, swollen, and tender; fever; and weight loss. What is the most likely interpretation of these manifestations?

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

A nurse is caring for a child with systemic-onset juvenile idiopathic arthritis (JIA). Which assessment finding should be the priority for the nurse to intervene?

Temperature of 103.5°F (39.7°C).

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.

When caring for a child with systemic lupus erythematosus, the nurse monitors which diagnostic tests to detect potential complications and disease progression?

Thyroid function

When teaching a group of nursing students about secondary causes of osteoarthritis (OA), the nurse should include which historical underlying diseases/disorders? Select all that apply.

Trauma Infection Osteonecrosis

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 teaching a client recently diagnosed with systemic lupus erythematosus (SLE), what does the nurse teach the client to avoid to prevent exacerbations?

Ultraviolet light (UV)

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

The nurse is assessing a client in early stage of rheumatoid arthritis. Which assessment findings would the nurse expect to find? Select all that apply.

Warmth Erythema Tenderness Swelling

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects?

Weight and nutritional status

Ankylosing spondylitis is a disease that typically manifests in late adolescence and early adulthood. What is the characteristic of the pain in ankylosing spondylitis?

Worse when lying down

The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first?

client with systemic lupus erythematosus reporting chest pain

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

elevated anti-nuclear antibodies (ANA)

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.

Giant cell arteritis is a comorbid condition of:

polymyalgia rheumatica