Ch. 50 Disorders of Musculoskeletal Function: Rheumatic Disorders

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."

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

A 30-year-old client has been diagnosed with ankylosing spondylitis. Which etiology is responsible for this health problem?

Immune response

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 nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?

Autoimmune process

A client recently diagnosed with rheumatoid arthritis (RA) tells the nurse she is glad there is nothing "really wrong with her" besides some joint swelling. Which information should the nurse tell the client about RA?

"Extra-articular manifestations may include anemia and deformities of the affected joints."

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."

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."

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."

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 teaching the client about the management of primary gout. Which medications will the nurse include as indicated to control uric acid levels? Select all that apply.

- Allopurinol - Febuxostat - Probenecid

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

When teaching a client about areas of the body typically affected by gout, the nurse would include which locations? Select all that apply.

- Metatarsals - Instep - Heel

Which clients with rheumatoid arthritis (RA) will the nurse prioritize to assess first?

Client with systemic lupus erythematosus (SLE) and chest pain

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

A client has undergone extensive diagnostic testing following several months of worsening pain in the first metatarsophalangeal joint with reduced range of motion. The client's results indicate hyperuricemia. What is the nurse's best interpretation of this finding?

Further testing is needed before a diagnosis of gout can be made.

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

Elevated anti-nuclear antibodies (ANA)

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

When assessing a client with rheumatoid arthritis, which statement about joint involvement is most accurate?

Involvement is symmetric and polyarticular, initially starting in the fingers, hands, and wrists.

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?

Joint pain and proteinuria

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 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

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

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

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

Raynaud phenomenon

When assessing a child for clinical manifestations of oligoarticular arthritis, the health care provider will base the diagnosis on which clinical findings?

Right knee is warm and painful when putting it through normal range of motion.

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 client with reactive arthritis is thought to have Reiter syndrome. For which specific past medical history should the nurse interview the client?

Sexually transmitted infections

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

Which substance helps maintain a smooth surface in joint cartilage?

Synovial fluid

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 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 conducting a health promotion class on osteoarthritis (OA). Which statement should the nurse include?

Obesity is a strong risk factor for developing OA.

When caring for a child with juvenile dermatomyositis (JDMS), the nurse looks for which clinical manifestations during the assessment? Select all that apply.

- Rash - Symmetrical muscle weakness - Elevated creatine kinase