Chapter 19

When assessing a patient who has scleroderma, the nurse recognizes which body system should be very carefully examined for evidence of impending complications? A. Pulmonary B. Integument C. Gastrointestinal D. Musculoskeletal

Answer: A Rationale: Pulmonary complications are potentially life threatening.

The nurse should intervene if the patient with scleroderma is noted to have , which is indicative of pending renal crisis. (Select all that apply.) A. Significant weight gain B. Blood pressure 174/100 mm Hg C. Creatinine 1.9 mg/dL D. Cloudy urine output E. BUN 15 mg/dL

Answer: A, B, and C Rationale: Weight gain, hypertension, and elevated serum creatinine are signs of pending renal crisis

When comparing osteoarthritis to RA, the nurse recognizes which of the following statements to be true? (Select all that apply.) A. Osteoarthritic pain tends to get worse with activity, but RA gets better with activity. B. Both RA and osteoarthritis are autoimmune diseases. C. Patients with RA are at risk for developing extraarticular manifestations such as eye inflammation and lung disease, whereas osteoarthritis affects only joints and surrounding structures. D. Patients with osteoarthritis typically have morning stiffness lasting less than 1 hour, whereas RA patients typically complain of morning stiffness lasting greater than 1 hour. E. Both RA and osteoarthritis affect joints in a symmetrical pattern.

Answer: A, C, and D Rationale: OA is not auto-immune, and RA has a symmetrical pattern.

Which statement by the patient with gout indicates that further teaching is needed? A. "Losing weight will help to reduce further gout attacks." B. "I should report my diagnosis of gout to my cardiologist because taking some forms of diuretics may increase gout flares." C. "Avoiding foods containing purines, such as red meats, seafood, and alcoholic beverages, will help to reduce the incidence of gout flares." D. "I can drink alcohol if I limit the number of beers I drink."

Answer: D Rationale: Beer should be avoided as it may cause elevated uric acid levels which could lead to a gout flare

Which statement by the patient with fibromyalgia indicates that teaching has been effective? A. "Because of my fibromyalgia, I may get inflammatory arthritis, which may lead to joint damage." B. "I won't know for sure about my diagnosis until I have diagnostic tests such as x-rays and blood tests done." C. "My only option to treat my pain is narcotic analgesics." D. "It's frustrating, but I understand that fibromyalgia typically presents with a normal physical examination with no evidence of joint or muscle inflammation."

Answer: D Rationale: Fibromyalgia patients usually have a normal physical exam with no evidence to suggest joint or muscle inflammation.

The nurse knows that which of following statements regarding laboratory values and RA are true? (Select all that apply.) A. Patients with a positive rheumatoid factor definitely have RA. B. An elevated CRP is indicative of inflammation but is not specific only for RA. C. Certain DMARD therapy may cause laboratory abnormalities such as elevated liver enzymes, thrombocytopenia, and leukocytopenia. D. Approximately 25% to 30% of patients who have RA do not have a positive rheumatoid factor. E. Patients with RA have elevated cardiac enzymes due to pharmacological therapy

Answer: B, C, and D Rationale: Elevated CRP is an indicator that can be useful in distinguishing inflammatory from noninflammatory arthritis. Certain DMARD therapy can be toxic to the liver and may cause thrombocytopenia or leukocytopenia. Approximately 25% to 30% of patients are negative for antibodies. A positive rheumatoid factor does not always indicate the presence of RA.

The nurse includes which information in the teaching plan about the management of fibromyalgia? (Select all that apply.) A. Narcotics should be taken for pain related to fibromyalgia. B. Stress management techniques are important tools. C. Daily exercise can help control fibromyalgia symptoms. D. Antidepressant medications may decrease pain as well as depression. E. Limit exercise because that may exacerbate pain.

Answer: B, C, and D Rationale: Narcotics are NOT recommended to treat fibromyalgia pain as they are not very effective and may become addictive. Stress management, daily exercise, and antidepressant medications may all improve symptoms related to fibromyalgia.

The nurse monitors for which clinical manifestations in the patient diagnosed with osteoarthritis? (Select all that apply.) A. Pain that improves with activity B. Joint pain C. Joint swelling D. Unsteady gait E. Increased temperature

Answer: B, C, and D Rationale: OA pain typically improves with rest while RA pain improves with activity. OA produces joint pain and may produce joint swelling and may cause and unsteady gait if lower extremity joints are affected.

The nurse monitors for which clinical manifestations in the patient diagnosed with osteoarthritis? (Select all that apply.) A. Shortness of breath B. Decreased range of motion of affected joint C. Joint pain that improves with activity D. Warmth and swelling of affected joints E. Heberden's nodes

Answer: B, D, and E Rationale: OA does not cause lung disease as RA can. Decreased ROM is an expected finding in patients with OA. Joint pain due to OA typically gets worse with activity not better as it is in the case of RA. Warmth and swelling in affected joints in a common finding. Heberden's nodes located over the distal phalanges are also a common finding in OA patients.

The nurse recognizes which patient to be at the highest risk for developing SLE? A. A 10-year-old Hispanic female B. An 18-year-old African American male C. A 30-year-old African American female D. A 50-year-old Caucasian male

Answer: C Rationale: African American females are at the highest risk as stated in text.

The nurse recognizes which patient to be at greatest risk for developing osteoarthritis? A. A 70-year-old African American male B. A 45-year-old Caucasian female C. A 65-year-old obese African American female D. A 30-year-old Caucasian male

Answer: C Rationale: Age, obesity, and gender are all strong risk factors for developing OA.

The nurse recognizes which patient with scleroderma to be at the highest risk for morbidity and mortality? A. An 18-year-old Caucasian female with linear skin lesions noted on her face B. A 20-year-old Hispanic male with patches of skin on the distal portions of his arms and legs C. A 32-year-old Caucasian female presenting with thickened skin on her trunk D. A 45-year-old African American male with Raynaud's disease

Answer: C Rationale: Involvement of the skin on the trunk indicates diffuse systemic sclerosis which is more serious than limited sclerosis which affects the limbs.

The nurse assesses for which initial clinical manifestation in the patient diagnosed with gout? A. Pain and inflammation in the shoulder B. Pain and inflammation in the wrist C. Pain and inflammation in the knee D. Pain and inflammation in the great toe

Answer: D Rationale: 80% of patients with gout present with podagra.