Chapter 50

A young adult client presents with "stiffening of the spine." Which diagnostic laboratory result leads the health care worker to diagnose ankylosing spondylitis?

Presence of HLA-B27 allele marker

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 nurse is caring for a client undergoing antineoplastic chemotherapy for acute leukemia. Which diagnostic study does the nurse monitor to detect the consequences of the rapid lysis of cancer cells?

Hyperuricemia

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

The nurse is reviewing laboratory results and notes an elevated uric acid level on a client. What action should the nurse take?

Interview the client about current or past joint and urinary symptoms

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)

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.

Which individual is at greatest risk for osteoarthritis?

Male, age 75

Which assessment finding best confirms the diagnosis of systemic lupus erythematosus (SLE)?

Negative anti-DNA antibody test

While speaking to a senior citizen club about osteoarthritis (OA), which facts are accurate to share?

Obesity in women has been correlated to having OA in the knees.

During assessment of a client with systemic lupus erythematosus (SLE), the nurse hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the nurse document in the medical records and report to the health care provider?

Pericarditis

A child has just been diagnosed with systemic lupus erythematosus (SLE). Which assessment finding would be considered the most accurate prognostic indicator of the extent/seriousness of the disease?

Rust/blood-colored urine.

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

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 administering the disease-modifying antirheumatic drug (DMARD) methotrexate to a client with rheumatoid arthritis (RA). When the client questions why the drug is needed, how should the nurse reply?

"Early use of these medications may prevent resistance to treatment later."

The nurse is preparing a client for testing to determine if the client's gout is due to overproduction or underexcretion of uric acid. How should the nurse explain the process used?

"Your serum uric acid levels will be compared to the urate content in your urine."

When a nurse is teaching a client with ankylosing spondylitis about an exercise regimen, which suggestion does the nurse make to reduce pain with movement?

Application of a heating pad prior to exercise

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 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

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 client with rheumatoid arthritis (RA) tells the nurse that the disease-modifying antirheumatic drug (DMARD) methotrexate does not seem to be working anymore. Which other antirheumatic medication category can the nurse relay that may be prescribed following DMARD failure?

Anti-TNFs like infliximab

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

Flat with one pillow

An older adult client has history of benign prostatic hyperplasia (BPH), osteoarthritis, loss of height by 1 in (2.5 cm), and presbycusis. Which disorder is not commonly attributed to age-related changes?

Osteoarthritis

A nurse is working on a health care cost analysis related to total knee arthroplasty in the treatment of osteoarthritis. What should the nurse cite as a priority reason to reduce surgery wait times for clients requiring joint replacement?

Stress placed on joints while awaiting surgery can increase the need for additional surgeries.

A nurse is teaching a newly-diagnosed client with rheumatoid arthritis (RA) about pharmacologic therapy with disease-modifying antirheumatic drug (DMARD) therapy. Which statement should the nurse include in the teaching?

"Ideally, DMARDs should be started at time of diagnosis."

The nurse determines further teaching is necessary when a client diagnosed with osteoarthritis makes which statement?

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

Which individual is most likely to develop a form of reactive arthritis?

A 24-year-old male who completed treatment for a chlamydia infection 1 year ago.

Which individual is at greatest risk for developing a form of reactive arthritis?

A 24-year-old male with urethritis who completed treatment for a chlamydia infection a few months ago.

While explaining the physiology behind systemic sclerosis (scleroderma), the nurse would mention which development as a hallmark of this disease?

Activation of fibroblasts, resulting in fibrosis

When a nurse is administering medications to a client with rheumatoid arthritis (RA), which medication interferes with tumor necrosis factor (TNF)-alpha?

Adalimumab

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

When a nurse is caring for a client newly diagnosed with systemic lupus erythematosus (SLE), which behavior will best help prevent exacerbations of the disease?

Avoiding ultraviolet light (UV)

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.

A client with a history of polymyalgia rheumatica is admitted with a suspected stroke and is permitted nothing by mouth (NPO). Given this client's prescribed medications, what parenteral medication will the nurse prioritize as most important to request from the health care provider?

Corticosteroid

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

When caring for a client with psoriatic arthritis, the nurse assesses for which altered laboratory studies frequently associated with this disease?

Elevated uric acid level

Gout, or gouty arthritis, cannot be diagnosed on the basis of hyperuricemia. What is the diagnostic criterion for gout?

Finding of monosodium urate crystals in the synovial fluid

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.

A client with systemic lupus erythematosus (SLE) presents with edema in legs and abdomen. What focused assessment should the nurse perform to best investigate the cause of this finding?

Genitourinary

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

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 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).

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

Thyroid function

A 56-year-old client has been dealing with chronic back pain throughout his entire life, but recently the pain has begun to involve the shoulder as well. The client has been subsequently diagnosed with a seronegative spondyloarthropathy. Which physiologic description encompasses the disease involvement?

the axial skeleton and an abnormal autoimmune response

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