Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Questions

A client with rheumatoid arthritis has been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory result(s) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply. A. Platelet count 10,000/µL (100 ×109/L) B. Creatinine level of 2.4 mg/dL (212.16 µmol/L) C. Red blood cell count of 8.0 ×106/µL (8.0 ×1012/L) D. Potassium level of 3.8 mEq/L (3.8 mmol/L) E. Absolute neutrophil count of 500/µL (0.50 ×109/L)

A, C, E

Which individual is at greatest risk for developing a form of reactive arthritis? A. A 24-year-old male with urethritis who completed treatment for a chlamydia infection a few months ago. B. A 3-year-old girl who was born with a 20-degree congenital scoliosis. C. A 46-year-old female who has a longstanding diagnosis of systemic lupus erythematosus (SLE). D. A 79-year-old male who had a total hip replacement 2 months prior.

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

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? A. Application of a heating pad prior to exercise B. Keeping a journal, noting frequency of morning stiffness C. Strengthening flexor muscles D. Sleeping with the head of the bed elevated

A. Application of a heating pad prior to exercise

When assessing a client with rheumatoid arthritis, which statement about joint involvement is most accurate? A. Involvement is symmetric and polyarticular, initially starting in the fingers, hands, and wrists. B. The joint involvement is usually diagnosed at the time of a fracture following an accident. C. If the hands are involved, it usually only occurs in the dominant hand in the distal interphalangeal joint. D. Involvement usually attacks the entire spinal column with the lumbar region being the most involved area.

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

The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find? A. Lower back pain B. Joint contractures C. Facial butterfly rash D. Bruises on the lower extremities

A. Lower back pain

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: A. "Do not worry; a course of antibiotic therapy will cure the child." B. "Children can be affected with almost all of the rheumatic diseases that occur in adults." C. "Children who acquire rheumatic diseases are more likely to have a higher intelligence level." D. "Your child will not be restricted with any activities and will have a normal lifestyle."

B. "Children can be affected with almost all of the rheumatic diseases that occur in adults."

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? A. "The disease can be reversed with medication and exercise." B. "Extra-articular manifestations may include anemia and deformities of the affected joints." C. "Joint involvement is typically the only manifestation of the disease in most clients." D. "Myocardial infarction develops in clients who have had the disease for an extended period."

B. "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? A. "Environment is the biggest contributing factor to the development of RA." B. "Genetic predisposition is very likely." C. "Exposure to workplace chemicals is a causative agent." D. "The disease is most common in those under 30."

B. "Genetic predisposition is very likely."

Which statement is true regarding the development of juvenile idiopathic arthritis? A. A diagnosis will be made when two joints are affected. B. Generalized stunted growth can occur. C. The condition will resolve in adulthood. D. Surgical intervention can stop the decline associated with the arthritis.

B. Generalized stunted growth can occur.

When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider would include which statement? A. Prevents flare-up during the first few months of starting medication B. Can be given intravenously to rapidly decrease serum uric acid levels C. Blocks the production of uric acid by the body D. Increases elimination of uric acid by the kidneys

C. Blocks the production of uric acid by the body

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? A. "Drug-induced lupus requires lifelong treatment." B. "Lupus is a disease of older individuals." C. "Lupus is more common in white people." D. "More women than men are affected by lupus."

D. "More women than men are affected by lupus."

The nurse determines that additional client education is needed when a client with gout makes which statement? A. "Increasing my intake of water each day will help stop the symptoms." B. "I should avoid eating shellfish to decrease the risk of an episode." C. "I will plan to eat more white meat rather than red meat." D. "When I have an exacerbation of my symptoms, a glass of red wine will be helpful."

D. "When I have an exacerbation of my symptoms, a glass of red wine will be helpful."

The nurse is conducting a health promotion class on osteoarthritis (OA). Which statement should the nurse include? A. Young women have a higher risk than young men of developing OA. B. Eating a diet low in calcium is the only contributing risk factor to OA. C. There is no hereditary link to the development of OA. D. Obesity is a strong risk factor for developing OA.

D. Obesity is a strong risk factor for developing OA.

The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate? A. Bone marrow aspiration of the pelvis B. Aspiration of the joint with biopsy sent to laboratory C. Exercise trials to monitor angle of joint movements D. Physical examination and x-ray studies

D. Physical examination and x-ray studies

When caring for a client with ankylosing spondylitis, the nurse tells the client that stiffness may be relieved by which intervention? A. Bed rest B. Calcium supplements c. Gentle exercise D. Acetaminophen

c. Gentle exercise

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess? A. Tremors B. Syndactyly C. Kyphosis D. Tachycardia

C. Kyphosis

The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include? A. The injections will be given only 3 to 4 times per year because they can increase joint destruction. B. There will be immediate relief with one injection and daily running can be resumed. C. There will be minimal discomfort because the injections are placed in the subcutaneous tissue. D. The client or a family member will be taught to administer the injections daily.

A. The injections will be given only 3 to 4 times per year because they can increase joint destruction.

A client with rheumatoid arthritis is taking high doses of aspirin to control inflammatory pain. Which statement leads the health care provider to suspect the client is experiencing an adverse reaction? A. "I can't go to the movies anymore. It's so noisy, I miss half the words." B. "I've been getting a lot of upset stomach attacks and I think I saw some blood in my stool." C. "I get dizzy and lightheaded sometimes." D. "When my grandchildren whisper, I can't hear a word they are saying."

B. "I've been getting a lot of upset stomach attacks and I think I saw some blood in my stool."

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? A. Cyclophosphamide B. Nonsteroidal anti-inflammatory drugs (NSAIDs) C. Belimumab D. Hydroxychloroquine

B. Nonsteroidal anti-inflammatory drugs (NSAIDs)

The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate? A. Exercise trials to monitor angle of joint movements B. Physical examination and x-ray studies C. Bone marrow aspiration of the pelvis D. Aspiration of the joint with biopsy sent to laboratory

B. Physical examination and x-ray studies

Which substance helps maintain a smooth surface in joint cartilage? A. Cytokines B. Synovial fluid C. Uric acid D. Surfactants

B. 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? A. Sarcoidosis B. Systemic lupus erythematosus (SLE) C. Rheumatoid arthritis (RA) D. Scleroderma

B. Systemic lupus erythematosus (SLE)

When a nurse assesses a client with scleroderma (systemic sclerosis), which manifestation does the nurse recognize is part of the CREST variant syndrome rather than the systemic type of this disorder? A. Thickened skin on the face with the fixation of the fascia B. Kidney damage secondary to possible autoantibodies C. Dermal thickening proximal to wrists D. Excessive collagen deposits in the heart

C. Dermal thickening proximal to wrists

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? A. Excessive collagen production and deposition B. A mismatch between bone resorption and remodeling C. Immunologically mediated joint inflammation D. Cytokine release following mechanical joint injury

C. Immunologically mediated joint inflammation

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? A. Microorganisms that attack the joint space causing stiffness B. Reversible calcium deposits affecting the joints C. Vascular granulation tissue that destroys cartilage and bone D. Muscles in the area that atrophy from disuse

C. Vascular granulation tissue that destroys cartilage and bone

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects? A. Oxygenation and respiratory status B. Sodium and potassium levels C. Weight and nutritional status D. Cognition and coping skills

C. Weight and nutritional status