Chapter 50: Disorders of Musculoskeletal System: Rheumatic Disorders

The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate?

Physical examination and x-ray studies

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."

Which substance helps maintain a smooth surface in joint cartilage?

Synovial fluid

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.

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

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."

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."

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

Obesity is a strong risk factor for developing OA.

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

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:

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

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."

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 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 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."

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 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."

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

Age

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 erythematosis (SLE). Which of the following causes the disease?

Autoimmune process

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

Corticosteroids

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

Client with systemic lupus erythematosus (SLE) and chest pain

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 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?

Dermal thickening proximal to wrists

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

Elevated anti-nuclear antibodies (ANA)

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

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

An otherwise healthy 35-year-old client has been admitted for treatment of active systemic lupus erythematosus (SLE) and is prescribed cyclophosphamide. What should the nurse include in the plan of care? Select all that apply.

Inspecting oral mucosa Avoiding invasive procedures Monitoring urine output

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

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.

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

A child, diagnosed with juvenile idiopathic arthritis, should receive education about commonly prescribed medications. Which other priority aspect(s) of care should the nurse assess during regular clinic visits? Select all that apply.

Nutiritonal status/issues Achieving growth and development milestones

When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease?

Obesity

Giant cell arteritis is a comorbid condition of:

Polymyalgia rheumatica

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 possible interpretation of these manifestations will the health care provider make?

Reactive arthritis

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

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)

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

Weight and nutritional status