NUR334 PrepU: Chapter 44 - Disorders of the Skeletal System: Metabolic and Rheumatic Disorders

When a nurse is assessing a patient with osteoarthritis, which of the following factors poses a risk factor for the disease?

Obesity.

A 75-year-old Caucasian female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely?

Osteoporosis.

The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for which of the following?

Rickets.

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which of the following important differences when caring for the older adult?

Risk for falls.

A nurse is caring for a patient with ankylosing spondylitis. For which of these associated symptoms does the nurse assess?

Kyphosis.

Which of the following pathophysiological phenomena would be most indicative of ankylosing spondylitis?

Loss of motion in the spinal column and eventual kyphosis.

The health care provider is assessing a client with a history of ankylosing spondylitis, to note progression of the disease. The most important area for the provider to assess would be:

Spine.

Which of the following substances helps maintain a smooth surface in joint cartilage?

Synovial fluid.

Select the statement that best describes systemic lupus erythematosus (SLE). SLE is characterized by which of the following?

The formation of autoantibodies and immune complexes (type III hypersensitivity).

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

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

A 64 year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which of the following statements by the client would necessitate further teaching?

"I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."

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 has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client states:

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."

A nurse is caring for a patient with a fractured elbow. Which of the following instructions is important to give the patient to prevent cartilage degeneration while the elbow is immobilized?

"To prevent cartilage atrophy, slowly and gradually resume exercising."

When working with a patient with diffuse scleroderma who is exhibiting a 'stone face' expression, the nurse should consider which of the following to be a priority nursing diagnosis for this patient?

Aspiration, risk for related to swallowing impairments.

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

Corticosteroids.

Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?

Dual-energy x-ray absorptiometry (DXA or DEXA) of the spine and hip.

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

Elevated anti-nuclear antibodies (ANA).

In general, children are not affected by rheumatic diseases, such as arthritis, that occur in adults.

False.

In a patient diagnosed with osteomalacia, which of the following would be recommended to aid with improvement of the condition?

Increasing dietary consumption of vitamin D.

A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that:

Intestinal absorption slows as a natural aging process.

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should recognize the need to monitor the client's:

Weight and nutritional status.

Ankylosing spondylitis is a disease that typically manifests in late adolescence and early adulthood. What is the characteristic of the pain in ankylosing spondylitis?

Worse when lying.

The nurse is assessing a patient for osteoarthritis (OS) of the knee. Which should the nurse consider to be expected findings? Select all that apply.

-Localized pain. -Limitation of motion. -Crepitus. -Quadricep atrophy.

A nurse is caring for a patient admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which of the following disease processes?

Systemic lupus erythematosus.

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

Elevated antinuclear antibodies (ANA) levels.

Rheumatoid arthritis is a chronic autoimmune system disease that affects a single joint.

False.

Which statement is true regarding the development of juvenile idiopathic arthritis?

Generalized stunted growth can occur.

When caring for a patient with ankylosing spondylitis, the nurse tells the patient that stiffness may be relieved by which of the following interventions?

Gentle exercise.

The nurse is assessing a patient with ankylosing spondylitis (AS). Which of the following does the nurse expect to find?

Lower back pain.

The nurse is caring for a patient with newly diagnosed systemic lupus erythematosus (SLE). Which of the following over-the-counter medications does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis?

Nonsteroidal anti-inflammatory drugs (NSAIDs).

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

Obesity is a strong risk factor for developing OA.

A nurse is caring for a patient who has developed vasculitis as a result of a rheumatology disorder. Which of the following factors does the nurse expect to uncover in assessing this patient?

Ulcers of the lower extremities.

The nurse is planning care for a client with ankylosing spondylitis (AS). Which interventions should the nurse include in the plan of care? Select all that apply.

-Application of heat to involved joints. -Physiotherapy consult. -Administration of analgesics.

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which of the following statements does the nurse is likely to make?

"More women than men are affected by lupus."

The nurse is caring for a patient diagnosed with osteoarthritis (OA). Which of the following does the nurse teach the patient about the disease?

"OA is a disease of the weight-bearing joints."

The nurse determines that additional patient education is needed when a patient with gout makes which one of the following statements?

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

When assessing a patient diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings?

-Hearing loss. -Vertigo. -Intermittent tinnitus. -Headaches.

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.

A client's presentation and recent health history are suggestive of systemic lupus erythematosus (SLE). Which findings would support this diagnosis? Select all that apply.

-The client reports being "really sensitive to sunshine." -The client states that she is highly prone to mouth sores. -The client is known to have arthritis in her knees. -The client has elevated creatinine and blood urea nitrogen (BUN) levels.

The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for:

Bone density testing on a scheduled basis.

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

Brisk walking three times per week on a flat surface.

Due to her progressing osteoarthritis (OA), an 80 year-old woman is no longer able to perform her activities of daily living without assistance. Which of the following phenomena most likely underlies the woman's situation?

Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself.

The client with a suspected diagnosis of osteoarthritis asks the health care provider how the diagnosis will be confirmed. The best response would be:

History and physical examination, x-ray studies, and laboratory findings that exclude other diseases.

The nurse is providing patient education related to intra-articular corticosteroid injections. Which of the following should the nurse include?

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