Assessment of Patients with Rheumatic Disorders

A client is admitted to the hospital with a preliminary diagnosis of RA. Which screening test should the nurse anticipate for this client? A. Antinuclear antibody (ANA) titer B. Complete blood count (CBC) C. Erythrocyte sedimentation rate (ESR) D. Rheumatoid factor (RF)

A ANA is a commonly used screening tool for RA. Many people without RA can have an elevated titer for the disease. A positive ANA titer test may assist in the diagnosis of autoimmune diseases. ANA tests results are just one factor considered when a diagnosis is being formulated. A client's clinical symptoms and other diagnostic test must also be considered by health care provider. The diagnosis of RA is based on multiple criteria , not simply a single test result. CBC, ESR, and RF are all diagnostic tools and to monitor progress of the disease or response to therapy.

The nurse asks a client, in the late stages of OA, to describe the pain. The nurse anticipates that this client will describe the pain how? A. Grating B. Dull Ache C. Dull and deep aching pain D. Deep aching pain that is only relieved by rest

A In the late stages of OA, the client often describes the joint pain as grating. As the disease progresses, the cartilage covering the ends of bones is destroyed and bones rub against each other. Osteophytes, or bone spurs may form on the ends of the bones. A dull ache or deep aching pain, with or with out relief with rest, is often seen in the early stages of OA.

The health care provider has prescribed salicylates for a client with osteoarthritis. The nurse assesses the client and determines that intervention is necessary when the client exhibits: A. hearing loss B. increased pain in joints C. decreased calcium absorption D. increased bone demineralization

A Many elderly people already have diminished hearing and salicylate use can lead to further or total hearing loss. Salicylates do not increase pain in joints, decrease calcium absorption, or increase bone demineralization.

What are the causes of primary osteoarthritis? A. Overuse of joints, aging and obesity B. Obesity, aging, and diabetes mellitus C. Congenital abnormality, aging, overuse of joints D. Diabetes, congenital abnormality, aging.

A Primary osteoarthritis may be caused by overuse of joints, aging and obesity. Congenital abnormalities and diabetes can cause secondary osteoarthritis.

The nurse is performing an admission assessment on a client with osteoarthritis. Which clinical manifestations would the nurse anticipate in this client? A. Joint pain following exercise that is relieved by rest B. Symmetrical swelling of the joints in both hands C. Morning stiffness that lasts longer than 30 minutes D. Elevated body temperature.

A The most common symptom of OA is joint pain following exercise or weight bearing that is usually relieved by rest. The other options are all symptoms of RA

A nurse is teaching about primary prevention of injury to a client diagnosed with osteoarthritis. Examples of primary prevention include: Select all that apply. A. Avoid repetitive tasks B. Avoiding physical activity C. Warming up before exercising D. Performing only repetitive tasks E. Using isometric exercises.

A & C Examples of primary prevention of injury from OA include warming up before exercise, and avoiding repetitive tasks. Bed rest would contribute to many other systemic complications. Physical activity is a key component of remaining fit and healthy and maintaining joint function. Isometric exercises are a type of strength training in which the joint angle and muscle length do not change during contraction. Isometric exercises are done in static positions, rather than being dynamic through a range of motion.

The nurse is elevating the effectiveness of colchicine, for a client recently diagnosed with gout. What outcomes would indicate that this medication has been effective? Select all that apply. A. Decreased inflammation B. Decreased infections C. Fewer gout attacks D. Effective pain management E. The client is able to perform daily living activities.

A,C,D,E The action of colchicine is to decrease inflammation by reducing migration of leukocytes to synovial fluid., which will decrease pain and the frequency of gout attacks. Colchicine doesn't decrease infections.

A client has experienced an exacerbation of SLE. The nurse determines further teaching is necessary when the client makes which statement? A. "I need to stay away from sunlight." B. " I don't have to worry if I get strep throat." C. " I need to work on managing the stress in my life." D. " I don't have to worry about changing my diet."

B An infection, such as strep throat, may cause an exacerbation of SLE. Other factors that can precipitate an exacerbation are immunizations, sunlight exposure, and stress.

An elderly client, with rheumatoid arthritis is being treated with prednisone. Which complications can occur with long term steroid therapy? A. Breast or uterine cancer B. Osteoporosis and diabetes mellitus C. Weight loss and lactose intolerance D. Deep vein thrombosis (DVT), pulmonary embolus, and stroke

B Long term prednisone therapy can increase the loss of calcium from bones, slow down the formation of new bone tissue, resulting in osteoporosis, and alter glucose metabolism. Breast and uterine cancer, DVT, pulmonary embolus, stroke, weight loss, and lactose intolerance are not common adverse effects of prednisone.

A client with joint pain, tenderness, and swelling has been admitted to the hospital. A disease modifying anti-rheumatic drug (DMARD) is prescribed by the health care provider. Which medication should the nurse expect to administer? A. Aspirin B. Methotrexate C. Ferrous Sulfate D. Prednisone

B Methotrexate is considered a first line DMARD for most clients with rheumatoid arthritis (RA). NSAIDS, such as ASA, cannot be toleratated. Ferrous sulfate is not used to treat RA. Prednisone may be used to control inflammation when NSAIDS cannot be used.

A nurse is assigned to care for a 70 year old client with acute rheumatoid arthritis. Which finding would the nurse anticipate during assessment of this client? A. Radial deviation of the distal phalanges B. Tender, painful and stiff joints C. Heberden's nodes D. Bouchard's nodes

B Tender, painful and stiff joints characterize acute rheumatoid arthritis. The other assessment findings characterize OA including Heberden's nodules and Bouchard's nodes.

The nurse assesses a client with systemic lupus erythematosus (SLE) for signs of neurologic involvement. Which finds would the nurse document? Select all that apply. A. Facial Tic B. Psychosis C. Extremity Weakness D. Cerebrovascular accidents

B & D Neurologic involvement may be shown by psychosis, seizures, and headaches. . Weakness may be present, but it usually related to muscle atrophy, not neurologic involvement.

A nurse is performing an assessment on a client diagnosed with OA. Which clinical manifestations would the nurse anticipate in this client? A. Elevated sedimentation rate B. Multiple subcutaneous nodules C. Asymmetrical joint involvement D. Localized warmth, fever, and malaise

C Asymmetrical joint involvement is present in OA. ESR, multiple subcutaneous nodules, inflammation, fever, and malaise are all present in RA.

A nurse is reviewing the health care provider's orders for a client admitted with SLE. Which medication would the nurse expect to find in this client's plan of care? A. Morphine B. Ketoconazole C. Hydroxychloroquine D. Dimenhydrinate

C Fatigue, photosensitivity, and a "butterfly" rash on the face are all signs and symptoms of SLE. Hydroxychloroquine is used in the treatment of SLE to prevent inflammation. Pharmacological treatment of SLE also involves nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive . Morphine is an opioid analgesic, ketoconazole is an antifungal agent, and dimenhydrinate is an antiemetic.

A 36 year old client tells the nurse that he is experiencing fatigue, weight loss, low-grade fever, and also has pain in his fingers, elbows, and ankles. The nurse recognizes that these could be symptoms of which condition? A. Anemia B. Leukemia C. Rheumatic arthritis D. Systemic lupus erythematosus

C Fatigue, weight loss and low grade fever are all early signs of many immune system diseases including anemia, leukemia and SLE. However only rheumatic arthritis is associated with pain in the fingers, elbows, wrists, ankles, and knees.

A client with suspected systemic lupus erythematosus (SLE) is admitted to the hospital. Which laboratory results would support the diagnosis? A. Leukopenia and an elevated serum complement level B. Thrombocytosis and an elevated sedimentation rate C. Pancytopenia and an elevated antinuclear antibody titer D. Leukocytosis and an elevated blood urea nitrogen level.

C Laboratory findings for clients with SLE usually show an elevated ANA titer and decreased serum complement levels. Some clients also have ,anti-erythrocyte, anti-lymphocyte, anti-platelet antibodies which causes pancytopenia. Clients may have elevated BUN and creatine levels from nephritis, but increase does not indicate SLE.

A client ask the nurse, "What is the difference between rheumatoid arthritis (RA) and osteoarthritis (OA)? What is the nurse's most appropriate response? A. OA is gender specific, RA is not B. OA is a systemic disease; RA is localized C. OA is a localized disease;, RA is systemic. D. OA has dislocations and subluxations; RA does not.

C OA is a degenerative disease caused primarily from wear and tear on joints, whereas RA is an autoimmune disease. Both types of arthritis are more common in women than in men. OA and RA are more prevalent in older adults, but RA can develop at any age. Clients have dislocations and subluxations in both disorders.

Which client is most likely to develop rheumatoid arthritis? A. A 25-year old woman B. A 40 year old man C. A 65 year old woman D. A 70 year old man

C RA affects women two to three times more often then men. The onset of RA in both men and women is highest among those in their 60s.

A client is admitted to the medical-surgical unit for OA and weakness in the left lower extremity. The client uses a walker at home. The provider orders a cane and physical therapy for the client. The client asks the nurse the difference between the cane and walker. What is the nurse's best response? A. A walker is a better choice than a cane. B. The cane should be used on the affected side. C. The cane should be used on the unaffected side. D. A client with OA should be encouraged to ambulate without the cane.

C The cane should be used on the unaffected side. A client with OA should be encouraged and educated to ambulate with a cane or walker, or other assistive device as needed. The assistive device takes the weight and stress off of joints.

The nurse informs a client diagnosed with gout that his x-rays are normal. Which statement, by the nurse, is most appropriate when the client asks if he still has gout? A. "No, you are cured." B. "Yes, X-rays are unreliable." C. "Yes, x-rays remain normal in the early stages of gout." D. "Yes, X-ray changes are seen with acute attacks."

C X-rays can be very valuable in the diagnosis of gout., and are normal in the early stages of the condition. Telling the client that he is cured is incorrect, because he may be in the early stages of gout when x-rays appear normal. With chronic gout, x-rays will show damage to the cartilage and bone. When x-ray changes occur, the changes will be present during both attacks and remission.

Which non-pharmacologic interventions should be included in the plan of care for a client who has moderate rheumatoid arthritis? Select all that apply. A. Massaging inflamed joints B. Avoiding range of motion (ROM) exercises C. Applying splints to inflamed joints D. Using assistive devices at all times E. Selecting clothing that has Velcro fasteners F. Applying moist heat to joints

C,E,F Supportive non-pharmacologic measures for the client with RA include applying splints to rest inflamed joints, using Velcro fasteners on clothes to aid dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate inflammation. A physical therapy program including ROM exercises and carefully individualized therapeutic exercises prevents loss of joint function. Assistive devices should be used only when marked loss of ROM occurs.

A client was prescribed an anti-inflammatory drug for osteoarthritis five days ago. The client says the pain has decreased a little but not completely. Which nursing intervention would be the MOST appropriate.? A. Notify the health care provider and suggest increasing the dose. B. Notify the health care provider and suggest stopping the medication. C. Notify the health care provider and suggest another medication. D. Continue the present dose and offer other pain relief measures.

D Anti-inflammatory medications may take 2 to 3 weeks to provide full benefits. If the client can tolerate the pain, the prescribed pain medication should be continued, and other pain measures, such as rest, massage, heat, or cold should be offered. Increasing, stopping, or adding another medication is not appropriate because the medication hasn't been taken long enough to provide full benefit.

The client asks the nurse for information about osteoarthritis. What is the MOST appropriate information for the nurse to include about the disease? A. It is a systemic inflammatory joint disease. B. It is a disease involving fusion of the joints in the hands. C. It is an inflammatory joint disease, with degeneration and loss of articular cartilage in synovial joints. D. It is a non-inflammatory joint disease, with degeneration and loss of articular cartilage in synovial joints.

D Osteoarthritis is a non-inflammatory joint disease with degeneration and loss of articular cartilage in synovial joints. Rheumatoid arthritis is systemic inflammatory joint disease. Arthrodesis is fusion of the joints.

A client asks for information about osteoarthritis. What is the MOST appropriate information for the nurse to include? A. Osteoarthritis is rarely debilitating B. Osteoarthritis is a rare form of arthritis C. Osteoarthritis afflicts people over age 60 D. Osteoarthritis is the most common form of arthritis.

D Osteoarthritis is the most common form of arthritis and can be debilitating. It can affect people of any age, although most are elderly.

The nurse has provided teaching to a client newly diagnosed with gout. The nurse determines that teaching has been effective when the client states: A. "Weight loss will decrease purine levels". B. "Weight loss will decrease inflammation." C. "Weight loss will increase uric acid levels and decrease stress on joints". D. "Weight loss will decrease uric acid level and decrease stress on joints."

D Weight loss will decrease uric acid levels and decrease stress on joints. Weight loss will not decrease purine levels, increase uric acid levels, or decrease inflammation.

The nurse has provided teaching to a client newly diagnosed with gout. The nurse determines that teaching has been effective when the client states: A. "Weight loss will decrease purine levels." B. "Weight loss will decrease inflammation." C. "Weight loss will increase uric acid levels and decrease stress on joints." D. "Weight loss will decrease uric acid levels and decrease stress on joints."

D Weight loss will decrease uric acid levels and decrease stress on joints. Weight loss will not decrease purine levels, increase uric acid levels, or decrease inflammation.