Ch. 34
A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?
age
The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout?
colchicine
A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?
common adverse effects
A client is being placed on a purine-restricted diet. What foods will the nurse include in the client's diet plan?
dairy products
The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find?
early morning stiffness
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?
If you have problems with a medication, you may stop it until your next physician visit.
A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?
eating organ meats and sardines
A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client?
"Are you taking the medication as prescribed?"
A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client?
"Be sure to wear nonslip footwear for safety."
A client with fibromyalgia asks why physical therapy has been prescribed. Which response will the nurse make?
"It will help with the overall deconditioning that has occurred."
An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client?
"Look at the cane as maintaining your independence."
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?
"My finger joints are oddly shaped."
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer?
"Pace yourself and rest frequently, especially after activities."
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?
"The belief is that it is an autoimmune disorder with an unknown trigger."
A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client?
"The lupus can affect your kidney function."
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?
"Your symptoms are a result of your body attacking itself."
As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.
6.8 mg/dL (0.40 mmol/L)
A client with rheumatoid arthritis (RA) is taking methotrexate. Which assessment findings indicate to the nurse that the client is experiencing side effects of this medication? Select all that apply.
Frequent infections Gastric distress Hair loss Skin rash
The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process?
Gout
Which of the following refers to fixation of a joint?
Ankylosis
Which term refers to fixation or immobility of a joint?
Ankylosis
The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply.
Avoiding purine-rich foods Decreasing alcohol intake Weight loss
The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about?
Celecoxib
The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis?
Clients may develop Heberden nodes.
The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)
Dysphagia owing to hardening of the esophagus Decreased ventilation owing to lung scarring Dyspnea owing to fibrotic cardiac tissue
Which is an appropriate nursing intervention in the care of the client with osteoarthritis?
Encourage weight loss and an increase in aerobic activity
The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care?
increased fatigue
A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response?
Hand and finger deformities are associated with the development of rheumatoid arthritis.
Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?
Hypertension
A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?
It is suggestive of rheumatoid arthritis.
A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?
Maintain good posture.
The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
During a home visit, the nurse notes that a client with polymyositis has difficulty combing the hair and putting on socks and shoes. Which referrals will the nurse recommend for this client? Select all that apply.
Physical therapy Occupational therapy
A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease?
Review the client's medical record.
The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis?
Rheumatoid arthritis
A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?
Sicca syndrome
The nurse is gathering objective data for a client at the clinic reporting arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?
Swan neck deformity
Which of the following disorders is characterized by an increased autoantibody production?
Systemic lupus erythematosus (SLE)
The nurse is caring for a client with ankylosing spondylitis. Which educational information will the nurse provide to this client?
Use of analgesics."
A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply.
Use relaxation exercises. Establish a set time to sleep every night. Avoid caffeine before bedtime. Create a quiet sleep environment.
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?
colchicine
Osteoarthritis is known as a disease that
is the most common and frequently disabling of joint disorders.
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis?
joint stiffness that increases with activity
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?
located over bony prominence
The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess?
low back pain
The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client?
small joint involvement
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
Administering ordered analgesics and monitoring their effects
A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?
Hyperuricemia
The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse?
The fluid will be milky, cloudy, and dark yellow.
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?
Tophi
A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects?
aspirin
The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of
gout
A client arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean?
purine-rich foods
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management?
strategies for remaining active
The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan?
tai chi
A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?
An exercise routine that includes range-of-motion (ROM) exercises
The nurse is caring for a client with systemic lupus erythematosus (SLE). Which interventions will the nurse incorporate into this client's plan of care? Select all that apply.
Antipyretic medications for fever Providing analgesics for joint pain Monitoring for rash to the skin
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?
Facial erythema, pericarditis, pleuritis, fever, and weight loss
A client with rheumatoid arthritis (RA) is having a routine examination. Which findings indicate to the nurse that this client has systemic involvement from the condition? Select all that apply.
Fever Fatigue Weight loss Enlarged lymph nodes
The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities?
Inflammation
Which points should be included in the medication teaching plan for a client taking adalimumab?
It is important to monitor for injection site reactions.
Which joint is most commonly affected in gout?
Metatarsophalangeal
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?
Muscle biopsy
