Chapter 18 - Connective Tissue Disease

Which assessment finding indicates to the nurse that the patient is experiencing early rheumatoid arthritis? A. Joint deformities B. Joint inflammation C. Weight loss D. Subcutaneous nodules

B. Joint inflammation

The patient with rheumatoid arthritis suffers a subluxation of the first and second vertebrae. What should the nurse do first, before immediately notifying the health care provider? A. Assess respiratory status and apply oxygen as needed. B. Assess for loss of sensation of loss of movement in the extremities. C. Assess for pain that radiates down the arm and check pulses. D. Assess for change in mental status and orient the patient.

A. Assess respiratory status and apply oxygen as needed

Although eh etiology of rheumatoid arthritis is unknown, it is considered to be what type of disorder? A. Autoimmune disease B. Disease associated with aging C. Genetic disorder D. Trauma disorder

A. Autoimmune disease

Patients with ankylosing spondylitis have risk for which condition? A. Compromised respiratory function B. Cardiac arrhythmias C. Hip pain with osteoecrosis D. Dysphagia and decreased gag reflex

A. Compromised respiratory function

A patient with systemic lupus erythematosus is prescribed a relatively new drug, belimumab. Which concept will the nurse use to emphasize important teaching points about this medication? A. Comfort B. Immunity C. Mobility D. Oxygenation

B. Immunity

The nurse is reviewing the CBC results of a patient wit RA. The results show a low hemoglobin, hematocrit and RBC. Based on these lab results, which interventions is the nurse most likely to implement? A. Encourage rest and ensure rest periods between activities and therapies. B. Instruct the patient to drink extra fluids and to fully consume meals and snacks. C. Instruct UAP to handle the patient carefully to prevent bruising. D. Encourage the patient to ambulate in the hall at least three times during the shift.

A. Encourage rest and ensure rest periods between activities and therapies.

Which patient reported symptoms would typify early rheumatoid arthritis? A. I feel tired and weak. B. I fell like my hands are burning. C. I have severe stiffness in the morning. D. I have gained a lot of weight.

A. I feel tired and weak.

Which treatment modalities might the nurse expect for a patient who is undergoing nonsurgical management of chronic joint pain? SATA A. Immobilization to promote rest B. Weight control C. Exercise balanced with rest D. Thermal modalities E. Limit foods and liquids that contain calcium F. Home traction

A. Immobilization to promote rest B. Weight control C. Exercise balanced with rest D. Thermal modalities

Which patient is manifesting signs/symptoms that are likely to be associated with connective tissue disease? A. Patient has chronic pain, decreased function, and joint deterioration. B. Patient has cardiac dysthymias and occasional chest pain. C. Patient has acute back pain after exercise and exertion. D. Patient has poor skin turgor and sluggish capillary refill.

A. Patient has chronic pain, decreased function, and joint deterioration.

For a patient with Reiter's syndrome, besides asking about joint pain, which additional question would the nurse ask? A. Is there any chance that you were bitten by an insect? B. Are you having pain or burning with urination? C. Do you have family history of arthritis? D. Do you get short of breath after minor exertion?

B. Are you having pain or burning with urination?

The patient tells the nurse that he has been taking glucosamine for joint pain. Which physical finding is cause for greatest concern? A. Patient is 15 lbs overweight B. Blood pressure is 150/80 C. Resting pulse is 90/min D. Patient has a light red rash

B. Blood pressure is 150/80

Based on the nurse's knowledge of the most common cause of death for patients with systemic lupus erythematosus which lab rests will the nurse closely monitor when caring for these patients? A. Cardiac enzymes and sedimentation rate B. Blood urea nitrogen and creatinine C. Complete blood count and platelet count D. Liver enzymes and cholesterol levels

B. Blood urea nitrogen and creatinine

The nurse sees an increased number of periungual lesions on a patient with RA and reports this vascular change to the HCP. What is the best rationale for reporting this finding? A. The nurse should always report any unusual findings to the health care provider. B. If arterial involvement is occurring major organs can become ischemic. C. The brownish spots affect body image but will readily resolve with treatment. D. The lesions will eventually ulcerate and become infected.

B. If arterial involvement is occurring major organs can become ischemic.

The nurse is reviewing the lab results of a patient with systemic lupus erythematosus. Which lab test is most likely to be a false positive? A. Elevated erythrocyte sedimentation rate B. Positive syphilis test C. Positive TB test D. Increase in components of CBC

B. Positive syphilis test

What can be expected for a patient with recently diagnosed systemic lupus erythematosus? A. Frequent acute inflammatory episodes B. Spontaneous remissions and exacerbations C. Symptoms similar to OA D. Frequent infections and reduced immune response

B. Spontaneous remissions and exacerbations

The health care provider informs the nurse that the patient has a joint effusion of the right knee. What is the nurse most likely to find during physical assessment of the knee? A. Hard bony protrusion palpated at the joint space B. Tightness during flexion and extension of knee C. Inability to independently stand or walk D. Dry, red, scaly skin over the knee that itches and flakes

B. Tightness during flexion and extension of knee

The UAP tells the nurse that the patient with RA is increasingly manipulative and demanding and trying to meet the patient's requests in interfering with the care of other patients. What is he best action of the nurse to take? A. tell the UAP to ignore the demands, complete assigned tasks, and go on to other patients. B. Inform the patient that the UAP has additional duties and has a fixed amount of time per patient. C. Assess patient behaviors and help the patient to focus on realistic goals and coping strategies. D. Temporarily perform the UAP duties until boundaries and expectations are established.

C. Assess patient behaviors and help the patient to focus on realistic goals and coping strategies.

What is the most common area of involvement of rheumatoid arthritis in the spine? A. Lumbar spine B. Sacral spine C. Cervical spine D. Thoracic spine

C. Cervical spine

A patient comes to the clinic because he thinks he may have lyme disease. What is the most important question to ask to assist the health care provider in determining if Lyme disease is the correct diagnosis? A. Have you had flu like symptoms? B. Do you notice stiffness in your joints? C. Did you notice a bull's-eye-shaped lesion? D. Have you had any facial drooping?

C. Did you notice a bull's-eye-shaped lesion?

The nurse is assessing the skin of a patient with systemic lupus erythematosus. What is the nurse most likely to notice about the skin? A. Small, brownish spots around the nail bed B. Generalized hardening of the skin C. Dry, scaly, raised rash on the face D. Raynaud's phenomenon

C. Dry, scaly, raised rash on the face

The nurse is teaching a patient about the common side effects of long term salicylate and non steroidal anti inflammatory therapy. Which body system side effects does the nurse focus on in the teaching plan? A. Central nervous system B. Skin C. Gastrointestinal D. Cardiovascular

C. Gastrointestinal

The nurse is caring for a patient with systemic lupus erythematosus who is having a flare-up of the condition. Which abnormal vital sign is a classic sign for an exacerbation. A. Increased BP B. Decreased pulse C. Increased temperature D. Decreased respirations

C. Increased temperature

The nurse reads in the documentation that the patient with rheumatoid arthritis may have Sjogren's syndrome. Which assessment is the nurse most likely to perform to validate this documentation? A. Weigh the patient and compare weight to baseline. B. Take the temperature and assess for signs of infection. C. Inspect mouth for dry sticky membranes and eyes for redness. D. Observe for joint contractures and loss of range of motion.

C. Inspect mouth for dry sticky membranes and eyes for redness.

The nurse is caring for a patient with rheumatoid arthritis who just had arthrocentesis. What is the priority intervention? A. Assess frequently for post procedural pain and ensure optimal pain relief. B. Place the patient in a prone position and elevate the extremity. C. Monitor the inception site for bleeding or leakage of synovial fluid. D. Teach and encourage leg, gluteal, and quadriceps setting exercises.

C. Monitor the inception site for bleeding or leakage of synovial fluid.

When a patient has rheumatoid arthritis of the temporomandibular joint, what is the major complain? A. Toothache on the affected side B. headache in the temple area C. Pain on chewing and opening the mouth D. Earache on the affected side

C. Pain on chewing and opening the mouth

A patient with RA may need to undergo vernal anesthesia for a hip replacement. Which information needs to be brought to the immediate attention of the surgeon before the procedure is scheduled? A. Patient has a previous history of joint surgery on the affected side. B. Patient has been taking vitamin C and nonsteroidal anti-inflammatory drugs for years. C. Patient has cervical spine disease and has not had any recent spinal x rays. D. Patient fears that the procedure will cause complications because of the RA.

C. Patient has cervical spine disease and has not had any recent spinal x rays.

The patient with rheumatoid arthritis expresses uncertainty about the disease process and fear of becoming dependent. What is the nurse's best response? A. You'll be okay. very few people with RA actually become wheelchair bound. B. Do you have anyone to help you when you can't take care of yourself? C. Tell me what you know about living with RA and the treatment options. D. So, you are feeling afraid and uncertain. That seems normal to me.

C. Tell me what you know about living with RA and the treatment options

What is the best laboratory test to detect early rheumatoid arthritis? A. Rheumatoid factor B. Erythrocyte sedimentation rate C. Complete blood cell count D. Anti-cyclic citrullinated peptide

D. Anti-cyclic citrullinated peptide

The nurse is providing teaching for a patient with RA who is receiving methotrexate. Which teaching point must the nurse include? A. medication is taken every morning on an empty stomach. B. Avoid driving or operating heavy machinery. C. Expect some increase in swelling while taking this medication. D. Avoid crowds of people and people who are ill.

D. Avoid crowds of people and people who are ill

The patient is taking hydroxychloroquine for RA. Which patient statement is cause for greatest concern? A. I seem to have a mild stomach discomfort when I take this medication. B. I get kind of light headed. I suppose I should stand up a little slowly. C. Could you give me a Tylenol or something mild? I have some muscle pain. D. I think I must need new glasses. Lately, my vision is really blurry.

D. I think I must need new glasses. Lately, my vision is really blurry.

In RA, autoantibodies are formed that attack healthy tissue, especially synovium, causing which condition? A. Nerve pain B. Bone porosity C. Ischemia D. Inflammation

D. Inflammation

A rheumatic disease is any condition of disease of which body systems? A. Cardiovascular B. Hematopoietic C. Integumentary D. Musculoskeletal

D. Musculoskeletal

What musculoskeletal health problem is often associated with rheumatoid arthritis? A. Paget's disease B. Lyme disease C. Marfan Syndrome D. Osteoporosis

D. Osteoporosis

Which lab test is the only significant test for diagnosing a patient with discord lupus? A. Antinuclear antibody B. Serum complement C. CBC D. Skin Biopsy

D. Skin Biopsy