Chapter 39: Assessment and Management of Patients With Rheumatic Disorders

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

The client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose. pg.1060

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed? a) Etanercept b) Celecoxib c) Diclofenac d) Indomethacin

a) Etanercept Explanation: Etanercept is an example of a tumor necrosis factor (TNF)-alpha inhibitor used to treat rheumatoid arthritis. Diclofenac and indomethacin are nonsteroidal anti-inflammatory drugs (NSAIDs). Celecoxib is a cyclooxygenase-2 (COX-2) inhibitor. pg.1061

Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 27-year-old black female b) A 25-year-old white male c) A 35-year-old Hispanic male d) A 25-year-old Jewish female

a) A 27-year-old black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women. pg.1069

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except? a) Avoid sunlight and ultraviolet radiation. b) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. c) If you have problems with a medication, you may stop it until your next physician visit. d) Pace activities.

c) If you have problems with a medication, you may stop it until your next physician visit. Explanation: Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. pg.1072

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Subchondral bone b) Pannus c) Joint effusion d) Tophi

d) Tophi Explanation: Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity. pg.1079

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound? a) Inhibits DNA synthesis b) Inhibits lysosomal enzymes c) Inhibits T- and B-cell activity d) Inhibits platelet aggregation

c) Inhibits T- and B-cell activity Explanation: Gold sodium thiolmalate (Myochrysine) inhibits T- and B-cell activity, thereby suppressing synovitis during the active stage of rheumatoid disease. pg.1060

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Disease-modifying antirheumatic drugs (DMARDS) b) Glucocorticoids c) Nonsteroidal anti-inflammatory drugs (NSAIDs) d) Tumor necrosis factor (TNF) blockers

c) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms. pg.1056

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is: a) obesity. b) congenital deformity. c) trauma. d) age.

d) age. Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma. pg.1075

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds? a) Lung sounds are diminished in the apical area. b) Crackles in the bases c) Pericardial friction rub d) Rhonchi

a) Lung sounds are diminished in the apical area. Explanation: The lumbar curve of the spine may flatten. The neck can be permanently flexed, and the client appears to be in a perpetual stooped position. Aortic regurgitation or atrioventricular node conduction disturbances may occur. Lung sounds may be reduced, especially in the apical area. The nurse would not hear rhonchi, crackles, or a pericardial friction rub unless the client had underlying cardiac or respiratory disorders. pg.1077

Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years? a) Small joint involvement b) Asymmetric joint involvement c) Bouchard's nodes d) Obesity

a) Small joint involvement Explanation: Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur. pg.1065

Which of the following is the leading cause of disability and pain in the elderly? a) Systemic lupus erythematous (SLE) b) Osteoarthritis c) Scleroderma d) Rheumatoid arthritis (RA)

b) Osteoarthritis Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly. pg.1067

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of: a) green vegetables. b) organ meats. c) fresh fish. d) citrus fruits.

b) organ meats. Explanation: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, chocolate, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with gouty arthritis. pg.1079

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication? a) Inform the physician if there is ringing in the ears. b) Since the medication is able to be obtained over the counter, it has few side effects. c) Take the medication with food to avoid stomach upset. d) Take the medication on an empty stomach in order to increase effectiveness.

c) Take the medication with food to avoid stomach upset. Explanation: The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. pg.1060

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? a) Allopurinol (Zyloprim) b) Propoxyphene hydrochloride (Darvon) c) Prednisone (Deltasone) d) Colchicine

d) Colchicine Explanation: The physician usually orders colchicine for a client experiencing an acute gout attack. This drug decreases leukocyte motility, phagocytosis, and lactic acid production, thereby reducing urate crystal deposits and relieving inflammation. Allopurinol is used to decrease uric acid production in clients with chronic gout. Although corticosteroids are ordered to treat gout, the nurse wouldn't give them because they must be administered interarticularly to this client. Propoxyphene, an opioid, may be used to treat osteoarthritis. pg.1079

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan? a) T'ai chi b) Yoga c) Pilates d) Jogging

d) Jogging Explanation: Jogging would be an inappropriate type of exercise, as it is a high impact, jarring type of exercise. pg.1077

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? a) Extension b) Internal rotation c) Hyperextension d) Slight dorsiflexion

d) Slight dorsiflexion Explanation: Devices such as braces, splints, and assistive devices for ambulation (e.g., canes, crutches, walkers) ease pain by limiting movement or stress from putting weight on painful joints. Acutely inflamed joints can be rested by applying splints to limit motion. Splints also support the joint to relieve spasm. pg.1056

A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis? a) "Client will lose 2 lb (0.91 kg) per week on a calorie-restricted diet." b) "Client will exhibit alertness and orientation to person, place, and time." c) "Client will exhibit no signs or symptoms of aspiration." d) "Client will exhibit bowel and bladder continence."

c) "Client will exhibit no signs or symptoms of aspiration." Explanation: An expected outcome of no signs or symptoms of aspiration relates to symmetrical muscle weakness — a potential problem associated with polymyositis that may lead to speaking and swallowing problems. A client with a potential swallowing problem is at risk for inadequate nutrition and shouldn't be placed on a calorie-restricted diet; an expected outcome focusing on maintaining weight would be more appropriate than an outcome based on losing weight. Polymyositis doesn't affect bowel or bladder function or mental status; it isn't necessary to develop outcomes based on these parameters. pg.1074

Scleroderma typically starts with which type of organ involvement? a) Lung b) Skin c) Kidney d) Brain

b) Skin Explanation: Scleroderma commonly begins with skin involvement. Mononuclear cells cluster on the skin and stimulate lymphokines to stimulate procollagen. Scleroderma does not commonly begin in the lung, brain, or kidney. pg.1073

The side effect of bone marrow depression may occur with which medication used to treat gout? a) Allopurinol (Zyloprim) b) Colchicine c) Prednisone d) Probenecid (Benemid)

a) Allopurinol (Zyloprim) Explanation: A patient taking Zyloprim needs to be monitored for the side effects of bone marrow depression, vomiting, and abdominal pain. pg.1080

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a) Limited passive movement b) Limb shortening c) Joint enlargement d) Joint instability

a) Limited passive movement Explanation: Limited passive movement can be the first and only physical sign of symptomatic OA. Physical assessment of the musculoskeletal system reveals joint enlargement, joint instability, and limb shortening. pg.1075

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Opioid therapy c) Surgery d) Ice packs

a) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat is used to relieve pain rather than ice packs. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional. It is not an intervention specific to relieving pain. pg.1056

Which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects? a) Viscosupplementation b) Glucosamine c) Capsaicin d) Chondroitin

a) Viscosupplementation Explanation: Viscosupplementation, the intra-articular injection of hyaluronic acid, is thought to improve cartilage function and retard degradation. It may also have some anti-inflammatory effects. Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage. Capsaicin is a topical analgesic.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Administering ordered analgesics and monitoring their effects c) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

b) Administering ordered analgesics and monitoring their effects Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management. pg.1066

Which of the following refers to fixation of a joint? a) Synovitis b) Ankylosis c) Pannus d) Articulations

b) Ankylosis Explanation: Fixation of a joint, called ankylosis, eliminates friction, but at the drastic cost of immobility. Inflammation is manifested in the joints as synovitis. Pannus has a destructive effect on the adjacent cartilage and bone. Articulations are joints. pg.1078

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? a) Hyperproteinuria b) Hyperuricemia c) Glucosuria d) Ketonuria

b) Hyperuricemia Explanation: Gout is caused by hyperuricemia (increased serum uric acid). pg.1079

Which of the following is the most common joint affected in gout? a) Tarsal area b) Metatarsophalangeal c) Knee d) Ankle

b) Metatarsophalangeal Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients), and this is referred to as podagra. Less commonly, the wrists, fingers, and elbows may be affected. The tarsal area, ankle, and knee are not the most commonly affected in gout. pg.1079

All of the following are symptoms of osteoarthritis, except? a) Limited joint motion b) Morning stiffness that lasts at least 1 hour. c) Instability of weight-bearing joints d) Deep, aching pain with motion early in the disease

b) Morning stiffness that lasts at least 1 hour. Explanation: Morning stiffness that lasts at least 1 hour is a symptom of rheumatoid arthritis. The following are symptoms of osteoarthritis: deep, aching pain with motion early in the disease; limited joint motion; and instability of weight-bearing joints. pg.1076

A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? a) Increased total serum complement levels b) Negative antinuclear antibody test c) An above-normal anti-deoxyribonucleic acid (DNA) test d) Negative lupus erythematosus cell test

c) An above-normal anti-deoxyribonucleic acid (DNA) test Explanation: Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE. pg.1070

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout? a) Increase fluids b) Place patient on bed rest c) Assess dietary diet and activity at home d) Insert a foley catheter

c) Assess dietary diet and activity at home Explanation: Patients with gout need teaching about diet restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to see what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a patient with this problem. pg.1079

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse? a) Raw vegetables b) Organ meats c) Dairy products d) Shellfish

c) Dairy products Explanation: Primary hyperuricemia may be caused by severe dieting or starvation, excessive intake of foods that are high in purines (shellfish, organ meats), or heredity. pg.1079

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a) The time of day when exercise is performed isn't important. b) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. d) Exercising in the evening before going to bed is beneficial.

c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Explanation: A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime. pg.1076

Which of the following statements is accurate regarding osteoarthritis? a) It is the most common inflammatory arthritic disorder. b) It is caused by an overproduction of uric acid. c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. d) It affects young males.

c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. Explanation: Osteoarthritis (OA), also known as degenerative joint disease, is a chronic, noninflammatory (even though inflammation may be present), progressive disorder that causes cartilage deterioration in synovial joints and vertebrae. OA is the most common and most frequently disabling of the joint disorders that is overdiagnosed and trivialized and frequently over or undertreated. Aging is the risk factor most strongly correlated with OA. Gout is caused by an overproduction of uric acid. Rheumatoid arthritis is the most common inflammatory arthritic disorder. pg.1075

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? a) The medication is administered IM. b) The medication is given at room temperature. c) It is important to monitor for injection site reactions. d) The patient should continue taking the medication if fever occurs.

c) It is important to monitor for injection site reactions. Explanation: It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs. pg.1061

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a) Computed tomography (CT) b) Bone scan c) Muscle biopsy d) Magnetic resonance imaging (MRI)

c) Muscle biopsy Explanation: As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity. pg.1074

Primary gout is often caused by an inherited disorder in which type of metabolism? a) Glucose b) Fat c) Purine d) Carbohydrate

c) Purine Explanation: Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism. pg.1079

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? a) The symptoms are primarily localized to the skin but may involve the joints. b) This disorder is more common in men in their thirties and forties than in women. c) The belief is that it is an autoimmune disorder with an unknown trigger. d) It has very specific manifestations that make diagnosis relatively easy.

c) The belief is that it is an autoimmune disorder with an unknown trigger. Explanation: Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems. pg.1069

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? a) Acupuncture b) Cold therapy c) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) d) An exercise routine that includes range-of-motion (ROM) exercises

d) An exercise routine that includes range-of-motion (ROM) exercises Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain. pg.1067

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis? a) Patchy hair loss on the scalp b) Red, butterfly-shaped facial rash c) Increased urine output d) Low back pain

d) Low back pain Explanation: The most common symptoms of ankylosing spondylitis are low back pain and stiffness. A red, butterfly-shaped rash on the face and a patchy loss of hair are the associated with systemic lupus erythematosus. Ankylosing spondylitis does not affect urine output. pg.1077

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? a) Eradicating pain b) Promoting sleep c) Eliminating deformities d) Minimizing damage

d) Minimizing damage Explanation: Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results. pg.1066

Which of the following is the leading cause of disability and pain in the elderly? a) SLE b) Scleroderma c) Rheumatoid arthritis (RA) d) Osteoarthritis

d) Osteoarthritis Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly. pg.1075

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a) Specific for RA b) Diagnostic for Sjögren's syndrome c) Diagnostic for SLE d) Suggestive of RA

d) Suggestive of RA Explanation: Rheumatoid factor is present in about 80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence does not rule out the diagnosis. pg.1066

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply. a) Nausea and vomiting b) Tingling in the arms c) Increase in pain in the affected extremity d) Intestinal cramping e) Diarrhea

e) Diarrhea d) Intestinal cramping a) Nausea and vomiting Explanation: Colchicine is administered every 1 or 2 hours until the pain subsides or nausea, vomiting, intestinal cramping, and diarrhea develop. When one or more of these symptoms occurs, the drug should be stopped temporarily. Tingling in the arms and increase in pain are not normal adverse reactions that are seen with this drug. pg.1080

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because: a) weight loss will reduce uric acid levels and reduce stress on joints. b) weight loss will reduce purine levels. c) weight loss will increase uric acid levels and reduce stress on joints. d) weight loss will reduce inflammation.

a) weight loss will reduce uric acid levels and reduce stress on joints. Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss won't reduce purine levels, reduce inflammation or increase uric acid levels. pg.1079

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about? a) Azathioprine (Imuran) b) Hydroxychloroquine (Plaquenil) c) Aurothioglucose (Solganal) d) Diclofenac (Voltaren)

b) Hydroxychloroquine (Plaquenil) Explanation: The DMARD hydroxychloroquine (Plaquenil) is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmologic examinations (every 6-12 months). pg.1060

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers b) Weight gain, hypervigilance, hypothermia, and edema of the legs c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

d) Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE. pg.1070

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? a) "My finger joints are oddly shaped." b) "I have pain in my hands." c) "My legs feel weak." d) "I have trouble with my balance."

a) "My finger joints are oddly shaped." Explanation: Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities. pg.1066

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process? a) Inflammation b) Degeneration c) Gout d) Infection

c) Gout Explanation: The presence of crystals is indicative of gout, and the presence of bacteria is indicative of infective arthritis. pg.1079

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"? a) "Your symptoms are a result of your body attacking itself." b) "You are not immune to the disease causing the symptoms." c) "You have inherited your parent's immunity to the disease." d) "You have antigens to the disease, but it they do not prevent the disease."

a) "Your symptoms are a result of your body attacking itself." Correct Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect "attacking itself." The other statements do not explain autoimmunity. pg.1055

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Chest pain c) Behavioral changes d) Decreased cognitive ability

a) Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous. pg.1070

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? a) "I do not need to make any changes in my diet." b) "I should avoid prolonged sun exposure." c) "My energy level will gradually increase over time." d) "My medications will ultimately correct my problem."

b) "I should avoid prolonged sun exposure." Explanation: Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression. pg.1072

Which of the following terms refers to fixation or immobility of a joint? a) Hemarthrosis b) Ankylosis c) Arthroplasty d) Diarthrodial

b) Ankylosis Explanation: Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into the joint. Diarthrodial refers to a joint with two free moving parts. Arthroplasty refers to replacement of a joint. pg.1078

Which of the following is the definitive diagnostic of gouty arthritis? a) Radiologic studies b) Polarized light microscopy of the synovial fluid c) Synovial biopsy d) Arthrocentesis

b) Polarized light microscopy of the synovial fluid Explanation: A definitive diagnosis of gouty arthritis is established by polarized light microscopy of the synovial fluid of the involved joint. Synovial biopsy, arthrocentesis, and radiological studies aid in the diagnosis of rheumatoid arthritis. pg.1079

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis? a) Small joint involvement b) Joint pain that diminishes with rest c) Early morning stiffness d) Subcutaneous nodules

c) Early morning stiffness Explanation: Osteoarthritis is characterized by early morning stiffness that decreases with activity. pg.1076

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? a) Rheumatoid nodules b) Tophi c) Heberden's nodes d) Bouchard's nodes

c) Heberden's nodes Explanation: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden's nodes are bony enlargement of the distal interphalangeal joints. Bouchard's nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels. pg.1076

After teaching a class comparing rheumatoid arthritis and osteoarthritis, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of osteoarthritis? a) Swan neck deformity b) Ulnar deviation c) Boutonniere deformity d) Heberden nodes

d) Heberden nodes Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis. pg.1066

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? a) Reiter's syndrome b) Ankylosing spondylitis c) Sjögren's syndrome d) Raynaud's phenomenon

d) Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon. pg.1057

A nurse should expect to administer which medication to a client with gout? a) Colchicine b) Furosemide (Lasix) c) Calcium gluconate (Kalcinate) d) Aspirin

a) Colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps, it doesn't treat gout. pg.1079

Which nursing diagnosis is most inappropriate for the client with osteoarthritis? a) Imbalanced nutrition: less than body requirements b) Impaired physical mobility c) Deficient knowledge: symptom management d) Chronic pain

a) Imbalanced nutrition: less than body requirements Explanation: Weight reduction is often part of the management plan for the client with osteoarthritis. pg.1067

A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.) a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L d) Red blood cell (RBC) count of <4.0 million/mcL e) Red blood cell (RBC) count of >4.0 million/mcL

a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) d) Red blood cell (RBC) count of <4.0 million/mcL Explanation: Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive. pg.1066

Which of the following medications are used in the treatment of gout? Select all that apply. a) Probenecid (Benemid) b) Febuxostat (Uloric) c) Sulfasalazine (Azulfidine) d) Hydroxychloroquine (Plaquenil) e) Allopurinol (Zyloprim)

a) Probenecid (Benemid) e) Allopurinol (Zyloprim) b) Febuxostat (Uloric) Explanation: Benemid, Zyloprim, and Uloric are used in the treatment of gout. Plaquenil and Azulfidine are useful in the treatment of rheumatoid arthritis. pg.1080

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Widespread chronic pain b) Jaw locking c) Butterfly facial rash d) Heberden nodes

a) Widespread chronic pain Explanation: The most common finding associated with fibromyalgia is widespread and chronic pain. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus. pg.1080

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout? a) penicillamine b) colchicine c) methotrexate d) prednisone

b) colchicine Explanation: Colchicine is prescribed for the treatment of an acute attack of gout. pg.1079

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a) Reports decreased joint pain b) Reports ability to perform ADLs c) Reports increased fatigue d) Shows a weight gain of 2 pounds

c) Reports increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. pg.1063

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply. a) Dressing changes b) Narcotic safety c) Safe exercise d) Medication dosages and side effects e) Assistive devices

c) Safe exercise d) Medication dosages and side effects e) Assistive devices Correct Explanation: The patient who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints or even walkers and canes, may assist the patient to care safely for him- or herself. Narcotics are not commonly used and there would be no reason for dressings. pg.671

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." b) "OA is more common in women. RA is more common in men." c) "OA affects joints on both sides of the body. RA is usually unilateral." d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally. pg.1075

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? a) Scoliosis b) Paget's disease c) Muscular dystrophy d) Degenerative joint disease

d) Degenerative joint disease Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease. pg.1076

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? a) Supine with pillows under the knees b) Semi-Fowler's c) Side-lying with pillows supporting the shoulders and legs d) Prone

d) Prone Explanation: It is best for the patient with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.

Osteoarthritis is known as a disease that a) requires early treatment because most of the damage appears to occur early in the course of the disease. b) affects the cartilaginous joints of the spine and surrounding tissues. c) affects young males. d) is the most common and frequently disabling of joint disorders.

d) is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly patients, is often ignored. Reiter's syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis requires early treatment because of early damage caused by disease. Ankylosing spondylitis causes the described problem and is usually diagnosed in the second or third decade of life. pg.1075

Which of the following would be consistent with the diagnosis of rheumatoid arthritis? a) Increased C4 complement component b) Increased red blood cell count c) Cloudy synovial fluid d) Decreased ESR

c) Cloudy synovial fluid Explanation: In a patient with rheumatoid arthritis, Arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement. pg.1066

A patient arrives at the clinic with complaints of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to? a) Fibromyalgia b) Osteoarthritis c) Gout d) Rheumatoid arthritis

c) Gout Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients) in gout. The abrupt onset often occurs at night, awakening the patient with severe pain, redness, swelling, and warmth of the affected joint. pg.1079

A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. An appropriate nursing diagnosis for the client is: a) Disturbed body image b) Risk for loneliness c) Chronic low self-esteem d) Spiritual distress

a) Disturbed body image Explanation: The client is exhibiting defining characteristics of disturbed body image. pg.1073

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? a) Sicca syndrome b) Episcleritis c) Cataracts d) Glaucoma

Sicca syndrome Explanation: Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye. pg.1072

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? a) After the client has had a warm paraffin hand bath b) First thing in the morning when the client wakes c) After the client has a diagnostic test d) After cool compresses have been applied to the hands

a) After the client has had a warm paraffin hand bath Explanation: Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises. pg.1056

Of the following, which drug is not used in the treatment of rheumatoid arthritis? a) Allopurinol (Zyloprim) b) Adalimumab (Humira) c) Methotrexate (Rheumatrex) d) Etanercept (Enbrel

a) Allopurinol (Zyloprim) Explanation: Allopurinol (Zyloprim) is used in the treatment of gout. Etanercept (Enbrel), adalimumab (Humira), and methotrexate (Rheumatrex) are all used in the treatment of rheumatoid arthritis. pg.1079

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Elevated erythrocyte sedimentation rate b) Increased albumin levels c) Increased red blood cell count d) Increased C4 complement

a) Elevated erythrocyte sedimentation rate Explanation: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin. pg.1058

Which findings best correlate with a diagnosis of osteoarthritis? a) Joint stiffness that decreases with activity b) Fever and malaise c) Erythema and edema over the affected joint d) Anorexia and weight loss

a) Joint stiffness that decreases with activity Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis. pg.1076

Which of the following procedures involves a surgical fusion of the joint? a) Synovectomy b) Tenorrhaphy c) Osteotomy d) Arthrodesis

d) Arthrodesis Explanation: An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint. pg.1067

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response? a) Hand and finger deformities are associated with the development of rheumatoid arthritis. b) A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. c) He should discuss this concern with his physician. d) It's impossible to determine at the time of diagnosis how the disease will progress.

a) Hand and finger deformities are associated with the development of rheumatoid arthritis. Explanation: The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease. pg.1066

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following? a) Rheumatoid arthritis b) Ankylosing spondylitis c) Osteoarthritis d) Gout

d) Gout Explanation: Joint swelling and tenderness of the great toe and tophi are classic manifestations of gout. pg.1079

What intervention is a priority for a patient diagnosed with osteoarthritis? a) Hydrotherapy b) Allopurinol (Zyloprim) c) Colchicine d) Physical therapy and exercise

d) Physical therapy and exercise Explanation: Patients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and Zyloprim are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care. pg.1077

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again." b) "It will never get any better than it is right now." c) "When it clears up, it will never come back." d) "I'll definitely need surgery for this."

a) "It will get better and worse again." Explanation: The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases. pg.1062

Nursing care for the patient with fibromyalgia should be guided by what assumption? a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously. b) All patients with fibromyalgia have the same type of symptoms. c) Patients with fibromyalgia will eventually lose their ability to walk. d) Patients with fibromyalgia rarely respond to treatment.

a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously. Explanation: Because patients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose patients. Patients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from patient to patient, and respond to different treatments. Patients do not lose their ability to walk. pg.1081

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: a) combat inflammation. b) prevent platelet aggregation. c) promote diuresis. d) prevent infection.

a) combat inflammation. Explanation: Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis. pg.1071

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Uric acid b) Creatinine c) Red blood cell count d) Erythrocyte sedimentation rate (ESR)

c) Red blood cell count Explanation: There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis. pg.1066

What should the nurse teach the patient about the diagnosis of osteoarthritis? a) "It affects young males." b) "It is the most common and frequently disabling of joint disorders." c) "It requires early treatment because most of the damage appears to occur early in the course of the disease." d) "It affects the cartilaginous joints of the spine and surrounding tissues."

b) "It is the most common and frequently disabling of joint disorders." Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly patients, is often ignored. Reiter's syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis causes the described problem and is usually diagnosed in the second or third decade of life. pg.1075

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "Monitor your body temperature." c) "Corticosteroids may be stopped when symptoms are relieved." d) "There are no activity limitations between flare-ups."

b) "Monitor your body temperature." Explanation: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation. pg.1071

Which of the following would a nurse encourage a client with gout to limit? a) Carbohydrates b) Purine-rich foods c) Fluid intake d) Protein-rich foods

b) Purine-rich foods Explanation: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid. pg.1079

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply. a) Autoantibodies immune complexes b) Susceptibility c) Damage d) Abnormal innate and adaptive immune responses e) Inflammation

b) Susceptibility d) Abnormal innate and adaptive immune responses a) Autoantibodies immune complexes e) Inflammation c) Damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns? a) Administering opioids at bed time b) Tricyclic antidepressants c) Range-of-motion exercise prior to sleeping d) Increasing activity during the day

b) Tricyclic antidepressants Explanation: Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in patients with fibromyalgia. Increasing activity during the day or using range-of-motion exercises will not increase the patient's ability to sleep. Narcotics are generally not needed for pain control with this disorder. pg.1080

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client's stage of disease? a) Auscultate the client's lung sounds. b) Observe the client's gait. c) Review the client's medical record. d) Inspect the client's mouth.

c) Review the client's medical record. Explanation: The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds. pg.1070

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate? a) "You should discuss that matter with your physician." b) "Tell me more about your concerns about this potential diagnosis." c) "The diagnosis won't be based on the findings of a single test but by combining all data found." d) "SLE is a very serious systemic disorder."

c) "The diagnosis won't be based on the findings of a single test but by combining all data found." Explanation: There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the physician, stating that SLE is a serious systemic disorder, and asking the client to express her feelings about the potential diagnosis don't answer the client's question. pg.1070

Which of the following classifications are considered antiarthritic drugs? Select all that apply. a) Disease-modifying antirheumatics (DMARDs) b) Diuretics c) Anti-inflammatory d) Muscle relaxants e) Glucocorticoids

c) Anti-inflammatory a) Disease-modifying antirheumatics (DMARDs) e) Glucocorticoids Explanation: Antiarthritic drugs fall into three major groups: nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and glucocorticoids. Diuretics and muscle relaxants are not antiarthritic drugs. pg.1056

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis? a) Provide an analgesic after exercise. b) Avoid the use of topical analgesics. c) Encourage weight loss and an increase in aerobic activity. d) Assess for the gastrointestinal complications associated with COX-2 inhibitors.

c) Encourage weight loss and an increase in aerobic activity. Explanation: Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Patients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, prior to their exercise session. Gastrointestinal complications, especially GI bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Topical analgesics, such as capsaicin and methylsalicylate, may be used for pain management. pg.1077

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? a) Self-care deficit: Bathing b) Ineffective airway clearance c) Fatigue d) Risk for infection

c) Fatigue Explanation: Low red blood cell count can be related to inadequate nutrition. Insufficient RBC levels compromise the oxygen-carrying capacity of the blood, which can lead to fatigue. pg.1063

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority? a) Risk for constipation b) Impaired gas exchange c) Impaired skin integrity d) Imbalanced nutrition: More than body requirements

c) Impaired skin integrity Explanation: Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursing diagnosis isn't the priority. Clients with scleroderma are at risk for Imbalanced nutrition: Less than body requirements. The client with advanced scleroderma, not newly diagnosed scleroderma, is at increased risk for developing respiratory complications. pg.1074

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to: a) wear protective devices when exercising. b) get help when lifting objects. c) install safety devices in the home. d) wear worn, comfortable shoes.

c) install safety devices in the home. Explanation: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises. pg.1077

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a) "Do all your chores after performing morning exercises to loosen up." b) "Do all your chores in the morning, when pain and stiffness are least pronounced." c) "Do all your chores in the evening, when pain and stiffness are least pronounced." d) "Pace yourself and rest frequently, especially after activities."

d) "Pace yourself and rest frequently, especially after activities." Explanation: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Telling the client to do her chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace herself and take frequent rests rather than doing all chores at once. pg.1076

A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? a) "The fasting is okay, but make sure you drink fluids when exercising." b) "Make sure to eat some fat occasionally with all that exercise." c) "Try combining the fasting with moderate exercise." d) "There might be some difficulties with your plan and fasting."

d) "There might be some difficulties with your plan and fasting." Explanation: Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout. pg.1079

Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition? a) Encouraging the client to eat a healthy diet b) Regular exercise and stress reduction c) Avoiding caffeine and alcohol d) Applications of ice

d) Applications of ice Explanation: Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan. pg.1056

The nurse intervenes to assist the patient with fibromyalgia to cope with what symptoms? a) Pain, viral infection, and tremors b) Generalized muscle aching, mood swings, and loss of balance c) Diminished vision, chronic fatigue, and reduced appetite d) Chronic fatigue, generalized muscle aching, and stiffness

d) Chronic fatigue, generalized muscle aching, and stiffness Explanation: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown and no pathologic characteristics have been identified that are specific for the condition. Treatment consists of attention to the specific symptoms reported by the patient. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals. pg.1080

A 68-year-old client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which of the following activities might enhance an acute attack? a) Frequently drinking coffee b) Frequently ingesting salicylates c) Frequently drinking alcohol d) Eating organ meats and sardines

d) Eating organ meats and sardines Explanation: During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. pg.1079

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis? a) Positive Anti-Sm antibodies b) Positive ANA titre c) Elevated ESR d) Positive Anti-dsDNA antibody test

d) Positive Anti-dsDNA antibody test Explanation: Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titre shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement. pg.1071

A nurse is poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis? a) Ineffective thermoregulation b) Risk for imbalanced nutrition: More than body requirements c) Constipation d) Risk for impaired skin integrity

d) Risk for impaired skin integrity Explanation: Progressive systemic sclerosis is a connective tissue disease characterized by fibrosis and degenerative changes of the skin, synovial membranes, and digital arteries. Therefore, the nurse is most likely to formulate a nursing diagnosis of Risk for impaired skin integrity. Because clients with the disease are prone to diarrhea from GI tract hypermotility (caused by pathologic changes), Constipation is an unlikely nursing diagnosis. Progressive systemic sclerosis doesn't cause Ineffective thermoregulation. GI hypermotility may lead to malabsorption, and esophageal dysfunction may cause dysphagia; these conditions put the client with the disease at risk for inadequate nutrition, making Risk for imbalanced nutrition: More than body requirements an improbable nursing diagnosis. pg.1074

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a) Systemic lupus erythematosus b) Polymyalgia rheumatic c) Rheumatoid arthritis d) Scleroderma

d) Scleroderma Explanation: Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries. pg.1073

The nurse is gathering objective data for a client at the clinic complaining of 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? a) Ulnar deviation b) Boutonnière deformity c) Rheumatoid nodules d) Swan neck deformity

d) Swan neck deformity Explanation: A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule. pg.1066

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) a) Dyspnea owing to fibrotic cardiac tissue b) Productive cough c) Butterfly-shaped rash on the face d) Dysphagia owing to hardening of the esophagus e) Decreased ventilation owing to lung scarring

e) Decreased ventilation owing to lung scarring d) Dysphagia owing to hardening of the esophagus a) Dyspnea owing to fibrotic cardiac tissue Explanation: The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur. pg.1073