Chapter 39: Nursing Management: Patients With Rheumatic Disorders

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 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 nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

"Monitor your body temperature."

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."

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

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.

The nurse is caring for a client with a new onset of gout. What medication does the nurse anticipate will be ordered by the health care provider?

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

Osteoarthritis is known as a disease that

is the most common and frequently disabling of joint disorders.

The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the most common finding associated with fibromyalgia?

widespread chronic pain

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."

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."

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 .weight loss

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

.Safe exercise .Medication dosages and side effects .Assistive devices

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply.

.Weight loss .Decreasing alcohol intake .Avoiding purine-rich foods

A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.

0.5

As part of the assessment process for a patient suspected of having gout, the nurse evaluated his serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.

6.8 mg/dL

A nurse at a small, rural nursing station that lacks the services of a physical therapist is responsible for planning the care of a local resident who has rheumatoid arthritis. When planning a regimen of physical activity for this patient, what principle should underlie the nurse's choice of interventions?

Active range-of-motion (ROM) exercises can reduce joint stiffness.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?

colchicine

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find?

early morning stiffness

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of

gout.

A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of?

organ meats

A patient has been has been admitted with an exacerbation of rheumatoid arthritis (RA). The nurse documents joint pain and swelling after performing the initial nursing assessment. In addition to these findings, what is a classic sign of RA?

Joint stiffness

A patient with osteoarthritis is taking up to 4 grams of acetaminophen daily. The nurse knows to obtain periodic:

Liver enzyme results.

Which joint is most commonly affected in gout?

Metatarsophalangeal

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?

Methotrexate

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)

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

The nursing educator is talking with a group of recent nursing graduates about common diagnoses on the unit. What diffuse connective tissue disease would the instructor tell the group is caused by an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?

Rheumatoid arthritis (RA)

A nurse is planning the care of a patient who has fibromyalgia and is aware of the damaging effect that the disease has had on the patient's quantity and quality of sleep. When discussing strategies to manage this problem with the patient, the nurse should recommend:

Setting consistent times for going to bed and for getting up in the morning

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Tophi

A client is recovering from an attack of gout. What will the nurse include in the client teaching?

Weight loss will reduce uric acid levels and reduce stress on joints.

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?

Elevated erythrocyte sedimentation rate

The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process?

Gout

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?

Hypertension