MS( OA, RA,Lupus)

The nurse recommends to patients with osteoarthritis that they consider physical therapy for assistance with (select all that apply): 1. isometric exercises. 2. moist heat application. 3. instruction with a TENS unit. 4. measures to increase range of motion. 5. measures to increase strength.

1, 2, 3, 4, 5 All the options are benefits attributed to physical therapy.

In preparing discharge plans for a patient with systemic lupus erythematosus (SLE), it is most important for the nurse to include: 1. the need to consume 2 L of fluid daily. 2. close monitoring of daily blood glucose. 3. use of daily sunscreens with SPF higher than 15. 4. careful concern for certain food allergies.

3 Patients with SLE are photosensitive to sunlight.

The patient presents with contracture deformities of the hand and complains of severe pain. What musculoskeletal disorder does this patient manifest? 1. Rheumatoid arthritis 2. Osteomyelitis 3. Osteoporosis 4. Ankylosing spondylitis

Rationale 1: The pattern of joint involvement in rheumatoid arthritis (RA) is typically polyarticular and symmetric. The proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the fingers, wrists, knees, ankles, and toes are most frequently involved, although RA can affect any joints.

The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as a. degeneration of articular cartilage in synovial joints. b. enzymatic breakdown of tissue in non-weight-bearing joints. c. joint destruction caused by an autoimmune process. d. overproduction of synovial fluid, resulting in joint destruction.

A OA is a chronic joint disease characterized by degeneration and loss of articular cartilage covering joint surfaces.

A client with a history of rheumatoid arthritis reports mobility impairment as a result of hip and knee joint stiffness. The nurse suggests the following interventions to assist the client in managing this problem: Select all that apply. 1. Encouraging frequent periods of rest for the affected hip and knee joints. 2. Instructing the client in the proper technique for active range of motion of the affected joints. 3. Educating the client's family to perform passive range-of-motion exercises of the affected joints. 4. Suggesting the application of ice to the affected joints to minimize pain. 5. Discussing the use of relaxation techniques when affected joints are most painful.

. Encouraging frequent periods of rest for the affected hip and knee joints. 2. Instructing the client in the proper technique for active range of motion of the affected joints. 3. Educating the client's family to perform passive range-of-motion exercises of the affected joints. Rationale: Encouraging frequent periods of rest for the affected hip and knee joints. Rest will help maintain maximum joint mobility. Instructing the client in the proper technique for active range of motion of the affected joints. Active range of motion exercises will help maintain maximum joint mobility. Educating the client's family to perform passive range-of-motion exercises of the affected joints. Passive range of motion exercises will help maintain maximum joint mobility. Suggesting the application of ice to the affected joints to minimize pain. The application of heat is more appropriate since it will facilitate movement of the joints while also impacting the inflammatory process. Discussing the use of relaxation techniques when affected joints are most painful. Relaxation techniques are directed toward pain management, not joint mobility.

The nurse would evaluate that a patient with systemic lupus erythematosus understands dietary teaching when the patient selects which food for breakfast? 1. Orange juice 2. Sausage, gravy, and biscuits 3. A doughnut 4. Toast

1 Rationale 1: The patient with SLE requires additional vitamin C. Rationale 2: Generally, the diet should be low in sodium. Rationale 3: Food choices should reflect a healthy, balanced diet. Rationale 4: There is no particular reason that toast is not a good choice, but it does not offer any special benefit, either. Another choice would be healthier for this patient.

Diagnostic procedures are being performed on a female patient who may have systemic lupus erythematosus (SLE). Which findings would the nurse evaluate as supporting this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Elevated LE prep 2. Hematuria 3. Negative anti-SM antibody 4. C3 complement protein of 94 mg/dL 5. Sodium 138

1,2 Rationale 1: An elevated LE prep supports the diagnosis of SLE, as there are normally no LE cells present. Rationale 2: Hematuria is often present in patients with SLE. Rationale 3: The normal result of this test is negative. The presence of anti-SM antibodies supports the diagnosis of SLE. Rationale 4: The C3 normal range for females is 76-120 mg/dL. SLE reduces these levels. Rationale 5: Sodium levels are not used to diagnose SLE.

A patient diagnosed with systemic lupus erythematosus exhibits a facial rash. What instruction should the nurse provide regarding skin care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Avoid being out of doors during the hours of greatest sun intensity. 2. Use sunscreen if sun exposure is possible. 3. Apply hydrocortisone cream 1% to the rash 4 to 6 times per day. 4. Wash the rash with antibacterial soap three times a day. 5. Swim in a chlorinated pool for relief of burning.

1,2 Rationale 1: The patient should avoid being out of doors during peak sunlight hours. Rationale 2: The patient should use sunscreen if sun exposure is possible. Rationale 3: There is no indication that hydrocortisone cream should be applied to this rash. Rationale 4: The skin should be kept clean, but mild soap should be used. There is no reason to wash th

An elderly patient with osteoarthritis has been told that he cannot have a joint replaced at this time. The patient is having progressive difficulty with normal self-care activities. Which of the following is this patient at risk for developing? 1. dehydration 2. depression 3. delirium 4. dementia

2 Rationale: The elderly patient has osteoarthritis which is affecting his ability to perform normal self-care activities. This could cause the patient to develop feelings of helplessness and hopelessness which could lead to depression. Depression is seen in those who have chronic illnesses and those who have experienced a loss. The patient is experiencing a loss of independence with routine activities and is at risk for depression at this time. There is no evidence to suggest that this patient is at risk for developing dehydration, delirium, or dementia.

Which condition or action represents a modifiable risk factor for prevention of osteoarthritis? A. Obesity B. Hypertension C. Cigarette smoking D. Walking as exercise

A Obesity increases the stress on weight-bearing joints and contributes to the development of de-generative joint disease.

The nurse is discharging a client with osteoarthritis. Which of the following would the nurse include in the teaching plan? Standard Text: Select all that apply. 1. Obesity increases the risks of bone, muscle, and joint disorders. 2. Musculoskeletal health is influenced by the diet. 3. Exercise is important in the prevention of osteoarthritis. 4. Smoking and alcohol contribute to the development of osteoarthritis. 5. As the condition progresses the hands may develop contractures that resemble swan necks

1,2,3 Rationale 1: Obesity increases the risks of bone, muscle, and joint disorders. Obesity places an increase in stress on the bones and joints. Obesity is viewed as a risk factor for the development of osteoarthritis. Rationale 2: Musculoskeletal health is influenced by the diet. Dietary intake has an impact on musculoskeletal health. Vitamin D and calcium are associated with bone health. Protein intake is associated with healthy muscles. Rationale 3: Exercise is important in the prevention of osteoarthritis. Exercise increases muscle strength and flexibility. Rationale 4: Smoking and alcohol contribute to the development of osteoarthritis. Smoking and alcohol are risk factors for the development of osteoporosis not osteoarthritis. Rationale 5: As the condition progresses the hands may develop contractures that resemble swan necks. Swan-neck contractures are a deformity noted in the hand of an individual diagnosed with rheumatoid arthritis. Rheumatoid arthritis is a systemic disorder of autoimmune origin.

Impaired physical mobility is a major nursing diagnosis for clients with osteoarthritis (OA). The nursing intervention best directed toward addressing this client's limitation is: 1. Assessing the client's range of motion of affected joints in order to plan and implement appropriate interventions. 2. Encouraging consistently high activity levels in order to minimize the development of associated emotional and self-esteem problems. 3. Encouraging client to assume responsibility for personal self-care needs in order to retain ability to be physically active. 4. Assessing and managing the client's need for narcotic analgesics in order to minimize the impact that pain has on personal activities of daily living.

1. Assessing the client's range of motion of affected joints in order to plan and implement appropriate interventions. Rationale: A determination of the client's range of motion is needed to provide the best individualized care. Clients with osteoarthritis (OA) will need to build in periodic rest periods in order to decrease pain and associated symptoms such as depression once depression is identified in this client. Realistic goals will need to be set for the client with OA. Assuming responsibility for personal self-care needs may not be realistic for all clients with OA. Simply encouraging the client to remain active does not provide comprehensive care. OA is a chronic condition, and the use of narcotics could lead to dependence.

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disorder but the nurse is aware that early, appropriate interventions may play a large role in managing the disease by: 1. Controlling pain generated by the disorder. 2. Reducing affected joint deformity. 3. Minimizing tissue and joint damage. 4. Maintaining optimum level of joint movement. 5. Bringing about a long-term remission of symptoms.

1. Controlling pain generated by the disorder. 2. Reducing affected joint deformity. 3. Minimizing tissue and joint damage. 4. Maintaining optimum level of joint movement. Rationale: Controlling pain generated by the disorder. Certain measures are used to control this disease and treat symptoms, such as pain control. Reducing affected joint deformity. Certain measures are used to control this disease, such as reducing joint deformity. Minimizing tissue and joint damage. Certain measures are used to control this disease and treat symptoms, such as reducing damage to joints. Maintaining optimum level of joint movement. Certain measures are used to control this disease and treat symptoms, such as maintaining joint function. Bringing about a long-term remission of symptoms. RA is a chronic condition without a cure or long-term remission.

A nurse is preparing a flyer on rheumatoid arthritis (RA) for distribution during a community health fair. The nurse includes the following facts: 1. Women are three times more likely to be affected. 2. Onset generally occurs between 20 and 40 years of age. 3. Rheumatoid arthritis appears to have a genetic component. 4. Rheumatoid arthritis is the most common form of arthritis. 5. Rheumatoid arthritis typically affects weight-bearing joints.

1. Women are three times more likely to be affected. 2. Onset generally occurs near 20 to 40 years of age. 3. Rheumatoid arthritis appears to have a genetic component. Rationale: Women are three times more likely to be affected. RA is noted worldwide as affecting three times more women than men. Onset generally occurs near 20 to 40 years of age. RA can occur at any age, with the peak incidence being between ages 20 and 40. Rheumatoid arthritis appears to have a genetic component. RA is thought to be an autoimmune disorder that not only involves tissue hypersensitivity but also has a genetic component. Rheumatoid arthritis is the most common form of arthritis. Osteoarthritis (OA) is the most common form of arthritis. Rheumatoid arthritis typically affects weight-bearing joints. Osteoarthritis (OA) is a chronic condition that accompanies aging, most commonly affecting weight-bearing joints.

A patient with rheumatoid arthritis has a hemoglobin level of 10.0 g/dL. Which of the following types of anemia is this patient most likely experiencing? 1. decreased red blood cell production 2. inflammation 3. increased red blood cell destruction 4. increased blood loss

2 Rationale: Anemia of inflammation is believed to exist worldwide in individuals with chronic inflammation and infections. Inflammatory anemia is seen in inflammatory bowel disease, rheumatoid arthritis, and systemic inflammatory response syndrome. Anemia caused by decreased red blood cell production results from an inadequate intake of iron, minerals, vitamin B12, and folic acid. This type of anemia is not associated with rheumatoid arthritis. Anemia caused by increased red blood cell destruction can occur from congenital or acquired problems and is not typically associated with rheumatoid arthritis. Anemia from increased blood loss can occur with any type of life-threatening health problem.

The nurse is instructing a client diagnosed with osteoarthritis. Which of the following statements indicates that the client understands these instructions? 1. "Exercise will not be of help because it will stress my joints." 2. "I will need to lose weight; my doctor says about 20 pounds." 3. "I will take my medications only if the pain is very bad." 4. "I can still go on my marathon shopping trips with my daughter."

2 Exercise and weight reduction help maintain joint mobility and muscle strength. Walking can be done at home and is low stress to the joints. Scheduled medications should be taken to relieve inflammation, and pain medications should be taken before the pain gets "very bad." The client should schedule rest periods with activity so as not to do too much at one time.

The nurse has chosen these nursing diagnoses for a patient who has systemic lupus erythematosus. Which NDX would be assigned the highest priority? 1. Skin Integrity: Impaired 2. Activity Intolerance 3. Anxiety 4. Fluid Volume Excess

2 Rationale 1: Impaired Skin Integrity is applicable to most patients with SLE, but this is not the NDX of highest priority. Rationale 2: Inability to tolerate activity is the highest priority of the NDX listed. Patients should be taught to balance rest and activity. Rationale 3: The patient with SLE is likely to be anxious about the disease process and its effect on daily life. This is not the NDX of highest priority. Rationale 4: The patient with SLE may have fluid volume problems if kidney function is impaired. This is not the NDX of highest priority.

The nurse recommends that to control chronic pain for the patient with osteoarthritis, the patient should: 1. administer analgesics only when needed. 2. administer analgesics as prescribed on a routine basis. 3. plan activities with no rest periods to be done quickly. 4. wear high-heeled shoes to keep the body in alignment.

2 Routine administration of prescribed analgesics is most appropriate for the treatment of chronic pain.

The nurse recognizes that a patient with rheumatoid arthritis will demonstrate the diagnostic characteristic of this disorder, which is: 1. absence of pain. 2. symmetric bilateral joint swelling. 3. evening stiffness that improves with activity. 4. increased appetite.

2 Symmetric bilateral joint swelling is a classic symptom of rheumatoid arthritis.

A patient diagnosed with rheumatoid arthritis (RA) is reluctant to start some recommended therapies. The nurse tells the patient that early intervention is crucial for long-term health. What rationales would the nurse provide for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Early intervention is instrumental in bringing about long-term remission of symptoms. 2. Beginning treatment early can help control pain generated by the disorder. 3. If the disease is not treated, tissue and joint damage can be extreme. 4. Early and aggressive exercise will help keep joints mobile. 5. If treatment is started early, joint deformity can be avoided.

2,3 Rationale 1: RA is a chronic condition without a cure or long-term remission. Rationale 2: RA is a painful condition that requires a combination of therapeutic approaches to treatment. Early treatment of pain helps maintain joint function. Rationale 3: Treatment can help reduce the amount of tissue and joint damage. If treatment is started earlier, rather than later, tissue and joint damage can be minimized. Rationale 4: Exercise should be balanced with rest, and joints should be safeguarded. Rationale 5: Joint deformity is likely to occur despite early treatment.

The nurse is caring for a patient with systemic lupus erythematosus. The nurse realizes that which of the following would cause thrombocytopenia to develop in this patient? 1. increased destruction of platelets 2. decreased production of platelets 3. increased utilization of platelets 4. inappropriate distribution of platelets

3 Rationale: Increased platelet utilization most commonly results from idiopathic thrombocytopenia purpura. In adults, it usually develops in young women as a chronic disorder of autoimmune origin, with formation of platelet autoantibodies and sometimes develops in conjunction with the autoimmune disorder, systemic lupus erythematosus. Increased destruction of platelets is seen in immune reactions from certain drugs such as heroin or morphine or in bacterial sepsis. Decreased production of platelets is seen in any health problem that injures the bone marrow. Inappropriate distribution of platelets is seen in cirrhosis, leukemias, and lymphomas.

The nurse, in conjunction with the patient, establishes a plan to treat the pain associated with rheumatoid arthritis. Which strategy is best? 1. Avoid exercise, because it aggravates the pain. 2. Use narcotics because nothing else alleviates this type of pain. 3. Apply warm, moist compresses before doing activity. 4. Avoid assistive devices because the patient becomes dependent on them.

3 Warmth before exercise loosens joints and decreases pain.

A client recently diagnosed with rheumatoid arthritis asks if she has passed on this disease to her children. Which nursing responses are most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "There is really no way for us to know until your children are adults." 2. "RA is an autoimmune disease with no genetic link." 3. "Genetic testing can be done to see if your children carry any genetic alterations associated with RA." 4. "I can get you information on your disease that will better explain your options." 5. "Autoimmune diseases are so complex, and genetics is only one factor in their development."

3,4 Rationale 1: Genetic testing is done at all ages. Rationale 2: RA does have a genetic link. Rationale 3: Autoimmune diseases can be caused by specific genetic alterations that can be discovered through genetic testing. Rationale 4: The nurse should be aware of and able to access information for the client. Rationale 5: This is a true statement, but it does not address the client's concern.

A 24-year-old woman is admitted to the hospital for a complete medical examination. Her current complaints are indicative of systemic lupus erythematosus (SLE). Which of the fol-lowing symptoms would indicate this diagnosis? 1. Recent weight gain of 10 pounds 2. Difficulty breathing in the morning 3. Frequent episodes of diarrhea 4. Musculoskeletal pain in the hands

4 Musculoskeletal symptoms are experienced by 95% of SLE patients at some time during the course of their disease.

The nurse is teaching a community health class about health promotion techniques. Which statement by a student indicates a strategy to help prevent the development of osteoarthritis? a. "I will keep my BMI under 24." b. "I will switch to low-tar cigarettes." c. "I will start jogging twice a week." d. "I will have a family tree done."

A Obesity increases the stress on weight-bearing joints and contributes to the development of de-generative joint disease. Smoking does not decrease risk for osteoarthritis. Jogging increases the risk because of increased wear and tear on the joints. There is a genetic link to osteoarthritis; creating a family tree might help the client discover if there is any familial link but will not help prevent the disorder.

Which symptom should a nurse recognize as being pertinent to a possible diagnosis of systemic lupus erythematosus (SLE)? a. Butterfly rash of the face b. Protruding abdomen c. Thinning hair d. Bloody diarrhea

A The classic butterfly rash of the face is one of the most recognizable signs. Because the symptoms come and go, SLE is extremely hard to diagnose quickly.

The client undergoing preoperative assessment before an elective procedure tells the nurse that she has been taking 10 mg of prednisone daily for rheumatoid arthritis. What is the nurse's best action? A. Notify the surgeon and anesthesiologist. B. Document the information as the only action. C. Reschedule the surgery in 2 weeks when the client has cleared the drug from her system. D. Suggest that the client switch to a nonsteroidal anti-inflammatory agent for pain relief.

A The surgery does not need to be delayed; however, corticosteroids have many adverse effects and will have an impact on the client's responses. In addition, clients who have been taking cor-ticosteroids on a daily basis need to continue this therapy through the perioperative period to prevent adrenal insufficiency from abrupt withdrawal.

A client with rheumatoid arthritis (RA) says to the nurse: "I thought I had osteoarthritis. How is this different?" The nurse explains it differs from osteoarthritis in that rheumatoid arthritis: A) has an abrupt onset of red, swollen joints. B) is slower to progress than osteoarthritis. C) affects only one joint at a time. D) does not cause fever or malaise.

A) RA has an abrupt or insidious onset, whereas osteoarthritis can be more gradual and insidious. RA progresses more rapidly and affects multiple joints, causing fever, weight loss, fatigue, and anemia.

A client's therapeutic regimen for rheumatoid arthritis may include which of the following treatments? (Select all that apply.) a. medications d. heat applications b. exercise e. cold applications c. rest f. stress management

A, B, C, D, E, F Medical management of RA centers around reducing inflammation, relieving pain, slowing down or stopping joint damage, and promoting general health. A therapeutic regimen includes medications, exercise, rest, hot and cold applications, and stress management.

During assessment of the patient diagnosed with systemic lupus erythematosus (SLE), which signs and symptoms would the nurse expect to find? (Select all that apply.) a. Hair loss b. Enlarged cervical lymph nodes c. Mouth sores d. Fatigue e. Rashes

A, C, D, E The patient with SLE does not typically have enlarged lymph nodes. Hair loss, mouth sores, fa-tigue, and rashes are just a few of the symptoms present in a patient with SLE.

Rheumatoid arthritis occurs when a person's immune system attacks the cells inside the joint(s), producing substances that act as antigens. Symptoms a client with rheumatoid arthritis may experience include which of the following? (Select all that may apply.) a. inflammation in joint b. decreased synovial fluid c. swelling d. thickening of synovial fluid e. demineralization of the joint f. joint pain g. limited mobility h. joint deformity

A, C, D, F, G, H With rheumatoid arthritis, immune complexes are formed within the joint, causing inflammation, swelling, and increased synovial fluid. As this chronic, systemic condition progresses, surrounding cartilage, tendons, and ligaments become involved. Thickening of synovial tissue eventually leads to calcification of the joint, joint pain, limited mobility, and deformity.

A patient who has been newly diagnosed with systemic lupus erythematosus has been admitted to your unit. You know that a typical diagnostic finding related to this disease is what? A) Thrombocytopenia B) Elevated hemoglobin level C) Negative antinuclear antibodies level

Ans: A Feedback: Blood testing reveals moderate to severe anemia, thrombocytopenia, leukocytosis, and positive antinuclear antibodies. Proteinuria is not diagnostic of systemic lupus erythematosus.

A patient with an exacerbation of his chronic systemic lupus erythematosus (SLE) has been hospitalized on your unit. He gets angry when his call bell isn't answered immediately. What would be the most appropriate response? A) "You seem angry. Would you like to talk about it?" B) "Calm down. You know that stress will make your symptoms worse." C) "Would you like to talk about the problem with the nursing supervisor?" D) "I can see you're angry. I'll come back when you've calmed down."

Ans: A Feedback: The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care and sensitivity to the psychological reactions of the patient. Offering to listen to the patient express anger can help the nurse and the patient understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the patient to calm down doesn't acknowledge his feelings. Ignoring the patient's feelings suggests that the nurse has no interest in what the patient has said. Offering to get the nursing supervisor also doesn't acknowledge the patient's feelings.

An elderly female diagnosed with osteoarthritis has been admitted to your unit. The patient has difficulty ambulating because of chronic pain. What intervention may the nurse use to help with the patient's mobility? A) Motivate the patient to walk in the afternoon B) Determine if self-care devices are needed C) Administer an analgesic as ordered to increase mobility D) Have another person with osteoarthritis visit the patient

Ans: C Feedback: At times, mobility is restricted because of pain, paralysis, loss of muscle strength, systemic disease, an immobilizing device (eg, cast, brace), or prescribed limits to promote healing. If mobility is restricted because of pain, providing pain management through the administration of an analgesic will increase the patient's level of comfort during ambulation and allow the patient to ambulate. The nurse should plan for ambulation with the patient and administer the analgesic in advance of the ambulation to allow sufficient time for the analgesic to take action. Motivating the patent or having another person with the same diagnosis visit are not interventions that will help with mobility. Determining if self-care devices are needed is a collaborative assessment; it is not an intervention.

A patient with systemic lupus erythematosus (SLE) is getting ready for discharge. The nurse knows the patient has understood the patient teaching when the patient states she needs to what? A) Get as much exposure to sunlight as possible to help control skin rashes. B) Be as active as possible between flare-ups. C) Monitor body temperature. D) Stop her corticosteroids when symptoms are relieved.

Ans: C Feedback: 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.

A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes the patient has lost some of her ability to function since her last office visit. What might be an appropriate intervention for the nurse to make for this patient? A) Recommend to the physician that the patient be hospitalized. B) Ask the physician for a referral to an arthritis support group in the community. C) Make a referral for home health so the patient can be assessed in her own environment. D) Make referrals for occupational therapy and physical therapy.

Ans: C Feedback: Appropriate adaptive equipment needed for increased independence is often identified more readily when the nurse sees how the patient functions in the home. There is nothing in the scenario that indicates the patient needs to be hospitalized. The nurse could make the referral to the support group; the physician does not need to do this. The nurse could not make referrals for occupational therapy and physical therapy.

The nurse is managing the care of a patient with osteoarthritis. Appropriate treatment strategies for osteoarthritis include: A) Administration of narcotics for pain control B) Bed rest for painful exacerbations C) Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) D) Vigorous physical therapy for the joints

Ans: C Feedback: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce the inflammation that causes pain. Narcotics aren't used for pain control in osteoarthritis. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

A patient with osteoarthritis comes to the clinic because he is not able to control the pain. The patient asks the nurse why it hurts so bad. What would be the nurse's best response? A) "Don't worry about why it hurts, let's just concentrate on taking away the pain." B) "You are hurting because you aren't following your treatment regimen." C) "The pain you are feeling is psychological. What is going on in your life to make you hurt so bad?" D) "You are experiencing pain from irritated nerve endings and muscle spasms."

Ans: D Feedback: The pain is caused by an inflamed synovium, stretching of the joint capsule or ligaments, irritation of nerve endings in the periosteum over osteophytes (bone spurs), trabecular microfracture, intraosseous hypertension, bursitis, tendinitis, and muscle spasm. Option A is incorrect because it does not answer the patient's question. Nowhere in the scenario does it say the patient is not following their treatment regimen. Option C is incorrect because no information you are given indicates psychological problems with the patient.

The nurse is working with a client who has severe rheumatoid arthritis in her hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silver-ware. What is the nurse's best response? a. "I'll have the nursing assistants set up your meal trays while you are in the hospital." b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use." c. "I'll arrange for a home nursing assistant to help you with your meals after you are discharged from the hospital." d. "Let's see if the physical therapist can suggest some muscle strengthening exercises for you."

B The client wishes to be more independent at mealtimes; adaptive eating utensils from the occu-pational therapist will help her meet this goal. Muscle-strengthening exercises will not be as ef-fective for the client's mealtime needs. The client wishes to remain as independent as possible, so a home nursing assistant should not be suggested.

An occupational therapist is treating a client with rheumatoid arthritis. Which assessment finding in the client does the nurse share with the occupational therapist? a. Difficulty sleeping because of pain in the knees and elbows b. Difficulty tying shoelaces and doing zip-pers on clothing c. Swollen knees with crepitus and limited range of motion d. Generalized joint stiffness that is worse in the early morning

B The functional assessment helps nurses and therapists measure how functional the client is with activities of daily living, including dressing. The occupational therapist can assist the client to explore clothing options that are easier to manage with arthritic fingers. The other findings would not necessarily need to be shared with the occupational therapist for the treatment plan.

The nurse is evaluating the patient's understanding of his new diagnosis of rheumatoid arthritis. Which statement reflects an understanding of the disease process? a. "My body lacks an appropriate response to invading bacteria." b. "My body produces an immune response to my own cells and tissues." c. "My body immediately produces a protein that is specifically designed to fight off an antigen." d. My body has a delayed response in which lymphocytes attack whole cells like bacteria."

B When a patient has an autoimmune disease such as rheumatoid arthritis, the body produces an immune response to a "self" cell or tissue. Lacking an appropriate response is characteristic of an immune deficiency. Immediate production of a protein (an antibody) to an antigen is a normal humoral immune response. The statement involving the delayed response of lymphocytes is re-ferred to a cell-mediated response.

The nurse is caring for a patient with systemic lupus erythematosus (SLE). The patient complains of severe fatigue, a butterfly rash, and joint pain. Which nursing interventions are most appropriate for this patient? (Select all that apply.) a. Encourage the use of a sun lamp to help with the rash. b. Assess pain control measures that have helped the patient in the past. c. Assist the patient with planning rest pe-riods throughout the day. d. Remind the patient to avoid contact with people who have an infection. e. Ensure the patient understands the impor-tance of her medication regimen.

B, C, D, E Any type of sunlight tends to worsen the rash of patient with SLE and can cause a generalized flare-up of the disease. Pain control measures that have previously been effective should be con-tinued; intense fatigue is a common problem with SLE, so planned rest periods are necessary; infections often exacerbate the disease, so it is important to decrease the chance of the patient with SLE from being exposed to others with infections; and the medication regimen for the SLE patient should be maintained in order to prevent flare-ups of the disease or other body systems from being affected by SLE.

As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest a. daily vigorous aerobic exercise followed by a warm shower or bath. b. minimal exercise several times daily, followed by rest periods. c. regular daily, low-impact exercise program. d. strength-building exercises with weights or resistance.

C All clients benefit from a careful balance of rest and activity. Low-impact aerobic exercise, such as walking, does not cause further harm to damaged joints.

Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis, for which she is given antiinflammatory medication. To assess her right knee pain, you should ask her if: a. the current pain is similar to previous pain. b. the left knee hurts as well. c. she took pain medication last night. d. the pain gets better when she sits.

C It is most appropriate to ask a present tense evaluation question, such as whether the patient took her pain medication; the question should be simply worded, without the addition of multiple fac-tors to consider. You should refrain from asking older patients to compare past with present symptoms because recollection may be uncertain and recollection of past pain is sometimes not readily achieved. Systematic evaluation of the right knee should be completed before any addi-tional symptoms are evaluated. Knowing that the pain gets better when she sits does not help as-sess the right knee pain.

A client with diagnosed osteoarthritis comes to the clinic reporting a low-grade fever, fatigue, and bilateral joint pain. What action by the nurse is most appropriate? a. Assess the client for a systemic infection. b. Discuss increasing the dose of an-ti-arthritis drugs. c. Prepare the client for a laboratory draw for rheumatoid factor. d. Teach the client joint protection activities.

C Osteoarthritis is generally a unilateral disease. The manifestations that this client exhibits are more consistent with rheumatoid arthritis, so the nurse will prepare the client for a blood draw. The nurse may need to teach joint protection measures, but an accurate diagnosis is most important.

The nurse caring for a client with systemic lupus erythematosus (SLE) should warn the client that the factor most likely to cause an exacerbation of this disorder is a. a diet high in saturated fats. b. changes in temperature. c. exposure to the sun. d. ingestion of aspirin.

C Sunlight may trigger local dermatitis or more severe manifestations of the disease. The other 3 options are not related to lupus exacerbations.

The nurse is caring for a client who has a history of severe rheumatoid arthritis. The client becomes combative and abusive to the staff when she is unable to perform personal care inde-pendently. What is the best statement the nurse can make to the client at this time? a. "I will have to restrain your hands if you cannot keep them to yourself." b. "I will ask your doctor for a psychiatrist to talk to you about anger management." c. "You seem frustrated. Would you like to try to dress again in a few minutes?" d. "Would you like me to get an order for medication to help you settle down?"

C The client is acting out her frustration over her chronic illness and loss of use of her hands. The nurse should acknowledge this frustration. Allowing the client to make decisions regarding care will help the client regain some sense of control and will help improve self-esteem. Requesting sedation, suggesting psychiatric therapy, or threatening use of restraints is not appropriate, be-cause the client is expressing frustration over the situation.

The nurse caring for a client with systemic lupus erythematosus (SLE) provides teaching about measures to avoid fatigue. The nurse recognizes that the client needs additional teaching if the client states he or she should: a. Avoid long periods of rest. b. Perform activities sitting whenever possible. c. Take a hot shower. d. Engage in low-impact exercise when well rested.

C To help reduce fatigue in the client with SLE, the nurse should instruct the client to sit whenever possible, to avoid hot baths, to schedule moderate low-impact exercises when not fatigued, and to maintain a balanced diet. The client is instructed not to rest for long periods, because it promotes joint stiffness.

A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included? A) If the client experiences nausea, omit the dose. B) The client should be alert for joint aches. C) This medication is commonly used for many inflammatory reactions and is relatively safe. D) Be alert for signs and symptoms of infection and report them immediately to the physician.

D Feedback: Instruct the client about signs and symptoms of and the increased risk for infection. Instruct the client to report signs and symptoms of infection immediately to the physician. Early treatment promotes a shorter duration of illness and reduced complication. Tell the client to avoid high-risk activities, such as being in crowds, during periods of immunosuppression. The client should not omit a dose if nausea is experienced; he may take the medication with food. There are many side effects and required laboratory work to detect the side effects from immunosuppressive therapy. Joint aches are vague symptoms and are not a priority for reporting purposes.

The nurse is teaching a client who has osteoarthritis ways to slow progression of the disease. Which statement indicates that the client understands the nurse's instruction? a. "I will eat more vegetables and less meat." b. "I will avoid exercising to minimize wear on my joints." c. "I will take calcium with vitamin D every day." d. "I will start swimming twice a week."

D Swimming is an excellent form of exercise for clients with arthritis because it involves minimal weight bearing and stress on the joints from gravity. Eating more vegetables will not decrease the progression of osteoarthritis. Taking calcium with vitamin D will decrease the risk of osteoporo-sis, not osteoarthritis. Gentle exercise is important to help slow progression of the disease.

A nurse is discussing the symptomology of osteoarthritis (OA) with a client. The nurse shows an understanding of the disease process when identifying which of the following as an initial symptom of the disease? 1. Painful stiffness in the joints of the fingers 2. Popping sensation felt in the wrist joint when typing 3. Knee pain when leg is at rest 4. A fine red rash on the elbow that is constant

Painful stiffness in the joints of the fingers Rationale: The onset of osteoarthritis (OA) is gradual and progressive. The symptoms that are noticed first are pain and stiffness in the affected joint or joints. Crepitus (grating, crackling, or popping sounds experienced at a joint) and pain at rest are late signs of OA in a joint. A red rash is not a typical indicator of OA.