Ch. 18 Connective Tissue Diseases

Which medication treats chronic gout?

Allopurinol

Which drug is an interleukin-1 (IL-1) receptor antagonist?

Anakinra

enlarged popliteal bursae behind the knee

Baker's cysts

he presence of rheumatoid nodules in the lungs.

Caplan's syndrome

leukopenia and hepatosplenomegaly

Fetty's syndrome

Which biologic is approved for administration once a month for patients with rheumatoid arthritis and psoriatic arthritis?

Golimumab

Which drug may help slow the progression of systemic sclerosis?

Imatinib

Autosomal dominant disorder resulting from mutations in the fibrillin I gene (FBNI) characterized by symptoms such as scoliosis and excessive height with elongated hands and feet

Maran syndrome

What medication causes transient lupus-like syndrome?

Procainamide

he presence of HLA- B27 antigen is indicative of

Reiter's syndrome

polyarthritis occurs in most patients with

SLE

autoimmune destruction of minor salivary glands and lacrimal glands

Sjogren's syndrome

characteristic triad of dryness in the mouth, vagina, and eyes

Sjogren's syndrome

What is the drug of choice to treat fibromyalgia syndrome (FMS) in a 72-year-old patient with memory impairment?

Trazodone

most potential life threatening complication after THA is

VTE

Which instructions for joint protection does the nurse recommend for a client with a connective tissue disease? Select all that apply. a. Use long-handled devices such as a reacher. b. When getting out of bed, use fingers to push off. c. Sit in a low back chair. d. Bend at the waist while keeping the back straight. e. Use adaptive devices such as Velcro closures. f. Turn a doorknob clockwise.

a and e

Which assessment findings will the nurse expect for the client with late-stage rheumatoid arthritis? (Select all that apply.) a. Bony nodes in finger joints b. Subcutaneous nodules c. Severe weight loss d. Joint deformity e. Thrombocytosis

a, b, c, d, and e

The health care provider prescribes acetaminophen for a client with osteoarthritis. What health teaching will the nurse provide for this client regarding this drug? (Select all that apply.) a. "Don't take more than 3000-4000 mg of this drug each day." b. "Stop taking the drug if unusual bleeding occurs and call your health care provider." c. "Tell your health care provider if you notice any yellowing of your skin or eyes." d. "Expect fluid accumulation in your legs and feet that usually gets worse during the day." e. "Check over-the-counter drugs to see if they contain acetaminophen."

a, c, and e

A client had a left anterior total hip arthroplasty 2 days ago. Which precautions will the nurse teach the client to prevent surgical complications? (Select all that apply.) a. "Avoid extending your left hip behind you when you sit." b. "Do not flex your hips more than 90 degrees when toileting." c. "You may cross your legs to be more comfortable in a chair." d. "Avoid twisting your body when moving or performing ADLs." e. "Stand on your right leg and pivot into the chair when getting out of bed."

a, d, and e

The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed? a. "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease." b. "It is best to walk in the center of an outside trail." c. "I should wait 4 to 6 weeks after being bitten by a tick to be tested for Lyme disease." d. "I'll wear light-colored clothes with long sleeves, long pants, closed shoes, and a hat when I am walking in the woods."

a. "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease."

A nursing assistant (NA) is assigned to care for a client who had a cemented total knee arthroplasty. Which statement by the NA indicates a need for further teaching and supervision by the nurse? a. "I'll keep an abduction pillow in place at all times." b. "I'll tell the client not to place a pillow under the surgical knee." c. "I'll apply ice packs to decrease swelling in the knee as ordered." d. "I'll check to make sure the client's leg is not rotated."

a. "I'll keep an abduction pillow in place at all times."

The nurse assesses a client diagnosed with Sjögren's syndrome. The nurse anticipates that the client will also have which common condition? a. Dry eyes b. Abdominal bloating after eating c. Excessive production of saliva in the mouth d. Intermittent episodes of diarrhea

a. Dry eyes

Before administering low-molecular-weight heparin (LMWH) to an older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3 (50 x 109/L). What action is most important for the nurse to take? a. Notify the health care provider of the platelet count. b. Administer the prescribed LMWH on schedule. c. Assess the activated partial thromboplastin time (aPTT). d.Assess the international normalized ratio (INR).

a. Notify the health care provider of the platelet count.

an oral retinoid given for patients with severe psoriatic arthritis

acritretin

inflammation of one or more joints

arthritis

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? a. "I do not know how long my wife will be able to take care of me at home." b. "The bus is coming to pick me up from the senior center three times a week so I can play cards." c. "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." d. "I do not know how much longer my neighbor can continue to help clean my house."

b. "The bus is coming to pick me up from the senior center three times a week so I can play cards."

In teaching a client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include? a. "Limit your intake of fruits and vegetables." b. "Weight Watchers has healthy meal plans." c. "Limit fluid intake to 1500 mL/day." d. "Discuss with your health care provider about having your estrogen and progesterone levels checked to see where you are in menopause."

b. "Weight Watchers has healthy meal plans."

Before administering prednisone IV push to a middle-aged adult with rheumatoid arthritis (RA), the nurse notes that the client's random blood glucose level is 139 mg/dl (7.7 mmol/L). Which action is most important for the nurse to take? a. Instruct the client to drink diet soda to prevent elevation of blood sugar. b. Administer the prescribed prednisone on schedule. c. Notify the health care provider of the random blood glucose result. d. Review the client's antinuclear antibody (ANA) level.

b. Administer the prescribed prednisone on schedule.

Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? a. Feeling tired and having a temperature that runs about 100° F during the day b. Disfiguring and embarrassing rash c. Peripheral neuropathies and cranial nerve palsies d. High risk for renal inflammation

b. Disfiguring and embarrassing rash

Which element is a risk factor for osteoarthritis (OA)? a. Thin build b. Obesity c. Nonsmoker d. Male

b. Obesity

A client has symptoms of rheumatoid arthritis (RA). Which laboratory finding indicates to the nurse that the client may have RA? a. Total serum complement, 75 units/mL b. Positive total antinuclear antibody (ANA) c. Erythrocyte sedimentation rate (ESR), 20 mm/hr d. Beta-globulin level, 1.0 g/dL (10 g/L)

b. Positive total antinuclear antibody (ANA)

A client diagnosed with exacerbation of systemic sclerosis (SSc) asks the nurse why a foot board and a bed cradle have been placed on the bed. The nurse explains that they are used for what purpose? a. Inspect skin for lesions or changes b. Promote comfort from Raynaud's phenomenon c. Prevent foot drop and contractures d. Decrease chilling of the extremities

b. Promote comfort from Raynaud's phenomenon

union of the bones of a joint by loss of articular cartilage, resulting in complete immobility

bony ankylosis

bony nodules at the proximal interphalangeal joints

bouchard's nodules

the major skin manifestation of SLE and DLE is a dry, scaly, raised rash on the face

butterfly rash

A client diagnosed with rheumatoid arthritis (RA) is started on methotrexate (Rheumatrex). Which statement made by the client indicates to the nurse that further teaching is needed regarding drug therapy? a. "Drinking alcoholic beverages should be avoided." b. "The health care provider should be notified 3 months before a planned pregnancy." c. "Any side effects of this drug will be mild." d. "I will avoid any live vaccines."

c. "Any side effects of this drug will be mild."

Which statement indicates to the nurse that a client with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms? a. "My Thera-Band really helps me loosen up my arms." b. "The brace on my lower leg is helping me walk better." c. "Focusing on the slow stretching movements and my breathing in tai chi helps me relax." d. "Water aerobic exercises have helped me sleep better."

c. "Focusing on the slow stretching movements and my breathing in tai chi helps me relax."

The nurse is caring for a middle-aged client diagnosed with rheumatoid arthritis. Which client statement requires further assessment for unproductive coping strategies? a. "I'm letting my husband do most of the cooking, but I help plan the menus." b. "Since I started taking etanercept (Enbrel), I can walk up and down the stairs of my home easier." c. "My husband is getting used to having sex only once a month." d. "I worry about what's going to happen to me if my husband cannot take care of me, but he says he'll hire someone if he must."

c. "My husband is getting used to having sex only once a month."

The nurse is preparing to give medications to a group of clients. Which drug is not appropriate to treat the disease with which it is matched? a. Rheumatoid arthritis - leflunomide b. Osteoarthritis - acetaminophen c. Acute gout - allopurinol d. Systemic lupus erythematosus — prednisone

c. Acute gout - allopurinol

An alert client who recently underwent total hip arthroplasty and is on anticoagulants is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver? a. Use an abduction pillow between the legs. b. Keep heels off the bed. c. Avoid using a straight razor. d. Re-orient frequently.

c. Avoid using a straight razor.

Assessment findings reveal that an older adult client with severe osteoarthritis of the left hip can no longer perform activities of daily living (ADLs) and has had several falls in the home over the past month. To which community resource does the nurse refer the client? a. Local senior citizen center b. Citizens for Better Care c. Home health care agency d. Meals on Wheels

c. Home health care agency

Which drug may be administered to a patient undergoing knee arthroplasty to reduce postoperative pain?

capsaicin

involves compression of the median nerve in the wrist

carpal túnel syndrome

collection of the person's own RBC durign surgery whihc is then reinfused directly back to the patient via a closed system

cell saver system

dietary supplement that strengthens cartilage

chondroitin

systemic lupus erythematosus (SLE)

complexes are drawn to glomeruli of kidney resultign in lupus nephritis

a crackling or grating sound usually of bones

crepitus

The nurse is caring for a postoperative client with total joint arthroplasty. What actions does the nurse take to prevent venous thromboembolism (VTE) postoperatively? Select all that apply. a. Massage the legs. b. Keep the legs slightly abducted. c. Use the knee gatch on the bed. d. Apply elastic stockings. e. Administer anticoagulants.

d and e

The nurse is teaching a client about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the client indicates a need for further teaching? a. "RA is inflammatory. OA is degenerative." b. "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." c. "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in clients older than 60 years." d. "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."

d. "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."

The nurse is reviewing the medication history for a client diagnosed with rheumatoid arthritis (RA) who has been ordered to start sulfasalazine (Azulfidine) therapy. The nurse plans to contact the health care provider if the client has which condition? a. Glaucoma b. Hypertension c. Hypothyroidism d. Sulfa allergy

d. Sulfa allergy

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? a. Begin a running program. b. Take up knitting to slow down joint degeneration. c. Eat at least 2 cups (17 ounces) of yogurt per day. d. Wear supportive shoes

d. Wear supportive shoes

Hydroxycholoroquine (Plaquenil)

decreases the absorption of ultraviolet light by the skin and therefore decreases the risk for skin lesions frequent eye exams if on this drug

mild form of lupus chronic disorder, primarily of the skin, characterized by lesions that are covered with scales

discoid lupus erythematosus (DLE)

joint swelling with fluids especially in the knees

effusions

dietary supplement that reduces inflammation

glucosamine

bony nodules at the distal interphalangeal joints

heberden's nodules

Which medication is beneficial in patients with acute gout?

ibuprofen

methotrexate or azathioprine are

immunosuppressive agents given to treat renal or CNS lupus

gel phenomenon

in patients with rheumatoid arthritis, morning stiffness that lasts between 45 minutes and several hours after awakening

vaculitis

inflammation of blood vessels

OA can affect the spine especially the

lumbar region: L3 -4 cervical region: C4-6 (neck)

most common form of arthritis

osteoarthritis

noninflammatory localized disorder progressive deterioration and loss of cartilage and bone in one or more joints

osteoarthritis

bone spurs

osteophytes

burning or tingling sensation

paresthesias

A small brownish spots, mot commonly around the nail bed

periungual lesions

Quadriceps-setting exercises

postoperative leg exercise performed by straightening the legs and pushing the back of the knees into the bed

disease caused by aging and genetic factors

primary osteoarthritis

panocytopenia

reduction in all elements of bone marrow blood cells

collection of RBC from a joint drain over a specific time frame, which then can be reinfused directly back into the patient's systemic circulation

reinfusion system

plasmapheresis

removal of plasma from withdrawn blood by centrifuge

any disease or condition involving the musculoskeletal system

rheumatic disease

systemic, inflammatory disorder a chronic progressive autoimmune disease process that affects primarily the synovial joints

rheumatoid arthritis

disease resulting from obesity, trauma, other joint disease, or joint injury

secondary osteoarthritis

round, moveable, nontender nodules that appear on teh ulnar surface of the arm, fingers, or along the achilles tendon

subcutaneous nodules

a chronic progressive inflammatory connective tissue disorder that can casue major body organ and systems to fail

systemic lupus erythematosus

Which antirheumatic drug acts by inhibiting tyrosine kinase?

tofacitinib