CH 38 Assessment and Management of Patients with Rheumatic Disorders (E4)
A nurse is discussing gout with a client who is concerned about developing the disorder. Which of the following findings should the nurse identify as risk factors for this disease? SELECT ALL THAT APPLY. A) Diuretic use B) Obesity C) Deep sleep deprivation D) Depression E) Cardiovascular disease
A, B, E
A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patient's care, what goal should the nurse include? A) The patient will express satisfaction with her ability to perform ADLs. B) The patient will recover from OA within 6 months. C) The patient will adhere to the prescribed plan of care. D) The patient will deny signs or symptoms of OA.
A
A nurse is providing information to a client newly diagnosed with rheumatoid arthritis (RA). Which of the following statements by the nurse is appropriate? A) "You may experience morning stiffness when you get out bed." B) "You may experience abdominal pain." C) "You may experience weight gain." D) "You may experience low blood sugar."
A
A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? A) I have this ringing in my ears that just won't go away. B) I feel so foggy in the mornings and it takes me so long to wake up. C) When I eat a meal that's high in fat, I get really nauseous. D) I seem to have lost my appetite, which is unusual for me.
A
A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia
A
A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A) OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. B) OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees. C) OA originates with an infection. RA is a result of your body's cells attacking one another. D) OA is associated with impaired immune function; RA is a consequence of physical damage.
A
A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? A) Fatigue Related to Anemia B) Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism C) Acute Confusion Related to Increased Serum Ammonia Levels D) Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit
A
A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses anger and irritation when her call bell isn't answered immediately. What would be the most appropriate response? A) "You seem like you're feeling angry. Is that something that we could talk about?" B) "Try to remember that stress can 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."
A
A patient's decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? A) Rheumatoid arthritis (RA) B) Systemic lupus erythematosus C) Osteoporosis D) Polymyositis
A
Chronic inflammatory disease of the spine; Rigid, decreasing mobility and leading to kyphosis. A) Ankylosing Spondylitis B) Psoriatic Arthritis
A
Chronic, systemic, inflammation of connective tissue in synovial joints. A) Rheumatoid arthritis B) Systemic Lupus Erythematosus (SLE) C) Sjogren's Syndrome D) Scleroderma
A
Complex process resulting in pannus. A) Inflammation B) Autoimmunity C) Degeneration
A
Gout: Hereditary error of purine metabolism leads to overproduction or retention of uric acid. A) Primary B) Secondary
A
Osteoarthritis A) Localized B) Systemic
A
Rheumatoid arthritis A) Symmetrical B) Asymmetrical
A
T/F: The cause of diffuse connective tissue diseases is unknown. A) True B) False
A
The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? A) Raynaud's phenomenon B) Thyroid dysfunction C) Esophageal varices D) Osteopenia
A
Osteoarthritis A) Symmetrical B) Asymmetrical
B
A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? SELECT ALL THAT APPLY. A) Recent influenza B) Decreased range of motion C) Hypersalivation D) Increased blood pressure E) Pain at rest A nurse is providing information to a client newly diagnosed with rheumatoid arthritis (RA). Which of the following statements by the nurse is appropriate? A) "You may experience morning stiffness when you get out bed." B) "You may experience abdominal pain." C) "You may experience weight gain." D) "You may experience low blood sugar." The client can experience stiffness in her joints upon rising. This is an appropriate statement for the nurse to give. The client who has RA may experience pleuritic pain (upon inspiration). The client who has RA may experience weight loss. The client who has RA does not experience a low blood sugar.
A, B, E
A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate ? SELECT ALL THAT APPLY. A) Positive ANA tier B) Increased hemoglobin C) 2+ urine protein D) Increased serum C3 and C4 E) Elevated BUN
A, C, E
Rheumatoid arthritis A) Localized B) Systemic
B
What are the clinical manifestations of rheumatic disease? A) Pain B) Limited movement C) Joint swelling D) Stiffness E) Weakness F) Fatigue G) All of the above
G
A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient? A) Referral for assistive devices B) Teaching about symptom management C) Referral to classes to stop smoking D) Setting up an exercise program
B
A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? A) The patient has a 30 pack-year smoking history. B) The patient's body mass index is 34 (obese). C) The patient has primary hypertension. D) The patient is 58 years old.
B
A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following clinical findings should the nurse anticipate? A) Swelling of joints of the fingers B) Pallor of toes with cold exposure C) Feet become reddened with ambulation D) Client report of intense feeling of heat in the fingers
B
A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? A) Petechiae B) Butterfly rash C) Jaundice D) Skin sloughing
B
A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect? A) Tinnitus B) Visual changes C) Stomatitis D) Hirsutism
B
A nurse is providing care for a patient who has a rheumatic disorder. The nurse's comprehensive assessment includes the patient's mood, behavior, LOC, and neurologic status. What is this patient's most likely diagnosis? A) Osteoarthritis (OA) B) Systemic lupus erythematosus (SLE) C) Rheumatoid arthritis (RA) D) Gout
B
A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol (Zyloprim) D) Prednisone
B
A patient has just been told by his physician that he has scleroderma. The physician tells the patient that he is going to order some tests to assess for systemic involvement. The nurse knows that priority systems to be assessed include what? A) Hepatic B) Gastrointestinal C) Genitourinary D) Neurologic
B
A patient with polymyositisis experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action? A) Initiate a program of passive range of motion exercises B) Facilitate referrals to occupational and physical therapy C) Administer skeletal muscle relaxants as ordered D) Encourage a progressive program of weight-bearing exercise
B
A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? A) Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy
B
A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize? A) Take OTC calcium supplements consistently. B) Restrict consumption of foods high in purines. C) Ensure fluid intake of at least 4 liters per day. D) Restrict weight-bearing on right foot.
B
Body recognizes own tissue as foreign. A) Inflammation B) Autoimmunity C) Degeneration
B
Gout: Related to another acquired disorder; Result of drugs that inhibit uric acid secretion, chemotherapy drugs that increase the rate of cell death, thiazide diuretics, and postmenopausal women. A) Primary B) Secondary
B
A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? SELECT ALL THAT APPLY.. A) Erythrocyte count B) Erythrocyte sedimentation rate C) Creatinine clearance D) C-reactive protein E) D-dimer
B, D
A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? SELECT ALL THAT APPLY. A) Urinalysis B) Erythrocyte sedimentation rate (ESR) C) BUN D) Antinuclear antibody (ANA) titer E) WBC count
B, D, E
A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patient's adherence to her medication regimen? A) Encourage the patient to store the bottles with their tops removed. B) Have a trusted family member take over the management of the patient's medication regimen. C) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. D) Have the patient approach her primary care provider to explore medication alternatives.
C
A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? A) Autoimmune processes in the joints B) Chronic metabolic acidosis C) Increased uric acid levels D) Unstable serum calcium levels
C
A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A) Ensuring adequate rest B) Limiting exposure to sunlight C) Limiting intake of alcohol D) Smoking cessation
C
A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A) Cool joints with decreased range of motion B) Signs of systemic infection C) Joint stiffness, especially in the morning D) Visible atrophy of the knee and shoulder joints
C
A nurse is providing teaching about self-care to a client who has SLE. Which of the following statements by the client indicates a need for further teaching? A) "I should limit my time to 10 minutes in the tanning bed." B) "I will apply powder to any skin rash." C) "I should use a mild hair shampoo." D) "I will inspect my skin once a month for rashes."
C
A patient with SLE asks the nurse why she has to come to the office so often for "check-ups." What would be the nurse's best response? A) Taking care of you in the best way involves seeing you face to face. B) Taking care of you in the best way involves making sure you are taking your medication the way it is ordered. C) Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. D)Taking care of you in the best way involves drawing blood work every month.
C
A patient with SLE has come to the clinic for a routine check-up. When auscultating the patient's apical heart rate, the nurse notes the presence of a distinct "scratching" sound. What is the nurse's most appropriate action? A) Reposition the patient and auscultate posteriorly. B) Document the presence of S3 and monitor the patient closely. C) Inform the primary care provider that a friction rub may be present. D) Inform the primary care provider that the patient may have pneumonia.
C
A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. Which of the following is the most appropriate action? A) Arrange a family meeting in order to explore assisted living options. B) Refer the patient to a support group. C) Arrange for the patient to be assessed in her home environment. D) Refer the patient to social work.
C
A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? A) I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels. B) I'll try to be as physically active as possible between flare-ups. C) I'll make sure to monitor my body temperature on a regular basis. D) I'll stop taking my steroids when I get relief from my symptoms.
C
Secondary process to inflammation. A) Inflammation B) Autoimmunity C) Degenerative
C
Systemic, autoimmune; Progressively affects lacrimal and salivary glands. A) Rheumatoid arthritis B) Systemic Lupus Erythematosus (SLE) C) Sjogren's Syndrome D) Scleroderma
C
A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? SELECT ALL THAT APPLY. A) Surgical treatment options B) The importance of weight loss C) Managing Raynaud's-type symptoms D) Smoking cessation E) The importance of vigilant skin care
C, D, E
A 40-year-old woman was diagnosed with Raynaud's phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem? A) Giant cell arteritis (GCA) B) Fibromyalgia (FM) C) Rheumatoid arthritis (RA) D) Scleroderma
D
A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patient's health should the nurse focus most closely during the visit? A) The patient's understanding of rheumatoid arthritis B) The patient's risk for cardiopulmonary complications C) The patient's social support system D) The patient's functional status
D
A nurse is admitting a client who has suspected SLE. Which of the following clinical findings supports this diagnosis? A) Weight gain B) Petechiae on thighs C) Systolic murmur D) Alopecia
D
A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurse's response to the patient? A) New evidence shows CAM to be as effective as medical treatment. B) CAM therapies negate many of the benefits of medications. C) CAM therapies typically do more harm than good. D) Evidence shows minimal benefits from most CAM therapies.
D
A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize? A) Assessment for subtle signs of bleeding disorders B) Assessment of the metatarsal joints and phalangeal joints C) Assessment for thoracic pain that is exacerbated by activity D) Assessment for headaches and jaw pain
D
A nurse's plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals? A) Maximize range of motion while minimizing exertion B) Increase joint size and strength C) Limit energy output in order to preserve strength for healing D) Preserve and increase range of motion while limiting joint stress
D
A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse emphasize the need for continued adherence to the prescribed medication? A) To avoid complications such as venous thromboembolism B) To avoid the progression to osteoporosis C) To avoid the progression of GCA to degenerative joint disease D) To avoid complications such as blindness
D
A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? A) Angiography B) Myelography C) Paracentesis D) Arthocentesis
D
A patient's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patient's drug regimen. What principle will guide this aspect of the patient's treatment? A) The patient will need daily blood testing for the duration of treatment. B) The patient must stop all other drugs 72 hours before starting prednisone. C) The drug should be used at the highest dose the patient can tolerate. D) The drug should be used for as short a time as possible.
D
What are some problems caused by rheumatic diseases? A) Limitations in mobility and ADLs B) Pain and fatigue C) Altered self-image D) Sleep disturbances E) Systemic effects F) All of the above
F
What are the systemic effects in diffuse connective disease? A) Fever B) Fatigue C) Anemia D) Lymph node enlargement E) Skin and mucosal manifestations F) All of the above
F
Inflammatory arthritis associated with psoriasis. A) Ankylosing Spondylitis B) Psoriatic Arthritis
B
Inflammatory, autoimmune; Immune system does not recognize cell components, sees it as an antigen; Develops antibodies and destroys host cell. A) Rheumatoid arthritis B) Systemic Lupus Erythematosus (SLE) C) Sjogren's Syndrome D) Scleroderma
B
Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? A) Hyperuricemia B) Increased erythrocyte sedimentation rate C) Elevated serum creatinine D) Decreased platelets
D
Autoimmune affecting connective tissue of the skin, blood vessels walls and internal organs. A) Rheumatoid arthritis B) Systemic Lupus Erythematosus (SLE) C) Sjogren's Syndrome D) Scleroderma
D
