Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders
Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding?
Decreased platelets
A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug?
"I have this ringing in my ears that just won't go away."
A nurse is providing care for a client who has a recent diagnosis of giant cell arteritis (GCA). Which aspect of physical assessment should the nurse prioritize?
Headaches and jaw pain
A client with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the client appears to have lost some ability to function since the last office visit. What is the nurse's most appropriate action?
Arrange for the client to be assessed in the home environment.
A client with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on a medical unit. The nurse observes that the client expresses anger and irritation when the call bell isn't answered immediately. Which response would be the most appropriate?
You seem like you're feeling angry. Is that something that we could talk about?"
A nurse is performing the initial assessment of a client who has a recent diagnosis of systemic lupus erythematosus (SLE). Which skin manifestation would the nurse expect to observe on inspection?
Erythematous rash
A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement?
"I'll make sure to monitor my body temperature on a regular basis."
A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?
"OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
A client has a diagnosis of rheumatoid arthritis, and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address which potential adverse effect?
Bone marrow suppression
A 68-year-old client with a history of rheumatic disease has persistent swelling, no stiffness, and full range of motion to his left knee after an injury sustained several months ago. X-rays reveal no fracture of the extremity. Which factor is the most likely cause of the client's continued swelling?
An inflammation process
A client is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this client is that the client will stop taking the medication as soon as the client starts to feel better. The nurse must emphasize the need for continued adherence to the prescribed medication so that the client can avoid which complication?
Blindness
A nurse is caring for a client who is suspected of having giant cell arteritis (GCA). Which laboratory tests are most useful in diagnosing this rheumatic disorder?
Erythrocyte sedimentation rate C-reactive protein
A client with polymyositis is experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action?
Facilitate referrals to occupational and physical therapy
A clinic nurse is caring for a client newly diagnosed with fibromyalgia. When developing a care plan for this client, which nursing diagnosis should the nurse prioritize?
Fatigue related to pain
A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On which aspect of the client's health should the nurse focus most closely during the visit?
Functional status
A client who was just diagnosed with scleroderma will be undergoing tests to assess for systemic involvement. Which system should the nurse prioritize in assessment?
Gastrointestinal
A clinic nurse is caring for a client with suspected gout. While describing the pathophysiology of gout to the client, what should the nurse explain?
Increased uric acid levels
A client with a documented history of allergies presents to the clinic. The client reports being frustrated by chronic nasal congestion, anosmia (inability to smell), and inability to concentrate. The nurse should identify which nursing diagnosis?
Ineffective individual coping with chronicity of condition
A nurse is planning the care of a client who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. Which nursing diagnosis is most likely to apply to this client's care needs?
Ineffective role performance related to pain
A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA?
Joint stiffness lasting longer than 1 hour, especially in the morning
A nurse is educating a client with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make?
Limiting intake of alcohol
A nurse is creating a teaching plan for a client who has a recent diagnosis of scleroderma. Which topics should the nurse address during health education?
Management of Raynaud-type symptoms Exercise Skin care
A nurse is providing care for a client who has just been diagnosed with early-stage rheumatoid arthritis (RA). The nurse should anticipate the administration of which medication?
Methotrexate
A client with systemic lupus erythematosus (SLE) asks the nurse why the client has to come to the office so often for "check-ups." Which rationale for frequent office visits would be best for the nurse to mention?
Monitoring the disease process and how well the prescribed treatment is working
A nurse is assessing a client with rheumatoid arthritis. The client expresses the intent to pursue complementary and alternative medicine (CAM) therapies. Which fact should underlie the nurse's response to the client?
Most CAM therapies lack sufficient evidence to support them.
A client has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of which aspects of PMR?
PMR has an association with the genetic marker HLA-DR4. Immunoglobulin deposits occur in PMR. PMR occurs predominately in Caucasians.
A client with a history of arthritis is being discharged to home after right wrist surgery, and the nurse reviews nonopioid pain relief measures. Which intervention(s) would best address the needs of this client?
Paraffin bath Nonsteroidal anti-inflammatory drugs (NSAIDs) Splint or brace
A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize?
Preserve or increase range of motion while limiting joint stress.
The nurse is preparing to care for a client who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which condition is a component of CREST syndrome?
Raynaud phenomenon
A client with rheumatoid arthritis comes to the clinic reporting pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this client, what management technique should the nurse emphasize?
Restrict consumption of foods high in purines.
A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with which health problem?
Rheumatoid arthritis (RA)
A 40-year-old woman was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The client 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?
Scleroderma
A nurse is providing care for a client who has a rheumatic disorder. The nurse's focused assessment includes the client's mood, behavior, level of consciousness, and neurologic status. Which diagnosis is most likely for this client?
Systemic lupus erythematosus (SLE)
A client has just been diagnosed with a spondyloarthropathy. Which nursing intervention should the nurse prioritize?
Teaching about symptom management
A client's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary provider has added prednisone to the client's drug regimen. What principle will guide this aspect of the client's treatment?
The drug should be used for as short a time as possible.
A nurse is planning client education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect?
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