Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders

A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis? a) Boney erosions on x-ray b) Reduced muscle mass on CT scan c) Evidence of healed fractures on MRI d) Atherosclerotic plaques on an arteriogram

a

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment? a) Joint pain, crepitus, Heberden's nodes b) Hot, inflamed joints; crepitus; joint pain c) Tophi, enlarged joints, Bouchard's nodes d) Swelling, joint pain, and tenderness on palpation

a

A client is being placed on a purine-restricted diet. What foods will the nurse include in the client's diet plan? a) dairy products b) organ meats c) alcohol d) shellfish

a

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack? a) eating organ meats and sardines b) frequently drinking coffee c) high carbohydrate intake d) frequently ingesting salicylates

a

A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities? a) prone b) semi-Fowler's position c) side-lying with pillows supporting the shoulders and legs d) supine with pillows under the knees

a

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is? a) Sicca syndrome b) Episcleritis c) Glaucoma d) Cataracts

a

A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of? a) organ meats b) citrus fruits c) green vegetables d) fresh fish

a

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again." b) "When it clears up, it will never come back." c) "I'll definitely need surgery for this." d) "It will never get any better than it is right now."

a

Fibromyalgia is a common condition that involves a) chronic fatigue, generalized muscle aching, and stiffness. b) pain, viral infection, and tremors. c) diminished vision, chronic fatigue, and reduced appetite. d) generalized muscle aching, mood swings, and loss of balance.

a

Osteoarthritis is known as a disease that a) is the most common and frequently disabling of joint disorders. b) affects young males. c) requires early treatment because most of the damage seems to occur early in the course of the disease. d) affects the cartilaginous joints of the spine and surrounding tissues.

a

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? a) low back pain b) increased urine output c) red, butterfly-shaped facial rash d) patchy hair loss on the scalp

a

The nurse is assessing a client with rheumatoid arthritis. The nurse knows that prolonged inflammation can cause compression of nerves. Which symptoms would accompany this level of involvement? a) Paresthesias of both hands b) Limited motion in the wrists c) Restricted movement in tendons d) Crepitus when moving major joints

a

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? a) colchicine b) probenecid c) anturane d) allopurinol

a

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? a) joint stiffness that increases with activity b) erythema and edema over the affected joint c) anorexia and weight loss d) fever and malaise

a

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? a) Methotrexate b) Celecoxib c) Methylprednisolone d) Mercaptopurine azathioprine

a

The nurse is gathering objective data for a client at the clinic reporting arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as? a) Swan neck deformity b) Boutonnière deformity c) Ulnar deviation d) Rheumatoid nodules

a

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of a) gout. b) infection. c) inflammation. d) degeneration.

a

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? a) Assess diet and activity at home b) Place client on bed rest c) Increase fluids d) Insert a Foley catheter

a

Which joint is most commonly affected in gout? a) Metatarsophalangeal b) Tarsal area c) Ankle d) Knee

a

Which of the following disorders is characterized by an increased autoantibody production? a) Systemic lupus erythematosus (SLE) b) Scleroderma c) Rheumatoid arthritis (RA) d) Polymyalgia rheumatic

a

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a) Limited passive movement b) Joint enlargement c) Joint instability d) Limb shortening

a

Which of the following refers to fixation of a joint? a) Ankylosis b) Synovitis c) Pannus d) Articulations

a

The nurse is planning care in the home for a client with rheumatoid arthritis. What instruction(s) should the nurseinclude in the plan of care? Select all that apply. a) Collaborate with occupational therapists for specialized equipment. b) Identify the exercise regimen planned by physical therapist. c) Provide nursing assistance for ADLs. d) Teach the nursing assistant to allow extra time in the evening for hygiene or other procedures. e) Ensure the home environment is safe.

a, b, c, e

A client taking medication for rheumatoid arthritis (RA) for several years is experiencing significant ongoing pain in the knees. Which surgical procedures will the nurse expect the client to consider to preserve joint function? Select all that apply. a) Arthrodesis b) Arthroscopy c) Tenorrhaphy d) Synovectomy e) Joint replacement

a, c, d, e

A client with polymyositis rheumatica has been taking corticosteroids for an extended period of time. Which information will the nurse instruct the client with to prevent the development of osteoporosis? Select all that apply. a) "Remember to limit your intake of alcohol." b) "Swimming would be the best exercise for you to do." c) "Perform weight-bearing exercises several times a week." d) "Increase your intake of foods that contain calcium and vitamin D." e) "Smoking cessation classes are held every week at the community center."

a, c, d, e

The nurse is performing an admission interview for a client with rheumatoid arthritis. Which finding will the nurse document as abnormal for this client? Select all that apply. a) Pain b) Nausea c) Stiffness d) Weakness e) Joint swelling

a, c, d, e

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. a) Safe exercise b) Narcotic safety c) Medication dosages and side effects d) Dressing changes e) Assistive devices

a, c, e

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) a) Decreased ventilation owing to lung scarring b) Dysphagia owing to hardening of the esophagus c) Dyspnea owing to fibrotic cardiac tissue d) Productive cough e) Butterfly-shaped rash on the face

a,, b, c

A client comes to the clinic and reports pain in the right great toe which is worse at night. Assessment reveals tophi. What does the nurse suspect? a) osteoarthritis b) gouty arthritis c) rheumatoid arthritis d) reactive arthritis

b

A client cringes in pain when the nurse places the stethoscope over the upper back to assess breath sounds. On which condition will the nurse focus when assessing this client? a) Liver disease b) Fibromyalgia c) Gallbladder disease d) Ankylosing spondylitis

b

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? a) Acupuncture b) An exercise routine that includes range-of-motion (ROM) exercises c) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) d) Cold therapy

b

A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease? a) Observe the client's gait. b) Review the client's medical record. c) Inspect the client's mouth. d) Auscultate the client's lung sounds.

b

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes b) Administering ordered analgesics and monitoring their effects c) Performing meticulous skin care d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

b

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? a) ibuprofen b) celecoxib c) methotrexate d) sulfasalazine

b

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? a) "My legs feel weak." b) "My finger joints are oddly shaped." c) "I have pain in my hands." d) "I have trouble with my balance."

b

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? a) congenital deformity b) age c) trauma d) obesity

b

The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse? a) The fluid will be clear and pale. b) The fluid will be milky, cloudy, and dark yellow. c) The amount of fluid will be scant in volume. d) The fluid will be straw colored.

b

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? a) Ibuprofen b) Celecoxib c) Piroxicam d) Tolmetin sodium

b

The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? a) Clients may have swan neck deformity. b) Clients may develop Heberden nodes. c) Clients will develop boutonniere deformity. d) Clients will have an ulnar deviation.

b

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? a) detection of systemic complications b) strategies for remaining active c) disease-modifying antirheumatic drug therapy d) prevention of joint deformity

b

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? a) "This disorder is more common in men in their thirties and forties than in women." b) "The belief is that it is an autoimmune disorder with an unknown trigger." c) "SLE has very specific manifestations that make diagnosis relatively easy." d) "The symptoms are primarily localized to the skin but may involve the joints."

b

Which finding is consistent with the diagnosis of rheumatoid arthritis? a) Decreased ESR b) Cloudy synovial fluid c) Increased red blood cell count d) Increased C4 complement component

b

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? a) Provide an analgesic after exercise b) Encourage weight loss and an increase in aerobic activity c) Assess for gastrointestinal complications associated with COX-2 inhibitors d) Avoid the use of topical analgesics

b

The nurse is providing education for a client with a new diagnosis of rheumatoid arthritis (RA). Which statement will the nurse include in the discussion with the client? Select all that apply. a) "A rash of the joints is common with rheumatoid arthritis." b) "Swelling of the joints will occur, causing pain." c) "You can expected warmth in your joints." d) "Redness can occur in the skin at the joints." e) "A symptom of RA will be joint pain on both sides."

b, c, d, e

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about? a) azathioprine b) diclofenac c) hydroxychloroquine d) cyclophosphamide

c

A clinic nurse is caring for a client diagnosed with rheumatoid arthritis (RA). The client 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 client's adherence to her medication regimen? a) Encourage the client to store the bottles with their tops removed. b) Have a trusted family member take over the management of the client's medication regimen. c) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. d) Have the client approach her primary provider to explore medication alternatives.

c

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "There are no activity limitations between flare-ups." c) "Monitor your body temperature." d) "Corticosteroids may be stopped when symptoms are relieved."

c

The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? a) Remission b) Exacerbation c) Inflammation d) Autoimmunity

c

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? a) Scleroderma b) Fibromyalgia c) Rheumatoid arthritis d) Systemic lupus erythematosus

c

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care? a) ability to perform activities of daily living (ADL) b) decreased joint pain c) increased fatigue d) a weight gain of 2 pounds

c

The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the mostcommon finding associated with fibromyalgia? a) Heberden nodes b) jaw locking c) widespread chronic pain d) butterfly facial rash

c

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? a) Increased red blood cell count b) Increased C4 complement c) Elevated erythrocyte sedimentation rate d) Increased albumin levels

c

The nurse notes that a client is being treated for fibromyalgia. For which additional rheumatic conditions will the nurse analyze the client's health history? Select all that apply. a) Ostearthritis b) Psoriatic arthritis c) Rheumatoid arthritis d) Ankylosing spondylitis e) Systemic lupus erythematosus

c, d, e

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? a) tender to the touch b) reddened c) nonmovable d) located over bony prominence

d

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result? a) It is diagnostic for Sjögren's syndrome. b) It is diagnostic for systemic lupus erythematosus. c) It is specific for rheumatoid arthritis. d) It is suggestive of rheumatoid arthritis.

d

A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? a) Heart disease b) Vascular diseases c) Metabolic disorders d) Autoimmune disorders

d

A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response? a) A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. b) It's impossible to determine at the time of diagnosis how the disease will progress. c) The client should discuss this concern with the health care provider. d) Hand and finger deformities are associated with the development of rheumatoid arthritis.

d

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate? a) Keep shifting weight from one foot to the other. b) Perform aerobic exercises. c) Maintain complete bed rest. d) Maintain good posture.

d

A client with fibromyalgia asks why physical therapy has been prescribed. Which response will the nurse make? a) "It will take your mind off your health problem." b) "I will ask the health care provider it if is necessary." c) "It is used instead of prescribing medications for the condition." d) "It will help with the overall deconditioning that has occurred."

d

A client with systemic lupus erythematosus is prescribed belimumab. For which reason will the nurse question giving the client this medication? a) Report of constipation b) Discoid rash present over the face c) Bilateral knee joint swelling is present d) Received a live vaccination a week ago

d

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a) Bone scan b) Computed tomography (CT) c) Magnetic resonance imaging (MRI) d) Muscle biopsy

d

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach? a) "Does exercise usually work for you?" b) "Why do you think the exercise didn't work?" c) "Do you think you are too old to exercise?" d) "What types of exercise were you doing?"

d

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia a) all have the same type of symptoms. b) rarely respond to treatment. c) will eventually lose their ability to walk. d) may feel as if their symptoms are not taken seriously.

d

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? a) Antibiotics b) Anticoagulants c) Oral corticosteroids d) Nonsteroidal anti-inflammatory drugs (NSAIDs)

d

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? a) small joint involvement b) joint pain that increases with rest c) subcutaneous nodules d) early morning stiffness

d

Which points should be included in the medication teaching plan for a client taking adalimumab? a) The medication is administered intramuscularly. b) The client should continue taking the medication if fever occurs. c) The medication is given at room temperature. d) It is important to monitor for injection site reactions.

d

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Subchondral bone b) Pannus c) Joint effusion d) Tophi

d

During a home visit, the nurse notes that a client with polymyositis has difficulty combing the hair and putting on socks and shoes. Which referrals will the nurse recommend for this client? Select all that apply. a) Hospice b) Pastoral care c) Social services d) Physical therapy e) Occupational therapy

d, e