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

A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client? "Don't go if your joints are inflamed." "Be sure to wear nonslip footwear for safety." "Have someone check your blood pressure before exercising." "That's not the best activity for misaligned joints."

"Be sure to wear nonslip footwear for safety."

An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client?

"Look at the cane as maintaining your independence."

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

Encourage weight loss and an increase in aerobic activity

The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis? Clients will have an ulnar deviation. Clients may develop Heberden nodes. Clients will develop boutonniere deformity. Clients may have swan neck deformity.

Clients may develop Heberden nodes.

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? Methotrexate Celecoxib Mercaptopurine azathioprine Methylprednisolone

Methotrexate

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

Muscle biopsy

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

located over bony prominence

The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan? tai chi running on a treadmill weight lifting jogging

tai chi

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? It's impossible to determine at the time of diagnosis how the disease will progress. The client should discuss this concern with the health care provider. Hand and finger deformities are associated with the development of rheumatoid arthritis. A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities.

Hand and finger deformities are associated with the development of rheumatoid arthritis.

Which joint is most commonly affected in gout? Metatarsophalangeal Tarsal knee cap ankle

Metatarsophalangeal

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? Rheumatoid arthritis Scleroderma Systemic lupus erythematosus Polymyalgia rheumatic

Scleroderma

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? "I have trouble with my balance." "My legs feel weak." "My finger joints are oddly shaped." "I have pain in my hands."

"My finger joints are oddly shaped."

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

"The belief is that it is an autoimmune disorder with an unknown trigger."

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

"Monitor your body temperature."

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? Gallbladder disease Fibromyalgia Ankylosing spondylitis Liver disease

Fibromyalgia

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. Weight loss Avoiding purine-rich foods Decreasing alcohol intake Limiting exercise Restricting the intake of water

Weight loss Decreasing alcohol intake Avoiding purine-rich foods

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? Boney erosions on x-ray Atherosclerotic plaques on an arteriogram Reduced muscle mass on CT scan Evidence of healed fractures on MRI

Boney erosions on x-ray

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

Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout? Elevated white blood count Elevated uric acid levels Decreased hemoglobin and hematocrit Increased AST and ALT

Elevated uric acid levels

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

It is important to monitor for injection site reactions.

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

Systemic lupus erythematosus (SLE)

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

Elevated erythrocyte sedimentation rate

A client arrives at the clinic with reports of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What disorder will the nurse relate the client symptoms to? Gout SLE Arthritis Fibromyalgia

Gout

The nurse is caring for a client with ankylosing spondylitis. Which educational information will the nurse provide to this client? Use of analgesics Use of diuretics Use of cough supressants Use of laxatives

Use of analgesics

Which of the following procedures involves a surgical fusion of the joint? Tenorrhaphy Osteotomy Synovectomy Arthrodesis

Arthrodesis

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? It is suggestive of rheumatoid arthritis. It is diagnostic for Sjögren's syndrome. It is specific for rheumatoid arthritis. It is diagnostic for systemic lupus erythematosus.

It is suggestive of rheumatoid arthritis.

A nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach the about for osteoarthritis? vigorous physical therapy for the joints. administration of nonsteroidal anti-inflammatory drugs (NSAIDs) administration of opioids for pain control. administration of monthly intra-articular injections of corticosteroids.

administration of nonsteroidal anti-inflammatory drugs (NSAIDs)

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

age

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? azathioprine diclofenac cyclophosphamide hydroxychloroquine

hydroxychloroquine

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? Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) Cold therapy An exercise routine that includes range-of-motion (ROM) exercises Acupuncture

An exercise routine that includes range-of-motion (ROM) exercises

A client with rheumatoid arthritis is discharging to home following an exacerbation of joint pain. Which type of referral will be the priority for the client? Physical therapy Social services Home health nurse Occupational therapy

Home health nurse

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? Review the client's medical record. Auscultate the client's lung sounds. Inspect the client's mouth. Observe the client's gait.

Review the client's medical record.

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis?

pain

Osteoarthritis is known as a disease that

is the most common and frequently disabling of joint disorders.

A client seeks medical attention for the development of red scaly lesions over the surface of both knees. Which question will the nurse ask to determine if the client is experiencing polymyositis?

"Have you had a change in the strength of your legs?"

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? allopurinol probenecid colchicine anturane

colchicine

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? eating organ meats and sardines frequently drinking coffee frequently ingesting salicylates high carbohydrate intake

eating organ meats and sardines

Which of the following refers to fixation of a joint? Articulations Synovitis Pannus Ankylosis

Ankylosis

A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? "Try combining the fasting with moderate exercise." "Make sure to eat some fat occasionally with all that exercise." "There might be some difficulties with your plan and fasting." "The fasting is okay, but make sure you drink fluids when exercising."

"There might be some difficulties with your plan and fasting."