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." "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."

"Be sure to wear nonslip footwear for safety." Appropriate programs of exercise have been shown to decrease pain and improve function in rheumatoid arthritis. Pool exercises provide a buoyant medium for performance of dynamic or aerobic exercise and the water supports movement while warm water provides muscle relaxation. The client should be reminded to wear nonslip footwear for safety and comfort. Range of motion exercises should not be done if the joints are inflamed. Dynamic exercise is not the best for unstable or misaligned joints. Blood pressure should be checked before engaging in isometric exercises.

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." "Everyone will get older at some time." "Invite people over to your home instead." "It must be hard to get older."

"Look at the cane as maintaining your independence." The body image and self-esteem of the older adult with rheumatic disease, combined with underlying depression, may interfere with the use of assistive devices such as canes. The use of adaptive equipment may be viewed by the older adult as evidence of aging rather than as a means of increasing independence. The nurse should focus on the cane as a method to increase independence rather than a sign of approaching old age. Reminding the client of aging are inappropriate responses. Inviting people to visit will not help improve the client's feelings about needing to use a cane for safe ambulation.

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." "Corticosteroids may be stopped when symptoms are relieved." "There are no activity limitations between flare-ups." "Monitor your body temperature."

"Monitor your body temperature." The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

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 belief is that it is an autoimmune disorder with an unknown trigger." "SLE has very specific manifestations that make diagnosis relatively easy." "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." Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate? "The diagnosis won't be based on the findings of a single test but by combining all data found." "You should discuss that matter with your health care provider." "SLE is a very serious systemic disorder." "Tell me more about your concerns about this potential diagnosis."

"The diagnosis won't be based on the findings of a single test but by combining all data found." There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the health care provider, stating that SLE is a serious systemic disorder, and asking the client to express feelings about the potential diagnosis do not answer the client's question.

A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? "The medication you take can affect your bladder." "The test will determine how long you will have the rash." "It is a routine test done on everyone." "The lupus can affect your kidney function."

"The lupus can affect your kidney function." Nephritis as a result of SLE, also referred to as lupus nephritis, occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons. Early detection allows for prompt treatment so that renal damage can be prevented. Serum creatinine levels and urinalysis are used in screening for renal involvement. Urinalysis is not a routine test done on every client. The urinalysis is not being used to determine if the client's medication is affecting the bladder. The urinalysis will not determine the length of time the client will have the rash.

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? "There might be some difficulties with your plan and fasting." "The fasting is okay, but make sure you drink fluids when exercising." "Make sure to eat some fat occasionally with all that exercise." "Try combining the fasting with moderate exercise."

"There might be some difficulties with your plan and fasting." Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.

A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.

0.5 mL 25 mg/50 mg per mL = 0.5 mL.

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

50

As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. 6.8 mg/dL (0.40 mmol/L) 3.2 mg/dL (0.19mmol/L) 5.4 mg/dL (0.32 mmol/L) 4.0 mg/dL (0.24 mmol/L)

6.8 mg/dL (0.40 mmol/L) Hyperuricemia, a serum uric acid concentration above 6.8 mg/dL (0.40 mol/L) can cause urate crystal deposition which can lead to gout.

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

Administering ordered analgesics and monitoring their effects An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?

Age Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

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

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

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? The time of day when exercise is performed isn't important. Exercising in the evening before going to bed is beneficial. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

A client is admitted with an acute attack of gout. What interventions are essential for this client? Select all that apply. Probenecid Serum uric acid concentration Pain medication Corticosteroid therapy Dietary consult

Dietary consult Probenecid Corticosteroid therapy Pain medication Serum uric acid concentration Steroids may be used in clients who have not responded to other therapies. They have been shown to decrease inflammation and pain in attacks of gout. Probenecid will assist in the excretion of uric acid, the causative agent. Serum uric acid concentrations will guide therapy and treatment. A dietary consult can wait until the client the acute, painful period is over but will be a necessary nursing intervention for a client experiencing gout.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? Tumor necrosis factor (TNF) blockers Disease-modifying antirheumatic drugs (DMARDs) Nonsteroidal anti-inflammatory drugs (NSAIDs) Glucocorticoids

Disease-modifying antirheumatic drugs (DMARDs) Once a diagnosis of RA has been made, treatment should begin with DMARDs. NSAIDs are used for pain and inflammation relief but must be used with caution in long-term chronic diseases due to the possibility of gastric ulcers. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms.

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

Elevated erythrocyte sedimentation rate The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.

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

Encourage weight loss and an increase in aerobic activity Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methyl salicylate may be used for pain management.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Facial erythema, pericarditis, pleuritis, fever, and weight loss Hypothermia, weight gain, lethargy, and edema of the arms Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Weight gain, hypervigilance, hypothermia, and edema of the legs

Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

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. 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.

Hand and finger deformities are associated with the development of rheumatoid arthritis. The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease.

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

It is suggestive of rheumatoid arthritis. Rheumatoid factor is present in about 70% to 80% of patients with rheumatoid arthritis, but its presence alone is not diagnostic of rheumatoid arthritis, and its absence does not rule out the diagnosis. The antinuclear antibody (ANA) test is used to diagnose Sjögren's syndrome and systemic lupus erythematosus.

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

Limited passive movement Limited passive movement can be the first and only physical sign of symptomatic OA. Physical assessment of the musculoskeletal system reveals joint enlargement, joint instability, and limb shortening.

Which joint is most commonly affected in gout? Metatarsophalangeal Tarsal area Ankle Knee

Metatarsophalangeal The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

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

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which is the leading cause of disability and pain in the elderly? Systemic lupus erythematosus (SLE) Rheumatoid arthritis (RA) Osteoarthritis (OA) Scleroderma

Osteoarthritis (OA) Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

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 stiffness weakness joint swelling

Pain The symptom that most commonly causes a person to seek medical attention is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

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

Review the client's medical record. The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.

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

Rheumatoid arthritis

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

Scleroderma Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

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? Episcleritis Glaucoma Cataracts Sicca syndrome

Sicca syndrome Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye.

Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Rheumatoid arthritis (RA) Scleroderma Systemic lupus erythematous (SLE) Polymyositis

Systemic lupus erythematous (SLE) The most familiar manifestation of SLE is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and the cheeks. This type of rash does not characterize RA, scleroderma, or polymyositis.

Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Rheumatoid arthritis (RA) Scleroderma Systemic lupus erythematous (SLE) Polymyositis

Systemic lupus erythematous (SLE) The most familiar manifestation of SLE is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and the cheeks. This type of rash does not characterize RA, scleroderma, or polymyositis.

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Since the medication is able to be obtained over the counter, it has few side effects. Inform the health care provider if there is ringing in the ears. Take the medication on an empty stomach in order to increase effectiveness. Take the medication with food to avoid stomach upset.

Take the medication with food to avoid stomach upset.

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

Use of analgesics Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine. Back pain is the characteristic feature. AS affects the cartilaginous joints of the spine and surrounding tissues, making them rigid, decreasing mobility, and leading to kyphosis or a stooped position. Constipation, chronic cough, and peripheral edema are not symptoms associated with AS.

A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce inflammation. Weight loss will reduce purine levels. Weight loss will increase uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints.

Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.

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? "What types of exercise were you doing?" "Do you think you are too old to exercise?" "Does exercise usually work for you?" "Why do you think the exercise didn't work?"

What types of exercise were you doing?" In an older adult with rheumatoid arthritis, exercise programs may not be instituted or may be ineffective because the client expects results too quickly or fails to appreciate the effectiveness of a program of exercise. Strength training is encouraged in the older adult with chronic diseases. The other questions will not help the nurse understand what type of exercise was used and what it was not effective for the client.

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? administration of nonsteroidal anti-inflammatory drugs (NSAIDs) administration of monthly intra-articular injections of corticosteroids. administration of opioids for pain control. vigorous physical therapy for the joints.

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

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? methotrexate celecoxib sulfasalazine ibuprofen

celecoxib The cyclooxygenase-2 inhibitors, such as celecoxib, have been shown to inhibit inflammatory processes but do not inhibit the protective prostaglandin synthesis in the gastrointestinal (GI) tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with celecoxib. Ibuprofen, methotrexate, and sulfasalazine may cause GI irritation.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? colchicine calcium gluconate aspirin furosemide

colchicine A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? prednisone colchicine methotrexate penicillamine

colchicine Colchicine is prescribed for the treatment of an acute attack of gout.

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? probenecid anturane allopurinol colchicine

colchicine The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Colchicine, along with indomethacin, ibuprofen, or a corticosteroid, is prescribed to relieve an acute attack of gout. Probenecid and anturane increase the urinary excretion of uric acid, and allopurinol breaks down purines before uric acid is formed.

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: combat inflammation. prevent infection. promote diuresis. prevent platelet aggregation.

combat inflammation. Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis.

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? loading-dose schedule activity restrictions dietary restrictions common adverse effects

common adverse effects The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

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

dairy products Purines are chemical compounds found in high concentrations in certain foods, particularly shellfish, organ meats, and some alcoholic beverages (e.g., beer, distilled liquors). Purines are implicated in gout. Another reason that clients with gout are advised to avoid alcohol is that alcohol of any kind may increase the free fatty acid concentrations that can exacerbate gout.

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

early morning stiffness Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.

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

eating organ meats and sardines During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. The other listed factors do not worsen attacks.

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of degeneration. inflammation. gout. infection.

gout. The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.

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? decreased joint pain a weight gain of 2 pounds increased fatigue ability to perform activities of daily living (ADL)

increased fatigue Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.

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

located over bony prominence Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.

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

low back pain The most common symptoms of ankylosing spondylitis are low back pain and stiffness. A red, butterfly-shaped rash on the face and a patchy loss of hair are associated with systemic lupus erythematosus. Ankylosing spondylitis does not affect urine output.

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 jogging weight lifting running on a treadmill

tai chi T'ai chi is low impact, so this is the best exercise for low joint impact. Jogging, weight lifting, and running on a treadmill are high-impact, jarring types of exercise.