Immune 1 - Prep U

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 - The client's functional status is a central focus of home assessment of the client with RA. The nurse may also address the client's understanding of the disease, complications, and social support, but the client's level of function and quality of life is a primary concern.

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?

Swan neck deformity - A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule.

A client seeks medical attention for facial swelling that appeared suddenly and did not respond to oral antihistamines. Which health history information will the nurse use to provide care for bradykinin-induced angioedema?

Takes an angiotensin-converting enzyme inhibitor for hypertension - Angiotensin-converting enzyme inhibitors are common causes of bradykinin-induced angioedema; swelling may appear within a week of starting the medication or after years of use. Because this type of angioedema does not involve histamine, antihistamines would be ineffective. Allergic reactions to insect stings and foods are examples of mast-cell mediated angioedema. Treatment for mast-cell mediated angioedema begins with epinephrine.

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which statement about anaphylaxis?

The most common cause of anaphylaxis is penicillin.

A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply. Use relaxation exercises. Establish a set time to sleep every night. Avoid caffeine before bedtime. Create a quiet sleep environment. Take pain medications four hours before sleep.

Use relaxation exercises. Establish a set time to sleep every night. Avoid caffeine before bedtime. Create a quiet sleep environment. - Clients need restful sleep so that they can cope with pain, minimize physical fatigue, and deal with the changes related to having a chronic disease. In clients with acute disease, sleep time is frequently reduced and fragmented by prolonged awakenings. Recommendations to improve sleep include using relaxation exercises, establishing a set time to sleep, avoiding caffeine before bedtime, and creating a quiet sleep environment. Pain medications should be taken closer to sleep time so that they can work effectively for someone experiecing pain and stiffness due to rheumatoid disease.

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid:

alcohol - The nurse should advise a client taking antihistamines not to take it with alcohol or other central nervous system depressants because additive sedative effects can occur.

A client with a history of allergies comes to the emergency department. The nurse suspects anaphylaxis based on which of the following? Select all that apply. Chest tightness Generalized itching Pallor Facial angioedema Increasing blood pressure

Chest tightness Generalized itching Pallor Facial angioedema - Manifestations suggesting anaphylaxis include chest tightness, generalized itching, pallor, massive facial angioedema, tachycardia or bradycardia, and decreasing blood pressure (as a result of peripheral vascular collapse).

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?

"My finger joints are oddly shaped." - Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.

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 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 systemic lupus erythematosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term should the nurse use to describe this characteristic pattern?

Butterfly rash - In the classic lupus rash, lesions appear on the cheeks and the bridge of the nose, creating a characteristic butterfly pattern. The rash may vary in severity from malar erythema to discoid lesions (plaque). Papular and pustular rashes aren't associated with SLE. The bull's eye rash is classic in client's with Lyme disease.

The nurse is creating a plan to assist an older adult to manage rheumatoid arthritis. Which areas will the nurse include in this plan? Select all that apply. Exercise Medication Financial assistance Psychological support Modification of daily activities

Exercise Medication Psychological support Modification of daily activities - The various rheumatic disease conditions in the older adult pose unique challenges. These challenges relate to disability, cognitive changes, comorbid conditions, and diagnosis. Older adults would benefit from a self-management plan to assist with care needs. This plan should include information about exercise, medication, psychological support, and modification of daily activities. Financial assistance is not a part of the self-management plan for rheumatoid arthritis.

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 - The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy. Management of SLE involves regular monitoring to assess disease process and therapeutic effectiveness. Stating the benefit of face-to-face interaction does not answer the client's question. Blood work is not necessarily drawn monthly, and assessing medication adherence is not the sole purpose of visits.

The nurse is reviewing laboratory values for a client experiencing symptoms of systemic lupus erythematosus (SLE). Which findings indicate to the nurse that the client's symptoms are consistent with this condition? Select all that apply. Elevated troponin level Positive anti-DNA antibody Positive antinuclear antibody Reduced level of serum glucose Elevated level of red blood cells

Positive anti-DNA antibody Positive antinuclear antibody - Blood tests are done to help validate the diagnosis of SLE. The anti-DNA antibody or the antibody that develops against the client's own DNA is present in SLE. The antinuclear antibody is positive in more than 95% of clients with SLE. Troponin level is used to diagnose cardiac damage after an acute myocardial infarction. SLE does not affect glucose level. The client with SLE may develop anemia and would not have an elevated level of red blood cells.

A client is newly diagnosed with rheumatoid arthritis. For which medications will the nurse prepare teaching for this client? Select all that apply. Aspirin Ibuprofen Prednisone Methotrexate Acetaminophen

Ibuprofen Prednisone Methotrexate - Once the diagnosis of RA is made, treatment should begin with either a nonbiologic or biologic disease-modifying antirheumatic drugs (DMARD). The goal of using DMARD therapy is preventing inflammation and joint damage. Recommended treatment guidelines include beginning with the nonbiologic DMARD methotrexate as the preferred agent. Ibuprofen may be prescribed as an analgesic however must be used with caution because of the risk of gastric ulcer. Corticosteroids are recommended as a 'bridge' in the early treatment but are not recommended for long term therapy due to side effects. Aspirin and acetaminophen are not identified as medications used to treat the symptoms of RA.

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms?

Raynaud's disease - Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.

A client has been diagnosed with Stevens-Johnson syndrome. Which factors are common triggers of this condition? Select all that apply. Tamoxifen and vemurafenib Exposure to cold objects, cold fluids, or cold air Allopurinol and nevirapine Wearing clothing washed in a detergent Radiation in combination with phenytoin

Tamoxifen and vemurafenib Allopurinol and nevirapine Radiation in combination with phenytoin - Stevens-Johnson syndrome is a severe reaction commonly triggered by medication. The syndrome can evolve into extensive epidermal necrosis and become life-threatening. Among the many medications that trigger this condition are tamoxifen, vemurafenib, allopurinol and nevirapine. The combination of radiation and antiepileptic drugs such as phenytoin can also trigger this condition. Exposure to cold objects, cold fluids, or cold air can trigger cold urticaria, resulting in wheals (hives) or angioedema, but would not trigger Steven-Johnson syndrome. Wearing clothing washed in a detergent can trigger contact dermatitis but would not trigger Steven-Johnson syndrome.

The nurse instructs a client with polymyositis rheumatica (PMR) about prescribed corticosteroids. Which statement regarding corticosteroid is correct?

"I will take the medication until my health care provider tells me to stop." - A management concern of clients with PMR is taking the medication as prescribed. Oftentimes clients will take the medication until symptoms improve and then will discontinue the medication. The decision to discontinue the medication should be based on clinical and laboratory findings and the length of the prescription. The dose should not be altered and doses should not be skipped if gastric distress occurs.

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"It will get better and worse again." - The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.

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 rash of the joints is common with rheumatoid arthritis." "Swelling of the joints will occur, causing pain." "You can expected warmth in your joints." "Redness can occur in the skin at the joints." "A symptom of RA will be joint pain on both sides."

"Swelling of the joints will occur, causing pain." "You can expected warmth in your joints." "Redness can occur in the skin at the joints." "A symptom of RA will be joint pain on both sides." - The initial clinical manifestations of RA include symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic symptoms. A rash is not a symptom of RA.

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." - 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 early-stage rheumatoid arthritis asks the nurse what the client can do to help ease the symptoms of the disease. What would be the best response by the nurse?

"The doctor could prescribe anti-inflammatory drugs."

A health care provider orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?

An above-normal anti-deoxyribonucleic acid (DNA) test - Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE.

The nurse is assessing a client with primary Sjogren's syndrome. Which interventions will the nurse add to this client's plan of care? Select all that apply. Analgesics for pain management Education on proper sleep practices Use of artificial tears Increased fluid intake Provide a high fiber diet

Analgesics for pain management Education on proper sleep practices Use of artificial tears Increased fluid intake - Primary Sjögren's syndrome is a rare systemic autoimmune disease that predominantly affects middle-aged women. The most common symptoms include pain, fatigue, kerotoconjunctivitis sicca or dry eyes, and xerostomia or dry mouth. Constipation is not commonly identified as a symptom of primary Sjogren's syndrome.

A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. What manifestation would the nurse most likely exhibit?

Blistering - Manifestations associated with allergic contact dermatitis related to latex include blisters, pruritus, erythema, swelling, and crusting or other skin lesions. Laryngeal edema, rhinitis, and angioedema would be noted with a latex allergy.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

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 preparing to educate a client with rheumatoid arthritis on long-term effects of prednisone therapy. Which topic will the nurse include in the teaching?

Eat a lower calorie diet to manage weight gain. - Common side effects of prednisone include weight gain and increased hunger. The nurse should educate the client on eating a well-balanced diet with a decreased calorie intake. Weight gain is common so it does not need to be reported immediately. A client should not decrease number of meals and should not fast as this can cause malnutrition and decreased energy to deal with chronic disease.

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply. Fatigue Pain Alteration of self-concept Fluid and electrolyte imbalance Fluid volume deficit

Fatigue Pain Alteration of self-concept - Clients with rheumatic diseases, which typically involve joints and muscles, experience problems with mobility, fatigue, and pain. Because of the limitations of the disease, clients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases.

A client with rheumatoid arthritis (RA) is having a routine examination. Which findings indicate to the nurse that this client has systemic involvement from the condition? Select all that apply. Fever Fatigue Weight loss Enlarged lymph nodes Hypoactive bowel sounds

Fever Fatigue Weight loss Enlarged lymph nodes - RA is a systemic disease with extra-articular features. The most common findings of systemic involvement include a fever, fatigue, weight loss, and enlarged lymph nodes. RA does not affect gastrointestinal motility.

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?

If you have problems with a medication, you may stop it until your next physician visit. - Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.

The nurse is preparing teaching for a client with rheumatoid arthritis (RA). Which information will the nurse include in these instructions? Select all that apply. Medication therapy Nutritious eating plan Actions to cope with stress Alternative living arrangements Nonpharmacologic pain management techniques

Medication therapy Nutritious eating plan Actions to cope with stress Nonpharmacologic pain management techniques - Client education is an essential aspect in nursing care of the client with RA to enable the client to maintain as much independence as possible, to take medications accurately and safely, and to use adaptive devices correctly. Teaching should include name, dose, side effects, frequency, and schedule for all medications; a dietary plan that focuses on weight management while maximizing nutrients for tissue building and repair; ways to cope with stress; and pain management techniques. A client with rheumatoid arthritis can lead a fulfilling life independently as long as they are supported with the appropriate equipment and skills to live in their home.

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 - Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

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 - Once the diagnosis of RA is made, treatment should begin with either a nonbiologic or biologic disease-modifying antirheumatic drug (DMARD). Recommended treatment guidelines include beginning with the nonbiologic DMARDs (methotrexate, leflunomide, sulfasalazine) or hydroxychloroquine within 3 months of disease onset. Allopurinol is used to treat gout. Opioids are not indicated in early RA. Prednisone is used in unremitting RA.

A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?

Nonsteroidal anti-inflammatory drugs - Nonsteroidal anti-inflammatory drugs are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat, rather than ice packs, is used to relieve pain. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional; it is not an intervention specific to relieving pain.

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. Pain Nausea Stiffness Weakness Joint swelling

Pain Stiffness Weakness Joint swelling - The most common symptom in the rheumatic diseases is pain. Other common symptoms include stiffness, weakness, and joint swelling in addition to limited movement and fatigue. Nausea is not a symptom of rheumatoid arthritis.

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis?

Red blood cell count - Clients diagnosed with rheumatic diseases have a decreased red blood cell count. ESR is increased in inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.

A client has been living with rheumatoid arthritis (RA) for several years. Which diagnostic test will the nurse prepare the client for to determine the progression of the disease?

X-ray - Plain x-ray is the most common radiographic study used to track disease progression as it is inexpensive, reliable, and reproducible. MRI may be used to detect erosions not visible on x-ray or ultrasound. CT scan is not routinely used to track the progression of RA. Ultrasound might be used to establish a baseline for joint evaluation however is not used to track progression of the condition.

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. - 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 asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?

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.

A client comes to the emergency department complaining of difficulty breathing and feeling strange after eating a shrimp cocktail. The client is leaning forward with a respiratory rate of 36 breaths per minute. The nurse suspects anaphylaxis. What is the nurse's priority action?

maintaining an open airway - The priority action at this time is maintaining an open airway because the client is experiencing a severe allergic reaction that is compromising the airway and ability to inhale. There is no indication that the client's difficulty breathing is causing pain. Anxiety and activity are important, but the priority is the client's airway.

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?

minimizing damage - Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results.

The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client?

small joint involvement - Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur over time. Obesity, Bouchard's nodes, and asymmetric joint involvement can be seen with the early stage of the disease.

A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying?

urticaria (hives) - Urticaria presents with itching, swelling, redness, and wheals of superficial skin layers. Dermatitis medicamentosa presents with sudden generalized bright red rash, itching, fever, malaise, headache, arthralgias. Contact dermatitis presents with itching, burning, redness, rash on contact with substance. Angioedema presents with itching, swelling, redness of deeper tissues and mucous membranes.

Which allergic reaction is potentially life threatening?

angioedema - Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction?

Angiotensin-converting enzyme (ACE) inhibitor - Several frequently prescribed medications, such as angiotensin-converting enzyme inhibitors and penicillin, may cause angioedema. The nurse needs to be aware of all medications the patient is taking and be alert to the potential of angioedema as a side effect.

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 - The American College of Rheumatology and the European League Against Rheumatism have established criteria for classifying RA. These criteria are based on a point system where a total score of 6 or greater is required for the diagnosis of RA. Clients diagnosed with RA who are excluded from these diagnostic criteria include those with bony erosions on X-ray. RA is not diagnosed by CT scans, MRIs, or arteriograms, however CT scans and MRIs can be used to detect bone erosions and inflammatory changes of rheaumatoid arthritis.

A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease?

Butterfly-shaped rash on the face over the bridge of the nose and cheeks - A prominent sign for about half of the clients with SLE is a red, butterfly-shaped rash known as malar rash, on the face over the bridge of the nose and the cheeks. The word lupus means "wolf." The term may have been used as a description for the facial rash that, to some, resembled the mask of reddish-brown fur on a wolf. The other choices are not routinely seen with SLE.

Which finding is consistent with the diagnosis of rheumatoid arthritis?

Cloudy synovial fluid - In a client with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.

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 - An acute cutaneous lesion consisting of an erythematous (butterfly-shaped) rash across the bridge of the nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Clients with SLE do not typically experience jaundice or skin sloughing.

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. - 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.

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?

Paresthesias of both hands (tingling) - The rheumatoid arthritis inflammatory process has been implicated in other disease processes. The nervous system is affected as synovial inflammation can compress adjacent nerves, causing neuropathies and paresthesias. Limited motion in the wrists and restricted movement in the tendons is caused by a breakdown of collagen and pannus formation which destroys cartilage and erodes the bone. This causes a loss of articular surfaces and joint motion and tendon and ligament elasticity and contractility is lost. Rheumatoid arthritis does not cause crepitus with movement.

The nurse is completing a health history with a client diagnosed with systemic lupus erythematosus (SLE). Which information will the nurse identify as environmental triggers for the condition? Select all that apply. Stress Sunlight Vegetarian diet Recent surgery Cigarette smoking

Stress Sunlight Recent surgery Cigarette smoking - It is hypothesized that exogenous or environmental triggers are implicated in the onset of SLE. These triggers include stress, sunlight, stress on the body from surgery, and cigarette smoking. A vegetarian diet is not identified as a trigger for SLE.

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 may develop Heberden nodes. - Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

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?

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 with early stage rheumatoid arthritis asks the nurse what to do to help ease the symptoms of the disease. What would be the best response by the nurse?

"The health care provider could prescribe anti-inflammatory drugs." - Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Antipyretic and antihypertensive drugs are not prescribed for autoimmune diseases. An antineoplastic drug is not ordered for an autoimmune disorder until it is in its' late stages and uncontrolled by the first line drugs.

A client is experiencing symptoms of rheumatoid arthritis. Which laboratory tests will the nurse expect to be prescribed for this client? Select all that apply. Creatinine Hematocrit Erythrocyte count Rheumatoid factor Antinuclear antibody

Erythrocyte count Rheumatoid factor Antinuclear antibody - Various blood studies can be done to help diagnose rheumatic diseases. Erythrocyte count may be decreased in rheumatoid arthritis. Rheumatoid factor is present in 80% of those with rheumatoid arthritis. A positive antinuclear antibody test may be associated with rheumatoid arthritis. Creatinine and hematocrit are not used to diagnose rheumatoid arthritis.

The nurse is completing the physical assessment of a client with systemic lupus erythematosus (SLE). Which finding will the nurse recognize is most likely to indicate that the client is experiencing a change to the cardiovascular system because of the condition?

Pericardial friction rub - The cardiac system is also commonly affected in SLE. Auscultating a pericardial friction rub would indicate myocarditis. Peripheral edema, jugular vein distention, and bounding peripheral pulses are not symptoms that indicate SLE is affecting the cardiovascular system.

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) - SLE has a high degree of neurologic involvement and can result in central nervous system changes. The client and family members are asked about any behavioral changes, including manifestations of neurosis or psychosis. Signs of depression are noted, as are reports of seizures, chorea, or other central nervous system manifestations. OA, RA, and gout lack this dimension.

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. - Exercise is vital to the management of rheumatic disorders. Goals should be preserving and promoting mobility and joint function while limiting stress on the joint and possible damage. Cardiovascular exertion should remain within age-based limits and individual ability, but it is not a goal to minimize exertion. Increasing joint size is not a valid goal.

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?

"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.

The nurse is caring for a client with systemic lupus erythematosus (SLE). Which interventions will the nurse incorporate into this client's plan of care? Select all that apply. Antipyretic medications for fever Monitoring for jaundice Providing high fiber diet for diarrhea Providing analgesics for joint pain Monitoring for rash to the skin

Antipyretic medications for fever Providing analgesics for joint pain Monitoring for rash to the skin - The disease process of SLE involves chronic states where symptoms are minimal or absent and acute flares where symptoms and lab results are elevated. Symptoms most often include fever, joint pain, and a discoid rash. SLE less commonly affects the gastrointestinal system and the liver. Because of this jaundice and diarrhea are not findings associated with SLE.

Nursing assessment findings reveal joint swelling and tenderness and a butterfly rash on the face. The nurse suspects which of the following?

Systemic lupus erythematous - The butterfly rash is a unique skin manifestation of systemic lupus erythematous. Other clinical manifestations include joint swelling and tenderness, pain on movement, and morning stiffness. The disease can affect all body systems.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

Raynaud's phenomenon - Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.

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) - In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. Support joints with splints and pillows. Assist the client to develop a sleep routine. Provide diversional activities. Provide opportunities for the client to verbalize feelings. Provide assistive devices for self-feeding.

Support joints with splints and pillows. Provide diversional activities. Provide opportunities for the client to verbalize feelings. - To manage pain, the nurse maintains normal alignment of extremities as much as possible by supporting the joints with splints and pillows. Diversional activities distract the client's focus from the pain. Providing opportunities for the client to verbalize feelings facilitates coping with pain. Assistive devices for self-feeding help the client meet nutritional needs independently. Assisting the client to develop a sleep routine promotes rest and minimizes fatigue.

The nurse teaches the client with allergies about anaphylaxis, including which statement?

The most common cause of anaphylaxis is penicillin. - The most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States, is penicillin. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions occur within about 30 minutes of exposure involving cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

The nurse is providing care for a client who has a diagnosis of hereditary angioedema. When planning this client's care, what nursing diagnosis should be prioritized?

Risk for impaired gas exchange related to airway obstruction - Edema of the respiratory tract can compromise the airway in clients with hereditary angioedema. As such, this is a priority nursing diagnosis over pain and possible infection. Skin integrity is not threatened by angioedema.

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Positive Anti-dsDNA antibody test - Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titer shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement.

A client with rheumatoid arthritis is concerned because the appearance of the hands is changing. Which hand deformities will the nurse expect to assess in this client? Select all that apply. Swan neck Ulnar deviation Heberden's nodes Bouchard's nodes Enlarged knuckles

Swan neck Ulnar deviation - Deformities of the hands is common in RA and includes swan neck deformities and ulnar deviation. The deformity may be caused by misalignment resulting from swelling, progressive joint destruction, or the subluxation (partial dislocation) that occurs when one bone slips over another and eliminates the joint space. Deformities of RA differ from those seen with osteoarthritis (OA), such as Heberden's and Bouchard's nodes. Enlarged knuckles are not associated with either condition.

A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply. Positive C-reactive protein (CRP) Positive antinuclear antibody (ANA) Red blood cell (RBC) count of >4.0 million/uL Red blood cell (RBC) count of <4.0 million/mcL Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L

Positive C-reactive protein (CRP) Positive antinuclear antibody (ANA) Red blood cell (RBC) count of <4.0 million/mcL - Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive.

A college student reports the onset of skin burning and hives when walking outdoors in cold weather. Which suggestions will the nurse make to limit this reaction from occurring? Select all that apply. Use a wetsuit when planning to go swimming in cold water. Soak in a tub of tepid water when the itching and hives occur. Avoid ingesting foods and beverages that are cold in temperature. Apply an over-the-counter topical corticosteroid to the areas every day. Take an over-the-counter antihistamine before going outdoors in cold weather.

Use a wetsuit when planning to go swimming in cold water. Avoid ingesting foods and beverages that are cold in temperature. Take an over-the-counter antihistamine before going outdoors in cold weather. - The client is describing cold urticaria, which is the development of wheals (hives) or angioedema due to exposure to cold. Mast cells release histamine and inflammatory mediators are stimulated in response to skin contact with cold objects, cold fluids, or cold air. It is an IgE-mediated atopic immune reaction. A wet suit can be used during swimming. Clients should understand that cold foods and beverages can stimulate oropharyngeal angioedema or anaphylaxis and should be avoided. Pretreatment with an antihistamine prior to predictable cold exposure is recommended, because clinical experience suggests that antihistamine pretreatment can prevent skin reactions and systemic reactions. Soaking in tepid water is not recommended to treat the hives and itching caused by cold urticaria. Over-the-counter corticosteroids are not recommended to treat the itching and hives caused by cold urticaria.