NU144- Chapter 38: Assessment and Management of Patients With Rheumatic Disorders
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
Administering ordered analgesics and monitoring their effects
A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?
applications of ice
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?
Has a weight gain of 5 pounds
A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment?
Joint pain, crepitus, Heberden's nodes
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?
Muscle biopsy
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?
increased fatigue
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis?
joint stiffness that increases with activity
cytokines
proteins that can be produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?
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 comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?
Degenerative joint disease
The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of
gout
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."
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer?
"Pace yourself and rest frequently, especially after activities."
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)
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?
Assess diet and activity at home
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?
Celecoxib
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?
Elevated erythrocyte sedimentation rate
Which is the leading cause of disability and pain in the elderly?
Osteoarthritis (OA)
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.
The nurse is providing medication teaching to a client with rheumatoid disease. What common actions are seen with diclofenac and aspirin? Select all that apply.
anti-inflammatory analgesic antipyretic antiplatelet
subchondral bone
bony plate that supports the articular cartilage
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
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."
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."
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?
"Your symptoms are a result of your body attacking itself."
Which client is most likely to develop systemic lupus erythematosus (SLE)?
A 27-year-old black female
Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?
Hypertension
Which points should be included in the medication teaching plan for a client taking adalimumab?
It is important to monitor for injection site reactions.
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 (Rheumatrex)
The nurse is gathering objective data for a client at the clinic complaining of 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
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?
Tophi
A client is recovering from an attack of gout. What will the nurse include in the client teaching?
Weight loss will reduce uric acid levels and reduce stress on joints.
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?
Widespread chronic pain
osteophyte
a bony outgrowth or protuberance; bone spur
rheumatoid arthritis
a systemic autoimmune disease with symmetric arthritic manifestations and multiple extra-articular features
tophi
accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage
A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?
age
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
ankylosis
fixation or immobility of a joint
arthritis
inflammation of a joint
rheumatic diseases
numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints
A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of?
organ meats
remission
period when disease symptoms are reduced or absent
exacerbation
period when disease symptoms occur or increase
The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply.
susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage
pannus
proliferation of newly formed synovial tissue infiltrated with inflammatory cells
A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities?
prone
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.
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
Which joint is most commonly affected in gout?
Metatarsophalangeal
The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.
Safe exercise Medication dosages and side effects Assistive devices
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?
Sicca syndrome
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?
The fluid will be milky, cloudy, and dark yellow.
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?
colchicine
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?
colchicine
arthroplasty
replacement of a joint
The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the most common finding associated with fibromyalgia?
widespread chronic pain
