Prep U Chapter 38

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of: green vegetables. organ meats. fresh fish. citrus fruits.

organ meats.

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

"Monitor your body temperature."

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." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints."

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

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

Assess diet and activity at home

The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins. Aloprim Benemid Colchicine Anturane

Colchicine

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? Chest pain Behavioral changes Decreased cognitive ability Hypertension

Hypertension

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? Infliximab (Remicade) Methylprednisolone (Medrol) Methotrexate (Rheumatrex) Etanercept (Enbrel)

Methotrexate (Rheumatrex)

Which of the following is the most common cause for a patient to seek medical attention for arthritis? Weakness Joint swelling Stiffness Pain

Pain

What intervention is a priority for a client diagnosed with osteoarthritis? Hydrotherapy Physical therapy and exercise Allopurinol Colchicine

Physical therapy and exercise

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis? Creatinine ESR Red blood cell count Uric acid

Red blood cell count

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use 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.

A nurse is poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis? Ineffective thermoregulation Constipation Risk for imbalanced nutrition: More than body requirements Risk for impaired skin integrity

Risk for impaired skin integrity

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? Hyperextension Internal rotation Extension Slight dorsiflexion

Slight dorsiflexion

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on: Strategies for remaining active DMARDs therapy Prevention of joint deformity Detection of systemic complications

Strategies for remaining active

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

Take the medication with food to avoid stomach upset.

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? It has very specific manifestations that make diagnosis relatively easy. The symptoms are primarily localized to the skin but may involve the joints. 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.

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

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

may feel as if their symptoms are not taken seriously.

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

Elevated erythrocyte sedimentation rate

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

"It will get better and worse again."

Which is not a symptom of osteoarthritis? deep, aching pain with motion early in the disease limited joint motion morning stiffness that lasts at least 1 hour instability of weight-bearing joints

morning stiffness that lasts at least 1 hour

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

Encourage weight loss and an increase in aerobic activity

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

Osteoarthritis (OA)

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? "My energy level will gradually increase over time." "My medications will ultimately correct my problem." "I do not need to make any changes in my diet." "I should avoid prolonged sun exposure."

"I should avoid prolonged sun exposure."

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." "I have pain in my hands." "My legs feel weak." "I have trouble with my balance."

"My finger joints are oddly shaped."

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive 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." "Tell me more about your concerns about this potential diagnosis." "You should discuss that matter with your physician." "SLE is a very serious systemic disorder."

"The diagnosis won't be based on the findings of a single test but by combining all data found."

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed? Diclofenac Indomethacin Etanercept Celecoxib

Etanercept

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports ability to perform ADLs Has a weight gain of 5 pounds Reports decreased joint pain Shows increased joint flexibility

Has a weight gain of 5 pounds

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include 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. Pace activities. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. Avoid sunlight and ultraviolet radiation.

If you have problems with a medication, you may stop it until your next physician visit.

Which findings best correlate with a diagnosis of osteoarthritis? Fever and malaise Anorexia and weight loss Joint stiffness that decreases with activity Erythema and edema over the affected joint

Joint stiffness that decreases with activity

Diagnosis of osteoarthritis is complicated because initial joint changes occur without symptoms. Therefore, a combination of physical assessment and X-ray review is necessary for a diagnosis. Select two signs that, when combined, are sensitive indicators of OA. Tender joints Osteophytes Joint pain Enlarged joints Joint space narrowing

Osteophytes Joint space narrowing

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports ability to perform ADLs Shows a weight gain of 2 pounds Reports decreased joint pain Reports increased fatigue

Reports increased fatigue

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

colchicine

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? Ulnar deviation Rheumatoid nodules Boutonnière deformity Swan neck deformity

Swan neck deformity

The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. What foods should the nurse encourage the patient to avoid? Asparagus Liver Pineapple Baked chicken

Liver

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

Metatarsophalangeal

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically: Clear and pale. Milky, cloudy, and dark yellow. Scanty in volume. Straw-colored.

Milky, cloudy, and dark yellow.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? "Do all your chores in the evening, when pain and stiffness are least pronounced." "Do all your chores in the morning, when pain and stiffness are least pronounced." "Pace yourself and rest frequently, especially after activities." "Do all your chores after performing morning exercises to loosen up."

"Pace yourself and rest frequently, especially after activities."

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about? Tolmetin sodium (Tolectin) Celecoxib (Celebrex) Ibuprofen (Motrin) Piroxicam (Feldene)

Celecoxib (Celebrex)

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? Prednisone (Deltasone) Allopurinol (Zyloprim) Colchicine Propoxyphene hydrochloride (Darvon)

Colchicine