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

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."

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

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.

Diarrhea Intestinal cramping Nausea and vomiting

Which is an appropriate nursing intervention in the care of the client with osteoarthritis?

Encourage weight loss and an increase in aerobic activity

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

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which is the leading cause of disability and pain in the elderly?

OA

The nurse is educating a client on signs and symptoms of fibromyalgia. Which assessment technique would cause pain that indicates fibromyalgia?

Pinch the Achilles tendon.

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.

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?

Hyperuricemia

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.

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 gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find?

early morning stiffness

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

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia

may feel as if their symptoms are not taken seriously.

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

A client arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean?

purine-rich foods

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management?

strategies for remaining active

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client?

"Are you taking the medication as prescribed?"

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

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

A client with fibromyalgia asks why physical therapy has been prescribed. Which response will the nurse make?

"It will help with the overall deconditioning that has occurred."

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."

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."

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."

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."

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?

Assess diet and activity at home

A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests?

Autoimmune disorders

The nurse is completing a physical assessment with a client demonstrating signs of rheumatoid arthritis. Which findings will the nurse associate with this condition? Select all that apply.

Bruises Dry eyes Weight loss Thinning hair

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

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?

Hypertension

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

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

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

colchicine

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.

"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."

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."

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

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects

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 Providing analgesics for joint pain

The nurse is reviewing prescriptions written for a client with giant cell arteritis (GCA). Which medication will the nurse expect to be prescribed with a corticosteroid to preserve the client's vision?

Aspirin

A client with rheumatoid arthritis is discharging to home following an exacerbation of joint pain. Which type of referral will be the priority for the client?

Home health nurse

A client is diagnosed with psoriatic arthritis. In which areas will the nurse expect the client to experience pain? Select all that apply.

Plantar fascia Achilles tendon Tibial tuberosities

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Tophi

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?

Chronic fatigue, generalized muscle aching, and stiffness

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

Red blood cell count

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

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