Ch 39: Rheumatic Disorders - PrepU

A client with a history of arthritis is being discharged to home after right wrist surgery, and thenurse reviews nonopioid pain relief measures. Which intervention(s) would best address the needs of this client? Select all that apply. Rolling walker Nonsteroidal anti-inflammatory drugs (NSAIDs) Paraffin bath Antiepileptic medications Splint or brace

Paraffin bath Nonsteroidal anti-inflammatory drugs (NSAIDs) Splint or brace

A 66-year-old man who originally sought care because of increasing pain in his great toe has subsequently been diagnosed with gout. In addition to pharmacological interventions, what dietary regimen should the nurse recommend to this patient? High calcium intake and low fat intake Low complex carbohydrate intake and high potassium intake High fluid intake and low protein intake High simple carbohydrate intake and avoidance of dairy products

High fluid intake and low protein intake

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 Encourage weight loss and an increase in aerobic activity Avoid the use of topical analgesics

Encourage weight loss and an increase in aerobic activity

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

Metatarsophalangeal

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

Physical therapy and exercise

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. Narcotic safety Medication dosages and side effects Assistive devices Safe exercise Dressing changes

Safe exercise Medication dosages and side effects Assistive devices

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? obesity congenital deformity trauma age

age

A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects? celecoxib hydroxychloroquine methotrexate aspirin

aspirin

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 teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? "Your symptoms are a result of your body attacking itself." "You are not immune to the disease causing the symptoms." "You have inherited your parent's immunity to the disease." "You have antigens to the disease, but they do not prevent the disease."

"Your symptoms are a result of your body attacking itself."

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 patient suspected of having gout, the nurse evaluated his serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. 6.8 mg/dL 5.4 mg/dL 4.3 mg/dL 3.2 mg/dL

6.8 mg/dL

Which term refers to fixation or immobility of a joint? Ankylosis Arthroplasty Diarthrodial Hemarthrosis

Ankylosis

A patient who has experienced a rapid progression of osteoarthritis has lost a significant amount of function in his hands. This pathophysiological process has been accompanied by obvious physical changes, to which the patient has stated, "I try to keep these gnarled old hands out of sight so no one has to look at them." How can the nurse best respond to this patient's statement about body image? Encourage him to verbalize his feelings about his appearance in more detail. Tell him that people are not normally as judgmental and superficial as he may think they are. Encourage him to focus on the function that remains rather than the function that has been lost. Help him to focus on his strength of character more than his physical appearance.

Encourage him to verbalize his feelings about his appearance in more detail.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? Bone scan Muscle biopsy Computed tomography (CT) Magnetic resonance imaging (MRI)

Muscle biopsy

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

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse reviews information collected during a health history with a client. Which information will the nurse identify that increases the client's risk of developing gout? Select all that apply. Body mass index 38 Works as a computer programmer Male gender Older adulthood Ingests 4 cans of beer a day

Older adulthood Male gender Body mass index 38 Ingests 4 cans of beer a day

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

Osteoarthritis (OA)

A client with rheumatoid arthritis expresses not feeling the need to take medication any longersince being in remission without symptoms. What is the best response by the nurse? "If you don't take your medication, you will become very ill." "It is important that you continue to take your medication to avoid an acute exacerbation." "Be sure to let the physician know after you stop your medications." "As long as you are not having symptoms, you can take a medication vacation."

"It is important that you continue to take your medication to avoid an acute exacerbation."

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." "Try combining the fasting with moderate exercise." "Make sure to eat some fat occasionally with all that exercise." "The fasting is okay, but make sure you drink fluids when exercising."

"There might be some difficulties with your plan and fasting."

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

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

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

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? "Be sure to wear nonslip footwear for safety." "Have someone check your blood pressure before exercising." "That's not the best activity for misaligned joints." "Don't go if your joints are inflamed."

"Be sure to wear nonslip footwear for safety."

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

"Monitor your body temperature."

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? "I have pain in my hands." "My legs feel weak." "I have trouble with my balance." "My finger joints are oddly shaped."

"My finger joints are oddly shaped."

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? "Tell me more about your concerns about this potential diagnosis." "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." "You should discuss that matter with your health care provider."

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

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware 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

Administering ordered analgesics and monitoring their effects

The nurse is conducting a health history with an older client. Which information indicates to the nurse that the client may be experiencing polymyalgia rheumatica (PMR)? Select all that apply. Anorexia Sore neck muscles Aching shoulder muscles Weight gain Body stiffness in the morning

Anorexia Sore neck muscles Aching shoulder muscles Body stiffness in the morning

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 Heart disease Metabolic disorders Vascular diseases

Autoimmune disorders

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? Reduced muscle mass on CT scan Atherosclerotic plaques on an arteriogram Boney erosions on x-ray Evidence of healed fractures on MRI

Boney erosions on x-ray

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 have swan neck deformity. Clients will have an ulnar deviation. Clients may develop Heberden nodes. Clients will develop boutonniere deformity.

Clients may develop Heberden nodes.

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 Increased albumin levels Increased C4 complement Increased red blood cell count

Elevated erythrocyte sedimentation rate

The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process? Degeneration Infection Inflammation Gout

Gout

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? 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. The client should discuss this concern with the health care provider. It's impossible to determine at the time of diagnosis how the disease will progress.

Hand and finger deformities are associated with the development of rheumatoid arthritis.

A 62-year-old male patient has been prescribed allopurinol (Zyloprim) for the treatment of gout. When providing health education to this patient about his new medication, the nurse should know that this drug achieves a therapeutic effect by: Increasing renal excretion of uric acid Buffering the presence of uric acid in joints Inhibiting the inflammatory process Interrupting the breakdown of purines

Interrupting the breakdown of purines

Which points should be included in the medication teaching plan for a client taking adalimumab? The medication is administered intramuscularly. It is important to monitor for injection site reactions. The client should continue taking the medication if fever occurs. The medication is given at room temperature.

It is important to monitor for injection site reactions.

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

It is suggestive of rheumatoid arthritis.

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate? Maintain good posture. Keep shifting weight from one foot to the other. Perform aerobic exercises. Maintain complete bed rest.

Maintain good posture.

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

Rheumatoid arthritis

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Subchondral bone Tophi Joint effusion Pannus

Tophi

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. Decreasing alcohol intake Limiting exercise Weight loss Avoiding purine-rich foods Restricting the intake of water

Weight loss Decreasing alcohol intake Avoiding purine-rich foods

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? MRI X-ray CT scan Ultrasound

X-ray

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

administration of nonsteroidal anti-inflammatory drugs (NSAIDs)

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 probenecid allopurinol anturane

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 joint pain that increases with rest small joint involvement subcutaneous nodules

early morning stiffness

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 ingesting salicylates eating organ meats and sardines frequently drinking coffee

eating organ meats and sardines

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about? hydroxychloroquine azathioprine cyclophosphamide diclofenac

hydroxychloroquine

Osteoarthritis is known as a disease that affects the cartilaginous joints of the spine and surrounding tissues. requires early treatment because most of the damage seems to occur early in the course of the disease. is the most common and frequently disabling of joint disorders. affects young males.

is the most common and frequently disabling of joint disorders.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? disease-modifying antirheumatic drug therapy prevention of joint deformity strategies for remaining active detection of systemic complications

strategies for remaining active

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? weight lifting tai chi running on a treadmill jogging

tai chi

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 frequent rest periods throughout the day?" "Have you reduced the amount of daily exercise?" "Are you taking the medication as prescribed?" "Have you increased your intake of fat-soluble vitamins?"

"Are you taking the medication as prescribed?"

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 Methylprednisolone Mercaptopurine azathioprine Celecoxib

Methotrexate