Ch 50: Disorders of Musculoskeletal Function (Rheumatic Disorders)

The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find?

Lower back pain

Which individual is at greatest risk for osteoarthritis?

Male, age 75

Which type of joint manifestations would the nurse anticipate finding in a client with rheumatoid arthritis?

Polyarticular

Giant cell arteritis is a comorbid condition of:

Polymyalgia rheumatica

The nurse is assessing a client's risk for osteoarthritis. Which factor places the client at greatest risk for this condition?

Age

When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease?

Obesity

A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology?

"Genetic predisposition is very likely."

A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client?

"Losing some weight and reducing your alcohol intake will likely be beneficial."

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make?

"More women than men are affected by lupus."

The nurse is caring for a client diagnosed with osteoarthritis (OA). What does the nurse teach the client about the disease?

"OA is a disease of the weight-bearing joints."

The nurse is preparing a client for testing to determine if the client's gout is due to overproduction or underexcretion of uric acid. How should the nurse explain the process used?

"Your serum uric acid levels will be compared to the urate content in your urine."

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client makes which statement?

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."

A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized?

"To prevent cartilage atrophy, slowly and gradually resume exercising."

The nurse determines that additional client education is needed when a client with gout makes which statement?

"When I have an exacerbation of my symptoms, a glass of red wine will be helpful."

Joint destruction in rheumatoid arthritis occurs by an obscure process. The cellular changes, however, have been documented. Place the process in the correct order.

1) Neutrophils, macrophages, and lymphocytes arrive 2) Immune complexes phagocytized, releasing lysosomal enzymes 3) Destructive changes in joint cartilage 4) Inflammatory response 5) Reactive hyperplasia of synovial cells and subsynovial tissues 6) Vasodilation and joint swelling

Juvenile dermatomyositis is a chronic inflammatory myopathy that commonly manifests systemically. What is the treatment of choice for this myopathy?

Corticosteroids

What is among the most commonly occurring symptoms in the early stages of systemic lupus erythematosus (SLE)?

Arthritis

A client presents with arthralgia and arthritis. Which is the priority nursing intervention?

Assessing the client's pain and history of treating it

A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?

Autoimmune process

When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease?

Autologous antibodies

Which statement is true regarding the development of juvenile idiopathic arthritis?

Generalized stunted growth can occur.

When caring for a client with ankylosing spondylitis, the nurse tells the client that stiffness may be relieved by which intervention?

Gentle exercise

A 30-year-old client has been diagnosed with ankylosing spondylitis. Which etiology is responsible for this health problem?

Immune response

An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health?

Immunologically mediated joint inflammation

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?

Joint pain and proteinuria

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess?

Kyphosis

A client presents with joint pain and suspected rheumatoid arthritis (RA). Which intervention is appropriate for the nurse to implement?

Muscle-strengthening exercises to support joints

The nurse is conducting a health promotion class on osteoarthritis (OA). Which statement should the nurse include?

Obesity is a strong risk factor for developing OA.

A client diagnosed with arthritis had a recent infection. Which intervention is necessary to determine if the client has bacterial arthritis?

Positive culture of synovial fluid

A client has been diagnosed with scleroderma. Which assessment finding does the nurse expect?

Raynaud phenomenon

The nurse assessing a client with scleroderma with CREST variant would include an assessment for:

Raynaud's phenomenon.

A client was diagnosed with Salmonella 1 week ago and is now experiencing joints that are warm, swollen, and tender; fever; and weight loss. What is the most likely interpretation of these manifestations?

Reactive arthritis

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which important differences when caring for the older adult?

Risk for falls

The health care provider is assessing a client with a history of ankylosing spondylitis to note progression of the disease. On which area of the body will the provider focus the assessment?

Spine

The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?

The injections will be given only 3 to 4 times per year because they can increase joint destruction.

A nurse is caring for a client who has developed vasculitis as a result of a rheumatology disorder. Which factor does the nurse expect to uncover in assessing this client?

Ulcers of the lower extremities

The nurse is teaching a client with rheumatoid arthritis about pannus, which develops in the affected joint area. What does the nurse include to describe pannus?

Vascular granulation tissue that destroys cartilage and bone

An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects?

Weight and nutritional status

The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first?

client with systemic lupus erythematosus reporting chest pain

Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?

elevated anti-nuclear antibodies (ANA)

Reiter syndrome is a reactive arthropathy. Reiter syndrome is associated with which disease?

gonorrhea

A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply.

• "I'm having a hard time opening doors since it hurts so bad." • "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands." • "Look how my hand is deformed. My doctor calls it hyperextension."

A rheumatology nurse is teaching a client about extra-articular signs and symptoms of rheumatoid arthritis (RA). Which item does the nurse include in the teaching session? Select all that apply.

• Fatigue • Loss of appetite • Temperature 99.3°F (37.4°C)

An otherwise healthy 35-year-old client has been admitted for treatment of active systemic lupus erythematosus (SLE) and is prescribed cyclophosphamide. What should the nurse include in the plan of care? Select all that apply.

• Inspecting oral mucosa • Avoiding invasive procedures • Monitoring urine output