Ch. 50 Disorders of Musculoskeletal Function: Rheumatic Disorders
A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which etiology is responsible for his health problem? A. Infection B. Friction between bones C. Immune response D. Inappropriate bone remodeling
Answer: C
An 8-year-old child has just been diagnosed with juvenile idiopathic arthritis (JIA). The parents ask the nurse about the prognosis for this condition. What is the nurse's best response? A. This condition is similar to rheumatoid arthritis in adults with both joint and systemic effects. B. With nonsteroidal anti-inflammatory and antirheumatic medications the prognosis is excellent. C. The prognosis is dependent on the type of JIA with which your child has been diagnosed. D. This type of arthritis involves moderate joint pain without impeding your child's mobility.
Answer: C
A child has just been diagnosed with systemic lupus erythematosus (SLE). Which assessment finding would be considered the most accurate prognostic indicator of the extent/seriousness of the disease? A. Complaints of arthralgias and arthritis in joints with movement. B. Ligaments and tendons hurt during passive ROM. C. Has a rash on the nose and cheeks. D. Rust/blood-colored urine.
Answer: D
A new client arrives at the clinic. The physician is suspecting the client may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and history of pleural effusions. The nurse should anticipate which diagnostic test will be a priority to facilitate with the diagnosis? A. Anti-DNA antibody test. B. Routine hemoglobin. C. C-reactive protein. D. B-cell lymphocytes.
Answer: A
Which individual is most likely to develop a form of reactive arthritis? A. A 24-year-old male who completed treatment for a chlamydia infection 1 year ago. B. A 46-year-old female who has a longstanding diagnosis of systemic lupus erythematosus. C. A 3-year-old girl who was born with a 20° congenital scoliosis. D. A 79-year-old male who had a total hip replacement 2 months prior.
Answer: A
Which pathophysiologic phenomenon would be most indicative of ankylosing spondylitis? A. Loss of motion in the spinal column and eventual kyphosis. B. A progressive loss of range of motion in knee and hip joints. C. A facial "butterfly rash" and multi-organ involvement. D. Decreased bone density in long bones.
Answer: A
A client returns to the clinic for review of previous laboratory values. A diagnose of ankylosing spondylitis (AS) is made, based on laboratory results and manifestations of low back pain which worsens when resting, thigh pain like that of sciatica, and morning stiffness. Which educational teaching would be appropriate for the nurse to provide? Select all that apply. A. Proper posture B. Use of firm mattress with one small pillow C. Muscle-strengthening exercises for extensor muscle group D. Immobilizing of joints that are sore when moved E. Education on first-line treatment disease-modifying antirheumatic drugs (DMARDs)
Answer: A, B, C
The nurse is creating a teaching plan on self-management for a client with moderate rheumatoid arthritis. What should the nurse include in the teaching plan? Select all that apply. A. Use of heat or cold on joints B. Techniques to reduce joint use C. Reduced sodium diet D. Use of assistive devices E. Joining a gym with a personal trainer
Answer: A, B, D
A client being investigated for systemic lupus erythematosus (SLE) has an elevated antinuclear antibody result and asks the nurse what this means. What is the nurse's best response? A. This test, combined with your symptoms, is used to determine if you have SLE. B. Antinuclear antibodies are decreased in SLE rather than elevated, so this result is encouraging. C. This test will be repeated in 3 months. If it is still elevated, it supports a diagnosis of SLE. D. This is a nonspecific marker for autoimmune activity, so you will require additional tests.
Answer: D
A health care provider is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which assessment and history findings correlate with SLE? Select all that apply. A. The client has a "butterfly rash" on her nose and cheeks. B. She complains of intermittent joint pain. C. The woman states that she has numerous environmental allergies. D. The client has been hospitalized twice in the past for pleural effusions. E. Blood work indicates low red cells, white cells, and platelets.
Answer: A, B, D, E
When educating the client with ankylosing spondylitis, the nurse should emphasize which treatment interventions? Select all that apply. A. Encourage sleeping supine on an extra firm mattress if possible. B. Prop self up in bed with extra pillows if having respiratory congestion. C. Try using the heating pad prior to exercise to help stretching and improve movement. D. Wear a knee immobilizer while biking to facilitate ability to exercise for longer periods. E. Modify diet to include more protein from red meats and green vegetables for vitamin K.
Answer: A, C
A client with rheumatoid arthritis has been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory result(s) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply. A. Platelet count 10,000/μL (100 ×109 /L) B. Creatinine level of 2.4 mg/dL (212.16 μmol/L) C. Red blood cell count of 8.0 ×106 /μL (8.0 ×1012/L) D. Potassium level of 3.8 mEq/L (3.8 mmol/L) E. Absolute neutrophil count of 500/μL (0.50 ×109 /L)
Answer: A, C, E
A nurse is working on a health care cost analysis related to total knee arthroplasty in the treatment of osteoarthritis. What should the nurse cite as a priority reason to reduce surgery wait times for clients requiring joint replacement? A. The pain clients experience while waiting creates unneeded suffering and loss of productivity. B. Stress placed on joints while awaiting surgery can increase the need for additional surgeries. C. The surgery is less likely to result in complications if performed before joint damage occurs. D. Clients are more likely to seek legal action due to delays, increasing lawsuit costs.
Answer: B
Due to her progressing osteoarthritis (OA), an 80-year-old woman is no longer able to perform her activities of daily living without assistance. Which phenomeon most likely underlies the woman's situation? A. Inappropriate T-cell mediated immune responses have resulted in articular cartilage degeneration. B. Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. C. Excessive collagen deposits have accumulated in the woman's synovial joints. D. Bone overgrowth in synovial joints has resulted in fusing of adjacent bones that normally articulate.
Answer: B
During assessment of a client with systemic lupus erythematosus (SLE), the nurse hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the nurse document in the medical records and report to the health care provider? A. Pleural effusion B. Pericarditis C. Pneumonia D. Vasculitis
Answer: B
Though the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A. Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B. The woman complains of aching and morning stiffness in her neck, shoulder and pelvis. C. Range-of-motion in the woman's wrists and ankles is greatest in the morning and decreases over the course of a day. D. The woman's metatarsal joints are inflamed and sensitive to touch.
Answer: B
While reviewing the following diagnostic findings on a group of clients with joint complaints, which finding would be a priority for further investigation and possible medical intervention? A. A male client has elevated levels of serum uric acid but lacks symptoms. B. Synovial fluid aspiration indicates the presence of monosodium urate crystals. C. A man reveals that he eats organ meat 2 to 3 times weekly. D. A 55-year-old male reveals that it takes a day or two for oral colchicines to relive his attacks of gout.
Answer: B
The nurse is planning care for a client with ankylosing spondylitis (AS). Which interventions should the nurse include in the plan of care? Select all that apply. A. Application of splints to reduce joint use B. Application of heat to involved joints C. Physiotherapy consult D. Administration of analgesics E. Placing client on an alternating pressure mattress
Answer: B, C, D
A male client has just been diagnosed with hyperuricemia following multiple flare-ups of his metatarsophalangeal joint associated with severe pain and swelling that is affecting his sleep. The nurse should anticipate that which medications may be prescribed for this client? Select all that apply. A. Acetaminophen for the pain. B. Allopurinol to decrease uric acid levels. C. Calcium carbonate used to increase the intake of calcium. D. Sulfinpyrazone to increase excretion of urate. E. Sevelamer to reduce the absorption of phosphate.
Answer: B, D
The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a client with rheumatoid arthritis (RA). Which statement is accurate about the advantages of using a TNF inhibitor? A. Since TNF inhibitors have few side effects, these drugs will fit well into your regimen. B. Your disease-modifying antirheumatic drug (DMARD) methotrexate has more cardiovascular side effects than TNF inhibitors. C. TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL functions. D. Not only do TNF inhibitors control your disease better, they also will interrupt the inflammatory cascade at several levels.
Answer: C
While speaking to a senior citizen club about osteoarthritis (OA), which facts are accurate to share? A. By the time people reach their 50s, about 50% of adults will have some form of OA. B. Men usually get OA in their hands whereas women get OA primarily in their hips. C. Obesity in women has been correlated to having OA in the knees. D. Heredity does not play a significant role in the development of OA.
Answer: C
A 36-year-old female who has experienced diverse symptoms for several years has finally had her health problems attributed to scleroderma (systemic sclerosis), and has committed herself to learning as much about the disease as she can. Which statement would her nurse want to correct or clarify? A. "I'm surprised that in this day and age they still don't know what causes scleroderma." B. "I suppose this explains why I have such terrible circulation to my hands and feet." C. "I'm scared by the damage that this could cause to my heart and lungs." D. "The worst part of this so far has been learning that there aren't any treatments for scleroderma."
Answer: D
A 64-year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which statement by the client would necessitate further teaching? A. "I'm really trying to lose weight and I've been able to lose 15 pounds this year so far." B. "I've been doing muscle strengthening exercises twice a week at the community center near my house." C. "Even though I don't like it, I've been using my walker to take some of the weight off my knees." D. "I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."
Answer: D
Following a progressive onset of fatigue, aching, and joint stiffness over the last two years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which teaching point should his primary care physician include during the office visit in which this diagnosis is communicated to the client? A. "The symptoms you've been experiencing are the result of damage inside your joints, but I'll start you on medications that will reverse this damage." B. "It's important that you maximize your level of activity, since decreasing your mobility will worsen the disease." C. "The best treatment plan is to try all other available treatments before resorting to using medications." D. "Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."
Answer: D
When working with a client with diffuse scleroderma who is exhibiting a 'stone face' expression, the nurse should consider which of these two to be a priority nursing diagnosis for this client? A. Ineffective tissue perfusion related to tightening of the facial skin. B. Activity intolerance related to muscle tightening in lower extremities. C. Oral mucous membrane, impaired due to restricted motion of the mouth. D. Risk for aspiration related to swallowing impairments.
Answer: D