Chapter 38: Assessment and Management of Patients With Rheumatic Disorders

A health care provider orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? Increased total serum complement levels Negative antinuclear antibody test Negative lupus erythematosus cell test An above-normal anti-deoxyribonucleic acid (DNA) test

An above-normal anti-deoxyribonucleic acid (DNA) test Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE.

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

Take the medication with food to avoid stomach upset. Ibuprofen is a nonsteroidal anti-inflammatory drug. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. Ibuprofen is available over the counter, but it still has side effects. Aspirin is known to cause ringing in the ears, not NSAIDs.

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

"Monitor your body temperature." The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

Which of the following procedures involves a surgical fusion of the joint? Arthrodesis Synovectomy Tenorrhaphy Osteotomy

Arthrodesis An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint.

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

Gout The presence of crystals is indicative of gout; the presence of bacteria is indicative of infective arthritis.

Which points should be included in the medication teaching plan for a client taking adalimumab? The medication is administered intramuscularly. 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.

It is important to monitor for injection site reactions. It is important to monitor for injection site reactions when taking adalimumab. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.

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

Osteoarthritis (OA) OA is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

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

Physical therapy and exercise Clients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and allopurinol are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care.

Primary gout is often caused by an inherited disorder in which type of metabolism? c Carbohydrate Fat Glucose

Purine Carbohydrate Fat Glucose Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism.

Which of the following disorders is characterized by an increased autoantibody production? Systemic lupus erythematosus (SLE) Scleroderma Rheumatoid arthritis (RA) Polymyalgia rheumatic

Systemic lupus erythematosus (SLE) SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition? applications of ice encouraging the client to eat a healthy diet avoiding caffeine and alcohol regular exercise and stress reduction

applications of ice Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan.

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 anturane allopurinol

colchicine The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Colchicine, along with indomethacin, ibuprofen, or a corticosteroid, is prescribed to relieve an acute attack of gout. Probenecid and anturane increase the urinary excretion of uric acid, and allopurinol breaks down purines before uric acid is formed.

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

Assistive devices Safe exercise Medication dosages and side effects The client with rheumatoid arthritis who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints, walkers, and canes, may assist the client to perform safe self-care. Narcotics are not commonly used, and there would be no reason for dressings.

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 joint swelling stiffness weakness

pain The symptom that most commonly causes a person to seek medical attention is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities? prone semi-Fowler's position side-lying with pillows supporting the shoulders and legs supine with pillows under the knees

prone It is best for the client with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture. Semi-Fowler's position, side-lying with pillows, and supine with pillows are positions that have hip flexion.

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 Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Weight gain, hypervigilance, hypothermia, and edema of the legs Hypothermia, weight gain, lethargy, and edema of the arms

Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the most common finding associated with fibromyalgia? Heberden nodes jaw locking widespread chronic pain butterfly facial rash

widespread chronic pain The most common finding associated with fibromyalgia is widespread and chronic pain. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus.

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

Elevated erythrocyte sedimentation rate The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.

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? Glucosuria Hyperuricemia Hyperproteinuria Ketonuria

Hyperuricemia Gout is caused by hyperuricemia (increased serum uric acid).

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

The client with rheumatoid arthritis who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints, walkers, and canes, may assist the client to perform safe self-care. Narcotics are not commonly used, and there would be no reason for dressings.

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

An exercise routine that includes range-of-motion (ROM) exercises Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain.

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

Assess diet and activity at home

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

Hypertension Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

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

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

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

is the most common and frequently disabling of joint disorders affects young males. The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.

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 erythema and edema over the affected joint anorexia and weight loss fever and malaise

joint stiffness that increases with activity A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that increases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? low back pain increased urine output red, butterfly-shaped facial rash patchy hair loss on the scalp

low back pain The most common symptoms of ankylosing spondylitis are low back pain and stiffness. A red, butterfly-shaped rash on the face and a patchy loss of hair are associated with systemic lupus erythematosus. Ankylosing spondylitis does not affect urine output.

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

strategies for remaining active The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? "Do all your chores in the morning, when pain and stiffness are least pronounced." "Do all your chores after performing morning exercises to loosen up." "Pace yourself and rest frequently, especially after activities." "Do all your chores in the evening, when pain and stiffness are least pronounced."

"Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.