Chapter 38: Assessment and Management of Patients With 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 symptoms are primarily localized to the skin but may involve the joints." "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." "SLE has very specific manifestations that make diagnosis relatively easy."

"The belief is that it is an autoimmune disorder with an unknown trigger." Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? "You have antigens to the disease, but they do not prevent the disease." "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."

"Your symptoms are a result of your body attacking itself." In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other statements do not explain autoimmunity.

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 25 mg/50 mg per mL = 0.5 mL.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Administering ordered analgesics and monitoring their effects 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 Performing meticulous skin care

Administering ordered analgesics and monitoring their effects An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? After the client has had a warm paraffin hand bath After cool compresses have been applied to the hands First thing in the morning when the client wakes After the client has a diagnostic test

After the client has had a warm paraffin hand bath Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises.

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 Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) Cold therapy Acupuncture

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.

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

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

Assess diet and activity at home Clients with gout need to be educated about dietary restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a client with this problem.

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? Exercising in the evening before going to bed is beneficial. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. The time of day when exercise is performed isn't important. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy.

Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

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 albumin levels Elevated erythrocyte sedimentation rate Increased C4 complement

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 client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout? Elevated uric acid levels Decreased hemoglobin and hematocrit Elevated white blood count Increased AST and ALT

Elevated uric acid levels Gout is characterized by hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. An elevated white blood count may be indicative of any inflammatory response and is not specific to gout. A decreased hemoglobin and hematocrit may indicate bleeding from somewhere in the body. Increased AST and ALT would indicate liver dysfunction.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? Provide an analgesic after exercise Avoid the use of topical analgesics Encourage weight loss and an increase in aerobic activity Assess for gastrointestinal complications associated with COX-2 inhibitors

Encourage weight loss and an increase in aerobic activity Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methyl salicylate may be used for pain management.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Weight gain, hypervigilance, hypothermia, and edema of the legs Facial erythema, pericarditis, pleuritis, fever, and weight loss Photosensitivity, polyarthralgia, and painful mucous membrane ulcers 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.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? So the client has strong drug therapy For their immunosuppressant effects To decrease the body's risk of infection Because an autoimmune disease is a neoplastic disease

For their immunosuppressant effects Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

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. 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.

Hand and finger deformities are associated with the development of rheumatoid arthritis. The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease.

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? Tophi Rheumatoid nodules Heberden's nodes Bouchard's nodes

Heberden's nodes DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden's nodes are bony enlargement of the distal interphalangeal joints. Bouchard's nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels.

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

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

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

Metatarsophalangeal The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

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

Osteoarthritis (OA) Osteoarthritis 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? Hydrotherapy Allopurinol Colchicine Physical therapy and exercise

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.

The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. What should the nurse include in the teaching plan? Take all antibiotics until they are gone. Avoid sunlight and ultraviolet light. Protect the hands and feet from cold. Perform weight-bearing exercises daily.

Protect the hands and feet from cold. Raynaud's phenomenon is associated with scleroderma. Client teaching must include strategies for protecting the feet and hands.

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is? Cataracts Episcleritis Sicca syndrome Glaucoma

Sicca syndrome Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye.

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

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 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. Inform the health care provider if there is ringing in the ears. Take the medication with food to avoid stomach upset.

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.

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

Tophi Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity.

A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce inflammation. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will increase uric acid levels and reduce stress on joints. Weight loss will reduce purine levels.

Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? penicillamine methotrexate prednisone colchicine

colchicine Colchicine is prescribed for the treatment of an acute attack of gout.

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? probenecid anturane allopurinol colchicine

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.

Osteoarthritis is known as a disease that affects young males. 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.

is the most common and frequently disabling of joint disorders. 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? erythema and edema over the affected joint joint stiffness that decreases with activity anorexia and weight loss fever and malaise

joint stiffness that decreases with activity A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases 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 red, butterfly-shaped facial rash increased urine output 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.

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia rarely respond to treatment. will eventually lose their ability to walk. all have the same type of symptoms. may feel as if their symptoms are not taken seriously.

may feel as if their symptoms are not taken seriously. Because clients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose them. Clients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from client to client and respond to different treatments. Clients do not lose their ability to walk.

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 weakness joint swelling stiffness

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 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 Ketonuria Hyperproteinuria Glucosuria

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

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? "It will never get any better than it is right now." "I'll definitely need surgery for this." "It will get better and worse again." "When it clears up, it will never come back."

"It will get better and worse again." The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.

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." "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." "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." There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the health care provider, stating that SLE is a serious systemic disorder, and asking the client to express feelings about the potential diagnosis do not answer the client's question.

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? "Try combining the fasting with moderate exercise." "The fasting is okay, but make sure you drink fluids when exercising." "Make sure to eat some fat occasionally with all that exercise." "There might be some difficulties with your plan and fasting."

"There might be some difficulties with your plan and fasting." Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.

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

Ankylosis Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

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? Tolmetin sodium Piroxicam Ibuprofen Celecoxib

Celecoxib The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

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

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

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include 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. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. Avoid sunlight and ultraviolet radiation. Pace activities.

If you have problems with a medication, you may stop it until your next physician visit. Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds? Crackles in the bases Pericardial friction rub Rhonchi Lung sounds are diminished in the apical area.

Lung sounds are diminished in the apical area. The lumbar curve of the spine may flatten. The neck can be permanently flexed, and the client appears to be in a perpetual stooped position. Aortic regurgitation or atrioventricular node conduction disturbances may occur. Lung sounds may be reduced, especially in the apical area. The nurse would not hear rhonchi, crackles, or a pericardial friction rub unless the client had underlying cardiac or respiratory disorders.

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

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.

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease? Inspect the client's mouth. Auscultate the client's lung sounds. Review the client's medical record. Observe the client's gait.

Review the client's medical record. The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.

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? avoiding caffeine and alcohol regular exercise and stress reduction encouraging the client to eat a healthy diet applications of ice

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.

Fibromyalgia is a common condition that involves pain, viral infection, and tremors. diminished vision, chronic fatigue, and reduced appetite. chronic fatigue, generalized muscle aching, and stiffness. generalized muscle aching, mood swings, and loss of balance.

chronic fatigue, generalized muscle aching, and stiffness. Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown, and no pathological characteristics specific for the condition have been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals.

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? frequently drinking coffee high carbohydrate intake frequently ingesting salicylates eating organ meats and sardines

eating organ meats and sardines During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. The other listed factors do not worsen attacks.

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of inflammation. gout. infection. degeneration.

gout. The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.

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? a weight gain of 2 pounds decreased joint pain increased fatigue ability to perform activities of daily living (ADL)

increased fatigue Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? reddened located over bony prominence nonmovable tender to the touch

located over bony prominence Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.

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 detection of systemic complications strategies for remaining active

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 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." "Monitor your body temperature." "Corticosteroids may be stopped when symptoms are relieved." "There are no activity limitations between flare-ups."

"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.

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." "My legs feel weak." "I have pain in my hands." "I have trouble with my balance."

"My finger joints are oddly shaped." Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.

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 evening, when pain and stiffness are least pronounced." "Pace yourself and rest frequently, especially after activities." "Do all your chores after performing morning exercises to loosen up." "Do all your chores in the morning, 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.