Chapter 38: Assessment and Management of Patients with Rheumatic Disorders
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?
"The diagnosis won't be based on the findings of a single test but by combining all data found."
A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis?
"Client will exhibit no signs or symptoms of aspiration."
A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse?
"It is important that you continue to take your medication to avoid an acute exacerbation."
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?
"It will get better and worse again."
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
"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?
"My finger joints are oddly shaped."
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer?
"Pace yourself and rest frequently, especially after activities."
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."
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."
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 mL
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 mg
As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.
6.8 mg/dL (0.40 mmol/L)
Which client is most likely to develop systemic lupus erythematosus (SLE)?
A 27-year-old Black female
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
Administering ordered analgesics and monitoring their effects
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
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
Which of the following refers to fixation of a joint?
Ankylosis
Which term refers to fixation or immobility of a joint?
Ankylosis
Which of the following procedures involves a surgical fusion of the joint?
Arthrodesis
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?
Assess diet and activity at home
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?
Celecoxib
The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?
Chronic fatigue, generalized muscle aching, and stiffness
The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful?
Clients may develop Heberden nodes.
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?
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 nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?
Elevated erythrocyte sedimentation rate
Which is an appropriate nursing intervention in the care of the client with osteoarthritis?
Encourage weight loss and an increase in aerobic activity
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
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.
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?
Hand and finger deformities are associated with the development of rheumatoid arthritis.
Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?
Hypertension
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
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say 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.
Which points should be included in the medication teaching plan for a client taking adalimumab?
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.
Which joint is most commonly affected in gout?
Metatarsophalangeal
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 (Rheumatrex)
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?
Muscle biopsy
Which condition is the leading cause of disability and pain in the elderly?
Osteoarthritis (OA)
What intervention is a priority for a client diagnosed with osteoarthritis?
Physical therapy and exercise
A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply.
Positive C-reactive protein (CRP) Positive antinuclear antibody (ANA) Red blood cell (RBC) count of <4.0 million/mcL
Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues?
Scleroderma
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?
Sicca syndrome
Which of the following disorders is characterized by an increased autoantibody production?
Systemic lupus erythematosus (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 with food to avoid stomach upset.
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?
Tophi
Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?
Viscosupplementation
A client is recovering from an attack of gout. What will the nurse include in the client teaching?
Weight loss will reduce uric acid levels and reduce stress on joints.
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 nonsteroidal anti-inflammatory drugs (NSAIDs)
A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?
age
Which drug is not used in the treatment of rheumatoid arthritis?
allopurinol
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
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?
colchicine
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
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?
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
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?
eating organ meats and sardines
The nursing assessment findings reveal joint swelling and tenderness in the great toe of a client. What does the nurse suspect?
gout
A client comes to the clinic and reports pain in the right great toe which is worse at night. Assessment reveals tophi. What does the nurse suspect?
gouty 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?
increased fatigue
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
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?
located over bony prominence
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management?
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?
t'ai chi
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?
"The belief is that it is an autoimmune disorder with an unknown trigger."