N406 Exam 3 PREPU Unit 10

A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a. Renal calculi b. Urinary tract infection (UTI) c. Benign prostatic hyperplasia d. Dehydration

a. Renal calculi Rationale: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

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? a. pain b. joint swelling c. stiffness d. weakness

a. pain Rationale: 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.

The side effect of bone marrow depression may occur with which medication used to treat gout? a. Colchicine b. Allopurinol c. Probenecid d. Prednisone

b. Allopurinol Rationale: A client taking allopurinol needs to be monitored for the side effects of bone marrow depression, vomiting, and abdominal pain.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? a. aspirin b. furosemide c. colchicine d. calcium gluconate

c. colchicine Rationale: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a. Living a sedentary lifestyle to reduce the incidence of injury b. Stopping estrogen therapy c. Taking a 300-mg calcium supplement to meet dietary guidelines d. Initiating weight-bearing exercise routines

d. Initiating weight-bearing exercise routines Rationale: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply: a. Acute pain b. Disturbed body image c. Imbalanced nutrition: less than body requirements d. Risk for injury e. Ineffective airway clearance

a, b, c Rationale: Pain is a priority problem for the client with osteomyelitis that can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. A draining ulcer on the face can make the individual very self-conscious about appearance, leading to disturbed body image. This client is not at risk for injury or ineffective airway clearance.

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client? a. "Are you taking the medication as prescribed?" b. "Have you reduced the amount of daily exercise?" c. "Have you increased your intake of fat-soluble vitamins?" d. "Are you taking frequent rest periods throughout the day?"

a. "Are you taking the medication as prescribed?" Rationale: Medication adherence is critical but poor among clients prescribed urate lowering therapies for gout. Between acute episodes, the client feels well and may abandon medications and preventive behaviors, which may result in an acute attack. Asking about medication adherence is the appropriate. Exercise, fat-soluble vitamins, and rest periods will not increase the risk of having an attack of gout.

Which of the following procedures involves a surgical fusion of the joint? a. Arthrodesis b. Synovectomy c. Tenorrhaphy d. Osteotomy

a. Arthrodesis Rationale: 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 is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? a. Decrease in estrogen b. Increase in calcitonin c. Decrease in parathyroid hormone d. Increase of vitamin D

a. Decrease in estrogen Rationale: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

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

a. Facial erythema, pericarditis, pleuritis, fever, and weight loss Rationale: 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.

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

a. Systemic lupus erythematosus (SLE) Rationale: 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 with rheumatoid arthritis wants to try nonpharmacologic approaches to control the pain and stiffness. Which approaches will the nurse suggest that might improve the client's comfort and mobility? Select all that apply: a. Golfing b. Imagery c. Massage d. Self-hypnosis e. Chiropractic adjustments

b, c, d, e Rationale: Physical and occupational therapy programs and interventions are beneficial in improving physical activity and maintaining range of motion. Such interventions may include stretching exercises, massage, and chiropractic manipulation. Other strategies for decreasing pain include imagery and self-hypnosis. Golf is not identified as improving range of motion or improving discomfort.

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

b. An exercise routine that includes range-of-motion (ROM) exercises Rationale: 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.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? a. High-Fowler's to allow for maximum hip flexion b. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees c. Prone, with a pillow under the shoulders d. Supine, with the bed flat and a firm mattress in place

b. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Rationale: A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? a. Increase fiber in the diet b. Walk or perform weight-bearing exercises outdoors c. Reduce stress d. Decrease the intake of vitamin A and D

b. Walk or perform weight-bearing exercises outdoors Rationale: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? a. Yoga b. Walking c. Bicycling d. Swimming

b. Walking Rationale: Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? a. congenital deformity b. age c. trauma d. obesity

b. age Rationale: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

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

b. strategies for remaining active Rationale: 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? a. "Exposure to sunlight will help control skin rashes." b. "There are no activity limitations between flare-ups." c. "Monitor your body temperature." d. "Corticosteroids may be stopped when symptoms are relieved."

c. "Monitor your body temperature." Rationale: 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 nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? a. "You will need to decrease the amount of dairy products you consume." b. "You will need to avoid foods high in phosphorus and vitamin D." c. "You may need to be evaluated for an underlying cause, such as renal failure." d. "You will need to engage in vigorous exercise three times a week for 30 minutes."

c. "You may need to be evaluated for an underlying cause, such as renal failure." Rationale: The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

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

c. Elevated erythrocyte sedimentation rate Rationale: 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 presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? a. Avascular necrosis b. Fat embolism c. Osteomyelitis d. Compartment syndrome

c. Osteomyelitis Rationale: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.

A client arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean? a. fluid intake b. protein-rich foods c. purine-rich foods d. carbohydrates

c. purine-rich foods Rationale: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.

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? a. jogging b. running on a treadmill c. t'ai chi d. weight lifting

c. t'ai chi Rationale: T'ai chi is low impact, so this is the best exercise for low joint impact. Jogging, weight lifting, and running on a treadmill are high-impact, jarring types of exercise.

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

d. "There might be some difficulties with your plan and fasting." Rationale: 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.

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? a. Wound packing b. Wound irrigation c. Vitamin supplements d. Surgical debridement

d. Surgical debridement Rationale: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach? a. "Does exercise usually work for you?" b. "Why do you think the exercise didn't work?" c. "Do you think you are too old to exercise?" d. "What types of exercise were you doing?"

d. "What types of exercise were you doing?" Rationale: In an older adult with rheumatoid arthritis, exercise programs may not be instituted or may be ineffective because the client expects results too quickly or fails to appreciate the effectiveness of a program of exercise. Strength training is encouraged in the older adult with chronic diseases. The other questions will not help the nurse understand what type of exercise was used and what it was not effective for the client.

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a. The time of day when exercise is performed isn't important. b. Exercising in the evening before going to bed is beneficial. c. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. d. 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.

d. 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. Rationale: 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.

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

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

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? a. It is diagnostic for Sjögren's syndrome. b. It is diagnostic for systemic lupus erythematosus. c. It is specific for rheumatoid arthritis. d. It is suggestive of rheumatoid arthritis.

d. It is suggestive of rheumatoid arthritis. Rationale: Rheumatoid factor is present in about 70% to 80% of patients with rheumatoid arthritis, but its presence alone is not diagnostic of rheumatoid arthritis, and its absence does not rule out the diagnosis. The antinuclear antibody (ANA) test is used to diagnose Sjögren's syndrome and systemic lupus erythematosus.

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate? a. Keep shifting weight from one foot to the other. b. Perform aerobic exercises. c. Maintain complete bed rest. d. Maintain good posture.

d. Maintain good posture. Rationale: The nurse needs to remind the client with degenerative joint disease to maintain good posture. While the client need not maintain complete bed rest, performing aerobic exercises is not advisable as it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.

A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a. 6 months b. 3 months c. 7 to 10 days d. At least 4 weeks

d. At least 4 weeks Rationale: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.

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: a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) c. Red blood cell (RBC) count of >4.0 million/uL d. Red blood cell (RBC) count of <4.0 million/mcL e. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L

a, b, d Rationale: Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive.

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? a. joint stiffness that decreases with activity b. erythema and edema over the affected joint c. anorexia and weight loss d. fever and malaise

a. joint stiffness that decreases with activity Rationale: 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.

What food can the nurse suggest to the client at risk for osteoporosis? a. Carrots b. Broccoli c. Chicken d. Bananas

b. Broccoli Rationale: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a. Magnesium level b. Potassium level c. Alkaline phosphatase d. Troponin levels

c. Alkaline phosphatase Rationale: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? a. Calcium of 9.2 mg/dL (2.3 mmol/L) b. Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) c. Alkaline phosphate of 165 IU/L (2750 mmol/L) d. Magnesium level of 2 mg/dL (0.82 mmol/L)

c. Alkaline phosphate of 165 IU/L (2750 mmol/L) Rationale: The normal range for alkaline phosphate level is 20 to 140 IU/L. An elevated serum concentration of alkaline phosphate reflects increased osteoblastic activity and is seen in clients with Paget's disease. A calcium level of 9.2 (2.3 mmol/L) is normal. A urinary creatinine level of 0.95 mg/dL (83.98 mmol/L) is normal. A magnesium level of 2 mg/dL (0.82 mmol/L) is normal.

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about? a. azathioprine b. diclofenac c. hydroxychloroquine d. cyclophosphamide

c. hydroxychloroquine Rationale: The DMARD hydroxychloroquine is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmologic examinations every 6-12 months. Azathioprine, diclofenac, and cyclophosphamide do not have visual changes as a side effect.

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: a. 3.2 mg/dL (0.19mmol/L) b. 4.0 mg/dL (0.24 mmol/L) c. 5.4 mg/dL (0.32 mmol/L) d. 6.8 mg/dL (0.40 mmol/L)

d. 6.8 mg/dL (0.40 mmol/L) Rationale: Hyperuricemia, a serum uric acid concentration above 6.8 mg/dL (0.40 mol/L) can cause urate crystal deposition which can lead to gout.

The nurse is caring for a client with hypertension and scleroderma. Which medication will the nurse expect to be prescribed for this client? a. Diuretic b. Vasodilator c. Beta blocker d. Angiotensin-converting enzyme inhibitors

d. Angiotensin-converting enzyme inhibitors Rationale: Treatment of scleroderma is mainly symptomatic and supportive. No medication regimen is effective in modifying the disease process in scleroderma, but various medications are used to treat organ system involvement. The use of angiotensin-converting enzyme inhibitors when there is kidney involvement has led to a substantial decrease in mortality from hypertensive kidney disease. Diuretics, vasodilators, and beta blockers are not used to treat hypertension caused by scleroderma.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? a. Install safety devices in the home. b. Wear worn, comfortable shoes. c. Get help when lifting objects. d. Wear protective devices when exercising.

a. Install safety devices in the home Rationale: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises.

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? a. First thing in the morning when the client wakes b. After cool compresses have been applied to the hands c. After the client has had a warm paraffin hand bath d. After the client has a diagnostic test

c. After the client has had a warm paraffin hand bath Rationale: 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.

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

c. increased fatigue Rationale: 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.

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a. Rheumatoid arthritis b. Systemic lupus erythematosus c. Polymyalgia rheumatic d. Scleroderma

d. Scleroderma Rationale: 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. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply: a. Use relaxation exercises. b. Establish a set time to sleep every night. c. Avoid caffeine before bedtime. d. Create a quiet sleep environment. e. Take pain medications four hours before sleep.

a, b, c, d Rationale: Clients need restful sleep so that they can cope with pain, minimize physical fatigue, and deal with the changes related to having a chronic disease. In clients with acute disease, sleep time is frequently reduced and fragmented by prolonged awakenings. Recommendations to improve sleep include using relaxation exercises, establishing a set time to sleep, avoiding caffeine before bedtime, and creating a quiet sleep environment. Pain medications should be taken closer to sleep time so that they can work effectively for someone experiencing pain and stiffness due to rheumatoid disease.

A client with rheumatoid arthritis (RA) is prescribed a topical analgesic medication to help reduce joint pain. Which information will the nurse emphasize with the client about this medication? Select all that apply: a. Avoid areas of open skin. b. Use the medication sparingly. c. Avoid contact with mucous membranes. d. Wrap gauze over the area after applying. e. Wash hands after applying the medication.

a, b, c, e Rationale: Topical analgesics may be prescribed to help with pain management. The nurse should educate the client to avoid areas of open skin and use the medication sparingly. The client should be instructed to avoid contact with mucous membranes and wash the hands after applying the medication. There is no recommendation for use of gauze over topical application of analgesic cream. Some of the cream could be absorbed in the gauze and would work less effectively for the client.

The nurse is creating a teaching tool about rheumatoid arthritis. Which tests will the nurse include that are used to diagnose the condition? Select all that apply: a. X-rays b. Arthrography c. Ultrasound d. Computed tomography (CT) e. Magnetic resonance imaging (MRI)

a, b, d, e Rationale: Imaging studies are often used to diagnose rheumatic diseases. These tests include x-rays, arthrography, CT scans, and MRIs. Ultrasound would not be used as a diagnostic indicator for rheumatoid arthritis.

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? a. eating organ meats and sardines b. frequently drinking coffee c. high carbohydrate intake d. frequently ingesting salicylates

a. eating organ meats and sardines Rationale: 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 nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? a. Clients may have swan neck deformity. b. Clients may develop Heberden nodes. c. Clients will develop boutonniere deformity. d. Clients will have an ulnar deviation.

b. Clients may develop Heberden nodes. Rationale: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

Which term refers to fixation or immobility of a joint? a. Hemarthrosis b. Diarthrodial c. Arthroplasty d. Ankylosis

d. Ankylosis Rationale: Ankylosis is the fixation or immobility of a joint. It may result from a disease process or from 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 preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a. Open reduction b. Needle aspiration c. Arthroplasty d. Arthroscopy

d. Arthroscopy Rationale: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? a. Heart disease b. Vascular diseases c. Metabolic disorders d. Autoimmune disorders

d. Autoimmune disorders Rationale: A hallmark of inflammatory rheumatic diseases is autoimmunity, where the body mistakenly recognizes its own tissue as a foreign antigen. Although focused in the joints, inflammation and autoimmunity also involve other areas. The blood vessels (vasculitis and arteritis), lungs, heart, and kidneys may be affected by the autoimmunity and inflammation. It is unlikely that the client's array of symptoms is being caused by heart disease, vascular diseases, or metabolic disorders.

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? a. Antibiotics b. Anticoagulants c. Oral corticosteroids d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

d. Nonsteroidal anti-inflammatory drugs (NSAIDs) Rationale: NSAIDs are the first-line therapy for treating all spondyloarthropathies. Antibiotics and anticoagulants are not used to treat AS. Corticosteroid injections may be used for periodic flares; however, oral and long-term use of steroids is not recommended.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? a. small joint involvement b. joint pain that increases with rest c. subcutaneous nodules d. early morning stiffness

d. early morning stiffness Rationale: Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." b. "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." c. "OA affects joints on both sides of the body. RA is usually unilateral." d. "OA is more common in women. RA is more common in men."

a. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Rationale: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.

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

a. chronic fatigue, generalized muscle aching, and stiffness. Rationale: 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.

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? a. colchicine b. probenecid c. anturane d. allopurinol

a. colchicine Rationale: 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

Which group is at the greatest risk for osteoporosis? a. Men b. European American women c. Asian American women d. African American women

b. European American women Rationale: Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

Which aspect should a nurse include in the teaching plan for a client with osteomalacia? a. Avoid dairy products b. Include calcium, phosphorus, and vitamin D supplements c. Avoid green, leafy vegetables d. Avoid any activity or exercise

b. Include calcium, phosphorus, and vitamin D supplements Rationale: The nurse should encourage clients with osteomalacia to include calcium, phosphorus, and vitamin D supplements; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation. Clients need not avoid dairy products, leafy vegetables, or mild exercise.

Which client is most likely to develop systemic lupus erythematosus (SLE)? a. A 25-year-old White male b. A 25-year-old Jewish female c. A 27-year-old Black female d. A 35-year-old Hispanic male

c. A 27-year-old Black female Rationale: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more Black women than white women; its incidence is about 1 in every 250 Black women, compared to 1 in every 700 white women.

The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? a. Remission b. Exacerbation c. Inflammation d. Autoimmunity

c. Inflammation Rationale: In clients with chronic inflammation, the immune response can deviate from normal. Instead of resolution of swelling and joint pain once the triggering event has subsided, pannus, or proliferation of newly formed synovial tissue infiltrated with inflammatory cells, formation occurs. Destruction of the joint's cartilage and erosion of bone soon follow. Remission is a period when the symptoms of the condition are reduced or absent. Exacerbation is a period when the symptoms occur or increase. Autoimmunity causes tissue destruction which leads to pain.

Which condition is a metabolic bone disease characterized by inadequate mineralization of bone? a. Osteoporosis b. Osteomyelitis c. Osteomalacia d. Osteoarthritis

c. Osteomalacia Rationale: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft-tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

Primary prevention of osteoporosis includes: a. placing items within the client's reach. b. installing grab bars in the bathroom to prevent falls. c. optimal calcium intake and estrogen replacement therapy. d. using a professional alert system in the home in case a client falls when she's alone.

c. optimal calcium intake and estrogen replacement therapy. Rationale: Primary prevention of osteoporosis includes maintaining optimal calcium intake and using estrogen replacement therapy. Placing items within a client's reach, using a professional alert system in the home, and installing grab bars in bathrooms to prevent falls are secondary and tertiary prevention methods.

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a. "Use your continuous passive motion machine for 2 hours each day." b. "You need to perform weight-bearing exercises twice a week." c. "You need to limit the amount of protein and calcium in your diet." d. "You will receive IV antibiotics for 3 to 6 weeks."

d. "You will receive IV antibiotics for 3 to 6 weeks." Rationale: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

Which joint is most commonly affected in gout? a. Metatarsophalangeal b. Tarsal area c. Ankle d. Knee

a. Metatarsophalangeal Rationale: 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.

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? a. Methotrexate b. Celecoxib c. Methylprednisolone d. Mercaptopurine azathioprine

a. Methotrexate Rationale: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

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

a. Osteoarthritis (OA) Rationale: 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.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? a. Bisphosphonates b. Calcitonin c. Selective estrogen receptor modulators d. Anabolic agents

a. Bisphosphonates Rationale: Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? a. Calcitonin b. Raloxifene c. Teriparatide d. Vitamin D

a. Calcitonin Rationale: Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.

Which of the following inhibits bone resorption and promotes bone formation? a. Calcitonin b. Estrogen c. Parathyroid hormone d. Corticosteroids

a. Calcitonin Rationale: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

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

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

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a. Limited passive movement b. Joint enlargement c. Joint instability d. Limb shortening

a. Limited passive movement Rationale: Limited passive movement can be the first and only physical sign of symptomatic OA. Physical assessment of the musculoskeletal system reveals joint enlargement, joint instability, and limb shortening.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a. Raloxifene b. Fosamax c. Forteo d. Denosumab

a. Raloxifene Rationale: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client? a. "Don't go if your joints are inflamed." b. "Be sure to wear nonslip footwear for safety." c. "That's not the best activity for misaligned joints." d. "Have someone check your blood pressure before exercising."

b. "Be sure to wear nonslip footwear for safety." Rationale: Appropriate programs of exercise have been shown to decrease pain and improve function in rheumatoid arthritis. Pool exercises provide a buoyant medium for performance of dynamic or aerobic exercise and the water supports movement while warm water provides muscle relaxation. The client should be reminded to wear nonslip footwear for safety and comfort. Range of motion exercises should not be done if the joints are inflamed. Dynamic exercise is not the best for unstable or misaligned joints. Blood pressure should be checked before engaging in isometric exercises.

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? a. "This disorder is more common in men in their thirties and forties than in women." b. "The belief is that it is an autoimmune disorder with an unknown trigger." c. "SLE has very specific manifestations that make diagnosis relatively easy." d. "The symptoms are primarily localized to the skin but may involve the joints."

b. "The belief is that it is an autoimmune disorder with an unknown trigger." Rationale: 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.

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? a. "You should discuss that matter with your health care provider." b. "The diagnosis won't be based on the findings of a single test but by combining all data found." c. "SLE is a very serious systemic disorder." d. "Tell me more about your concerns about this potential diagnosis."

b. "The diagnosis won't be based on the findings of a single test but by combining all data found." Rationale: 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 nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? a. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. b. To prevent fractures, the client should avoid strenuous exercise. c. The recommended daily allowance of calcium may be found in a wide variety of foods. d. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

c. The recommended daily allowance of calcium may be found in a wide variety of foods. Rationale: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? a. The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. b. The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. c. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. d. The nurse is caring for this client on the intensive care unit.

d. The nurse is caring for this client on the intensive care unit. Rationale: This client is critically ill; the diagnosis and immunosuppression place the client at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.