PrepU Ch 38: Rheumatic Disorders

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. Maintain complete bed rest. b. Keep shifting weight from one foot to the other. c. Perform aerobic exercises. 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 nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a. Photosensitivity, polyarthralgia, and painful mucous membrane ulcers b. Hypothermia, weight gain, lethargy, and edema of the arms c. Facial erythema, pericarditis, pleuritis, fever, and weight loss d. Weight gain, hypervigilance, hypothermia, and edema of the legs

c. 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.

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms? a. Chronic fatigue, generalized muscle aching, and stiffness b. Diminished vision, chronic fatigue, and reduced appetite c. Generalized muscle aching, mood swings, and loss of balance d. Pain, viral infection, and tremors

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 pathologic 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 assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) a. Decreased ventilation owing to lung scarring b. Dysphagia owing to hardening of the esophagus c. Butterfly-shaped rash on the face d. Dyspnea owing to fibrotic cardiac tissue e. Productive cough

a. Decreased ventilation owing to lung scarring b. Dysphagia owing to hardening of the esophagus d. Dyspnea owing to fibrotic cardiac tissue Rationale: The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur.

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

a. 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.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a. Administering ordered analgesics and monitoring their effects b. Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware c. Performing meticulous skin care d. Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes

a. Administering ordered analgesics and monitoring their effects Rationale: 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.

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? a. ibuprofen b. sulfasalazine c. celecoxib d. methotrexate

c. celecoxib Rationale: The cyclooxygenase-2 inhibitors, such as celecoxib, have been shown to inhibit inflammatory processes but do not inhibit the protective prostaglandin synthesis in the gastrointestinal (GI) tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with celecoxib. Ibuprofen, methotrexate, and sulfasalazine may cause GI irritation.

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. Wear worn, comfortable shoes. b. Install safety devices in the home. c. Wear protective devices when exercising. d. Get help when lifting objects.

b. 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 assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client? a. asymmetric joint involvement b. small joint involvement c. Bouchard's nodes d. obesity

b. small joint involvement Rationale: Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur over time. Obesity, Bouchard's nodes, and asymmetric joint involvement can be seen with the early stage of the disease.

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

b. 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.

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. It's impossible to determine at the time of diagnosis how the disease will progress. b. Hand and finger deformities are associated with the development of rheumatoid arthritis. c. A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. d. The client should discuss this concern with the health care provider.

b. Hand and finger deformities are associated with the development of rheumatoid arthritis. Rationale: 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.

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

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

c. 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.

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

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

b. 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.

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

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

A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects? a. aspirin b. celecoxib c. methotrexate d. hydroxychloroquine

a. aspirin Rationale: Salicylates like aspirin may have side effects such as tinnitus, gastric intolerance and bleeding. While celecoxib, methotrexate, and hydroxychloroquine have GI upset effects, the tinnitus is unique to aspirin.

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

d. 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 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? a. Celecoxib b. Piroxicam c. Tolmetin sodium d. Ibuprofen

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

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as? a. Swan neck deformity b. Boutonnière deformity c. Rheumatoid nodules d. Ulnar deviation

a. Swan neck deformity Rationale: A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule.

Which finding is consistent with the diagnosis of rheumatoid arthritis? a. Increased red blood cell count b. Increased C4 complement component c. Cloudy synovial fluid d. Decreased ESR

c. Cloudy synovial fluid Rationale: In a client with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.

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.

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

b. 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 a new onset of gout. What medication does the nurse anticipate will be ordered by the health care provider? a. allopurinol b. colchicine c. probenecid d. anturane

b. 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.

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

b. "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.

Which points should be included in the medication teaching plan for a client taking adalimumab? a. The medication is administered intramuscularly. b. It is important to monitor for injection site reactions. c. The medication is given at room temperature. d. The client should continue taking the medication if fever occurs.

b. It is important to monitor for injection site reactions. Rationale: 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.

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. "SLE has very specific manifestations that make diagnosis relatively easy." c. "The symptoms are primarily localized to the skin but may involve the joints." d. "The belief is that it is an autoimmune disorder with an unknown trigger."

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

a. 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 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.

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

b. 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.

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

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

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a. Bone scan b. Magnetic resonance imaging (MRI) c. Computed tomography (CT) d. Muscle biopsy

d. Muscle biopsy Rationale: As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity.

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? a. "My legs feel weak." b. "I have pain in my hands." c. "My finger joints are oddly shaped." d. "I have trouble with my balance."

c. "My finger joints are oddly shaped." Rationale: 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 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? a. encouraging the client to eat a healthy diet b. regular exercise and stress reduction c. applications of ice d. avoiding caffeine and alcohol

c. applications of ice Rationale: 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.

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? a. reactive arthritis b. rheumatoid arthritis c. gouty arthritis d. osteoarthritis

c. gouty arthritis Rationale: Gout results from the inability to metabolize purines. This condition is most commonly seen in men and usually affects the legs, feet, and knees. Osteoarthritis is caused by degeneration of the joints. Rheumatoid arthritis is a systemic disorder more common in women of childbearing age. Reactive arthritis is seen with infections and is most common in young adult males.

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

b. 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.

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

a. 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 is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease? a. Review the client's medical record. b. Auscultate the client's lung sounds. c. Observe the client's gait. d. Inspect the client's mouth.

a. Review the client's medical record. Rationale: 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.

Which drug is not used in the treatment of rheumatoid arthritis? a. methotrexate b. allopurinol c. adalimumab d. etanercept

b. allopurinol Rationale: Allopurinol is used in the treatment of gout. Etanercept, adalimumab, and methotrexate are all used in the treatment of rheumatoid arthritis.

The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis? a. Clients may develop Heberden nodes. b. Clients will have an ulnar deviation. c. Clients will develop boutonniere deformity. d. Clients may have swan neck deformity.

a. 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.

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

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

A client 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. hydroxychloroquine b. azathioprine c. diclofenac d. cyclophosphamide

a. 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.

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

a. "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.

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

a. Physical therapy and exercise Rationale: 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.

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

d. Take the medication with food to avoid stomach upset. Rationale: 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.

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

d. is the most common and frequently disabling of joint disorders. Rationale: 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 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. After cool compresses have been applied to the hands b. After the client has a diagnostic test c. After the client has had a warm paraffin hand bath d. First thing in the morning when the client wakes

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.

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? a. "Be sure to let the physician know after you stop your medications." b. "If you don't take your medication, you will become very ill." c. "It is important that you continue to take your medication to avoid an acute exacerbation." d. "As long as you are not having symptoms, you can take a medication vacation."

c. "It is important that you continue to take your medication to avoid an acute exacerbation." Rationale: Even with remission, most people must continue taking prescribed medications to avoid another acute exacerbation. The client should be encouraged to maintain the therapeutic regimen in order to avoid an exacerbation and prolong the period of remission as long as possible. If the client is considering the discontinuation of the medication, he should notify the physician prior. The nurse is not at liberty to allow the client to discontinue medication use. Informing the client he will become ill if he discontinues the medication does not inform them of the rationale.

A client with early stage rheumatoid arthritis asks the nurse what to do to help ease the symptoms of the disease. What would be the best response by the nurse? a. "The health care provider could prescribe antihypertensive drugs." b. "The health care provider could prescribe antipyretic drugs." c. "The health care provider could prescribe anti-inflammatory drugs." d. "The health care provider could prescribe antineoplastic drugs."

c. "The health care provider could prescribe anti-inflammatory drugs." Rationale: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Antipyretic and antihypertensive drugs are not prescribed for autoimmune diseases. An antineoplastic drug is not ordered for an autoimmune disorder until it is in its' late stages and uncontrolled by the first line drugs.

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

c. Encourage weight loss and an increase in aerobic activity Rationale: 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.

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. Infliximab (Remicade) b. Methylprednisolone (Medrol) c. Methotrexate (Rheumatrex) d. Etanercept (Enbrel)

c. Methotrexate (Rheumatrex) Rationale: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Etanercept and Infliximab are TNF-alpha inhibitors that reduce pain and inflammation. Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? a. Sjögren's syndrome b. Reiter's syndrome c. Ankylosing spondylitis d. Raynaud's phenomenon

d. Raynaud's phenomenon Rationale: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.

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

d. 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.

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a. Reports ability to perform ADLs b. Shows increased joint flexibility c. Reports decreased joint pain d. Has a weight gain of 5 pounds

d. Has a weight gain of 5 pounds Rationale: Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.

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? a. Avoid sunlight and ultraviolet radiation. b. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. c. Pace activities. d. If you have problems with a medication, you may stop it until your next physician visit.

d. If you have problems with a medication, you may stop it until your next physician visit. Rationale: 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.

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

d. Osteoarthritis (OA) Rationale: 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 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? a. Sicca syndrome b. Glaucoma c. Cataracts d. Episcleritis

a. Sicca syndrome Rationale: 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.

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

b. "Pace yourself and rest frequently, especially after activities." Rationale: 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.