143 Mod 4 - Rheumatic Diseases (PRACTICE QUESTIONS)

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. Safe exercise C. Dressing changes D. Medication dosages and side effects E. Narcotic safety

A, B, D. 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 newly diagnosed with rheumatoid arthritis. For which medications will the nurse prepare teaching for this client? Select all that apply. A) Prednisone B) Aspirin C) Ibuprofen D) Acetaminophen E) Methotrexate

A, C, E. Once the diagnosis of RA is made, treatment should begin with either a nonbiologic or biologic disease-modifying antirheumatic drugs (DMARD). The goal of using DMARD therapy is preventing inflammation and joint damage. Recommended treatment guidelines include beginning with the nonbiologic DMARD methotrexate as the preferred agent. Ibuprofen may be prescribed as an analgesic however must be used with caution because of the risk of gastric ulcer. Corticosteroids are recommended as a 'bridge' in the early treatment but are not recommended for long term therapy due to side effects. Aspirin and acetaminophen are not identified as medications used to treat the symptoms of RA.

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. Performing meticulous skin care C. Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes D. Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

A. 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's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with which health problem? A. Rheumatoid arthritis (RA) B. Systemic lupus erythematosus (SLE) C. Osteoporosis D. Polymyositis

ANS: A Rationale: In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.

A nurse is planning client education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect? A. Tinnitus B. Visual changes C. Stomatitis D. Hirsutism

ANS: B Rationale: Antimalarials may cause visual changes; regular ophthalmologic examinations are necessary. Tinnitus is associated with salicylate therapy and hirsutism is associated with corticosteroid therapy. Antimalarials do not normally cause stomatitis.

A client with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the client appears to have lost some ability to function since the last office visit. What is the nurse's most appropriate action? A. Arrange a family meeting in order to explore assisted living options. B. Refer the client to a support group. C. Arrange for the client to be assessed in the home environment. D. Refer the client to social work.

ANS: C Rationale: Assessment in the client's home setting can often reveal more meaningful data than an assessment in the health care setting. There is no indication that assisted living is a pressing need or that the client would benefit from social work or a support group.

A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A. Cool joints with decreased range of motion B. Signs of systemic infection C. Joint stiffness lasting longer than 1 hour, especially in the morning D. Visible atrophy of the knee and shoulder joints

ANS: C Rationale: In addition to joint pain and swelling, another classic sign of RA is joint stiffness lasting longer than 1 hour, especially in the morning. Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often warm rather than cool.

A client's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary provider has added prednisone to the client's drug regimen. What principle will guide this aspect of the client's treatment? A. The client will need daily blood testing for the duration of treatment. B. The client must stop all other drugs 72 hours before starting prednisone. C. The drug should be used at the highest dose the client can tolerate. D. The drug should be used for as short a time as possible.

ANS: D Rationale: Corticosteroids are used for shortest duration and at lowest dose possible to minimize adverse effects. Daily blood work is not necessary and the client does not need to stop other drugs prior to using corticosteroids.

A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On which aspect of the client's health should the nurse focus most closely during the visit? A. Understanding of rheumatoid arthritis B. Risk for cardiopulmonary complications C. Social support system D. Functional status

ANS: D Rationale: The client's functional status is a central focus of home assessment of the client with RA. The nurse may also address the client's understanding of the disease, complications, and social support, but the client's level of function and quality of life are a primary concern.

A patient with an autoimmune disorder says, I don't know why this happened to me. I try to exercise and eat well. How should the nurse respond? 1. These disorders are usually associated with a vitamin deficiency. 2. These problems happen when your body misinterprets normal cells as being foreign and attempts to destroy them. 3. It happened because you were exposed to something repeatedly, and then the body decided it needed to destroy it. 4. Chronic illnesses are the cause of autoimmune disorders.

Answer: 2 Explanation: 1. Autoimmune disorders are not specifically linked to vitamin deficiencies. 2. One theory about autoimmunity is that of molecular mimicry. This is when the body will react appropriately to an allergen but then incorrectly identifies normal body tissue as being the same allergen and begins to destroy normal tissue. 3. Autoimmune disorders do not occur in response to repeated exposure to an allergen. 4. Autoimmune disorders are not linked specifically to chronic illnesses.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

A client with rheumatoid arthritis tells the nurse, I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult. Which of the following responses by the nurse would be most appropriate? 1. You are probably exercising too much. Decrease your exercise to every other day. 2. Tell the physician about your symptoms. Maybe your analgesic medication can be increased. 3. Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy. 4. Take a warm tub bath or shower before exercising. This may help with your discomfort.

4. Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize? A. Maximize range of motion while minimizing exertion. B. Increase joint size and strength. C. Limit energy output in order to preserve strength for healing. D. Preserve or increase range of motion while limiting joint stress.

ANS: D Rationale: Exercise is vital to the management of rheumatic disorders. Goals should be preserving and promoting mobility and joint function while limiting stress on the joint and possible damage. Cardiovascular exertion should remain within age-based limits and individual ability, but it is not a goal to minimize exertion. Increasing joint size is not a valid goal.

The nurse is caring for a client recently diagnosed with rheumatoid arthritis. The client asks the nurse, Is there a cure for rheumatoid arthritis? Which would be the best response by the nurse? A) Yes, the cure is bedrest and alternating heat and cold applications to the inflamed joints. B) Yes, the cure is to limit exercise. C) No, treatment is aimed at management of symptoms. D) No, no cure exists. Relaxation is the best treatment.

C. Treatment of rheumatoid arthritis is aimed at the management of symptoms such as fatigue, joint pain and stiffness. Low impact exercises such as swimming, riding a stationary bike, and light walking are recommended to help with pain and joint stiffness and deformity. Alternating heat and cold compresses is recommended to help with the pain and swelling. Performing active range-of-motion (ROM) exercises helps maintain strength and reduces deconditioning. Medications such as NSAIDs, steroids, and methotrexate are utilized to treat the symptoms of rheumatoid arthritis.

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 systemic lupus erythematosus. C. It is diagnostic for Sjögren's syndrome. D. It is specific for rheumatoid arthritis.

A. 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 experiencing symptoms of rheumatoid arthritis. Which laboratory tests will the nurse expect to be prescribed for this client? Select all that apply. A. Hematocrit B. Creatinine C. Rheumatoid factor D. Erythrocyte count E. Antinuclear antibody

C, D, E. Various blood studies can be done to help diagnose rheumatic diseases. Erythrocyte count may be decreased in rheumatoid arthritis. Rheumatoid factor is present in 80% of those with rheumatoid arthritis. A positive antinuclear antibody test may be associated with rheumatoid arthritis. Creatinine and hematocrit are not used to diagnose rheumatoid arthritis.

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. I have pain in my hands. B. I have trouble with my balance. C. My legs feel weak. D. My finger joints are oddly shaped.

D. 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.

During a routine health exam, the client informs the nurse that she has been very fatigued in the past 2 weeks. The client states that every morning for the past week, the joints in her hands are very painful, swollen, and stiff. The nurse assesses the client's joints in her hands and notes the redness, swelling, and stiffness. What non-pharmacological nursing interventions would you recommend to help alleviate the swelling, pain, and stiffness? Select all that apply. A) Instruct to perform active ROM exercises every 2 hours B) Instruct to take a warm shower or bath in the morning and before bedtime C) Instruct to alternate heat and cold therapy to affected joints D) Instruct to make an appointment for an hour massage to the affected joints E) Instruct to rest the affected joints when in severe pain

B, C, E. When a client is experiencing a flare-up of rheumatoid arthritis, the client should be instructed on the non-pharmacological nursing interventions to perform before adding medications. The non-pharmacological nursing interventions should include instructing to take a shower or bath in the morning and at night before bedtime. The heat will help reduce the swelling and stiffness and reduce the pain. The client should be instructed to alternate heat and cold therapy to reduce inflammation and alleviate pain. During flare-ups, the client should be instructed to rest the affected joints. Instructing the client to perform active ROM exercises is important to help maintain function and strength, but should not be instructed to do so every 2 hours during a flare-up. The client should be instructed to perform low-impact exercises to assist and maintain function and strength. An hour massage would not be recommended due to increasing the client's pain with the massage.

Which of these clients are exhibiting the signs and symptoms associated with rheumatoid arthritis? Select all that apply. A) A 30-year-old football star with crepitus in the left knee B) A 35-year-old client with severe warmth, redness, and inflammation of both hands C) A 40-year-old female with fatigue, joint stiffness, and joint pain in the mornings D) A 32-year-old ice skater with soreness and swelling in both ankles E) A 42-year-old male with a grating sensation and MRI results revealing bone spur formation in the right knee

B, C. Rheumatoid arthritis signs and symptoms include fatigue, anorexia, weight loss, morning joint stiffness, symmetrical joint swelling, and severe pain in the small joints of the hands. Rheumatoid arthritis causes swans neck, boutonniere's deformity, contractures of the joints, joint pain that gets better with activity and gets worse at rest. Rheumatoid arthritis results in deconditioning of the joints resulting in decreased muscle strength with systemic symptoms. Currently, no cure exists for rheumatoid arthritis. health care provider (HCP)s teach management of fatigue, joint pain and stiffness through low impact exercises, range-of-motion exercises, and alternating heat and cold applications.

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

C. 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.