309 Quiz #14 Connective tissue disorders

Which statements regarding rheumatoid arthritis (RA) are true? (Select all that apply.) a. It is a chronic, progressive, systemic, inflammatory process. b. It primarily affects the synovial joints c. It is known to have periods of remission d. It occurs most often in older men and women e. It often involves an inflamed, red rash.

a. It is a chronic, progressive, systemic, inflammatory process. b. It primarily affects the synovial joints c. It is known to have periods of remission

A nurse plans care to prevent deformities in a client with RA. which intervention should be alternated with periods of rest? a. active exercise b. passive massage c. bracing of joints d. isometric exercises

a. active exercise

You are checking medication orders that were received by telephone for a client with RA who was admitted with methotrexate toxicity. Which order is most important to clarify with the physician? a. administer chlorambucil (Leukeran) 4mg PO daily b. infuse normal saline at 250 mL/hr for 4 hours c. administer folic acid (Folacin) 2000 mcg PO daily d. give cyanocobalamin (vitamin B12) 10,000 mcg PO

a. administer chlorambucil (Leukeran) 4mg PO daily

although the etiology of RA is unknown, it is considered to be what type of disorder? a. an autoimmune disease b. associated with aging c. genetic d. the result of joint misuse

a. an autoimmune disease

Which medication should the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with RA? a. aspirin b. codeine c. meperidine d. alprazolam

a. aspirin

A client newly diagnose with scleroderma states, "where did I get this from?" the nurse's best response is "although no cause has been determined for scleroderma, it is thought to be the result of: a. autoimmunity b. ocular motility c. increased amino acid metabolism d. defective sebaceous gland formation

a. autoimmunity

A nurse is interviewing a client who is diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? Select all that apply a. butterfly facial rash b. firm skin fixed to tissue c. inflammation of the joints d. muscle mass degeneration e. inflammation of small arteries

a. butterfly facial rash c. inflammation of the joints

Complications of spinal involvement in RA may be seen as which signs/symptoms? (select all that apply). A. compression of the phrenic nerve that controls the diaphragm b. resulting subluxation of the first and second vertebrae c. becoming quadriplegic or quadriparetic d. bilateral sciatic pain in the legs e. numbness of the hands and feet

a. compression of the phrenic nerve that controls the diaphragm b. resulting subluxation of the first and second vertebrae c. becoming quadriplegic or quadriparetic

A client with RA has been taking a steroid medication for the past year. For which complication of prolonged use of the medication should the nurse assess the client? a. decreased white blood cells b. increased C-reactive protein c. increased sedimentation rate d. decreased serum glucose levels

a. decreased white blood cells

Raynaud's phenomenon in a patient with scleroderma may present as which signs/symptoms? (select all that apply) a. digit necrosis b. excruciating pain c. autoamputations of digits d. periungual lesions e. peripheral neuropathy

a. digit necrosis b. excruciating pain c. autoamputations of digits d periungul lesions

A patient with scleroderma may have which problems? (select all that apply) a. dysphagia b. smooth tongue c. malabsorption problems causing malodorous diarrhea stools d. butterfly lesions on the face and nose e. spider-like hemangiomas

a. dysphagia b. smooth tongue e. spider-like hemangiomas

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). What recommendations are essential for the nurse to include? Select all that apply a. eat foods high in vitamin C b. take your temperature daily c. balance periods of rest and activity d. use a strong soap when washing the skin e. expose the skin to the sun as often as possible

a. eat foods high in vitamin C b. take your temperature daily c. balance periods of res and activity

A patient with SLE is admitted to the hospital for evaluation and management of acute joint inflammation. Which information obtained in the admission laboratory testing concerns you most? a. elevated blood urea nitrogen level b. increased C-reactive protein level c. positive antinuclear antibody test result d. positive lupus erythematosus.

a. elevated blood urea nitrogen level

What should the nurse do to prevent deformities of the knee in a client with an exacerbation of arthritis? (select all that apply). a. encourage motion of the joint b. maintain a knee brace on the leg c. keep the client on a regimen of bed rest. d. maintain joints in functional alignment when resting e immobilize the joint with pillows until pain subsides.

a. encourage motion of the joint d. maintain joints in functional alignment when resting

The nurse's plan of care for a patient with RA includes which interventions? (select all that apply) a. ensure optimal pain relief b. utilize the prone position c. encourage frequent rest periods d. decrease exercise to every other day. e. recommend liberal used of arthritic creams

a. ensure optimal pain relief c. encourage frequent rest periods

What CBC laboratory values does the nurse expect to be low for a patient with RA? (select all that apply) a. hemoglobin b. hematocrit c. red blood cell count (RBC) d. white blood cell count (WBC) e. platelets

a. hemoglobin b. hematocrit c. red blood cell count (RBC)

The nurse is assessing a patient admitted with RA. Which manifestations indicate to the nurse that the patient is experiencing late RA? a. joint deformities b. joint inflammation c. vasculitis d. subcutaneous nodules e. paresthesis f. low-grade fever g. anemia

a. joint deformities c. vasculitis d. subcutaneous nodules g. anemia

In late RA, the patient may have systemic involvement called "flareups." How are these characterized? (select all that apply) a. moderate to severe weight loss b. fever and fatigue c. muscle atrophy d. joint contractures e. complete loss of mobility

a. moderate to severe weight loss b. fever and fatigue

What should the nurse take into consideration when planning nursing care for a client experiencing an acute episode of RA? a. inflammation of the synovial membrane rarely occurs b. bony ankylosis of a joint is irreversible and causes immobility c. complete immobility is desired during the acute phase of inflammation d. redness and swelling of a joint signify irreversible damage has occurred.

b. bony ankylosis of a joint is irreversible and causes immobility

A client is admitted with acute gouty arthritis. Which medication does the nurse anticipate the health care provider may prescribe to prevent and treat an acute attack of gout? a. ibuprofen (motrin) b. colchicine (colsalide) c. probenecid (benemid) d. hydrocortisone (cortef)

b. colchicine (colsalide)

What is the nurse's primary consideration when caring for a client with rheumatoid arthritis? a. surgery b. comfort c. education d. motivation

b. comfort

Then nurse is performing an assessment of a patient with RA. Which findings does the nurse expect? a. head and neck pain b. early morning joint pain c. increased range of motion (ROM) in the hands d. absence of joint swelling

b. early morning joint pain

An 18-year-old college student with an exacerbation of systemic lupus erythematosus (SLE) has been receiving prednisone (Deltasone) 20 mg daily for 4 days. Which medical order should you question? a. discontinue prednisone after today's does b. give a "catch-up" dose of varicella vaccine c. check the patient's C-reactive protein level d. administer ibuprofen (Advil) 800mg PO.

b. give a "catch-up" dose of varicella vaccine

Arthrocentesis done one the patient with RA may reveal which elements in the synovial fluid of the joint? (select all that apply) a glucose and glycogen b. inflammatory cells and immune complexes c protein, such as albumin d. platelet aggregation e. increased WBCs

b. inflammatory cells and immune complexes e. increased WBCs

Which foods should the nurse teach a client with gout to avoid to limit painful attacks. (select all that apply) a. eggs b. liver c. cheese d. salon e. shellfish

b. liver e. shellfish

A client with RA asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? a. lubricate the joint b. reduce inflammation c. provide physiotherapy d. prevent ankylosis of the joint

b. reduce inflammation

What are characteristics of primary gout? (select all that apply) a. results from medications such as diuretics b. sodium urate deposited in the synovium c. affects large joints most commonly d. affects middle-aged and older men e. peak time of onset after age 50

b. sodium urate deposited in the snovium d. affects middle-aged and older men

What can be expected for a patient with recently diagnosed systemic lupus erythematosus (SLE)? a. an acute inflammatory disorder b. spontaneous remission and exacerbations c. symptoms limited to arthritis d. symptoms limited to skin lesions

b. spontaneous remission and exacerbations

You assess a 24-year-old patient with RA who is considering using methotrexate (Rheumatrex) for treatment. Which patient information is most important to communicate to the health care provider? a. the patient has many concerns about the safety of the drug b. the patient has been trying to get pregnant c. the patient takes a daily multivitamin tablet d. the patient says that she has taken methotrexate in the past.

b. the patient has been trying to get pregnant

Because of the inflammatory process in RA, a pannus forms in the joint. What is a pannus? a. scar tissue restricting the joint b. vascular granulation tissue in the joint c. necrotic tissue sloughing into the joint d. fluid encapsulated in the joint

b. vascular granulation tissue in the joint.

A nurse is caring for a client with rheumatoid arthritis. Based on the clients diagnosis, the nurse should review the result of which laboratory test? a. pancreatic lipase b. Bence Jones protein c. antinuclear antibody d. alkaline phosphatase

c. antinuclear antibody

The nurse is teaching a patient about the common side effects of chronic salicylate and nonsteroidal antiinflammatory (NSAID) therapy. Which body system side effects does the nurse focus on in the teaching plan? a. central nervous system b. skin c. gastrointestinal d. cardiovascular

c. gastrointestinal

The patient with SLE is taking hydroxychloroquine (Plaquenil). What essential teaching point must the nurse include when teaching the patient about this drug? a. watch for signs of malaria as this is an antimalarial drug b. you are at risk for an increase in skin lesions while taking this drug. c. have eye examinations before and every 6 months after starting this drug. d. be sure to get lots of the sunlight while taking this drug.

c. have eye examinations before and every 6 months after starting this drug

A regimen of rest, exercise, and physical therapy is ordered for a client with RA. What should the nurse explain is the intended purpose of the regimen? a. prevent arthritic pain b. halt the inflammatory process. c. help prevent the crippling effects of the disease d. provide for the return of joint motion after prolonged loss

c. help prevent the crippling effects of the disease

The nurse questions a client with RA about pain. When should the nurse expect the client to experience increased pain and limited movement of the joints? a. after assistive exercise b when the room is cool c. in the morning on awakening d. when the latex fixation test is positive

c. in the morning on awakening

Which statement best describes disoid lupus? a. it is most frequently diagnosed type of lupus b. it results in an increase in immune complexes within the joint cavity c. it is not a systemic condition and is limited to involvement of the skin. d. it is a lupus-like syndrome that occurs in patients taking certain medications.

c. it is not a systemic condition an dis limited to involvement of the skin

In patients with RA, where might Baker's cysts be located? a. ankles b. wrists c. popliteal bursae d. achilles tendon

c. popliteal bursae

A client with RA has severe pain and swelling of the joints in both hands. Range-of-motion exercises for this client should be: a. passively performed by the nurse b. avoided if the client reports discomfort c. preceded by the application of heat or cold d gradually increased to improve mobility and independence

c. preceded by the application of heat or cold

A client with arthritis reports receiving the following dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? a. wheat germ and yeast b. yogurt and blakstrap molasses c. multiple vitamin supplements in large doses d. adequate foods in a variety of different food groups

d. adequate foods in a variety of different food groups

what common musculoskeletal health problem is often associated with RA? a. Paget's disease b. Fibromyalgia c. Marfan syndrome d. osteoporosis

d. osteoporosis

A nurse is caring for a client attending a community-based health center and reviews the client's medical record. What should the nurse encourage the client to do? "health care provider progress note" client has stage lll RA, which is progressively causing more joint deformity, stiffness, and pain. "Nurse's History and Physical Assessment" Client has ulnar drift of both hands and hallux valgus deformity of both feet. Client reports pain when walking and joint stiffness for several hours in the morning, particularly the small joints of the hands and feet. Joints of the hands reflect signs and symptoms of inflammation (heat, swelling, tenderness). "Laboratory Results" Rheumatoid factor (RF): 1:70 (positive for RA) Erythrocyte sedimentation rate (ESR): 40 mm/hour C-reactive protein (CRP): 20 mg/dL WBC 13,000ul a. Wring a sponge repeatedly when washing dishes b. install faucets that require turning rather than pushing c. engage in a sewing project several hours each morning. d. push with the palms rather than the fingers when rising from a chair

d. push with the palms rather than the fingers when rising from a chair

A client who has intermittently been having painful, swollen knee and wrist joints during the past 3 months is diagnosed with RA. What type of diet should the nurse expect the health care provider to order? a. salt-free, low-fiber diet b. high-calorie, low-cholesterol diet c. high-protein diet with minimal calcium d. regular diet with vitamins and minerals

d. regular diet with vitamins and minerals

What is the most common cause of death in patients with SLE? a. cardiac failure b. skin involvement c. central nervous system involvement d. renal failure

d. renal failure

Which laboratory test is the only significant test for diagnosing a patient with disoid lupus? a. antinuclear antibody b. serum complement c. CBC d. skin biopsy

d. skin biopsy

When preparing an individualized teaching plan for a client with rheumatoid arthritis, which topic should the nurse omit from the generalized teaching plan for clients with arthritis? a. ulnar drift b. Heberden nodes c. Swan neck deformity d Boutonniere deformity

B. Heberden nodes

The nurse assessing a patient with fibromyalgia identifies the trigger points by palpation. In which specific areas does the nurse expect to elicit pain and tenderness? (select all that apply) a. neck b. lips c. trunk d. lower back e. upper back

a. neck c. trunk d. lower back

A patient is prescribed amitriptyline (Elavil) for the diagnosis of fibromyalgia. What kind of drug is the medication? a. antiinflammatory b. antiheumatic c. antidepressant d. antipsychotic

c. antidepressant

Your patient with RA is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? a. RA symptoms are worst in the morning b. dry eyes c. round and movable nodules just under the skin d. dark-colored stools

d. dark-colored stools

In RA, autoantibodies (rheumatoid factors [RFs]) are formed that attack healthy tissue, especially synovium, causing which condition? a. nerve pain b. bone porosity c. ischemia d. inflammation

d. inflammation

A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (glucophage) and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? a. decrease the daily dose of NSAIDs. b. limit fluid intake to one quart a day c. take the medication on an empty stomach d. monitor blood glucose levels more frequently

d. monitor blood glucose levels more frequently

A patient was prescribed the combination drug of probenicid (Lannett's Probalan) adn colchicine (Colcrys) for the treatment of gout. How does the health care team evaluate the effectiveness of the therapy? a. monitor the serum uric acid level. b. check the results of urinalysis c. review the patient's compliance with a low-purine diet d. assess the mobility of affected joints.

a. monitor the serum uric acid level

which patient-reported symptoms are typical of RA? (select all that apply). a. my hands are stiff, swollen, and tender. b. my right hand is weak. c. my pain and stiffness is worse in the morning. d. my knees are swollen and stiff. e. I am weak and fatigued

a. my hands are stiff, swollen, and tender. c. my pain and stiffness is worse in the morning. d. my knees are swollen and stiff. e. I am weak and fatigued

When a patient has RA of the temporomandibular joint, what is the major complaint? a. pain on chewing and opening the mouth b. headache at the temple c toothache d. earache

a. pain on chewing and opening the mouth

What might a psychosocial examination of a patient with advanced RA reveal? (select all that apply) a. role changes b. poor self-esteem and body image c. grieving and depression d. loss of control and independence e. inability to perform relaxation techniques

a. role changes b. poor self-esteem and body image c. grieving and depression d. loss of control and independence

the nurse is providing teaching for a patient with RA who is receiving methotrexate (Rheumatrex). Which teaching points must the nurse include? (select all that apply) a. the medication is given in a low dose once a week. b. methotrexate is an immunosuppressant medication c. expect some increase in swelling while taking this medication. d. avoid crowds of people and people who are ill e. report any mouth sores to the health care provider immediately.

a. the medication is given in a low dose once a week. b. methotrexate is an immunosuppressant medication. d. avoid all crowds of people and people who are ill. e. report any mouth sores to the health care provider immediately.

Aspirin is prescribed for a client with RA. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? (select all that apply) a. nausea b. joint pain c. blood in the stool d. ringing in the ears e. increased urine output

c. blood in the stool d ringing in the ears

what is the most common area of involvement of RA in the spine? a. lumbar spine b. sacral spine c. cervical spine d. thoracic spine

c. cervical spine

What should the nurse consider as the goal of therapy when administering allopurinol (Zyloprim) to a client with gout? a. increase bone density b. decrease synovial swelling c. decrease uric acid production d. prevent crystallization of uric acid

c. decrease uric acid production

A nurse is assessing a client with the diagnosis of scleroderma for the signs of CREST syndrome. What clinical indicators should the nurse expect to identify? select all that apply a. joint pain b. mask-like facies c. esophageal reflux d. spider-like hemangiomas e. episodic blanching of the fingers

c. esophageal reflux d. spider-like hemangiomas e. episodic blanching of the fingers