CH 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders
The nurse is caring for a client with bilateral lower extremity weakness. Which test(s) will the nurse expect to be prescribed to determine if the client has polymyositis? Select all that apply. A) Serum electrolytes B) Complete blood count C) Muscle biopsy D) Electromyogram E) Blood urea nitrogen
C and D
Osteoarthritis is known as a disease that A) affects the cartilaginous joints of the spine and surrounding tissues. B) is the most common and frequently disabling of joint disorders. C) requires early treatment because most of the damage seems to occur early in the course of the disease. D) affects young males.
B
The nurse is performing an admission interview for a client with rheumatoid arthritis. Which finding will the nurse document as abnormal for this client? Select all that apply. A) Nausea B) Stiffness C) Pain D) Joint swelling E) Weakness
B, C, D, and E
Which of the following disorders is characterized by an increased autoantibody production? A) Polymyalgia rheumatic B) Scleroderma C) Rheumatoid arthritis (RA) D) Systemic lupus erythematosus (SLE)
D
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
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? A) prevention of joint deformity B) strategies for remaining active C) detection of systemic complications D) disease-modifying antirheumatic drug therapy
B
Which client is most likely to develop systemic lupus erythematosus (SLE)? A) A 25-year-old White male B) A 27-year-old Black female C) A 25-year-old Jewish female D) A 35-year-old Hispanic male
B
Which of the following procedures involves a surgical fusion of the joint? A) Tenorrhaphy B) Arthrodesis C) Osteotomy D) Synovectomy
B
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) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Anticoagulants D) Oral corticosteroids
B
Which term refers to fixation or immobility of a joint? A) Arthroplasty B) Diarthrodial C) Ankylosis D) Hemarthrosis
C
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) "Have you reduced the amount of daily exercise?" B) "Are you taking frequent rest periods throughout the day?" C) "Have you increased your intake of fat-soluble vitamins?" D) "Are you taking the medication as prescribed?"
D
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? A) "Pace yourself and rest frequently, especially after activities." B) "Do all your chores after performing morning exercises to loosen up." C) "Do all your chores in the morning, when pain and stiffness are least pronounced." D) "Do all your chores in the evening, when pain and stiffness are least pronounced."
A
A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? A) age B) congenital deformity C) trauma D) obesity
A
A nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach the about for osteoarthritis? A) administration of nonsteroidal anti-inflammatory drugs (NSAIDs) B) administration of opioids for pain control. C) administration of monthly intra-articular injections of corticosteroids. D) vigorous physical therapy for the joints.
A
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? A) Pannus B) Tophi C) Subchondral bone D) Joint effusion
B
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) Hypertension D) Behavioral changes
C
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) Ibuprofen B) Celecoxib C) Piroxicam D) Tolmetin sodium
B
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) "SLE is a very serious systemic disorder." C) "You should discuss that matter with your health care provider." D) "Tell me more about your concerns about this potential diagnosis."
A
A client with kyphosis caused by ankylosing spondylitis (AS) asks if there are any procedures available to help with the spinal deformity and pain. Which procedure will the nurse prepare teaching for this client? A) Osteotomy of the spine B) Bracing C) Traction D) Cervical collar
A
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? A) "Monitor your body temperature." B) "Exposure to sunlight will help control skin rashes." C) "Corticosteroids may be stopped when symptoms are relieved." D) "There are no activity limitations between flare-ups."
A
A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal? A) Hyperuricemia B) Glucosuria C) Hyperproteinuria D) Ketonuria
A
Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? A) Scleroderma B) Polymyalgia rheumatic C) Rheumatoid arthritis D) Systemic lupus erythematosus
A
A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.
0.5 mL
The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? A) patchy hair loss on the scalp B) low back pain C) increased urine output D) red, butterfly-shaped facial rash
B
A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment? A) Joint pain, crepitus, Heberden's nodes B) Hot, inflamed joints; crepitus; joint pain C) Tophi, enlarged joints, Bouchard's nodes D) Swelling, joint pain, and tenderness on palpation
A
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) If you have problems with a medication, you may stop it until your next physician visit. B) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. C) Avoid sunlight and ultraviolet radiation. D) Pace activities.
A
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) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes D) Performing meticulous skin care
A
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) Autoimmune disorders B) Heart disease C) Metabolic disorders D) Vascular diseases
A
A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? A) Take the medication with food to avoid stomach upset. B) Since the medication is able to be obtained over the counter, it has few side effects. C) Take the medication on an empty stomach in order to increase effectiveness. D) Inform the health care provider if there is ringing in the ears.
A
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) increased fatigue B) ability to perform activities of daily living (ADL) C) decreased joint pain D) a weight gain of 2 pounds
A
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) Mercaptopurine azathioprine C) Methylprednisolone D) Celecoxib
A
The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? A) Clients may develop Heberden nodes. B) Clients will have an ulnar deviation. C) Clients may have swan neck deformity. D) Clients will develop boutonniere deformity.
A
Which joint is most commonly affected in gout? A) Metatarsophalangeal B) Tarsal area C) Ankle D) Knee
A
A client taking medication for rheumatoid arthritis (RA) for several years is experiencing significant ongoing pain in the knees. Which surgical procedures will the nurse expect the client to consider to preserve joint function? Select all that apply. A) Joint replacement B) Arthrodesis C) Arthroscopy D) Tenorrhaphy E) Synovectomy
A, B, D, and E
The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. A) Decreasing alcohol intake B) Weight loss C) Limiting exercise D) Restricting the intake of water E) Avoiding purine-rich foods
A, B, and E
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) Dysphagia owing to hardening of the esophagus B) Butterfly-shaped rash on the face C) Dyspnea owing to fibrotic cardiac tissue D) Productive cough E) Decreased ventilation owing to lung scarring
A, C, and E
A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout? A) Increased AST and ALT B) Elevated uric acid levels C) Decreased hemoglobin and hematocrit D) Elevated white blood count
B
A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease? A) Inspect the client's mouth. B) Review the client's medical record. C) Observe the client's gait. D) Auscultate the client's lung sounds.
B
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) "My finger joints are oddly shaped." C) "I have trouble with my balance." D) "I have pain in my hands."
B
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) An exercise routine that includes range-of-motion (ROM) exercises C) Cold therapy D) Acupuncture
B
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? A) "OA affects joints on both sides of the body. RA is usually unilateral." B) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." C) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." D) "OA is more common in women. RA is more common in men."
C
A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening? A) Crackles in the bases B) Pericardial friction rub C) Lung sounds are diminished in the apical area. D) Rhonchi
C
A client is recovering from an attack of gout. What will the nurse include in the client teaching? A) Weight loss will increase uric acid levels and reduce stress on joints. B) Weight loss will reduce inflammation. C) Weight loss will reduce uric acid levels and reduce stress on joints. D) Weight loss will reduce purine levels.
C
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) sulfasalazine B) methotrexate C) celecoxib D) ibuprofen
C
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) Get help when lifting objects. B) Wear worn, comfortable shoes. C) Install safety devices in the home. D) Wear protective devices when exercising.
C
Fibromyalgia is a common condition that involves A) generalized muscle aching, mood swings, and loss of balance. B) diminished vision, chronic fatigue, and reduced appetite. C) chronic fatigue, generalized muscle aching, and stiffness. D) pain, viral infection, and tremors.
C
Primary gout is often caused by an inherited disorder in which type of metabolism? A) Fat B) Glucose C) Purine D) Carbohydrate
C
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) anturane B) probenecid C) colchicine D) allopurinol
C
The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? A) Systemic lupus erythematosus B) Scleroderma C) Rheumatoid arthritis D) Fibromyalgia
C
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) joint swelling B) weakness C) pain D) stiffness
C
The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? A) "I do not need to make any changes in my diet." B) "My medications will ultimately correct my problem." C) "I should avoid prolonged sun exposure." D) "My energy level will gradually increase over time."
C
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) Ankylosing spondylitis B) Reiter's syndrome C) Raynaud's phenomenon D) Sjögren's syndrome
C
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? A) tender to the touch B) nonmovable C) reddened D) located over bony prominence
D
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
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) "Try combining the fasting with moderate exercise." C) "Make sure to eat some fat occasionally with all that exercise." D) "There might be some difficulties with your plan and fasting."
D
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) Weight gain, hypervigilance, hypothermia, and edema of the legs D)Facial erythema, pericarditis, pleuritis, fever, and weight loss
D
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) "Why do you think the exercise didn't work?" B) "Does exercise usually work for you?" C) "Do you think you are too old to exercise?" D) "What types of exercise were you doing?"
D
Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia A) all have the same type of symptoms. B) rarely respond to treatment. C) will eventually lose their ability to walk. D) may feel as if their symptoms are not taken seriously.
D
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) running on a treadmill B) weight lifting C) jogging D) tai chi
D
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? A) erythema and edema over the affected joint B) fever and malaise C) anorexia and weight loss D) joint stiffness that increases with activity
D
The nurse is preparing to educate a client with rheumatoid arthritis on long-term effects of prednisone therapy. Which topic will the nurse include in the teaching? A) Report weight gain to your health care provider immediately. B) Make sure to fast for at least 12 hours per day C) Decrease food intake to two meals per day. D) Eat a lower calorie diet to manage weight gain.
D
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? A) Increased albumin levels B) Increased red blood cell count C) Increased C4 complement D) Elevated erythrocyte sedimentation rate
D
Which is an appropriate nursing intervention in the care of the client with osteoarthritis? A) Provide an analgesic after exercise B) Avoid the use of topical analgesics C) Assess for gastrointestinal complications associated with COX-2 inhibitors D) Encourage weight loss and an increase in aerobic activity
D
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) carbohydrates C) purine-rich foods D) protein-rich foods
C
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? A) "SLE has very specific manifestations that make diagnosis relatively easy." B) "The symptoms are primarily localized to the skin but may involve the joints." C) "The belief is that it is an autoimmune disorder with an unknown trigger." D) "This disorder is more common in men in their thirties and forties than in women."
C
Which points should be included in the medication teaching plan for a client taking adalimumab? A) The medication is given at room temperature. B) The medication is administered intramuscularly. C) It is important to monitor for injection site reactions. D) The client should continue taking the medication if fever occurs.
C
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) early morning stiffness C) subcutaneous nodules D) joint pain that increases with rest
B
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? A) "You are not immune to the disease causing the symptoms." B) "Your symptoms are a result of your body attacking itself." C) "You have antigens to the disease, but they do not prevent the disease." D) "You have inherited your parent's immunity to the disease."
B
The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. A) Narcotic safety B) Dressing changes C) Assistive devices D) Safe exercise E) Medication dosages and side effects
C, D, and E
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) frequently ingesting salicylates C) high carbohydrate intake D) eating organ meats and sardines
D