Ch 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders
a) strategies for remaining active Pg. 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.
11. The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? a) Strategies for remaining active b) Prevention of joint deformity c) Detection of systemic complications d) Disease-modifying antirheumatic drug therapy
c) Systemic lupus erythematosus (SLE) Pg. 1082 SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.
32. Which of the following disorders is characterized by an increased autoantibody production? a) Scleroderma b) Rheumatoid arthritis (RA) c) Systemic lupus erythematosus (SLE) d) Polymyalgia rheumatic
c) Allopurinol Pg. 1090 Allopurinol is used in the treatment of gout. Etanercept, adalimumab, and methotrexate are all used in the treatment of rheumatoid arthritis.
48. Which drug is not used in the treatment of rheumatoid arthritis? a) Adalimumab b) Methotrexate c) Allopurinol d) Etanercept
c) Raynaud's phenomenon Pg. 1070 Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.
6. 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) Sjögren's syndrome c) Raynaud's phenomenon d) Reiter's syndrome
c) "The lupus can affect your kidney function" Pg. 1083 Nephritis as a result of SLE, also referred to as lupus nephritis, occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons. Early detection allows for prompt treatment so that renal damage can be prevented. Serum creatinine levels and urinalysis are used in screening for renal involvement. Urinalysis is not a routine test done on every client. The urinalysis is not being used to determine if the client's medication is affecting the bladder. The urinalysis will not determine the length of time the client will have the rash.
19. A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? a) "The medication you take can affect your bladder" b) "It is a routine test done on everyone" c) "The lupus can affect your kidney function" d) "The test will determine how long you will have the rash"
c) Colchicine Pg. 1090 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.
23. 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) Administering ordered analgesics and monitoring their effects Pg. 1075 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.
13. A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes c) Administering ordered analgesics and monitoring their effects d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware
c) Located over bony prominenced Pg. 1079 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.
40. A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? a) Reddened b) Nonmovable c) Located over bony prominence d) Tender to the touch
a) Education on proper sleep practices c) Use of artificial tears d) Analgesics for pain management e) Increased fluid intake Pg. 1085 Primary Sjögren's syndrome is a rare systemic autoimmune disease that predominantly affects middle-aged women. The most common symptoms include pain, fatigue, kerotoconjunctivitis sicca or dry eyes, and xerostomia or dry mouth. Constipation is not commonly identified as a symptom of primary Sjogren's syndrome.
35. The nurse is assessing a client with primary Sjogren's syndrome. Which interventions will the nurse add to this client's plan of care? Select all that apply. a) Education on proper sleep practices b) Provide a high fiber diet c) Use of artificial tears d) Analgesics for pain management e) Increased fluid intake
c) "I should avoid prolonged sun exposure" Pg. 1082 Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression.
12. 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) "My medications will ultimately correct my problem" b) "My energy level will gradually increase over time" c) "I should avoid prolonged sun exposure" d) "I do not need to make any changes in my diet"
a) Weight loss c) Bruises d) Thinning hair e) Dry eyes Pg. 1069 Assessment for rheumatic diseases combines the physical examination with a functional assessment. Inspection of the client's general appearance occurs during the initial contact. Findings associated with rheumatoid arthritis include bruising, dry eyes, weight loss, and thinning hair. Headaches are associated with temporal arteritis.
17. The nurse is completing a physical assessment with a client demonstrating signs of rheumatoid arthritis. Which findings will the nurse associate with this condition? Select all that apply. a) Weight loss b) Headaches c) Bruises d) Thinning hair e) Dry eyes
d) "What types of exercise were you doing?" Pg. 1078 In an older adult with rheumatoid arthritis, exercise programs may not be instituted or may be ineffective because the client expects results too quickly or fails to appreciate the effectiveness of a program of exercise. Strength training is encouraged in the older adult with chronic diseases. The other questions will not help the nurse understand what type of exercise was used and what it was not effective for the client.
20. 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) "Do you think you are too old to exercise?" b) "Why do you think the exercise didn't work?" c) "Does exercise usually work for you?" d) "What types of exercise were you doing?"
d) Facial erythema, pericarditis, pleuritis, fever, and weight loss Pg. 1082 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.
3. A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Weight gain, hypervigilance, hypothermia, and edema of the legs b) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss
b) Tophi Pg. 1089-1090 Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity.
30. Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Pannus b) Tophi c) Joint effusion d) Subchondral bone
a) Medication dosages and side effects d) Assistive devices e) Safe exercise Pg. 1081 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.
41. The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. a) Medication dosages and side effects b) Dressing changes c) Narcotic safety d) Assistive devices e) Safe exercise
b) Inflammation Pg. 1068 In clients with chronic inflammation, the immune response can deviate from normal. Instead of resolution of swelling and joint pain once the triggering event has subsided, pannus, or proliferation of newly formed synovial tissue infiltrated with inflammatory cells, formation occurs. Destruction of the joint's cartilage and erosion of bone soon follow. Remission is a period when the symptoms of the condition are reduced or absent. Exacerbation is a period when the symptoms occur or increase. Autoimmunity causes tissue destruction which leads to pain.
42. The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? a) Exacerbation b) Inflammation c) Autoimmunity d) Remission
b) Review the client's medical record Pg. 1082 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.
51. 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) Auscultate the client's lung sounds b) Review the client's medical record c) Observe the client's gait d) Inspect the client's mouth
a) Aspirin c) Methotrexate d) Ibuprofen Pg. 1069 Medications are used with the rheumatic diseases to manage symptoms, to control inflammation, and, in some instances, to modify the disease. Medications used include the salicylates, NSAIDs, and DMARDs. Opioid and anticoagulants are not identified as being used to treat rheumatoid arthritis.
7. The nurse is reviewing medications prescribed for a client with rheumatoid arthritis. Which medications will the nurse expect to be prescribed for this client? Select all that apply. a) Aspirin b) Heparin sodium c) Methotrexate d) Ibuprofen e) Morphine sulfate
b) Joint stiffness that increases with activity Pg. 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.
14. The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? a) Anorexia and weight loss b) Joint stiffness that increases with activity c) Erythema and edema over the affected joint d) Fever and malaise
d) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open Pg. 1081 The client's pharmacy will likely be able to facilitate a practical solution that preserves the client's independence while still fostering adherence to treatment. There should be no need to change medications, and storing open medication containers is unsafe. Delegating medications to a family member is likely unnecessary at this point and promotes dependence.
21. A clinic nurse is caring for a client diagnosed with rheumatoid arthritis (RA). The client tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the client's adherence to her medication regimen? a) Have a trusted family member take over the management of the client's medication regimen b) Have the client approach her primary provider to explore medication alternatives c) Encourage the client to store the bottles with their tops removed d) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open
b) An exercise routine that includes range-of-motion (ROM) exercises Pg. 1080 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.
36. A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? a) Acupuncture b) An exercise routine that includes range-of-motion (ROM) exercises c) Cold therapy d) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs)
c) Ankylosis Pg. 1088 Fixation of a joint, called ankylosis, eliminates friction, but at the drastic cost of immobility. Inflammation is manifested in the joints as synovitis. Pannus has a destructive effect on the adjacent cartilage and bone. Articulations are joints.
43. Which of the following refers to fixation of a joint? a) Articulations b) Synovitis c) Ankylosis d) Pannus
c) Hydroxychloroquine Pg. 1080 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.
47. 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) Cyclophosphamide b) Diclofenac c) Hydroxychloroquine d) Azathioprine
a) Tai chi Pg. 1074 T'ai chi is low impact, so this is the best exercise for low joint impact. Jogging, weight lifting, and running on a treadmill are high-impact, jarring types of exercise.
39. 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) Tai chi b) Running on a treadmill c) Weight lifting d) Jogging
b) It is important to monitor for injection site reactions Pg. 1073 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.
4. 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 client should continue taking the medication if fever occurs d) The medication is given at room temperature
b) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints" Pg. 1078 OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
15. 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 is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints" c) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints" d) "OA is more common in women. RA is more common in men"
c) Boney erosions on x-ray Pg. 1078 The American College of Rheumatology and the European League Against Rheumatism have established criteria for classifying RA. These criteria are based on a point system where a total score of 6 or greater is required for the diagnosis of RA. Clients diagnosed with RA who are excluded from these diagnostic criteria include those with bony erosions on X-ray. RA is not diagnosed by CT scans, MRIs, or arteriograms, however CT scans and MRIs can be used to detect bone erosions and inflammatory changes of rheaumatoid arthritis.
49. A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis? a) Reduced muscle mass on CT scan b) Evidence of healed fractures on MRI c) Boney erosions on x-ray d) Atherosclerotic plaques on an arteriogram
a) Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) Pg. 1068 NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.
5. 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) Vigorous physical therapy for the joints c) Administration of opioids for pain control d) Administration of monthly intra-articular injections of corticosteroids
c) Common adverse effects Pg. 1115 The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.
8. A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? a) Activity restrictions b) Dietary restrictions c) Common adverse effects d) Loading-dose schedule
c) Methotrexate Pg. 1079 Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID).Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.
9. 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) Methylprednisolone b) Celecoxib c) Methotrexate d) Mercaptopurine azathioprine
a) "It will get better and worse again" Pg. 1067 The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.
16. A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again" b) "I'll definitely need surgery for this" c) "When it clears up, it will never come back" d) "It will never get any better than it is right now"
b) If you have problems with a medication, you may stop it until your next physician visit Pg. 1081 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.
18. 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) If you have problems with a medication, you may stop it until your next physician visit c) Pace activities d) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing
c) "The belief is that it is an autoimmune disorder with an unknown trigger" Pg. 1082 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.
25. The nurse is teaching a newly diagnosed client about systemic lupus erythematosus (SLE). What statement by the client indicates the teaching was successful? a) "The symptoms are primarily localized to the skin but may involve the joints" b) "SLE has very specific manifestations that make diagnosis relatively easy" 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) Complement Pg. 1068 Complement is a plasma protein associated with immunologic reactions. Leukotrienes are chemical mediators from constituents of cell membranes. Cytokines are nonantibody proteins that act as intercellular mediators, as in the generation of the immune response. Prostaglandins are lipid-soluble molecules synthesized from constituents of cell membranes.
26. Which of the following is a plasma protein associated with the immunologic reaction? a) Prostaglandins b) Cytokines c) Complement d) Leukotrienes
b) "Monitor your body temperature" Pg. 1084 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.
27. A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "There are no activity limitations between flare-ups" b) "Monitor your body temperature" c) "Exposure to sunlight will help control skin rashes" d) "Corticosteroids may be stopped when symptoms are relieved"
b) Antipyretic medications for fever c) Monitoring for rash to the skin d) Providing analgesics for joint pain Pg. 1083 The disease process of SLE involves chronic states where symptoms are minimal or absent and acute flares where symptoms and lab results are elevated. Symptoms most often include fever, joint pain, and a discoid rash. SLE less commonly affects the gastrointestinal system and the liver. Because of this jaundice and diarrhea are not findings associated with SLE.
28. The nurse is caring for a client with systemic lupus erythematosus (SLE). Which interventions will the nurse incorporate into this client's plan of care? Select all that apply. a) Providing high fiber diet for diarrhea b) Antipyretic medications for fever c) Monitoring for rash to the skin d) Providing analgesics for joint pain e) Monitoring for jaundice
c) "My finger joints are oddly shaped" Pg. 1078 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.
29. 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 trouble with my balance" b) "I have pain in my hands" c) "My finger joints are oddly shaped" d) "My legs feel weak"
d) Antidepressant therapy e) Referral to group therapy Pg. 1080 For most clients with RA, the emotional and possible financial burden of the disease can lead to depressive symptoms and sleep deprivation. The client may require the short-term use of low-dose antidepressant medications to reestablish an adequate sleep pattern and manage depressive symptoms. Clients may benefit from referrals for talk therapy or group support. Physical therapy and occupational therapy will help the client cope with the disabling characteristics of progressive joint damage due to RA. Corticosteroid therapy is used to treat flareups of inflammation and not psycholoigcal effects of the disease.
31. A client with rheumatoid arthritis (RA) reports feeling down and not able to sleep. Which approaches would the nurse anticipate being considered for this client? Select all that apply. a) Physical therapy b) Occupational therapy c) Corticosteroid therapy d) Antidepressant therapy e) Referral to group therapy
b) Ibuprofen c) Prednisone d) Methotrexate Pg. 1079 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.
33. A client is newly diagnosed with rheumatoid arthritis. For which medications will the nurse prepare teaching for this client? Select all that apply. a) Aspirin b) Ibuprofen c) Prednisone d) Methotrexate e) Acetaminophen
d) It is suggestive of rheumatoid arthritis Pg. 1085 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.
37. 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 specific for rheumatoid arthritis b) It is diagnostic for systemic lupus erythematosus c) It is diagnostic for Sjögren's syndrome d) It is suggestive of rheumatoid arthritis
b) Ankylosis Pg. 1088 Ankylosis is the fixation or immobility of a joint. It may result from a disease process or from scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.
38. Which term refers to fixation or immobility of a joint? a) Hemarthrosis b) Ankylosis c) Diarthrodial d) Arthroplasty
c) Maintain good posture Pg. 1076 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.
46. 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) Perform aerobic exercises b) Maintain complete bed rest c) Maintain good posture d) Keep shifting weight from one foot to the other
d) Elevated erythrocyte sedimentation rate Pg. 1071 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.
1. The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? a) Increased red blood cell count b) Increased albumin levels c) Increased C4 complement d) Elevated erythrocyte sedimentation rate
a) Eat small frequent meals b) Limit the intake of alcohol c) Avoid smoking e) Omit spicy and salty foods Pg. 1085 There is no cure for Sjögren's syndrome, and treatment is aimed at symptom management and improving quality of life. Suggestions to help reduce xerostomia include avoiding smoking, eating small frequent meals, omitting spicy and salty foods, and avoiding excessive alcohol use. Antiseptic mouthwash is not recommended to alleviate the symptom of xerostomia due to its drying effects.
10. A client with Sjogren's syndrome is experiencing xerostomia. Which information will the nurse provide to help alleviate this client's problem? Select all that apply. a) Eat small frequent meals b) Limit the intake of alcohol c) Avoid smoking d) Use antiseptic mouthwash twice a day e) Omit spicy and salty foods
b) Autoimmune disorders Pg. 1068 A hallmark of inflammatory rheumatic diseases is autoimmunity, where the body mistakenly recognizes its own tissue as a foreign antigen. Although focused in the joints, inflammation and autoimmunity also involve other areas. The blood vessels (vasculitis and arteritis), lungs, heart, and kidneys may be affected by the autoimmunity and inflammation. It is unlikely that the client's array of symptoms is being caused by heart disease, vascular diseases, or metabolic disorders.
2. 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) Metabolic disorders b) Autoimmune disorders c) Heart disease d) Vascular diseases
d) Arthodesis Pg. 1080 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.
34. Which of the following procedures involves a surgical fusion of the joint? a) Tenorrhaphy b) Synovectomy c) Osteotomy d) Arthrodesis
b) Computed tomography (CT) c) Magnetic resonance imaging (MRI) d) Arthrography e) X-rays Pg. 1069 Imaging studies are often used to diagnose rheumatic diseases. These tests include x-rays, arthrography, CT scans, and MRIs. Ultrasound would not be used as a diagnostic indicator for rheumatoid arthritis.
45. The nurse is creating a teaching tool about rheumatoid arthritis. Which tests will the nurse include that are used to diagnose the condition? Select all that apply. a) Ultrasound b) Computed tomography (CT) c) Magnetic resonance imaging (MRI) d) Arthrography e) X-rays
d) Aspirin Pg. 1072 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.
50. 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) Hydroxychloroquine b) Methotrexate c) Celecoxib d) Aspirin
a) Hypertension Pg. 1083 Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.
24. Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Decreased cognitive ability c) Behavioral changes d) Chest pain
b) Genetic c) Environmental d) Immunological e) Hormonal Pg. 1082 While the exact cause is not known, SLE starts with the body's immune system inaccurately recognizing one or more components of the cell's nucleus as foreign, seeing it as an antigen. The immune system starts to develop antibodies to the nuclear antigen. The antibodies also act to destroy host cells. The immunoregulatory disturbance is thought to be brought about by some combination of four distinct factors: genetic, hormonal, immunologic, and environmental. Psychosocial is not an immunoregulatory disturbance factor that affects SLE.
52. The nurse is preparing a teaching tool about the pathophysiology of systemic lupus erythematosus (SLE). Which immunoregulatory disturbance factors will the nurse include in this tool? Select all that apply. a) Psychosocial b) Genetic c) Environmental d) Immunological e) Hormonal
d) Increased fatigue Pg. 1079 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.
22. 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) Decreased joint pain b) A weight gain of 2 pounds c) Ability to perform activities of daily living (ADL) d) Increased fatigue
a) Sicca syndrome Pg. 1085 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.
44. 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) Episcleritis c) Glaucoma d) Cataracts