Ch. 38 Rheumatic Diseases

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20. A 22-year-old patient hospitalized with severe pain in the knees and a fever and shaking chills is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient a. has a parent who has reactive arthritis. b. recently returned from a trip to South America. c. is sexually active and has multiple partners. d. had several sports-related knee injuries as a teenager.

Answer: C Rationale: Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis. Cognitive Level: Application Text Reference: p. 1713 Nursing Process: Assessment NCLEX: Physiological Integrity

30. A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question? a. Naproxen (Aleve) 200 mg BID b. Give measles-mumps-rubella (MMR) immunization c. Draw anti-DNA titer d. Famotidine (Pepcid) 20 mg daily

Answer: B Rationale: Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient. Cognitive Level: Application Text Reference: p. 1718 Nursing Process: Implementation NCLEX: Psychosocial Integrity

17. A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate?" a. "Your family may need some help to understand the impact of your rheumatoid arthritis." b. "You may need to see a family therapist for some help." c. "Perhaps it would be helpful for you and your family to get involved in a support group." d. "Tell me more about the situations that are causing stress."

Answer: D Rationale: The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment. Cognitive Level: Application Text Reference: p. 1711 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? A) Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture. The nurse needs to remind the client with degenerative joint disease to maintain good posture. While the client need not maintain complete bed rest, performing aerobic exercises is not advisable as it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to:

install safety devices in the home.

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? "I'll definitely need surgery for this." "It will get better and worse again." "It will never get any better than it is right now." "When it clears up, it will never come back."

"It will get better and worse again."

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

"Monitor your body temperature."

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Has a weight gain of 5 pounds

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

Has a weight gain of 5 pounds

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about?

Hydroxychloroquine (Plaquenil)

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement?

Hypertension

Which of the following disorders is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?

systemic lupus erythematous (SLE)

What intervention will best help the patient with ankylosing spondylitis (AS)?

teach the patient to use a walker or cane

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

tophi

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns?

tricyclic antidepressants

Which joint is most commonly affected in gout? Knee Ankle Tarsal area Metatarsophalangeal

Metatarsophalangeal

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis?

"Client will exhibit no signs or symptoms of aspiration."

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints."

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities."

Primary gout is often caused by an inherited disorder in which type of metabolism?

Purine

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? Hyperextension Internal rotation Extension Slight dorsiflexion

Slight dorsiflexion

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on:

Strategies for remaining active

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on: Strategies for remaining active DMARDs therapy Prevention of joint deformity Detection of systemic complications

Strategies for remaining active

Which of the following disorders is characterized by an increased autoantibody production?

Systemic lupus erythematosus (SLE)

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication?

Take the medication with food to avoid stomach upset.

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

a) A 27-year-old black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women. pg.1069

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

age

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

b) Osteoarthritis Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly. pg.1067

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout? a) penicillamine b) colchicine c) methotrexate d) prednisone

b) colchicine Explanation: Colchicine is prescribed for the treatment of an acute attack of gout. pg.1079

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of: a) green vegetables. b) organ meats. c) fresh fish. d) citrus fruits.

b) organ meats. Explanation: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, chocolate, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with gouty arthritis. pg.1079

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse? a) Raw vegetables b) Organ meats c) Dairy products d) Shellfish

c) Dairy products Explanation: Primary hyperuricemia may be caused by severe dieting or starvation, excessive intake of foods that are high in purines (shellfish, organ meats), or heredity. pg.1079

A patient is admitted with an acute attack of gout. What interventions are essential to this patient?

probenecid (Benemid), serum uric acid level, corticosteroid therapy, pain medications

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA is more common in women. RA is more common in men." b) "OA affects joints on both sides of the body. RA is usually unilateral." c) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." d) "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." 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.

A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? a) Increased total serum complement levels b) Negative antinuclear antibody test c) An above-normal anti-deoxyribonucleic acid (DNA) test d) Negative lupus erythematosus cell test

c) An above-normal anti-deoxyribonucleic acid (DNA) test Explanation: Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE. pg.1070

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? a) Promoting sleep b) Eliminating deformities c) Minimizing damage d) Eradicating pain

c) Minimizing damage Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results.

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

d) Swan neck deformity Explanation: A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule. pg.1066

A nurse should advise a patient with gout to avoid which of the following foods?

Organ meats and scallops- An excessive intake of foods that are high in purines (shellfish, organ meats) may result in symptoms of gout in susceptible persons. A diet low in purine is recommended.

Which is the leading cause of disability and pain in the elderly? Rheumatoid arthritis (RA) Osteoarthritis (OA) Systemic lupus erythematosus (SLE) Scleroderma

Osteoarthritis (OA)

Which condition is the leading cause of disability and pain in the elderly?

Osteoarthritis (OA) OA is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

Diagnosis of osteoarthritis is complicated because initial joint changes occur without symptoms. Therefore, a combination of physical assessment and X-ray review is necessary for a diagnosis. Select two signs that, when combined, are sensitive indicators of OA. Tender joints Osteophytes Joint pain Enlarged joints Joint space narrowing

Osteophytes Joint space narrowing

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective?

"I should avoid prolonged sun exposure."

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

"My finger joints are oddly shaped."

A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects

A clinic nurse is caring for a patient newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient? A) Impaired Urinary Elimination Related to Neuropathy B) Altered Nutrition Related to Impaired Absorption C) Disturbed Sleep Pattern Related to CNS Stimulation D) Fatigue Related to Pain

A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply. A) Surgical treatment options B) The importance of weight loss C) Managing Raynauds-type symptoms D) Smoking cessation E) The importance of vigilant skin care

C, D, E

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about? Tolmetin sodium (Tolectin) Celecoxib (Celebrex) Ibuprofen (Motrin) Piroxicam (Feldene)

Celecoxib (Celebrex)

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

Facial erythema, pericarditis, pleuritis, fever, and weight loss -

Which of the following statements is accurate regarding osteoarthritis?

It is a noninflammatory disorder and the most common and frequently disabling of joint

Which findings best correlate with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity

Which findings best correlate with a diagnosis of osteoarthritis? Fever and malaise Anorexia and weight loss Joint stiffness that decreases with activity Erythema and edema over the affected joint

Joint stiffness that decreases with activity

Methotrexate (Rheumatrex)

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? Infliximab (Remicade) Methylprednisolone (Medrol) Methotrexate (Rheumatrex) Etanercept (Enbrel)

Methotrexate (Rheumatrex)

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically:

Milky, cloudy, and dark yellow.

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically: Clear and pale. Milky, cloudy, and dark yellow. Scanty in volume. Straw-colored.

Milky, cloudy, and dark yellow.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following is the most common cause for a patient to seek medical attention for arthritis?

Pain

Which of the following is the most common cause for a patient to seek medical attention for arthritis? Weakness Joint swelling Stiffness Pain

Pain

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

Physical therapy and exercise

What intervention is a priority for a client diagnosed with osteoarthritis?

Physical therapy and exercise Clients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and allopurinol are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care.

A nurse is poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis? Ineffective thermoregulation Constipation Risk for imbalanced nutrition: More than body requirements Risk for impaired skin integrity

Risk for impaired skin integrity

Which of the following disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?

SLE

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

Swan neck deformity

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication? Since the medication is able to be obtained over the counter, it has few side effects. Inform the physician if there is ringing in the ears. Take the medication with food to avoid stomach upset. Take the medication on an empty stomach in order to increase effectiveness.

Take the medication with food to avoid stomach upset.

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?

The belief is that it is an autoimmune disorder with an unknown trigger.

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? It has very specific manifestations that make diagnosis relatively easy. The symptoms are primarily localized to the skin but may involve the joints. This disorder is more common in men in their thirties and forties than in women. The belief is that it is an autoimmune disorder with an unknown trigger.

The belief is that it is an autoimmune disorder with an unknown trigger.

A patient has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply. A) PMR has an association with the genetic marker HLA-DR4. B) Immunoglobulin deposits occur in PMR. C) PMR is considered to be a wear-and-tear disease. D) Foods high in purines exacerbate the biochemical processes that occur in PMR. E) PMR occurs predominately in Caucasians.

A, B, E

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

The client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose. pg.1060

Osteoarthritis is known as a disease that

is the most common and frequently disabling of joint disorders. The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)?

it is important to monitor for injection site reactions

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan?

jogging

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia will eventually lose their ability to walk. all have the same type of symptoms. may feel as if their symptoms are not taken seriously. rarely respond to treatment.

may feel as if their symptoms are not taken seriously.

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

scleroderma

1. A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would expect to be present on examination of the patient's knee is a. Heberden's nodules. b. redness and swelling of the knee joint. c. pain upon joint movement. d. stiffness that increases with movement.

Answer: C Rationale: Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA), and stiffness in OA is worse right after the patient rests and decreases with joint movement. Cognitive Level: Comprehension Text Reference: p. 1694 Nursing Process: Assessment NCLEX: Physiological Integrity

40. A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management? a. The patient takes one aspirin a day prophylactically to prevent angina. b. The patient sleeps about 8 to 10 hours every night. c. The patient generally drinks about 3 quarts of juice and water daily. d. The patient usually eats beef once or twice a week.

Answer: A Rationale: Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout. Cognitive Level: Application Text Reference: p. 1716 Nursing Process: Assessment NCLEX: Physiological Integrity

15. When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with a. a warm bath followed by a short rest. b. a 10-minute routine of isometric exercises. c. stretching exercises to relieve joint stiffness. d. active range-of-motion (ROM) exercises.

Answer: A Rationale: Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased. Cognitive Level: Comprehension Text Reference: p. 1708 Nursing Process: Implementation NCLEX: Physiological Integrity

39. The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? a. The patient sleeps with two pillows under the head. b. The patient has been taking 16 aspirins daily. c. The patient requires a 2 hour midday nap. d. The patient sits on a stool when preparing meals.

Answer: A Rationale: The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective. Cognitive Level: Application Text Reference: pp. 1708-1709 Nursing Process: Evaluation NCLEX: Physiological Integrity

16. The biologic agent anakinra (Kineret) is prescribed for a patient who has moderately severe rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about a. symptoms of gastrointestinal (GI) irritation or bleeding. b. self-administration of subcutaneous injections. c. taking the medication with at least 8 oz of fluid. d. avoiding concurrently taking aspirin or NSAIDs.

Answer: B Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or NSAIDs and these should not be discontinued. Cognitive Level: Application Text Reference: pp. 1700, 1705-1706 Nursing Process: Implementation NCLEX: Physiological Integrity

6. A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to teach the patient about the use of a. prednisone (Deltasone). b. capsaicin cream (Zostrix). c. sulfasalazine (Azulfidine). d. doxycycline (Vibramycin).

Answer: B Rationale: Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA. Cognitive Level: Application Text Reference: p. 1696 Nursing Process: Planning NCLEX: Physiological Integrity

11. When teaching range-of-motion exercises to a patient who is having an acute exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both hands, the nurse teaches the patient that a. affected joints should not be exercised when pain is present. b. cold applications before exercise will decrease joint pain. c. exercises should be performed passively by someone other than the patient. d. regular walking may substitute for range-of-motion (ROM) exercises on some days.

Answer: B Rationale: Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises. Cognitive Level: Application Text Reference: pp. 1707, 1710 Nursing Process: Implementation NCLEX: Physiological Integrity

37. The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "That drug has too many side effects; I would rather wait until my joint problems are worse before beginning any drugs." The most appropriate response by the nurse is a. "You should tell the doctor how you feel so the two of you can make a decision together." b. "It is important to start methotrexate early in order to decrease the joint damage." c. "Methotrexate is not expensive and will be cheaper to take than other possible drugs." d. "Methotrexate is very effective and has no more side effects than the other available drugs."

Answer: B Rationale: Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible. Cognitive Level: Application Text Reference: pp. 1699, 1705 Nursing Process: Implementation NCLEX: Physiological Integrity

35. A patient with fibromyalgia syndrome (FMS) tells the nurse, "I don't know why the doctor has prescribed amitriptyline (Elavil) for me. I don't feel depressed, just tired and achy." The most appropriate response by the nurse is, "The Elavil a. is ordered to prevent depression from occurring." b. will improve the quality of your sleep at night." c. relaxes your muscles and helps prevent spasm." d. has antiinflammatory actions to reduce joint pain."

Answer: B Rationale: Elavil is ordered to improve sleep, to decrease stress and fatigue, and as an adjuvant medication for pain control. It would not be ordered to prevent depression, although it might be ordered to treat depression in a patient with FMS. Elavil is not a muscle relaxant or an antiinflammatory drug, although medications from these categories are used in treating FMS. Cognitive Level: Application Text Reference: p. 1728 Nursing Process: Implementation NCLEX: Physiological Integrity

13. When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to a. stand rather than sit when performing household chores. b. avoid activities that require continuous use of the same muscles. c. strengthen small hand muscles by wringing sponges or washcloths. d. protect the knee joints by sleeping with a small pillow under the knees.

Answer: B Rationale: Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position, and sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee ROM. Cognitive Level: Application Text Reference: p. 1710 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

41. When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE), which result is most important to communicate to the health care provider? a. Elevated blood urea nitrogen (BUN) and creatinine b. Positive lupus erythematosus cell prep c. Positive antinuclear antibodies (ANA) d. Decreased C-reactive protein (CRP)

Answer: A Rationale: The elevated BUN and creatinine levels indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive LE cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process. Cognitive Level: Application Text Reference: p. 1718 Nursing Process: Assessment NCLEX: Physiological Integrity

33. A patient hospitalized for IV corticosteroid therapy to treat polymyositis has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is a. risk for aspiration related to dysphagia. b. acute pain related to inflammation. c. risk for impaired skin integrity related to scratching. d. disturbed visual perception related to eyelid swelling.

Answer: A Rationale: The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses are also appropriate but are not as high a priority as the maintenance of the patient's airway. Cognitive Level: Application Text Reference: p. 1725 Nursing Process: Diagnosis NCLEX: Physiological Integrity

MULTIPLE RESPONSE 1. During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (Select all that apply.) a. sleep disturbances. b. multiple tender points. c. urinary frequency and urgency. d. cardiac palpitations and dizziness. e. multijoint pain with inflammation and swelling. f. widespread bilateral, burning musculoskeletal pain.

Answer: A, B, C, F Rationale: These symptoms are commonly described by patients with FMS. Cardiac involvement and joint inflammation are not typical of FMS. Cognitive Level: Comprehension Text Reference: p. 1727 Nursing Process: Assessment NCLEX: Physiological Integrity

14. When the nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex), which information is most important to communicate to the health care provider? a. The platelet count is 130,000/μl. b. The white blood cell count (WBC) is 1500/μl. c. The blood glucose is 130 mg/dl. d. The potassium is 5.2 mEq/L.

Answer: B Rationale: Bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The other laboratory values are also abnormal but are not far from normal values and would not have any immediate serious consequences. Cognitive Level: Application Text Reference: p. 1699 Nursing Process: Evaluation NCLEX: Physiological Integrity

28. A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of a. rheumatoid factor. b. anti-Smith antibody (Anti-Sm). c. antinuclear antibody (ANA). d. lupus erythematosus (LE) cell prep.

Answer: B Rationale: The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE. Cognitive Level: Comprehension Text Reference: pp. 1718-1719 Nursing Process: Assessment NCLEX: Physiological Integrity

25. A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n) a. hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant. b. autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body. c. disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression. d. disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response.

Answer: C Rationale: SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors. Cognitive Level: Comprehension Text Reference: pp. 1717, 1719 Nursing Process: Implementation NCLEX: Physiological Integrity

27. A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is a. activity intolerance related to fatigue and inactivity. b. impaired skin integrity related to itching and skin sloughing. c. social isolation related to embarrassment about the effects of SLE. d. impaired social interaction related to lack of social skills.

Answer: C Rationale: The patient's statement about not going anyplace because of hating the way he or she looks supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient. Cognitive Level: Application Text Reference: p. 1722 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

12. Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. When the patient has a follow-up visit 1 month later, the nurse recognizes that the patient's response to the treatment may be best evaluated by a. blood glucose testing. b. liver function tests. c. serum electrolyte levels. d. C-reactive protein level.

Answer: D Rationale: C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored for patients receiving steroids. Cognitive Level: Application Text Reference: pp. 1698-1699 Nursing Process: Evaluation NCLEX: Physiological Integrity

Which joint is most commonly affected in gout?

Metatarsophalangeal The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

29. Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says, a. "I should expect to have a low fever all the time with this disease." b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." c. "I should try to ignore my symptoms as much as possible and have a positive outlook." d. "I can expect a temporary improvement in my symptoms if I become pregnant."

Answer: B Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period. Cognitive Level: Application Text Reference: pp. 1717, 1720 Nursing Process: Evaluation NCLEX: Physiological Integrity

36. A patient who has had fatigue and muscle weakness for several years is diagnosed with chronic fatigue syndrome. The patient expresses anger at the health care professional for not offering relief of the symptoms and also anger at family members for saying "snap out of it and get busy." Based on the patient's statements, the nurse identifies a nursing diagnosis of a. activity intolerance related to fatigue. b. powerlessness related to lack of control over illness. c. altered family process related to illness of family member. d. situational low self-esteem related to inability to meet role expectation.

Answer: B Rationale: The patient's statements support the problem and etiology of powerlessness related to lack of control. The patient does not complain about activity intolerance. Although the patient may have risk for altered family process, but there are not enough data to support this diagnosis. The patient is not expressing low self-esteem or feelings of inadequacy regarding meeting role expectations. Cognitive Level: Application Text Reference: p. 1729 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

18. In teaching a patient with ankylosing spondylitis (AS) about the management of the condition, the nurse instructs the patient to a. sleep on the side with hips flexed. b. take slow, long walks as a form of exercise. c. perform daily deep-breathing exercises. d. take frequent naps during the day.

Answer: C Rationale: Deep-breathing exercises are used to decrease the risk for pulmonary complications that may occur with the reduced chest expansion that can occur with ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps. Cognitive Level: Comprehension Text Reference: p. 1712 Nursing Process: Implementation NCLEX: Physiological Integrity

38. A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? a. The patient has experienced a recent 5-pound weight loss. b. The patient's erythrocyte sedimentation rate (ESR) has increased. c. The patient's blood glucose is 166 mg/dl. d. The patient has no improvement in symptoms.

Answer: C Rationale: Hyperglycemia is a side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication. Cognitive Level: Application Text Reference: p. 1699 Nursing Process: Evaluation NCLEX: Physiological Integrity

26. A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care? a. Institute seizure precautions. b. Reorient to time and place PRN. c. Monitor intake and output. d. Place on cardiac monitor.

Answer: C Rationale: Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE. Cognitive Level: Application Text Reference: pp. 1718, 1720 Nursing Process: Planning NCLEX: Physiological Integrity

8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient, the most important information for the nurse to communicate to the health care provider is that the patient has a. a history of infectious mononucleosis as a teenager. b. a family history of age-related macular degeneration of the retina. c. been trying to have a baby before her disease becomes more severe. d. been using large doses of vitamins and health foods to treat the RA.

Answer: C Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy. Cognitive Level: Application Text Reference: p. 1699 Nursing Process: Assessment NCLEX: Physiological Integrity

2. When screening patients at a community center, the nurse will plan to teach ways to reduce risk factors for osteoarthritis to a a. 24-year-old man who participates in a summer softball team. b. 36-year-old woman who is newly diagnosed with diabetes mellitus. c. 49-year-old woman who works on an automotive assembly line. d. 56-year-old man who is a member of a construction crew.

Answer: C Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky. Cognitive Level: Application Text Reference: p. 1694 Nursing Process: Planning NCLEX: Physiological Integrity

4. When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae about management of the condition, the nurse determines that additional instruction is needed when the patient says, a. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." b. "A warm shower in the morning will help relieve the stiffness I have when I get up." c. "I should try to stay active throughout the day to keep my joints from becoming stiff." d. "I should take no more than 1 g of acetaminophen four times a day to control the pain."

Answer: C Rationale: Protection and avoidance of joint stressors are recommended for patients with OA, so this patient should alternate periods of rest with necessary activity. The other patient statements indicate that teaching has been effective. Cognitive Level: Application Text Reference: pp. 1696, 1701 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

9. A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrists, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time is to a. maintain a positive self-image. b. perform activities of daily living independently. c. achieve satisfactory control of pain. d. make a successful adjustment to disease progression.

Answer: C Rationale: The focus during an acute exacerbation of RA is to manage pain effectively. The other outcomes are appropriate long-term outcomes. Cognitive Level: Application Text Reference: p. 1707 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

7. A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches the patient that the most beneficial measure to protect the joints is to a. use a wheelchair to avoid walking as much as possible. b. sit in chairs that do not cause the hips to be lower than the knees. c. use a walker for ambulation to relieve the pressure on the hips. d. eat according to a weight-reduction diet to obtain a healthy body weight.

Answer: D Rationale: Because the patient's major risk factor is obesity, the nurse should teach the patient that weight loss is the best way to reduce stress on the hips. Avoiding activity by sitting in a wheelchair would likely increase the patient's weight; moderate activity is recommended for patients with OA. Sitting with the hips higher than the knees and using a walker would be recommended but are not as helpful as weight loss for this obese patient. Cognitive Level: Application Text Reference: p. 1701 Nursing Process: Implementation NCLEX: Physiological Integrity

5. A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The best response by the nurse is that a. progression of OA can be prevented with a regimen of exercise, diet, and drugs. b. OA is an inflammatory process with periods of exacerbation and remission. c. joint degeneration with pain and deformity occurs with OA by age 60 to 70. d. OA is common with aging, but usually it is localized and does not cause deformity.

Answer: D Rationale: OA is localized to joints that have been injured or have high use. Although exercise, diet, and drugs can help to decrease symptoms and slow disease progression, they will not prevent progression of the disease. OA is progressive and does not have exacerbations and remissions, which are typical of RA. Joint degeneration and pain occur later in OA; joint deformity is not a common symptom. Cognitive Level: Application Text Reference: pp. 1701, 1704 Nursing Process: Implementation NCLEX: Physiological Integrity

19. A patient who had arthroscopic surgery of the left knee 5 days previously is admitted with a red, swollen, and hot-to-touch knee. Which of these assessment data obtained by the nurse should be reported to the health care provider immediately? a. The white blood cell count is 14,200/μl. b. The patient rates the knee pain at 9 on a 10-point pain scale. c. The patient has recently taken ibuprofen (Motrin). d. The oral temperature is 104.1° F degrees.

Answer: D Rationale: The elevated temperature suggests that the patient may have an infection and be in danger of developing septicemia as a complication of septic arthritis. Immediate blood cultures and initiation of antibiotic therapy are indicated. The other information is typical of septic arthritis and should also be reported to the health care provider, but it does not indicate any immediately life-threatening problems. Cognitive Level: Application Text Reference: p. 1713 Nursing Process: Assessment NCLEX: Physiological Integrity

A nurse should expect to administer which medication to a client with gout?

Colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps, it doesn't treat gout.

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia

may feel as if their symptoms are not taken seriously. Because clients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose them. Clients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from client to client and respond to different treatments. Clients do not lose their ability to walk.

What should the nurse teach the patient about the diagnosis of osteoarthritis?

"It is the most common and frequently disabling of joint disorders."

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"It will get better and worse again."

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? "Corticosteroids may be stopped when symptoms are relieved." "Monitor your body temperature." "There are no activity limitations between flare-ups." "Exposure to sunlight will help control skin rashes."

"Monitor your body temperature."

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? "Do all your chores in the evening, when pain and stiffness are least pronounced." "Do all your chores in the morning, when pain and stiffness are least pronounced." "Pace yourself and rest frequently, especially after activities." "Do all your chores after performing morning exercises to loosen up."

"Pace yourself and rest frequently, especially after activities."

"The diagnosis won't be based on the findings of a single test but by combining all data found."

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate? "The diagnosis won't be based on the findings of a single test but by combining all data found." "Tell me more about your concerns about this potential diagnosis." "You should discuss that matter with your physician." "SLE is a very serious systemic disorder."

"The diagnosis won't be based on the findings of a single test but by combining all data found."

The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? A) Raynauds phenomenon B) Thyroid dysfunction C) Esophageal varices D) Osteopenia

The nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnosis will most likely apply to this patient's care?

fluid and electrolyte imbalance, alteration in self-concept, fatigue, pain

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound?

Inhibits T- and B-cell activity

A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? A) Autoimmune processes in the joints B) Chronic metabolic acidosis C) Increased uric acid levels D) Unstable serum calcium levels

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse?

Dairy products

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

Elevated erythrocyte sedimentation rate

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

Elevated erythrocyte sedimentation rate

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?

Elevated uric acid levels

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

Encourage weight loss and an increase in aerobic activity

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed? Diclofenac Indomethacin Etanercept Celecoxib

Etanercept

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client?

Fatigue

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? Chest pain Behavioral changes Decreased cognitive ability Hypertension

Hypertension

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?

Hyperuricemia

Fibromyalgia is a common condition that

Involves chronic fatigue, generalized muscle aching, and stiffness

The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. What foods should the nurse encourage the patient to avoid? Asparagus Liver Pineapple Baked chicken

Liver

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?

Located over bony prominence

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?

Low back pain

Which of the following is the definitive diagnostic of gouty arthritis?

Polarized light microscopy of the synovial fluid A definitive diagnosis of gouty arthritis is established by polarized light microscopy of the synovial fluid of the involved joint. Synovial biopsy, arthrocentesis, and radiological studies aid in the diagnosis of rheumatoid arthritis.

The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. Which of the following should the nurse include in the teaching plan?

Protect the hands and feet from cold. Explanation: Raynaud's phenomenon is associated with scleroderma. Client teaching must include strategies for protecting the feet and hands.

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis? Creatinine ESR Red blood cell count Uric acid

Red blood cell count

Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis?

Red blood cell count

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? Review the client's medical record. Auscultate the client's lung sounds. Inspect the client's mouth. Observe the client's gait.

Review the client's medical record.

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) Cataracts d) Glaucoma

Sicca syndrome Explanation: 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. pg.1072

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Widespread chronic pain

A nurse practitioner is managing the care of a patient who has gout. Choose the medication that she would prescribe as the drug of choice to prevent tophi formation and promote tophi regression.

Zyloprim

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan? a) T'ai chi b) Yoga c) Pilates d) Jogging

d) Jogging Explanation: Jogging would be an inappropriate type of exercise, as it is a high impact, jarring type of exercise. pg.1077

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis?

encourage weight loss and an increase in aerobic activity

Scleroderma typically begins with which system involvement?

integumentary

"There might be some difficulties with your plan and fasting."

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity?"

"Your symptoms are a result of your body attacking itself."

A client with rheumatoid arthritis presents to the clinic for a second dose of gold thioglucose (Solganal). The dose prescribed is 25 mg intramuscularly. The medication is available in 50 mg per ml. How many milliliters will the nurse administer to the client?

0.5

10. A home health patient with rheumatoid arthritis (RA) complains to the nurse about having chronically dry eyes and a dry mouth. Which action by the nurse is most appropriate? a. Have the patient withhold the daily methotrexate (Rheumatrex) until talking with the health care provider. b. Reassure the patient that dry eyes and mouth are very common with RA. c. Teach the patient to use an antiseptic mouth wash tid. d. Suggest that the patient start using over-the-counter (OTC) artificial tears.

Answer: D Rationale: The patient's dry eyes and oral mucous membranes are consistent with Sjögren's syndrome, a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes and mouth are not side effects of methotrexate. Although dry eyes and mouth are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. Rinsing the mouth to decrease oral dryness is appropriate, but the frequent use of antiseptic mouthwashes is not appropriate unless the patient has oral symptoms that require this. Cognitive Level: Application Text Reference: p. 1726 Nursing Process: Implementation NCLEX: Physiological Integrity

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? Insert a Foley catheter Assess diet and activity at home Place client on bed rest Increase fluids

Assess diet and activity at home

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

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

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) "It will never get any better than it is right now." c) "When it clears up, it will never come back." d) "I'll definitely need surgery for this."

a) "It will get better and worse again." Explanation: 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. pg.1062

Which of the following would be consistent with the diagnosis of rheumatoid arthritis?

cloudy synovial fluid

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply. a) Nausea and vomiting b) Tingling in the arms c) Increase in pain in the affected extremity d) Intestinal cramping e) Diarrhea

e) Diarrhea d) Intestinal cramping a) Nausea and vomiting Explanation: Colchicine is administered every 1 or 2 hours until the pain subsides or nausea, vomiting, intestinal cramping, and diarrhea develop. When one or more of these symptoms occurs, the drug should be stopped temporarily. Tingling in the arms and increase in pain are not normal adverse reactions that are seen with this drug. pg.1080

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process?

gout

The presence of crystals in synovial fluid obtained from an arthrocentesis is indicative of

gout

A male client comes to the clinic with complaints of pain in his right great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has:

gouty arthritis.

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis?

imbalanced nutrition: greater than body requirements

Which of the following is the most common joint affected in gout?

metatarsophalangeal

Which is not a symptom of osteoarthritis? deep, aching pain with motion early in the disease limited joint motion morning stiffness that lasts at least 1 hour instability of weight-bearing joints

morning stiffness that lasts at least 1 hour

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

nonsteroidal anti-inflammatory drugs (NSAIDs)

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

organ meats.

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of: green vegetables. organ meats. fresh fish. citrus fruits.

organ meats.

Which of the following is the leading cause of disability and pain in the elderly?

osteoarthritis

Nursing care for the patient with fibromyalgia should be guided by what assumption?

patients with fibromyalgia may feel as if their symptoms are not taken seriously

What intervention is a priority for a patient diagnosed with osteoarthritis?

physical therapy and exercise

Which of the following would a nurse encourage a client with gout to limit?

purine-rich foods

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis?

red blood cell count

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol (Zyloprim) D) Prednisone

A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? A) I have this ringing in my ears that just wont go away. B) I feel so foggy in the mornings and it takes me so long to wake up. C) When I eat a meal thats high in fat, I get really nauseous. D) I seem to have lost my appetite, which is unusual for me.

A nurse is planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this womans care needs? A) Ineffective Role Performance Related to Pain B) Risk for Impaired Skin Integrity Related to Myalgia C) Risk for Infection Related to Tissue Alterations D) Unilateral Neglect Related to Neuropathic Pain

A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A) OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. B) OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees. C) OA originates with an infection. RA is a result of your bodys cells attacking one another. D) OA is associated with impaired immune function; RA is a consequence of physical damage.

A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient? A) Referral for assistive devices B) Teaching about symptom management C) Referral to classes to stop smoking D) Setting up an exercise program

A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? A) The patient has a 30 pack-year smoking history. B) The patients body mass index is 34 (obese). C) The patient has primary hypertension. D) The patient is 58 years old.

A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? A) Petechiae B) Butterfly rash C) Jaundice D) Skin sloughing

The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins. Aloprim Benemid Colchicine Anturane

Colchicine

A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A) Ensuring adequate rest B) Limiting exposure to sunlight C) Limiting intake of alcohol D) Smoking cessation

A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize? A) Assessment for subtle signs of bleeding disorders B) Assessment of the metatarsal joints and phalangeal joints C) Assessment for thoracic pain that is exacerbated by activity D) Assessment for headaches and jaw pain

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Reports increased fatigue

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports ability to perform ADLs Shows a weight gain of 2 pounds Reports decreased joint pain Reports increased fatigue

Reports increased fatigue

The side effect of bone marrow depression may occur with which medication used to treat gout?

allopurinol (Zyloprim)

A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand irritation when her call bell isnt answered immediately. What would be the most appropriate response? A) You seem like youre feeling angry. Is that something that we could talk about? B) Try to remember that stress can make your symptoms worse. C) Would you like to talk about the problem with the nursing supervisor? D) I can see youre angry. Ill come back when youve calmed down.

A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? A) Rheumatoid arthritis (RA) B) Systemic lupus erythematosus C) Osteoporosis D) Polymyositis

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

A nurse is providing care for a patient who has a rheumatic disorder. The nurses comprehensive assessment includes the patients mood, behavior, LOC, and neurologic status. What is this patients most likely diagnosis? A) Osteoarthritis (OA) B) Systemic lupus erythematosus (SLE) C) Rheumatoid arthritis (RA) D) Gout

A patient has just been told by his physician that he has scleroderma. The physician tells the patient that he is going to order some tests to assess for systemic involvement. The nurse knows that priority systems to be assessed include what? A) Hepatic B) Gastrointestinal C) Genitourinary D) Neurologic

A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient 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 patients adherence to her medication regimen? A) Encourage the patient to store the bottles with their tops removed. B) Have a trusted family member take over the management of the patients medication regimen. C) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. D) Have the patient approach her primary care provider to explore medication alternatives.

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? Prednisone (Deltasone) Allopurinol (Zyloprim) Colchicine Propoxyphene hydrochloride (Darvon)

Colchicine

The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins.

Colchicine - Colchicine, along with indomethacin, ibuprofen, or a corticosteroid is prescribed to relieve an acute attack of gout. Benemid and Anturane increase the urinary excretion of uric acid, and Aloprim breaks down purines before uric acid is formed.

A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patients health should the nurse focus most closely during the visit? A) The patients understanding of rheumatoid arthritis B) The patients risk for cardiopulmonary complications C) The patients social support system D) The patients functional status

A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurses response to the patient? A) New evidence shows CAM to be as effective as medical treatment. B) CAM therapies negate many of the benefits of medications. C) CAM therapies typically do more harm than good. D) Evidence shows minimal benefits from most CAM therapies.

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

a) "My finger joints are oddly shaped." Explanation: 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. pg.1066

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? a) After the client has had a warm paraffin hand bath b) First thing in the morning when the client wakes c) After the client has a diagnostic test d) After cool compresses have been applied to the hands

a) After the client has had a warm paraffin hand bath Explanation: Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises. pg.1056

The side effect of bone marrow depression may occur with which medication used to treat gout? a) Allopurinol (Zyloprim) b) Colchicine c) Prednisone d) Probenecid (Benemid)

a) Allopurinol (Zyloprim) Explanation: A patient taking Zyloprim needs to be monitored for the side effects of bone marrow depression, vomiting, and abdominal pain. pg.1080

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout?

assess dietary diet and activity at home

The nurse intervenes to assist the patient with fibromyalgia to cope with what symptoms?

chronic fatigue, generalized muscle aching, and stiffness

colchicine

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

combat inflammation.

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is: a) obesity. b) congenital deformity. c) trauma. d) age.

d) age. Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma. pg.1075

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

d) is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly patients, is often ignored. Reiter's syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis requires early treatment because of early damage caused by disease. Ankylosing spondylitis causes the described problem and is usually diagnosed in the second or third decade of life. pg.1075

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) Dyspnea owing to fibrotic cardiac tissue b) Productive cough c) Butterfly-shaped rash on the face d) Dysphagia owing to hardening of the esophagus e) Decreased ventilation owing to lung scarring

e) Decreased ventilation owing to lung scarring d) Dysphagia owing to hardening of the esophagus a) Dyspnea owing to fibrotic cardiac tissue Explanation: The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur. pg.1073

Which of the following newer pharmacological therapies, used for treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects?

vicosupplementation

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? a) Extension b) Internal rotation c) Hyperextension d) Slight dorsiflexion

d) Slight dorsiflexion Explanation: Devices such as braces, splints, and assistive devices for ambulation (e.g., canes, crutches, walkers) ease pain by limiting movement or stress from putting weight on painful joints. Acutely inflamed joints can be rested by applying splints to limit motion. Splints also support the joint to relieve spasm. pg.1056

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? "My energy level will gradually increase over time." "My medications will ultimately correct my problem." "I do not need to make any changes in my diet." "I should avoid prolonged sun exposure."

"I should avoid prolonged sun exposure."

A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? A) Fatigue Related to Anemia B) Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism C) Acute Confusion Related to Increased Serum Ammonia Levels D) Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit

24. A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will need to monitor a. blood pressure. b. blood glucose. c. erythrocyte count. d. lymphocyte count.

Answer: A Rationale: Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes. Cognitive Level: Comprehension Text Reference: p. 1716 Nursing Process: Planning NCLEX: Physiological Integrity

A patient with polymyositisis experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action? A) Initiate a program of passive range of motion exercises B) Facilitate referrals to occupational and physical therapy C) Administer skeletal muscle relaxants as ordered D) Encourage a progressive program of weight-bearing exercise

A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize? A) Take OTC calcium supplements consistently. B) Restrict consumption of foods high in purines. C) Ensure fluid intake of at least 4 liters per day. D) Restrict weight-bearing on right foot.

A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply. A) Erythrocyte count B) Erythrocyte sedimentation rate C) Creatinine clearance D) C-reactive protein E) D-dimer

B, D

A nurse is performing the health history and physical assessment of a patient 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, especially in the morning D) Visible atrophy of the knee and shoulder joints

A patient with SLE asks the nurse why she has to come to the office so often for check-ups. What would be the nurses best response? A) Taking care of you in the best way involves seeing you face to face. B) Taking care of you in the best way involves making sure you are taking your medication the way it is ordered. C) Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. D) Taking care of you in the best way involves drawing blood work every month.

A patient with SLE has come to the clinic for a routine check-up. When auscultating the patients apical heart rate, the nurse notes the presence of a distinct scratching sound. What is the nurses most appropriate action? A) Reposition the patient and auscultate posteriorly. B) Document the presence of S3 and monitor the patient closely. C) Inform the primary care provider that a friction rub may be present. D) Inform the primary care provider that the patient may have pneumonia.

A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? A) Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels. B) Ill try to be as physically active as possible between flare-ups. C) Ill make sure to monitor my body temperature on a regular basis. D) Ill stop taking my steroids when I get relief from my symptoms.

A nurses plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals? 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 and increase range of motion while limiting joint stress

A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse emphasize the need for continued adherence to the prescribed medication? A) To avoid complications such as venous thromboembolism B) To avoid the progression to osteoporosis C) To avoid the progression of GCA to degenerative joint disease D) To avoid complications such as blindness

A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? A) Angiography B) Myelography C) Paracentesis D) Arthocentesis

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

Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? A) Hyperuricemia B) Increased erythrocyte sedimentation rate C) Elevated serum creatinine D) Decreased platelets

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease? If you have problems with a medication, you may stop it until your next physician visit. Pace activities. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. Avoid sunlight and ultraviolet radiation.

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

Of the following, which drug is not used in the treatment of rheumatoid arthritis? a) Allopurinol (Zyloprim) b) Adalimumab (Humira) c) Methotrexate (Rheumatrex) d) Etanercept (Enbrel

a) Allopurinol (Zyloprim) Explanation: Allopurinol (Zyloprim) is used in the treatment of gout. Etanercept (Enbrel), adalimumab (Humira), and methotrexate (Rheumatrex) are all used in the treatment of rheumatoid arthritis. pg.1079

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Joint effusion b) Subchondral bone c) Pannus d) Tophi

d) Tophi 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.

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Subchondral bone b) Pannus c) Joint effusion d) Tophi

d) Tophi Explanation: 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. pg.1079

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Heberden nodes b) Butterfly facial rash c) Jaw locking d) Widespread chronic pain

d) Widespread chronic pain The most common finding associated with fibromyalgia is widespread and chronic pain. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus.

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a) Suggestive of RA b) Diagnostic for SLE c) Specific for RA d) Diagnostic for Sjögren's syndrome

a) Suggestive of RA Rheumatoid factor is present in about 80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence does not rule out the diagnosis.

3. The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient with osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use that the drug does not seem to be effective in controlling the pain. The nurse should teach the patient that a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of variations in individual response to the drugs. b. it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood. c. if NSAIDs are not effective in controlling symptoms, corticosteroids are the next drug of choice. d. adding a twice-daily aspirin to the naproxen may improve the effectiveness of the drug.

Answer: A Rationale: Individual responses to NSAIDs can vary, so the health care provider may prescribe a different NSAID. Full effectiveness of NSAIDs occurs in 2 to 3 weeks. Corticosteroids are usually reserved for use in RA. Patients are instructed to avoid aspirin when taking NSAIDs because of the increased risk for bleeding and gastrointestinal irritation. Cognitive Level: Application Text Reference: p. 1697 Nursing Process: Implementation NCLEX: Physiological Integrity

A 40-year-old woman was diagnosed with Raynauds phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are stiff, like the skin is being stretched from all directions. The nurse should recognize the need for medical referral for the assessment of what health problem? A) Giant cell arteritis (GCA) B) Fibromyalgia (FM) C) Rheumatoid arthritis (RA) D) Scleroderma

31. A patient has systemic sclerosis manifested by the CREST syndrome. During assessment of the patient, the nurse would expect to find a. bony ankylosis of the small joints in the feet. b. a recent history of significant weight gain. c. burning, itching, and photosensitivity of the eyes. d. a history of numbness and tingling in the fingers.

Answer: D Rationale: Raynaud's phenomenon is one aspect of the CREST syndrome. Bony ankylosis is not a symptom of systemic sclerosis, which does not affect bone. Weight loss occurs with CREST syndrome as a result of esophageal scarring. Burning, itching, and photosensitivity of the eyes are not associated with systemic sclerosis. Cognitive Level: Application Text Reference: p. 1723 Nursing Process: Assessment NCLEX: Physiological Integrity

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

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"? a) "Your symptoms are a result of your body attacking itself." b) "You are not immune to the disease causing the symptoms." c) "You have inherited your parent's immunity to the disease." d) "You have antigens to the disease, but it they do not prevent the disease."

a) "Your symptoms are a result of your body attacking itself." Correct Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect "attacking itself." The other statements do not explain autoimmunity. pg.1055

A nurse should expect to administer which medication to a client with gout? a) Colchicine b) Furosemide (Lasix) c) Calcium gluconate (Kalcinate) d) Aspirin

a) Colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps, it doesn't treat gout. pg.1079

A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. An appropriate nursing diagnosis for the client is: a) Disturbed body image b) Risk for loneliness c) Chronic low self-esteem d) Spiritual distress

a) Disturbed body image Explanation: The client is exhibiting defining characteristics of disturbed body image. pg.1073

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Elevated erythrocyte sedimentation rate b) Increased albumin levels c) Increased red blood cell count d) Increased C4 complement

a) Elevated erythrocyte sedimentation rate Explanation: 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. pg.1058

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed? a) Etanercept b) Celecoxib c) Diclofenac d) Indomethacin

a) Etanercept Explanation: Etanercept is an example of a tumor necrosis factor (TNF)-alpha inhibitor used to treat rheumatoid arthritis. Diclofenac and indomethacin are nonsteroidal anti-inflammatory drugs (NSAIDs). Celecoxib is a cyclooxygenase-2 (COX-2) inhibitor. pg.1061

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Facial erythema, pericarditis, pleuritis, fever, and weight loss b) Hypothermia, weight gain, lethargy, and edema of the arms c) Weight gain, hypervigilance, hypothermia, and edema of the legs d) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers

a) Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

The nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnoses will most likely apply to this patient's care? Select all that apply a) Fatigue b) Alteration in self-concept c) Fluid and electrolyte imbalance d) Pain e) Fluid volume deficit

a) Fatigue b) Alteration in self-concept d) Pain Patients with rheumatic diseases, which typically involve joints and muscles, cause problems with mobility, fatigue, and pain. Due to limitations of the disease, the patients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases.

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response? a) Hand and finger deformities are associated with the development of rheumatoid arthritis. b) A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. c) He should discuss this concern with his physician. d) It's impossible to determine at the time of diagnosis how the disease will progress.

a) Hand and finger deformities are associated with the development of rheumatoid arthritis. Explanation: The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease. pg.1066

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Chest pain c) Behavioral changes d) Decreased cognitive ability

a) Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous. pg.1070

Which nursing diagnosis is most inappropriate for the client with osteoarthritis? a) Imbalanced nutrition: less than body requirements b) Impaired physical mobility c) Deficient knowledge: symptom management d) Chronic pain

a) Imbalanced nutrition: less than body requirements Explanation: Weight reduction is often part of the management plan for the client with osteoarthritis. pg.1067

Which findings best correlate with a diagnosis of osteoarthritis? a) Joint stiffness that decreases with activity b) Fever and malaise c) Erythema and edema over the affected joint d) Anorexia and weight loss

a) Joint stiffness that decreases with activity Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases 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. pg.1076

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a) Limited passive movement b) Limb shortening c) Joint enlargement d) Joint instability

a) Limited passive movement Explanation: Limited passive movement can be the first and only physical sign of symptomatic OA. Physical assessment of the musculoskeletal system reveals joint enlargement, joint instability, and limb shortening. pg.1075

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds? a) Lung sounds are diminished in the apical area. b) Crackles in the bases c) Pericardial friction rub d) Rhonchi

a) Lung sounds are diminished in the apical area. Explanation: The lumbar curve of the spine may flatten. The neck can be permanently flexed, and the client appears to be in a perpetual stooped position. Aortic regurgitation or atrioventricular node conduction disturbances may occur. Lung sounds may be reduced, especially in the apical area. The nurse would not hear rhonchi, crackles, or a pericardial friction rub unless the client had underlying cardiac or respiratory disorders. pg.1077

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Disease-modifying antirheumatic drugs (DMARDS) c) Tumor necrosis factor (TNF) blockers d) Glucocorticoids

a) Nonsteroidal anti-inflammatory drugs (NSAIDs) In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms.

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Opioid therapy c) Surgery d) Ice packs

a) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat is used to relieve pain rather than ice packs. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional. It is not an intervention specific to relieving pain. pg.1056

Nursing care for the patient with fibromyalgia should be guided by what assumption? a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously. b) All patients with fibromyalgia have the same type of symptoms. c) Patients with fibromyalgia will eventually lose their ability to walk. d) Patients with fibromyalgia rarely respond to treatment.

a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously. Explanation: Because patients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose patients. Patients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from patient to patient, and respond to different treatments. Patients do not lose their ability to walk. pg.1081

What intervention is a priority for a patient diagnosed with osteoarthritis? a) Physical therapy and exercise b) Colchicine c) Allopurinol (Zyloprim) d) Hydrotherapy

a) Physical therapy and exercise Patients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and Zyloprim are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care.

Which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects? a) Viscosupplementation b) Glucosamine c) Capsaicin d) Chondroitin

a) Viscosupplementation Explanation: Viscosupplementation, the intra-articular injection of hyaluronic acid, is thought to improve cartilage function and retard degradation. It may also have some anti-inflammatory effects. Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage. Capsaicin is a topical analgesic.

A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.) a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L d) Red blood cell (RBC) count of <4.0 million/mcL e) Red blood cell (RBC) count of >4.0 million/mcL

a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) d) Red blood cell (RBC) count of <4.0 million/mcL Explanation: Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive. pg.1066

Which of the following medications are used in the treatment of gout? Select all that apply. a) Probenecid (Benemid) b) Febuxostat (Uloric) c) Sulfasalazine (Azulfidine) d) Hydroxychloroquine (Plaquenil) e) Allopurinol (Zyloprim)

a) Probenecid (Benemid) e) Allopurinol (Zyloprim) b) Febuxostat (Uloric) Explanation: Benemid, Zyloprim, and Uloric are used in the treatment of gout. Plaquenil and Azulfidine are useful in the treatment of rheumatoid arthritis. pg.1080

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

a) Scleroderma Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a) Shows a weight gain of 2 pounds b) Reports decreased joint pain c) Reports increased fatigue d) Reports ability to perform ADLs

a) Shows a weight gain of 2 pounds Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen.

Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years? a) Small joint involvement b) Asymmetric joint involvement c) Bouchard's nodes d) Obesity

a) Small joint involvement Explanation: Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur. pg.1065

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Widespread chronic pain b) Jaw locking c) Butterfly facial rash d) Heberden nodes

a) Widespread chronic pain Explanation: The most common finding associated with fibromyalgia is widespread and chronic pain. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus. pg.1080

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: a) combat inflammation. b) prevent platelet aggregation. c) promote diuresis. d) prevent infection.

a) combat inflammation. Explanation: Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis. pg.1071

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because: a) weight loss will reduce uric acid levels and reduce stress on joints. b) weight loss will reduce purine levels. c) weight loss will increase uric acid levels and reduce stress on joints. d) weight loss will reduce inflammation.

a) weight loss will reduce uric acid levels and reduce stress on joints. Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss won't reduce purine levels, reduce inflammation or increase uric acid levels. pg.1079

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?

applications of ice Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan.

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient?

assistive devices, safe exercise, medication dosages and side effects

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) "I should avoid prolonged sun exposure." c) "My energy level will gradually increase over time." d) "My medications will ultimately correct my problem."

b) "I should avoid prolonged sun exposure." Explanation: Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression. pg.1072

What should the nurse teach the patient about the diagnosis of osteoarthritis? a) "It affects young males." b) "It is the most common and frequently disabling of joint disorders." c) "It requires early treatment because most of the damage appears to occur early in the course of the disease." d) "It affects the cartilaginous joints of the spine and surrounding tissues."

b) "It is the most common and frequently disabling of joint disorders." Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly patients, is often ignored. Reiter's syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis causes the described problem and is usually diagnosed in the second or third decade of life. pg.1075

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "Monitor your body temperature." c) "Corticosteroids may be stopped when symptoms are relieved." d) "There are no activity limitations between flare-ups."

b) "Monitor your body temperature." Explanation: 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. pg.1071

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about? a) Azathioprine (Imuran) b) Hydroxychloroquine (Plaquenil) c) Aurothioglucose (Solganal) d) Diclofenac (Voltaren)

b) Hydroxychloroquine (Plaquenil) Explanation: The DMARD hydroxychloroquine (Plaquenil) 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). pg.1060

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Administering ordered analgesics and monitoring their effects 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

b) Administering ordered analgesics and monitoring their effects Explanation: 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. pg.1066

Which of the following terms refers to fixation or immobility of a joint? a) Hemarthrosis b) Ankylosis c) Arthroplasty d) Diarthrodial

b) Ankylosis Explanation: Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into the joint. Diarthrodial refers to a joint with two free moving parts. Arthroplasty refers to replacement of a joint. pg.1078

Which of the following refers to fixation of a joint? a) Synovitis b) Ankylosis c) Pannus d) Articulations

b) Ankylosis Explanation: 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. pg.1078

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. b) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. c) Exercising in the evening before going to bed is beneficial. d) The time of day when exercise is performed isn't important.

b) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

b) Hyperuricemia Explanation: Gout is caused by hyperuricemia (increased serum uric acid). pg.1079

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority? a) Impaired gas exchange b) Impaired skin integrity c) Imbalanced nutrition: More than body requirements d) Risk for constipation

b) Impaired skin integrity Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursing diagnosis isn't the priority. Clients with scleroderma are at risk for Imbalanced nutrition: Less than body requirements. The client with advanced scleroderma, not newly diagnosed scleroderma, is at increased risk for developing respiratory complications.

Which of the following is the most common joint affected in gout? a) Tarsal area b) Metatarsophalangeal c) Knee d) Ankle

b) Metatarsophalangeal The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients), and this is referred to as podagra. Less commonly, the wrists, fingers, and elbows may be affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

Which of the following is the most common joint affected in gout? a) Tarsal area b) Metatarsophalangeal c) Knee d) Ankle

b) Metatarsophalangeal Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients), and this is referred to as podagra. Less commonly, the wrists, fingers, and elbows may be affected. The tarsal area, ankle, and knee are not the most commonly affected in gout. pg.1079

All of the following are symptoms of osteoarthritis, except? a) Limited joint motion b) Morning stiffness that lasts at least 1 hour. c) Instability of weight-bearing joints d) Deep, aching pain with motion early in the disease

b) Morning stiffness that lasts at least 1 hour. Explanation: Morning stiffness that lasts at least 1 hour is a symptom of rheumatoid arthritis. The following are symptoms of osteoarthritis: deep, aching pain with motion early in the disease; limited joint motion; and instability of weight-bearing joints. pg.1076

Which of the following is the definitive diagnostic of gouty arthritis? a) Radiologic studies b) Polarized light microscopy of the synovial fluid c) Synovial biopsy d) Arthrocentesis

b) Polarized light microscopy of the synovial fluid Explanation: A definitive diagnosis of gouty arthritis is established by polarized light microscopy of the synovial fluid of the involved joint. Synovial biopsy, arthrocentesis, and radiological studies aid in the diagnosis of rheumatoid arthritis. pg.1079

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? a) Side-lying with pillows supporting the shoulders and legs b) Prone c) Supine with pillows under the knees d) Semi-Fowler's

b) Prone It is best for the patient with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.

Which of the following would a nurse encourage a client with gout to limit? a) Carbohydrates b) Purine-rich foods c) Fluid intake d) Protein-rich foods

b) Purine-rich foods Explanation: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid. pg.1079

Scleroderma typically starts with which type of organ involvement? a) Lung b) Skin c) Kidney d) Brain

b) Skin Explanation: Scleroderma commonly begins with skin involvement. Mononuclear cells cluster on the skin and stimulate lymphokines to stimulate procollagen. Scleroderma does not commonly begin in the lung, brain, or kidney. pg.1073

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply. a) Autoantibodies immune complexes b) Susceptibility c) Damage d) Abnormal innate and adaptive immune responses e) Inflammation

b) Susceptibility d) Abnormal innate and adaptive immune responses a) Autoantibodies immune complexes e) Inflammation c) Damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns? a) Administering opioids at bed time b) Tricyclic antidepressants c) Range-of-motion exercise prior to sleeping d) Increasing activity during the day

b) Tricyclic antidepressants Explanation: Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in patients with fibromyalgia. Increasing activity during the day or using range-of-motion exercises will not increase the patient's ability to sleep. Narcotics are generally not needed for pain control with this disorder. pg.1080

A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis? a) "Client will lose 2 lb (0.91 kg) per week on a calorie-restricted diet." b) "Client will exhibit alertness and orientation to person, place, and time." c) "Client will exhibit no signs or symptoms of aspiration." d) "Client will exhibit bowel and bladder continence."

c) "Client will exhibit no signs or symptoms of aspiration." Explanation: An expected outcome of no signs or symptoms of aspiration relates to symmetrical muscle weakness — a potential problem associated with polymyositis that may lead to speaking and swallowing problems. A client with a potential swallowing problem is at risk for inadequate nutrition and shouldn't be placed on a calorie-restricted diet; an expected outcome focusing on maintaining weight would be more appropriate than an outcome based on losing weight. Polymyositis doesn't affect bowel or bladder function or mental status; it isn't necessary to develop outcomes based on these parameters. pg.1074

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Corticosteroids may be stopped when symptoms are relieved." b) "There are no activity limitations between flare-ups." c) "Monitor your body temperature." d) "Exposure to sunlight will help control skin rashes."

c) "Monitor your body temperature." 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.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a) "Do all your chores in the morning, when pain and stiffness are least pronounced." b) "Do all your chores in the evening, when pain and stiffness are least pronounced." c) "Pace yourself and rest frequently, especially after activities." d) "Do all your chores after performing morning exercises to loosen up."

c) "Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Telling the client to do her chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace herself and take frequent rests rather than doing all chores at once.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate? a) "You should discuss that matter with your physician." b) "Tell me more about your concerns about this potential diagnosis." c) "The diagnosis won't be based on the findings of a single test but by combining all data found." d) "SLE is a very serious systemic disorder."

c) "The diagnosis won't be based on the findings of a single test but by combining all data found." Explanation: There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the physician, stating that SLE is a serious systemic disorder, and asking the client to express her feelings about the potential diagnosis don't answer the client's question. pg.1070

A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? a) "Try combining the fasting with moderate exercise." b) "The fasting is okay, but make sure you drink fluids when exercising." c) "There might be some difficulties with your plan and fasting." d) "Make sure to eat some fat occasionally with all that exercise."

c) "There might be some difficulties with your plan and fasting." Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.

Which of the following classifications are considered antiarthritic drugs? Select all that apply. a) Disease-modifying antirheumatics (DMARDs) b) Diuretics c) Anti-inflammatory d) Muscle relaxants e) Glucocorticoids

c) Anti-inflammatory a) Disease-modifying antirheumatics (DMARDs) e) Glucocorticoids Explanation: Antiarthritic drugs fall into three major groups: nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and glucocorticoids. Diuretics and muscle relaxants are not antiarthritic drugs. pg.1056

Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition? a) Regular exercise and stress reduction b) Encouraging the client to eat a healthy diet c) Applications of ice d) Avoiding caffeine and alcohol

c) Applications of ice Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan.

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout? a) Increase fluids b) Place patient on bed rest c) Assess dietary diet and activity at home d) Insert a foley catheter

c) Assess dietary diet and activity at home Explanation: Patients with gout need teaching about diet restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to see what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a patient with this problem. pg.1079

Which of the following would be consistent with the diagnosis of rheumatoid arthritis? a) Increased C4 complement component b) Increased red blood cell count c) Cloudy synovial fluid d) Decreased ESR

c) Cloudy synovial fluid Explanation: In a patient with rheumatoid arthritis, Arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement. pg.1066

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis? a) Small joint involvement b) Joint pain that diminishes with rest c) Early morning stiffness d) Subcutaneous nodules

c) Early morning stiffness Explanation: Osteoarthritis is characterized by early morning stiffness that decreases with activity. pg.1076

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

c) Encourage weight loss and an increase in aerobic activity Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening are important approaches to pain management. Patients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, prior to their exercise session. Gastrointestinal complications, especially GI bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Topical analgesics such as capsaicin and methylsalicylate may be used for pain management.

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

c) Encourage weight loss and an increase in aerobic activity. Explanation: Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Patients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, prior to their exercise session. Gastrointestinal complications, especially GI bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Topical analgesics, such as capsaicin and methylsalicylate, may be used for pain management. pg.1077

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a) The time of day when exercise is performed isn't important. b) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. d) Exercising in the evening before going to bed is beneficial.

c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Explanation: A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime. pg.1076

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? a) Self-care deficit: Bathing b) Ineffective airway clearance c) Fatigue d) Risk for infection

c) Fatigue Explanation: Low red blood cell count can be related to inadequate nutrition. Insufficient RBC levels compromise the oxygen-carrying capacity of the blood, which can lead to fatigue. pg.1063

A patient arrives at the clinic with complaints of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to? a) Fibromyalgia b) Osteoarthritis c) Gout d) Rheumatoid arthritis

c) Gout Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients) in gout. The abrupt onset often occurs at night, awakening the patient with severe pain, redness, swelling, and warmth of the affected joint. pg.1079

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process? a) Inflammation b) Degeneration c) Gout d) Infection

c) Gout Explanation: The presence of crystals is indicative of gout, and the presence of bacteria is indicative of infective arthritis. pg.1079

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? a) Rheumatoid nodules b) Tophi c) Heberden's nodes d) Bouchard's nodes

c) Heberden's nodes Explanation: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden's nodes are bony enlargement of the distal interphalangeal joints. Bouchard's nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels. pg.1076

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except? a) Avoid sunlight and ultraviolet radiation. b) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. c) If you have problems with a medication, you may stop it until your next physician visit. d) Pace activities.

c) If you have problems with a medication, you may stop it until your next physician visit. Explanation: 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. pg.1072

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority? a) Risk for constipation b) Impaired gas exchange c) Impaired skin integrity d) Imbalanced nutrition: More than body requirements

c) Impaired skin integrity Explanation: Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursing diagnosis isn't the priority. Clients with scleroderma are at risk for Imbalanced nutrition: Less than body requirements. The client with advanced scleroderma, not newly diagnosed scleroderma, is at increased risk for developing respiratory complications. pg.1074

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound? a) Inhibits DNA synthesis b) Inhibits lysosomal enzymes c) Inhibits T- and B-cell activity d) Inhibits platelet aggregation

c) Inhibits T- and B-cell activity Explanation: Gold sodium thiolmalate (Myochrysine) inhibits T- and B-cell activity, thereby suppressing synovitis during the active stage of rheumatoid disease. pg.1060

Which of the following statements is accurate regarding osteoarthritis? a) It is the most common inflammatory arthritic disorder. b) It is caused by an overproduction of uric acid. c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. d) It affects young males.

c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. Explanation: Osteoarthritis (OA), also known as degenerative joint disease, is a chronic, noninflammatory (even though inflammation may be present), progressive disorder that causes cartilage deterioration in synovial joints and vertebrae. OA is the most common and most frequently disabling of the joint disorders that is overdiagnosed and trivialized and frequently over or undertreated. Aging is the risk factor most strongly correlated with OA. Gout is caused by an overproduction of uric acid. Rheumatoid arthritis is the most common inflammatory arthritic disorder. pg.1075

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? a) The medication is administered IM. b) The patient should continue taking the medication if fever occurs. c) It is important to monitor for injection site reactions. d) The medication is given at room temperature.

c) It is important to monitor for injection site reactions. It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? a) The medication is administered IM. b) The medication is given at room temperature. c) It is important to monitor for injection site reactions. d) The patient should continue taking the medication if fever occurs.

c) It is important to monitor for injection site reactions. Explanation: It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs. pg.1061

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include? a) Reddened b) Nonmovable c) Located over bony prominence d) Tender to touch

c) Located over bony prominence Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. They are not reddened.

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

c) Muscle biopsy Explanation: As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity. pg.1074

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Disease-modifying antirheumatic drugs (DMARDS) b) Glucocorticoids c) Nonsteroidal anti-inflammatory drugs (NSAIDs) d) Tumor necrosis factor (TNF) blockers

c) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms. pg.1056

Primary gout is often caused by an inherited disorder in which type of metabolism? a) Glucose b) Fat c) Purine d) Carbohydrate

c) Purine Explanation: Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism. pg.1079

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Uric acid b) Creatinine c) Red blood cell count d) Erythrocyte sedimentation rate (ESR)

c) Red blood cell count Explanation: There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis. pg.1066

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a) Reports decreased joint pain b) Reports ability to perform ADLs c) Reports increased fatigue d) Shows a weight gain of 2 pounds

c) Reports increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. pg.1063

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) Auscultate the client's lung sounds. b) Observe the client's gait. c) Review the client's medical record. d) Inspect the client's mouth.

c) Review the client's medical record. Explanation: 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. pg.1070

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

c) Safe exercise d) Medication dosages and side effects e) Assistive devices Correct Explanation: The patient 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 or even walkers and canes, may assist the patient to care safely for him- or herself. Narcotics are not commonly used and there would be no reason for dressings. pg.671

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) Systemic lupus erythematosus (SLE) 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.

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

c) Take the medication with food to avoid stomach upset. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset.

c) Take the medication with food to avoid stomach upset. Explanation: The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. pg.1060

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? a) The symptoms are primarily localized to the skin but may involve the joints. b) This disorder is more common in men in their thirties and forties than in women. c) The belief is that it is an autoimmune disorder with an unknown trigger. d) It has very specific manifestations that make diagnosis relatively easy.

c) The belief is that it is an autoimmune disorder with an unknown trigger. Explanation: 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. pg.1069

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is: a) congenital deformity. b) trauma. c) age. d) obesity.

c) age. Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to: a) wear protective devices when exercising. b) get help when lifting objects. c) install safety devices in the home. d) wear worn, comfortable shoes.

c) install safety devices in the home. Explanation: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises. pg.1077

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." b) "OA is more common in women. RA is more common in men." c) "OA affects joints on both sides of the body. RA is usually unilateral." d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: 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. pg.1075

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a) "Do all your chores after performing morning exercises to loosen up." b) "Do all your chores in the morning, when pain and stiffness are least pronounced." c) "Do all your chores in the evening, when pain and stiffness are least pronounced." d) "Pace yourself and rest frequently, especially after activities."

d) "Pace yourself and rest frequently, especially after activities." Explanation: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Telling the client to do her chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace herself and take frequent rests rather than doing all chores at once. pg.1076

A client with gout has been advised to lose weight. She informs the nurse that she 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) "Make sure to eat some fat occasionally with all that exercise." c) "Try combining the fasting with moderate exercise." d) "There might be some difficulties with your plan and fasting."

d) "There might be some difficulties with your plan and fasting." Explanation: Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout. pg.1079

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

d) An exercise routine that includes range-of-motion (ROM) exercises Explanation: 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. pg.1067

Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition? a) Encouraging the client to eat a healthy diet b) Regular exercise and stress reduction c) Avoiding caffeine and alcohol d) Applications of ice

d) Applications of ice Explanation: Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan. pg.1056

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

d) Arthrodesis Explanation: 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. pg.1067

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

d) Chronic fatigue, generalized muscle aching, and stiffness Explanation: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown and no pathologic characteristics have been identified that are specific for the condition. Treatment consists of attention to the specific symptoms reported by the patient. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals. pg.1080

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? a) Allopurinol (Zyloprim) b) Propoxyphene hydrochloride (Darvon) c) Prednisone (Deltasone) d) Colchicine

d) Colchicine Explanation: The physician usually orders colchicine for a client experiencing an acute gout attack. This drug decreases leukocyte motility, phagocytosis, and lactic acid production, thereby reducing urate crystal deposits and relieving inflammation. Allopurinol is used to decrease uric acid production in clients with chronic gout. Although corticosteroids are ordered to treat gout, the nurse wouldn't give them because they must be administered interarticularly to this client. Propoxyphene, an opioid, may be used to treat osteoarthritis. pg.1079

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? a) Scoliosis b) Paget's disease c) Muscular dystrophy d) Degenerative joint disease

d) Degenerative joint disease Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease. pg.1076

A 68-year-old client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which of the following activities might enhance an acute attack? a) Frequently drinking coffee b) Frequently ingesting salicylates c) Frequently drinking alcohol d) Eating organ meats and sardines

d) Eating organ meats and sardines Explanation: During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. pg.1079

Which findings best correlate with a diagnosis of osteoarthritis? a) Erythema and edema over the affected joint b) Anorexia and weight loss c) Fever and malaise d) Joint stiffness that decreases with activity

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

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers b) Weight gain, hypervigilance, hypothermia, and edema of the legs c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

d) Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: 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. pg.1070

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following? a) Rheumatoid arthritis b) Ankylosing spondylitis c) Osteoarthritis d) Gout

d) Gout Explanation: Joint swelling and tenderness of the great toe and tophi are classic manifestations of gout. pg.1079

After teaching a class comparing rheumatoid arthritis and osteoarthritis, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of osteoarthritis? a) Swan neck deformity b) Ulnar deviation c) Boutonniere deformity d) Heberden nodes

d) Heberden nodes Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis. pg.1066

Diagnosis of osteoarthritis is complicated because initial joint changes occur without symptoms. Therefore, a combination of physical assessment and X-ray review is necessary for a diagnosis. Select two signs that, when combined, are sensitive indicators of OA. a) Tender joints b) Joint pain c) Enlarged joints d) Joint space narrowing e) Osteophytes

d) Joint space narrowing e) Osteophytes Standard X-rays of affected joints show osteophytes, the most characteristic feature of OA, and in more advanced disease, joint space narrowing and sclerosis. When these two are combined, a diagnosis of OA is established.

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis? a) Patchy hair loss on the scalp b) Red, butterfly-shaped facial rash c) Increased urine output d) Low back pain

d) Low back pain Explanation: The most common symptoms of ankylosing spondylitis are low back pain and stiffness. A red, butterfly-shaped rash on the face and a patchy loss of hair are the associated with systemic lupus erythematosus. Ankylosing spondylitis does not affect urine output. pg.1077

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate? a) Maintain complete bed rest. b) Keep shifting weight from one foot to the other. c) Perform aerobic exercises. d) Maintain good posture.

d) Maintain good posture. The nurse needs to remind the client with degenerative joint disease to maintain good posture. While the client need not maintain complete bed rest, performing aerobic exercises is not advisable as it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? a) Eradicating pain b) Promoting sleep c) Eliminating deformities d) Minimizing damage

d) Minimizing damage Explanation: Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results. pg.1066

Which of the following is the leading cause of disability and pain in the elderly? a) SLE b) Scleroderma c) Rheumatoid arthritis (RA) d) Osteoarthritis

d) Osteoarthritis Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly. pg.1075

What intervention is a priority for a patient diagnosed with osteoarthritis? a) Hydrotherapy b) Allopurinol (Zyloprim) c) Colchicine d) Physical therapy and exercise

d) Physical therapy and exercise Explanation: Patients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and Zyloprim are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care. pg.1077

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis? a) Positive Anti-Sm antibodies b) Positive ANA titre c) Elevated ESR d) Positive Anti-dsDNA antibody test

d) Positive Anti-dsDNA antibody test Explanation: Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titre shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement. pg.1071

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? a) Supine with pillows under the knees b) Semi-Fowler's c) Side-lying with pillows supporting the shoulders and legs d) Prone

d) Prone Explanation: It is best for the patient with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.

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) Reiter's syndrome b) Ankylosing spondylitis c) Sjögren's syndrome d) Raynaud's phenomenon

d) Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon. pg.1057

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Creatinine b) Erythrocyte sedimentation rate (ESR) c) Uric acid d) Red blood cell count

d) Red blood cell count There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.

A nurse is poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis? a) Ineffective thermoregulation b) Risk for imbalanced nutrition: More than body requirements c) Constipation d) Risk for impaired skin integrity

d) Risk for impaired skin integrity Explanation: Progressive systemic sclerosis is a connective tissue disease characterized by fibrosis and degenerative changes of the skin, synovial membranes, and digital arteries. Therefore, the nurse is most likely to formulate a nursing diagnosis of Risk for impaired skin integrity. Because clients with the disease are prone to diarrhea from GI tract hypermotility (caused by pathologic changes), Constipation is an unlikely nursing diagnosis. Progressive systemic sclerosis doesn't cause Ineffective thermoregulation. GI hypermotility may lead to malabsorption, and esophageal dysfunction may cause dysphagia; these conditions put the client with the disease at risk for inadequate nutrition, making Risk for imbalanced nutrition: More than body requirements an improbable nursing diagnosis. pg.1074

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

d) Scleroderma Explanation: Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries. pg.1073

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a) Specific for RA b) Diagnostic for Sjögren's syndrome c) Diagnostic for SLE d) Suggestive of RA

d) Suggestive of RA Explanation: Rheumatoid factor is present in about 80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence does not rule out the diagnosis. pg.1066

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply.

-Fatigue -Pain -Alteration of self-concept -Fluid and electrolyte imbalance Clients with rheumatic diseases, which typically involve joints and muscles, experience problems with mobility, fatigue, and pain. Because of the limitations of the disease, clients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases.

Ch. 38 Rheumatic Diseases

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