Ch 50
10. Which individual is most likely to develop a form of reactive arthritis? A. A 24-year-old male who completed treatment for a chlamydia infection 1 year ago. B. A 46-year-old female who has a longstanding diagnosis of systemic lupus erythematosus. C. A 3-year-old girl who was born with a 20° congenital scoliosis. D. A 79-year-old male who had a total hip replacement 2 months prior.
Answer: A A. A 24-year-old male who completed treatment for a chlamydia infection 1 year ago. Rationale: Reactive arthritis, and Reiter syndrome in particular, are precipitated by time-distant bacterial infections; Chlamydia trachomatis is frequently implicated. SLE, scoliosis and hip fractures, and/or surgery are not noted risk factors for the health problem. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1255-1256
25. A client returns to the clinic for review of previous laboratory values. A diagnose of ankylosing spondylitis (AS) is made, based on laboratory results and manifestations of low back pain which worsens when resting, thigh pain like that of sciatica, and morning stiffness. Which educational teaching would be appropriate for the nurse to provide? Select all that apply. A. Proper posture B. Use of firm mattress with one small pillow C. Muscle-strengthening exercises for extensor muscle group D. Immobilizing of joints that are sore when moved E. Education on first-line treatment disease-modifying antirheumatic drugs (DMARDs)
Answer: A, B, C A. Proper posture B. Use of firm mattress with one small pillow C. Muscle-strengthening exercises for extensor muscle group Rationale: Treatment of AS is directed at pain control and maintaing mobility by suppressing inflammation. Proper posture and positioning are important. This includes sleeping in supine position on a firm mattress and using one small pillow. Muscle-strengthening exercises for extensor muscle group also are prescribed. Immobilizing of joints is not recommended. Although DMARDs are used in the treatment of other inflammatory illnesses, they have not been shown to be effective for axial ankylosing spondylitis; with the exception of sulfasalazine for peripheral joint involvement. Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1254-1255
17. The nurse is creating a teaching plan on self-management for a client with moderate rheumatoid arthritis. What should the nurse include in the teaching plan? Select all that apply. A. Use of heat or cold on joints B. Techniques to reduce joint use C. Reduced sodium diet D. Use of assistive devices E. Joining a gym with a personal trainer
Answer: A, B, D A. Use of heat or cold on joints B. Techniques to reduce joint use D. Use of assistive devices Rationale: The nurse should focus the education on the importance of joint support (including the use of splints and assistive devices) and rest balanced with therapeutic exercises. Rather than joining a gym and having the exercise designed by a personal trainer, the client should be advised on therapeutic exercise by a physiotherapist knowledgeable in the management of rheumatoid arthritis. Heat or cold may be used depending on client preference, but there is no need for a reduced sodium diet unless the client is taking medications that cause sodium retention (e.g., corticosteroids). Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1245-1250
3. A health care provider is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which assessment and history findings correlate with SLE? Select all that apply. A. The client has a "butterfly rash" on her nose and cheeks. B. She complains of intermittent joint pain C. The woman states that she has numerous environmental allergies. D. The client has been hospitalized twice in the past for pleural effusions. E. Blood work indicates low red cells, white cells, and platelets.
Answer: A, B, D, E A. The client has a "butterfly rash" on her nose and cheeks. B. She complains of intermittent joint pain D. The client has been hospitalized twice in the past for pleural effusions. E. Blood work indicates low red cells, white cells, and platelets. Rationale: A butterfly rash, joint pain, pleural effusion and low levels of blood cellular components are all associated with SLE. Environmental allergies are not noted to be risk factors or associated symptoms of the disease. Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1251
9. When educating the client with ankylosing spondylitis, the nurse should emphasize which treatment interventions? Select all that apply. A. Encourage sleeping supine on an extra firm mattress if possible. B. Prop self up in bed with extra pillows if having respiratory congestion. C. Try using the heating pad prior to exercise to help stretching and improve movement. D. Wear a knee immobilizer while biking to facilitate ability to exercise for longer periods. E. Modify diet to include more protein from red meats and green vegetables for vitamin K.
Answer: A, C A. Encourage sleeping supine on an extra firm mattress if possible. C. Try using the heating pad prior to exercise to help stretching and improve movement. Rationale: Treatment of ankylosing spondylitis is directed at controlling pain and maintaining mobility by suppressing inflammation. Proper posture and position are important. This includes sleeping in a supine position on a firm mattress using one small pillow. Therapeutic exercises are important. Heat applications or a shower or bath may be beneficial before exercise to improve ease of movement. Swimming is an excellent exercise. Immobilizing joints is not recommended. Maintaining ideal weight reduces the stress on weight-bearing joints. However, dietary changes are usually very individualized. Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1255
23. A client with rheumatoid arthritis has been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory results) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply. A. Platelet count is 10,000/μL (100x10^9L) B. Creatinine level of 2.4 mg/dL (212.15 μmol/L) C. Red blood cell count of 8.0 x10^6/μL (8.0 ×10^12/L) D. Potassium level of 3.8 mEq/L (3.8 mmol/L) E. Absolute neutrophil count of 500/μL (0.50 ×10^9/L)
Answer: A, C, E A. Platelet count is 10,000/μL (100x10^9L) C. Red blood cell count of 8.0 x10^6/μL (8.0 ×10^12/L) E. Absolute neutrophil count of 500/μL (0.50 ×10^9/L) Rationale: Bone marrow suppression, also known asmyelosuppression, is the decrease in production of cells responsible for providing immunity (leukocytes), carrying oxygen (erythrocytes), and/or those responsible for normal blood clotting (thrombocytes). Anemia occurs when red blood cells are low. Leukopenia/neutropenia happens when the white blood cells are low. White blood cells help your body fight off diseases. Leukopenia does not cause many noticeable side effects, but it means the person will be at higher risk of developing an infection. Thrombocytopenia is when your platelet count is low. A normal platelet count ranges from 150,000/ML to 400,000/L (1500 to 4000 ×10°/L) ; below 10,000/ML (100 x10°L) is a severely low count. With this disorder, one will likely notice bruising easier, bleeding easier, having tiny red spots on the skin, or having blood in the urine. Normal adult red blood cell count is between 12 to 14 g/dL Below that is low and called anemia. Neutropenia is an abnormally low concentration of neutrophils (a type of white blood cell) in the blood. Normal serum potassium levels are between 3.5 and 5.0 mEq/L (3.5 and 5.0 mol/L). Normal adult creatinine levels (which indicates renal function) is 0.6 to 1.2 mg/dL (53-106 umol/L). Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 1256
4. A new client arrives at the clinic. The physician is suspecting the client may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and history of pleural effusions. The nurse should anticipate which diagnostic test will be a priority to facilitate with the diagnosis? A. Anti-DNA antibody test. B. Routine hemoglobin. C. C-reactive protein. D. B-cell lymphocytes.
Answer: A. Anti-DNA antibody test. Rationale: 95% of people with untreated SLE have high ANA levels. However, ANA is not specific for SLE. The anti-DNA antibody test is more specific for the diagnosis of SLE. Hemoglobin may be low if the client has severe anemia but it is not specific for SLE. C-reactive protein will show an inflammatory response but again not specific for SLE. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1252
8. Which pathophysiologic phenomeon would be most indicative of ankylosing spondylitis? A. Loss of motion in the spinal column and eventual kyphosis. B. A progressive loss of range of motion in knee and hip joints, C. A facial "butterfly rash" and multi-organ involvement. D. Decreased bone density in long bones
Answer: A. Loss of motion in the spinal column and eventual kyphosis. Rationale: The characteristic trait of ankylosing spondylitis is progressive loss of spinal ROM and eventual kyphosis. Synovial joint involvement is not associated with the disease. A butterfly rash and multisystem involvement are associated with SLE. Decreased bone density does not normally accompany ankylosing spondylitis. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1254-1255
18. The nurse is planning care for a client with ankylosing spondylitis (AS). Which interventions should the nurse include in the plan of care? Select all that apply. A. Application of splints to reduce joint use B. Application of heat to involved joints C. Physiotherapy consult D. Administration of analgesics E. Placing client on an alternating pressure mattress
Answer: B, C, D B. Application of heat to involved joints C. Physiotherapy consult D. Administration of analgesics Rationale: Controlling pain with analgesia and maintaining mobility is a priority, so splints that would reduce joint use are not indicated. Proper posture and positioning-including sleeping in a supine position on a firm mattress=is recommended, so an alternating pressure mattress should not be used, as these are used to reduce pressure and prevent pressure ulcers. Therapeutic exercises are important and would require consultation with a physiotherapist. Heat application may be beneficial before exercise for ease of movement. Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 1254-1255
14. A male client has just been diagnosed with hyperuricemia following multiple flare-ups of his metatarsophalangeal joint associated with severe pain and swelling that is affecting his sleep. The nurse should anticipate that which medications may be prescribed for this client? Select all that apply. A. Acetaminophen for the pain. B. Allopurinol to decrease uric acid levels. C. Calcium carbonate used to increase the intake of calcium. D. Sulfinpyrazone to increase excretion of rate. E. Sevelamer to reduce the absorption of phosphate.
Answer: B, D B. Allopurinol to decrease uric acid levels. D. Sulfinpyrazone to increase excretion of rate. Rationale: Treatment of hyperuricemia is aimed at maintaining normal uric acid levels and is lifelong. One method is to reduce hyperuricemia through the use of allopurinol. Allopurinol inhibits xanthine oxidase, an enzyme needed for the conversion of hypoxanthine to xanthine and xanthine to uric acid as does a newer medication, febuxostat. The uricosuric drugs (sulfinpyrazone) prevent tubular reabsorption of urate and increase its excretion in the urine. NSAIDs, not acetaminophen, are usually prescribed for the pain. Calcium does not play a factor in gout. Sevelamer to reduce the absorption of phosphate is primarily used in clients with renal failure. Question format: Multiple Select Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 1263
11. Due to her progressing osteoarthritis (OA), an 80-year-old woman is no longer able to perform her activities of daily living without assistance. Which phenomeon most likely underlies the woman's situation? A. Inappropriate T-cell mediated immune responses have resulted in articular cartilage degeneration. B. Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. C. Excessive collagen deposits have accumulated in the woman's synovial joints. D. Bone overgrowth in synovial joints has resulted in fusing of adjacent bones that normally articulate.
Answer: B. Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. Rationale: The joint changes associated with osteoarthritis, which include a progressive loss of articular cartilage and synovitis, results from the inflammation caused when cartilage attempts to repair itself, creating osteophytes or spurs. These changes are accompanied by joint pain, stiffness, limitation of motion, and in some cases by joint instability and deformity. Immune etiology is more associated with rheumatoid arthritis. Collagen deposits are characteristic of scleroderma. Bones do not tend to fuse in the pathogenesis of 0A Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1257
6. When working with a client with diffuse scleroderma who is exhibiting a 'stone face' expression, the nurse should consider which of these two to be a priority nursing diagnosis for this client? A. Ineffective tissue perfusion related to tightening of the facial skin. B. Activity intolerance related to muscle tightening in lower extremities. C. Oral mucous membrane, impaired due to restricted motion of the mouth. D. Risk for aspiration related to swallowing impairments
Answer: D. Risk for aspiration related to swallowing impairments Rationale: Diffuse scleroderma is characterized by severe and progressive disease of the skin and the early onset of organ involvement. The typical person has a "stone face" due to tightening of the facial skin with restricted motion of the mouth Involvement of the esophagus leads to hypomotility and difficulty swallowing. The other NANDAs would be of lower priority given the assessment data presented. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 1253
24. During assessment of a client with systemic lupus erythematosus (SLE), the nurse hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the nurse document in the medical records and report to the health care provider? A. Pleural effusion B. Pericarditis C. Pneumonia D. Vasculitis
Answer: B. Pericarditis Rationale: A pericardial friction rub is pathognomonic for acute pericarditis; the rub has a scratching, grating sound similar to leather rubbing against leather. The inner and outer (visceral and parietal, respectively) layers are normally lubricated by a small amount of pericardial fluid, but the inflammation of pericardium causes the walls to rub against each other with audible friction. Pleural effusions are accumulation of fluids within the pleural space and are associated with symptoms of chest pain and shortness of breath. Pneumonia is an infection of the lungs caused by bacteria, viruses, or fungi. General symptoms of pneumonia include chest pain, fever, productive cough, and trouble breathing. Vasculitis is an inflammation of the blood vessels. It happens when the body's immune system attacks the blood vessel by mistake. Vasculitis can affect arteries, veins and capillaries so symptoms depend on the vessel involved. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1251
20. A nurse is working on a health care cost analysis related to total knee arthroplasty in the treatment of osteoarthritis. What should the nurse cite as a priority reason to reduce surgery wait times for clients requiring joint replacement? A. The pain clients experience while waiting creates unneeded suffering and loss of productivity. B. Stress placed on joints while awaiting surgery can increase the need for additional surgeries. C. The surgery is less likely to result in complications if performed before joint damage occurs. D. Clients are more likely to seek legal action due to delays, increasing lawsuit costs.
Answer: B. Stress placed on joints while awaiting surgery can increase the need for additional surgeries. Rationale: Although suffering and a decrease in productivity while awaiting surgery are consequences of treatment delays, these are not costs directly incurred by the health care system; accordingly, these are not as relevant to the nurse's focus as is the need for additional surgical procedures. When a client is awaiting surgery on a single knee, the opposite knee often becomes affected because of the additional stress placed on it while trying to protect the involved knee. This can lead to the need for replacement of the second knee. This is more relevant than the risk for litigation. The surgical procedure of total knee arthroplasty would not be indicated for a client if joint damage had not already occurred. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 1261
13. While reviewing the following diagnostic findings on a group of clients with joint complaints, which finding would be a priority for further investigation and possible medical intervention? A. A male client has elevated levels of serum uric acid but lacks symptoms. B. Synovial fluid aspiration indicates the presence of monosodium rate crystals. C. A man reveals that he eats organ meat 2 to 3 times weekly. D. A 55-year-old male reveals that it takes a day or two for oral colchicines to relive his attacks of gout.
Answer: B. Synovial fluid aspiration indicates the presence of monosodium rate crystals. Rationale: The presence of crystalline deposits in synovial fluid confirms a diagnosis of gout and would necessitate further investigation and/or treatment. Hyperuricemia is not necessarily indicative of gout, and while diet can contribute to gout, this would not necessarily require modification in the absence of gout. Oral colchicine often takes 48 hours to take effect during an acute attack of gout. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1262
16. Though the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A. Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B. The woman complains of aching and morning stiffness in her neck, shoulder and pelvis. C. Range-of-motion in the woman's wrists and ankles is greatest in the morning and decreases over the course of a day. D. The woman's metatarsal joints are inflamed and sensitive to touch.
Answer: B. The woman complains of aching and morning stiffness in her neck, shoulder and pelvis. Rationale: Polymyalgia rheumatica is an inflammatory condition of unknown origin characterized by aching and morning stiffness in the cervical regions and shoulder and pelvic girdle areas. Lower limb pain, wrist and ankle stiffness, and pain in the joints of the foot would not be as clearly suggestive of polymyalgia rheumatica. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1266
7. A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which etiology is responsible for his health problem? A. Infection B. Friction between bones C. Immune response D. Inappropriate bone remodeling
Answer: C. Immune response Rationale: Ankylosing spondylitis is thought to have an etiology that suggests an immune response. Physical wear and tear, infection, and inappropriate remodeling are not considered primarily responsible forthe disease. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1254-1255
22. While speaking to a senior citizen club about osteoarthritis (A), which facts are accurate to share? A. By the time people reach their 50s, about 50% of adults will have some form of OA. B. Men usually get O in their hands whereas women get OA primarily in their hips. C. Obesity in women has been correlated to having OA in the knees. D. Heredity does not play a significant role in the development of OA.
Answer: C. Obesity in women has been correlated to having OA in the knees. Rationale: 85% of people with OA are in their 70s. Men are affected more commonly at a younger age. Heredity influences the occurrence of hand OA in the DIP joint. Hand OA is more likely to affect white women, whereas knee OA is more common in black women. Obesity is a particular risk factor for OA of the knee in women. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 1257
2. The physician is considering prescribing an anti-tumor necrosis factor (TF) like infliximab for a client with rheumatoid arthritis (RA). Which statement is accurate about the advantages of using a TF inhibitor? A. Since TNF inhibitors have few side effects, these drugs will fit well into your regimen. B. Your disease-modifying antirheumatic drug (DMARD) methotrexate has more cardiovascular side effects than TF inhibitors. C. TN inhibitors help slow the disease progression and improve your ability to perform routine ADL functions. D. Not only do TN inhibitors control your disease better, they also will interrupt the inflammatory cascade at several levels
Answer: C. TN inhibitors help slow the disease progression and improve your ability to perform routine ADL functions. Rationale: Second-line antirheumatic drugs include anti-TNF drugs such as etanercept, infliximab, and adalimumab. These drugs are biologic response-modifying agents or TF inhibitors that block TNF-a, one of the key proinflammatory cytokines in RA. Anti-TN-a agents have significant efficacy, although they do have some potential adverse side effects. Evidence indicates that CV side effects are not different for TN inhibitors than for DMARDs. The TNK inhibitor agents also have been show to inhibit radiologic disease progression and improve functional outcomes. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 1255
21. An 8-year-old child has just been diagnosed with juvenile idiopathic arthritis (JIA). The parents ask the nurse about the prognosis for this condition. What is the nurse's best response? A. This condition is similar to rheumatoid arthritis in adults with both joint and systemic effects. B. With nonsteroidal anti-inflammatory and antirheumatic medications the prognosis is excellent. C. The prognosis is dependent on the type of JIA with which your child has been diagnosed. D. This type of arthritis involves moderate joint pain without impeding your child's mobility.
Answer: C. The prognosis is dependent on the type of JIA with which your child has been diagnosed. Rationale: The nurse should tell the parents that prognosis for children with JIA depends on the subtype and whether the disease is systemic. Some subtypes such as more severe forms of polyarticular JIA resemble rheumatoid arthritis in adults; others such as enthesitis-related JIA present quite differently, with pain between bones and tendons, ligaments or other connective tissue as well as inflammation in other parts of the body. Treatment also varies, so although NSAIDs and antirheumatics are often indicated, this should not be discussed until the subtype is identified. Treatment also carries issues related to growth and development as well as to nutritional issues, so the nurse should not present the treatment and prognosis as "excellent." Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1264
1. Following a progressive onset of fatigue, aching, and joint stiffness over the last two years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which teaching point should his primary care physician include during the office visit in which this diagnosis is communicated to the client? A. "The symptoms you've been experiencing are the result of damage inside your joints, but I'll start you on medications that will reverse this damage." B. "It's important that you maximize your level of activity, since decreasing your mobility will worsen the disease." C. "The best treatment plan is to try all other available treatments before resorting to using medications." D. "Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."
Answer: D D. "Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms." Rationale: Current treatment guidelines for RA involve early and aggressive pharmacologic treatment, including NSAIDs and corticosteroids. Damage cannot be reversed, and while therapeutic exercise plays a role in treatment, rest is also important. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1256
12. A 64-year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his fammy physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which statement by the client would necessitate further teaching? A. 'I'm really trying to lose weight and I've been able to lose 15 pounds this year so far." B. "I've been doing muscle strengthening exercises twice a week at the community center near my house." C. "Even though I don't like it, I've been using my walker to take some of the weight off my knees." D. "I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."
Answer: D. "I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees." Rationale: Analgesics are a common and appropriate treatment for OA, and it would be unnecessary and inappropriate to forego pain control in order to maximize pain signals from affected joints. Weight loss, the use of assistive devices, and muscle-strengthening exercises are appropriate treatments for OA Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 1261
5. A 36-year-old female who has experienced diverse symptoms for several years has finally had her health problems attributed to scleroderma (systemic sclerosis, and has committed herself to learning as much about the disease as she can. Which statement would her nurse want to correct or clarify? A. "I'm surprised that in this day and age they still don't know what causes scleroderma." B. "I suppose this explains why I have such terrible circulation to my hands and feet." C. "I'm scared by the damage that this could cause to my heart and lungs." D. "The worst part of this so far has been learning that there aren't any treatments for scleroderma."
Answer: D. "The worst part of this so far has been learning that there aren't any treatments for scleroderma." Rationale: While the cause of scleroderma remains unknown, supportive treatments that address symptoms do exist. Reynaud phenomenon is a very common accompaniment to the disease; cardiac and pulmonary involvement are common. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1253
15. A child has just been diagnosed with systemic lupus erythematosus (SLE). Which assessment finding would be considered the most accurate prognostic indicator of the extent/seriousness of the disease? A. Complaints of arthralgias and arthritis in joints with movement. B. Ligaments and tendons hurt during passive ROM. C. Has a rash on the nose and cheeks. D. Rust/blood-colored urine.
Answer: D. Rust/blood-colored urine. Rationale: The clinical manifestations of SLE in children reflect the extent and severity of systemic involvement. The best prognostic indicator in children is the extent of renal involvement, which is more common and more severe in children than in adults with SLE. Edema and rusty or bloody urine are classic signs of glomerulonephritis. It is expected that people/children with SLE have arthralgias/arthritis in joints, sore ligaments and tendons, as well as integumentary signs/symptoms like a rash on the nose and cheeks (butterfly rash). Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1264
19. A client being investigated for systemic lupus erythematosus (SLE) has an elevated antinuclear antibody result and asks the nurse what this means. What is the nurse's best response? A. This test, combined with your symptoms, is used to determine if you have SLE. B. Antinuclear antibodies are decreased in SLE rather than elevated, so this result is encouraging. C. This test will be repeated in 3 months. If it is still elevated, it supports a diagnosis of SLE. D. This is a nonspecific marker for autoimmune activity, so you will require additional tests.
Answer: D. This is a nonspecific marker for autoimmune activity, so you will require additional tests. Rationale: Ninety-five percent of people with untreated SLE have high ANA levels, so this result is an indicator of possible SLE. However, because it is not specific for SLE, the nurse should tell the client that additional tests will be required and not state that the ANA test along with the symptoms is sufficient for diagnosis. The client will require an anti-DNA antibody test, which is more specific for the diagnosis of SLE. There is no benefit to waiting and repeating the ANA test instead of testing the anti-DNA. Question format: Multiple Choice Chapter 50: Disorders of Musculoskeletal Function: Rheumatic Disorders Cognitive Level: Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1252
