ch39: rheumatism
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 legs feel weak." "I have trouble with my balance." "My finger joints are oddly shaped." "I have pain in my hands."
"My finger joints are oddly shaped." 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.
The nurse is caring for a 69-year-old patient with a history of osteoarthritis (OA) who has just been admitted to the medical unit. The patient asks the nurse what the difference is between OA and rheumatoid arthritis (RA). What is the best response by the nurse? " OA and RA are very similar. OA affects the smaller joints, and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA is more common in women. RA is more common in men."
"OA is considered 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, whereas OA affects both sexes equally.
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? "Pace yourself and rest frequently, especially after activities." "Do all your chores after performing morning exercises to loosen up." "Do all your chores in the morning, when pain and stiffness are least pronounced." "Do all your chores in the evening, when pain and stiffness are least pronounced."
"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 oneself during daily activities. Telling the client to do 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 oneself and take frequent rests rather than doing all chores at once.
The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis? Clients may develop Heberden nodes. Clients will have an ulnar deviation. Clients will develop boutonniere deformity. Clients may have swan neck deformity.
Clients may develop Heberden nodes. Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? The time of day when exercise is performed isn't important. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Exercising in the evening before going to bed is beneficial.
Delaying exercise for 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.
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Weight gain, hypervigilance, hypothermia, and edema of the legs Hypothermia, weight gain, lethargy, and edema of the arms Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Facial erythema, pericarditis, pleuritis, fever, and weight loss
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. SLE causes PAINLESS mucous membrane ulcers
A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? Rheumatoid nodules Tophi Bouchard nodes Heberden nodes
Heberden nodes DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden nodes are bony enlargement of the distal interphalangeal joints. Bouchard 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.
Which points should be included in the medication teaching plan for a client taking adalimumab? The medication is administered intramuscularly. The medication is given at room temperature. The client should continue taking the medication if fever occurs. It is important to monitor for injection site reactions.
It is important to monitor for injection site reactions. It is important to monitor for injection site reactions when taking adalimumab. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.
Which joint is most commonly affected in gout? Metatarsophalangeal Ankle Knee Tarsal area
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.
A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce purine levels. Weight loss will reduce inflammation. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will increase uric acid levels and reduce stress on joints.
Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.
The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? colchicine penicillamine prednisone methotrexate
colchicine Colchicine is prescribed for the treatment of an acute attack of gout.
The nurse is caring for a client with a new onset of gout. What medication does the nurse anticipate will be ordered by the health care provider? anturane probenecid allopurinol colchicine
colchicine The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Colchicine, along with indomethacin, ibuprofen, or a corticosteroid, is prescribed to relieve an acute attack of gout. Probenecid and anturane increase the urinary excretion of uric acid, and allopurinol breaks down purines before uric acid is formed.
As part of the assessment process for a patient suspected of having gout, the nurse evaluated his serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. a. 3.2 mg/dL c. 5.4 mg/dL d. 6.8 mg/dL b. 4.3 mg/dL
d. 6.8 mg/dL The biologic value of 6.8 mg/dL or 408 ?mol/L, is a level of serum uric acid above the saturation point for crystal formation.
The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? early morning stiffness small joint involvement subcutaneous nodules joint pain that increases with rest
early morning stiffness Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.
