Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders

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

-Hypertension

The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse?

-The fluid will be milky, cloudy, and dark yellow.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

-Topi

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply.

-Weight loss -Decreasing alcohol intake -Avoiding purine-rich foods

The nurse is creating a teaching tool about rheumatoid arthritis. Which tests will the nurse include that are used to diagnose the condition? Select all that apply.

-X-ray -Arthrography -CT -MRI

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining?

-celecoxib

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?

-colchicine

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find?

-early morning stiffness

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?

-eating organ meats and sardines

A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client?

-"The lupus can affect your kidney function."

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach?

-"What types of exercise were you doing?"

A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client?

"Be sure to wear nonslip footwear for safety."

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?

-Age

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."

Which drug is not used in the treatment of rheumatoid arthritis?

-Allopurinol

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

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

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?

-hydroxychloroquine

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care?

-increased fatigue F

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis?

-joint stiffness that increases with activity

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

Administering ordered analgesics and monitoring their effects

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

Systemic lupus erythematosus (SLE)

Which joint is most commonly affected in gout?

metatarsophalangeal

Which term refers to fixation or immobility of a joint?

-Ankylosis

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client?

-"Are you taking the medication as prescribed?"

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."

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

-Scleroderma

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?

-Sicca syndrome

A client with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. Which teaching will the nurse include for this client?

-Smoking cessation

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication?

-Take the medication with food to avoid stomach upset.

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.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management?

-strategies for remaining active

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?

-Muscle biopsy

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client?

-Nonsteroidal anti-inflammatory drugs (NSAIDs)

During a home visit, the nurse notes that a client with polymyositis has difficulty combing the hair and putting on socks and shoes. Which referrals will the nurse recommend for this client? Select all that apply.

-Physical therapy -Occupational therapy

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis?

-Rheumatoid arthritis

Which points should be included in the medication teaching plan for a client taking adalimumab?

-It is important to monitor for injection site reactions.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?

-located over bony prominence

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess?

-low back pain

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?

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

Which of the following procedures involves a surgical fusion of the joint?

-Arthrodesis

A client is experiencing symptoms of rheumatoid arthritis. Which laboratory tests will the nurse expect to be prescribed for this client? Select all that apply.

-Erythrocyte count -Rheumatoid factor -Antinuclear antibody

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

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

A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response?

-Hand and finger deformities are associated with the development of rheumatoid arthritis.

A client has been living with rheumatoid arthritis (RA) for several years. Which diagnostic test will the nurse prepare the client for to determine the progression of the disease?

-X-ray

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.

An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client?

-"Look at the cane as maintaining your independence."

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."

A client with fibromyalgia is hesitant to talk about the symptoms. Which statement will the nurse make to help support the client?

-"Tell me what you've been experiencing."

Which client is most likely to develop systemic lupus erythematosus (SLE)?

-A 27-year-old Black female

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

-Safe exercise -Medication dosages and side effects -Assistive devices

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply.

-Support joints with splints and pillows. -Provide diversional activities. -Provide opportunities for the client to verbalize feelings.

As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.

-6.8 mg/dL (0.40 mmol/L) Hyperuricemia, a serum uric acid concentration above 6.8 mg/dL (0.40 mol/L) can cause urate crystal deposition which can lead to gout.

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?

-An exercise routine that includes range-of-motion (ROM) exercises

A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis?

-Boney erosions on x-ray

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about?

-Celecoxib

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?

-Chronic fatigue, generalized muscle aching, and stiffness.

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 is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?

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

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?

-It is suggestive of rheumatoid arthritis.

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?

-Methotrexate

The nurse is reviewing medications prescribed for a client with rheumatoid arthritis. Which medications will the nurse expect to be prescribed for this client? Select all that apply.

-Methotrexate -Ibuprofen -Aspirin

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

-Elevated erythrocyte sedimentation rate

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

-Encourage weight loss and an increase in aerobic activity