Chapter 52: Alterations in Musculoskeletal Function: Rheumatic Disorders

To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should a. avoid sun exposure. b. avoid excessive use of moisturizers. c. refrain from washing the affected areas. d. apply warm, wet compresses daily.

a. avoid sun exposure.

Characteristics of gout include (Select all that apply.) a. disturbed uric acid metabolism. b. crystalline deposits in bony and connective tissue. c. onset before menopause in women. d. cardiac involvement. e. renal involvement.

a. disturbed uric acid metabolism. b. crystalline deposits in bony and connective tissue. d. cardiac involvement. e. renal involvement.

Signs/symptoms of Lyme disease include (Select all that apply.) a. fever and chills. b. migratory rash. c. arthritic pain. d. headache. e. myalgia.

a. fever and chills. c. arthritic pain. d. headache. e. myalgia.

The pathophysiology of rheumatoid arthritis involves a. immune cells accumulating in pannus and destroying articular cartilage. b. free radicals attaching to the synovial membrane and tunneling into articular cartilage. c. excessive wear and tear and microtrauma that damage articular cartilage. d. cysts developing in subchondral bone and creating fissures in articular cartilage

a. immune cells accumulating in pannus and destroying articular cartilage. b. free radi

It is true that scleroderma involves a. inflammation and fibrosis of connective tissue. b. autoantibodies against acetylcholine receptors. c. infection by beta-hemolytic streptococcus. d. inflammation caused by antigenic fragments of dead organisms.

a. inflammation and fibrosis of connective tissue.

Ankylosing spondylitis is characterized by a. inflammation, stiffness, and fusion of spinal joints. b. loss of articular cartilage in weight-bearing joints. c. excessive bone remodeling leading to soft bone. d. immune mechanisms leading to widespread joint inflammation.

a. inflammation, stiffness, and fusion of spinal joints.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be a. systemic manifestations of inflammation. b. localized pain in weight-bearing joints. c. reduced excretion of uric acid by the kidney. d. firm, crystallized nodules or "tophi" at the affected joints.

a. systemic manifestations of inflammation.

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called a. tophaceous gout. b. gouty arthritis. c. complicated gout. d. asymptomatic hyperuricemia.

a. tophaceous gout.

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be a. caused by bacterial infection. b. an autoimmune process. c. an infective process. d. because of an enzymatic defect.

b. an autoimmune process.

Tophi are a. renal calculi composed of uric acid. b. deposits of urate crystals in tissues. c. painful edematous joints. d. spots that coalesce in a malar rash.

b. deposits of urate crystals in tissues.

Enteropathic arthritis is associated with a. irritable bowel syndrome. b. inflammatory bowel disease. c. chronic constipation. d. chronic diarrhea.

b. inflammatory bowel disease.

The most common presenting sign/symptom with rheumatic fever is a. cardiac murmur. b. polyarthritis. c. rash. d. painless nodules.

b. polyarthritis.

"Please explain the pathophysiology of osteoarthritis to me," says another nurse. "Is it just wear and tear so that the cartilage wears out?" Your best response is a. "Yes; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation." b. "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears." c. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone." d. "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage."

c. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone."

Rheumatoid arthritis involves joint inflammation caused by a. bacterial infection. b. trauma. c. autoimmune injury. d. congenital hypermobility.

c. autoimmune injury.

The chief pathologic features of osteoarthritis are a. stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid. b. autoimmune damage to the synovium, destruction of articular cartilage by pannus, and thickening of synovial fluid. c. degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. d. thinning of the joint capsule, resorption of bone, excessive formation of new bone, and formation of bone spurs.

c. degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium.

Prosthetic joint infection is most often because of a. defective replacement material. b. injury to the joint. c. hematogenous transfer. d. arthritis.

c. hematogenous transfer.

A laboratory test result that helps confirm the diagnosis of systemic lupus erythematosus (SLE) is a. elevated serum calcium level. b. elevated monoclonal antibody titer. c. positive antinuclear antibodies. d. positive microsomal antibodies.

c. positive antinuclear antibodies.

Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes a. lesions affecting the palms of hands and the soles of feet. b. dry, scaly patches in the antecubital area and behind the knees. c. cracked, scaly areas in the webs of fingers. d. a butterfly pattern rash on the face across the bridge of the nose.

d. a butterfly pattern rash on the face across the bridge of the nose.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to a. wear and tear on weight-bearing joints. b. septic joint inflammation and necrosis. c. unknown etiologic factors. d. autoimmune mechanisms.

d. autoimmune mechanisms.

The pain of nonarticular rheumatism ("growing pain") is worse a. during activity. b. following strenuous exercise. c. upon awakening. d. during the night.

d. during the night.

Gouty arthritis is a complication of a. group A streptococcal infection. b. autoimmune destruction of joint collagen. c. excessive production of urea. d. inadequate renal excretion of uric acid.

d. inadequate renal excretion of uric acid.

Systemic disorders include a. adhesive capsulitis. b. verrucae. c. osteoarthritis. d. rheumatoid arthritis.

d. rheumatoid arthritis.

Ankylosing spondylitis causes a. intervertebral joint fusion. b. instability of synovial joints. c. costal cartilage degeneration. d. temporomandibular joint degeneration.

a. intervertebral joint fusion.

Manifestations of osteoarthritis include (Select all that apply.) a. nodules on joints of the hands. b. crepitus with joint movement. c. pain that is worse upon arising in the morning. d. stiffness that worsens with joint use. e. narrowing of joint spaces.

a. nodules on joints of the hands. b. crepitus with joint movement. e. narrowing of joint spaces.

Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of a. excessive production of connective tissue. b. formation of osteophytes in tissues. c. immune injury to basement membranes. d. impaired tissue oxygen transport.

c. immune injury to basement membranes.

"Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client. The nurse's best response is a. calcium phosphate. b. urea. c. uric acid. d. beta-hydroxybutyric acid.

c. uric acid.

The earliest manifestation of scleroderma is a. thick, tight, shiny skin. b. skin hyper/hypopigmentation. c. renal impairment. d. Raynaud phenomenon.

d. Raynaud phenomenon.

In contrast to osteoarthritis, rheumatoid arthritis may be associated with a. debilitating joint pain and stiffness. b. improvement in symptoms with aspirin therapy. c. changes in activities of daily living. d. systemic aching in the musculoskeletal system.

d. systemic aching in the musculoskeletal system.