Chapter 63
Which of the following would a nurse encourage a client with gout to limit? A) Fluid intake B) Protein-rich foods C) Purine-rich foods D) Carbohydrates
C
Which suggestion would be most important to give a client who has a mild case of bunions? A) Avoid strenuous exercise. B) Avoid foot creams. C) Don proper footwear. D) Regularly use analgesics.
C
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) Glaucoma D) Cataracts
A
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-dsDNA antibody test B) Positive Anti-Sm antibodies C) Positive ANA titre D) Elevated ESR
A
A client is instructed to take an oral calcium preparation with vitamin D daily for the prevention of osteoporosis. What statement made by the client demonstrates understanding of the medication instructions? A) "I can't take the medication with my other medication." B) "I will take the medication on an empty stomach." C) "I will take the calcium and the vitamin D at different times." D) "I should take my medication once a week."
A
A client calls the clinic and tells the nurse that he was bitten by a tick and is afraid he has Lyme disease. How long does the nurse understand that the tick must be attached to have Lyme disease? A) 1 to 2 hours B) 12 to 24 hours C) 24 to 36 hours D) 36 to 48 hours
D
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) Bouchard's nodes D) Heberden's nodes
D
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? A) Alendronate (Fosamax) B) Calcium gluconate C) Tamoxifen (Nolvadex) D) Raloxifene (Evista)
D
A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease? A) Diffuse purplish lesions on the trunk B) Butterfly-shaped rash on the face over the bridge of the nose and cheeks C) Fluid-filled vesicles clustered on the cheeks, chin, and forehead D) Pustules scattered on the chest and back
B
A nurse is monitoring a client diagnosed with Lyme disease. Which finding would suggest that the disease is in the early stages? A) Breathlessness B) Red macule or papule C) Bony nodule D) Swollen painful knees
B
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) Crackles in the bases B) Pericardial friction rub C) Lung sounds are diminished in the apical area. D) Rhonchi
C
A client is informed that he has a benign bone tumor but is the type of tumor that may become malignant. What type of tumor does the nurse know that this is characteristic of? A) Osteochondroma B) Enchondroma C) Osteoclastoma D) Osteoid osteoma
C
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? A) Proteus vulgaris B) Psuedomonas aeruginosa C) Escherichia coli D) Staphylococcus aureus
D
A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit? A) Making sure the client is receiving a daily bath B) Ensuring that the client is eating enough C) Observing for safety hazards that could be a fall risk D) Making sure the client has adequate financial resources
C
An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density? A) Diabetes B) Hypertension C) Compression fractures D) Cardiac disease
C
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? A) Open reduction B) Needle aspiration C) Arthroplasty D) Arthroscopy
D
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) Observe the client's gait. B) Review the client's medical record. C) Inspect the client's mouth. D) Auscultate the client's lung sounds.
B
A client is receiving treatment for rheumatoid arthritis but states that he is allergic to eggs. What medication would the client not be able to receive? A) Methotrexate (Rheumatrex) B) Synvisc C) Anakinra (Kineret) D) Prednisone
B
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? A) High fever B) Persistent draining sinus C) Rapid pulse D) Tenderness over the affected area
B
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) Swan neck deformity B) Boutonnière deformity C) Ulnar deviation D) Rheumatoid nodules
A
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) Increased red blood cell count B) Increased C4 complement C) Elevated erythrocyte sedimentation rate D) Increased albumin levels
C
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? A) Trigeminal neuralgia B) Temporomandibular disorder C) Loose teeth D) Dislocated jaw
B
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? A) Elevated white blood count B) Elevated uric acid levels C) Decreased hemoglobin and hematocrit D) Increased AST and ALT
B
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? A) Heberden's nodes B) Jaw locking C) Widespread chronic pain D) Butterfly facial rash
C
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) Keep shifting weight from one foot to the other. B) Perform aerobic exercises. C) Maintain complete bed rest. D) Maintain good posture.
D
A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? A) 6 months B) 3 months C) 7 to 10 days D) 3 to 6 weeks
D
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) Diarrhea B) Tingling in the arms C) Intestinal cramping D) Increase in pain in the affected extremity E) Nausea and vomiting
A,C,E
A client is suspected to have Lyme disease and has a red macule at the site of the tick bite with a bull's-eye rash with round rings surrounding the center. In addition, the client has a severe headache with neck stiffness. What stage of Lyme disease is the client experiencing? A) Early stage 1 B) Midstage C) Later stage D) Latent stage
A
A client is taking large amounts of salicylates for the treatment of bursitis of the left shoulder. The client should be aware to report which symptoms of salicylism? A) Ringing in the ears B) Diarrhea C) Dry hacking cough D) Dry eyes
A
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? A) A bone biopsy B) Demineralization of the bone C) Increased and decreased areas of bone metabolism D) Elevated levels of alkaline phosphatase
A
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? A) Methotrexate (Rheumatrex) B) Etanercept (Enbrel) C) Methylprednisolone (Medrol) D) Infliximab (Remicade)
A
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? A) Bind the toes so that they will straighten. B) Do active range of motion on the toes. C) Have surgery to fix them. D) Wear properly fitting shoes.
D
A client has been diagnosed with temporomandibular disorder and has not been able to eat. What suggestion can the nurse make to modify the diet so that the client will be able to eat? A) Have the client's food pureed. B) Have the client placed on a liquid diet. C) Have the client eat soft rather than coarse food. D) Give the client clear liquids as well as intravenous fluids.
C
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) First thing in the morning when the client wakes B) After cool compresses have been applied to the hands C) After the client has had a warm paraffin hand bath D) After the client has a diagnostic test
C