Chapter 63: Caring for Clients with Orthopedic and Connective Tissue Disorders

A client with SLE has come to the clinic for a routine check-up. When auscultating the client's apical heart rate, the nurse notes the presence of a distinct "scratching" sound. What is the nurse's most appropriate action?

Inform the primary provider that the client may have pneumonia.

A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize?

The client will express satisfaction with her ability to perform ADLs.

A client's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary provider has added prednisone to the client's drug regimen. What principle will guide this aspect of the client's treatment?

The drug should be used for as short a time as possible.

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods.

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

allopurinol

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

c) Safe exercise d) Medication dosages and side effects e) Assistive devices

A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug?

"I have this ringing in my ears that just won't go away."

A nurse is providing care for a client who has a rheumatic disorder. The nurse's comprehensive assessment includes the client's mood, behavior, LOC, and neurologic status. What is this client's most likely diagnosis?

Systemic lupus erythematosus (SLE)

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

"You will receive IV antibiotics for 3 to 6 weeks."

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Administering large doses of I.V. antibiotics as ordered

A client has been admitted to the hospital for the treatment of gout. Which is not an appropriate nursing care activity for a gout client?

Apply heat for pain.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?

Assess diet and activity at home

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?

Bisphosphonates

An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis?

Bone fracture

A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?

Calcitonin

Which of the following inhibits bone resorption and promotes bone formation?

Calcitonin

A nurse is caring for a client who is 12 hours postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure chould the nurse implement to control the edema?

Elevate the foot on several pillows.

In which deformity does the great toe deviate laterally?

Hallux valgus

The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. What foods should the nurse encourage the patient to avoid?

Liver

A nurse is creating a teaching plan for a client who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply.

Managing Raynaud-type symptoms Smoking cessation The importance of vigilant skin care

A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?

Nonsteroidal anti-inflammatory drugs

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize?

Preserve or increase range of motion while limiting joint stress

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

Quadriceps

The nurse is preparing to care for a client who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome?v

Raynaud phenomenon

A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with what health problem?

Rheumatoid arthritis (RA)

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.

A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend?

Client's general condition, balance, and weight-bearing prescription

A clinic nurse is caring for a client diagnosed with rheumatoid arthritis (RA). The client tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the client's adherence to her medication regimen?

Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply.

Fatigue Pain Alteration of self-concept Fluid and electrolyte imbalance

A clinic nurse is caring for a client newly diagnosed with fibromyalgia. When developing a care plan for this client, what nursing diagnosis should the nurse prioritize?

Fatigue Related to Pain

Which of the following was formerly called a bunion?

Hallux valgus

A client's x-ray looks similar to the image depicted. The nurse would recognize that the client likely has a

Hammer toe

An older adult woman's current medication regimen includes alendronate. What outcome would indicate successful therapy?

Increased bone mass

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

Performing hourly neurovascular assessments for the first 24 hours

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for falls

A 40-year-old woman was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The client also states that many of her skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem?

Scleroderma

A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing?

Support the affected arm on pillows at night.

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

Surgical debridement

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

Surgical debridement

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis?

raloxifene (Evista)

A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?

Small frame and female sex

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

What intervention is a priority for a client diagnosed with osteoarthritis?

Physical therapy and exercise

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?

Calcitonin

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?

Calcitonin

A clinic nurse is caring for a client with suspected gout. While explaining the pathophysiology of gout to the client, what should the nurse explain?

Increased uric acid levels

A client with a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify what nursing diagnosis?

Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification