FONTAINE WK 5 PREPU CHAPER 9
The nurse is conducting a musculoskeletal assessment on a patient documented to have rheumatoid arthritis. Which of the following would the nurse anticipate finding when inspecting the patient's fingers? a) Soft, subcutaneous nodules along the tendons b) Hard nodules of bony overgrowth c) Hard nodules adjacent to the joints d) Soft, nodules along the palmar surface
a) Soft, subcutaneous nodules along the tendons (The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule.)
In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on: a) Strategies for remaining active b) DMARDs therapy c) Prevention of joint deformity d) Detection of systemic complications
a) Strategies for remaining active Exercise is important for pain and disease management.
The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? a) The patient has rheumatoid arthritis. b) The patient has osteoarthritis. c) The patient has lupus erythematosus. d) The patient has neurofibromatosis.
a) The patient has rheumatoid arthritis.
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? a) Numbness b) Patchy blindness c) Diplopia and ptosis d) Loss of proprioception
c) Diplopia and ptosis
The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds? a) Gout b) Rheumatoid arthritis c) Osteoporosis d) Lupus erythematosus
a) Gout
A patient arrives at the clinic with complaints of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to? a) Gout b) Rheumatoid arthritis c) Osteoarthritis d) Fibromyalgia
a) Gout The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients) in gout. The abrupt onset often occurs at night, awakening the patient with severe pain, redness, swelling, and warmth of the affected joint.
The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men? a) Leukocytes are increased in females. b) Androgen tends to enhance immunity. c) Estrogen tends to enhance immunity. d) Testosterone tends to enhance immunity.
c) Estrogen tends to enhance immunity. (Androgen, on the other hand, tends to be immunosuppressive.)
A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder? a) The immune system recognizes one's own tissues as "self." b) Regulatory mechanisms fail to halt the immune response. c) The immune system recognizes one's own tissues as "foreign." d) Excess cytokines cause tissue damage.
c) The immune system recognizes one's own tissues as "foreign."
The nurse is preparing to provide care for a patient diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what? a) Genetic dysfunction b) Upper and lower motor neuron lesions c) Decreased conduction of impulses in an upper motor neuron lesion d) A lower motor neuron lesion
d) A lower motor neuron lesion Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower neuron lesion at the myoneural junction.
A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurse's response to the patient? a) CAM therapies typically do more harm than good. b) New evidence shows CAM to be as effective as medical treatment. c) CAM therapies negate many of the benefits of medications. d) Evidence shows minimal benefits from most CAM therapies.
d) Evidence shows minimal benefits from most CAM therapies.
A male client comes to the clinic with complaints of pain in his right great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has: a) osteoarthritis. b) reactive arthritis. c) rheumatoid arthritis. d) gouty arthritis.
d) gouty arthritis.
Osteoarthritis is known as a disease that a) is the most common and frequently disabling of joint disorders. b) affects young males. c) requires early treatment because most of the damage appears to occur early in the course of the disease. d) affects the cartilaginous joints of the spine and surrounding tissues.
a) is the most common and frequently disabling of joint disorders.
A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? a) "The disease is a disorder of motor and sensory dysfunction." b) "This disease doesn't cause sensory impairment." c) "You'll need to take edrophonium (Tensilon) to treat the disease." d) "You'll continue to experience progressive muscle weakness and sensory deficits."
b) "This disease doesn't cause sensory impairment."
Which of the following disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? a) Scleroderma b) Rheumatoid arthritis c) SLE d) Polymyositis
c) SLE
Select all answer choices that apply. Which of the following are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. a) Aphasia b) Depression c) Pain d) Numbness e) Spasticity f) Fatigue
• Numbness • Pain • Spasticity • Fatigue • Depression
Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis? a) Imbalanced nutrition: Less than body requirements related to effects of aging b) Risk for injury related to altered mobility c) Ineffective breathing pattern related to immobility d) Impaired urinary elimination related to effects of aging
b) Risk for injury related to altered mobility
The diagnosis of multiple sclerosis is based on which of the following tests? a) Neuropsychological testing b) Cerebrospinal fluid (CSF) electrophoresis c) Magnetic resonance imaging (MRI) d) Evoked potential studies
c) Magnetic resonance imaging (MRI)
Which of the following is the most common clinical manifestation of multiple sclerosis? a) Pain b) Ataxia c) Spasticity d) Fatigue
d) Fatigue Fatigue affects 87% of people with MS and 40% of that group indicate that fatigue is the most disabling symptom.
A client with early stage rheumatoid arthritis asks the nurse what they can do to help ease the symptoms of their disease. What would be the best response by the nurse? a) "The doctor could prescribe anti-inflammatory drugs." b) "The doctor could prescribe antineoplastic drugs." c) "The doctor could prescribe antihypertensive drugs." d) "The doctor could prescribe antipyretic drugs."
a) "The doctor could prescribe anti-inflammatory drugs."
An 80-year-old client with osteoarthritis and osteoporosis has difficulty ambulating and is seeking a prescription for a walker. The nurse assesses the client's type of disability as a) Age-associated b) Sensory c) Developmental d) Acquired
a) Age-associated
Which of the following terms is used to describe rapid, jerky, involuntary, purposeless movements of the extremities? a) Chorea b) Spondylosis c) Dyskinesia d) Bradykinesia
a) Chorea Choreiform movements, such as grimacing, may also be observed in the face.
Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis? a) Imbalanced nutrition: greater than body requirements b) Impaired physical mobility c) Deficient knowledge: symptom management d) Chronic pain
a) Imbalanced nutrition: greater than body requirements
A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? a) Methotrexate (Rheumatrex) b) Allopurinol (Zyloprim) c) Prednisone d) Hydromorphone (Dilaudid)
a) Methotrexate (Rheumatrex) In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that treatment with the non-biologic DMARDs begin within 3 months of disease onset.
All of the following are symptoms of osteoarthritis, except? a) Morning stiffness that lasts at least 1 hour. b) Instability of weight-bearing joints c) Deep, aching pain with motion early in the disease d) Limited joint motion
a) Morning stiffness that lasts at least 1 hour. Morning stiffness that lasts at least 1 hour is a symptom of rheumatoid arthritis. The following are symptoms of osteoarthritis: deep, aching pain with motion early in the disease; limited joint motion; and instability of weight-bearing joints.
A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Surgery c) Opioid therapy d) Ice packs
a) Nonsteroidal anti-inflammatory drugs (NSAIDs)
Which of the following disorders is characterized by an increased autoantibody production? a) Systemic lupus erythematosus (SLE) b) Polymyalgia rheumatic c) Rheumatoid arthritis (RA) d) Scleroderma
a) Systemic lupus erythematosus (SLE) SLE is an immunoregulatory disturbance that results in increased autoantibody production.
A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication? a) Take the medication with food to avoid stomach upset. b) Take the medication on an empty stomach in order to increase effectiveness. c) Inform the physician if there is ringing in the ears. d) Since the medication is able to be obtained over the counter, it has few side effects.
a) Take the medication with food to avoid stomach upset.
A patient has a diagnosis of multiple sclerosis. The nurse is aware that neuromuscular disorders such as multiple sclerosis may lead to a decreased vital capacity. What does vital capacity measure? a) The maximal volume of air exhaled from the point of maximal inspiration b) The volume of air in the lungs after a maximal inspiration c) The volume of air inhaled and exhaled with each breath d) The maximal volume of air inhaled after normal expiration
a) The maximal volume of air exhaled from the point of maximal inspiration Vital capacity is measured by having the patient take in a maximal breath and exhale fully through a spirometer.
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "When it clears up, it will never come back." b) "It will get better and worse again." c) "It will never get any better than it is right now." d) "I'll definitely need surgery for this."
b) "It will get better and worse again." The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA affects joints on both sides of the body. RA is usually unilateral." b) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." c) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." d) "OA is more common in women. RA is more common in men."
b) "OA is 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; OA affects both sexes equally.
A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? a) Visible atrophy of the knee and shoulder joints b) Joint stiffness, especially in the morning c) Signs of systemic infection d) Cool joints with decreased range of motion
b) Joint stiffness, especially in the morning In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning. Joints are typically swollen, not atrophied.
The nurse teaches the patient with postpolio syndrome that bone density testing will be completed to assist with identifying what potential complication? a) Osteoarthritis b) Low bone mass and osteoporosis c) Calcification of long bones d) Pathologic fractures
b) Low bone mass and osteoporosis Bone density testing in patients with postpolio syndrome has demonstrated low bone mass and osteoporosis.
Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Tumor necrosis factor (TNF) blockers b) Nonsteroidal anti-inflammatory drugs (NSAIDs) c) Glucocorticoids d) Disease-modifying antirheumatic drugs (DMARDS)
b) Nonsteroidal anti-inflammatory drugs (NSAIDs) In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease.
The nursing instructor is teaching the senior nursing class about neuromuscular disorders. When talking about Multiple Sclerosis (MS) what diagnostic finding would the instructor list as being confirmatory of a diagnosis of MS? a) IV administration of edrophonium b) Oligoclonal bands c) Episodes of muscle fasciculations d) An elevated acetylcholine receptor antibody titer
b) Oligoclonal bands Electrophoresis of the CSF, a technique for electrically separating and identifying proteins, demonstrates abnormal immunoglobulin G bands, described as oligoclonal bands.
When educating a patient about the use of antiseizure medication, what should the nurse inform the patient is a result of long-term use of the medication in women? a) Osteoarthritis b) Osteoporosis c) Anemia d) Obesity
b) Osteoporosis
Which of the following is the most common cause for a patient to seek medical attention for arthritis? a) Weakness b) Pain c) Joint swelling d) Stiffness
b) Pain
What intervention is a priority for a patient diagnosed with osteoarthritis? a) Allopurinol (Zyloprim) b) Physical therapy and exercise c) Hydrotherapy d) Colchicine
b) Physical therapy and exercise
Which of the following is the first-line therapy for myasthenia gravis (MG)? a) Lioresal (Baclofen) b) Pyridostigmine bromide (Mestinon) c) Azathioprine (Imuran) d) Deltasone (Prednisone)
b) Pyridostigmine bromide (Mestinon) Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction.
A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? a) Arterial occlusive diseases b) Raynaud's disease c) Peripheral vascular disease d) Buerger's disease
b) Raynaud's disease Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis.
Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Creatinine b) Red blood cell count c) Uric acid d) Erythrocyte sedimentation rate (ESR)
b) Red blood cell count There is a decreased red blood cell count in patients diagnosed with rheumatic diseases.
The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest? a) Increasing the dose of muscle relaxants b) Resting in an air-conditioned room whenever possible c) Taking a hot bath at least once daily d) Avoiding naps during the day
b) Resting in an air-conditioned room whenever possible Fatigue is a common symptom of patients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue.
Which of the following disorders is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? a) Scleroderma b) Systemic lupus erythematous (SLE) c) Rheumatoid arthritis d) Polymyositis
b) Systemic lupus erythematous (SLE) The most familiar manifestation of SLE is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and the cheeks.
An elderly patient has presented to the clinic with a new diagnosis of osteoarthritis. The patient's daughter is accompanying him and you have explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should you describe? a) Older adults often have less support and care from their family, resulting in illness. b) With age, biologic changes reduce the efficiency of body systems. c) There is an increased morbidity of peers in this age group, and this leads to the older adult's desire to also assume the "sick role." d) Chronic illnesses are diagnosed more often in older adults because they have more contact with the health care system.
b) With age, biologic changes reduce the efficiency of body systems.
Select all answer choices that apply. A client with multiple sclerosis is learning to perform intermittent self-catherizations of the urinary bladder. The nurse obtains the following equipment for teaching. Select all that apply. a) Forceps b) Syringe with sterile water c) Anatomically correct model d) Foley bag e) 16-French catheters
c) Anatomically correct model e) 16-French catheters
Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis? a) Assess for the gastrointestinal complications associated with COX-2 inhibitors. b) Avoid the use of topical analgesics. c) Encourage weight loss and an increase in aerobic activity. d) Provide an analgesic after exercise.
c) Encourage weight loss and an increase in aerobic activity.
A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Weight gain, hypervigilance, hypothermia, and edema of the legs b) Hypothermia, weight gain, lethargy, and edema of the arms c) Facial erythema, pericarditis, pleuritis, fever, and weight loss d) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers
c) 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. )
A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? a) Acute Confusion Related to Increased Serum Ammonia Levels b) Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism c) Fatigue Related to Anemia d) Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit
c) Fatigue Related to Anemia Patients with SLE nearly always experience fatigue, which is partly attributable to anemia.
A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? a) Use pressure-relieving devices when the client is in bed or in a wheelchair. b) Change body position every 2 hours. c) Help the client perform range-of-motion (ROM) exercises every 8 hours. d) Use a footboard and trochanter rolls.
c) Help the client perform range-of-motion (ROM) exercises every 8 hours. Helping the client perform ROM exercises every 8 hours helps in promoting joint flexibility and muscle tone in a client with muscle weakness.
A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? a) Promoting sleep b) Eliminating deformities c) Minimizing damage d) Eradicating pain
c) Minimizing damage (Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures.)
Which of the following is considered a central nervous system (CNS) disorder? a) Guillain-Barré b) Bell's palsy c) Multiple sclerosis d) Myasthenia gravis
c) Multiple sclerosis Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the CNS
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time? a) First thing in the morning b) Only when needed c) With each meal d) Daily at bedtime
c) With each meal Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. b) The time of day when exercise is performed isn't important. c) Exercising in the evening before going to bed is beneficial. d) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
d) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
Which of the following diseases is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia? a) Creutzfeldt-Jakob disease b) Parkinson's disease c) Multiple sclerosis d) Huntington disease
d) Huntington disease Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with HD has a 50% risk of inheriting the illness.
Which findings best correlate with a diagnosis of osteoarthritis? a) Anorexia and weight loss b) Erythema and edema over the affected joint c) Fever and malaise d) Joint stiffness that decreases with activity
d) Joint stiffness that decreases with activity
A nurse's plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals? a) Increase joint size and strength b) Limit energy output in order to preserve strength for healing c) Maximize range of motion while minimizing exertion d) Preserve and increase range of motion while limiting joint stress
d) Preserve and increase range of motion while limiting joint stress
A nurse is providing care for a patient who has a rheumatic disorder. The nurse's comprehensive assessment includes the patient's mood, behavior, LOC, and neurologic status. What is this patient's most likely diagnosis? a) Rheumatoid arthritis (RA) b) Gout c) Osteoarthritis (OA) d) Systemic lupus erythematosus (SLE)
d) Systemic lupus erythematosus (SLE)
A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? a) Absent deep tendon reflexes b) Tremors at rest c) Flaccid muscles d) Vision changes
d) Vision changes Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of MS.
Choice Multiple question - Select all answer choices that apply. A 38-year old female has recently been diagnosed with rheumatoid arthritis. She is also receiving further testing for disorders of the immune system. She works as an aide at a facility which cares for children infected with AIDS. Which of the following factors will hold the greatest implications during the client's assessment? Select all that apply. a) Her diet b) Her work environment c) Her history of immunizations and allergies d) Her home environment e) Her use of other drugs f) Her age
• Her work environment • Her history of immunizations and allergies • Her use of other drugs (It is important for the nurse to obtain a history of past immunizations and infectious diseases, any allergies, and any recent exposure to infectious diseases. The nurse also needs to review the client's drug history. These data will help the nurse to assess the client's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The nurse should question the client about the practices that put her at risk for AIDS, such as her work environment.)
The nurse is caring for a patient with myasthenia gravis. The nurse generates a plan of care for the patient based on which of the following types of hypersensitivity reaction? a) Cytotoxic b) Immune complex c) Delayed d) Anaphylactic
a) Cytotoxic Cytotoxic hypersensitivity occurs when the body mistakenly identifies a part of the body as foreign, such as in myasthenia gravis where the body mistakenly identifies normal nerve endings as foreign.
The nurse is obtaining a history from a patient with severe psoriasis. What question would be the most important to ask this patient to determine a genetic predisposition? a) "Does anyone in your family have more than one autoimmune disease?" b) "Does your spouse or significant other have an autoimmune disease?" c) "How did you know you developed this disease?" d) "How many children do you have?"
a) "Does anyone in your family have more than one autoimmune disease?"
A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? a) "I'll make sure to monitor my body temperature on a regular basis." b) "I'll try to be as physically active as possible between flare-ups." c) "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." d) "I'll stop taking my steroids when I get relief from my symptoms."
a) "I'll make sure to monitor my body temperature on a regular basis." Fever can signal an exacerbation and should be reported to the physician.
A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a) "Pace yourself and rest frequently, especially after activities." b) "Do all your chores in the evening, when pain and stiffness are least pronounced." c) "Do all your chores after performing morning exercises to loosen up." d) "Do all your chores in the morning, when pain and stiffness are least pronounced."
a) "Pace yourself and rest frequently, especially after activities."
A patient tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a "chronic condition." She asks the nurse what "chronic condition" means. What would be the nurse's best response? a) "Chronic conditions are those that require short-term management in extended-care facilities." b) "Chronic conditions are defined as health problems that require management of several months or longer." c) "Chronic conditions are medical conditions that culminate in disabilities that require hospitalization." d) "Chronic conditions are diseases that come and go in a relatively predictable cycle."
b) "Chronic conditions are defined as health problems that require management of several months or longer."
Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 25-year-old Jewish female b) A 27-year-old black female c) A 35-year-old Hispanic male d) A 25-year-old white male
b) A 27-year-old black female
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Administering ordered analgesics and monitoring their effects c) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware d) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes
b) Administering ordered analgesics and monitoring their effects An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority.
The nurse is caring for a client hospitalized with a severe exacerbation of myasthenia gravis. When administering medications to this client, what is a priority nursing action? a) Document medication given and dose. b) Assess client's reaction to new medication schedule. c) Administer medications at exact intervals ordered. d) Give client plenty of fluids with medications.
c) Administer medications at exact intervals ordered. He or she must administer medications at the exact intervals ordered to maintain therapeutic blood levels and prevent symptoms from returning.
The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform? a) Relax in a hot bath. b) Exercise following a circuit training regimen. c) Apply warm packs to the affected area. d) Avoid swimming and any weight-bearing activity.
c) Apply warm packs to the affected area. Warm packs to the affected area may be beneficial.
A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability in the United States. The nurse should focus on what health problem? a) Osteoporosis b) Lower back pain c) Arthritis d) Hip fractures
c) Arthritis
A patient diagnosed with multiple sclerosis (MS) has ataxia. Which of the following medications could be used to treat this clinical manifestation? a) Baclofen b) Dantrium c) Neurontin d) Valium
c) Neurontin Ataxia is a chronic problem most resistant to treatment. Medications used to treat ataxia include beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), and benzodiazepines (Klonopin).
A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize? a) Take OTC calcium supplements consistently. b) Restrict weight-bearing on right foot. c) Restrict consumption of foods high in purines. d) Ensure fluid intake of at least 4 liters per day.
c) Restrict consumption of foods high in purines. lthough severe dietary restriction is not necessary, the nurse should encourage the patient to restrict consumption of foods high in purines, especially organ meats.
Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years? a) Asymmetric joint involvement b) Bouchard's nodes c) Small joint involvement d) Obesity
c) Small joint involvement Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning.
The presence of crystals in synovial fluid obtained from an arthrocentesis is indicative of a) inflammation. b) degeneration. c) gout. d) infection.
c) gout. The presence of crystals is indicative of gout, and the presence of bacteria is indicative of infective arthritis.
A client being treated for rheumatoid arthritis has been prescribed a type of drug that is commonly used for joint inflammation. The nurse will administer an initial dose as an injection, and the client will continue taking an oral form of the medication. Which type of analgesic drug will the nurse administer? a) Opioid b) Antidepressant c) Narcotic d) Corticosteroid
d) Corticosteroid Corticosteroids are used to treat pain that involves inflammation, such as that related to rheumatoid arthritis.
Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following? a) Ankylosing spondylitis b) Osteoarthritis c) Rheumatoid arthritis d) Gout
d) Gout Joint swelling and tenderness of the great toe and tophi are classic manifestations of gout.
Which of the following is the leading cause of disability and pain in the elderly? a) Rheumatoid arthritis (RA) b) Systemic lupus erythematous (SLE) c) Scleroderma d) Osteoarthritis
d) Osteoarthritis
Choice Multiple question - Select all answer choices that apply. A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Choose all that apply. a) Ignore threats to identity b) Validate individual self-worth c) Validate family functioning d) Alleviate and manage symptoms e) Die without comfort
• Alleviate and manage symptoms • Validate family functioning • Validate individual self-worth
Select all answer choices that apply. After teaching a class about the inheritance patterns of different conditions, the instructor determines that the teaching was successful when the students identify which of the following as resulting from multifactorial inheritance? Select all that apply. a) Familial Alzheimer's disease b) Anencephaly c) Familial hypercholesterolemia d) Congenital heart defect e) Osteroarthritis f) Factor V Leiden thrombophilia
• Familial Alzheimer's disease • Anencephaly • Osteroarthritis • Congenital heart defect (Factor V Leiden thrombophilia and familial hypercholesterolemia involve an autosomal-dominant inheritance pattern.)
Which of the following is the leading cause of disability and pain in the elderly? a) Osteoarthritis b) SLE c) Scleroderma d) Rheumatoid arthritis (RA)
a) Osteoarthritis
A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered? a) A cause-and-effect relationship b) An exacerbation of a previous disorder c) An alloimmunity disorder d) Autoimmune
d) Autoimmune
The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder began? a) Sensitivity to bright light b) Shortness of breath c) Muscle spasms d) Drooping eyelids
d) Drooping eyelids Ptosis is the most common manifestation of myasthenia gravis. Muscle weakness varies depending on the muscles affected. Shortness of breath and respiratory distress occurs later as the disease progresses.
Which of the following is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord? a) Creutzfeldt-Jakob disease b) Huntington disease c) Parkinson's disease d) Multiple sclerosis
d) Multiple sclerosis
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Widespread chronic pain b) Jaw locking c) Heberden's nodes d) Butterfly facial rash
a) Widespread chronic pain
A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? a) Sphygmomanometer b) Padded tongue blade c) Suction machine with catheters d) Nasal cannula and oxygen
c) Suction machine with catheters MS weakens the respiratory muscles and impairs swallowing, putting the client at risk for aspiration.
To help prevent osteoporosis, what should a nurse advise a young woman to do? a) Avoid trauma to the affected bone. b) Encourage the use of a firm mattress. c) Consume at least 1,000 mg of calcium daily. d) Keep the serum uric acid level within the normal range.
c) Consume at least 1,000 mg of calcium daily.
Select all answer choices that apply. Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. a) Provide opportunities for the client to express concerns. b) Provide diversional activities. c) Assist the client to develop a sleep routine. d) Support joints with splints and pillows. e) Provide assistive devices for self-feeding.
• Support joints with splints and pillows. • Assist the client to develop a sleep routine.
