NRS 3013 Chapter 34 PrepU
The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? A. pain B. joint swelling C. stiffness D. weakness
A. pain
The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? A. small joint involvement B. joint pain that increases with rest C. subcutaneous nodules D. early morning stiffness
D. early morning stiffness
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? A. "My legs feel weak." B. "My finger joints are oddly shaped." C. "I have pain in my hands." D. "I have trouble with my balance."
B. "My finger joints are oddly shaped."
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? A. Subchondral bone B. Pannus C. Joint effusion D. Tophi
D. Tophi
A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? A. Take the medication on an empty stomach in order to increase effectiveness. B. Since the medication is able to be obtained over the counter, it has few side effects. C. Take the medication with food to avoid stomach upset. D. Inform the health care provider if there is ringing in the ears.
C. Take the medication with food to avoid stomach upset.
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. A. 3.2 mg/dL (0.19mmol/L) B. 4.0 mg/dL (0.24 mmol/L) C. 5.4 mg/dL (0.32 mmol/L) D. 6.8 mg/dL (0.40 mmol/L)
D. 6.8 mg/dL (0.40 mmol/L)
A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? A. Heart disease B. Vascular diseases C. Metabolic disorders D. Autoimmune disorders
D. Autoimmune disorders
Which is the leading cause of disability and pain in the elderly? A. Osteoarthritis (OA) B. Rheumatoid arthritis (RA) C. Systemic lupus erythematosus (SLE) D. Scleroderma
A. Osteoarthritis (OA)
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 B. Celecoxib C. Methylprednisolone D. Mercaptopurine azathioprine
A. Methotrexate
Which of the following procedures involves a surgical fusion of the joint? A. Arthrodesis B. Synovectomy C. Tenorrhaphy D. Osteotomy
A. Arthrodesis
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 titer D. Elevated ESR
A. Positive Anti-dsDNA antibody test
Which of the following disorders is characterized by an increased autoantibody production? A. Systemic lupus erythematosus (SLE) B. Scleroderma C. Rheumatoid arthritis (RA) D. Polymyalgia rheumatic
A. Systemic lupus erythematosus (SLE)
Fibromyalgia is a common condition that involves A. chronic fatigue, generalized muscle aching, and stiffness. B. pain, viral infection, and tremors. C. diminished vision, chronic fatigue, and reduced appetite. D. generalized muscle aching, mood swings, and loss of balance.
A. chronic fatigue, generalized muscle aching, and stiffness.
A client is recovering from an attack of gout. What will the nurse include in the client teaching? A. Weight loss will reduce purine levels. B. Weight loss will reduce inflammation. C. Weight loss will increase uric acid levels and reduce stress on joints. D. Weight loss will reduce uric acid levels and reduce stress on joints.
D. Weight loss will reduce uric acid levels and reduce stress on joints.
A client presents with an edematous and red left great toe and reports the same symptoms occured 2 months ago. Which questions will the nurse ask to determine if the client is experiencing gout? Select all that apply. A. "Have you had any recent surgeries?" B. "Have you had any change in your oral intake?" C. "What time of day does the pain occur?" D. "Do you consume alcoholic beverages?" E. "How long did the previous episode last?"
ALL
A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate? A. "You should discuss that matter with your health care provider." B. "The diagnosis won't be based on the findings of a single test but by combining all data found." C. "SLE is a very serious systemic disorder." D. "Tell me more about your concerns about this potential diagnosis."
B. "The diagnosis won't be based on the findings of a single test but by combining all data found."
A client is newly diagnosed with rheumatoid arthritis. For which medications will the nurse prepare teaching for this client? Select all that apply. A. Aspirin B. Ibuprofen C. Prednisone D. Methotrexate E. Acetaminophen
B,C,D
A client with rheumatoid arthritis is prescribed a disease-modifying antirheumatic drug (DMARD). Which information will the nurse explain regarding the purpose of this medication? Select all that apply. A. Control pain B. Induce remission C. Slow further tissue damage D. Suppress the immune response E. Alter progression of the disease
B,C,D,E
A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis? A. "Client will lose 2 lb (0.91 kg) per week on a calorie-restricted diet." B. "Client will exhibit no signs or symptoms of aspiration." C. "Client will exhibit bowel and bladder continence." D. "Client will exhibit alertness and orientation to person, place, and time."
B. "Client will exhibit no signs or symptoms of aspiration."
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? A. Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes B. Administering ordered analgesics and monitoring their effects C. Performing meticulous skin care D. Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware
B. Administering ordered analgesics and monitoring their effects
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? A. Acupuncture B. An exercise routine that includes range-of-motion (ROM) exercises C. Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) D. Cold therapy
B. An exercise routine that includes range-of-motion (ROM) exercises
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. Butterfly-shaped rash on the face over the bridge of the nose and cheeks
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? A. Ibuprofen B. Celecoxib C. Piroxicam D. Tolmetin sodium
B. Celecoxib
Which is an appropriate nursing intervention in the care of the client with osteoarthritis? A. Provide an analgesic after exercise B. Encourage weight loss and an increase in aerobic activity C. Assess for gastrointestinal complications associated with COX-2 inhibitors D. Avoid the use of topical analgesics
B. Encourage weight loss and an increase in aerobic activity
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? A. detection of systemic complications B. strategies for remaining active C. disease-modifying antirheumatic drug therapy D. prevention of joint deformity
B. strategies for remaining active
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? A. "Exposure to sunlight will help control skin rashes." B. "There are no activity limitations between flare-ups." C. "Monitor your body temperature." D. "Corticosteroids may be stopped when symptoms are relieved."
C. "Monitor your body temperature."
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? A. "Do all your chores in the morning, when pain and stiffness are least pronounced." B. "Do all your chores after performing morning exercises to loosen up." C. "Pace yourself and rest frequently, especially after activities." D. "Do all your chores in the evening, when pain and stiffness are least pronounced."
C. "Pace yourself and rest frequently, especially after activities."
The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? A. Remission B. Exacerbation C. Inflammation D. Autoimmunity
C. Inflammation
The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? A. Scleroderma B. Fibromyalgia C. Rheumatoid arthritis D. Systemic lupus erythematosus
C. Rheumatoid arthritis
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? A. aspirin B. furosemide C. colchicine D. calcium gluconate
C. colchicine
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? A. ability to perform activities of daily living (ADL) B. decreased joint pain C. increased fatigue D. a weight gain of 2 pounds
C. increased fatigue
A client arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean? A. fluid intake B. protein-rich foods C. purine-rich foods D. carbohydrates
C. purine-rich foods
A client with fibromyalgia asks why physical therapy has been prescribed. Which response will the nurse make? A. "It will take your mind off your health problem." B. "I will ask the health care provider it if is necessary." C. "It is used instead of prescribing medications for the condition." D. "It will help with the overall deconditioning that has occurred."
D. "It will help with the overall deconditioning that has occurred."
Which term refers to fixation or immobility of a joint? A. Hemarthrosis B. Diarthrodial C. Arthroplasty D. Ankylosis
D. Ankylosis
Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? A. Chest pain B. Decreased cognitive ability C. Behavioral changes D. Hypertension
D. Hypertension
Which points should be included in the medication teaching plan for a client taking adalimumab? A. The medication is administered intramuscularly. B. The client should continue taking the medication if fever occurs. C. The medication is given at room temperature. D. It is important to monitor for injection site reactions.
D. It is important to monitor for injection site reactions.
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? A. Bone scan B. Computed tomography (CT) C. Magnetic resonance imaging (MRI) D. Muscle biopsy
D. Muscle biopsy
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? A. "Are you taking the medication as prescribed?" B. "Have you reduced the amount of daily exercise?" C. "Have you increased your intake of fat-soluble vitamins?" D. "Are you taking frequent rest periods throughout the day?"
A. "Are you taking the medication as prescribed?"
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? A. Facial erythema, pericarditis, pleuritis, fever, and weight loss B. Photosensitivity, polyarthralgia, and painful mucous membrane ulcers C. Weight gain, hypervigilance, hypothermia, and edema of the legs D. Hypothermia, weight gain, lethargy, and edema of the arms
A. Facial erythema, pericarditis, pleuritis, fever, and weight loss
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? A. If you have problems with a medication, you may stop it until your next physician visit. B. Avoid sunlight and ultraviolet radiation. C. Pace activities. D. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
A. If you have problems with a medication, you may stop it until your next physician visit.
A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? A. Install safety devices in the home. B. Wear worn, comfortable shoes. C. Get help when lifting objects. D. Wear protective devices when exercising.
A. Install safety devices in the home.
Which joint is most commonly affected in gout? A. Metatarsophalangeal B. Tarsal area C. Ankle D. Knee
A. Metatarsophalangeal
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? A. eating organ meats and sardines B. frequently drinking coffee C. high carbohydrate intake D. frequently ingesting salicylates
A. eating organ meats and sardines
The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? A. joint stiffness that increases with activity B. erythema and edema over the affected joint C. anorexia and weight loss D. fever and malaise
A. joint stiffness that increases with activity
The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? A. low back pain B. increased urine output C. red, butterfly-shaped facial rash D. patchy hair loss on the scalp
A. low back pain
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? A. "It is a routine test done on everyone." B. "The lupus can affect your kidney function." C. "The medication you take can affect your bladder." C. "The test will determine how long you will have the rash."
B. "The lupus can affect your kidney function."
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? A. MRI B. X-ray C. CT scan D. Ultrasound
B. X-ray
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? A. Encourage the client to store the bottles with their tops removed. B. Have a trusted family member take over the management of the client's medication regimen. C. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. D. Have the client approach her primary provider to explore medication alternatives.
C. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.
The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan? A. jogging B. running on a treadmill C. tai chi D. weight lifting
C. tai chi
The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? A. Antibiotics B. Anticoagulants C. Oral corticosteroids D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? A. Rheumatoid arthritis B. Systemic lupus erythematosus C. Polymyalgia rheumatic D. Scleroderma
D. Scleroderma
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? A. tender to the touch B. reddened C. nonmovable D. located over bony prominence
D. located over bony prominence
Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia A. all have the same type of symptoms. B. rarely respond to treatment. C. will eventually lose their ability to walk. D. may feel as if their symptoms are not taken seriously.
D. may feel as if their symptoms are not taken seriously.
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? A. "This disorder is more common in men in their thirties and forties than in women." B. "The belief is that it is an autoimmune disorder with an unknown trigger." C. "SLE has very specific manifestations that make diagnosis relatively easy." D. "The symptoms are primarily localized to the skin but may involve the joints."
B. "The belief is that it is an autoimmune disorder with an unknown trigger."
A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? A. "The fasting is okay, but make sure you drink fluids when exercising." B. "Make sure to eat some fat occasionally with all that exercise." C. "Try combining the fasting with moderate exercise." D. "There might be some difficulties with your plan and fasting."
D. "There might be some difficulties with your plan and fasting."
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? A. "Does exercise usually work for you?" B. "Why do you think the exercise didn't work?" C. "Do you think you are too old to exercise?" D. "What types of exercise were you doing?"
D. "What types of exercise were you doing?"
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? A. The time of day when exercise is performed isn't important. B. Exercising in the evening before going to bed is beneficial. C. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. D. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
