Patho Exam ? Ch 50
Obesity
21. When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease? Smoking Obesity Sedentary life style Hypertension
Make, age 75
3. Which individual is at greatest risk for osteoarthritis? Male with a BMI of 30 Male, age 75 40-year-old runner Postmenopausal female, age 50
client with systemic lupus erythematosus reporting chest pain
10. The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first? client with rheumatoid arthritis reporting joint pain client with systemic lupus erythematosus reporting chest pain client with rheumatoid arthritis and vasculitis reporting numbness and tingling client with systemic lupus erythematosus reporting a rash on the face
Physical examination and x-ray studies
1. The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate? Exercise trials to monitor angle of joint movements Physical examination and x-ray studies Bone marrow aspiration of the pelvis Aspiration of the joint with biopsy sent to laboratory
A T-cell-mediated response to an immunologic trigger, such as a microbial agent
11. A client who has developed rheumatoid arthritis can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response? A decreased production of inflammatory mediators and cytokines A T-cell-mediated response to an immunologic trigger, such as a microbial agent An exposure to a virus that triggers a B-cell response A macrophage-mediated response that attacks self
Polymyalgia rheumatica
12. An older adult reports waking up in the morning with pain/stiffness in the neck/shoulders. Laboratory work reveals an elevated erythrocyte sedimentation rate (ESR). Following a short trial of prednisone with significant improvement, the health care provider likely will diagnose which disorder? Ankylosing spondylitis Polymyalgia rheumatica Psoriatic arthritis Reiter syndrome
Autoimmune process
13. A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease? Genetic disorder Autoimmune process Infectious process Ischemic response
"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular"
14. The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client makes which statement? "Rheumatoid arthritis is a chronic autoimmune system disease that affects a single joint." "The disease will not fluctuate in occurrence." "Only upper extremity diarthrodial joint can be involved." "Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."
Weight and nutritional status
15. An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects? Sodium and potassium levels Weight and nutritional status Oxygenation and respiratory status Cognition and coping skills
Joint pain and proteinuria
16. Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)? thromboembolic events and varicose veins, joint pain and proteinuria, dysmenorrhea and recent spontaneous abortion, chronic nausea and vomiting
"Children can be affected with almost all of the rheumatic diseases that occur in adults."
17. The parents of a child diagnosed with rheumatic disease are shocked by the diagnosis and tell the nurse that they did not think children could acquire the disease. The best response would be: "Do not worry; a course of antibiotic therapy will cure the child." "Your child will not be restricted with any activities and will have a normal lifestyle." "Children can be affected with almost all of the rheumatic diseases that occur in adults." "Children who acquire rheumatic diseases are more likely to have a higher intelligence level."
Inspecting oral mucosa Avoiding invasive procedures Monitoring urine output
18. An otherwise healthy 35-year-old client has been admitted for treatment of active systemic lupus erythematosus (SLE) and is prescribed cyclophosphamide. What should the nurse include in the plan of care? Select all that apply. Frequent repositioning Administration of potassium supplements Avoiding invasive procedures Monitoring urine output Inspecting oral mucosa
Lower back pain
19. The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find? Bruises on the lower extremities Lower back pain Joint contractures Facial butterfly rash
"Genetic predisposition is very likely."
2. A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology? "The disease is most common in those under 30." "Genetic predisposition is very likely." "Environment is the biggest contributing factor to the development of RA." "Exposure to workplace chemicals is a causative agent."
"When I have an exacerbation of my symptoms, a glass of red wine will be helpful."
20. The nurse determines that additional client education is needed when a client with gout makes which statement? "When I have an exacerbation of my symptoms, a glass of red wine will be helpful." "Increasing my intake of water each day will help stop the symptoms." "I will plan to eat more white meat rather than red meat." "I should avoid eating shellfish to decrease the risk of an episode."
a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Antimalarial drug (hydroxychloroquine) c) Systemic corticosteroid drugs d) Immunosuppressive medications Pg. 1250 Systemic Lupus Erythematosus Treatment of SLE begins with the anti-inflammatory medications that pose the least side effects while symptoms are mild, such as an NSAID to control fever and arthritis. If this class fails to control symptoms, the antimalarial drug hydroxychloroquine is generally the next medication used. Once this medication fails to control symptoms, corticosteroids may be added to control the more significant symptoms. Sometimes high-dose corticosteroids may need to be used to control symptoms. Finally, immunosuppressive drugs such as cyclophosphamide are used in cases of severe disease.
22. The nurse is teaching a client with systemic lupus erythematosus (SLE) about the typical treatment course with this condition. Place in order the typical classes of medication used from earliest stages to the latest stages of the disease. Use all options. a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Antimalarial drug (hydroxychloroquine) c) Systemic corticosteroid drugs d) Immunosuppressive medications
The injections will be given only 3 to 4 times per year because they can increase joint destruction
23. The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include? There will be minimal discomfort because the injections are placed in the subcutaneous tissue. The client or a family member will be taught to administer the injections daily. There will be immediate relief with one injection and daily running can be resumed. The injections will be given only 3 to 4 times per year because they can increase joint destruction.
RA has an autoimmune and genetic predisposition
24. A nurse is caring for a client with rheumatoid arthritis (RA) who states she "caught" this from her mother. Which statement is the correct explanation of how this type of arthritis develops? RA is related to overuse of a joint. RA is caused by a virus, transmitted in utero. RA has an autoimmune and genetic predisposition. RA is a disease of older adults, especially women.
Vascular granulation tissue that destroys cartilage and bone
25. The nurse is teaching a client with rheumatoid arthritis about pannus, which develops in the affected joint area. What does the nurse include to describe pannus? Microorganisms that attack the joint space causing stiffness Muscles in the area that atrophy from disuse Vascular granulation tissue that destroys cartilage and bone Reversible calcium deposits affecting the joints
Systemic lupus erythematosus (SLE)
4. A nurse is caring for a client admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which disease process? Sarcoidosis Systemic lupus erythematosus (SLE) Rheumatoid arthritis (RA) Scleroderma
Nonsteroidal anti-inflammatory drugs (NSAIDs)
5. The nurse is caring for a client with newly diagnosed systemic lupus erythematosus (SLE). Which over-the-counter medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis? Cyclophosphamide Hydroxychloroquine Nonsteroidal anti-inflammatory drugs (NSAIDs) Belimumab
Synovial fluid
6. Which substance helps maintain a smooth surface in joint cartilage? Uric acid Surfactants Cytokines Synovial fluid
"To prevent cartilage atrophy, slowly and gradually resume exercising."
7. A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "To prevent cartilage atrophy, slowly and gradually resume exercising." "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed."
"Losing some weight and reducing your alcohol intake will likely be beneficial."
8. A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client? "It's important that you have your bloodwork drawn weekly and that you adjust your diet." "Losing some weight and reducing your alcohol intake will likely be beneficial." "In a lot of cases, clients with gout are able to control their symptoms through physiotherapy." "Your doctor will likely prescribe acetaminophen with codeine to manage your pain."
Assessment of eyes for pain and inflammation. Assessment of dyspnea and respiratory function. Assist with ambulation due to increased risk for falls.
9. The nurse is caring for a client with advanced ankylosing spondylitis (AS). What does the nurse include in the plan of care? Select all that apply. Assessment of eyes for pain and inflammation. Assessment of dyspnea and respiratory function. Assist with ambulation due to increased risk for falls. Schedule physiotherapy for early morning. Elevating head of bed to 45 degrees for sleeping.