Prep U for Brunner Ch. 39 Assessment and Management of Patients With Rheumatic Disorders

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"It will get better and worse again." pg. 1062

The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

"Monitor your body temperature." pp. 1071-1072.

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?

"Pace yourself and rest frequently, especially after activities." pg. pp. 1076-1077.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

"The diagnosis won't be based on the findings of a single test but by combining all data found." pg. 1070

A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate?

"There might be some difficulties with your plan and fasting." pg. 1079

The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?

"Your symptoms are a result of your body attacking itself." pg. 1055

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects pg. 1066

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?

After the client has had a warm paraffin hand bath pg. 1056

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?

An exercise routine that includes range-of-motion (ROM) exercises pg. 1067

Which term refers to fixation or immobility of a joint?

Ankylosis pg. 1078

CREST Scleroderma

C - Calcinosis/anti-Centromere antibodies R - Raynaud's E - Esophageal Dysmotility S - Sclerodactyly T - Telangiectasias

Which of the following procedures involves a surgical fusion of the joint?

Arthrodesis pg. 1067

RA-Joint Changes

Boutonniere: Concave Ulnar Deviation: medial joint toward ulnar bone Swan's neck: distal joint flexion Pannus Synovial proliferation- "pannus" formation • Pannus grows to engulf the surrounding tissues • Soft tissue destruction laxity of tendons and ligaments • X-ray findings-joint swelling, loss of cartilage, and joint space narrowing

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?

Butterfly-shaped rash on the face over the bridge of the nose and cheeks pg. 1070

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about?

Celecoxib (Celebrex) pg. 1060

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?

Chronic fatigue, generalized muscle aching, and stiffness pg. 1080

The treatment of gout involves managing the acute inflammatory stage, preventing flare-ups, and controlling hyperuricemia. Select the agent of first choice when an acute inflammatory attack begins

Colchicine pg. 1079

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)

Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue pg. 1073

A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. An appropriate nursing diagnosis for the client is:

Disturbed body image pg. 1073

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

Elevated erythrocyte sedimentation rate pg. p. 1058,1066.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis?

Encourage weight loss and an increase in aerobic activity pg. 1076

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

Facial erythema, pericarditis, pleuritis, fever, and weight loss pg. 1070

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client?

Fatigue pg. 1063

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

For their immunosuppressant effects

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?

Gout pg. 1079

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following?

Gout pg. 1079

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?

Heberden's nodes pg. 1076

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement?

Hypertension pg. 1070

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?

Hyperuricemia pg. 1079

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease?

If you have problems with a medication, you may stop it until your next physician visit. pg. 1072

Which of the following statements is accurate regarding osteoarthritis?

It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. pg. 1075

Which points should be included in the medication teaching plan for a client taking adalimumab?

It is important to monitor for injection site reactions. pg. 1061

Which findings best correlate with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity pg. 1076

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?

Located over bony prominence pg. 1066

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?

Low back pain pg. 1077

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture pg. 1064

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?

Methotrexate (Rheumatrex) pg. 1060

Which is the leading cause of disability and pain in the elderly?

Osteoarthritis (OA) pg. 1075

Which of the following is the most common cause for a patient to seek medical attention for arthritis?

Pain pg. 1056

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

Physical therapy and exercise pg. 1077

Which of the following would a nurse encourage a client with gout to limit?

Purine-rich foods pg. 1079

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis?

RBC count pg. 1066

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

Raynaud's phenomenon pg. 1057

A nurse is providing care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

Risk for impaired skin integrity pg. 1074

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on:

Strategies for remaining active pg. 1076

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result?

Suggestive of RA pg. 1066

Which of the following disorders is characterized by an increased autoantibody production?

Systemic lupus erythematosus (SLE) pg. 1069

Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?

Systemic lupus erythematosus (SLE) pg. 1070

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication?

Take the medication with food to avoid stomach upset. pg. 1060

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?

The belief is that it is an autoimmune disorder with an unknown trigger. pg. 1069

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Tophi pg. 1079

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?

applications of ice pg. pp. 1056-1058.

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

age pg. 1075

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 suffering from an acute attack of gout?

colchicine pg. 1079

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?

eating organ meats and sardines pg. 1079

The presence of crystals in synovial fluid obtained from an arthrocentesis is indicative of

gout. pg. 1079

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. pg. 1081

The nurse teach the client that osteoarthritis is Non inflammatory disease

the most common and frequently disabling of joint disorders. pg. 1075

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:

weight loss will reduce uric acid levels and reduce stress on joints. pg. 1079

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 in self-concept • Fluid and electrolyte imbalance pg. 1054