PrepU Chapter 39: Assessment and Management of Patients With Rheumatic Disorders

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

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)?

it is important to monitor for injection site reactions.

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

A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis?

"Client will exhibit no signs or symptoms of aspiration."

What should the nurse teach the patient about the diagnosis of osteoarthritis?

"It is the most common and frequently disabling of joint disorders."

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."

A client with rheumatoid arthritis presents to the clinic for a second dose of gold thioglucose (Solganal). The dose prescribed is 25 mg intramuscularly. The medication is available in 50 mg per ml. How many milliliters will the nurse administer to the client?

0.5

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

Administering ordered analgesics and monitoring their effects

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

Assess dietary diet and activity at home

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse?

Dairy products

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

Encourage weight loss and an increase in aerobic activity

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

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 -

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

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process?

Gout

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Has a weight gain of 5 pounds

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about?

Hydroxychloroquine (Plaquenil)

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

Hypertension

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound?

Inhibits T- and B-cell activity

Scleroderma typically begins with which system involvement?

Integumentary

Fibromyalgia is a common condition that

Involves chronic fatigue, generalized muscle aching, and stiffness

Which of the following statements is accurate regarding osteoarthritis?

It is a noninflammatory disorder and the most common and frequently disabling of joint

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

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

Low back pain

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)

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically:

Milky, cloudy, and dark yellow.

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

Pain

Nursing care for the patient with fibromyalgia should be guided by what assumption?

Patients with fibromyalgia may feel as if their symptoms are not taken seriously.

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

Physical therapy and exercise

Primary gout is often caused by an inherited disorder in which type of metabolism?

Purine

Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis?

Red blood cell count

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Reports increased fatigue

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

SLE

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

Strategies for remaining active

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

Systemic lupus erythematosus (SLE)

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.

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Tophi

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Widespread chronic pain

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

age

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

combat inflammation.

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

purine-rich foods

A nurse practitioner is managing the care of a patient who has gout. Choose the medication that she would prescribe as the drug of choice to prevent tophi formation and promote tophi regression.

Zyloprim

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective?

"I should avoid prolonged sun exposure."

A 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."

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."

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."

The side effect of bone marrow depression may occur with which medication used to treat gout?

Allopurinol (Zyloprim)

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

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

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.

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

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

gout

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis?

imbalanced nutrition: greater than body requirements

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to:

install safety devices in the home.

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

organ meats.

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

50

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?

Elevated uric acid levels

Which of the following is the most common joint affected in gout?

Metatarsophalangeal

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."

Which findings best correlate with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity

A nurse should advise a patient with gout to avoid which of the following foods?

Organ meats and scallops

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

Osteoarthritis

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:

gouty arthritis.

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan?

jogging