RA, Gout, LE

15. A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate? a. Giving subcutaneous injections b. Having a chest x-ray once a year c. Taking the medication with food d. Using heat on the injection site

ANS: A Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.

Which syndrome is associated with leukopenia in a patient with rheumatoid arthritis? A. Felty's syndrome B. Caplan's syndrome C. Sjogren's syndrome D. Carpal tunnel syndrome

ANS: A Felty's syndrome is characterized by leukopenia and hepatosplenomegaly. Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs. Sjogren's syndrome includes a characteristic triad of dryness in the mouth, vagina, and eyes. Carpal tunnel syndrome involves compression of the median nerve in the wrist.

12. A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like "pins and needles" and that the neck is very painful since returning from surgery. What action by the nurse is best? a. Assist the client to change positions. b. Document the findings in the client's chart. c. Encourage range of motion of the neck. d. Notify the provider immediately.

ANS: D Clients with RA can have cervical joint involvement. This can lead to an emergent situation in which the phrenic nerve is compressed, causing respiratory insufficiency. The client can also suffer a permanent spinal cord injury. The nurse needs to notify the provider immediately. Changing positions and doing range of motion may actually worsen the situation. The nurse should document findings after notifying the provider.

Which syndrome is characterized by the presence of rheumatoid nodules in the lungs? A. Felty's syndrome B. Caplan's syndrome C. Sjogren's syndrome D. Carpal tunnel syndrome

Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs. Felty's syndrome is characterized by leukopenia and hepatosplenomegaly. Dryness of the eyes, mouth, and vagina is a characteristic feature of Sjogren's syndrome. Carpal tunnel syndrome is caused by the compression of the median nerve in the wrist.

The drug leflunomide is often used for pain management in patients with rheumatoid arthritis (RA). What is the drug's initial loading dose? Record your answer using a whole number. ___ mg

ANS: 100 Leflunomide is a slow-acting, immune-modulating drug that reduces inflammatory disorders in patients with RA. A dosage of 100 mg for 3 days, followed by 20 mg daily reduces the occurrence of symptoms.

What is the recommended daily dosage of vitamin D for patients taking chronic steroid therapy to prevent osteoporosis?___ mg

ANS: 400 Rheumatoid arthritis is treated with steroids, which have anti-inflammatory and immunosuppressive effects. Chronic steroid therapy causes numerous side effects, including osteoporosis. To prevent osteoporosis and maintain bone density, 400 mg of vitamin D is recommended along with 1200 mg to 1500 mg of calcium.

4. The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met? a. Attends meetings of a book club b. Has a positive outlook on life c. Takes medication as directed d. Uses assistive devices to protect joints

ANS: A All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met.

Which drug is an interleukin-1 (IL-1) receptor antagonist? A. Anakinra B. Rituximab C. Abatacept D. Tocilizumab

ANS: A Anakinra is an IL-1 receptor antagonist. Rituximab is a monoclonal antibody. Abatacept is a selective T-lymphocyte co-stimulator modulator. Tocilizumab is an interleukin-6 (IL-6) inhibitor. These drugs are biological response modifiers (biologics) and are used for rheumatoid arthritis and other connective tissue diseases.

19. A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best? a. Assess medication records for steroid use. b. Facilitate a consultation with physical therapy. c. Measure the range of motion in both hips. d. Notify the health care provider immediately.

ANS: A Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.

28. A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement? a. "I always wear long sleeves, pants, and a hat when outdoors." b. "I try not to use cosmetics that contain any type of sunblock." c. "Since I tend to sweat a lot, I use a lot of baby powder." d. "Since I can't be exposed to the sun, I have been using a tanning bed."

ANS: A Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, avoiding drying agents such as powder, and avoiding tanning beds.

22. The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate? a. "Drink 1 to 2 liters of water each day." b. "Have 10 to 12 ounces of juice a day." c. "Liver is a good source of iron." d. "Never eat hard cheeses or sardines."

ANS: A Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in ash, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not eat organ meats or fish with bones, such as sardines.

18. The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further? a. Creatinine: 3.9 mg/dL b. Platelet count: 210,000/mm3 c. Red blood cell count: 5.2/mm3 d. White blood cell count: 4400/mm3

ANS: A Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.

24. A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started "acting up," especially both hips and knees. What action by the nurse is best? a. Assess the client for the presence of subcutaneous nodules or Baker's cysts. b. Inspect the client's feet and hands for podagra and tophi on fingers and toes. c. Prepare to teach the client about an acetaminophen (Tylenol) regimen. d. Reassure the client that the problems will fade as the weather changes again.

ANS: A Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Podagra and tophi are seen in gout. Acetaminophen is not used for rheumatoid arthritis. Telling the client that the symptoms will fade with weather changes is not accurate.

33. A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the condition. What action by the nurse is best? a. Assess the client's culture more thoroughly. b. Discuss options for performing duties. c. See if the client will call a community meeting. d. Suggest the client give up the role of elder.

ANS: A The nurse needs a more thorough understanding of the client's culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions. If the nurse does not understand the consequences of what is suggested, the client may simply be unwilling to listen or participate in problem solving. The other options may be reasonable depending on the outcome of a better cultural understanding.

The nurse is teaching a nursing student about measures to facilitate sleep in patients with arthritis. Which statement made by the nursing student indicates a need for further teaching? A. "I should provide cold beverages before sleeping." B. "I should administer a hypnotic drug 30 minutes before sleep." C. "I should maintain a quiet environment in the patient's room." D. "I should instruct the patient to elevate the legs with a pillow while sleeping."

ANS: A The nurse should provide warm, not cold, beverages to a patient with arthritis before the patient goes to sleep. Hypnotic drugs are sleeping aids that can be beneficial to patients with arthritis. A quiet environment will help the patient sleep without disturbance. In a patient with arthritis, the knees should be elevated with a pillow to promote sleep.

23. A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include? a. "Avoid large crowds or people who are ill." b. "Stay upright for 1 hour after taking this drug." c. "This drug may cause your hair to fall out." d. "You may double the dose if pain is severe."

ANS: A This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.

9. A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort

ANS: A, B, D Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.

3. A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications. What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.) a. Acupuncture b. Stretching c. Supplements d. Tai chi e. Vigorous aerobics

ANS: A, B, D There are many nonpharmacologic means for controlling the symptoms of fibromyalgia, including acupuncture, stretching, tai chi, low-impact aerobics, swimming, biking, strengthening, massage, stress management, and hypnosis. Dietary supplements and vigorous aerobics are not recommended.

2. A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. "Avoid acetaminophen in over-the-counter medications." b. "It may take several weeks to become effective on pain." c. "Pregnancy and breast-feeding are not affected by MTX." d. "Stay away from large crowds and people who are ill." e. "You may find that folic acid, a B vitamin, reduces side effects."

ANS: A, B, D, E MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.

6. The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash - Systemic lupus erythematosus (SLE) b. Esophageal dysmotility - Systemic sclerosis c. Excess uric acid excretion - Gout d. Footdrop and paresthesias - Osteoarthritis e. Vasculitis causing organ damage - Rheumatoid arthritis

ANS: A, B, E A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis.

11. A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client who reports jaw pain when eating b. Client with a red, hot, swollen right wrist c. Client who has a puffy-looking area behind the knee d. Client with a worse joint deformity since the last visit

ANS: B All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.

Rheumatoid arthritis (RA) affects most of the synovial joints. Which joint may be involved in the most severe cases? A. Sacroiliac B. Temporomandibular C. Metacarpophalangeal D. Proximal interphalangeal

ANS: B Almost all of the joints are eventually affected by RA. The temporomandibular joint (TMJ) may be involved in severe disease, causing pain when chewing or opening the mouth, although such involvement is uncommon. Metacarpophalangeal and proximal interphalangeal joints are usually affected in earlier stages of RA. The sacroiliac joint is affected more in psoriatic arthritis.

The nurse is explaining the clinical manifestations of joint involvement of rheumatoid arthritis with a nursing student. What is the best way to describe a Baker's cyst? A. Enlarged liver and spleen B. Enlarged popliteal bursae behind the knee C. Presence of rheumatoid nodules in the lungs D. Presence of small, brownish spots around the nail bed

ANS: B Baker's cysts are enlarged popliteal bursae behind the knee. They may occur in patients with rheumatoid arthritis and can cause tissue compression and pain. Liver and spleen enlargement is called hepatosplenomegaly. The presence of rheumatoid nodules is a typical characteristic of Caplan's syndrome. Periungual lesions are small, brownish spots around the nail bed.

17. A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply? a. Heating pad b. Ice packs c. Splints d. Wax dip

ANS: B Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness.

Which drug is contraindicated for a patient with rheumatoid arthritis and multiple sclerosis? A. Celecoxib B. Infliximab C. Methotrexate D. Hydroxychloroquine

ANS: B Remind patients with multiple sclerosis (MS), tuberculosis (TB), or a positive TB test that they should not receive TNF inhibitors because they make them more susceptible to flare-ups of these diseases. Infliximab is a tumor necrosis factor—alpha (TNFA) inhibitor, which may be used for rheumatoid arthritis. All TNFA inhibitor drugs should be avoided by a patient with multiple sclerosis. Celecoxib is contraindicated in patients with cardiovascular disease. Methotrexate is not contraindicated in patients with multiple sclerosis. Hydrochloroquine would not be recommended for patients with retinal damage.

20. A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family. What action by the nurse is best? a. Explain to the client that SLE is an unpredictable disease. b. Help the client create backup plans to minimize disruption. c. Offer to talk to the family and educate them about SLE. d. Tell the client to remain compliant with treatment plans.

ANS: B SLE is an unpredictable disease and acute exacerbations can occur without warning, creating chaos in the family. Helping the client make backup plans for this event not only will decrease the disruption but will give the client a sense of having more control. Explaining facts about the disease is helpful as well but does not engage the client in problem solving. The family may need education, but again this does not help the client to problem-solve. Remaining compliant may help decrease exacerbations, but is not as powerful an intervention as helping the client plan for such events.

Which condition is associated with the presence of HLA- B27? A. Felty's syndrome B. Reiter's syndrome C. Sjogren's syndrome D. Carpal tunnel syndrome

ANS: B The presence of HLA- B27 antigen is indicative of Reiter's syndrome. Felty's syndrome would be indicated if there is a decreased WBC count. The presence of anti-SS-A (RO) and anti-SS-B (La) in antinuclear antibodies may indicate Sjogren's syndrome. Carpal tunnel syndrome is not associated with the presence of HLA- B27 antigen.

1. The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.) a. It affects single joints only. b. Antibodies lead to inflammation. c. It consists of an autoimmune process. d. Morning stiffness is rare. e. Permanent damage is inevitable.

ANS: B, C RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.

7. A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.) a. Allopurinol (Zyloprim) - Acute gout b. Colchicine (Colcrys) - Acute gout c. Febuxostat (Uloric) - Chronic gout d. Indomethacin (Indocin) - Acute gout e. Probenecid (Benemid) - Chronic gout

ANS: B, C, D, E Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout.

4. The nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.) a. Anorexia b. Felty's syndrome c. Joint deformity d. Low-grade fever e. Weight loss

ANS: B, C, E Late manifestations of RA include Felty's syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease.

32. A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best? a. "A little sedation will help you get some rest." b. "Depression often accompanies fibromyalgia." c. "This drug works in the brain to decrease pain." d. "You will have more energy after taking this drug."

ANS: C Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate.

35. A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? a. "Be sure you get enough sleep at night." b. "Eat plenty of high-protein, high-iron foods." c. "Notify your provider at once if you get a fever." d. "Weigh yourself every day on the same scale."

ANS: C Fever is the classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if he or she develops an elevated temperature. Daily weights may or may not be important depending on renal involvement.

34. A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. "Let's ask the provider about increasing your pain pills." b. "Hold ice bags against your hands before quilting." c. "Try a paraffin wax dip 20 minutes before you quilt." d. "You need to stop quilting before it destroys your fingers."

ANS: C Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a "hot" or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints.

Which characteristic is associated with gel phenomenon? A. Bony ankylosis B. Fibrous adhesions C. Morning stiffness D. Secondary osteoporosis

ANS: C The gel phenomenon is characterized by frequent morning stiffness lasting 45 minutes to several hours after awakening. Complications such as bony ankylosis, fibrous adhesions, and secondary osteoporosis are associated with pannus formation.

1. The student nurse learns that the most important function of inflammation and immunity is which purpose? a. Destroying bacteria before damage occurs b. Preventing any entry of foreign material c. Providing protection against invading organisms d. Regulating the process of self-tolerance

ANS: C The purpose of inflammation and immunity is to provide protection to the body against invading organisms, whether they are bacterial, viral, protozoal, or fungal. These systems eliminate, destroy, or neutralize the offending agents. The cells of the immune system are the only cells that can distinguish self from non-self. This function is generalized and incorporates destroying bacteria, preventing entry of foreign invaders, and regulating self-tolerance.

Which biologic is approved for administration once a month for patients with rheumatoid arthritis and psoriatic arthritis? A. Infliximab B. Abatacept C. Etanercept D. Golimumab

ANS: D Golimumab is the biologic administered only once each month for patients with rheumatoid arthritis or psoriatic arthritis. A dosage of infliximab is repeated every 2nd and 6th week after the initial infusion. Abatacept requires IV infusions every 2 weeks. Etanercept is given subcutaneously twice weekly in most patients with rheumatoid arthritis.

Which condition is the consequence of pannus formation in a patient with rheumatoid arthritis? A. Vasculitis B. Pericarditis C. Paresthesias D. Bony ankylosis

ANS: D In rheumatoid arthritis patients, the synovium may thicken and become hyperemic, causing fluid accumulation in the joint space. This condition may lead to the formation of pannus. This pannus formation may erode articular cartilage and eventually destroy the bone. Therefore, as the destruction of the bone progresses, bony ankylosis may occur. Vasculitis is one of the systemic complications of rheumatoid arthritis. Pericarditis is one of the complications of rheumatoid arthritis that may occur in the later stages. Paresthesias may occur as a result of vasculitis in patients with rheumatoid arthritis. Vasculitis, pericarditis, and parestesias are not associated with pannus formation.

Which is a late manifestation of rheumatoid arthritis? A. Anorexia B. Paresthesias C. Joint inflammation D. Morning stiffness

ANS: D Late manifestations of rheumatoid arthritis include morning stiffness. Symptoms such as anorexia, paresthesias, and inflammation are early manifestations of rheumatoid arthritis.

Chronic rheumatoid arthritis (RA) can manifest as one of several associated syndromes. Which of the following is the most common in advanced RA? A. Paresthesias B. Felty's syndrome C. Caplan's syndrome D. Sjogren's syndrome

ANS: D Sjogren's syndrome is the most common syndrome associated with advanced RA. Symptoms include dry eyes, dry mouth, and dry vagina. Note the patient's report of dry mouth or dry eyes. Some patients state that their eyes feel "gritty," as if sand is in their eyes. Paresthesias are neurological manifestations of RA, and Felty's syndrome is associated with hepatosplenomegaly and leukopenia. Paresthesias may be seen in older adults with RA.

13. The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjögren's syndrome? a. Abdominal assessment b. Oxygen saturation c. Renal function studies d. Visual acuity

ANS: D Sjögren's syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjögren's syndrome.

8. The nurse working with clients who have autoimmune diseases understands that what component of cell-mediated immunity is the problem? a. CD4+ cells b. Cytotoxic T cells c. Natural killer cells d. Suppressor T cells

ANS: D Suppressor T cells help prevent hypersensitivity to one's own cells, which is the basis for autoimmune disease. CD4+ cells are also known as helper/inducer cells, which secrete cytokines. Natural killer cells have direct cytotoxic effects on some non-self cells without first being sensitized. Suppressor T cells have an inhibitory action on the immune system. Cytotoxic T cells are effective against self cells infected by parasites such as viruses or protozoa.

16. The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client taking celecoxib (Celebrex) and ranitidine (Zantac) b. Client taking etanercept (Enbrel) with a red injection site c. Client with a blood glucose of 190 mg/dL who is taking steroids d. Client with a fever and cough who is taking tofacitinib (Xeljanz)

ANS: D Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels.

Which antirheumatic drug acts by inhibiting tyrosine kinase? A. Infliximab B. Etanercept C. Abatacept D. Tofacitinib

ANS: D Tofacitinib is a tyrosine kinase inhibitor (TKI). Tyrosine kinases usually facilitate cytokine-mediated (e.g., interleukin) signals that promote the inflammatory process. Infliximab inhibits the tumor necrosis factor—alpha (TNFA). Etanercept also produces the desired effects in rheumatoid arthritis by inhibiting TNFA. Abatacept inhibits T-lymphocyte co-stimulator modulator.

12. A client has a possible connective tissue disease and the nurse is reviewing the client's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.) a. Elevated antinuclear antibody (ANA) - Normal value; no connective tissue disease b. Elevated sedimentation rate - Rheumatoid arthritis c. Lowered albumin - Indicative only of nutritional deficit d. Positive human leukocyte antigen B27 (HLA-B27) - Reiter's syndrome or ankylosing spondylitis e. Positive rheumatoid factor - Possible kidney disease

ANS: D, E The HLA-B27 is diagnostic for Reiter's syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia. An elevated ANA is indicative of inflammatory CTDs, although a small minority of healthy adults also have this finding. An elevated sedimentation rate indicates inflammation, whether from an infection, an injury, or an autoimmune CTD. Lowered albumin is seen in nutritional deficiencies but also in chronic infection or inflammation.