Rheumatic Diseases

Question 18 of 40 A nurse should advise a client with gout to avoid which foods? Organ meats and scallops Nuts and peanut butter Bread and cereal Fruits and juices

Correct response: Organ meats and scallops Explanation: An excessive intake of foods that are high in purines (shellfish, organ meats) may result in symptoms of gout in susceptible persons. A diet low in purine is recommended.

Question 33 of 40 Which condition is the leading cause of disability and pain in the elderly? Scleroderma Systemic lupus erythematous (SLE) Osteoarthritis (OA) Rheumatoid arthritis (RA)

Correct response: Osteoarthritis (OA) Explanation: OA is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly. Reference:

Question 29 of 40 A client with rheumatoid arthritis comes to the clinic reporting pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this client, what management technique should the nurse emphasize? Restrict weight-bearing on right foot. Restrict consumption of foods high in purines. Take OTC calcium supplements consistently. Ensure fluid intake of at least 4 L per day.

Correct response: Restrict consumption of foods high in purines. Explanation: Although severe dietary restriction is not necessary, the nurse should encourage the client to restrict consumption of foods high in purines, especially organ meats. Calcium supplementation is not necessary and activity should be maintained as tolerated. Increased fluid intake is beneficial, but it is not necessary for the client to consume more than 4 L daily.

Question 39 of 40 An older adult client has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this client's plan of care, which nursing diagnosis would most likely be appropriate? Self-care deficit related to fatigue and joint stiffness Anxiety related to chronic joint pain Risk for hopelessness related to body image disturbance Ineffective airway clearance related to chronic pain

Correct response: Self-care deficit related to fatigue and joint stiffness Explanation: Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.

Question 12 of 40 Nursing assessment findings reveal joint swelling and tenderness and a butterfly rash on the face. The nurse suspects which of the following? Systemic lupus erythematous Fibromyalgia Ankylosing spondylitis Scleroderma

Correct response: Systemic lupus erythematous Explanation: The butterfly rash is a unique skin manifestation of systemic lupus erythematous. Other clinical manifestations include joint swelling and tenderness, pain on movement, and morning stiffness. The disease can affect all body systems.

Question 2 of 40 A nurse is planning client education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect? Stomatitis Tinnitus Hirsutism Visual changes

Correct response: Visual changes Explanation: Antimalarials may cause visual changes; regular ophthalmologic examinations are necessary. Tinnitus is associated with salicylate therapy and hirsutism is associated with corticosteroid therapy. Antimalarials do not normally cause stomatitis.

Question 3 of 40 A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? furosemide colchicine calcium gluconate aspirin

Correct response: colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

Question 7 of 40 A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

Correct response: "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.

Question 8 of 40 The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client? small joint involvement asymmetric joint involvement obesity Bouchard's nodes

Correct response: small joint involvement Explanation: Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur over time. Obesity, Bouchard's nodes, and asymmetric joint involvement can be seen with the early stage of the disease.

Question 22 of 40 Place an "X on the figure where the nurse would expect to find the butterfly rash associated with systemic lupus erythematosus

The most common skin manifestation in patients with systemic lupus erythematosus is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks.

Question 37 of 40 A client comes to the clinic and reports pain in the right great toe which is worse at night. Assessment reveals tophi. What does the nurse suspect? rheumatoid arthritis gouty arthritis reactive arthritis osteoarthritis

Correct response: gouty arthritis Explanation: Gout results from the inability to metabolize purines. This condition is most commonly seen in men and usually affects the legs, feet, and knees. Osteoarthritis is caused by degeneration of the joints. Rheumatoid arthritis is a systemic disorder more common in women of childbearing age. Reactive arthritis is seen with infections and is most common in young adult males.

Question 15 of 40 The nursing assessment findings reveal joint swelling and tenderness in the great toe of a client. What does the nurse suspect? ankylosing spondylitis rheumatoid arthritis osteoarthritis gout

Correct response: gout Explanation: Joint swelling and tenderness of the great toe and tophi are classic manifestations of gout. Clients with ankylosing spondylitis have pain and stiffness in the back. Clients with osteoarthritis have general joint swelling and tenderness. Clients with rheumatoid arthritis have joint swelling; pain in the back, joints, and muscles; tenderness; and multiple other symptoms

Question 28 of 40 A client with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on a medical unit. The nurse observes that the client expresses anger and irritation when the call bell isn't answered immediately. Which response would be the most appropriate? "You seem like you're feeling angry. Is that something that we could talk about?" "Would you like to talk about the problem with the nursing supervisor?" "Try to remember that stress can make your symptoms worse." "I can see you're angry. I'll come back when you've calmed down."

Correct response: "You seem like you're feeling angry. Is that something that we could talk about?" Explanation: The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care, as well as sensitivity to the psychological reactions of the client. Offering to listen to the client express anger can help the nurse and the client understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the client to calm down doesn't acknowledge the client's feelings. Ignoring the client's feelings suggests that the nurse has no interest in what the client has said. Offering to get the nursing supervisor also does not acknowledge the client's feelings.

Question 9 of 40 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? Diffuse purplish lesions on the trunk Butterfly-shaped rash on the face over the bridge of the nose and cheeks Fluid-filled vesicles clustered on the cheeks, chin, and forehead Pustules scattered on the chest and back

Correct response: Butterfly-shaped rash on the face over the bridge of the nose and cheeks Explanation: A prominent sign for about half of the clients with SLE is a red, butterfly-shaped rash known as malar rash, on the face over the bridge of the nose and the cheeks. The word lupus means "wolf." The term may have been used as a description for the facial rash that, to some, resembled the mask of reddish-brown fur on a wolf. The other choices are not routinely seen with SLE.

Question 34 of 40 The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process? Infection Gout Inflammation Degeneration

Correct response: Gout Explanation: The presence of crystals is indicative of gout; the presence of bacteria is indicative of infective arthritis.

Question 4 of 40 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: promote diuresis. combat inflammation. prevent infection. prevent platelet aggregation.

Correct response: combat inflammation. Explanation: Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis.

Question 23 of 40 A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? eliminating deformities minimizing damage promoting sleep eradicating pain

Correct response: minimizing damage Explanation: Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results.

Question 19 of 40 The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? "My medications will ultimately correct my problem." "I should avoid prolonged sun exposure." "I do not need to make any changes in my diet." "My energy level will gradually increase over time."

Correct response: "I should avoid prolonged sun exposure." Explanation: Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression.

Question 17 of 40 Which is the leading cause of disability and pain in the elderly? Systemic lupus erythematosus (SLE) Scleroderma Osteoarthritis (OA) Rheumatoid arthritis (RA)

Correct response: Osteoarthritis (OA) Explanation: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

Question 21 of 40 Primary gout is often caused by an inherited disorder in which type of metabolism? Purine Fat Carbohydrate Glucose

Correct response: Purine Explanation: Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism.

Question 6 of 40 A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? Arterial occlusive diseases Raynaud's disease Buerger's disease Peripheral vascular disease

Correct response: Raynaud's disease Explanation: Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.

Question 30 of 40 The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis? Creatinine Red blood cell count ESR Uric acid

Correct response: Red blood cell count Explanation: Clients diagnosed with rheumatic diseases have a decreased red blood cell count. ESR is increased in inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.

Question 1 of 40 A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will increase uric acid levels and reduce stress on joints. Weight loss will reduce inflammation. Weight loss will reduce purine levels.

Correct response: Weight loss will reduce uric acid levels and reduce stress on joints. Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.

Question 31 of 40 A nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach the about for osteoarthritis? administration of monthly intra-articular injections of corticosteroids. administration of nonsteroidal anti-inflammatory drugs (NSAIDs) vigorous physical therapy for the joints. administration of opioids for pain control.

Correct response: administration of nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

Question 13 of 40 A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about? ankylosing spondylitis osteoarthritis of the shoulder a fracture of the clavicle bursitis

Correct response: bursitis Explanation: A bursa is a small sac filled with synovial fluid. Bursae reduce friction between areas, such as tendon and bone and tendon and ligament. Inflammation of these sacs is called bursitis. A fracture of the clavicle is a bone break. Osteoarthritis is an inflammatory disease. Ankylosing spondylitis is a form of arthritis affecting the spine.

Question 26 of 40 A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? methotrexate celecoxib sulfasalazine ibuprofen

Correct response: celecoxib Explanation: The cyclooxygenase-2 inhibitors, such as celecoxib, have been shown to inhibit inflammatory processes but do not inhibit the protective prostaglandin synthesis in the gastrointestinal (GI) tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with celecoxib. Ibuprofen, methotrexate, and sulfasalazine may cause GI irritation.

Question 5 of 40 The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? prednisone colchicine penicillamine methotrexate

Correct response: colchicine Explanation: Colchicine is prescribed for the treatment of an acute attack of gout.

The nurse teaches the client that osteoarthritis requires early treatment because most of the damage appears to occur early in the course of the disease. affects young males. is the most common and frequently disabling of joint disorders. affects the cartilaginous joints of the spine and surrounding tissues.

Correct response: is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues and is usually diagnosed in the second or third decade of life.

Question 38 of 40 Osteoarthritis is known as a disease that affects the cartilaginous joints of the spine and surrounding tissues. requires early treatment because most of the damage seems to occur early in the course of the disease. is the most common and frequently disabling of joint disorders. affects young males.

Correct response: is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.

Question 36 of 40 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?

Correct response: 50 Explanation: The client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose.

Question 25 of 40 What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? Assess diet and activity at home Place client on bed rest Insert a Foley catheter Increase fluids

Correct response: Assess diet and activity at home Explanation: Clients with gout need to be educated about dietary restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a client with this problem.

Question 14 of 40 A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included? This medication is commonly used for many inflammatory reactions and is relatively safe. The client should be alert for joint aches. Be alert for signs and symptoms of infection and report them immediately to the physician. If the client experiences nausea, omit the dose.

Correct response: Be alert for signs and symptoms of infection and report them immediately to the physician. Explanation: Instruct the client about signs and symptoms of and the increased risk for infection. Instruct the client to report signs and symptoms of infection immediately to the physician. Early treatment promotes a shorter duration of illness and reduced complication. Tell the client to avoid high-risk activities, such as being in crowds, during periods of immunosuppression. The client should not omit a dose if nausea is experienced; he may take the medication with food. There are many side effects and required laboratory work to detect the side effects from immunosuppressive therapy. Joint aches are vague symptoms and are not a priority for reporting purposes.

Question 20 of 40 A client with systemic lupus erythematosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term should the nurse use to describe this characteristic pattern? Papular rash Butterfly rash Bull's eye rash Pustular rash

Correct response: Butterfly rash Explanation: In the classic lupus rash, lesions appear on the cheeks and the bridge of the nose, creating a characteristic butterfly pattern. The rash may vary in severity from malar erythema to discoid lesions (plaque). Papular and pustular rashes aren't associated with SLE. The bull's eye rash is classic in client's with Lyme disease.

Question 24 of 40 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 white blood count Increased AST and ALT Elevated uric acid levels Decreased hemoglobin and hematocrit

Correct response: Elevated uric acid levels Explanation: Gout is characterized by hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. An elevated white blood count may be indicative of any inflammatory response and is not specific to gout. A decreased hemoglobin and hematocrit may indicate bleeding from somewhere in the body. Increased AST and ALT would indicate liver dysfunction.

Question 16 of 40 A client arrives at the clinic with reports of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What disorder will the nurse relate the client symptoms to? Osteoarthritis Gout Fibromyalgia Rheumatoid arthritis

Correct response: Gout Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of patients) in gout. The abrupt onset often occurs at night, awakening the patient with severe pain, redness, swelling, and warmth of the affected joint. Clients with osteoarthritis and rheumatoid arthritis will have joint swelling and tenderness in the hands, knees and spine. Clients with fibromyalgia will have chronic fatigue, generalized muscle aching, stiffness, sleep disturbances, and functional impairment.

Question 11 of 40 The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports ability to perform ADLs Reports decreased joint pain Has a weight gain of 5 pounds Shows increased joint flexibility

Correct response: Has a weight gain of 5 pounds Explanation: Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.

Question 32 of 40 A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? Tophi Bouchard nodes Heberden nodes Rheumatoid nodules

Correct response: Heberden nodes Explanation: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden nodes are bony enlargement of the distal interphalangeal joints. Bouchard nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels

Question 10 of 40 Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? Behavioral changes Hypertension Chest pain Decreased cognitive ability

Correct response: Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

Question 40 of 40 Which joint is most commonly affected in gout? Tarsal area Ankle Knee Metatarsophalangeal

Correct response: Metatarsophalangeal Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

Question 35 of 40 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? purine-rich foods carbohydrates fluid intake protein-rich foods

Correct response: purine-rich foods Explanation: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.