Rheumatic Disorders (RA, SLE, Gout, Fibromyalgia etc.)

The nurse is performing an assessment on a female client who complains of fatigue, weakness, muscle and joint pain, anorexia, and photosensitivity. Systemic lupus erythematosus (SLE) is suspected. What should the nurse further assess for that also is indicative of SLE? 1. Ascites 2. Emboli 3. Facial rash 4. Two hemoglobin S genes

Facial rash A butterfly rash on the cheeks and bridge of the nose is an essential sign of SLE

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment? Joint pain, crepitus, Heberden's nodes Tophi, enlarged joints, Bouchard's nodes Hot, inflamed joints; crepitus; joint pain Swelling, joint pain, and tenderness on palpation

Joint pain, crepitus, Heberden's nodes

Which client is most likely to develop systemic lupus erythematosus (SLE)? A 27-year-old Black female A 25-year-old White male A 35-year-old Hispanic male A 25-year-old Jewish female

A 27-year-old Black female

The nurse is caring for a client with hypertension and scleroderma. Which medication will the nurse expect to be prescribed for this client? Angiotensin-converting enzyme inhibitors Vasodilator Diuretic Beta blocker

Angiotensin-converting enzyme inhibitors Treatment of scleroderma is mainly symptomatic and supportive. No medication regimen is effective in modifying the disease process in scleroderma, but various medications are used to treat organ system involvement. The use of angiotensin-converting enzyme inhibitors when there is kidney involvement has led to a substantial decrease in mortality from hypertensive kidney disease.

The nurse is reviewing medications prescribed for a client with rheumatoid arthritis. Which medications will the nurse expect to be prescribed for this client? Select all that apply. Heparin sodium Morphine sulfate Ibuprofen Aspirin Methotrexate

Aspirin Ibuprofen Methotrexate Medications are used with the rheumatic diseases to manage symptoms, to control inflammation, and, in some instances, to modify the disease. Medications used include the salicylates, NSAIDs, and DMARDs.

Which finding is consistent with the diagnosis of rheumatoid arthritis?

Cloudy synovial fluid

A client with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. Which teaching will the nurse include for this client? High-protein diet Smoking cessation Exercise Vitamin D supplements

Smoking cessation smoking inhibits the effectiveness of hydroxychloroquine

The nurse is preparing to assess a client experiencing symptoms of gout. Which findings indicate to the nurse that the client is experiencing gout syndrome? Select all that apply. Lack of hair over the lower extremities Uric acid urinary calculi Tophi Lower extremity wounds Severe articular inflammation

Tophi Uric acid urinary calculi Severe articular inflammation

A test for the presence of rheumatoid factor is performed in a client with a diagnosis of rheumatoid arthritis (RA). What result should the nurse anticipate in the presence of this disease? 1.Neutropenia 2.Hyperglycemia 3.Antigens of immunoglobulin A (IgA) 4.Unusual antibodies of the IgG and IgM type

Unusual antibodies of the IgG and IgM type he test for rheumatoid factor detects the presence of unusual antibodies of the IgG and IgM type, which develop in a number of connective tissue diseases.

A client has been living with rheumatoid arthritis (RA) for several years. Which diagnostic test will the nurse prepare the client for to determine the progression of the disease? CT scan MRI X-ray Ultrasound

X-ray

The nurse is providing medication teaching to a client with rheumatoid disease. What common actions are seen with diclofenac and aspirin? Select all that apply. anti-inflammatory antipyretic analgesic antiplatelet antispasmodic

anti-inflammatory analgesic antipyretic antiplatelet

A client is suspected of having CREST syndrome and is seeking medical attention. Which criterion is among those used to diagnose this client? Esophageal dysmobility Reduction in voice volume Change in liver enzyme values Elevated white blood cell count

Esophageal dysmobility Generally, the patient is diagnosed with the CREST type of scleroderma if they have four of the five symptoms in the syndrome, which include esophageal dysmobility, calcinosis (calcium deposits in the tissues), Raynaud's phenomenon, sclerodactyly (scleroderma of the digits), and telangiectasia (capillary dilation that forms a vascular lesion)

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?

celecoxib

The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? 1."I should take hot baths because they are relaxing." 2."I should sit whenever possible to conserve my energy." 3."I should avoid long periods of rest because it causes joint stiffness." 4."I should do some exercises, such as walking, when I am not fatigued."

"I should take hot baths because they are relaxing. To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.

The nurse is completing the physical assessment of a client with systemic lupus erythematosus (SLE). Which finding will the nurse recognize is most likely to indicate that the client is experiencing a change to the cardiovascular system because of the condition? Pericardial friction rub Bounding peripheral pulses Peripheral edema Jugular vein distention

Pericardial friction rub the cardiac system is also commonly affected in SLE. Auscultating a pericardial friction rub would indicate myocarditis

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

Uric acid level of 9.0 mg/dL (540 mcmol/L) In addition to the presence of clinical manifestations, gout is diagnosed by the presence of persistent hyperuricemia, with a uric acid level higher than 8 mg/dL

The nurse is performing a health history with a new client with fibromyalgia. What will the nurse expect to assess as the most common finding associated with fibromyalgia? widespread chronic pain jaw locking Heberden nodes butterfly facial rash

widespread chronic pain

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? Joint enlargement Joint instability Limb shortening Limited passive movement

Limited passive movement

A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis? Evidence of healed fractures on MRI Atherosclerotic plaques on an arteriogram Boney erosions on x-ray Reduced muscle mass on CT scan

Boney erosions on x-ray

A complete blood cell count is performed on a client with systemic lupus erythematosus (SLE). The nurse suspects that which finding will be reported with this blood test?

Decreased numbers of all cell types In the client with SLE, a complete blood cell count commonly shows pancytopenia, a decrease in all cell types. This probably is caused by a direct attack on all blood cells or bone marrow by immune complexes.

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide?

Drink 3000 mL of fluid a day. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day, unless otherwise contraindicated. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk

A client is experiencing symptoms of rheumatoid arthritis. Which laboratory tests will the nurse expect to be prescribed for this client? Select all that apply. Hematocrit Rheumatoid factor Antinuclear antibody Erythrocyte count Creatinine

Erythrocyte count Rheumatoid factor Antinuclear antibody erythrocyte count may be decreased in rheumatoid arthritis. Rheumatoid factor is present in 80% of those with rheumatoid arthritis. A positive antinuclear antibody test may be associated with rheumatoid arthritis.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? Wear worn, comfortable shoes. Get help when lifting objects. Wear protective devices when exercising. Install safety devices in the home.

Install safety devices in the home.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?

Kidney disease

The nurse reviews information collected during a health history with a client. Which information will the nurse identify that increases the client's risk of developing gout? Select all that apply. Body mass index 38 Male gender Works as a computer programmer Ingests 4 cans of beer a day Older adulthood

Older adulthood Male gender Body mass index 38 Ingests 4 cans of beer a day the incidence of gout increases with age and men are 3 to 4 times more likely to be diagnosed with gout than women. The incidence also increases with body mass index and alcohol consumption

The nurse is assessing a client with rheumatoid arthritis. The nurse knows that prolonged inflammation can cause compression of nerves. Which symptoms would accompany this level of involvement? Paresthesias of both hands Crepitus when moving major joints Limited motion in the wrists Restricted movement in tendons

Paresthesias of both hands

The nurse is reviewing laboratory values for a client experiencing symptoms of systemic lupus erythematosus (SLE). Which findings indicate to the nurse that the client's symptoms are consistent with this condition? Select all that apply. Reduced level of serum glucose Elevated level of red blood cells Positive anti-DNA antibody Elevated troponin level Positive antinuclear antibody

Positive anti-DNA antibody Positive antinuclear antibody

The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. What should the nurse include in the teaching plan? Take all antibiotics until they are gone. Protect the hands and feet from cold. Perform weight-bearing exercises daily. Avoid sunlight and ultraviolet light.

Protect the hands and feet from cold. Raynaud's phenomenon is associated with scleroderma. Client teaching must include strategies for protecting the feet and hands

The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action? Restricting fluids Maintaining bed rest Eating a low-purine diet Taking nonsteroidal anti-inflammatory drugs

Restricting fluids Ample fluid intake is encouraged to promote the excretion of uric acid. The client is placed on bed rest during an acute attack until the pain subsides. A diet low in purine normally is prescribed. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and inflammation. Colchicine, which also may be prescribed, reduces the migration of leukocytes to the synovial fluid

A client is suspected of having systemic lupus erythematosus (SLE). On reviewing the client's record, the nurse should expect to note documentation of which characteristic sign of SLE? 1.Fever 2.Fatigue 3.Skin lesions 4.Elevated red blood cell count

Skin lesions The major skin manifestation of SLE is a dry, scaly, raised rash on the face known as the butterfly rash. Fever and fatigue may occur before and during exacerbation, but these signs and symptoms are vague. Anemia is most likely to occur in SLE.

A client with rheumatoid arthritis is concerned because the appearance of the hands is changing. Which hand deformities will the nurse expect to assess in this client? Select all that apply. Bouchard's nodes Swan neck Enlarged knuckles Ulnar deviation Heberden's nodes

Swan neck Ulnar deviation

A client with rheumatoid arthritis (RA) is being evaluated for medication therapy. Which testing will the nurse anticipate the client will need before medications are started? Select all that apply. Testing for hepatitis C Testing for hepatitis B Serum electrolytes Liver function tests Tuberculin skin test

Testing for hepatitis C Testing for hepatitis B Liver function tests Tuberculin skin test

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns? Tricyclic antidepressants Administering opioids at bed time Increasing activity during the day Range-of-motion exercise before sleeping

Tricyclic antidepressants Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in clients with fibromyalgia

The nurse is reviewing the health care record of a client with a new diagnosis of rheumatoid arthritis (RA). The nurse should recognize that which are early clinical manifestations of this disorder? Select all that apply. 1.Fatigue 2.Anorexia 3.High fever 4.Weight loss 5.Generalized weakness

1.Fatigue 2.Anorexia 3.Generalized weakness Early manifestations of RA include fatigue, anorexia, generalized weakness, low-grade fever, and paresthesias. Weight loss is one of the late manifestations.

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply. Tingling in the arms Nausea and vomiting Increase in pain in the affected extremity Intestinal cramping Diarrhea

Diarrhea Intestinal cramping Nausea and vomiting

A client is diagnosed with scleroderma. Which intervention should the nurse anticipate to be prescribed? 1.Maintain bed rest as much as possible. 2.Administer corticosteroids as prescribed for inflammation. 3.Advise the client to remain supine for 1 to 2 hours after meals. 4.Keep the room temperature warm during the day and cool at night.

Scleroderma is a chronic connective tissue disease similar to systemic lupus erythematosus. Corticosteroids may be prescribed to treat inflammation.

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply 1.Control of symptoms during periods of emotional stress 2.Normal white blood cell, platelet, and neutrophil counts 3.Radiological findings that show no progression of joint degeneration 4.An increased range of motion in the affected joints 3 months into therapy 5.Inflammation and irritation at the injection site 3 days after the injection is given 6.A low-grade temperature on rising in the morning that remains throughout the day

1.Control of symptoms during periods of emotional stress 2.Normal white blood cell, platelet, and neutrophil counts 3.Radiological findings that show no progression of joint degeneration 4.An increased range of motion in the affected joints 3 months into therapy

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) Dysphagia owing to hardening of the esophagus Decreased ventilation owing to lung scarring Productive cough Butterfly-shaped rash on the face Dyspnea owing to fibrotic cardiac tissue

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

A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease? Auscultate the client's lung sounds. Review the client's medical record. Observe the client's gait. Inspect the client's mouth.

Review the client's medical record.

A client with Sjogren's syndrome is experiencing xerostomia. Which information will the nurse provide to help alleviate this client's problem? Select all that apply. Limit the intake of alcohol Omit spicy and salty foods Use antiseptic mouthwash twice a day Eat small frequent meals Avoid smoking

Avoid smoking Eat small frequent meals Omit spicy and salty foods Limit the intake of alcohol