Deck 65: Nursing Management: Arthritis and Conncective Tissue Diseases

Question 1

A patient with OA asks the nurse whether he could try glucosamine and chondroitin for control of his symptoms.The best response by the nurse includes what information?

A) Some patients find these supplements helpful for relieving arthritis pain and improving mobility.
B) Although these substances may not help, there is no evidence that they can cause any untoward effects.
C) These supplements are a fad that has not been shown to reduce pain or increase joint mobility in patients with OA.
D) Only dosages of these supplements available by prescription are high enough to provide any benefit in treatment of OA.

Answer 1

A. Some relief for moderate to severe arthritic pain but not for mild arthritic pain has been observed with the use of over-the-counter glucosamine and chondroitin sulfate. These substances should be discontinued if there are no effects after consistent use over 90 to 120 days. They may decrease the effectiveness of antidiabetic drugs and increase the risk of bleeding.

Question 2

A patient with gout is treated with drug therapy to prevent future attacks.The nurse teaches the patient that what is most important for the patient to do?

A) Avoid all foods high in purine, such as organ meats.
B) Have periodic determination of serum uric acid levels.
C) Increase the dosage of medication with the onset of an acute attack.
D) Perform active range of motion (ROM) of all joints that have been affected by gout.

Answer 2

B. During therapy with probenecid or allopurinol, the patient must have periodic determination of serum uric acid levels to evaluate the effectiveness of the therapy and to ensure that levels are kept low enough to prevent future attacks of gout. With the use of medications, strict dietary restrictions on alcohol and high-purine foods are usually not necessary. When the patient is taking probenecid, urine output should be maintained at 2 to 3 L per day to prevent urate from precipitating in the urinary tract and causing kidney stones. Patients should not alter their doses of medications without medical direction and the drugs used for control of gout are not useful in the treatment of an acute attack. Joint immobilization is used for an acute attack of gout

Question 3

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
How should the nurse explain the pathophysiology of rheumatoid arthritis to N.M.?

Answer 3

N.M. needs to know that it is not known what causes RA but that in a genetically susceptible person autoantibodies, or RF, are formed that react with substances causing inflammation and damage to a variety of organs. Inflammation and fibrosis of the joint capsule and supporting structures may lead to complete immobilization of the joint and cause deformities similar to those she is developing in her hands. She should be told that RA is a disease that affects her whole body, even though her joints are primarily affected at this time. She should be told that the fatigue and low-grade fever she has are part of the disease and that with disease control these symptoms will improve.

Question 4

A patient taking ibuprofen (Motrin) for treatment of OA has good pain relief but is experiencing increased dyspepsia and nausea with the drug's use.The nurse consults the patient's primary care provider about doing what?

A) Adding misoprostol (Cytotec) to the patient's drug regimen
B) Substituting naproxen (Naprosyn) for the ibuprofen (Motrin)
C) Returning to the use of acetaminophen but at a dose of 5 g/day instead of 4 g/day
D) Administering the ibuprofen with antacids to decrease the gastrointestinal (GI) irritation

Question 5

What characteristics are common in spondyloarthritides associated with human leukocyte antigen (HLA)-B27?

A) Symmetric polyarticular arthritis
B) Absence of extraarticular disease
C) Presence of rheumatoid factor and autoantibodies
D) High level of involvement of sacroiliac joints and the axial skeleton

Question 6

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
What manifestations does N.M.have that suggest the diagnosis of RA?

Question 7

Which description is most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)?

A) Not systemic or symmetric
B) Rheumatoid factor (RF) positive
C) Most commonly occurs in women
D) Morning joint stiffness lasts one to several hours

Question 8

An important nursing intervention for the patient with ankylosing spondylitis is to teach the patient to do what?

A) Wear roomy shoes with good orthotic support.
B) Sleep on the side with the knees and hips flexed.
C) Keep the spine slightly flexed while sitting, standing, or walking.
D) Perform back, neck, and chest stretches and deep-breathing exercises.

Question 9

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
What diagnostic studies will confirm the diagnosis of RA?

Question 10

What best describes the manifestations of OA?

A) Smaller joints are typically affected first.
B) There is joint stiffness after periods of inactivity.
C) Joint stiffness is accompanied by fatigue, anorexia, and weight loss.
D) Pain and immobility may be aggravated by falling barometric pressure.

Question 11

Which descriptions are related to reactive arthritis (select all that apply)?

A) Methotrexate is a treatment of choice
B) Symptoms include urethritis and conjunctivitis
C) Diagnosed by finding of hypersensitive tender points
D) Increased risk in persons with decreased host resistance
E) Infection of a joint often caused by hematogenous route
F) Self-limiting arthritis following GI (enteral) or sexually transmitted infections

Question 12

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
What results may be expected from methotrexate therapy? What are the nursing responsibilities related to methotrexate therapy?

Question 13

During the physical assessment of the patient with early to moderate RA, what should the nurse expect to find?

A) Hepatomegaly
B) Heberden's nodes
C) Spindle-shaped fingers
D) Crepitus on joint movement

Question 14

What is the pathophysiology of systemic lupus erythematosus (SLE) characterized by?

A) Destruction of nucleic acids and other self-proteins by autoantibodies
B) Overproduction of collagen that disrupts the functioning of internal organs
C) Formation of abnormal IgG that attaches to cellular antigens, activating complement
D) Increased activity of T suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency

Question 15

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
What are some suggestions that may be offered to N.M.concerning home management and joint protection?

Question 16

Laboratory findings that the nurse would expect to be present in the patient with RA include

A) polycythemia.
B) increased immunoglobulin G (IgG).
C) decreased white blood cell (WBC) count.
D) anti-citrullinated protein antibody (ACPA).

Question 17

What is an ominous sign of advanced SLE disease?

A) Proteinuria from early glomerulonephritis
B) Anemia from antibodies against blood cells
C) Dysrhythmias from fibrosis of the atrioventricular node
D) Cognitive dysfunction from immune complex deposit in the brain

Question 18

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
How can the nurse help N.M.to recognize ineffective, unproven methods of treatment?

Question 19

Which other extraarticular manifestation of RA is most likely to be seen in the patient with rheumatoid nodules?

A) Lyme disease
B) Felty syndrome
C) Sjögren's syndrome
D) Spondyloarthropathies

Question 20

A patient with newly diagnosed SLE asks the nurse how the disease will affect her life.What is the best response the nurse can give the patient?

A) "You can plan to have a near-normal life since SLE rarely causes death."
B) "It is difficult to tell because the disease is so variable in its severity and progression."
C) "Life span is shortened somewhat in people with SLE but the disease can be controlled with long-term use of corticosteroids."
D) "Most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage."

Question 21

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
What other sources of information regarding arthritis might the nurse suggest to N.M.?

Question 22

Which drug that prevents binding of the tumor necrosis factor and inhibits the inflammatory response is used in the management of RA?

A) Anakinra (Kineret)
B) Entanercept (Enbrel)
C) Leflunomide (Arava)
D) Azathioprine (Imuran)

Question 23

During an acute exacerbation, a patient with SLE is treated with corticosteroids.The nurse would expect the corticosteroids to begin to be tapered when which serum laboratory results are evident?

A) Decreased anti-DNA
B) Increased complement
C) Increased red blood cells (RBCs)
D) Decreased erythrocyte sedimentation rate (ESR)

Question 24

CASE STUDY: Rheumatoid Arthritis Patient Profile N.M. is a 36-year-old overweight white woman who has RA. When her symptoms began to interfere with her daily activities, she sought medical help. Subjective Data
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports an intermittent low-grade fever
• Takes naproxen (Aleve) 220 mg twice daily
• Wears a copper bracelet on the advice of a neighbor Objective Data
• Hands show mild ulnar drift and puffiness
• Temp: 100°F (37.8°C)
• Admitted to the hospital for examination and comprehensive treatment plan
• Methotrexate (Rheumatrex) therapy
Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems? 66 Nursing Management: Critical Care

Question 25

The patient has had RA for some time but has not had success with previous medications.Although there is an increased risk for tuberculosis, which monoclonal antibody is used with methotrexate to best treat symptoms?

A) Parenteral gold
B) Certolizumab (Cimzia)
C) Tocilizumab (Actemra)
D) Hydroxychloroquine (Paquenil)

Question 26

What should the nurse include in the teaching plan for the patient with SLE?

A) Ways to avoid exposure to sunlight
B) Increasing dietary protein and carbohydrate intake
C) The necessity of genetic counseling before planning a family
D) The use of nonpharmacologic pain interventions instead of analgesics

Question 27

A 70-year-old patient is being evaluated for symptoms of RA.The nurse recognizes what as the major problem in the management of RA in the older adult?

A) RA is usually more severe in older adults.
B) Older patients are not as likely to comply with treatment regimens.
C) Drug interactions and toxicity are more likely to occur with multidrug therapy.
D) Laboratory and other diagnostic tests are not effective in identifying RA in older adults.

Question 28

During assessment of the patient with scleroderma, what should the nurse expect to find?

A) Thickening of the skin of the fingers and hands
B) Cool, cyanotic fingers with thinning skin over the joints
C) Swan neck deformity or ulnar drift deformity of the hands
D) Low back pain, stiffness, and limitation of spine movement

Question 29

After teaching a patient with RA about the prescribed therapeutic regimen, the nurse determines that further instruction is needed when the patient says what?

A) "It is important for me to perform my prescribed exercises every day."
B) "I should perform most of my daily chores in the morning when my energy level is highest."
C) "An ice pack to a joint for 10 minutes may help to relieve pain and inflammation when I have an acute flare."
D) "I can use assistive devices such as padded utensils, electric can openers, and elevated toilet seats to protect my joints."

Question 30

When caring for the patient with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) associated with scleroderma, what should the nurse teach the patient to do?

A) Maintain a fluid intake of at least 3000 mL/day.
B) Avoid exposure to the sun or other ultraviolet light.
C) Monitor and keep a log of daily blood pressure (BP).
D) Protect the hands and feet from cold exposure and injury.

Question 31

A patient recovering from an acute exacerbation of RA tells the nurse that she is too tired to bathe.What should the nurse do for this patient?

A) Give the patient a bed bath to conserve her energy.
B) Allow the patient a rest period before showering with the nurse's help.
C) Tell the patient that she can skip bathing if she will walk in the hall later.
D) Inform the patient that it is important for her to maintain self-care activities.

Question 32

During the acute phase of dermatomyositis, what is an appropriate patient outcome?

A) Relates improvement in pain
B) Does not experience aspiration
C) Performs active ROM four times daily
D) Maintains absolute rest of affected joints

Question 33

A 60-year-old woman has pain on motion in her fingers and asks the nurse whether this is just a result of aging.The best response by the nurse should include what information?

A) Joint pain with functional limitation is a normal change that affects all people to some extent.
B) Joint pain that develops with age is usually related to previous trauma or infection of the joints.
C) This is a symptom of a systemic arthritis that eventually affects all joints as the disease progresses.
D) Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age.

Question 34

After teaching a patient with RA to use heat and cold therapy to relieve symptoms, the nurse determines that teaching has been effective when what is said by the patient?

A) "Heat treatments should not be used if muscle spasms are present."
B) "Cold applications can be applied for 15 to 20 minutes to relieve joint stiffness."
C) "I should use heat applications for 20 minutes to relieve the symptoms of an acute flare."
D) "When my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relieve the pain."

Question 35

During assessment of the patient diagnosed with fibromyalgia, what should the nurse expect the patient to report?

A) Generalized muscle twitching and spasms
B) Nonrestorative sleep with resulting fatigue
C) Profound and progressive muscle weakness that limits ADLs
D) Widespread musculoskeletal pain that is accompanied by inflammation and fever

Question 36

Number in sequence from 1 to 6 the pathophysiologic processes that occur in osteoarthritis (OA).
a. Erosion of articular surfaces
________
b. Incongruity in joint surfaces
________
c. Reduction in motion
________
d. Joint cartilage becomes yellow and granular
________
e. Osteophytes form at joint margins
________
f. Cartilage becomes softer and less elastic_______

Question 37

The nurse teaches the patient with RA that which exercise is one of the most effective methods of aerobic exercise?

A) Ballet dancing
B) Casual walking
C) Aquatic exercises
D) Low-impact aerobic exercises

Question 38

What is one criterion identified by the American College of Rheumatology for a diagnosis of fibromyalgia?

A) Fiber atrophy found on muscle biopsy
B) Elimination of all other causes of musculoskeletal pain
C) The presence of the manifestations of chronic fatigue syndrome
D) The elicitation of pain on palpation of at least 11 of 18 identified tender points

Question 39

What is most likely to cause the pain experienced in the later stages of OA?

A) Crepitation
B) Bouchard's nodes
C) Heberden's nodes
D) Bone surfaces rubbing together

Question 40

A patient is seen at the outpatient clinic for a sudden onset of inflammation and severe pain in the great toe.A definitive diagnosis of gouty arthritis is made on the basis of what?

A) A family history of gout
B) Elevated urine uric acid levels
C) Elevated serum uric acid levels
D) Presence of monosodium urate crystals in synovial fluid

Question 41

One important nursing intervention for the patient with fibromyalgia is to teach the patient to do what?

A) Rest the muscles as much as possible to avoid triggering pain.
B) Plan nighttime sleep and naps to obtain 12 to 14 hours of sleep a day.
C) Try the use of food supplements such as glucosamine and chondroitin for relief of pain.
D) Use stress management techniques such as biofeedback, meditation, or cognitive behavioral therapy

Question 42

To preserve function and the ability to perform activities of daily living (ADLs), what should the nurse teach the patient with OA?

A) Avoid exercise that involves the affected joints.
B) Plan and organize task performance to be less stressful to joints.
C) Maintain normal activities during an acute episode to prevent loss of function.
D) Use mild analgesics to control symptoms when performing tasks that cause pain.

Question 43

During treatment of the patient with an acute attack of gout, the nurse would expect to administer which drug?

A) Aspirin
B) Colchicine
C) Allopurinol (Zyloprim)
D) Probenecid (Benemid)

Question 44

A patient with debilitating fatigue has been diagnosed with chronic fatigue syndrome.Which criteria are considered the four major criteria that must be present for this diagnosis to be made (select all that apply)?

A) Unexplained muscle pain
B) Fatigue not due to ongoing exertion
C) Tender cervical or axillary lymph nodes
D) Fatigue not substantially alleviated by rest
E) Headaches of a new type, pattern, or severity
F) Unexplained, persistent, or relapsing chronic fatigue of new and definite onset
G) Fatigue resulting in substantial reduction in occupational, educational, social, or personal activities