Chapter 43: Connective Tissue Disorders Nursing School Test Banks

Chapter 43: Connective Tissue Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A 51-year-old professional tennis instructor is newly diagnosed with osteoarthritis. What is the nurses best explanation to the patient when asked what this diagnosis means?
a. Presence of antibodies in the synovial fluid
b. Dislocation of the patella over the tibia
c. Degeneration of articular cartilage
d. Bodys autoimmune response
ANS: C
Degeneration of articular cartilage is one of the pathophysiologic changes of arthritis.

DIF: Cognitive Level: Knowledge REF: p. 950 OBJ: 6
TOP: Osteoarthritis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A nurse explains to a patient with rheumatoid arthritis that the drug leflunomide (Arava) is a disease-modifying antirheumatic drug (DMARD). What is the action of this medication?
a. Retards the progress of the disease
b. Builds new bone
c. Decreases inflammation
d. Increases flexibility
ANS: A
Arava is a DMARD and slows the progression of the disease.

DIF: Cognitive Level: Knowledge REF: p. 958 OBJ: 5
TOP: DMARDs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. A patient with osteoarthritis in both knees and shoulders states that she cannot manage her household tasks without pain. Which is the most appropriate nursing diagnosis for this patient?
a. Ineffective coping, related to pain
b. Risk for disuse syndrome
c. Impaired physical mobility, related to pain
d. Activity intolerance, related to pain
ANS: C
The patients concern is not so much the pain but her difficulty in accomplishing household tasks.

DIF: Cognitive Level: Application REF: p. 953 OBJ: 8
TOP: Osteoarthritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A nurse is caring for a patient with osteoarthritis. What is the best recommendation by the nurse to this patient to control chronic pain?
a. Administer analgesics only when needed.
b. Administer analgesics as prescribed on a routine basis.
c. Plan activities with no rest periods to complete the activities quickly.
d. Wear high-heeled shoes to keep the body in alignment.
ANS: B
The routine administration of prescribed analgesic medications is the most appropriate treatment for chronic pain.

DIF: Cognitive Level: Application REF: p. 952 OBJ: 8
TOP: Osteoarthritis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. An older patient with osteoarthritis complains of stomach discomfort and shortness of breath after years of taking aspirin for pain relief. What change in pain control medication would be most appropriate for the home health care nurse to suggest?
a. Nonsteroidal antiinflammatory drugs (NSAIDs)
b. Oral corticosteroids
c. Mild exercise
d. Warm baths
ANS: A
The use of NSAIDs is less irritating than aspirin or glucocorticoids. Mild exercise is good but not for pain relief.

DIF: Cognitive Level: Application REF: p. 951 OBJ: 5
TOP: Drug Therapy for Connective Tissue Disorders
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. A home health care nurse is visiting a patient after a total hip replacement. What should the nurse include when teaching the patient how to protect the new joint?
a. Put an extension on the toilet seat.
b. Keep the legs crossed when at rest.
c. Frequently change positions from side to side.
d. Slowly pull the knee to the chest twice a day to stretch the hip abductors.
ANS: A
Placing an extender on the toilet seat will assist in the objective of not flexing the hip more than 90 degrees. Crossing the legs adducts the hip, which is contraindicated.

DIF: Cognitive Level: Comprehension REF: p. 955 OBJ: 8
TOP: Total Hip Replacement and Nursing Implementations
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. After a knee replacement, an 87-year-old patient rejects the use of the continuous passive motion (CPM) machine, saying, I did not march when I was a child, and I am not marching now. What benefits of CPM should the nurse point out to encourage patient use?
a. Decrease in pain
b. Increase in circulation in the new joint
c. Increase in leg strength
d. Increase in flexibility for the new joint
ANS: D
The CPM machines major benefit is to increase flexibility, although it does cause discomfort. No strength-building potential is present with passive motion.

DIF: Cognitive Level: Application REF: p. 955 OBJ: 8
TOP: Total Hip Replacement KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. What do connective tissue diseases affect?
a. Bones, ligaments, cartilage, and tendons
b. Bones, ligaments, and tendons
c. Spurs, ligaments, cartilage, and tendons
d. Tendons, cartilage, and tophi
ANS: A
Connective tissue diseases affect bones, ligaments, cartilage, and tendons.

DIF: Cognitive Level: Knowledge REF: p. 939-940 OBJ: 1
TOP: Connective Tissue Disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. Which patient is most likely to develop a connective tissue disease?
a. A teenage girl who swims
b. A 30-year-old woman who plays tennis
c. A 35-year-old male golfer
d. A 40-year-old male computer analyst
ANS: B
Women have a greater chance than men of developing connective tissue disease.

DIF: Cognitive Level: Comprehension REF: p. 939 OBJ: 7
TOP: Connective Tissue Disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. Which is true regarding connective tissue function?
a. Helps provide a source of storage for calcium
b. Stores hormones in the pores of bone tissue
c. Controls the distribution of minerals
d. Provides protection to body parts
ANS: D
Providing protection is a function of connective tissue.

DIF: Cognitive Level: Knowledge REF: p. 939 OBJ: 2
TOP: Connective Tissue Function KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. A nurse is collecting a health history from a patient with a connective tissue disease. What is the most important inquiry by the nurse?
a. Family history of atherosclerosis
b. Last time the patient had his or her blood tested
c. History of a prior injury to a specific body part
d. Family history of a fracture
ANS: C
Previous injuries may be relevant to a patients current problem.

DIF: Cognitive Level: Comprehension REF: p. 940 OBJ: 3
TOP: Connective Tissue Disease Assessment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis?
a. Absence of pain
b. Symmetric bilateral joint swelling
c. Evening stiffness that improves with activity
d. Increased appetite
ANS: B
Symmetric bilateral joint swelling is a classic symptom of rheumatoid arthritis.

DIF: Cognitive Level: Comprehension REF: p. 957 OBJ: 6
TOP: Rheumatoid Arthritis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A nurse is educating an osteoporotic patient taking alendronate (Fosamax).Which instruction should the nurse stress?
a. Take the drug after breakfast.
b. Avoid the use of supplemental vitamin D.
c. Decrease fluid intake.
d. Sit or stand for 30 minutes after administration.
ANS: D
After taking the drug Fosamax with 8 oz of fluid, the patient should sit or stand for 30 minutes so the drug will be evenly distributed. The drug is taken on an empty stomach.

DIF: Cognitive Level: Application REF: p. 948 OBJ: 5
TOP: Fosamax KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. A patient asks why systemic glucocorticoid medications are used as the last choice for the treatment of rheumatoid arthritis. What is the nurses most informative reply?
a. The other drugs are just as effective and work in similar ways.
b. They are used as a last choice or for short periods because they have many side effects.
c. Those drugs are given three or four times daily, which is more difficult for patients to remember.
d. A higher incidence of vomiting occurs with prolonged use.
ANS: B
Glucocorticoids are used as a last choice because they have many side effects.

DIF: Cognitive Level: Comprehension REF: p. 949 OBJ: 5
TOP: Drug Therapy of Rheumatoid Arthritis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. A nurse, in conjunction with a patient, establishes a plan to treat the pain associated with arthritis. What is the most effective strategy?
a. Avoid exercise to spare painful joints.
b. Use narcotics for pain relief.
c. Apply warm, moist compresses before doing activity.
d. Avoid assistive devices that encourage dependence.
ANS: C
Applying heat before exercise loosens the joints and decreases pain.

DIF: Cognitive Level: Comprehension REF: p. 952 OBJ: 8
TOP: Arthritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. What is the best physiologic reason for a patient with osteoporosis to maintain a regular exercise regimen?
a. Involves the patient in her or his own care
b. Increases cardiac output
c. Promotes better mental health
d. Promotes bone formation and improves strength
ANS: D
Regular exercise promotes bone formation, which is important for patients with osteoporosis for physiologic reasons.

DIF: Cognitive Level: Comprehension REF: p. 961 OBJ: 8
TOP: Osteoporosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. A nurse is organizing a teaching plan for a patient with gout. What should the nurse caution this patient he is at an increased risk for?
a. Kidney stones
b. Tophi
c. Visual disturbances
d. Facial lesions
ANS: A
The threat of kidney stones is a lifelong problem for patients with gout. Tophi are symptomatic of the disease but are not a complication. Facial lesions and visual disturbances are noncontributory.

DIF: Cognitive Level: Comprehension REF: p. 964 OBJ: 8
TOP: Gout Complications KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. A nurse is educating a patient with gout about a low-purine diet. Which food choice by the patient would indicate the need for further teaching?
a. Pizza with pepperoni
b. Seafood platter with scallops and mussels
c. Chicken salad with nuts
d. Tuna sandwich with potato chips
ANS: B
Seafood, such as scallops and mussels, are high in purine.

DIF: Cognitive Level: Application REF: p. 964 OBJ: 8
TOP: Low-Purine Diet KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. Which diagnosis is most appropriate for the nurse to select for a patient with Behet syndrome?
a. Activity intolerance, related to unsteady gait
b. Risk for injury, related to falls
c. Imbalance in nutrition: Less than body requirements, related to anorexia
d. Sexual dysfunction, related to pain in genital area
ANS: D
Pain from the genital ulcers interferes with sexual expression.

DIF: Cognitive Level: Application REF: p. 968 OBJ: 8
TOP: Behet Syndrome KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. A nurse is caring for a patient immediately after total knee replacement surgery. What assessment requires priority?
a. Quality of pulses in the affected limb
b. Degree of nausea and vomiting
c. Understanding of the procedure
d. Amount of pain
ANS: A
Assessments related to postoperative circulatory efficiency are priority assessments.

DIF: Cognitive Level: Application REF: p. 954 OBJ: 6
TOP: Postoperative Care of Total Knee Replacement
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. Imbalanced nutrition: Less than body requirements is the nursing diagnosis applicable to a patient with progressive systemic sclerosis. What is the most important point for the nurse to teach this patient?
a. Eat three large meals spaced throughout the day.
b. Schedule rest periods to prevent overtiring.
c. Severe stress can trigger vasospasm.
d. Eat smaller, more frequent meals.
ANS: D
Smaller, more frequent meals may be better tolerated by a patient who has esophageal involvement.

DIF: Cognitive Level: Application REF: p. 966 OBJ: 8
TOP: PSS KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

22. Which diagnostic test result should the nurse expect for a patient with polymyositis?
a. Muscle biopsy positive for muscle degeneration
b. Positive antinuclear antibody (ANA) blood test result
c. Positive 24-hour urine test result for urate crystals
d. Urate crystals in the synovial fluid
ANS: A
A biopsy, positive for muscle degeneration, is the only result that pertains to polymyositis.

DIF: Cognitive Level: Comprehension REF: p. 967 OBJ: 4
TOP: Polymyositis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

23. What instruction should a nurse include in a teaching plan for a patient with carpal tunnel syndrome?
a. Anticoagulants and glucocorticoids
b. Methotrexate
c. Lubricating ointments
d. Splinting to prevent flexion and hyperextension
ANS: D
Resting and supporting the joint are first-line treatments.

DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 8
TOP: Carpal Tunnel Syndrome KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. Two days after a total hip replacement, a patient is being discharged. Which statement indicates that the patient understands the discharge teaching?
a. I can sit comfortably with my legs crossed.
b. I will ask my husband to tie my shoes for me.
c. I am glad I wont have to use that bulky pillow between my legs at night.
d. My straight dining room chair will be helpful when I do the hip flexion exercises.
ANS: B
If the patient bends over to tie her own shoes, her hips would have more than 90 degrees of flexion.

DIF: Cognitive Level: Comprehension REF: p. 955 OBJ: 8
TOP: Hip Arthroplasty KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

25. What action would best benefit the patient diagnosed with bursitis of the shoulder?
a. Lifting a 5-lb weight as a daily exercise
b. Walking the fingers of the affected arm up the wall
c. Splinting the affected arm to keep the shoulder immobile
d. Performing gentle push-ups on the floor
ANS: B
Walking the fingers up the wall is a gentle exercise to increase range of motion.

DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 6
TOP: Exercises for Bursitis KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

26. A nurse is educating a patient with gout about the medication probenecid (Benemid). What active effect should the nurse relay when explaining why this medication is prescribed?
a. Reduces inflammation in the affected joint
b. Relieves pain
c. Diminishes swelling
d. Increases excretion of uric acid
ANS: D
Probenecid (Benemid) increases the excretion of uric acid to reduce the symptoms of gout.

DIF: Cognitive Level: Comprehension REF: p. 963 OBJ: 5
TOP: Probenecid KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

27. A nurse questions an older patient about the age-related changes she has experienced in her connective tissue, which have lessened her mobility. What do these changes most commonly include? (Select all that apply.)
a. Loss of bone, which may cause fragile bones
b. Thickening of the tendons, causing loss of strength
c. Bony deposits in the joints, causing pain and altered movement
d. Hardening of cartilage, causing more friction in joints
e. Diminished energy, causing decreased activity
ANS: A, B, C, D
Reduced energy, although observed in older adults, is not caused by a change in connective tissue.

DIF: Cognitive Level: Comprehension REF: p. 940 OBJ: 7
TOP: Age-Related Changes in Connective Tissue
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. What are the goals of therapy for patients with rheumatic arthritis? (Select all that apply.)
a. Decrease inflammation.
b. Balance activity and rest.
c. Promote adaptation to limitations.
d. Plan frequent periods of bed rest.
e. Supply patient education and support.
ANS: A, B, C, E
Bed rest of any long period increases the problems of immobility.

DIF: Cognitive Level: Comprehension REF: p. 958-960 OBJ: 6
TOP: Goals for Therapy for Rheumatoid Arthritis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

29. What actions would be best for patients with osteoarthritis to seek the assistance of physical therapy? (Select all that apply.)
a. Isotonic exercises
b. Moist heat application
c. Instruction with a transcutaneous electrical nerve stimulation (TENS) unit
d. Measures to increase range of motion
e. Measures to increase strength
ANS: B, C, D, E
Isotonic exercises place increased stress on the joints.

DIF: Cognitive Level: Comprehension REF: p. 953 OBJ: 6
TOP: Benefits of Physical Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. What signs of progressive systemic sclerosis does the anonym CREST represent? (Select all that apply.)
a. Calcinosis
b. Rash
c. Esophageal dysfunction
d. Sore joints
e. Telangiectasis
ANS: A, C, E
CREST stands for calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis.

DIF: Cognitive Level: Knowledge REF: p. 966-967 OBJ: 6
TOP: CREST KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

COMPLETION

31. To decrease osteoporosis, a nurse explains that women can benefit from _____ for 15 years after the onset of menopause.

ANS:
estrogen
A program of oral estrogen replacement therapy can decrease the occurrence of osteoporosis.

DIF: Cognitive Level: Comprehension REF: p. 961 OBJ: 5
TOP: Hormone Replacement Therapy (HRT)
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

32. A nurse assesses ischemic spots around the nail beds of a patient with rheumatoid arthritis and recognizes that these are a complication of medical diagnosis, rheumatoid arthritis, related to _____.

ANS:
vasculitis
Vasculitis occurs when the vessels become inflamed and cause ischemia and necrosis.

DIF: Cognitive Level: Comprehension REF: p. 957 OBJ: 6
TOP: Vasculitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

33. A nurse clarifies that a postmenopausal woman who is not taking hormone replacement therapy should take ____ mg elemental calcium on a daily basis.

ANS:
1500

Women who are not taking hormone replacements need calcium, 1500 mg/day.

DIF: Cognitive Level: Knowledge REF: p. 961 OBJ: 8
TOP: Osteoporosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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