Chapter 77: Management of Clients with Rheumatic Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 77: Management of Clients with Rheumatic Disorders

MULTIPLE CHOICE

1. The intervention the client with rheumatoid arthritis (RA) can do that is most effective in preserving motor function during periods when the affected joints are not inflamed is

a.

application of moist heat to joints.

b.

encouraging moderate increase in activity.

c.

promotion of a high-protein diet.

d.

restriction of the clients activity.

ANS: B

The use of rest requires a fine balance; however, once inflammation subsides, the client should begin activity again to preserve as much joint function as possible. Heat is a helpful intervention, but does not preserve joint function. Good nutrition is important, but again does not preserve joint function. Restricting the clients activity will not help when the client is not having a flair, and may, in fact, make the situation worse.

DIF: Comprehension/Understanding REF: p. 2061 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

2. A client with RA is anxious to perform all of her activities of daily living. The nurse can best help the client by encouraging

a.

a slow, progressive schedule of daily activities.

b.

complete rest during periods of exacerbation.

c.

performance of activities in the early morning.

d.

the use of assistive devices for dressing.

ANS: A

Encourage the client to stay active. Maintaining function and mobility is necessary for clients to take care of themselves. Progressive exercise, activity, and range-of-motion (ROM) exercises help accomplish this goal. Especially bothersome is morning stiffness, which may require the client reorganize the days activities, or begin some activities the night before.

DIF: Application/Applying REF: p. 2065 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

3. The nurse cautions a client with RA that uninformed self-treatment that has the potential to make her condition worse is

a.

application of cold compresses.

b.

performing isometric exercises.

c.

the use of aspirin to mask pain.

d.

the use of deep heat.

ANS: D

Deep heat raises the temperature in the intra-articular joint spaces, increasing pain.

DIF: Application/Applying REF: p. 2063 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

4. The caution the nurse should give the client who is taking nonsteroidal anti-inflammatory drugs (NSAIDs) as a remedy for arthritis is to

a.

avoid taking NSAIDs with milk.

b.

liberalize fluids while taking NSAIDs.

c.

take NSAIDs with food.

d.

watch for manifestations of skin damage.

ANS: C

Because of the gastric irritation and possible gastritis, NSAIDs should be taken with food.

DIF: Comprehension/Understanding REF: pp. 2062-2063

OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

5. The nurse caring for a client with systemic lupus erythematosus (SLE) should warn the client that the factor most likely to cause an exacerbation of this disorder is

a.

a diet high in saturated fats.

b.

changes in temperature.

c.

exposure to the sun.

d.

ingestion of aspirin.

ANS: C

Sunlight may trigger local dermatitis or more severe manifestations of the disease. The other 3 options are not related to lupus exacerbations.

DIF: Knowledge/Comprehension REF: p. 2069 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

6. The nursing assessment of clients with SLE should focus most intensely on the presence of the common and serious sequela of this disorder, which is

a.

difficulty swallowing.

b.

interruptions in skin integrity.

c.

peripheral neuropathies.

d.

renal failure.

ANS: D

The leading cause of death in clients with SLE is active lupus nephritis, leading to renal failure. There is some degree of kidney involvement, causing progressive changes within the glomeruli, in most clients with SLE.

DIF: Application/Applying REF: p. 2070 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

7. A client is being evaluated for SLE. The nurse would be concerned when the client lists which drug as one of his/her routine medications?

a.

Aspirin

b.

Digoxin (Lanoxin)

c.

Gentamicin (Garamycin)

d.

Procainamide (Pronestyl)

ANS: D

About 25 drugs can produce a lupus-like reaction, but only a few (hydralazine, procainamide, and isoniazid) can cause the disorder with any great frequency.

DIF: Application/Applying REF: p. 2071 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

8. When the nurse is caring for a client with progressive systemic sclerosis (PSS), the highest-priority nursing diagnosis would be

a.

Constipation.

b.

Disturbed Thought Processes.

c.

Risk for Imbalanced Body Temperature.

d.

Risk for Impaired Skin Integrity.

ANS: D

Nursing interventions are directed at the control of manifestations. One of the major areas of concern is skin care to prevent breakdown and ulceration. Clients with PSS can have gastrointestinal disturbances such as constipation or diarrhea. They also have to avoid becoming cold. Disturbed Thought Processes is not a typical nursing diagnosis for the client with PSS.

DIF: Application/Applying REF: p. 2078 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

9. The nurse caring for a client with systemic sclerosis should include in the teaching plan the measure to prevent pain and injury, which is

a.

do not stand for longer than 30 minutes at a time.

b.

exercise only moderately.

c.

wash the hands with plain water only.

d.

wear gloves when removing food from the freezer.

ANS: D

Because of Raynauds phenomenon that accompanies this disorder, clients should protect their digits by using gloves or wearing warm socks when exposure to the cold is unavoidable.

DIF: Application/Applying REF: pp. 2076, 2078

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

10. The nursing care plan should be modified for a client with RA who develops Sjgrens syndrome to include

a.

encouraging fluids to prevent constipation.

b.

lubricating the eyes with artificial tears.

c.

providing skin care daily.

d.

restricting activity in the late evening.

ANS: B

Clients with Sjgrens syndrome have diminished lacrimal secretions and complain of eyes that feel gritty. Artificial tears are helpful for keeping the eyes moist and preventing corneal abrasions. The other three options will not help with this ocular condition.

DIF: Application/Applying REF: p. 2059 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

11. A client has dermatomyositis. The nurse will include priority interventions in the care plan provisions to meet the problem of

a.

difficulty ambulating.

b.

difficulty swallowing.

c.

disorientation.

d.

phlebitis.

ANS: B

The muscle weakness can lead to problems with swallowing and ambulating. Both problems are safety concerns for the client; however, airway patency is a higher priority.

DIF: Analysis/Analyzing REF: p. 2088 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

12. The common complication of ankylosing spondylitis that the nurse should address in the plan of care is

a.

cardiac dysrhythmias.

b.

respiratory compromise.

c.

renal failure.

d.

weight gain.

ANS: B

Because stiffening of the spine is inevitable, the goals of management are to relieve pain, maintain optimal posture, and prevent respiratory involvement from minimal chest movements.

DIF: Analysis/Analyzing REF: p. 2082 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

13. The nurse planning teaching for the client with ankylosing spondylitis includes information on which drug?

a.

Acetaminophen (Tylenol)

b.

Antihistamines

c.

Etanercept

d.

Lorazepam (Ativan)

ANS: C

Medications for ankylosing spondylitis have historically included NSAIDs, sulfasalazine, and methotrexate. Recently the FDA has approved two tumor necrosis factor-alpha (TNF-a) drugs for this condition: etanercept and infliximab.

DIF: Knowledge/Remembering REF: p. 2080 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

14. A client with RA asks the nurse about the purpose of a synovectomy. The most appropriate response from the nurse is This operation will provide you with

a.

improved appearance of the joint.

b.

pain relief.

c.

reduced amount of inflammation.

d.

removal of infected material in the joint.

ANS: C

Synovectomy (surgical removal of synovia, as in the elbows, wrists, fingers, or knees) may be used in RA to help maintain joint function. Early synovectomy helps prevent recurrent inflammation because it removes the synovia, which is the first part of the joint attacked by the disease.

DIF: Comprehension/Understanding REF: p. 2067 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

15. The nurse performing an assessment on a client with fibromyalgia syndrome asks about the most common clinical manifestation, which is

a.

deformities of the fingers and toes.

b.

fatigue, unrelieved by sleep.

c.

migratory areas of numbness.

d.

varying degrees of paresthesias.

ANS: B

Fatigue that is unrelieved by sleep or rest is the most commonly presented problem of fibromyalgia. Fatigue is often caused by depression and is the result of a lack of stage 4 sleep.

DIF: Comprehension/Understanding REF: p. 2085 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. The nurse explains that one of the few rheumatic joint diseases about which we know the infectious etiology is

a.

ankylosing spondylitis.

b.

Lyme disease.

c.

rheumatoid arthritis.

d.

Sjgrens syndrome.

ANS: B

Lyme disease is one form of rheumatic joint disease with a known cause. This complex multisystem disease is caused by the tick-borne spirochete Borrelia burgdorferi.

DIF: Comprehension/Understanding REF: p. 2090 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The nurse caring for a client who had a shoulder arthroplasty yesterday will include in the postoperative care provisions for

a.

assessing the ability to grasp the nurses hand.

b.

avoiding lifting objects heavier than 10 pounds.

c.

limiting flexion and extension of the elbow.

d.

positioning the arm below the shoulder.

ANS: A

A possible complication after shoulder arthroplasty is postoperative brachial plexus compromise. Assessments of the median, radial, ulnar, cutaneous, and axillary nerve status are contained in the Critical Monitoring box. Having the client squeeze the nurses hand assesses the median nerve.

DIF: Analysis/Analyzing REF: p. 2068 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

18. To help promote sleep for a client with RA, the nurse would recommend

a.

exercising just before bedtime.

b.

sleeping in thermal underwear.

c.

taking a cool shower before bedtime.

d.

using a large pillow and warm, heavy blankets.

ANS: B

Sleeping in warm clothing, taking a warm shower, warming the bed, using small pillows with lighter blankets, and engaging in soothing activities before bedtime all will assist with sleep problems.

DIF: Application/Applying REF: p. 2064 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

19. A client with ankylosing spondylitis has severe kyphosis. The nurse planning care for this client would provide priority interventions to

a.

create a safe environment.

b.

consult with physical therapy for an exercise regimen.

c.

encourage a high-calorie diet with vitamin supplements.

d.

use meticulous technique when changing surgical dressings.

ANS: A

The client with severe kyphosis has seriously impaired visual function because of the loss of range of motion in the neck. The nurse needs to create an environment that is safe for the client who is ambulatory.

DIF: Analysis/Analyzing REF: p. 2081 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

20. An important health promotion measure the nurse would advise the client beginning therapy with hydroxychloroquine for RA would be to

a.

avoid drinking red wine.

b.

avoid excessive sun exposure.

c.

have eye examinations every 6 months.

d.

measure blood pressure daily.

ANS: C

Hydroxychloroquine has a tendency to cause maculopathy and regular eye exams are necessary in clients taking this drug.

DIF: Analysis/Analyzing REF: pp. 2062-2063

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

21. The nurse clarifies that a client can be diagnosed with RA when, out of the seven criteria, the client exhibits

a.

two.

b.

three.

c.

four.

d.

five.

ANS: C

To be diagnosed with RA, the client must have four of the seven criteria for several weeks. It is important to remember that RA is a clinical diagnosis. Criteria can be found in Table 77-1.

DIF: Knowledge/Remembering REF: pp. 2056-2058

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

22. A client newly diagnosed with RA is depressed after the nurse provides education on the disease process. Important interventions the nurse can offer include helping the client

a.

choose a high-protein, high-carbohydrate diet to provide energy.

b.

find medical supply companies that carry adaptive devices.

c.

learn to participate actively in response to their illness.

d.

understand the importance of taking medications on time.

ANS: C

The client with RA can easily become exhausted trying to adapt to the illness. Unless clients learn to participate actively in modulating their responses to the illness, the amount of energy adaptation requires will increase until the client is no longer able to adapt and be as functional as possible. None of the other options addresses this psychosocial need.

DIF: Application/Applying REF: pp. 2063, 2066

OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

23. A client has advanced systemic sclerosis and presents with a mask-like face and limited ROM of the mouth. Which nursing diagnosis is most important to address an important concept related to this client?

a.

Altered Body Image

b.

Impaired Skin Integrity

c.

Risk for Constipation

d.

Risk for Imbalanced Nutrition

ANS: A

While all the above diagnoses may be pertinent, a client with such physical deformities to the face must be assessed for Altered Body Image. Coping with such alterations in body image can be an overwhelming task for the client. There are no data to show the client has impaired skin, and the other two diagnoses are risk for diagnoses, and therefore lower priority.

DIF: Analysis/Analyzing REF: p. 2078 OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

24. A client who has dermatomyositis (DM) and is receiving high-dose steroids needs surgery for an unrelated problem. The surgeon orders the steroids to be stopped at midnight the night before surgery. The most appropriate action by the nurse is to

a.

call the physician and ask to have the order clarified.

b.

consult with the pharmacist about tapering the dose instead.

c.

discontinue the steroid because the client will be NPO.

d.

speak to the physician and explain concerns with this order.

ANS: D

Clients taking high-dose steroids must never change a dose on their own, and their dose must be tapered slowly because the body cannot respond quickly to changes in cortisol levels. Discontinuing the steroids could precipitate an addisonian crisis. The nurse must speak to the physician and relay his/her concerns about this order.

DIF: Analysis/Analyzing REF: p. 2088 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

MULTIPLE RESPONSE

1. A client has just been admitted to the nursing unit with the diagnosis of CREST syndrome. The findings the nurse would expect to note during the assessment are (Select all that apply)

a.

calcinosis.

b.

esophageal dysfunction.

c.

rash.

d.

Raynauds phenomenon.

e.

spider angiomas.

f.

telangiectasia.

ANS: A, B, D, F

CREST syndrome is a group of manifestations involving calcinosis, Raynauds syndrome, esophageal motility (decreased), sclerodactyly, and telangiectasia.

DIF: Application/Applying REF: p. 2075 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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