Rheumatoid Arthritis
True or False?
Rheumatoid arthritis occurs later in life, after years of mechanical wear and tear on the cartilage which lines and cushions your joints.
False.
Rheumatoid arthritis is chronic systemic inflammatory disease that leads to the destruction of connective tissue and synovial membrane within the joints.
A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor?
A) The patient has a 30 pack-year smoking history.
B) The patients body mass index is 34 (obese).
C) The patient has primary hypertension.
D) The patient is 58 years old.
Ans:B
Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly heightened risk.
A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection?
A) Petechiae
B) Butterfly rash
C) Jaundice
D) Skin sloughing
Ans:B
An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin sloughing.
*Everyone must say one answer for this:)*
What are some risk factors for Osteoporosis?
-Genetics
-Age
-Nutrition: low calcium intake, low vitamin D intake, high phosphate intake, inadequate calories.
-Physical exercise: sedentary, lack of weight-bearing exercise, low weight and BMI.
-Lifestyle choices: alcohol, smoking, lack of exposure to sunlight, caffeine.
-Medications: e.g., corticosteroids, antiseizure meds, heparin, thyroid hormone.
-Comorbidity: e.g., anorexia nervosa, hyperthyroidism, malabsorption syndrome, kidney failure.
The client with a long arm cast is complaining of unrelenting severe pain and feeling as if the fingers are asleep. Which complication should the nurse suspect the client is experiencing?
A. Fat embolism.
B. Compartment syndrome.
C. Pressure ulcer under the cast.
D. Surgical incision infection.
ANS: B
These are the classic signs/symptoms of compartment syndrome.
A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved?
A) Angiography
B) Myelography
C) Paracentesis
D) Arthocentesis
Ans:D
Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through the abdominal wall under sterile conditions.
After the nurse has finished teaching a 68-year-old patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?
a. I can take glucosamine to help decrease my knee pain.
b. I will take 1 g of acetaminophen (Tylenol) every 4 hours.
c. I will take a shower in the morning to help relieve stiffness.
d. I can use a cane to decrease the pressure and pain in my hip.
ANS: B
No more than 4 g of acetaminophen should be taken daily to avoid liver damage. The other patient statements are correct and indicate good understanding of OA management.
A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture?
a. Sedentary lifestyle
b. A 30pack-year smoking history
c. Prescribed oral contraceptives
d. Pagets disease
ANS: D
Pagets disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.
A patient at risk for the development of osteoporosis has reported plans to increase calcium intake. When making menu choices, which selection demonstrates an understanding of calcium-rich foods?
a. Grilled salmon, green beans, and milk
b. Hamburger patty on a wheat bun, baked chips, and milk
c. Grilled chicken breast, tossed salad, and fruit punch
d. Bacon, lettuce, and tomato sandwich on whole grain bread, orange slices, and milk
ANS: A
In addition to dairy products, sources of calcium include canned sardines or salmon, tofu, figs, and green vegetables.
The day after a 60-year-old patient has an open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the priority nursing diagnosis is
a. activity intolerance related to deconditioning.
b. risk for constipation related to prolonged bed rest.
c. risk for impaired skin integrity related to immobility.
d. risk for infection related to disruption of skin integrity.
ANS: D
A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely.
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first?
a. Client who reports jaw pain when eating
b. Client with a red, hot, swollen right wrist
c. Client who has a puffy-looking area behind the knee
d. Client with a worse joint deformity since the last visit
ANS: B
All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.
A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?
A) OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
B) OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees.
C) OA originates with an infection. RA is a result of your bodys cells attacking one another.
D) OA is associated with impaired immune function; RA is a consequence of physical damage.
Ans: A
OA is a degenerative arthritis with a noninflammatory etiology, 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. The diseases are not distinguished by the joints affected and neither has an infectious etiology.
A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first?
a. Patient who reports foot pain after hammertoe surgery
b. Patient with low back pain and a positive straight-leg-raise test
c. Patient who has not voided 10 hours after having a laminectomy
d. Patient with osteomyelitis who has a temperature of 100.5 F (38.1 C)
ANS: C
Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately. The information about the other patients is consistent with their diagnoses. The nurse will need to assess them as quickly as possible, but the information about them does not indicate a need for immediate intervention.
The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis?
A. X-ray of the femur.
B. Serum alkaline phosphatase.
C. Dual-energy x-ray absorptiometry (DEXA).
D. Serum bone Gla-protein test.
ANS: C
This test measures bone density in the lumbar spine or hip and is considered to be highly accurate.
The client admitted with a diagnosis of a fractured hip who is in Buck’s traction is complaining of severe pain. Which intervention should the nurse implement?
A. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
B. Ensure the weights of the Buck’s traction are off the floor and hang freely.
C. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
D. Turn the client on the affected leg using pillows to support the other leg.
ANS: B
Weights from traction should be off the floor and hanging freely. Buck’s traction is used to reduce muscle spasms preoperatively in clients who have fractured hips.
A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment?
A) The patient will need daily blood testing for the duration of treatment.
B) The patient must stop all other drugs 72 hours before starting prednisone.
C) The drug should be used at the highest dose the patient can tolerate.
D) The drug should be used for as short a time as possible.
Ans: D
Corticosteroids are used for shortest duration and at lowest dose possible to minimize adverse effects. Daily blood work is not necessary and the patient does not need to stop other drugs prior to using corticosteroids.
A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberdens nodules. What assessment technique is correct?
a. Inspect the clients distal finger joints.
b. Palpate the clients abdomen for tenderness.
c. Palpate the clients upper body lymph nodes.
d. Perform range of motion on the clients wrists.
ANS: A
Herberdens nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal joints. To assess for this finding, the nurse inspects the clients distal fingertips. These nodules are not found in the abdomen, lymph nodes, or wrists.
Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)?
a. Sleep in a prone position with the legs extended.
b. Keep the knees straight when leaning forward to pick something up.
c. Avoid activities that require twisting of the back or prolonged sitting.
d. Symptoms of acute low back pain frequently improve in a few weeks.
e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain.
ANS: C, D, E
Acute back pain usually starts to improve within 2 weeks. In the meantime, the patient should use medications such as nonsteroidal antiinflammatory drugs (NSAIDs) or acetaminophen to manage pain and avoid activities that stress the back. Sleeping in a prone position and keeping the knees straight when leaning forward will place stress on the back, and should be avoided.
The client must take three (3) grams of calcium supplement a day. The medication comes in 500-mg tablets. How many tablets will the client need to take daily? _______
6 tablets daily.
A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?
a. Administer oxygen via nasal cannula.
b. Re-position to a high-Fowlers position.
c. Increase the intravenous flow rate.
d. Assess response to pain medications.
ANS: A
The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Sitting the client in a high-Fowlers position will not decrease hypoxia related to a fat embolism. The IV rate is not related. Pain medication most likely would not cause the client to be restless.
The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)
a. It affects single joints only.
b. Antibodies lead to inflammation.
c. It consists of an autoimmune process.
d. Morning stiffness is rare.
e. Permanent damage is inevitable.
ANS: B, C
RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.
Which clinical manifestation of osteoarthritis (OA) should the nurse include when teaching about osteoarthritis? (Select all that apply)
A. Joint pain with activity
B. Pain and stiffness at night
C. Abrupt onset
D. Mild fever
E. Crepitus with movement of joint
Answer: A, B, E
Joint pain with activity, grating or crepitus noted with movement, and pain and stiffness with prolonged inactivity are general manifestations of OA. Mild fever is associated with rheumatoid arthritis, not OA. Osteoarthritis is a degenerative disease that develops over time, although symptoms may appear suddenly.
The nurse points out the age-related changes that occur in the musculoskeletal system, which are: (Select all that apply.)
a. increase of bone density.
b. bones are brittle and break easily.
c. bones heal slowly.
d. decrease in muscle mass.
e. tendon sclerosis.
ANS: B, C, D, E
All options listed are age-related changes in the musculoskeletal system except increase in bone density. Bone density is usually decreased with aging.
When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will
a. ask about any leg cramps or hot flashes.
b. assist the patient to sit up at the bedside.
c. be sure that the patient has recently eaten.
d. administer the ordered calcium carbonate.
ANS: B
To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates.
The nurse is caring for a client diagnosed with a fracture of the right distal humerus. Which data indicate a complication? Select all that apply.
A. Numbness and mottled cyanosis.
B. Paresthesia and paralysis.
C. Proximal pulses and point tenderness.
D. Coldness of the extremity and crepitus.
E. Palpable radial pulse and functional movement.
ANS: A, B, C
The nurse should assess for numbness and mottled cyanosis, which might indicate nerve damage. The presence of paresthesia and paralysis indicates impaired circulation. Coldness indicates decreased blood supply. Crepitus indicates air in subcutaneous tissue and is not expected.