NURS 317 Unit 6 Path Chapter 50 Flashcards
What are the criteria categories required for the diagnosis of early-onset rheumatoid arthritis (RA)? Select all that apply.
A) Acute phase reactants
B) Joint involvement
C) Serology
D) Duration of symptoms
E) Existence of comorbid conditions
A) Acute phase reactants
B) Joint involvement
C) Serology
D) Duration of symptoms
Rationale:The criteria for RA developed by the American College of Rheumatology and the European League Against Rheumatism (EULAR) consist of four categories (joint involvement, serology, acute phase reactants, and duration of symptoms). Comorbid conditions are not included as an assessment criteria.
A child, diagnosed with juvenile idiopathic arthritis, should receive education about commonly prescribed medications. Which other priority aspect(s) of care should the nurse assess during regular clinic visits? Select all that apply.
A) Nutiritonal status/issues
B) Pain and swelling in the first metatarsophalangeal in the joint
C) Achieving growth and development milestones
D) Appearance of calcifications at pressure points
E) Development of hip dysplas
A) Nutiritonal status/issues
C) Achieving growth and development milestones
Rationale:Medications are focused on reducing inflammation with nonsteroidal anti-inflammatory drugs being the first-line type of drugs prescribed. Other aspects of treatment of children with juvenile idiopathic arthritis require careful attention to growth and development as well as any nutritional issues that may arise. Appearance of calcifications at pressure points is the most debilitating symptom in children with juvenile dermatomyositis. Hip dysplasia is usually discovered at birth and places the child at risk for early onset osteoarthritis. Pain and swelling in the first metatarsophalangeal in the joint is usually associated with gout. The typical acute attack is monoarticular and affects the “big toe.”
When administering a corticosteroid to a client with rheumatoid arthritis, a nurse includes which education about the medication? Select all that apply.
A) “Pain is relieved with use of corticosteroid medications.”
B) “Corticosteroids do not prevent joint destruction.”
C) “Corticosteroids may be given to inhibit tumor necrosis factor.”
D) “Corticosteroids are taken for life to reduce inflammation.”
E) “These drugs are for short-term use.”
A) “Pain is relieved with use of corticosteroid medications.”
B) “Corticosteroids do not prevent joint destruction.”
E) “These drugs are for short-term use.”
Rationale:Corticosteroids interrupt the inflammation and immune response at several levels, interfering with inflammatory cell adhesion and migration, impairing prostaglandin synthesis, and inhibiting neutrophil superoxide production. To avoid long-term side effects, they are used only for short-term therapy at a low-dose level and should not be repeated more than a few times each year.
Which statement is true regarding the development of juvenile idiopathic arthritis?
A) A diagnosis will be made when two joints are affected.
B) The condition will resolve in adulthood.
C) Surgical intervention can stop the decline associated with the arthritis.
D) Generalized stunted growth can occur.
D) Generalized stunted growth can occur.
Rationale:Generalized stunted growth can occur as well as unilateral increased growth related to the influence on epiphyseal growth. It will not resolve in adulthood, and surgical intervention is not an option to eliminate the disease.
The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find?
A) Lower back pain
B) Facial butterfly rash
C) Joint contractures
D) Bruises on the lower extremities
A) Lower back pain
Rationale:The client with AS has an inflammatory erosion of the sites where tendons and ligaments attach to bone. The disease progresses with bilateral involvement of the sacroiliac joints and produces lower back pain. Joint contractures, butterfly rash, and bruises are not characteristic of this disease.
The nurse determines that additional client education is needed when a client with gout makes which statement?
A) “I will plan to eat more white meat rather than red meat.”
B) “I should avoid eating shellfish to decrease the risk of an episode.”
C) “Increasing my intake of water each day will help stop the symptoms.”
D) “When I have an exacerbation of my symptoms, a glass of red wine will be helpful.”
D) “When I have an exacerbation of my symptoms, a glass of red wine will be helpful.”
Rationale:The statement about drinking alcohol to decrease the symptoms would need more follow-up, since it is a strong contributor to an exacerbation of gout. The other statements are valid.
Which symptoms are required for a diagnosis of psoriatic arthritis? Select all that apply.
A) A prominent butterfly-shaped rash on the face
B) Bone biopsy
C) Evidence of nail changes
D) Characteristic skin changes are evident
C) Evidence of nail changes
D) Characteristic skin changes are evident
Rationale:A diagnosis of psoriatic arthritis is made based on symptoms and evidence of skin or nail changes and arthritis symptoms. A butterfly-shaped rash is more closely related to SLE. A bone biopsy is not relevant.
The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?
A) There will be immediate relief with one injection and daily running can be resumed.
B) The client or a family member will be taught to administer the injections daily.
C) There will be minimal discomfort because the injections are placed in the subcutaneous tissue.
D) The injections will be given only 3 to 4 times per year because they can increase joint destruction.
D) The injections will be given only 3 to 4 times per year because they can increase joint destruction.
Rationale:The client needs to be educated regarding the limited use of the injections and the risk of these injections causing additional joint destruction. The client should not be encouraged to run, but can participate in muscle-strengthening exercises. The statements regarding discomfort and daily administration are not correct.
A nurse is caring for an adolesecnt female who is undergoing diagnostic studies for systemic lupus erythematosus (SLE). Which assessment findings does the nurse recognize as being consistent with childhood SLE? Select all that apply.
A) Child has increased serum creatinine.
B) Child is fatigued and generally feels “under the weather.”
C) Child is between 8 and 15 years of age.
D) Child has gained 20 lb (9.1 kg).
E) Child is of Asian descent.
A) Child has increased serum creatinine.
B) Child is fatigued and generally feels “under the weather.”
C) Child is between 8 and 15 years of age.
Rationale:Black girls between 8 and 15 years of age are most frequently affected by SLE. The best prognostic indicator in children is the extent of renal involvement, which is more common and more severe in children than in adults with SLE. Constitutional symptoms, including fever, malaise, anorexia, and weight loss, may be present.
The nurse is assessing a client for osteoarthritis (OS) of the knee. Which should the nurse consider to be expected findings? Select all that apply.
A) Quadricep atrophy
B) Crepitus
C) Localized pain
D) Limitation of motion
E) Shuffling gait
A) Quadricep atrophy
B) Crepitus
C) Localized pain
D) Limitation of motion
Rationale:Localized discomfort with pain on motion; limitation of motion; crepitus; quadriceps atrophy due to lack of use; joint instability; genu varus or valgus; and joint effusion are all clinical features of osteoarthritis of the knee. Osteoarthritis of the hip results in difficulty getting in and out of chairs into a standing position.
The nurse assessing a client with scleroderma with CREST variant would include an assessment for:
A) thrombocytopenia.
B) Raynaud’s phenomenon.
C) leukocytosis.
D) butterfly rash.
B) Raynaud’s phenomenon.
Rationale:Raynaud’s phenomenon is the characteristic symptom of CREST variant of scleroderma that is identified by the R in the CREST acronym. The other options are associated with systemic lupus erythematosus.
Which disease in children presents with an inflammatory myopathy primarily involving skin and muscle with a heliotrope rash around the eyes?
A) Juvenile spondyloarthropathies
B) Juvenile arthritis
C) Juvenile dermatomyositis
D) Systematic lupus erythematous
C) Juvenile dermatomyositis
Rationale:The condition described is juvenile dermatomyositis because of the involvement of skin and muscle. In children with this condition, characteristic symptoms include weak proximal muscles, a heliotrope rash around the eyes, Gottron papules, and vasculopathy. The other options do not involve skin and muscle.
Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?
A) Elevated anti-nuclear antibodies (ANA)
B) Low red blood cell count
C) Decreased rheumatoid factor
D) An abnormal serum SLE assay
A) Elevated anti-nuclear antibodies (ANA)
Rationale:While there is no laboratory finding that will provide a definite diagnosis of SLE, the ANA is elevated in 95% of untreated SLE.
Giant cell arteritis is a comorbid condition of:
A) Polymyalgia rheumatica
B) Pseudogout
C) Systemic lupus erythematosus
D) Gout
A) Polymyalgia rheumatica
Rationale:A certain percentage of people with polymyalgia rheumatica also develop giant cell arteritis (i.e., temporal arteritis) with involvement of the ophthalmic arteries. This is not an associated outcome of any of the other options.
A client is experiencing an episode of gout. The nurse recognizes that the condition is a result of:
A) Serum blood urea nitrogen (BUN)
B)Serum calcitonin levels
C) Serum uric acid levels
D) Serum calcium levels
C) Serum uric acid levels
Rationale:Gout resides in an elevation of serum uric acid levels. The elevation of uric acid and the subsequent development of gout can result from overproduction of purines, decreased salvage of free purine bases, augmented breakdown of nucleic acids as a result of increased cell turnover, or decreased urinary excretion of uric acid. The other lab values would not contribute to gout.
