Porth (2020) 5th nur 317 Flashcards
Chapter 50
Which disease in children presents with an inflammatory myopathy primarily involving skin and muscle with a heliotrope rash around the eyes?
Juvenile spondyloarthropathies
Juvenile arthritis
Systematic lupus erythematous
Juvenile dermatomyositis
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.
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.
Child is between 8 and 15 years of age.
Child is fatigued and generally feels “under the weather.”
Child has gained 20 lb (9.1 kg).
Child has increased serum creatinine.
Child is of Asian descent.
Child is between 8 and 15 years of age.,
Child is fatigued and generally feels “under the weather.”,
Child has increased serum creatinine.
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.
Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?
Low red blood cell count
An abnormal serum SLE assay
Elevated anti-nuclear antibodies (ANA)
Decreased rheumatoid factor
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.
Which statement is true regarding the development of juvenile idiopathic arthritis?
Generalized stunted growth can occur.
A diagnosis will be made when two joints are affected.
Surgical intervention can stop the decline associated with the arthritis.
The condition will resolve in adulthood.
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 determines that additional client education is needed when a client with gout makes which statement?
“I should avoid eating shellfish to decrease the risk of an episode.”
“Increasing my intake of water each day will help stop the symptoms.”
“When I have an exacerbation of my symptoms, a glass of red wine will be helpful.”
“I will plan to eat more white meat rather than red meat.”
“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.
Characteristic skin changes are evident
Bone biopsy
Evidence of nail changes
A prominent butterfly-shaped rash on the face
Characteristic skin changes are evident,
Evidence of nail changes
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 assessing a client for osteoarthritis (OS) of the knee. Which should the nurse consider to be expected findings? Select all that apply.
Crepitus
Shuffling gait
Limitation of motion
Localized pain
Quadricep atrophy
Crepitus,
Limitation of motion,
Localized pain,
Quadricep atrophy
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.
Crepitus, Limitation of motion, Localized pain, Quadricep atrophy
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.
Nutiritonal status/issues, 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.”
A client is experiencing an episode of gout. The nurse recognizes that the condition is a result of:
Serum calcium levels
Serum uric acid levels
Serum calcitonin levels
Serum blood urea nitrogen (BUN)
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.
The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?
The injections will be given only 3 to 4 times per year because they can increase joint destruction.
The client or a family member will be taught to administer the injections daily.
There will be minimal discomfort because the injections are placed in the subcutaneous tissue.
There will be immediate relief with one injection and daily running can be resumed.
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.
When a nurse is caring for a client with gout, which medications will the nurse likely administer? Select all that apply.
Indomethacin
Colchicine
Simvastatin
Ibuprofen
Cyclosporine
Indomethacin, Colchicine, Ibuprofen
Rationale:NSAIDs, particularly indomethacin and ibuprofen, are used for treating acute gouty arthritis. Alternative therapies include colchicine and intra-articular deposition of corticosteroids. Allopurinol or febuxostat may be used after the acute attack is relieved.
The nurse is assessing a client with ankylosing spondylitis (AS). What does the nurse expect to find?
Facial butterfly rash
Lower back pain
Joint contractures
Bruises on the lower extremities
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.
What are the criteria categories required for the diagnosis of early-onset rheumatoid arthritis (RA)? Select all that apply.
Joint involvement
Existence of comorbid conditions
Acute phase reactants
Serology
Duration of symptoms
Joint involvement, Acute phase reactants, Serology, 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.
Which assessment findings will help the nurse to confirm the diagnosis of rheumatoid arthritis? Select all that apply.
Limited joint mobility
Asymmetrical joint involvement
Wrist pain
Finger and hand pain
Joint stiffness
Limited joint mobility, Wrist pain, Finger and hand pain, Joint stiffness
Rationale:Joint stiffness and limited joint mobility—usually starting in the fingers, hands, and wrists—are hallmarks of rheumatoid arthritis. Joint involvement is usually symmetrical not asymmetrical.
The nurse is assessing a client in early stage of rheumatoid arthritis. Which assessment findings would the nurse expect to find? Select all that apply.
Crepitus
Tenderness
Warmth
Swelling
Erythema
Tenderness, Warmth, Swelling, Erythema
Rationale:RA has symptoms that apply to the affected joints showing signs of inflammation (erythema), swelling, tenderness, warmth, and possibly reduced motion. Crepitus is related to degenerative disease.
Giant cell arteritis is a comorbid condition of:
Pseudogout
Gout
Systemic lupus erythematosus
Polymyalgia rheumatica
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.
When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease?
Smoking
Hypertension
Sedentary life style
Obesity
Obesity
Rationale:Obesity is a particular risk factor for OA of the knee in women and a contributory biomechanical factor in the pathogenesis of the disease; OA is a problem occurring in weight-bearing joints.
When planning care for the client with severe osteoarthritis (OA) of the hip, the nurse includes which statement in a teaching session with the client? Select all that apply.
“Losing weight or maintaining your ideal weight reduces stress on your joints.”
“Avoid nonsteroidal anti-inflammatory medications.”
“A walker may be helpful to avoid excess pressure on your hips.”
“Using heat or cold to relieve pain may be helpful.”
“Try to balance your rest and exercise.”
“Losing weight or maintaining your ideal weight reduces stress on your joints.”, “A walker may be helpful to avoid excess pressure on your hips.”, “Using heat or cold to relieve pain may be helpful.”, “Try to balance your rest and exercise.”
Rationale:Treatment of OA focuses on symptom relief: a balance of rest and exercise, use of splints to protect and rest the joint, use of heat and cold to relieve pain and muscle spasms, and adjusting the activities of daily living. Weight reduction is helpful (when weight-bearing surfaces are involved), and the use of a cane or walker if the hips and knees are involved is recommended.
The nurse assessing a client with scleroderma with CREST variant would include an assessment for:
butterfly rash.
leukocytosis.
thrombocytopenia.
Raynaud’s phenomenon.
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.
When administering a corticosteroid to a client with rheumatoid arthritis, a nurse includes which education about the medication? Select all that apply.
“Pain is relieved with use of corticosteroid medications.”
“These drugs are for short-term use.”
“Corticosteroids are taken for life to reduce inflammation.”
“Corticosteroids may be given to inhibit tumor necrosis factor.”
“Corticosteroids do not prevent joint destruction.”
“Pain is relieved with use of corticosteroid medications.”,
“These drugs are for short-term use.”,
“Corticosteroids do not prevent joint destruction.”
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.
