Question 1

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.

Accepted Answer

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.

Question 2

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.

Accepted Answer

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.

Question 3

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) Raynaud's phenomenon.
E) spider angiomas.
F) telangiectasia.

Accepted Answer

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

Question 4

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

Accepted Answer

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.

Question 5

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.

Accepted Answer

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.

Quiz 77: Management of Clients with Rheumatic Disorders

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

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 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 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 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