Chapter 43: Connective Tissue Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A 51-year-old professional tennis instructor is newly diagnosed with osteoarthritis. What is
the nurse’s best explanation to the patient when asked what this diagnosis means?
a.
Presence of antibodies in the synovial fluid
b.
Dislocation of the patella over the tibia
c.
Degeneration of articular cartilage
d.
Body’s autoimmune response
2. A nurse explains to a patient with rheumatoid arthritis that the drug leflunomide (Arava) is a
disease-modifying antirheumatic drug (DMARD). What is the action of this medication?
a.
Retards the progress of the disease
b.
Builds new bone
c.
Decreases inflammation
d.
Increases flexibility
3. A patient with osteoarthritis in both knees and shoulders states that she cannot manage her
household tasks without pain. Which is the most appropriate nursing diagnosis for this
patient?
a.
Ineffective coping, related to pain
b.
Risk for disuse syndrome
c.
Impaired physical mobility, related to pain
d.
Activity intolerance, related to pain
4. A nurse is caring for a patient with osteoarthritis. What is the best recommendation by the
nurse to this patient to control chronic pain?
a.
Administer analgesics only when needed.
b.
Administer analgesics as prescribed on a routine basis.
c.
Plan activities with no rest periods to complete the activities quickly.
d.
Wear high-heeled shoes to keep the body in alignment.
5. An older patient with osteoarthritis complains of stomach discomfort and shortness of breath
after years of taking aspirin for pain relief. What change in pain control medication would be
most appropriate for the home health care nurse to suggest?
a.
Nonsteroidal antiinflammatory drugs (NSAIDs)
b.
Oral corticosteroids
c.
Mild exercise
d.
Warm baths
6. A home health care nurse is visiting a patient after a total hip replacement. What should the
nurse include when teaching the patient how to protect the new joint?
a.
Put an extension on the toilet seat.
b.
Keep the legs crossed when at rest.
c.
Frequently change positions from side to side.
d.
Slowly pull the knee to the chest twice a day to stretch the hip abductors.
7. After a knee replacement, an 87-year-old patient rejects the use of the continuous passive
motion (CPM) machine, saying, “I did not march when I was a child, and I am not marching
now.” What benefits of CPM should the nurse point out to encourage patient use?
a.
Decrease in pain
b.
Increase in circulation in the new joint
c.
Increase in leg strength
d.
Increase in flexibility for the new joint
8. What do connective tissue diseases affect?
a.
Bones, ligaments, cartilage, and tendons
b.
Bones, ligaments, and tendons
c.
Spurs, ligaments, cartilage, and tendons
d.
Tendons, cartilage, and tophi
9. Which patient is most likely to develop a connective tissue disease?
a.
A teenage girl who swims
b.
A 30-year-old woman who plays tennis
c.
A 35-year-old male golfer
d.
A 40-year-old male computer analyst
10. Which is true regarding connective tissue function?
a.
Helps provide a source of storage for calcium
b.
Stores hormones in the pores of bone tissue
c.
Controls the distribution of minerals
d.
Provides protection to body parts
11. A nurse is collecting a health history from a patient with a connective tissue disease. What is
the most important inquiry by the nurse?
a.
Family history of atherosclerosis
b.
Last time the patient had his or her blood tested
c.
History of a prior injury to a specific body part
d.
Family history of a fracture
12. Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis?
a.
Absence of pain
b.
Symmetric bilateral joint swelling
c.
Evening stiffness that improves with activity
d.
Increased appetite
13. A nurse is educating an osteoporotic patient taking alendronate (Fosamax).Which instruction
should the nurse stress?
a.
Take the drug after breakfast.
b.
Avoid the use of supplemental vitamin D.
c.
Decrease fluid intake.
d.
Sit or stand for 30 minutes after administration.
14. A patient asks why systemic glucocorticoid medications are used as the last choice for the
treatment of rheumatoid arthritis. What is the nurse’s most informative reply?
a.
“The other drugs are just as effective and work in similar ways.”
b.
“They are used as a last choice or for short periods because they have many side
effects.”
c.
“Those drugs are given three or four times daily, which is more difficult for
patients to remember.”
d.
“A higher incidence of vomiting occurs with prolonged use.”
15. A nurse, in conjunction with a patient, establishes a plan to treat the pain associated with
arthritis. What is the most effective strategy?
a.
Avoid exercise to spare painful joints.
b.
Use narcotics for pain relief.
c.
Apply warm, moist compresses before doing activity.
d.
Avoid assistive devices that encourage dependence.
16. What is the best physiologic reason for a patient with osteoporosis to maintain a regular
exercise regimen?
a.
Involves the patient in her or his own care
b.
Increases cardiac output
c.
Promotes better mental health
d.
Promotes bone formation and improves strength
17. A nurse is organizing a teaching plan for a patient with gout. What should the nurse caution
this patient he is at an increased risk for?
a.
Kidney stones
b.
Tophi
c.
Visual disturbances
d.
Facial lesions
18. A nurse is educating a patient with gout about a low-purine diet. Which food choice by the
patient would indicate the need for further teaching?
a.
Pizza with pepperoni
b.
Seafood platter with scallops and mussels
c.
Chicken salad with nuts
d.
Tuna sandwich with potato chips
19. Which diagnosis is most appropriate for the nurse to select for a patient with Behçet
syndrome?
a.
Activity intolerance, related to unsteady gait
b.
Risk for injury, related to falls
c.
Imbalance in nutrition: Less than body requirements, related to anorexia
d.
Sexual dysfunction, related to pain in genital area
20. A nurse is caring for a patient immediately after total knee replacement surgery. What
assessment requires priority?
a.
Quality of pulses in the affected limb
b.
Degree of nausea and vomiting
c.
Understanding of the procedure
d.
Amount of pain
21. Imbalanced nutrition: Less than body requirements is the nursing diagnosis applicable to a
patient with progressive systemic sclerosis. What is the most important point for the nurse to
teach this patient?
a.
Eat three large meals spaced throughout the day.
b.
Schedule rest periods to prevent overtiring.
c.
Severe stress can trigger vasospasm.
d.
Eat smaller, more frequent meals.
22. Which diagnostic test result should the nurse expect for a patient with polymyositis?
a.
Muscle biopsy positive for muscle degeneration
b.
Positive antinuclear antibody (ANA) blood test result
c.
Positive 24-hour urine test result for urate crystals
d.
Urate crystals in the synovial fluid
23. What instruction should a nurse include in a teaching plan for a patient with carpal tunnel
syndrome?
a.
Anticoagulants and glucocorticoids
b.
Methotrexate
c.
Lubricating ointments
d.
Splinting to prevent flexion and hyperextension
24. Two days after a total hip replacement, a patient is being discharged. Which statement
indicates that the patient understands the discharge teaching?
a.
“I can sit comfortably with my legs crossed.”
b.
“I will ask my husband to tie my shoes for me.”
c.
“I am glad I won’t have to use that bulky pillow between my legs at night.”
d.
“My straight dining room chair will be helpful when I do the hip flexion
exercises.”
25. What action would best benefit the patient diagnosed with bursitis of the shoulder?
a.
Lifting a 5-lb weight as a daily exercise
b.
Walking the fingers of the affected arm up the wall
c.
Splinting the affected arm to keep the shoulder immobile
d.
Performing gentle push-ups on the floor
26. A nurse is educating a patient with gout about the medication probenecid (Benemid). What
active effect should the nurse relay when explaining why this medication is prescribed?
a.
Reduces inflammation in the affected joint
b.
Relieves pain
c.
Diminishes swelling
d.
Increases excretion of uric acid
MULTIPLE RESPONSE
27. A nurse questions an older patient about the age-related changes she has experienced in her
connective tissue, which have lessened her mobility. What do these changes most commonly
include? (Select all that apply.)
a.
Loss of bone, which may cause fragile bones
b.
Thickening of the tendons, causing loss of strength
c.
Bony deposits in the joints, causing pain and altered movement
d.
Hardening of cartilage, causing more friction in joints
e.
Diminished energy, causing decreased activity
28. What are the goals of therapy for patients with rheumatic arthritis? (Select all that apply.)
a.
Decrease inflammation.
b.
Balance activity and rest.
c.
Promote adaptation to limitations.
d.
Plan frequent periods of bed rest.
e.
Supply patient education and support.
29. What actions would be best for patients with osteoarthritis to seek the assistance of physical
therapy? (Select all that apply.)
a.
Isotonic exercises
b.
Moist heat application
c.
Instruction with a transcutaneous electrical nerve stimulation (TENS) unit
d.
Measures to increase range of motion
e.
Measures to increase strength
30. What signs of progressive systemic sclerosis does the anonym CREST represent? (Select all
that apply.)
a.
Calcinosis
b.
Rash
c.
Esophageal dysfunction
d.
Sore joints
e.
Telangiectasis
COMPLETION
31. To decrease osteoporosis, a nurse explains that women can benefit from _____ for 15 years
after the onset of menopause.
32. A nurse assesses ischemic spots around the nail beds of a patient with rheumatoid arthritis and
recognizes that these are a complication of medical diagnosis, rheumatoid arthritis, related to
_____.
33. A nurse clarifies that a postmenopausal woman who is not taking hormone replacement
therapy should take ____ mg elemental calcium on a daily basis.