Osborn Chapter 58: Learning Outcomes Number and Title

Osborn chapter 58
Learning Outcomes Number and Title
Learning Outcome 1
Learning Outcome 2
Learning Outcome 3
Learning Outcome 4
Learning Outcome 5
Learning Outcome 6
Differentiate autoimmune disease from connective tissue

disease.
Utilize the nursing process when planning care for each
autoimmune disease.
Compare and contrast the etiology, pathophysiology, clinical
manifestations, nursing management, and prevention of the
various type of arthritis.
Identify the four highest-priority nursing diagnoses for
rheumatoid arthritis and osteoarthritis.
Describe nursing management for patients experiencing gout.
Compare and contrast the clinical manifestations and nursing
management of each of the following connective tissue
diseases: (a) myositis, (b) polymyositis, and (c)
dermatomyositis.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.
1. When preparing an educational program on autoimmune disorders, the nurse should include
the following topics:
Select all that apply.
1.
2.
3.
4.
5.
Rheumatoid arthritis (RA)

Scleroderma
Systemic lupus erythematosus (SLE)
Gouty arthritis
Reactive arthritis
Correct Answer:
1. Rheumatoid arthritis (RA)
2. Scleroderma
3. Systemic lupus erythematosus (SLE)
Rationale: Rheumatoid arthritis (RA). Rheumatoid arthritis (RA) is an autoimmune disorder.
Scleroderma. Sclerodermais an autoimmune disorder. Systemic lupus erythematosus (SLE).
Systemic lupus erythematosus (SLE) is an autoimmune disorder. Gouty arthritis. Gouty arthritis
is a connective tissue disorder. Reactive arthritis. Reactive arthritis is a connective tissue
disorder.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 1

2. Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disorder but the nurse is
aware that early, appropriate interventions may play a large role in managing the disease by:
1.
2.
3.
4.
5.
Controlling pain generated by the disorder.

Reducing affected joint deformity.
Minimizing tissue and joint damage.
Maintaining optimum level of joint movement.
Bringing about a long-term remission of symptoms.
Correct Answer:
1. Controlling pain generated by the disorder.
2. Reducing affected joint deformity.
3. Minimizing tissue and joint damage.
4. Maintaining optimum level of joint movement.
Rationale: Controlling pain generated by the disorder. Certain measures are used to control
this disease and treat symptoms, such as pain control. Reducing affected joint deformity.
Certain measures are used to control this disease, such as reducing joint deformity. Minimizing
tissue and joint damage. Certain measures are used to control this disease and treat symptoms,
such as reducing damage to joints. Maintaining optimum level of joint movement. Certain
measures are used to control this disease and treat symptoms, such as maintaining joint function.
Bringing about a long-term remission of symptoms. RA is a chronic condition without a cure
or long-term remission.
LO: 1

3. A client diagnosed with gouty arthritis is prescribed the drug colchicine to decrease the
symptoms he is experiencing. When educating the client regarding this medication, the nurse
includes that:
1.
2.
3.
4.
Vomiting and/or diarrhea can result with frequent use.

A reduction of pain by 60% to 75% is typically experienced.
A less restrictive high-purine diet may be adopted.
There is a possibility of orthostatic hypotension.
Correct Answer: Vomiting and/or diarrhea can result with frequent use.
Rationale: Research has shown that for patients who had taken colchicine, there was a reduction
of pain by 34%. However, all patients on colchicine (100%) developed gastrointestinal (GI)
symptoms of vomiting and/or diarrhea due to the frequency necessary to reduce pain, swelling,
and other symptoms causing the gout attack. Encouraging patients to maintain a low-purine diet
and avoid excessive use of alcohol in order to prevent an acute attack may be a better alternative
for the patient. Orthostatic hypotension is not a typical side effect of colchicines.
Cognitive Level: Application
LO: 1

4. A nurse has completed a health assessment physical examination and interview at a local
health clinic. Which of the following assessment data would support the clients diagnosis of
reactive arthritis?
1.
2.
3.
4.
5.
Client reports having food poisoning 12 days ago.

Urination results in a painful sensation.
Conjunctiva of right eye is reddened, with a thin watery drainage.
Serum creatinine increasing from 0.9 to 1.1 mg/dl.
Serum potassium 3.5 mM.
Correct Answer:
1. Client reports having food poisoning 12 days ago.
2. Urination results in a painful sensation.
3. Conjunctiva of right eye is reddened, with a thin watery drainage.
4. Serum creatinine increasing from 0.9 to 1.1 mg/dl.
Rationale: Client reports having food poisoning 12 days ago. Assessment data supporting a
diagnosis of reactive arthritis would include gastrointestinal bacterial infection occurring 1 to 3
weeks prior to the outbreak of symptoms. Urination results in a painful sensation. Assessment
data supporting a diagnosis of reactive arthritis would include symptoms associated with
urethritis. Conjunctiva of right eye is reddened, with a thin watery drainage. Assessment
data supporting a diagnosis of reactive arthritis would include symptoms associated with these
eye conditions. Serum creatinine increasing from 0.9 to 1.1 mg/dl. Diagnostic lab testing
would reveal an increasing serum creatinine level. Serum potassium 3.5 mM. Diagnostic lab
testing would reveal a serum potassium level that is elevated (> 5.0 mM).
Nursing Process: Assessment
LO: 2
5. The nurse assessing a client who has been diagnosed with Lyme disease in its early stage
recognizes the following symptoms as classically seen in that stage:


1.
2.
3.
4.
5.
Bulls eye rash

Stiff neck
Forgetfulness
Severe headache
Painful urination
Correct Answer:
1. Bulls eye rash
2. Stiff neck
3. Forgetfulness
Rationale: Bulls eye rash. Assessment of the early localized disease, the first stage, which
occurs between days 7 and 10, includes evaluating for a growing rash called erythema chronicum
migrans (ECM). ECM looks like a bulls eye on the affected part. Stiff neck. The early localized
disease symptoms include stiff neck. Forgetfulness. The early localized disease symptoms
include forgetfulness. Severe headache. The early localized disease symptoms include
headache. Painful urination. Painful urination is not symptom of any stage of Lymes disease.
LO: 2

6. The nurse caring for a client who is a smoker, was diagnosed with scleroderma, and has been
experiencing esophageal irritation and heartburn includes the following interventions into the
clients plan of care:
1.
2.
3.
4.
5.
Elevate head of the bed to 30 degrees.

Reapply nicotine patch as prescribed.
Provide decaffeinated beverages only.
Administer omeprazole (Prilosec) as prescribed.
Provide six small meals daily.
Correct Answer:
1. Elevate head of the bed to 30 degrees.
2. Reapply nicotine patch as prescribed.
3. Provide decaffeinated beverages only.
4. Administer omeprazole (Prilosec) as prescribed.
Rationale: Elevate head of the bed to 30 degrees. Elevating the head of the bed can reduce the
backflow of acid into the esophagus that causes inflammation and heartburn. Reapply nicotine
patch as prescribed. Avoiding cigarette smoking helps. Provide decaffeinated beverages only.
Avoiding caffeine helps. Administer omeprazole (Prilosec) as prescribed . Medications used to
treat esophagus irritation and heartburn include omeprazole (Prilosec). Provide six small meals
daily. The clients heartburn will not be positively affected by frequent, small meals.
LO: 2

7. A nurse is preparing a flyer on rheumatoid arthritis (RA) for distribution during a community
health fair. The nurse includes the following facts:
1.
2.
3.
4.
5.
Women are three times more likely to be affected.

Onset generally occurs between 20 and 40 years of age.
Rheumatoid arthritis appears to have a genetic component.
Rheumatoid arthritis is the most common form of arthritis.
Rheumatoid arthritis typically affects weight-bearing joints.
Correct Answer:
1. Women are three times more likely to be affected.
2. Onset generally occurs near 20 to 40 years of age.
3. Rheumatoid arthritis appears to have a genetic component.
Rationale: Women are three times more likely to be affected. RA is noted worldwide as
affecting three times more women than men. Onset generally occurs near 20 to 40 years of
age. RA can occur at any age, with the peak incidence being between ages 20 and 40.
Rheumatoid arthritis appears to have a genetic component. RA is thought to be an
autoimmune disorder that not only involves tissue hypersensitivity but also has a genetic
component. Rheumatoid arthritis is the most common form of arthritis. Osteoarthritis (OA)
is the most common form of arthritis. Rheumatoid arthritis typically affects weight-bearing
joints. Osteoarthritis (OA) is a chronic condition that accompanies aging, most commonly
affecting weight-bearing joints.
Nursing Process: Implementation
LO: 3

8. A client is receiving a series of diagnostic tests to confirm the diagnosis of osteoarthritis (OA).
The nurse recognizes that the following results tend to support the presence of OA:
1.
2.
3.
4.
5.
Dexa scan showed increased bone density

Increased erythrocyte sedimentation rate (ESR) in blood
Bone spurs visible on computed tomography (CT)
Asymmetrical joint cartilage loss seen on x-ray
Presence of antinuclear antibodies in blood
Correct Answer:
1. Dexa scan showed increased bone density
2. Increased erythrocyte sedimentation rate (ESR) in blood
3. Bone spurs visible on computed tomography (CT)
4. Asymmetrical joint cartilage loss seen on x-ray
Rationale: Dexa scan showed increased bone density. Increased bone density is a positive
diagnostic result for OA. Increased erythrocyte sedimentation rate (ESR) in blood. Increased
erythrocyte sedimentation rate (ESR) is a positive diagnostic result for OA. Bone spurs visible
on computed tomography (CT). Bone spurs are a positive diagnostic result for OA.
Asymmetrical joint cartilage loss seen on x-ray. Asymmetrical joint cartilage loss is a positive
diagnostic result for OA. Presence of antinuclear antibodies in blood. Presence of antinuclear
antibodies in blood is reflective of RA.
LO: 3

9. The nurse is providing dietary education for a client recently diagnosed with a form of
arthritis. The client is encouraged to avoid alcohol, organ meats, and dried peas, beans, and
peanuts. These recommendations are appropriate for clients diagnosed with:
1.
2.
3.
4.
Gouty arthritis.
Osteoarthritis.
Rheumatoid arthritis.
Reactive arthritis.
Correct Answer: Gouty arthritis.

Rationale: Because gouty arthritis is caused by indulging in foods high in purines, it can be
controlled by eating a well-balanced, low-calorie, low-purine diet and by reducing alcohol
consumption. Foods to be avoided are alcohol, organ meats, and rich foods such as gravies, dried
legumes, and anchovies. Osteoarthritis, rheumatoid arthritis, and reactive arthritis are not
affected by diet as directly as is gouty arthritis.
LO: 3

10. A nurse is discussing the symptomology of osteoarthritis (OA) with a client. The nurse shows
an understanding of the disease process when identifying which of the following as an initial
symptom of the disease?
1.
2.
3.
4.
Painful stiffness in the joints of the fingers

Popping sensation felt in the wrist joint when typing
Knee pain when leg is at rest
A fine red rash on the elbow that is constant
Correct Answer: Painful stiffness in the joints of the fingers

Rationale: The onset of osteoarthritis (OA) is gradual and progressive. The symptoms that are
noticed first are pain and stiffness in the affected joint or joints. Crepitus (grating, crackling, or
popping sounds experienced at a joint) and pain at rest are late signs of OA in a joint. A red rash
is not a typical indicator of OA.
LO: 4

11. A client with a history of rheumatoid arthritis reports mobility impairment as a result of hip
and knee joint stiffness. The nurse suggests the following interventions to assist the client in
managing this problem:
1. Encouraging frequent periods of rest for the affected hip and knee joints.
2. Instructing the client in the proper technique for active range of motion of the affected
joints.
3. Educating the clients family to perform passive range-of-motion exercises of the
affected joints.
4. Suggesting the application of ice to the affected joints to minimize pain.
5. Discussing the use of relaxation techniques when affected joints are most painful.
Answers:
1. Encouraging frequent periods of rest for the affected hip and knee joints.
2. Instructing the client in the proper technique for active range of motion of the affected
joints.
3. Educating the clients family to perform passive range-of-motion exercises of the
affected joints.
Rationale: Encouraging frequent periods of rest for the affected hip and knee joints. Rest
will help maintain maximum joint mobility. Instructing the client in the proper technique for
active range of motion of the affected joints. Active range of motion exercises will help
maintain maximum joint mobility. Educating the clients family to perform passive range-ofmotion exercises of the affected joints. Passive range of motion exercises will help maintain
maximum joint mobility. Suggesting the application of ice to the affected joints to minimize
pain. The application of heat is more appropriate since it will facilitate movement of the joints
while also impacting the inflammatory process. Discussing the use of relaxation techniques
when affected joints are most painful. Relaxation techniques are directed toward pain
management, not joint mobility.
LO: 4

12. Impaired physical mobility is a major nursing diagnosis for clients with osteoarthritis (OA).
The nursing intervention best directed toward addressing this clients limitation is:
1. Assessing the clients range of motion of affected joints in order to plan and
implement appropriate interventions.
2. Encouraging consistently high activity levels in order to minimize the development of
associated emotional and self-esteem problems.
3. Encouraging client to assume responsibility for personal self-care needs in order to
retain ability to be physically active.
4. Assessing and managing the clients need for narcotic analgesics in order to minimize
the impact that pain has on personal activities of daily living.
Correct Answer: Assessing the clients range of motion of affected joints in order to plan and
implement appropriate interventions.
Rationale: A determination of the clients range of motion is needed to provide the best
individualized care. Clients with osteoarthritis (OA) will need to build in periodic rest periods in
order to decrease pain and associated symptoms such as depression once depression is identified
in this client. Realistic goals will need to be set for the client with OA. Assuming responsibility
for personal self-care needs may not be realistic for all clients with OA. Simply encouraging the
client to remain active does not provide comprehensive care. OA is a chronic condition, and the
use of narcotics could lead to dependence.
LO: 4

13. When providing care to the client with an exacerbation of gout resulting in foot pain, which
of the following nursing interventions will aid in promoting comfort?
1.
2.
3.
4.
Elevating the extremity using a foot cradle

Wrapping the extremity in an ace bandage
Encouraging liberal fluid intake
Providing passive range-of-motion exercises
Correct Answer: Elevating the extremity using a foot cradle

Rationale: The pain in the affected extremity will be lessened with elevation; elevation will
reduce inflammation. Wrapping the extremity and range of motion could increase the pain being
experienced. Fluid intake is encouraged, but will not directly reduce the clients discomfort.
LO: 5

14. A client is experiencing a reoccurrence of the symptoms typical of gout in his right foot. The
nurse shows an understanding of the diagnostic testing appropriate for this client when preparing
the client for a(n):
1.
2.
3.
4.
5.
Serum uric acid level.

Complete blood count (CBC).
X-ray of the affected foot.
MRI of the affected foot.
CT of the affected foot.
Correct Answer:
1. Serum uric acid level.
2. Complete blood count (CBC).
3. X-ray of the affected foot.
Rationale: Serum uric acid level. An elevated uric acid level greater than7.5 mg/dL is almost
always identified with gout. Complete blood count (CBC). A complete blood count includes a
white blood cell (WBC) count, which shows a significant elevation during an acute attack of
gout. X-ray of the affected foot. An x-ray would be appropriate to assess underlying joint
damage, especially in patients who have had multiple episodes of gouty arthritis. MRI of the
affected foot. An MRI is an expensive test and would not be needed to diagnose gout but could
be ordered to rule out other diagnoses if the typical indicators for gout are not discovered. CT of
the affected foot. A CT is an expensive test and would not be needed to diagnose gout but could
be ordered to rule out other diagnoses if the typical indicators for gout are not discovered.
LO: 5

15. The nurse preparing discharge medication instructions for a client with a history of hepatic
disease who has been diagnosed with gouty arthritis and prescribed colchicine includes the
following information in the discharge teaching:
1.
2.
3.
4.
5.
Signs of medication toxicity include diarrhea, anorexia, and weakness.

Adverse reactions to the medication include sore throat, bruising, and fever.
Take medication as prescribed, but arrange schedule to coincide with meals.
Keep scheduled appointments for the monitoring of prothrombin time.
Maintain current weight with the inclusion of calorie-dense foods.
Correct Answer:
1. Signs of medication toxicity include diarrhea, anorexia, and weakness.
2. Adverse reactions to the medication include sore throat, bruising, and fever.
3. Take medication as prescribed, but arrange schedule to coincide with meals.
Rationale: Signs of medication toxicity include diarrhea, anorexia, and weakness. Observe
for early signs of toxicity (colchicine): weakness, anorexia, nausea, vomiting, and diarrhea,
especially in presence of cardiac, renal, or hepatic disease. Adverse reactions to the medication
include sore throat, bruising, and fever. Observe for severe adverse effects: nausea, sore throat
or mouth, fever, fatigue, unusual bleeding, or bruising (bone marrow depression). Take
medication as prescribed but arrange schedule to coincide with meals. Give medications
after a meal to reduce gastric distress. Keep scheduled appointments for the monitoring of
prothrombin time. Prothrombin time is not usually monitored for clients prescribed colchicines.
Maintain current weight with the inclusion of calorie-dense foods. Gouty arthritis is seen
more frequently in clients who are overweight, so the inclusion of calorie-dense foods would not
be encouraged.
LO: 5

16. When preparing an informational sheet on myositis for distribution at a meeting of a lupus
support group, the nurse includes the following facts concerning this disease:
Select all that apply:
1.
2.
3.
4.
5.
Myositis contains four different forms of the disorder.

Onset for polymyositis (PM) is usually between the ages of 40 and 50.
Inclusion body myositis (IBM) is more common in females.
Existing autoimmune conditions are a contributing factor in its development.
It is a commonly seen immune disorder.
Correct Answer:
1. Myositis contains four different forms of the disorder.
2. Onset for polymyositis (PM) is usually between the ages of 40 and 50.
3. Inclusion body myositis (IBM) is more common in females.
4. Existing autoimmune conditions are a contributing factor in its development.
Rationale: Myositis contains four different forms of the disorder. There are four kinds of
myositis: polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM), and
juvenile myositis (JM). Onset for polymyositis (PM) is usually between the ages of 40 and 50.
PM can occur at any age, but affects those between the ages 40 and 50. Inclusion body myositis
(IBM) is more common in females. IBM typically begins after age 50 and is more common in
women than in men. Existing autoimmune conditions are a contributing factor in its
development. Myositis occurs more readily with patients who have lupus. It is a commonly
seen immune disorder. Myositis is an uncommon disease wherein the immune system inflames
the bodys own healthy muscle tissue. These conditions are usually caused by an injury,
infection, or autoimmune condition.
LO: 6

17. The nurse caring for a client with symptomlogy suggestive of myositis shows an
understanding of the disease when providing the client with information concerning appropriate
diagnostic testing that includes:
1.
2.
3.
4.
5.
Serum creatine kinase.

Electrogram.
Magnetic resonance (MI).
Echocardiograms.
Synovial fluid culture.
Correct Answer:
1. Serum creatine kinase.
2. Electrogram.
3. Magnetic resonance (MI).
Rationale: Serum creatine kinase. A laboratory test that can assist with the diagnosis of myositis
is the creatine kinase. This test measures autoantibodies and the muscle enzymes. Electrogram.
A diagnostic test that can confirm the diagnosis is the electromyogram to identify the inflamed
muscles. Magnetic resonance (MI). A diagnostic test that also can confirm the diagnosis is
magnetic resonance imaging to identify the inflamed muscles. Echocardiograms.
Echocardiograms are sometimes required to assess cardiac involvement in clients with
scleroderma. Synovial fluid culture. Synovial fluid cultures are appropriate in the diagnosis of
septic arthritis.
LO: 6

18. A client experiencing the typical physical limitations associated with myositis shows the
nurse he is achieving independence by reporting that:
1.
2.
3.
4.
5.
On a daily basis, he is capable of providing 80% of self-care independently.

He has not been injured as a result of a fall in the last 6 months.
Nonsteroidal anti-inflammatory medications allow for a pain rating of 3 out of 10.
He is considering reducing physical therapy (PT) visits by two visits a month.
The rash on his face and neck has diminished drastically.
Correct Answer:
1. On a daily basis, he is capable of providing 80% of self-care independently.
2. He has not been injured as a result of a fall in the last 6 months.
3. Nonsteroidal anti-inflammatory medications allow for a pain rating of 3 out of 10.
Rationale: On a daily basis, he is capable of providing 80% of self-care independently.
Evaluation parameters include that the patient is able to provide self-care. He has not been
injured as a result of a fall in the last 6 months. Evaluation parameters include that the patient
reports no falls. Nonsteroidal anti-inflammatory medications allow for a pain rating of 3 out
of 10. Evaluation parameters include that the patient has no pain or minimal pain with or without
medications. He is considering reducing physical therapy (PT) visits by two visits a month.
Reducing PT is likely to reduce his capacity to ambulate and to be independent in self-care. An
exercise program may be beneficial to prevent muscle atrophy and promote range of motion. The
rash on his face and neck has diminished drastically. A diminished rash indicates that his
medication therapy is effective, not that he is achieving independence.
Nursing Process: Evaluation
LO: 6


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Osborn chapter 58

Learning Outcomes Number and Title

Differentiate autoimmune disease from connective tissue

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Rheumatoid arthritis (RA)

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Controlling pain generated by the disorder.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Vomiting and/or diarrhea can result with frequent use.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Client reports having food poisoning 12 days ago.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Select all that apply.

Bulls eye rash

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Elevate head of the bed to 30 degrees.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Women are three times more likely to be affected.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Dexa scan showed increased bone density

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Correct Answer: Gouty arthritis.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Painful stiffness in the joints of the fingers

Correct Answer: Painful stiffness in the joints of the fingers

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Elevating the extremity using a foot cradle

Correct Answer: Elevating the extremity using a foot cradle

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Serum uric acid level.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Signs of medication toxicity include diarrhea, anorexia, and weakness.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Myositis contains four different forms of the disorder.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

Serum creatine kinase.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

On a daily basis, he is capable of providing 80% of self-care independently.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

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