Chapter 44 - Connective Tissue Disorders

Chapter 44: Connective Tissue Disorders
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
ANS: C
Degeneration of articular cartilage is one of the pathophysiologic changes of arthritis.
DIF: Cognitive Level: Knowledge REF: p. 857 OBJ: 2

TOP: Osteoarthritis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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
ANS: A
Arava is a DMARD and slows the progression of the disease.

TOP: DMARDs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
3. 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.
ANS: B
The routine administration of prescribed analgesic medications is the most appropriate
treatment for chronic pain.
DIF: Cognitive Level: Application REF: p. 869 OBJ: 2

TOP: Osteoarthritis KEY: Nursing Process Step: Implementation
4. 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 anti-inflammatory drugs (NSAIDs)
b. Oral corticosteroids
c. Mild exercise
d. Warm baths
ANS: A
The use of NSAIDs is less irritating than aspirin or glucocorticoids. Mild exercise is good but
not for pain relief.

TOP: Drug Therapy for Connective Tissue Disorders
KEY: Nursing Process Step: Implementation
5. 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.
ANS: A
Placing an extender on the toilet seat will assist in the objective of not flexing the hip more
than 90 degrees. Crossing the legs adducts the hip, which is contraindicated.
DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 2

TOP: Total Hip Replacement and Nursing Implementations
6. 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
ANS: D
The CPM machine’s major benefit is to increase flexibility, although it does cause discomfort.
No strength-building potential is present with passive motion.

TOP: Total Hip Replacement KEY: Nursing Process Step: Implementation
7. 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
ANS: A
Connective tissue diseases affect bones, ligaments, cartilage, and tendons.

TOP: Connective Tissue Disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
8. 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
ANS: B
Women have a greater chance than men of developing connective tissue disease.

TOP: Connective Tissue Disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. 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
ANS: D
Providing protection is a function of connective tissue.

TOP: Connective Tissue Function KEY: Nursing Process Step: Assessment
10. 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
ANS: B
Symmetric bilateral joint swelling is a classic symptom of rheumatoid arthritis.

TOP: Rheumatoid Arthritis KEY: Nursing Process Step: Implementation
11. 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.”
ANS: B
Glucocorticoids are used as a last choice because they have many side effects.

TOP: Drug Therapy of Rheumatoid Arthritis
12. 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.
ANS: C
Applying heat before exercise loosens the joints and decreases pain.

TOP: Arthritis KEY: Nursing Process Step: Planning
13. 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
ANS: D
Regular exercise promotes bone formation, which is important for patients with osteoporosis
for physiologic reasons.

TOP: Osteoporosis KEY: Nursing Process Step: Implementation
14. 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
ANS: A
The threat of kidney stones is a lifelong problem for patients with gout. Tophi are
symptomatic of the disease but are not a complication. Facial lesions and visual disturbances
are noncontributory.

TOP: Gout Complications KEY: Nursing Process Step: Planning
15. 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
ANS: B
Seafood, such as scallops and mussels, are high in purine.

TOP: Low-Purine Diet KEY: Nursing Process Step: Evaluation
16. 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
ANS: A
Assessments related to postoperative circulatory efficiency are priority assessments.

TOP: Postoperative Care of Total Knee Replacement
KEY: Nursing Process Step: Assessment
17. Inadequate nutrition is the patient problem 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.
ANS: D
Smaller, more frequent meals may be better tolerated by a patient who has esophageal
involvement.

TOP: PSS KEY: Nursing Process Step: Implementation
18. 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
ANS: D
Resting and supporting the joint are first-line treatments.

TOP: Carpal Tunnel Syndrome KEY: Nursing Process Step: Planning
19. 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.”
ANS: B
If the patient bends over to tie her own shoes, her hips would have more than 90 degrees of
flexion.

TOP: Hip Arthroplasty KEY: Nursing Process Step: Evaluation
20. 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
ANS: B
Walking the fingers up the wall is a gentle exercise to increase range of motion.

TOP: Exercises for Bursitis KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
MULTIPLE RESPONSE
1. 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.
ANS: A, B, C, E
Bed rest of any long period increases the problems of immobility.

TOP: Goals for Therapy for Rheumatoid Arthritis
2. 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
ANS: B, C, D, E
Isotonic exercises place increased stress on the joints.

TOP: Benefits of Physical Therapy KEY: Nursing Process Step: Implementation
3. 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
ANS: A, C, E
CREST stands for calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly,
and telangiectasis.

TOP: CREST KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
COMPLETION
1. To decrease osteoporosis, a nurse explains that women can benefit from ______ for 15 years
after the onset of menopause.
ANS:
estrogen
A program of oral estrogen replacement therapy can decrease the occurrence of osteoporosis.

TOP: Hormone Replacement Therapy (HRT)
2. 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
______.
ANS:
vasculitis
Vasculitis occurs when the vessels become inflamed and cause ischemia and necrosis.

TOP: Vasculitis KEY: Nursing Process Step: Assessment
3. A nurse clarifies that a postmenopausal woman who is not taking hormone replacement
therapy should take ______ mg elemental calcium on a daily basis. (Use numeric characters
only.)
ANS:
1500
Women who are not taking hormone replacements need calcium, 1500 mg/day.

TOP: Osteoporosis KEY: Nursing Process Step: Implementation

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Chapter 44: Connective Tissue Disorders

DIF: Cognitive Level: Knowledge REF: p. 857 OBJ: 2

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7. What do connective tissue diseases affect?

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8. Which patient is most likely to develop a connective tissue disease?

DIF: Cognitive Level: Comprehension REF: p. 868 OBJ: 1

9. Which is true regarding connective tissue function?

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10. Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis?

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