Deck 52: Alterations in Musculoskeletal Function: Rheumatic Disorders

Question 1

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be

A) systemic manifestations of inflammation.
B) localized pain in weight-bearing joints.
C) reduced excretion of uric acid by the kidney.
D) firm, crystallized nodules or "tophi" at the affected joints.

Answer 1

systemic manifestations of inflammation.

Question 2

To avoid the progression of cutaneous lesions,a patient diagnosed with systemic lupus erythematosus (SLE)should

A) avoid sun exposure.
B) avoid excessive use of moisturizers.
C) refrain from washing the affected areas.
D) apply warm, wet compresses daily.

Answer 2

avoid sun exposure.

Question 3

Ankylosing spondylitis is characterized by

A) inflammation, stiffness, and fusion of spinal joints.
B) loss of articular cartilage in weight-bearing joints.
C) excessive bone remodeling leading to soft bone.
D) immune mechanisms leading to widespread joint inflammation.

Answer 3

inflammation, stiffness, and fusion of spinal joints.

Question 4

Individuals diagnosed with systemic lupus erythematosus (SLE)are at risk for developing numerous complications of various organs because of

A) excessive production of connective tissue.
B) formation of osteophytes in tissues.
C) immune injury to basement membranes.
D) impaired tissue oxygen transport.

Question 5

Enteropathic arthritis is associated with

A) irritable bowel syndrome.
B) inflammatory bowel disease.
C) chronic constipation.
D) chronic diarrhea.

Question 6

Prosthetic joint infection is most often because of

A) defective replacement material.
B) injury to the joint.
C) hematogenous transfer.
D) arthritis.

Question 7

Although skin manifestations may occur in numerous locations,the classic presentation of systemic lupus erythematosus (SLE)includes

A) lesions affecting the palms of hands and the soles of feet.
B) dry, scaly patches in the antecubital area and behind the knees.
C) cracked, scaly areas in the webs of fingers.
D) a butterfly pattern rash on the face across the bridge of the nose.

Question 8

It is true that scleroderma involves

A) inflammation and fibrosis of connective tissue.
B) autoantibodies against acetylcholine receptors.
C) infection by beta-hemolytic streptococcus.
D) inflammation caused by antigenic fragments of dead organisms.

Question 9

Systemic lupus erythematosus (SLE)is a rheumatic disease attributed to

A) wear and tear on weight-bearing joints.
B) septic joint inflammation and necrosis.
C) unknown etiologic factors.
D) autoimmune mechanisms.

Question 10

In contrast to osteoarthritis,rheumatoid arthritis may be associated with

A) debilitating joint pain and stiffness.
B) improvement in symptoms with aspirin therapy.
C) changes in activities of daily living.
D) systemic aching in the musculoskeletal system.

Question 11

The pain of nonarticular rheumatism ("growing pain")is worse

A) during activity.
B) following strenuous exercise.
C) upon awakening.
D) during the night.

Question 12

Tophi are

A) renal calculi composed of uric acid.
B) deposits of urate crystals in tissues.
C) painful edematous joints.
D) spots that coalesce in a malar rash.

Question 13

Gouty arthritis is a complication of

A) group A streptococcal infection.
B) autoimmune destruction of joint collagen.
C) excessive production of urea.
D) inadequate renal excretion of uric acid.

Question 14

Rheumatoid arthritis involves joint inflammation caused by

A) bacterial infection.
B) trauma.
C) autoimmune injury.
D) congenital hypermobility.

Question 15

The earliest manifestation of scleroderma is

A) thick, tight, shiny skin.
B) skin hyper/hypopigmentation.
C) renal impairment.
D) Raynaud phenomenon.

Question 16

A laboratory test result that helps confirm the diagnosis of systemic lupus erythematosus (SLE)is

A) elevated serum calcium level.
B) elevated monoclonal antibody titer.
C) positive antinuclear antibodies.
D) positive microsomal antibodies.

Question 17

The most common presenting sign/symptom with rheumatic fever is

A) cardiac murmur.
B) polyarthritis.
C) rash.
D) painless nodules.

Question 18

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream.This indicates that rheumatoid arthritis is likely to be

A) caused by bacterial infection.
B) an autoimmune process.
C) an infective process.
D) because of an enzymatic defect.

Question 19

Systemic disorders include

A) adhesive capsulitis.
B) verrucae.
C) osteoarthritis.
D) rheumatoid arthritis.

Question 20

The final stage of gout,characterized by crystalline deposits in cartilage,synovial membranes,and soft tissue,is called

A) tophaceous gout.
B) gouty arthritis.
C) complicated gout.
D) asymptomatic hyperuricemia.

Question 21

Characteristics of gout include (Select all that apply.)

A) disturbed uric acid metabolism.
B) crystalline deposits in bony and connective tissue.
C) onset before menopause in women.
D) cardiac involvement.
E) renal involvement.

Question 22

The chief pathologic features of osteoarthritis are

A) stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid.
B) autoimmune damage to the synovium, destruction of articular cartilage by pannus, and thickening of synovial fluid.
C) degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium.
D) thinning of the joint capsule, resorption of bone, excessive formation of new bone, and formation of bone spurs.

Question 23

Manifestations of osteoarthritis include (Select all that apply.)

A) nodules on joints of the hands.
B) crepitus with joint movement.
C) pain that is worse upon arising in the morning.
D) stiffness that worsens with joint use.
E) narrowing of joint spaces.

Question 24

The pathophysiology of rheumatoid arthritis involves

A) immune cells accumulating in pannus and destroying articular cartilage.
B) free radicals attaching to the synovial membrane and tunneling into articular cartilage.
C) excessive wear and tear and microtrauma that damage articular cartilage.
D) cysts developing in subchondral bone and creating fissures in articular cartilage.

Question 25

"Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client.The nurse's best response is

A) calcium phosphate.
B) urea.
C) uric acid.
D) beta-hydroxybutyric acid.

Question 26

Ankylosing spondylitis causes

A) intervertebral joint fusion.
B) instability of synovial joints.
C) costal cartilage degeneration.
D) temporomandibular joint degeneration.

Question 27

Signs/symptoms of Lyme disease include (Select all that apply.)

A) fever and chills.
B) migratory rash.
C) arthritic pain.
D) headache.
E) myalgia.

Question 28

"Please explain the pathophysiology of osteoarthritis to me," says another nurse."Is it just wear and tear so that the cartilage wears out?" Your best response is

A) "Yes; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation."
B) "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears."
C) "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone."
D) "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage."