BRUNNER REVIEW CHAPTER 34 2026/2027 | NURSING STUDY GUIDE,
PRACTICE QUESTIONS, ANSWERS & EXAM REVIEW
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?
a. Place client on bed rest
b. Increase fluids
c. Insert a Foley catheter
d. Assess diet and activity at home - correct answer ✔✔D
Rationale: Clients with gout need to be educated about dietary restrictions in order to prevent repeated
attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities
should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of
gout. The other interventions are not appropriate for a client with this problem.
Which finding is consistent with the diagnosis of rheumatoid arthritis?
a. Decreased ESR
b. Cloudy synovial fluid
c. Increased C4 complement component
d. Increased red blood cell count - correct answer ✔✔B
Rationale: In a client with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky,
or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.
Which is the leading cause of disability and pain in the elderly?
a. Scleroderma
b. Osteoarthritis (OA)
c. Rheumatoid arthritis (RA)
d. Systemic lupus erythematosus (SLE) - correct answer ✔✔B
Rationale: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and
scleroderma are not leading causes of disability and pain in the elderly.
Which is an appropriate nursing intervention in the care of the client with osteoarthritis?
a. Assess for gastrointestinal complications associated with COX-2 inhibitors
b. Avoid the use of topical analgesics
c. Encourage weight loss and an increase in aerobic activity
d. Provide an analgesic after exercise - correct answer ✔✔C
Rationale: Weight loss and an increase in aerobic activity such as walking, with special attention to
quadriceps strengthening, are important approaches to pain management. Clients should be assisted to
plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if
appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are
associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and
methyl salicylate may be used for pain management.
, Which points should be included in the medication teaching plan for a client taking adalimumab?
a. The medication is given at room temperature.
b. The client should continue taking the medication if fever occurs.
c. The medication is administered intramuscularly.
d. It is important to monitor for injection site reactions. - correct answer ✔✔D
Rationale: It is important to monitor for injection site reactions when taking adalimumab. The
medication is injected subcutaneously and must be refrigerated. The medication should be withheld if
fever occurs.
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue,
and cartilage?
a. Joint effusion
b. Subchondral bone
c. Pannus
d. Tophi - correct answer ✔✔D
Rationale: Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that
supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with
inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels
into the joint cavity.
The nurse is teaching a client about rheumatic disease. What statement best helps to explain
autoimmunity?
a. "You have antigens to the disease, but they do not prevent the disease."
b. "You have inherited your parent's immunity to the disease."
c. "Your symptoms are a result of your body attacking itself."
d. "You are not immune to the disease causing the symptoms." - correct answer ✔✔C
Rationale: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it.
Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other
statements do not explain autoimmunity.
Fibromyalgia is a common condition that involves...
a. chronic fatigue, generalized muscle aching, and stiffness.
b. diminished vision, chronic fatigue, and reduced appetite.
c. pain, viral infection, and tremors.
d. generalized muscle aching, mood swings, and loss of balance. - correct answer ✔✔A
Rationale: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching,
and stiffness. The cause is unknown, and no pathological characteristics specific for the condition have
been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs
may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to
improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease
muscle weakness and discomfort and to improve the general deconditioning that occurs in these
individuals.
PRACTICE QUESTIONS, ANSWERS & EXAM REVIEW
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?
a. Place client on bed rest
b. Increase fluids
c. Insert a Foley catheter
d. Assess diet and activity at home - correct answer ✔✔D
Rationale: Clients with gout need to be educated about dietary restrictions in order to prevent repeated
attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities
should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of
gout. The other interventions are not appropriate for a client with this problem.
Which finding is consistent with the diagnosis of rheumatoid arthritis?
a. Decreased ESR
b. Cloudy synovial fluid
c. Increased C4 complement component
d. Increased red blood cell count - correct answer ✔✔B
Rationale: In a client with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky,
or dark yellow and contains numerous inflammatory components, such as leukocytes and complement.
Which is the leading cause of disability and pain in the elderly?
a. Scleroderma
b. Osteoarthritis (OA)
c. Rheumatoid arthritis (RA)
d. Systemic lupus erythematosus (SLE) - correct answer ✔✔B
Rationale: Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and
scleroderma are not leading causes of disability and pain in the elderly.
Which is an appropriate nursing intervention in the care of the client with osteoarthritis?
a. Assess for gastrointestinal complications associated with COX-2 inhibitors
b. Avoid the use of topical analgesics
c. Encourage weight loss and an increase in aerobic activity
d. Provide an analgesic after exercise - correct answer ✔✔C
Rationale: Weight loss and an increase in aerobic activity such as walking, with special attention to
quadriceps strengthening, are important approaches to pain management. Clients should be assisted to
plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if
appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are
associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and
methyl salicylate may be used for pain management.
, Which points should be included in the medication teaching plan for a client taking adalimumab?
a. The medication is given at room temperature.
b. The client should continue taking the medication if fever occurs.
c. The medication is administered intramuscularly.
d. It is important to monitor for injection site reactions. - correct answer ✔✔D
Rationale: It is important to monitor for injection site reactions when taking adalimumab. The
medication is injected subcutaneously and must be refrigerated. The medication should be withheld if
fever occurs.
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue,
and cartilage?
a. Joint effusion
b. Subchondral bone
c. Pannus
d. Tophi - correct answer ✔✔D
Rationale: Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that
supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with
inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels
into the joint cavity.
The nurse is teaching a client about rheumatic disease. What statement best helps to explain
autoimmunity?
a. "You have antigens to the disease, but they do not prevent the disease."
b. "You have inherited your parent's immunity to the disease."
c. "Your symptoms are a result of your body attacking itself."
d. "You are not immune to the disease causing the symptoms." - correct answer ✔✔C
Rationale: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it.
Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other
statements do not explain autoimmunity.
Fibromyalgia is a common condition that involves...
a. chronic fatigue, generalized muscle aching, and stiffness.
b. diminished vision, chronic fatigue, and reduced appetite.
c. pain, viral infection, and tremors.
d. generalized muscle aching, mood swings, and loss of balance. - correct answer ✔✔A
Rationale: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching,
and stiffness. The cause is unknown, and no pathological characteristics specific for the condition have
been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs
may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to
improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease
muscle weakness and discomfort and to improve the general deconditioning that occurs in these
individuals.
