A client has a possible connective tissue disease and the nurse ...

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A client has a possible connective tissue disease and the nurse is reviewing the client's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.)
 
  a. Elevated antinuclear antibody (ANA) - Normal value; no connective tissue disease
  b. Elevated sedimentation rate - Rheumatoid arthritis
  c. Lowered albumin - Indicative only of nutritional deficit
  d. Positive human leukocyte antigen B27 (HLA-B27) - Reiter's syndrome or ankylosing spondylitis
  e. Positive rheumatoid factor - Possible kidney disease

Question 2

A client with fibromyalgia is in the hospital for an unrelated issue. The client reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? (Select all that apply.)
 
  a. Allow the client uninterrupted rest time.
  b. Assess the client's usual bedtime routine.
  c. Limit environmental noise as much as possible.
  d. Offer a massage or warm shower at night.
  e. Request an order for a strong sleeping pill.

[jjorrostieta]

Answer to Question 1

ANS: D, E
The HLA-B27 is diagnostic for Reiter's syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia. An elevated ANA is indicative of inflammatory CTDs, although a small minority of healthy adults also have this finding. An elevated sedimentation rate indicates inflammation, whether from an infection, an injury, or an autoimmune CTD. Lowered albumin is seen in nutritional deficiencies but also in chronic infection or inflammation.

Answer to Question 2

ANS: A, B, C, D
Clients with fibromyalgia often have sleep disturbances, which can be exacerbated by the stress, noise, and unfamiliar environment of the hospital. Allowing uninterrupted rest time, adhering to the client's usual bedtime routine as much as possible, limiting noise and light, and offering massages or warm showers can help. The client does not need a strong sleeping pill unless all other options fail and the client requests something for sleep. At that point a mild sleeping agent can be tried.