Review Ankylosing Spondylitis

Pathophysiology of the Musculoskeletal System > Pathophysiology

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Ankylosing Spondylitis

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Question 1:

A nurse is discussing the causes of Ankylosing Spondylitis with a patient.
Which statement accurately describes a risk factor associated with this condition?

A. "Environmental factors, such as bacterial infections, are the primary cause of Ankylosing Spondylitis.” B. "Ankylosing Spondylitis predominantly affects females.” C. "The HLA-B27 gene is not associated with an increased risk of Ankylosing Spondylitis.” D. "Symptoms of Ankylosing Spondylitis typically manifest in childhood.”

Answer and Explanation

Choice A:

Environmental factors, such as bacterial infections, are the primary cause of Ankylosing Spondylitis. Rationale: Ankylosing Spondylitis (AS) is believed to have a multifactorial etiology, and while genetics play a significant role (particularly the HLA-B27 gene), environmental factors, such as bacterial infections, have been implicated in triggering the condition. Certain bacteria, such as Klebsiella pneumoniae, have been associated with AS, and their presence may exacerbate inflammation in genetically predisposed individuals. This statement accurately reflects the current understanding of AS's etiology.

Choice B:

"Ankylosing Spondylitis predominantly affects females." Rationale: This statement is incorrect. Ankylosing Spondylitis is more common in males than in females. It has a male-to-female ratio of approximately 3:1. Therefore, it predominantly affects males, not females.

Choice C:

"The HLA-B27 gene is not associated with an increased risk of Ankylosing Spondylitis." Rationale: This statement is incorrect. The HLA-B27 gene is strongly associated with an increased risk of Ankylosing Spondylitis. In fact, it is one of the most significant genetic risk factors for the development of AS. Over 90% of individuals with AS are HLA-B27 positive.

Choice D:

"Symptoms of Ankylosing Spondylitis typically manifest in childhood." Rationale: This statement is incorrect. Ankylosing Spondylitis symptoms typically do not manifest in childhood. The onset of AS symptoms usually occurs in late adolescence or early adulthood, typically between the ages of 17 and 45. It is rare for AS symptoms to appear in childhood.

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Question 2:

A client with Ankylosing Spondylitis is curious about the disease's pathophysiology.
What explanation by the nurse is correct?

A. "The inflammation in Ankylosing Spondylitis primarily occurs in the peripheral joints.” B. "Immune cells infiltrate muscles, leading to muscle wasting in Ankylosing Spondylitis.” C. "Pro-inflammatory cytokines like TNF-α and IL-17 contribute to inflammation in Ankylosing Spondylitis.” D. "The chronic inflammation in Ankylosing Spondylitis causes cartilage regeneration.”

Answer and Explanation

Choice A:

"The inflammation in Ankylosing Spondylitis primarily occurs in the peripheral joints." Rationale: This statement is incorrect. Ankylosing Spondylitis primarily affects the axial skeleton, including the spine and sacroiliac joints. Peripheral joint involvement is less common and usually occurs in the later stages of the disease.

Choice B:

"Immune cells infiltrate muscles, leading to muscle wasting in Ankylosing Spondylitis." Rationale: This statement is not accurate. Ankylosing Spondylitis primarily involves inflammation of the spine and sacroiliac joints, rather than muscle tissue. Muscle wasting is not a characteristic feature of AS.

Choice C:

"Pro-inflammatory cytokines like TNF-α and IL-17 contribute to inflammation in Ankylosing Spondylitis." Rationale: This statement is correct. Ankylosing Spondylitis is associated with increased levels of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17). These cytokines play a key role in the inflammation and tissue damage seen in AS.

Choice D:

"The chronic inflammation in Ankylosing Spondylitis causes cartilage regeneration." Rationale: This statement is not accurate. Chronic inflammation in AS can lead to structural damage and fusion of the spinal vertebrae (ankylosis), but it does not promote cartilage regeneration.

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Question 3:

A nurse is assessing a patient with Ankylosing Spondylitis.
Which of the following clinical manifestations should the nurse expect? (Select all that apply).

A. Limited range of motion in the spine. B. Pain and stiffness in the back and pelvis. C. Swelling and redness in the fingers and toes. D. Fatigue and muscle weakness. E. Skin rashes and lesions.

Answer and Explanation

Choice A:

"Limited range of motion in the spine." Rationale: Limited range of motion in the spine is a common clinical manifestation of Ankylosing Spondylitis (AS). The inflammation and eventual fusion of the spinal vertebrae can lead to stiffness and reduced flexibility in the spine.

Choice B:

"Pain and stiffness in the back and pelvis." Rationale: Pain and stiffness in the back and pelvis are hallmark symptoms of Ankylosing Spondylitis. These symptoms are typically worse in the morning and improve with physical activity.

Choice C:

"Swelling and redness in the fingers and toes." Rationale: Swelling and redness in the fingers and toes are not typical clinical manifestations of Ankylosing Spondylitis. These symptoms are more characteristic of other rheumatic conditions, such as rheumatoid arthritis.

Choice D:

"Fatigue and muscle weakness." Rationale: Fatigue and muscle weakness can be associated with Ankylosing Spondylitis, especially when the disease is active. Chronic inflammation and pain can lead to fatigue, and muscle weakness may occur as a result of reduced physical activity.

Choice E:

"Skin rashes and lesions." Rationale: Skin rashes and lesions are not common clinical manifestations of Ankylosing Spondylitis. These symptoms are more commonly associated with other autoimmune or dermatological conditions.

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Question 4:

A client with Ankylosing Spondylitis asks the nurse about treatment options.
What should the nurse include in the response?

A. "Treatment typically involves surgical joint replacement.” B. "Physical therapy and exercise are crucial components of managing Ankylosing Spondylitis.” C. "There are no effective treatments available for Ankylosing Spondylitis.” D. "Ankylosing Spondylitis is primarily managed with antibiotics.”

Answer and Explanation

Choice A:

"Treatment typically involves surgical joint replacement." Rationale: This statement is not accurate. While joint replacement surgery may be considered in severe cases of Ankylosing Spondylitis when joint damage is extensive, it is not a typical or first-line treatment option. Other conservative treatments are usually attempted before considering surgery.

Choice B:

"Physical therapy and exercise are crucial components of managing Ankylosing Spondylitis." Rationale: This statement is correct. Physical therapy and exercise play a crucial role in managing Ankylosing Spondylitis. They help improve flexibility, maintain range of motion, and strengthen the muscles supporting the spine, which can reduce pain and disability.

Choice C:

"There are no effective treatments available for Ankylosing Spondylitis." Rationale: This statement is not accurate. There are several effective treatments available for Ankylosing Spondylitis, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologic medications, and physical therapy.

Choice D:

"Ankylosing Spondylitis is primarily managed with antibiotics." Rationale: This statement is not accurate. Ankylosing Spondylitis is not primarily managed with antibiotics. While bacterial infections may be associated with AS in some cases, the mainstay of treatment is focused on controlling inflammation and managing symptoms with medications and lifestyle interventions.

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Question 5:

A nurse is planning interventions for a patient with Ankylosing Spondylitis.
Which nursing intervention is appropriate for managing this condition?

A. Encouraging the patient to avoid all physical activity to prevent joint damage. B. Administering corticosteroids to suppress the immune response. C. Teaching the patient exercises to improve posture and flexibility. D. Recommending a high-sugar diet to boost energy levels.

Answer and Explanation

Choice A:

"Encouraging the patient to avoid all physical activity to prevent joint damage." Rationale: This statement is not appropriate. While rest during periods of active inflammation may be necessary, complete avoidance of physical activity is not recommended. Physical activity and exercise, when tailored to the individual's condition, can help maintain joint flexibility and reduce pain in Ankylosing Spondylitis.

Choice B:

"Administering corticosteroids to suppress the immune response." Rationale: Corticosteroids may be used in the short term to control acute inflammation in Ankylosing Spondylitis but are not typically used as a long-term treatment due to their side effects. They are not a primary intervention for managing the condition.

Choice C:

"Teaching the patient exercises to improve posture and flexibility." Rationale: This statement is appropriate. Teaching the patient exercises to improve posture and flexibility is an essential nursing intervention for managing Ankylosing Spondylitis. These exercises can help maintain spinal mobility and reduce the risk of deformities.

Choice D:

"Recommending a high-sugar diet to boost energy levels." Rationale: Recommending a high-sugar diet is not appropriate. Ankylosing S . Questions

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Question 6:

A nurse is assessing a client with suspected Ankylosing Spondylitis.
The client complains of lower back pain and stiffness that worsens in the morning or after periods of inactivity but improves with physical activity.
Which statement accurately describes the hallmark symptom of Ankylosing Spondylitis?

A. "My pain is constant throughout the day.” B. "My pain is worse with physical activity.” C. "My pain is relieved by heat therapy.” D. "My pain radiates to my buttocks.”

Answer and Explanation

Choice A:

The hallmark symptom of Ankylosing Spondylitis is lower back pain and stiffness that worsens in the morning or after periods of inactivity but improves with physical activity. This is known as inflammatory back pain, which is characteristic of Ankylosing Spondylitis. The pain is typically most severe in the morning and gradually improves with activity as the day progresses. This pattern is due to the inflammatory nature of the condition, and it distinguishes Ankylosing Spondylitis from other causes of lower back pain.

Choice B:

This statement is incorrect. Pain in Ankylosing Spondylitis typically worsens with inactivity and improves with physical activity, which is the opposite of what is described here.

Choice C:

This statement is incorrect. Heat therapy may provide some temporary relief for muscle tension or minor aches, but it is not the primary method of relieving pain associated with Ankylosing Spondylitis.

Choice D:

This statement is incorrect. Pain radiating to the buttocks is not the hallmark symptom of Ankylosing Spondylitis. While some individuals with the condition may experience radiating pain, it is not the defining characteristic of the disease.

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Question 7:

During a nursing assessment of a client with Ankylosing Spondylitis, the nurse observes that the client is experiencing buttock pain and stiffness that may radiate to the hips and thighs.
Which statement made by the client aligns with the symptom of sacroiliitis associated with this condition?

A. "My buttock pain only occurs after physical activity.” B. "My hip pain is worse in the morning.” C. "My thigh pain improves with rest.” D. "My buttock pain sometimes extends to my hips.”

Answer and Explanation

Choice A:

This statement is incorrect. Buttock pain in Ankylosing Spondylitis is not solely related to physical activity; it can occur at any time, and it often worsens with inactivity or prolonged periods of sitting.

Choice B:

This statement is not entirely accurate. While pain in the hips can occur in Ankylosing Spondylitis, it is not limited to the morning. The hallmark feature is morning stiffness in the lower back.

Choice C:

This statement is incorrect. Pain in the thighs is not typically associated with Ankylosing Spondylitis, and it does not improve with rest.

Choice D:

This statement aligns with the symptom of sacroiliitis, which is a common feature of Ankylosing Spondylitis. Pain in the buttocks can indeed extend to the hips in individuals with this condition, especially when the inflammation affects the sacroiliac joints.

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Question 8:

A nurse is educating a client about the pharmacological management of Ankylosing Spondylitis.
Which class of medications is considered the first-line treatment to reduce inflammation and relieve pain in this condition?

A. Disease-modifying antirheumatic drugs (DMARDs). B. Nonsteroidal anti-inflammatory drugs (NSAIDs). C. Biologic agents. D. Corticosteroids.

Answer and Explanation

Choice A:

Disease-modifying antirheumatic drugs (DMARDs) are not typically considered first-line treatment for Ankylosing Spondylitis. While they are used in some cases, nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary first-line treatment for reducing inflammation and relieving pain in this condition.

Choice B:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered the first-line treatment for Ankylosing Spondylitis. They help reduce inflammation and alleviate pain in affected individuals. This class of medication is often effective in managing the symptoms of the disease.

Choice C:

Biologic agents are typically reserved for individuals with Ankylosing Spondylitis who do not respond adequately to NSAIDs or have severe, progressive disease. They are not the first-line treatment option.

Choice D:

Corticosteroids may be used in some cases to manage acute symptoms or as a short-term intervention, but they are not considered the first-line treatment for Ankylosing Spondylitis due to their potential side effects and limited long-term efficacy.

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Question 9:

During a nursing assessment of a client with Ankylosing Spondylitis, the nurse notes limited range of motion in the client's spine, resulting in decreased flexibility.
Which nursing intervention is appropriate for this client?

A. Encourage the client to avoid physical activity to prevent further discomfort. B. Recommend surgery to correct the spine's limited range of motion. C. Assist the client in performing range of motion exercises and physical therapy. D. Administer nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed.

Answer and Explanation

Choice A:

Encouraging the client to avoid physical activity is not an appropriate intervention. Physical activity and exercise, including range of motion exercises, are essential in managing Ankylosing Spondylitis. Inactivity can worsen symptoms and lead to further stiffness.

Choice B:

Recommending surgery to correct the spine's limited range of motion is not typically the first step in managing Ankylosing Spondylitis. Surgery may be considered in severe cases with spinal deformities, but it is not the initial intervention.

Choice C:

Assisting the client in performing range of motion exercises and physical therapy is an appropriate nursing intervention. These exercises help maintain and improve flexibility, reduce pain, and slow the progression of the disease. Physical therapy is a key component of Ankylosing Spondylitis management.

Choice D:

Administering nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed can help manage pain and inflammation in Ankylosing Spondylitis, but it is not a nursing intervention related to improving range of motion. It is essential to combine NSAID therapy with exercise and physical therapy for optimal management of the condition. Questions

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Question 10:

A nurse is providing education to a patient newly diagnosed with Ankylosing Spondylitis.
Which of the following statements is appropriate for the nurse to include in the teaching plan?

A. "You should avoid exercise to prevent further joint stiffness.” B. "Heat therapy is not recommended for pain relief.” C. "Proper body mechanics and posture are not essential.” D. "Using assistive devices can improve your mobility and reduce fall risk.”

Answer and Explanation

Choice A:

"You should avoid exercise to prevent further joint stiffness." This statement is not appropriate for the nurse to include in the teaching plan. Exercise is actually important for individuals with Ankylosing Spondylitis (AS) to maintain joint flexibility and mobility. Encouraging exercise is a key aspect of managing AS. Avoiding exercise can lead to increased joint stiffness and decreased mobility, which is contrary to the goals of treatment.

Choice B:

"Heat therapy is not recommended for pain relief." This statement is not accurate. Heat therapy, such as warm baths or heating pads, can be recommended for pain relief in individuals with AS. Heat helps to relax muscles, reduce pain, and improve mobility in AS patients. Therefore, the nurse should not provide this incorrect information to the patient.

Choice C:

"Proper body mechanics and posture are not essential." This statement is incorrect. Proper body mechanics and posture are essential for individuals with Ankylosing Spondylitis. Maintaining good posture and using proper body mechanics can help prevent further spinal deformities and reduce pain. The nurse should emphasize the importance of these practices in the teaching plan.

Choice D:

"Using assistive devices can improve your mobility and reduce fall risk." This is the correct answer. Using assistive devices, such as canes or walkers, can indeed improve mobility and reduce the risk of falls for individuals with AS. These devices provide stability and support when walking, which is especially important for those with spinal involvement in AS. Therefore, this statement should be included in the teaching plan to provide helpful advice to the patient.

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Question 11:

A client with Ankylosing Spondylitis reports experiencing back pain and stiffness.
Which statement by the client indicates the need for further education?

A. "I will try using heat therapy as directed for pain relief.” B. "I should avoid physical therapy to prevent worsening of my symptoms.” C. "Maintaining good posture will help minimize strain on my spine.” D. "I'll ask my healthcare team about assistive devices for mobility.”

Answer and Explanation

Choice A:

"I will try using heat therapy as directed for pain relief." This statement indicates that the client is willing to try a pain relief method, which is a positive response. Heat therapy can be a helpful strategy for managing pain in Ankylosing Spondylitis (AS). Therefore, this statement does not indicate a need for further education.

Choice B:

"I should avoid physical therapy to prevent worsening of my symptoms." This statement is concerning and indicates a need for further education. Physical therapy is an important part of managing AS, as it helps improve flexibility, maintain joint function, and reduce pain. Advising the client to avoid physical therapy could lead to worsening symptoms and decreased quality of life.

Choice C:

"Maintaining good posture will help minimize strain on my spine." This statement reflects an understanding of the importance of posture in managing AS. It is a positive response that shows the client's awareness of proper self-care techniques.

Choice D:

"I'll ask my healthcare team about assistive devices for mobility." This statement is also a positive response, as it indicates the client's willingness to explore options for improving mobility and managing their condition. Asking the healthcare team about assistive devices is a proactive step in self-care.

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Question 12:

A nurse is assessing a patient with Ankylosing Spondylitis.
Select all the appropriate nursing interventions for this patient.

A. Administering opioid pain medications as needed. B. Encouraging regular exercise and physical therapy. C. Providing emotional support and counseling for anxiety. D. Recommending smoking cessation as a preventive measure. E. Monitoring the patient's lung capacity and spinal curvature.

Answer and Explanation

Choice A:

"Administering opioid pain medications as needed." Administering opioid pain medications as needed is not typically a first-line treatment for Ankylosing Spondylitis (AS). Opioids may be reserved for severe cases or when other pain management strategies have failed. It is not a primary nursing intervention and can have side effects and risks associated with its use.

Choice B:

"Encouraging regular exercise and physical therapy." Encouraging regular exercise and physical therapy is a crucial nursing intervention for patients with AS. Exercise and physical therapy help improve mobility, maintain joint function, and reduce pain. Therefore, this intervention is appropriate and should be included in the care plan.

Choice C:

"Providing emotional support and counseling for anxiety." Emotional support and counseling for anxiety are essential for patients with AS. Chronic conditions like AS can have a significant emotional impact, and addressing the patient's mental health is an important nursing intervention.

Choice D:

"Recommending smoking cessation as a preventive measure." Smoking cessation is a relevant nursing intervention for AS patients. Smoking has been associated with worse outcomes in AS, and quitting smoking can be beneficial for overall health and symptom management.

Choice E:

"Monitoring the patient's lung capacity and spinal curvature." Monitoring lung capacity and spinal curvature is important in the assessment and management of AS. AS can affect the spine and lungs, and regular monitoring helps identify any complications or disease progression. This nursing intervention is appropriate and necessary.

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Question 13:

A client with Ankylosing Spondylitis is at risk for which of the following complications?

A. Kidney stones. B. Decreased risk of osteoporosis. C. Reduced lung capacity. D. Improved cardiovascular health.

Answer and Explanation

Choice A:

"Kidney stones." Kidney stones are not a common complication of Ankylosing Spondylitis (AS). While AS primarily affects the spine and joints, it does not directly increase the risk of kidney stones. Therefore, this choice is not the correct answer.

Choice B:

"Decreased risk of osteoporosis." AS is associated with an increased risk of osteoporosis, not a decreased risk. The chronic inflammation and reduced mobility associated with AS can contribute to bone loss, making osteoporosis a potential complication.

Choice C:

"Reduced lung capacity." Reduced lung capacity is a known complication of AS. In severe cases, AS can lead to restrictive lung disease due to the fusion of the ribs to the spine. This can restrict lung expansion and reduce lung capacity, leading to respiratory issues.

Choice D:

"Improved cardiovascular health." AS itself does not typically lead to improved cardiovascular health. In fact, chronic inflammation associated with AS may increase the risk of cardiovascular disease. Therefore, this choice is not the correct answer.

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Question 14:

A nurse is discussing preventive measures for Ankylosing Spondylitis with a patient.
What advice should the nurse provide to the patient?

A. "Avoid exercise to prevent joint stiffness.” B. "Don't worry about your posture; it won't affect your condition.” C. "Early diagnosis and prompt treatment are essential.” D. "Smoking can help reduce the risk of severe symptoms.”

Answer and Explanation

Choice A:

"Avoid exercise to prevent joint stiffness." This statement is not accurate and is not a part of the recommended management for Ankylosing Spondylitis (AS). Exercise is crucial in managing AS to prevent joint stiffness and maintain mobility. Therefore, the nurse should not provide this advice.

Choice B:

"Don't worry about your posture; it won't affect your condition." Proper posture is essential in managing AS to prevent further spinal deformities and reduce pain. This statement is not accurate and should not be included in the nurse's advice to the patient.

Choice C:

"Early diagnosis and prompt treatment are essential." This is the correct answer. Early diagnosis and prompt treatment are indeed essential in managing AS. Starting treatment early can help slow the progression of the disease and improve the patient's quality of life. Therefore, the nurse should emphasize the importance of early intervention.

Choice D:

"Smoking can help reduce the risk of severe symptoms." This statement is completely inaccurate and should not be included in the nurse's advice. Smoking is detrimental to overall health and can worsen the symptoms of AS. The nurse should strongly advise against smoking for AS patients. Questions

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Question 15:

A client with Ankylosing Spondylitis asks the nurse about treatment options.
What should the nurse include in the response?

Answer and Explanation

Choice A:

"Treatment typically involves surgical joint replacement." Rationale: This statement is not accurate.
While joint replacement surgery may be considered in severe cases of Ankylosing Spondylitis when joint damage is extensive, it is not a typical or first-line treatment option.
Other conservative treatments are usually attempted before considering surgery.

Choice B:

"Physical therapy and exercise are crucial components of managing Ankylosing Spondylitis." Rationale: This statement is correct.
Physical therapy and exercise play a crucial role in managing Ankylosing Spondylitis.
They help improve flexibility, maintain range of motion, and strengthen the muscles supporting the spine, which can reduce pain and disability.

Choice C:

"There are no effective treatments available for Ankylosing Spondylitis." Rationale: This statement is not accurate.
There are several effective treatments available for Ankylosing Spondylitis, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologic medications, and physical therapy.

Choice D:

"Ankylosing Spondylitis is primarily managed with antibiotics." Rationale: This statement is not accurate.
Ankylosing Spondylitis is not primarily managed with antibiotics.
While bacterial infections may be associated with AS in some cases, the mainstay of treatment is focused on controlling inflammation and managing symptoms with medications and lifestyle interventions.

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Ankylosing Spondylitis

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