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Rheumatoid vs. Osteoarthritis: Signs, Symptoms, and Treatment, Exams of Nursing

A comprehensive comparison of rheumatoid arthritis (ra) and osteoarthritis (oa), highlighting key differences in their causes, symptoms, and treatment approaches. It includes multiple-choice questions and answers that test understanding of the key concepts related to these conditions. Particularly useful for students in healthcare fields, such as nursing and medical assisting, who need to understand the differences between these two common forms of arthritis.

Typology: Exams

2024/2025

Available from 12/06/2024

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THE GLOBE

  1. Gold sodium thiomalate is prescribed to a client with rheumatoid arthritis. Which of the following side effects indicates an overdosage of the medication? A. Flushing. B. Dizziness. C. Joint pain. D. Metallic taste. - - correct ans- - 1. Answer: D. Metallic taste. D: Gold sodium thiomalate toxicity signs are pruritus, diarrhea, dermatitis, stomatitis, and metallic taste. A&B: Flushing and dizziness are the side effects that may occur soon after the injection. C: Increased joint pain may occur 1-2 days after the injection.
  2. Adalimumab (Humira) is given to a client for the treatment of rheumatoid arthritis. Which of the following side effect is associated with the medication? A. Numbness. B. Diarrhea. C. Urinary retention. D. Weight gain. - - correct ans- - Answer: A. Numbness. A: Adalimumab (Humira) has been associated with neurological side effects such as numbness, tingling, dizziness, visual disturbances, and weakness in the legs). B, C, D: Options B, C, and D are not associated with the use of medication.
  1. A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to? A. Clay-colored stool is a normal response of the treatment. B. Pregnancy is not contraindicated with the use of the medication. C. Strict hand washing. D. Get a daily source of sunlight during the day. - - correct ans- - 3. Answer: C. Strict hand washing. C: Clients taking Methotrexate are more likely to get infections or may worsen any current infections. Therefore, hand washing will help to prevent the spread of infection. A: Option A is a sign of a liver toxicity and the physician should be notified of it. B: Pregnancy is not allowed during the treatment. D: Photosensitivity may happen during the treatment so the client is advised to wear sunscreen or any protective gear against the sunlight.
  2. Mr. Mc Princeton who is diagnosed with rheumatoid arthritis (RA) complains about joints that always hurt, saying, "I just feel like staying in bed all day." Which discharge instruction would be aimed at maintaining as such function as possible? A. "Refrain from exercise because it only aggravates the disease process." B. "Apply elastic bandages to all joints to increase the pain threshold." C. "Maintain a supine position most of the day to prevent the stress of weight bearing." D. "Promote aquatic (water) exercises to enhance joint mobility." - - correct ans- - 4. Answer: D. "Promote aquatic (water) exercises to enhance joint mobility." D: Water exercises are excellent because water promotes buoyancy, which eases joint movement. A: Persons with RA should maintain an active exercise program to strengthen and preserve muscle movement. B: Elastic bandage wraps would not be helpful.

C: Being active instead of just lying supine all day could help strengthen the muscles and joints.

  1. The classic signs and symptoms of rheumatoid arthritis include which of the following? A. Pain on weight-bearing, rash and low-grade fever. B. Joint swelling, joint stiffness in the morning and bilateral joint movement. C. Crepitus, development of Heberden's nodes and anemia. D. Fatigue, leucopenia and joint pain. - - correct ans- - 5. Answer: B. Joint swelling, joint stiffness in the morning and bilateral joint movement. B: Joint swelling, joint stiffness in the morning and bilateral joint movement are the classic signs of rheumatoid arthritis. A, C, D: The other symptoms are not found on a patient with rheumatoid arthritis.
  2. Your patient has arthritis that affects the weight-bearing joints such as the hands, knees, hips, and spine. This type of arthritis is most likely:* A. Rheumatoid arthritis B. Osteoarthritis - - correct ans- - The answer is B. Osteoarthritis is a form of arthritis that causes deterioration of the articular hyaline cartilage of the bones. It affects the weight- bearing joints. This can include the hands, knees, hips, and spine because these joints experience a lot of stress.
  3. Select all the risk factors for developing osteoarthritis:* A. Malnutrition B. Obesity C. Manual labor jobs D. Premature birth E. Older age

F. Diabetes - - correct ans- - The answers are B, C, and E. These are risk factors for developing OA. In addition, repeated joint injuries and genetics can play a role in developing OA.

  1. ____________ affects the joints in a symmetrical fashion.* A. Osteoarthritis B. Rheumatoid arthritis - - correct ans- - The answer is B. RA affects the joints in a symmetrical fashion. It is UNsymmetrical in OA. RA most commonly affects the fingers and wrist but can also affect the neck, shoulders, elbows, ankles, knee, and feet.
  2. Which patient below is presenting with signs and symptoms of rheumatoid arthritis? Select all that apply:* A. A 35 year old patient who has severe morning stiffness for 45 minutes. B. A 45 year old male with crepitus in the right knee. C. A 30 year old female with warm, red, soft joints on the hands and wrist. D. A 40 year old male whose x-ray imaging results showed osteophytes formation and decreased joint space in the left knee. - - correct ans- - The answer is A and C. These are common findings in RA. However, options B and D are found in OA.
  3. You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition:* A. Herberden's Node B. Morning stiffness for less than 30 minutes C. Soft, tender, warm joints D. Fever E. Anemia F. Hard and bony joints G. Crepitus

H. Bouchard's Node - - correct ans- - The answers are A, B, F, G, and H. These are common findings found in osteoarthritis. Options C, D, and E are found in rheumatoid arthritis.

  1. ________________ is a form of arthritis that is an autoimmune condition that causes inflammation within the joints, specifically the synovium.* A. Rheumatoid arthritis B. Osteoarthritis - - correct ans- - The answer is A. Rheumatoid arthritis is an autoimmune condition that causes inflammation of the synovium. Osteoarthritis is a type of arthritis that causes deterioration of the articular hyaline cartilage of the bone.
  2. Which statement is FALSE concerning rheumatoid arthritis?* A. Rheumatoid arthritis most commonly affects the fingers and wrist. B. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. C. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). D. Ankylosis can occur in severe cases of rheumatoid arthritis. - - correct ans- - The answer is B. This statement is false. It should say that, "Rheumatoid arthritis is different from osteoarthritis in that it DOES (not doesn't) affect other systems of the body. RA is systemic, while OA only affects the joints. This is why a fever and anemia can present in RA.
  3. You are assessing the diagnostic testing results for a patient that has rheumatoid arthritis. What result is NOT an indicator of this disease?* A. Elevated erythrocyte sedimentation B. X-ray imaging showing osteophyte formation C. Positive c-reactive protein D. Positive rheumatoid factor - - correct ans- - The answer is B. This is found in osteoarthritis NOT rheumatoid arthritis. Osteophytes (bones spurs) are only found in OA.
  1. During a head-to-toe assessment of a patient with arthritis, you note bony outgrowths on the proximal interphalangeal joint. These outgrowths are known as __________ and occur in ______________.* A. Heberden's Node, osteoarthritis B. Bouchard's Node, rheumatoid arthritis C. Heberden's Node, rheumatoid arthritis D. Bouchard's Node, osteoarthritis - - correct ans- - The answer is D. Bouchard's Node are bony outgrowths on the proximal interphalangeal joint (middle joint of the finger and occur in osteoarthritis). Heberden's Node occur on the distal interphalangeal joint (finger joint closet to the fingernail).
  2. A patient is newly diagnosed with osteoarthritis. Which medication below is NOT ordered to treat this condition?* A. NSAIDs B. Intra-articular corticosteroids C. DMARDs D. Glucosamine - - correct ans- - The answer is C. DMARDs (disease-modifying antirheumatic drugs) are ordered in rheumatoid arthritis NOT osteoarthritis. These drugs suppress the immune system from attacking the joint along with helping slow down the destruction of the disease on the joints and bones. All the other options are drugs that can be prescribed in OA.
  3. Nurse Kaye is carrying out her operative teachings for an older client who will have cataract surgery on the right eye. The nurse concludes that the client needs further understanding about the teachings if he says: A. "I will sleep on my left side after surgery." B. "I will wipe my nose gently if it is congested after surgery." C. "I will call my physician if I have sharp and sudden pain or a fever after surgery."

D. "I will bend below my waist frequently to increase circulation after surgery." - - correct ans- - 1. Answer: D. "I will bend below my waist frequently to increase circulation after surgery." D: Immediately after the procedure, the client should avoid bending over, to prevent putting extra pressure on the eye. A: Sleeping on the left side avoids injuring the operated side. B: Wiping the nose gently avoids increasing the intraocular pressure. C: The patient must recognize any signs and symptoms of complications.

  1. After cataract surgery, the patient is encouraged to: A. Maintain bed rest for 1 week. B. Lie on his or her stomach while sleeping. C. Avoid bending his or her head below the waist. D. Lift weights to increase muscle strength. - - correct ans- - 2. Answer: C. Avoid bending his or her head below the waist. C & B: Bending the head below the waist and lying on the stomach increase the intraocular pressure and affect the newly operated eye. A: Bed rest for a week is unnecessary for post cataract surgery patients. D: Lifting heavy objects ate contraindicated after a cataract surgery.
  2. Upon assessment, the patient told the nurse that she was experiencing the three common symptoms found with cataracts and these are listed below except for: A. Blurred vision. B. Glare. C. Halos. D. Eye pain. - - correct ans- - 3. Answer: D. Eye pain. D: Pain is not present in cataract; only in glaucoma. A, B, C are the three common symptoms found with cataract.
  1. On ophthalmic examination, the physician noted the major objective finding seen with cataracts: A. Tunnel vision. B. Glare. C. Opaque lens. D. Eye pain. - - correct ans- - 4. Answer: C. Opaque lens. C: The lens of the eye turns milky white in cataracts, and this is the major objective finding seen. A & D: Tunnel vision and eye pain are common in patients with glaucoma. B: Patients with cataracts experience glare, but this is not a major finding in cataract
  2. The nurse is right when she instructs the patient to avoid: A. Getting up from bed for 2 weeks after surgery. B. Chewing on the same side of the operated area. C. Taking anticoagulants. D. Using eyeglasses when going outside. - - correct ans- - 5. Answer: C. Taking anticoagulants. C: Taking anticoagulants predisposes the patient to hemorrhage A & B: Complete bed rest for 2 weeks and chewing on the side of the operated area unnecessary for a post cataract surgery patient D: The sunglasses protect the eyes from potential infectious agents such as dust and smoke. Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client's chart and understands that normal intraocular pressure is:
  3. 2-7 mmHg
  1. 10-21 mmHg
  2. 22-30 mmHg
  3. 31-35 mmHg - - correct ans- - Answer: 2. 10-21 mmHg Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered within normal range. The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is:
  4. "Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan."
  5. "Your vision will return as soon as the medications begin to work."
  6. "Your vision will never return to normal."
  7. "Your vision loss is temporary and will return in about 3-4 weeks." - - correct ans- - Answer: 1. "Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option C does not provide reassurance to the client. The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care?
  8. Decrease fluid intake to control the intraocular pressure
  9. Avoid overuse of the eyes
  10. Decrease the amount of salt in the diet
  11. Eye medications will need to be administered lifelong. - - correct ans- - Answer: 4. Eye medications will need to be administered lifelong. The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life.

Which of the following instruments is used to record intraocular pressure?

  1. Goniometer
  2. Ophthalmoscope
  3. Slit lamp
  4. Tonometer - - correct ans- - Tonometer A tonometer is a device used in glaucoma screening to record intraocular pressure. A goniometer measures joint movement and angles. An ophthalmoscope examines the interior of the eye, especially the retina. A slit lamp evaluates structures in the anterior chamber in the eye. When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress?
  5. Glaucoma is easily corrected with eyeglasses
  6. White and Asian individuals are at the highest risk for glaucoma.
  7. Yearly screening for people ages 20-40 years is recommended.
  8. Glaucoma can be painless and vision may be lost before the person is aware of a problem. - - correct ans- - 23. Answer: 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem. Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened. For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications?
  9. Acetazolamide (Diamox)
  1. Atropine
  2. Furosemide (Lasix)
  3. Urokinase (Abbokinase) - - correct ans- - Answer: 1. Acetazolamide (Diamox) Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren't used for the treatment of glaucoma. The nurse is developing a plan of care for the client scheduled for cataractsurgery. The nurse documents which more appropriate nursing diagnosis in the plan of care?
  4. Self-care deficit
  5. Imbalanced nutrition
  6. Disturbed sensory perception
  7. Anxiety - - correct ans- - Answer: 3. Disturbed sensory perception The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed sensory perception (visual) related to lens extraction and replacement. Although the other options identify nursing diagnoses that may be appropriate, they are not related specifically to cataract surgery. The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is:
  8. Eye pain
  9. Floating spots
  10. Blurred vision
  11. Diplopia - - correct ans- - Answer: 3. Blurred vision A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled?

  1. An osmotic diuretic
  2. A miotic agent
  3. A mydriatic medication
  4. A thiazide diuretic - - correct ans- - Answer: 3. A mydriatic medication A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract. During the early postoperative period, the client who had a cataractextraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to:
  5. Call the physician
  6. Administer the ordered main medication and antiemetic
  7. Reassure the client that this is normal.
  8. Turn the client on his or her operative side - - correct ans- - Answer: 1. Call the physician Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to the physician immediately. The other options are inappropriate. The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions?
  9. "I will take Aspirin if I have any discomfort."
  10. "I will sleep on the side that I was operated on."
  11. "I will wear my eye shield at night and my glasses during the day."
  1. "I will not lift anything if it weighs more that 10 pounds." - - correct ans- - Answer: 3. "I will wear my eye shield at night and my glasses during the day." The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is instructed to take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the body on which the operation occurred. The client is not to lift more than 5 pounds. Cataract surgery results in aphakia. Which of the following statements best describes this term?
  2. Absence of the crystalline lens
  3. A "keyhole" pupil
  4. Loss of accommodation
  5. Retinal detachment - - correct ans- - Answer: 1. Absence of the crystalline lens Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction. A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the client's wife to:
  6. Feed him soft foods for several days to prevent facial movement
  7. Keep the eye dressing on for one week
  8. Have her husband remain in bed for 3 days
  9. Allow him to walk upstairs only with assistance. - - correct ans- - Answer: 4. Allow him to walk upstairs only with assistance. Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs when the eyes cannot accommodate. Therefore, the client should walk up and down stairs only with assistance.
  1. Based on the nurse's understanding of the physiology of bone and cartilage, the injury that the nurse would expect to heal most rapidly is a a. fracture of the midhumerus. b. torn knee cruciate ligament. c. fractured nose. d. severely sprained ankle. - - correct ans- - Answer: A Rationale: Bone is dynamic tissue that is continually growing. Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal. Cognitive Level: Application Text Reference: p. 1615 Nursing Process: Assessment NCLEX: Physiological Integrity
  2. The nurse is assessing the passive range of motion of a patient's shoulder. The patient complains of pain during circumduction when the nurse moves the arm behind the patient. Which question should the nurse ask? a. "Do you ever have trouble making it to the toilet?" b. "Do you have difficulty in putting on a jacket?" c. "Are you able to feed yourself without difficulty?" d. "How well are you able to sleep at night?" - - correct ans- - Answer: B Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient's ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping. Cognitive Level: Application Text Reference: pp. 1620- 1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
  1. When the health care provider tells a patient that the pain in the patient's knee is caused by bursitis, the patient asks the nurse to explain just what bursitis is. The nurse's best response would be to tell the patient bursitis is an inflammation of a. the fibrocartilage that acts as a shock absorber in the knee joint. b. a small, fluid-filled sac found at many joints. c. any connective tissue that is found supporting the joints of the body. d. the synovial membrane that lines the area between two bones of a joint. - - correct ans- - Answer: B Rationale: Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa. Cognitive Level: Comprehension Text Reference: p. 1618 Nursing Process: Implementation NCLEX: Physiological Integrity
  2. During assessment of the musculoskeletal system of a 74-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit two years ago. The nurse will plan to teach the patient about a. diskography studies. b. magnetic resonance imaging (MRI). c. dual-energy x-ray absorptiometry (DEXA). d. myelographic testing. - - correct ans- - Answer: C Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis. Cognitive Level: Application Text Reference: pp. 1619, 1625

Nursing Process: Planning NCLEX: Health Promotion and Maintenance

  1. When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for the patient who reports a. that a parent became much shorter with aging. b. a sprained ankle 2 years previously. c. a family history of tuberculosis. d. taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches. - - correct ans- - Answer: A Rationale: A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
  2. Which information obtained during the nurse's assessment of the patient's nutritional- metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient is 5 ft 2 in and weighs 180 lb. b. The patient prefers whole milk to nonfat milk. c. The patient dislikes fruits and vegetables. d. The patient takes a multivitamin daily. - - correct ans- - Answer: A Rationale: The patient's height and weight indicate obesity, which places stress on weight- bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.

Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

  1. When the nurse is assessing a new patient in the clinic, which information about the patient's medications will be of most concern? a. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." b. The patient takes a daily multivitamin and calcium supplement. c. The patient has severe asthma and requires frequent therapy with steroids. d. The patient has migraine headaches which are treated with NSAIDs. - - correct ans- - Answer: C Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1619 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
  2. While testing the patient's muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient's muscle strength as level a. 1. b. 2. c. 3. d. 4. - - correct ans- - Answer: C

Rationale: A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance. Cognitive Level: Comprehension Text Reference: p. 1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

  1. When assessing the musculoskeletal system, the nurse's initial action will usually be to a. have the patient move the extremities against resistance. b. feel for the presence of crepitus during joint movement. c. observe the patient's body build and muscle configuration. d. check active and passive range of motion for the extremities. - - correct ans- - Answer: C Rationale: The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection. Cognitive Level: Comprehension Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
  2. A patient is seen at the urgent care center following a blunt injury to the left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient's knee, the nurse would expect the aspirated fluid to appear a. sanguineous. b. purulent and thick.

c. straw colored. d. white, thick, and ropelike. - - correct ans- - Answer: A Rationale: The patient's clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection. Cognitive Level: Comprehension Text Reference: p. 1628 Nursing Process: Assessment NCLEX: Physiological Integrity

  1. A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, the nurse would expect the patient to be evaluated with a. radioisotope bone scanning. b. arthroscopy. c. standard x-rays. d. magnetic resonance imaging (MRI). - - correct ans- - Answer: D Rationale: MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints. Cognitive Level: Comprehension Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity
  2. A patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to a. start an intravenous line. b. screen the patient for shellfish allergies.

c. teach the patient that DEXA is noninvasive. d. give an oral sedative. - - correct ans- - Answer: C Rationale: DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Implementation NCLEX: Physiological Integrity

  1. A patient has a new order for open magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI? a. The patient is claustrophobic. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient has a pacemaker. - - correct ans- - Answer: D Rationale: Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? - - correct ans- - "Weakness and fatigue commonly occur and will diminish with continued medication use."

A client diagnosed with gout has been started on medication therapy with allopurinol (Zyloprim). The nurse reinforces teaching with this client regarding which point about this medication? - - correct ans- - "It is important to drink 3 L of fluid per day." A client has a new medication prescription for allopurinol (Zyloprim). A practical nursing student co-assigned with the licensed practical nurse (LPN) states, "I know this is for gout, but how does it work?" In formulating a response, the LPN includes that allopurinol works in which manner? - - correct ans- - Decreases uric acid production Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse evaluates that the medication is having the intended effect if which finding is noted in the client? - - correct ans- - Decreased muscle spasms A licensed practical nurse (LPN) is told that baclofen (Lioresal) is prescribed for an assigned client. The LPN questions the registered nurse about the health care provider's prescription if which condition is noted on the client problem list? - - correct ans- - Seizure disorder A client with osteoarthritis is receiving diclofenac sodium (Voltaren). The licensed practical nurse (LPN) reviewing the client's medication prescription sheet should verify the prescription with the registered nurse (RN) if which other medication is listed? - - correct ans- - Warfarin (Coumadin) The nurse is caring for a client with a diagnosis of gout. Which laboratory value should the nurse expect to note in the client? - - correct ans- - Uric acid level of 8 mg/dL Baclofen (Lioresal) is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching? - - correct ans- - Photosensitivity

A client has been taking indomethacin (Indocin) for gout and experiencing side/adverse effects. Which assessment should the nurse expect the health care provider to prescribe? -

  • correct ans- - Checking for occult blood The nurse is caring for a client with Paget's disease of the bone. The nurse understands that the client is receiving calcitonin (Cibacalcin) to produce which effect? - - correct ans- - Decrease bone reabsorption. A client with a history of spinal cord injury is beginning medication therapy with baclofen (Lioresal). The nurse who is providing medication information should caution the client about which side effect of this medication? - - correct ans- - Drowsiness Differentiate between rheumatoid arthritis and OA in terms of joint involvement. - - correct ans- - Rheumatoid arthritis occurs bilaterally. OA occurs asymmetrically. Identify the categories of drugs commonly used to treat arthritis. - - correct ans- - NSAIDs, of which salicylates are the cornerstone of treatment, and corticosteroids (used when arthritic symptoms are severe). Identify pain relief interventions for clients with arthritis. - - correct ans- - Warm, moist heat (compresses, baths, showers); diversionary activities (imaging, distraction, self-hypnosis, biofeedback); and medications. What measures should the nurse encourage female clients to take to prevent osteoporosis? - - correct ans- - Possible estrogen replacement after menopause, high calcium and vitamin D intake beginning in early adulthood, calcium supplements after menopause, and weight-bearing exercise

What are the common side effects of salicylates? - - correct ans- - GI irritation, tinnitus, thrombocytopenia, mild liver enzyme elevation What is the priority nursing intervention used with clients taking NSAIDs? - - correct ans- - Administer or teach clients to take drugs with food or milk. List three of the most common joints that are replaced. - - correct ans- - Hip, knee, finger Describe postoperative residual limb (stump) care (after amputation) for the first 48 hours.

    • correct ans- - Elevate residua limb for first 24 hours. Do not elevate residual limb after 48 hours. Keep residual limb in extended position, and turn client to prone position three times a day to prevent flexion contractions. Describe nursing care for the client who is experiencing phantom pain after amputation. - - correct ans- - Be aware that phantom pain is real and will eventually disappear. Administer pain medication; phantom pain responds to medication. A nurse discovers that a client who is in traction for a long bone fracture has a slight fever, is short of breath, and is restless. What does the client most likely have? - - correct ans- - A fat embolism, characterized by hypoxemia, respiratory distress, irritability, restlessness, fever and petechiae What are the immediate nursing actions if fat embolization is suspected in a client with a fracture or other orthopedic condition? - - correct ans- - Notify physician state, draw blood gases, administer O2 according to blood gas results, assist with endotracheal intubation and treatment of respiratory failure List three problems associated with immobility. - - correct ans- - Venous thrombosis, urinary calculi, skin integrity problems

List three nursing interventions for the prevention of thromboembolism in immobilized clients with musculoskeletal problems. - - correct ans- - Passive ROM exercises; elastic stockings; elevation of foot of bed 25 degrees to increase venous return Allopurinol - - correct ans- - Medication given for prevention of gout. It can take several months to become effective. Gout is the buildup of uric acid deposited in the joints that causes pain and inflammation. Should take with a glass of water and increase daily fluid intake to prevent kidney stones. Can also take with food or following a meal ANY RASH SHOULD BE REPORTED IMMEDIATELY AND CLIENT STOPS MEDICATION. Can lead to steven johnsons syndrome (Super anaphlyaxis) Methotrexate - - correct ans- - Nonbiologic Disease-modifying antirheumatic drug used for RHEUMATOID ARTHRITIS. Adverse effects include bone marrow suppression, hepatotoxicity, and GI irritation Bone marrow suppression can lead to anemia, leukopenia, and thrombocytopenia. Anemia leads to fatigue, dyspnea on EXERTION, and pallor. Leukopenia increases risk for infection Thrombocytopenia presents as petechiae, purpura, or bleeding. Stomatitis (Inflammation of the mouth, oral ulcers) is a common side effect

Boston Brace, Wilmington Brace, Milwaukee brace - - correct ans- - Used to diminish the progression of deformed spinal curves in scoliosis. Braces DO NOT CURE but prevent further worsening. Patients should wear cotton t-shirt under the brace to decrease skin irritation and absorb sweat. The use of lotion or powder can cause skin irritation due to heat buildup under the brace. The exact course of treatment varies but braces are worn for 18-23 hours and taken off during bathing and exercise. NEVER SHOWER WITH BRACE. Rheumatoid Arthritis Morning Routine - - correct ans- - Warm shower or bath immediately after getting out of bed Perform range of motion exercises Eat a balanced breakfast Take NSAID medication Tumor Necrosis Factor Inhibitors (3) - - correct ans- - Infliximab Adalimumab Etanercept