last quiz

the nurse is educating a patient that is prescribed adalimumab for the treatment of psoriatic arthritis. which statement made by patient indicates that further education is required

" I should avoid large crowds and protect myself from infections"

after a bone density test, an older adult female patient tells the nurse, "I dont understand why I have osteoporosis because I eat well and take my calcium." which is the best response by the nurse

"The loss is from withdrawl of estrogen and a decrease in activity levels"

A patient tells the nurse, " I was working out and lifting weights and now that i have stopped, I am flabby and my muscles have gone!" which is best response

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued"

a patient asks the nurse why she seems to have bone changes since getting older. which is the best response by the nurse

"bone changes from aging results from a loss of calcium"

an older adult female patient tells the nurse, "I have lost an inch of height and have a hump on my back. what can i do about this?" which is the best response

"in order to prevent further bone loss, eat a diet high in calcium and low in phosphorus"

name two age related alterations in metabolism

Decreased cardiac output and decreased perfusion of liver

leading cause of injury in the older adult

Falls

a patient had a stroke and is unable to move the right upper and lower extremities. during assessment, the nurse picks up the arm and finds it limp and without tone. how will the nurse document this finding?

Flaccidity

in the human body, there are ____ bones

206

the nurse is assisting an older adult patient with dietary planning. which will the patient's daily carbohydrate intake be?

55-60%

the approximate percentage of total-body calcium present in the bones is

98%

what is the most common form of dementia

Alzheimer's disease/ vascular dementia

Bones change associated with aging frequently result from a loss of

Calcium

lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition)

scoliosis

abnormal lateral curvature of the spine

what are the clinical manifestations of gout?

acute gouty arthritis, tophi, gouty nephropathy , and uric acid urinary calculi

concept of continuing care retirement communities

aging in place, independent single dwelling, assisted living and skilled nursing services

uric acid

an increase in this substance is seen with gout

creatinine

an increase may indicate renal damage, as in scleroderma

the leading cause of musculoskeletal-related disability in the united states is

arthritis

nursing interventions can be used to help patients manage their medication and adhere to the prescribed medication regimen

ask patient or reliable informants to provide all medications for review, assess patient of knowledge of medication

when administering medications to an older patient, which medication does the nurse understand may remain in the body longer due to increased body fat?

barbiturates

the nurse assessing the genitourinary status of an older adult female patient who is experiencing stress incontinence. which finding is a common age-related finding for this population

bladder capacity decreases with advanced age

osteoblasts

bone forming cells by secreting bone matrix

a patient tells the health care provider about shoulder pain that is present even without any strenuous movement. the health care provider identifies a sac filled with synovial fluid. which condition will the nurse educate about

chronic bursitis

the rheumatoid arthritis (RA) reaction produces enzymes that break down

collagen

geriatric syndrome

common conditions found in older adults that tend to be multifactorial and do not fall under discrete disease categories; these conditions include falls, delirium, frailty, dizziness, and urinary incontinence

describes the grating, crackling sound heard over irregular joint surfaces like the knee

crepitus

a patient is being placed on a purine restricted diet. which food should be suggested by the nurse `

dairy products

the nurse is assessing a patient with a diagnosis of scleroderma. Which clinical manifestations of scleroderma does the nurse assess?

decreased ventilation owing to lung scarring. dysphagia owing to hardening of the esophagus dyspnea owing to fibrotic cardiac tissue

difference between medicare and medicaid

Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

a patient is hospitalized with a severe case of gout. the patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, which will the laboratory results reveal

hyperuricemia

the nurse performing a respiratory assessment for an older adult patient. which age-related findings could be identified with this patient

increased residual volume, loss of elastic tissue surrounding the alveoli , reduced vital capacity

what is the process of fracture healing, including the three stages of progression

Phase 1- reactive phase phase 2- preoperative phase phase 3- remodeling

inflammatory process in rheumatic disease, triggering event starts the process by activating

T lymphocytes

Prick the distal fat pad of the small finger

Ulnar

Hematocrit

a decrease can be seen in chronic inflammation

antinuclear antibody (ANA)

a positive test is associated with systemic lupus erythematosus (SLE), RA, and Raynaud's disease

what is the difference between isotonic and isometric contractions

isometric- almost all of energy is released in form of heat Isotonic- some energy is expended in mechanical work, need to generate heat is primary stimulus for muscle contraction

osteoclasts

large cells that resorb or break down bone matrix

an older adult male patient tells the nurse that he wakes several times a night to pass his urine but never feels as though he fully empties his bladder. which suggestion can the nurse make to help control this in the evening?

limit drinking a lot of fluid in the evening, especially caffeinated beverages

primary cause of age-related vision loss in the older adult is

macular degeneration

prick the top or distal surface of the index finger

median

what nursing management options exist for fibromyalgia

nurses pay attention to supporting patients with fibromyalgia and encouragement as they begin therapy

what are the general functions of the musculoskeletal system

protection for vital organs, provides sturdy framework, support body structures, produce mobility

the nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. which foods will the nurse encourage the patient to avoid

steak

red bone marrow is located in the shaft of four long and flat bones :

sternum, Ilium, vertebrae, and calcitonin

in RA, the autoimmune reaction primarily occurs in the

synovial tissue

what is psoriatic arthritis characterized by?

synovitis, polyarthritis, and spondylitis

complement

this protein substance is decreases in RA and SLE

calcium daily is essential to maintain adult bone mass

~1000-1200 mg

osteocytes

a bone cell, formed when an osteoblast becomes embedded in the matrix it has secreted. (bone maintenance in lacunae )

exacerbation

a period of time when a disease's signs and symptoms recur in all their severity after a period of remission.

remission

a period of time when symptoms disappear

the nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and which symptoms should be reported, which COX-2 inhibitor is the nruse educating the patient about

Celecoxib

the nurse is working in a long term care facility. when assessing the patients, which body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population

cardiovascular

the nurse caring for a pregnant patient with pregnancy-induced hypertension. when assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. what would the nurse document this finding as?

clonus

the nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine, which does the nurse identify this common finding as

Kyphosis

primary source of federal funding, provides nursing home care for the older adult poor

Medicare

the nurse is caring for a patient who presents with the symptom of blanching of fingers when exposed to cold. which rheumatic disorder does the nurse prepare to asses the patient for

Raynaud's phenomenon

what is the purpose of older americans act

enhance the quality of life for older Americans

what is the role of the sex hormone testosterone and estrogen on bone remodeling

estrogen stimulates osteoblasts and inhibits osteoclasts. Testosterone has both direct and indirect effects on bone growth directly causes skeletal growth in adolescence and continued effect on skeletal muscle growth throughout life span

kyphosis

excessive outward curvature of the spine, causing hunching of the back.

when the patient is taking corticosteroids for the treatment of an inflammatory rheumatic disease, which side effects should the nurse educate the patient about

fluid retention, causing swelling in your lower legs, high blood pressure, upset stomach

C-reactive protein (CRP)

frequently positive for RA and SLE

what is the theory of degradation as it relates to the pathophysiology of inflammatory rheumatic disease

genetic or hormonal influences, mechanical factor, prior joint damage causes cartilage failure

a patient is prescribed a DMARD that is successful in the treatment of rheumatoid arthritis (RA) but has side effects, including retinal eye changes, which medication does the nurse educate the patient about ?

hydroxychloroquine

how does vitamin D regulate the balance between bone formation and bone reabsorption

increases calcium in blood by promoting calcium absorption from gastrointestinal tract and accelerating mobilization of calcium from bone

synovial fluid from an inflamed joint is characteristically

milky, cloudy, and dark yellow

depression

most common affective or mood disorder of the older adult patient

a patient is suspected for having myositis. the nurse prepares the patient for which procedure that will confirm the diagnosis

muscle biopsy

what are the age related changes of the musculoskeletal system specific to bones, muscles, joints, and ligaments

muscle= rigid with age, lose tone, bones more brittle, and break easily, height decreases

age related changes reduce the efficiency of the cardiovascular system. these changes include --; which results in

myocardial hypertrophy, fibrosis, valvular stenosis, and decreased pacemaker cells ; reduced stroke volume

pathophysiology of inflammatory rheumatic disease and that of degenerative rheumatic disease

newly formed synovial tissue is infiltrated with inflammatory cells (pannus formation) and joint degeneration occurs secondary. synovitis results from mechanical irritation. secondary inflammation occurs

what nursing interventions can be used to help other adults with learning and memory

orient patient to the environment as needed if patient's short term memory

the most common symptom of inflammatory rheumatic disease that causes a patient to seek medical attention is

pain

major hormonal regulators of calcium homeostasis

parathyroid hormone and calcitonin

a patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. Which type of symptom would this be documented as?

paresthesia

A patient has a fracture treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored

perform serial X-rays

prick the skin midway between the great and second toe

peroneal

five common infections in the older adult

pneumonia, urinary tract infections, tuberculosis, gastrointestinal infection, and skin infection

a patient is seen in the office for reports of joint pain, swelling, and a low-grade fever. which laboratory studies reviewed by the nurse indicate a positive diagnosis of RA?

positive C-reactive protein (CRP) positive antinuclear antibody (ANA) serum complement level (C3) of >130 mg/dl

a patient with an acute exacerbation of arthritis is temporarily confined to bed. Which position will the nurse recommend to prevent flexion deformities

prone

Prick the skin midway between the thumb and second finger

radial

what type of exercises and precautions are used to promote mobility for a patient with an inflammatory rheumatic disease

range-of-motion, isometric, dynamic, aerobic, and pobl exercise are used to promote motility

a patient has a fracture of the right femur sustained in a motor vehicle crash. which process of fracture healing does the nurse determine will occur with this patient

reactive phase, reparative phase, remodeling phase

three goals and corresponding management strategies for the treatment of inflammatory rheumatic disease

reduction of joint stress, physical therapy, and surgical interventions

describe the patient self-determination act (PSDA)

require to inform patients of their right under state law to make decisions

a patient comes to the clinic with an inflamed wrist. How will the nurse splint the joint to immobilize it

slight dorsiflexion

purpose of a living will and a durable power of attorney, and what are their limitations

states wishes in regards to medical treatments and decisions

a patient is taking nonsteroidal anti-inflammatory drugs (NSAIDS) for the treatment of osteoarthritis. which education should the nurse give the patient about the medication

take the medication with food to avoid upset stomach

the nurse assess soft subcutaneous nodules along the line of tendons in a patient's hand and wrist. which does this finding indicate to the nurse?

the patient has rheumatoid arthritis

a patient has a serum study that is positive for the rheumatoid factor. which does the nurse identify is the significance of this test result?

the test results are suggestive for rheumatoid arthritis

with aging, there is gradual decline in

thinking and problem solving; verbal skills tend to remain intact

rheumatoid factor

this is present in 80 % of those who have RA

HLA-B27 antigen

this is present in 85% of those with ankylosing spondylitis

prick the medial and lateral surface of the sole

tibial

a patient arrives at the clinic with reports of pain in the left great toe. the nurse assess a swollen, warm, erythematous left great toe. which laboratory test will the nurse prepare the patient for to identify the cause

uric acid level

an older adult female patient informs the nurse that she is sexually active but has a problem with vaginal dryness, what can the nurse suggest to the patient that may help relieve this problem

use a water-based lubricant when having sexual intercourse

The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.)

use low-sodium herbs and spices, use pepper instead of salt, use lemon instead of salt to flavor food