Mobility

Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis? ESR Uric acid Creatinine Red blood cell count

Red blood cell count

A nurse is performing a primary survey on a patient. Place the following steps in the order in which the nurse would perform them. 1 Evaluate neurologic function 2 Assess pulses 3 Provide ventilations 4 Use the head-tilt, chin-lift manuever

Use the head-tilt, chin-lift manuever Provide ventilations Assess pulses Evaluate neurologic function

Which of the following terms refers to fixation or immobility of a joint? Diarthrodial Hemarthrosis Arthroplasty Ankylosis

Ankylosis

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? "My medications will ultimately correct my problem." "I should avoid prolonged sun exposure." "I do not need to make any changes in my diet." "My energy level will gradually increase over time."

"I should avoid prolonged sun exposure."

What should the nurse teach the patient about the diagnosis of osteoarthritis? "It affects the cartilaginous joints of the spine and surrounding tissues." "It requires early treatment because most of the damage appears to occur early in the course of the disease." "It affects young males." "It is the most common and frequently disabling of joint disorders."

"It is the most common and frequently disabling of joint disorders."

Postmenopausal women and the elderly need to consume approximately ___ mg of daily calcium.

1200

Which of the following is the definitive diagnostic of gouty arthritis? Polarized light microscopy of the synovial fluid Synovial biopsy Arthrocentesis Radiologic studies

Polarized light microscopy of the synovial fluid

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? Systemic lupus erythematosus Polymyalgia rheumatic Scleroderma Rheumatoid arthritis

Scleroderma

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. Provide diversional activities. Provide assistive devices for self-feeding. Assist the client to develop a sleep routine. Provide opportunities for the client to express concerns. Support joints with splints and pillows.

Support joints with splints and pillows. Assist the client to develop a sleep routine.

Osteoarthritis is known as a disease that

is the most common and frequently disabling of joint disorders.

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? The patient should continue taking the medication if fever occurs. The medication is administered IM. It is important to monitor for injection site reactions. The medication is given at room temperature.

It is important to monitor for injection site reactions.

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? Ice packs Surgery Opioid therapy Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nursing care for the patient with fibromyalgia should be guided by what assumption? Patients with fibromyalgia will eventually lose their ability to walk. All patients with fibromyalgia have the same type of symptoms. Patients with fibromyalgia may feel as if their symptoms are not taken seriously. Patients with fibromyalgia rarely respond to treatment.

Patients with fibromyalgia may feel as if their symptoms are not taken seriously.

Which of the following classifications are considered antiarthritic drugs? Select all that apply. Glucocorticoids Diuretics Muscle relaxants Anti-inflammatory Disease-modifying antirheumatics (DMARDs)

Anti-inflammatory Disease-modifying antirheumatics (DMARDs) Glucocorticoids

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout? Place patient on bed rest Increase fluids Insert a foley catheter Assess dietary diet and activity at home

Assess dietary diet and activity at home

While the patient is in pain, her vital signs are taken and recorded. Sodium 136 mEq/L HCT 41.6% Potassium 4.6 mEq/L HGB 12.8 g/dL Calcium 8.9 mg/dL E SR 28 mm/hr Are any of these vital signs a cause for concern?

CBC and electrolytes (sodium, potassium, calcium, HCT, and HGB) are within normal limits. The patient's ESR is high-normal, which is common in patients with osteoarthritis.

_____ syndrome, the most serious complication of casting and splinting, occurs when increased pressure within a confined space compromises blood flow.

Compartment

T/F: Osteoblasts aid in bone remodeling by dissolving and reabsorbing bone.

False; osteoclasts

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? Fatigue Ineffective airway clearance Self-care deficit: Bathing Risk for infection

Fatigue

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis? Imbalanced nutrition: greater than body requirements Chronic pain Deficient knowledge: symptom management Impaired physical mobility

Imbalanced nutrition: greater than body requirements

Which of the following is the most common joint affected in gout? Knee Metatarsophalangeal Tarsal area Ankle

Metatarsophalangeal

Which of the following disorders is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Systemic lupus erythematous (SLE) Rheumatoid arthritis Scleroderma Polymyositis

Systemic lupus erythematous (SLE)

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns? Increasing activity during the day Range-of-motion exercise prior to sleeping Tricyclic antidepressants Administering opioids at bed time

Tricyclic antidepressants

T/F: Fracture, pain, frequently described as sharp and piercing, is usually relieved by immobilization.

True

T/F: Muscle tone can be assessed by palpating the muscle while passively moving the relaxed extremity.

True

T/F: Normal synovial fluid obtained during arthrocentesis is clear, pale, straw colored, and scanty in volume.

True

T/F: Nursing assessment of the patient following the application of a body cast includes auscultation of bowel sounds every 4 to 8 hours.

True

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout? colchicine prednisone penicillamine methotrexate

colchicine

What interventions does the nurse recommend for an older adult client who is to be discharged home following total hip replacement surgery?

elevated toilet seat walker TED house

Following the application of an immobilization device, the nurse should assess the affected extremity using the five Ps:

pain pallor pulselessness paresthesia paralysis

Adequate intake of vitamin _ is essential for absorption of calcium from the gastrointestinal track and for bone mineralization.

D

Which of the following is the leading cause of disability and pain in the elderly? Rheumatoid arthritis (RA) Osteoarthritis Scleroderma SLE

Osteoarthritis

The side effect of bone marrow depression may occur with which medication used to treat gout? Prednisone Allopurinol (Zyloprim) Probenecid (Benemid) Colchicine

Allopurinol (Zyloprim)

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis? Avoid the use of topical analgesics Provide an analgesic after exercise Encourage weight loss and an increase in aerobic activity Assess for the gastrointestinal complications associated with COX-2 inhibitors

Encourage weight loss and an increase in aerobic activity

T/F: Casts made of plaster are preferred over fiberglass because they an dry in 15 minutes post-application.

False

T/F: Predicting bone fracture risk related to osteoporosis is only achieved through dual-energy x-ray absorptiometry (DXA) of the wrist.

False

T/F: The patient in Buck's extension traction may be turned from side-to-side for back every 4 hours.

False

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan? T'ai chi Yoga Jogging Pilates

Jogging

Primary gout is often caused by an inherited disorder in which type of metabolism? Carbohydrate Fat Purine Glucose

Purine

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? The medication is administered IM. The patient should continue taking the medication if fever occurs. The medication is given at room temperature. It is important to monitor for injection site reactions.

It is important to monitor for injection site reactions.

Which nursing diagnosis is most inappropriate for the client with osteoarthritis? Impaired physical mobility Imbalanced nutrition: less than body requirements Deficient knowledge: symptom management Chronic pain

Imbalanced nutrition: less than body requirements

The side effect of bone marrow depression may occur with which medication used to treat gout? Probenecid (Benemid) Allopurinol (Zyloprim) Colchicine Prednisone

Allopurinol (Zyloprim)

Which of the following refers to fixation of a joint? Articulations Ankylosis Synovitis Pannus

Ankylosis

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following? Osteoarthritis Ankylosing spondylitis Rheumatoid arthritis Gout

Gout

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process? Gout Infection Degeneration Inflammation

Gout

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Has a weight gain of 5 pounds Reports decreased joint pain Shows increased joint flexibility Reports ability to perform ADLs

Has a weight gain of 5 pounds

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? Disease-modifying antirheumatic drugs (DMARDS) Tumor necrosis factor (TNF) blockers Glucocorticoids Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? Polymyalgia rheumatic Scleroderma Rheumatoid arthritis Systemic lupus erythematosus (SLE)

Scleroderma

Scleroderma typically starts with which type of organ involvement? Lung Skin Brain Kidney

Skin

T/F: Nursing care of a patient in skeletal traction requires inspection of the pin site at least every 8 hours for sings of inflammation and evidence of infection.

True

A nurse is teaching a community group about none /health. Which recommendations should the nurse include

engage in regular weight-bearing exercise get plenty of calcium and vitamin D in the diet if diagnosed with osteoporosis, take meds as prescribed stop, or do not start, smoking

A nurse case manager is assigned to a client who will not regain mobility. What important topics does the nurse need to address in client's long-term plan of care?

informal caregivers sexuality recreation vocational adjustments

The patient with an immobilized lower extremity (cast, splint, or brace) must be assessed for _____ nervy injury which can cause footdrop.

peroneal

To prevent dislocation of a hip prosthesis, a wedge pillow should be placed between the legs to prevent _____ beyond the midline of the body.

adduction

During a health history assessment of a patient with RA, chronic HTN, and a recent CVA, she states that she takes 2 fish oil capsules (5 g) daily as a supplement for her RA. What additional question should the nurse ask? "Have you found the fish oil to help your RA?" "Does your physician know you are taking the fish oil capsules to treat your RA?" "Are you taking any anticoagulant medications as well?" "How long have you been taking the fish oil capsules?"

"Are you taking any anticoagulant medications as well?" Some supplements have been found to help decrease inflammation and prevent bone loss for patients with RA. These supplements include calcium, fish oil capsules containing omega-3 fatty acids, and gamma-linolenic acid. Calcium supplements should not be taken in excess to prevent kidney stones, and fish oil capsules should not be taken if the patient is taking anticoagulant therapy.

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"? "You have antigens to the disease, but it they do not prevent the disease." "Your symptoms are a result of your body attacking itself." "You have inherited your parent's immunity to the disease." "You are not immune to the disease causing the symptoms."

"Your symptoms are a result of your body attacking itself."

Antibiotics are given prophylactically before total knee arthroplasty and continued for __ hours postoperatively.

24

Which of the following procedures involves a surgical fusion of the joint? Osteotomy Arthrodesis Tenorrhaphy Synovectomy

Arthrodesis

The patient is a 63-year-old woman admitted to the acute medical care unit. She is 5'4" and weighs 211 lb. Her medical history includes hypertension and GERD. On admission, she reports pain in her hands and joints that is unrelieved by OTC medications. What additional assessment data should you collect from the patient at this time?

Based on her age and reports of pain, the patient is most likely experiencing osteoarthritis, which may be precipitated by her weight. It is important to know when the pain started, and she should be asked to rate her pain on a 0-10 scale. Which OTC medications has she taken? How long has she experienced this pain? Does she have a family history?

The nurse intervenes to assist the patient with fibromyalgia to cope with what symptoms? Pain, viral infection, and tremors Chronic fatigue, generalized muscle aching, and stiffness Diminished vision, chronic fatigue, and reduced appetite Generalized muscle aching, mood swings, and loss of balance

Chronic fatigue, generalized muscle aching, and stiffness

Which of the following would be consistent with the diagnosis of rheumatoid arthritis? Decreased ESR Increased C4 complement component Cloudy synovial fluid Increased red blood cell count

Cloudy synovial fluid

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? Hypertension Chest pain Behavioral changes Decreased cognitive ability

Hypertension

Which of the following is the leading cause of disability and pain in the elderly? Scleroderma Systemic lupus erythematous (SLE) Rheumatoid arthritis (RA) Osteoarthritis

Osteoarthritis

Which of the following is the most common cause for a patient to seek medical attention for arthritis? Pain Joint swelling Weakness Stiffness

Pain

What intervention is a priority for a patient diagnosed with osteoarthritis? Hydrotherapy Allopurinol (Zyloprim) Physical therapy and exercise Colchicine

Physical therapy and exercise

Which of the following medications are used in the treatment of gout? Select all that apply. Febuxostat (Uloric) Sulfasalazine (Azulfidine) Allopurinol (Zyloprim) Probenecid (Benemid) Hydroxychloroquine (Plaquenil)

Probenecid (Benemid) Allopurinol (Zyloprim) Febuxostat (Uloric)

A patient is admitted with an acute attack of gout. What interventions are essential for this patient? Select all that apply Dietary consult Probenecid (Benemid) Corticosteroid therapy Serum uric acid level Pain medications

Probenecid (Benemid) Corticosteroid therapy Pain medications Serum uric acid level

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports decreased joint pain Shows a weight gain of 2 pounds Reports increased fatigue Reports ability to perform ADLs

Reports increased fatigue

Which of the following disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Rheumatoid arthritis Polymyositis SLE Scleroderma

SLE

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on: Strategies for remaining active DMARDs therapy Detection of systemic complications Prevention of joint deformity

Strategies for remaining active

Which of the following disorders is characterized by an increased autoantibody production? Rheumatoid arthritis (RA) Polymyalgia rheumatic Systemic lupus erythematosus (SLE) Scleroderma

Systemic lupus erythematosus (SLE)

What intervention will best help the patient with ankylosing spondylitis (AS)? Have the patient do range-of-motion exercises. Teach the patient about surgery. Immobilize the patient in traction. Teach the patient to use a walker or cane.

Teach the patient to use a walker or cane.

T/F: A nurse should instruct a patient in a case, splint, or brace to perform isometric exercises to prevent disuse syndrome.

True

Which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects? Glucosamine Capsaicin Viscosupplementation Chondroitin

Viscosupplementation

Which population group is most likely to be diagnosed with fibromyalgia syndrome? Men between 30 and 50 years of age Women between 30 and 50 years of age Men between 50 and 70 years of age Women between 50 and 70 years of age

Women between 30 and 50 years of age. Most patients diagnosed with fibromyalgia syndrome are women between 30 and 50 years of age.

The presence of crystals in synovial fluid obtained from an arthrocentesis is indicative of degeneration. gout. infection. inflammation.

gout

The elbow and the knee are examples of diarthrosis joints also known as _____ joints.

hinge

Common deformities of the spine include _____, an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back and leads to a hunchback or slouching posture.

kyphosis

The most prevalent bone disease in the world is _____.

osteoporosis

Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse teaches the patient that: 1. The drug must be taken with food to prevent GI side effects. 2. All of the bisphosphonates prevent calcium from being taken from the bones. 3. Lying down after taking the drug prevents light-headedness and dizziness. 4. Taking the drug with milk enhances the absorption of calcium from the bowel.

Answer: 2 Rationale: Alendronate is a bisphosphonate that prevents calcium from being taken from the bones by inhibiting osteoclast-mediated bone resorption. Bisphosphonates should be taken with a full glass of water, 30 minutes before food or other medications, and the patient should remain upright for at least 30 minutes after administration. These precautions aid in drug absorption and decrease gastrointestinal side effects (especially esophageal irritation).

Which of the following is a plasma protein associated with the immunologic reaction? Cytokines Leukotrienes Complement Prostaglandins

Complement

______ is a procedure that allows direct visualization of a joint through the use of fiberoptic endoscope.

Athroscopy

_____ muscle contraction is characterized by shortening of the muscle without an increase in tension within the muscle.

Isotonic

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis? Encourage weight loss and an increase in aerobic activity. Assess for the gastrointestinal complications associated with COX-2 inhibitors. Avoid the use of topical analgesics. Provide an analgesic after exercise.

Encourage weight loss and an increase in aerobic activity.

Which of the following statements is accurate regarding osteoarthritis? It is caused by an overproduction of uric acid. It affects young males. It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. It is the most common inflammatory arthritic disorder.

It is a noninflammatory disorder and the most common and frequently disabling of joint disorders.

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? Erythrocyte sedimentation rate (ESR) Creatinine Uric acid Red blood cell count

Red blood cell count

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply. Dressing changes Medication dosages and side effects Safe exercise Assistive devices Narcotic safety

Safe exercise Medication dosages and side effects Assistive devices