Musculoskeletal EAQ
During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis? a. A measurable loss of height b. The presence of bowed legs c. Poor appetite and aversion to dairy products d. Development of unstable, wide-gait ambulation
a. (A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis, in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis, but are not indicative of osteoporosis. A wide gait is used to support balance and does not indicate osteoporosis.)
A patient is suspected of having systemic lupus erythematosus (SLE). Which would be considered diagnostic for systemic lupus erythematosus? a. Anti-Smith antibody b. Lupus erythematosus c. Swan-neck deformity d. Raynaud's phenomenon
a. (Anti-Smith antibodies, swan-neck deformity, antinuclear antibodies, and Raynaud's phenomenon are all found in patients with systemic lupus erythematosus (SLE). Anti-Smith antibodies are present in 30 to 40 percent of patients with lupus and are almost always considered diagnostic of SLE. The lupus erythematosus cell prep test is nonspecific to SLE. Hence, it is not diagnostic of SLE. Swan-neck deformity is not specific to SLE. It is also found in patients with rheumatoid arthritis. Raynaud's phenomenon is also found in other diseases, such as scleroderma.)
The nurse is completing an admission history for a patient with osteoarthritis who has been admitted for a knee arthroplasty. When the nurse asks the patient why the procedure is being performed, what does the nurse anticipate the patient will state? a. "I have chronic knee pain." b. "I have a fractured patella." c. "I have frequent and multiple falls." d. "My knee needs to be totally immobilized."
a. (The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. A fractured patella would be the result of a fall or trauma, not osteoarthritis. Frequent and multiple falls are not associated with osteoarthritis, and although pain is chronic, the knee will not be completely immobilized.)
A patient is experiencing osteoarthritis. Which finding on the x-ray report of a patient experiencing osteoarthritis indicates that the patient is developing a permanent limitation of motion? a. Joint-space narrowing b. Dislocation of the joint c. Increased synovial fluid d. A thickened synovial membrane
a. (The x-ray for a patient diagnosed with osteoarthritis with permanent limitation of motion would show joint-space narrowing. Dislocation of the joint occurs with fractures. Increased synovial fluid indicates the presence of infection or inflammation in the joint. A thickened synovial membrane would be seen with degenerative joint diseases.)
The nurse suspects that a patient is at a high risk of developing osteoporosis. The nurse made this conclusion based on which statement made by the patient? a. "I do not perform any weight-bearing exercises." b. "I take folic acid supplements on a regular basis." c. "I take cod liver oil supplements on a regular basis." d. "I refrain from following drastic diets for weight loss."
a. (Weight-bearing exercises improve bone health and reduce the risk of osteoporosis in patients. Therefore, a patient who refrains from performing weight-bearing exercises has an increased risk of osteoporosis. Folic acid supplements do not decrease calcium absorption and do not cause osteoporosis. Cod liver oil is a rich source of vitamin D. Therefore, taking cod liver oil supplements reduces the risk of osteoporosis. The patient should abstain from following drastic diets, because they cause nutritional deficiencies and increase the risk of osteoporosis.)
The community health nurse is teaching a group of adults about prevention of osteoarthritis (OA). What important teaching points should the nurse include? Select all that apply. a. Eat a balanced diet. b. Avoid cigarette smoking. c. Maintain a healthy weight. d. Take a low-dose aspirin daily. e. Consume a diet high in carbohydrates.
a., b., c. (Prevention measures for OA include eating a balanced diet, avoiding cigarette smoking, and maintaining a healthy weight. Taking daily low-dose aspirin may be effective for preventing cardiac disease, but it does not prevent osteoarthritis. Consuming a diet high in carbohydrates will not prevent OA and may result in excess weight gain, which places more stress on body joints.)
The patient with fibromyalgia has pain at 12 of the 18 identification sites, including the neck and upper back and the knees. The patient also reports nonrefreshing sleep, depression, and being anxious when dealing with multiple tasks. About what treatments should the nurse teach this patient? Select all that apply. a. Antiseizure drug pregabalin b. Low-impact aerobic exercise c. Relaxation strategy (biofeedback) d. Morphine sulfate extended release tablets e. Serotonin reuptake inhibitor (e.g. sertraline)
a., b., c., e. (Low impact aerobic exercise will prevent muscle atrophy without increasing pain at the knees. Relaxation can help decrease the patient's stress and anxiety. Because the treatment of fibromyalgia is symptomatic, this patient will be prescribed something for pain, such as pregabalin, and a serotonin reuptake inhibitor for depression. Long-acting opioids generally are avoided unless pain cannot be relieved by other medications.)
A nurse is reviewing subjective and objective data from the examination of a patient with rheumatoid arthritis. Which assessment findings indicate rheumatoid arthritis? Select all that apply. a. Joint stiffness b. Dry, itchy eyes c. Rheumatoid nodules d. High white blood cell (WBC) count e. Mouth infection and dental caries
a., c., d. (Joint stiffness, rheumatoid nodules, and high WBC count indicate rheumatoid arthritis. In rheumatoid arthritis, the inflammation and fibrosis of the joint components may cause joint stiffness. Rheumatoid nodules are subcutaneous firm, nontender, granuloma-type masses. These nodules are usually located over the extensor surfaces of joints such as fingers and elbows. A high WBC count is due to the ongoing inflammatory process. Dry itchy eyes may be indicative of Sjögren's syndrome, which diminishes lacrimal gland secretion, causing dry eyes. Sjögren's syndrome also affects the salivary glands, causing dry mouth and increasing the risk of mouth infections and dental caries.)
A nurse caring for a patient with osteoarthritis instructs the patient about the various nonpharmaceutical interventions for the management of pain. Which information should the nurse include in these instructions? Select all that apply. a. Use of paraffin baths or hot packs b. Immobilization of the affected joint c. Use of crutches or walker if required d. Regulation of a normal body mass index (BMI) e. Strenuous exercise to keep the joints functional
a., c., d. (Osteoarthritis is usually caused by a known event or condition that directly damages cartilage or causes joint instability. Pain management in osteoarthritis involves regulation of a normal body mass index, because an increase in weight may pose stress on the joints. Paraffin baths or hot packs may be used to relieve the associated pain by reducing inflammation. The use of assistive devices like a walker or crutches can ease mobility while avoiding undue excessive pressure on the affected joint. The affected joint should not be immobilized; however, strenuous activities of the joint should be avoided. Strenuous exercise can worsen the situation, and so rest should be taken during periods of acute inflammation.)
Which approaches does interprofessional care for the patient diagnosed with osteoarthritis (OA) include? Select all that apply. a. Managing pain b. Curing osteoarthritis c. Prevention of disability d. Managing inflammation e. Improving joint function f. Reviewing diagnostic labs
a., c., d., e. (Interprofessional care for the patient diagnosed with osteoarthritis focuses on prevention of disability, managing inflammation, improving joint function, and managing pain. Osteoarthritis cannot be cured, and laboratory tests or biomarkers cannot be used to diagnose osteoarthritis.)
As a part of discharge teaching, the nurse has explained to a patient with osteoarthritis about the disease and its treatment. Which statements by the patient indicate the need for furthering education? Select all that apply. a. "I'll never use a staircase." b. "I should maintain a healthy body weight." c. "My bones have become weak and fragile." d. "I should not stand or kneel for a long time." e. "I can skip doses if I don't have any symptoms."
a., c., e. (The use of a staircase is permitted, but using it repeatedly may be deleterious. Skipping a medication dose when there are no symptoms is not advisable. The patient should take the medication as prescribed by the health care provider. The patient should be taught that osteoarthritis involves joints and not the bones, unlike osteoporosis. Body weight is to be regulated to prevent a heavy load on the joints. The misconception that there should be no body activity should be cleared up. A balance should be maintained in rest and activity, neither of which should be prolonged.)
The nurse is caring for an older adult patient that is being treated for Paget's disease. Which medications does the nurse expect to find in the patient's prescription? Select all that apply. a. Calcitonin b. Raloxifene c. Denosumab d. Teriparatide e. Bisphosphonates
a., e. (Calcitonin and bisphosphonates are used in the treatment of Paget's disease. Postmenopausal women use raloxifene in the treatment of osteoporosis, which also reduces the risk of breast cancer. Denosumab is prescribed for patients with osteoporosis. Teriparatide stimulates new bone formation and is prescribed to treat osteoporosis in men and postmenopausal women at a high risk for fractures.)
The nurse is creating a plan of care for a patient with osteoarthritis. What would the nurse plan as an appropriate short-term goal for this patient? a. The patient will limit physical activity in the morning. b. The patient will participate in physical therapy activities. c. The patient will eliminate the use of narcotic analgesics if diarrhea develops. d. The patient will limit pain medications to nonnarcotic drugs to prevent addiction.
b. (Because pain and discomfort are major clinical manifestations of osteoarthritis, relief measures are the first priority. Relief can be achieved with physical therapy and other pain-management measures. Limitation of physical therapy, elimination of pain medication, and limitation of pain medication to nonnarcotic drugs are all incorrect goals for a patient with osteoarthritis. The patient needs to stay physically active and use narcotic or nonnarcotic analgesics, depending on the level of pain.)
The nurse is caring for a patient with osteoarthritis. What statement made by the patient demonstrates accurate knowledge of the disorder? a. An underproduction of synovial fluid b. Degeneration of cartilage in synovial joints c. An autoimmune disorder that is hereditary in nature d. Breakdown of tissue caused by a sedentary lifestyle
b. (Osteoarthritis is a degeneration or breakdown of the articular cartilage in synovial joints. The condition also has been referred to as degenerative joint disease. Osteoarthritis does not affect synovial fluid, is unrelated to a sedentary lifestyle, and is not mediated by an autoimmune response.)
The nurse teaches a patient with osteoporosis about dietary modifications to improve calcium intake. Which patient food choices indicate the need for additional teaching? a. One glass of milk, cottage cheese, and one cup yogurt b. Boiled egg, carrot and lettuce salad, and a fresh cut apple c. Spinach soup and roasted salmon with cheddar cheese dip d. Steamed broccoli salad, steamed oysters, and one cup ice cream
b. (Osteoporosis refers to the demineralization of bone. A patient with this condition should get enough calcium to keep the bones strong and healthy. Egg, carrot, lettuce, and apple are poor sources of calcium, so a meal that only contains these foods indicates the patient does not understand the best diet for treating osteoporosis. Milk, cottage cheese, and yogurt are good sources of calcium, and indicate a clear understanding of the nurse's teaching. Spinach, salmon, and cheddar cheese provide good sources of calcium and can be included in the diet. Broccoli, oysters, and ice cream are also good sources of calcium, and should be included in the diet of the patient with osteoporosis.)
Which factor makes women more prone to osteoporosis compared to men? a. Large-boned frame b. Estrogen deficiency c. High-impact aerobics d. Bisphosphonates intake
b. (Postmenopausal women are at a greater risk for osteoporosis due to decreased estrogen. Women with larger boned frames with more bone mass are less prone to osteoporosis. High-impact aerobics can result in stress fractures due to extra pressure on the bones. Postmenopausal women are prescribed bisphosphonates to treat estrogen deficiency.)
A patient with gout asks the nurse why a low-purine diet is recommended. What explanation should the nurse provide? a. Purine causes the joint pain associated with gout. b. The metabolism of purine results in the formation of uric acid. c. Urine retention can result from a high purine level and thus increase the uric acid level. d. Limiting purine can decrease the incidence of headaches and dizziness that occur with gout.
b. (Purine, an end product of protein digestion, breaks down into uric acid. The uric acid then acts to form crystals in joints, usually beginning the great toe, which produces intense pain. Purine does not cause the joint pain of gout. Urine retention will not result in an increased uric acid level. Limiting purine will not relieve headaches or dizziness.)
A patient has been diagnosed with increased joint inflammation that spreads across cartilage into the joint cavity. Which stage of rheumatoid arthritis does the nurse determine the patient has? a. Stage I b. Stage II c. Stage III d. Stage IV
b. (The patient with stage II rheumatoid arthritis exhibits increased joint inflammation that spreads across cartilage into the joint cavity. Stage I is characterized by the occurrence of synovitis with an increased white blood cell count in the synovial fluid. Stage III is characterized by erosion of cartilage, bone exposure, and possible deformity. Stage IV is the end stage of rheumatoid arthritis, in which the patient loses function of the joint.)
The nurse is caring for a patient with gout. Which actions are appropriate for the nurse to perform? Select all that apply. a. Encourage weight gain b. Provide warm compresses c. Decrease joint mobilization d. Encourage increased oral water intake e. Encourage intake of spinach, mushrooms, and cauliflower
b., c., d. (Gout is associated with inflammation of joints caused by deposition of uric acid crystals in one or more joints. Limiting joint mobilization helps alleviate the patient's symptoms. Providing warm compresses helps relieve joint pain. Increasing water intake enhances the elimination of uric acid from the body. Significant weight gain will affect the weight bearing joints and aggravate the patient's symptoms. Vegetables like spinach, mushrooms and cauliflower are rich in purines. A patient with gout should avoid purines.)
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. Which risk factors for osteoporosis should the nurse include in the discussion? Select all that apply. a. Obesity b. Smoking c. Asian descent d. Hyperlipidemia e. Sedentary lifestyle
b., c., e. (A small frame, Asian descent, smoking, and a sedentary lifestyle all contribute to the development of osteoporosis. Obesity and hyperlipidemia are not risk factors for osteoporosis.)
The nurse is educating a patient newly diagnosed with systemic lupus erythematosus (SLE). What should the nurse include in the education about things to avoid? Select all that apply. a. Pregnancy b. Physical and emotional stress c. Exposure to individuals with infections d. Nonsteroidal antiinflammatory medications e. Drying soaps, powders, and household chemicals
b., c., e. (Drying soaps, powder, and household chemicals will all exacerbate symptoms in the integumentary system. Exposure to individuals with infections should be limited, since those with SLE are often immunocompromised or taking immunosuppressant drugs. Avoidance of physical and emotional stress may help reduce SLE flares. Nonsteroidal antiinflammatory drugs are a mainstay of treatment for arthralgias in SLE. Pregnancy is safe for those with mild to moderate SLE but should be done in consultation with a physician.)
The nurse is educating a patient about the prevention of osteoarthritis. What information would be most beneficial for the nurse to discuss with the patient? Select all that apply. a. Avoiding alcohol b. Avoiding smoking c. Avoiding heavy lifting d. Maintaining a healthy weight e. Promptly treating any joint injury f. Sliding objects rather than lifting them
b., d., e. (Maintaining a healthy weight, avoiding smoking, and promptly treating any joint injuries are all measures the patient can take to prevent osteoarthritis. Avoiding alcohol, avoiding heavy lifting, and sliding objects rather than lifting them are measures that may be recommended to some patients with risk potential for other diseases, but they do not help prevent osteoarthritis.)
A patient with adrenal insufficiency is advised to take corticosteroids for four months. What should be told to the patient about how to prevent osteoporosis? Select all that apply. a. "Eat a protein-rich diet." b. "Take vitamin D tablets." c. "Avoid a calcium-rich diet." d. "Avoid bisphosphonates." e. "Avoid high-impact exercise."
b., e. (Vitamin D tablets should be taken to aid in calcium absorption to prevent osteoporosis. The patient should be advised to do low-impact exercise rather than high-impact exercise, because high-impact exercise may lead to complications. A protein-rich diet should be eaten by patients undergoing corticosteroid therapy; this diet will not lower the risk of osteoporosis. A calcium-rich diet and bisphosphonates help to prevent osteoporosis.)
The nurse is caring for a patient diagnosed with fibromyalgia. What action should the nurse consider while caring for this patient? a. Administering long-acting opioids b. Avoiding administering any sedatives c. Encouraging the patient to reduce the intake of coffee and alcohol d. Advising the patient to completely avoid any stretching and exercise
c. (Coffee and alcohol can act as irritants to muscles. Hence the nurse should encourage the patient with fibromyalgia to reduce the intake of coffee and alcohol. Long-acting opioids are generally not given unless fibromyalgia is refractory to other therapies. Sedatives, such as benzodiazepines, can be prescribed. Stretching and exercise can reduce muscle tension and spasm and can be performed under the guidance of a physical therapist.)
A patient with osteoporosis has a history of multiple fractures. Which prescription should the nurse question the health care provider about that is contraindicated in this patient? a. Calcitonin b. Raloxifene c. Corticosteroids d. Bisphosphonates
c. (Corticosteroids should be used with extreme caution in patients with osteoporosis. Calcitonin therapy is advised in patients who have low tolerance for bisphosphonates drugs. Raloxifene is a selective estrogen receptor modulator (SERM) that decreases the risk of breast cancer in a menopausal patient with osteoporosis. Treatment with bisphosphonates is considered for patients who are already being treated with corticosteroids.)
The nurse is educating a patient with systemic lupus erythematosus (SLE) about precipitating factors of the disease. Which precipitating factors should the nurse be sure to include when discussing them? a. Azathioprine, hydralazine, and procainamide b. Procainamide, chloroquine, and sun exposure c. Sun exposure, hydralazine, and oral contraceptives d. Cyclophosphamide, oral contraceptives, and azathioprine
c. (In SLE patients, the onset or exacerbation of disease symptoms sometimes occurs due to sun exposure. SLE may also be precipitated or aggravated by certain drugs, such as hydralazine and oral contraceptives. Azathioprine is used as a treatment drug in SLE. Procainamide can also precipitate SLE. However, chloroquine is used to treat fatigue and moderate skin and joint problems in patients with SLE. Cyclophosphamide and azathioprine are used to treat SLE.)
Repetitive physical activity that results in osteoarthritis is an example of what? a. Trauma b. Joint instability c. Mechanical stress d. Neurologic disorder
c. (Mechanical stress occurs due to repetitive physical activities, such as sports, and can result in osteoarthritis. Pain and loss of reflexes may be a result of a neurologic disorder. Dislocations, fractures that lead to avascular necrosis, or uneven stress on cartilage are examples of trauma; these do not result in osteoarthritis. Damage to supporting structures can result in joint instability.)
A patient has osteoarthritis of the knees. Which finding would the nurse expect upon examination of the patient's knees? a. Morning stiffness b. Positive Phalen's sign c. Pain with joint movement d. Positive anterior drawer test
c. (Osteoarthritis is characterized predominantly by joint pain on movement. Stiffness in the morning is associated with rheumatoid arthritis. Phalen's and Tinel's signs are indicative of carpal tunnel syndrome, and an anterior drawer test is not associated with osteoarthritis.)
The nurse is reinforcing general health teaching for a patient with osteoarthritis of the knees. Which statement by the patient demonstrates correct understanding of osteoarthritis? a. "Cartilage destruction does not begin until after age 50." b. "Osteoarthritis is a normal part of the aging process." c. "Osteoarthritis is more common with aging, but usually it remains confined to a few joints and does not cause crippling." d. "Osteoarthritis is an inflammatory disease of the joints that may present symptoms at any age."
c. (Osteoarthritis occurs with greater frequency with increasing age, but it usually remains confined to a few joints and can be managed with a combination of exercise, diet, and medication. Cartilage destruction may actually begin between ages 20-30 with majority of adults affected by age 40. Osteoarthritis is a result of cartilage destruction which is not a normal part of aging.)
Which stage of rheumatoid arthritis does the nurse determine a patient is in who has extensive muscle atrophy and joint deformity? a. Stage I b. Stage II c. Stage III d. Stage IV
c. (Stage III of rheumatoid arthritis is characterized by formation of synovial pannus, bone exposure from eroded joint cartilage, and deformity, such as subluxation, ulnar deviation, and osteoporosis. Stage I of rheumatoid arthritis is characterized by possible x-ray evidence of osteoporosis with no evidence of joint destruction. A patient with Stage II rheumatoid arthritis will experience increased joint inflammation that spreads across the cartilage and into the joint cavity, signs of gradual destruction of joint cartilage, and narrowing joint spaces. Stage IV of rheumatoid arthritis is characterized by loss of joint function and formation of subcutaneous nodules.)
A patient is admitted for a fractured hip. A nurse is reviewing the medical history with the patient on admission. Which conditions does the nurse tell the patient place this patient at risk for osteoporosis? Select all that apply. a. Depression b. Breast cancer c. Kidney disease d. Hyperthyroidism e. Diabetes mellitus f. Rheumatoid arthritis
c., d., e., f. (Rheumatoid arthritis, kidney disease, diabetes mellitus, and hyperthyroidism place the patient at risk for osteoporosis. Breast cancer and depression are not associated with a greater risk for osteoporosis.)
A patient is admitted to the hospital with Boutonnière deformity. What are the signs and symptoms that the nurse is likely to find during assessment? Select all that apply. a. Partial dislocation of finger joints b. Fingers drift to ulnar side of forearm c. Flexion of proximal interphalangeal joint d. Flexion of the metacarpophalangeal joint e. Hyperextension of the distal interphalangeal joint
c., e. (Boutonnière deformity is the deformity of rheumatoid and psoriatic arthritis caused by the rupture of the extensor tendons over the fingers. It is characterized by the flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joints of the fingers. Flexion of the metacarpophalangeal joint occurs in swan neck deformity. Ulnar drift refers to the deformity of rheumatoid arthritis due to tendon contracture. Dislocation of the finger joints does not happen in Boutonnière deformity.)
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? a. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. b. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. c. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
d. (The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements or foods high in calcium, and engages in regular weight-bearing exercise. Even if the patient has a family history of osteoporosis, there are methods to prevent and slow bone resorption. Corticosteroids interfere with bone metabolism and would not be effective. Estrogen therapy is no longer used to prevent osteoporosis, because of the associated increased risk of heart disease and breast and uterine cancer.)
The nurse reviews the laboratory reports of an obese patient who is diagnosed with gout. Which finding does the nurse associate with the patient's condition? a. Hypovolemia b. Hyperkalemia c. Hyponatremia d. Hyperuricemia
d. (A patient with gout will have crystallization of uric acid, which is deposited in joints and causes inflammation. This condition is associated with hyperuricemia. Obesity and gout are not associated with loss of blood or hypovolemia. Obesity and gout do not affect the potassium and sodium electrolyte balance. Therefore, hyperkalemia and hyponatremia are not observed in obese patients who are diagnosed with gout)
The nurse is educating a patient at the clinic. Which measures can the nurse discuss with the patient to reduce the risk of osteoarthritis? Select all that apply. a. Avoiding intake of fish b. Exercising on a hard surface c. Increasing the intake of vitamin K d. Avoiding forceful, repetitive movements e. Avoiding bending the knee past 90 degrees
d., e. (Bending the knees past 90 degrees increases the risk of knee injury. Hence, maintaining an appropriate angle during exercise will prevent osteoarthritis. Forceful and repetitive movements on a hard surface may tear the ligaments and cause permanent damage. There is no reason for patients with osteoarthritis to avoid eating fish. Exercising on a soft surface will prevent injuries to the smaller joints. Vitamin K supplements reduce the risk of bleeding disorders but not the risk of osteoarthritis.)
The nurse is providing discharge teaching to a patient after a stress fracture of the foot. Which drug does the nurse inform the patient would increase the risk for osteoporosis? Select all that apply. a. Aspirin b. Lisinopril c. Metformin d. Hydrocodone e. Betamethasone f. Calcium carbonate
e., f. (Aluminum-containing antacids such as calcium carbonate and corticosteroids such as betamethasone can interfere with bone metabolism and weaken the bone. They therefore increase the risk for osteoporosis. Lisinopril, aspirin, metformin, and hydrocodone do not interfere with bone metabolism and do not increase the risk for osteoporosis.)
