NUR 1024: NCLEX Questions for Osteoarthritis
A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for which reason? A. To rule out inflammatory arthritis and gout B. To identify irregular joint space narrowing C. To evaluate for increased density of subchondral bone D. To determine the extent of joint damage
Answer: A Rationale: Joint fluid analysis is used to detect inflammation, bacteria, and uric acid crystals to rule out inflammatory arthritis and gout. This test will not provide information on the extent of the joint damage. This test cannot identify the amount of joint space that has narrowed. This test cannot evaluate bone density.
Which health promotion activity supports a healthy lifestyle for clients with osteoarthritis? (Select all that apply.) A. Maintaining a normal weight B. Using proper body mechanics C. Using assistive devices as needed D. Increasing dietary intake of calcium E. Using soft chairs and recliners for rest
Answer: A, B, C Rationale: Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab bars, a shower chair, or long-handled grippers help the client to maintain an independent lifestyle in safety. Using proper body mechanics during activities reduces stress on joints. Although calcium intake is essential for preventing osteoporosis, especially in older adults, increasing daily calcium intake does not have a positive effect on OA. Chairs and mattresses should provide support and help to maintain normal body alignment. Soft chairs and recliners do not provide such support.
The nurse is providing teaching about home care for a client with osteoarthritis of the knees. Which information should the nurse include? (Select all that apply.) A. Installing handrails in the bathroom B. Using assistive devices to minimize stress placed on affected joint C. Taking pain medications as ordered D. Continuing activity with repetitive movement E. Encouraging heavy lifting to maintain muscle strength
Answer: A, B, C Rationale: Taking pain medications as ordered will assist with pain management and allow the client to participate in daily activities. Installing handrails in the bathroom is information that the nurse should include when educating a client to keep the client safer during activities of daily living at home. The nurse should educate the client on the importance of using assistive devices to minimize joint stress. The nurse should instruct the client to avoid repetitive movement and to avoid heavy lifting, because these actions will increase pain and joint degeneration and will not improve physical mobility.
Which is a common risk factor for osteoarthritis? (Select all that apply.) A. Overuse of joints from sports or strenuous activities B. Obesity C. Ingestion of large amounts of purine D. Autoimmune disorder E. Activities affecting weight-bearing joints
Answer: A, B, E Rationale: Common risk factors for osteoarthritis include obesity, overuse of joints from sports injuries or strenuous activities, and activities affecting weight-bearing joints. Rheumatoid arthritis is thought to be an autoimmune disorder. Ingestion of large amounts of purines is a risk factor for gout.
Which clinical manifestation of osteoarthritis (OA) should the nurse include when teaching about osteoarthritis? (Select all that apply.) A. Joint pain with activity B. Pain and stiffness at night C. Abrupt onset D. Mild fever E. Crepitus with movement of joint
Answer: A, B, E Rationale: Joint pain with activity, grating or crepitus noted with movement, and pain and stiffness with prolonged inactivity are general manifestations of OA. Mild fever is associated with rheumatoid arthritis, not OA. Osteoarthritis is a degenerative disease that develops over time, although symptoms may appear suddenly.
Which health promotion activity supports a healthy lifestyle for clients with osteoarthritis? (Select all that apply.) A. Maintaining a normal weight B. Using proper body mechanics C. Using assistive devices as needed D. Increasing dietary intake of calcium E. Using soft chairs and recliners for rest
Answer: A, C Rationale: Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab bars, a shower chair, or long-handled grippers help the client to maintain an independent lifestyle in safety. Using proper body mechanics during activities reduces stress on joints. Although calcium intake is essential for preventing osteoporosis, especially in older adults, increasing daily calcium intake does not have a positive effect on OA. Chairs and mattresses should provide support and help to maintain normal body alignment. Soft chairs and recliners do not provide such support.
Which surgical treatment should the nurse anticipate may be offered to clients with osteoarthritis who cannot be managed with traditional treatment? (Select all that apply.) A. Arthroplasty B. Serum hyaluronic acid C. Joint fusion D. Cortisone therapy E. Osteotomy
Answer: A, C, E Rationale: Arthroplasty, osteotomy, and joint fusion are all surgical interventions indicated for a client with osteoarthritis. Serum hyaluronic acid is a diagnostic blood test for knee osteoarthritis and is not a surgical treatment. Cortisone therapy is not a surgical treatment; it is injected into the inflamed joint.
The parents of a child newly diagnosed with juvenile osteoarthritis (OA) are concerned about their child's future ability to be disability free and remain independent. Which information should the nurse give the parents? (Select all that apply.) A. "Children may outgrow OA as they age." B. "OA in children is generalized, thus impacting all joints and increasing possible impairment." C. "The amount of disability will depend on how well the OA is managed as a child." D. "OA in children is usually idiopathic, making it difficult to determine how it will affect them as adults." E. "Children with OA are less likely to become disabled."
Answer: A, E Rationale: Children with OA are less likely to become disabled as adults and may outgrow the OA as they age. It is not likely that children with OA will be disabled as adults.
A 32-year-old client who has limited hip joint damage from osteoarthritis asks the nurse why an osteotomy is being performed rather than other procedures. Which response by the nurse provides the most accurate information? A. "This procedure is usually tried first; arthroplasty will be done later if this does not work." B. "This procedure can be done since you are young and healthy and your hip damage is limited." C. "This procedure prepares you for joint resurfacing and a total hip replacement later in life." D. "An osteotomy is much less invasive than all of the other procedures."
Answer: B Rationale: An osteotomy is performed to realign the joint or to shift the joint load toward areas of less cartilage damage. It is used instead of joint replacement surgery if the client is young, healthy, and damage is limited to only one side of the joint. This would provide the most accurate explanation to the client. It is not indicated as a surgery to necessarily be done first before an arthroplasty, nor to prepare the client for joint resurfacing surgery.
The nurse is planning care for a client with osteoarthritis (OA). Which nursing diagnosis is a priority for the nurse to address? A. Lifestyle, Sedentary B. Pain, Chronic C. Skin Integrity, Impaired D. Family Processes, Interrupted
Answer: B Rationale: Chronic pain is the priority problem for the nurse to address when planning care for a client diagnosed with osteoarthritis. Sedentary lifestyle would be a concern because exercise can help to address OA but would not be a priority nursing diagnosis. Skin integrity and impaired family processes are not expected problems for the nurse to address when planning care for a client diagnosed with OA.
After performing a physical assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis (OA). Which finding supports the nurse's suspicion? (Select all that apply.) A. Leg tremors B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness
Answer: B, C, D, E Rationale: Manifestations of OA include crackling sounds, or crepitation, with joint movement; joint stiffness and tenderness; and reduced joint flexibility. Leg tremors can be associated with multiple sclerosis or Parkinson disease.
The nurse is teaching older adults with osteoarthritis (OA) actions to effectively manage chronic pain. Which recommendation should the nurse include? (Select all that apply.) A. Limiting isometric exercises to reduce strain on the joints B. Using firm support in chairs and mattresses to properly align the body C. Applying cool compresses to painful joints to reduce inflammation D. Teaching proper posture and good body mechanics for activities of mobility E. Encouraging resting painful joints
Answer: B, D, E Rationale: Chronic pain is frequently associated with OA. When joints are painful, they should be rested. The rest should be balanced with periods of activity, which will reduce joint stiffness. Using proper posture and good body mechanics places the body in proper alignment and offers the joints a neutral platform to perform range of motion activities. Firm chairs and mattresses assist the body in proper alignment. Heat should be applied to painful joints, which will increase joint mobility. Cool compresses may increase joint pain and will limit joint mobility. Isometric exercises strengthen muscle groups, which is important to provide additional strength in movement. Strong muscles will reduce strain on joints.
The nurse is teaching a class about the joints commonly affected by osteoarthritis (OA). Which joints should the nurse include? A. Ankles, feet, and spine B. Knees, feet, and spine C. Hands, knees, and hips D. Neck, shoulders, and ankles
Answer: C Rationale: Hands, knees, and hips are the most commonly affected joints of OA. Feet, spine, neck, shoulders, and ankles are not the most common locations.
The nurse is evaluating a client who has osteoarthritis (OA) of the hips and knees. Which statement by the client indicates progress toward meeting identified activity goals? A. "I've increased my running time to 30 minutes 3 times a week and use orthotics in my sneakers." B. "I have been completing the range of motion (ROM) exercises for all joints every other day." C. "I've been able to manage my pain so that I can independently complete my daily activities." D. "I limit the use of acetaminophen unless I absolutely need it to decrease my risk of liver toxicity."
Answer: C Rationale: Successful management of pain so that the client with OA can independently complete daily activities indicates progress toward an important goal. ROM should be done every day for all joints. Acetaminophen should be used regularly to help avoid severe pain from occurring. Running is a high-impact activity that can increase stress on joints. Low-activity aerobic exercise, not high-impact exercise, should be included in activity goals for the client with OA.
A client with osteoarthritis asks the nurse how to decrease wrist swelling. Which intervention should the nurse suggest? A. Increasing range of motion exercises for that joint to 3 times a day B. Applying a warm towel to the wrist joint 3 times per day for 20 minutes at a time C. Using compression cold packs to provide a deeper cold to the wrist joint D. Encouraging use of assistive devices during daily activities to decrease stress on the joint
Answer: C Rationale: The use of deep cold can best help to address swelling. Increasing ROM exercises to 3 times a day is not the best approach to decrease swelling; ROM helps to maintain flexibility of the joint. Heat decreases pain and increases flexibility; it does not address swelling. Assistive device use can decrease stress on the joint to possibly prevent swelling, but it would not be the best approach to address swelling once it has occurred.
A client diagnosed with localized idiopathic osteoarthritis (OA) asks the nurse what this means. Which response by the nurse provides the most accurate information? A. "Idiopathic describes OA overall while localized indicates that it affects one body joint only." B. "Idiopathic refers to the fact that the OA has already progressed significantly in one or two joints." C. "Idiopathic OA has no identifiable cause; when it is localized, it only affects one or two joints." D. "Idiopathic OA, as compared with secondary OA, is caused by some kind of underlying condition."
Answer: C Rationale: There are two types of OA, idiopathic and secondary. Idiopathic OA has no identifiable cause and can be further subdivided as localized or generalized, with localized indicating that the OA only affects one or two joints, so stating that it has no identifiable cause and is limited to one or two joints would be the most accurate response. Idiopathic OA is not due to an underlying condition. Idiopathic refers to cause, not progression of the disease. Idiopathic is not a term used in general for OA, nor does the term localized indicate that affected joints are either in the upper or lower torso.
The nurse is counseling a newly pregnant client with osteoarthritis (OA). Which information should the nurse include? A. "Pregnancy has no impact on OA if you keep your weight gain within the recommended limits." B. "You need to restrict your participation in low-impact aerobic exercises." C. "Your pain from the OA may increase due to the weight gain of pregnancy." D. "You may continue to take your prescription nonsteroidal anti-inflammatory drug without any risk of harm to the fetus."
Answer: C Rationale: Weight gain of pregnancy may increase the pain resulting from OA due to the increased stress on the joints; this would be important information to include. The impact of nonsteroidal anti-inflammatory drugs, such as celecoxib (Celebrex), on the fetus is unknown; the nurse would not tell the client that it is safe to use. Low-impact aerobic exercises are recommended for clients with OA. The recommended weight gain for pregnancy would not be changed due to the OA, nor is it valid to indicate that pregnancy will have no impact on the OA.
Which assistive device should the nurse recommend to a client with osteoarthritis (OA) of the hands? (Select all that apply.) A. Handrails B. Reacher device C. Electric can opener D. Zipper hook E. Large-handled toothbrush
Answer: C, D, E Rationale: Zipper hooks, electric can openers, and large-handled toothbrushes can be helpful for clients with OA of the hands. Handrails can be useful for clients with OA of the hips. Reacher devices can be helpful for clients with OA of the shoulders.
The nurse is teaching an older adult recently diagnosed with osteoarthritis (OA) about interventions to help maintain mobility of the joints. Which should the nurse include? A. Jogging three times a week B. Routine nonsteroidal anti-inflammatory drug (NSAID) use C. Glucosamine and chondroitin supplements D. Physical therapy
Answer: D Rationale: Physical therapy is particularly important for older adults with OA to help them maintain or improve joint mobility. NSAIDs should generally not be used by older adults due to the risks associated with their use. Older adults should use acetaminophen as a first-line drug and narcotics as a second-line choice. Jogging is a high-impact activity that could place more stress on the joints and would not be recommended. The utility of supplements has not been supported as effective; additionally, the use of glucosamine and chondroitin may increase the risk of bleeding.
The nurse is assessing an older adult who has osteoarthritis (OA). Which finding indicates the impact of OA? A. Sitting in a soft chair and not getting up to greet the nurse B. Requesting a dose of acetaminophen to address joint pain C. Asking the nurse to retrieve items from across the room D. Leaning on furniture while walking
Answer: D Rationale: When assessing the client with OA, the nurse should observe how the client moves and ambulates. Noting that the client leans on furniture while walking indicates possible issues related to the OA. Asking the nurse to retrieve items from across the room, requesting a dose of acetaminophen, and not getting up when the nurse arrives do not provide any direct observable data to indicate the possible impact of OA on the client.
