Arthritis

Which intervention is beneficial for protecting the joints in a patient who has bilateral osteoarthritis of the knees? 1 Exercise regularly and maintain a well-balanced diet. 2 Use a wheelchair to avoid walking as much as possible. 3 Avoid sitting at a 90-degree angle and avoid full flexion of the knees. 4 Use a cane for ambulation to relieve the pressure on the hips.

1 Exercise regularly and maintain a well-balanced diet. Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage adaptation, the patient should maintain an optimal overall body weight or lose weight if overweight. Avoiding walking is contraindicated; exercise should continue to promote mobility and relieve pain. Sitting at a 90-degree angle would be indicated following hip replacement. A cane may be indicated to help with mobility, but is not used to relieve hip pressure because the osteoarthritis is in the knees.

Serum analysis of uric acid levels is used in the diagnosis of with which condition? 1 Gout 2 Scleroderma 3 Osteoarthritis 4 Rheumatoid arthritis

1 Gout

The nurse reviews the diagnostic results of a patient with rheumatoid arthritis (RA) and expects which findings? Select all that apply. 1 High C-reactive protein (CRP) 2 Negative rheumatoid factor (RF) 3 Clear synovial fluid 4 Increased erythrocyte sedimentation rate (ESR) 5 Increased white blood cell (WBC) count of the synovial fluid

1 High C-reactive protein (CRP) 4 Increased erythrocyte sedimentation rate (ESR) 5 Increased white blood cell (WBC) count of the synovial fluid CRP and ESR are increased as general indicators of active inflammation. The WBC count of synovial fluid is increased. Positive RF occurs in 80% of adults with RA. Synovial fluid analysis in early disease often shows slightly cloudy, straw-colored fluid with many fibrin flecks.

Which alternative therapies will the nurse suggest for a patient with rheumatoid arthritis? Select all that apply. 1 Hypnosis 2 Aerobic exercises 3 Use of a firm mattress 4 Vigorous range-of-motion exercises 5 Transcutaneous electrical nerve stimulation

1 Hypnosis 3 Use of a firm mattress 5 Transcutaneous electrical nerve stimulation The pain involved in rheumatoid arthritis poses a lot of distress in the patient. Hypnosis helps to reduce the psychologic stress along with relaxing the mind and body. Using a firm mattress helps to maintain the proper body alignment and reduces the risk of stiffness. Transcutaneous electrical nerve stimulation helps to maintain the functionality of the nerves. Aerobic and vigorous range-of-motion exercises should not be done because of the increased risk of joint injury, pain, and inflammation. A rheumatic collaborative care plan should be a mixed program of joint movements, rest, and mind and body relaxation.

Which assessment findings may be associated with rheumatoid arthritis (RA)? Select all that apply. 1 Joint stiffness 2 Dry, itchy eyes 3 Rheumatoid nodules 4 Inflammation of the great toe 5 Mouth infection and dental caries 6 High white blood cell (WBC) count

1 Joint stiffness 2 Dry, itchy eyes 3 Rheumatoid nodules 5 Mouth infection and dental caries 6 High white blood cell (WBC) count In RA, 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. Sjögren's syndrome can occur by itself or with other arthritic disorders, such as RA and systemic lupus erythematosus (SLE). 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. Inflammation of the great toe is the most common initial problem with gout, not RA.

Which instructions will the nurse include when teaching a group of caregivers about the home care of a patient with rheumatoid arthritis (RA)? Select all that apply. 1 Never place pillows below the knees. 2 Ensure complete bed rest for patients. 3 Apply heat for at least 30 to 60 minutes. 4 Perform aquatic exercise in warm water. 5 Use lifts and elevators instead of the stairs.

1 Never place pillows below the knees. 4 Perform aquatic exercise in warm water. 5 Use lifts and elevators instead of the stairs. The goals of RA therapy include satisfactory pain management and minimal loss of functional ability of the affected joints. Good body alignment while resting can be maintained, and to decrease the risk of joint contracture, pillows should never be placed under the knees. A small, flat pillow may be used under the head and shoulders. Aquatic exercise in warm water helps in pain management. It helps to relieve joint stiffness and allows the patient to perform daily activities more comfortably. Lifts and elevators should be used rather than stairs to help protect the affected joint. Patients with RA should alternate between rest and activity regimens. Heat application should not exceed 20 minutes at a time because it may aggravate the condition.

Which nonpharmaceutical interventions may help to manage pain for a patient with osteoarthritis? Select all that apply. 1 Use of paraffin baths or hot packs 2 Immobilization of the affected joint 3 Use of crutches or walker if required 4 Regulation of a normal body mass index (BMI) 5 Strenuous exercise to keep the joints functional

1 Use of paraffin baths or hot packs 3 Use of crutches or walker if required 4 Regulation of a normal body mass index (BMI) Osteoarthritis is usually caused by a known event or condition that directly damages cartilage or causes joint instability. 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. Pain management in osteoarthritis involves regulation of a normal body mass index, because an increase in weight may pose stress on the joints. 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 diagnostic tests help to determine the severity of osteoarthritis and plan the course of treatment? Select all that apply. 1 Serum uric acid 2 CT scan 3 MRI 4 Anticitrullinated protein antibody (ACPA) 5 Erythrocyte sedimentation rate (ESR) blood test

2 CT scan 3 MRI CT scan and MRI are useful tests in detecting the changes in the joints due to their high sensitivity. An ESR blood test is done to rule out acute synovitis. Serum uric acid indicates occurrence of gout. ACPA indicates presence of rheumatoid arthritis.

Which clinical manifestation is associated with osteoarthritis (OA)? 1 Fever and malaise 2 Crepitation in the weight-bearing joints 3 Increased erythrocyte sedimentation rate 4 Morning stiffness of all joints that tends to last all day

2 Crepitation in the weight-bearing joints Osteoarthritis primarily affects the weight-bearing joints; therefore crepitation (a cracking or clicking sound heard in joint movement) may be present in affected individuals. Fever and malaise and increased erythrocyte sedimentation rate are manifestations of rheumatoid arthritis. Morning stiffness may appear in OA but usually resolves within 30 minutes instead of lasting all day.

Which definition describes osteoarthritis (OA)? 1 Joint destruction caused by an autoimmune process 2 Degeneration of articular cartilage in synovial joints 3 Overproduction of synovial fluid resulting in joint destruction 4 Breakdown of tissue in non-weight-bearing joints by enzymes

2 Degeneration of articular cartilage in synovial joints OA is a degeneration of the articular cartilage in diarthrodial (synovial) joints from damage to the cartilage. The condition also has been referred to as degenerative joint disease. Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints. There is no overproduction of synovial fluid causing destruction or breakdown of tissue by enzymes in osteoarthritis.

The nurse will suggest which action for a patient with osteoarthritis? 1 Limit physical activity in the morning. 2 Participate in physical therapy activities. 3 Eliminate the use of narcotic analgesics if diarrhea develops. 4 Limit pain medications to nonnarcotic drugs to prevent addiction.

2 Participate in physical therapy activities. 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. A patient with osteoarthritis needs to stay physically active and use narcotic or nonnarcotic analgesics, depending on the level of pain.

In which order should the nurse perform interventions for a patient recently diagnosed with rheumatoid arthritis (RA)? Place the options in order of importance. 1. Educate about pharmacologic interventions. 2. Perform a careful physical assessment. 3. Coordinate a carefully planned program for rehabilitation and education. 4. Evaluate psychosocial needs and environmental concerns.

2. Perform a careful physical assessment. 4. Evaluate psychosocial needs and environmental concerns. 1. Educate about pharmacologic interventions. 3. Coordinate a carefully planned program for rehabilitation and education. Interventions must begin with a good physical assessment involving joint pain, swelling, and range of motion (ROM). Next, any psychosocial concerns, including family support, stress, financial constraints, and work or career concerns, as well as environmental issues involving transportation problems, home, and work modifications, are determined. Next, education about any pharmacologic interventions that have been prescribed occurs. After the data have been obtained, the nurse coordinates an interdisciplinary health care team to develop a program focusing on rehabilitation and education.

Which explanation will the nurse provide for a patient with osteoarthritis of the knees who tells the nurse that the celecoxib 200 mg they have been taking every 12 hours does not seem to work as well as it used to in controlling the pain? 1 "It may take several months for nonsteroidal antiinflammatory drugs (NSAIDs) to reach maximal effectiveness." 2 "You may have developed a tolerance to the medication and should double your dose." 3 "You may respond better to an alternate NSAID." 4 "If NSAIDs are not effective in controlling your symptoms, the next line of therapy is systemic corticosteroids."

3 "You may respond better to an alternate NSAID." Patients vary in their responses to medications, and another type of NSAID may be tried. This NSAID is a cyclooxygenase-2 (COX-2) inhibitor, which decreases the risk of gastrointestinal (GI) bleeding. Maximal effectiveness occurs within several days, not months. It is not within the nurse's scope of practice to increase the patient's medication dose; maximal effectiveness occurs within several days, not months. Systemic corticosteroids are not indicated for osteoarthritis related to the adverse reactions associated with them.

Which type of nodules occur on the distal interphalangeal (DIP) joints of the fingers in a patient with osteoarthritis (OA)? 1 Tophi nodules 2 Bouchard's nodes 3 Heberden's nodes 4 Rheumatoid nodules

3 Heberden's nodes Patients with OA may develop small, hard, round nodules on the DIP joints (near the tips of the fingers or toes) called Heberden's nodes. Tophi are hard, white nodules typically seen in subcutaneous tissue, synovial membranes, tendons, and soft tissues in a patient with chronic gout. Bouchard's nodes occur with OA at the proximal interphalangeal joints. Rheumatoid nodules develop in about half the patients with rheumatoid arthritis (RA) and appear under the skin as firm, nontender masses.

Which knee assessment finding does the nurse expect for a patient who has osteoarthritis of the knees? 1 Evening stiffness 2 Positive Phalen's sign 3 Pain with joint movement 4 Positive anterior drawer test

3 Pain with joint movement Osteoarthritis is characterized predominantly by joint pain on movement. Early morning stiffness is common and generally resolves within 30 minutes. Phalen's and Tinel's signs are indicative of carpal tunnel syndrome, and an anterior drawer test is not associated with osteoarthritis.

Which diagnosis does the nurse expect for a patient with fever who reports fatigue, joint pain, and stiffness, especially in the morning lasting approximately three hours? 1 Gout 2 Osteoarthritis 3 Rheumatoid arthritis 4 Ankylosing spondylitis

3 Rheumatoid arthritis The nurse should suspect rheumatoid arthritis in this patient, since systemic manifestations such as fatigue and fever are not present in osteoarthritis, gout, and ankylosing spondylitis.

Which patient statement indicates the need for further teaching about the management of osteoarthritis? 1 "I should modify my typical exercise to reduce stress on my joints." 2 "I should take the acetaminophen as prescribed to help to control the pain." 3 "I can use a cane if I find it helpful in relieving the pressure on my back and hip." 4 "A cold shower in the morning will help relieve the stiffness I have when I get up."

4 "A cold shower in the morning will help relieve the stiffness I have when I get up." The patient should take warm, not cold, showers or apply moist heat to help with inflammation. It is important to maintain a balance between rest and activity to avoid overstressing the joints with osteoarthritis, so exercises may have to be modified to accomplish this. Acetaminophen is an analgesic and will help with mild to moderate joint pain. A cane can be used for mobility and to decrease joint stress.

Which actions help to reduce the risk of osteoarthritis? Select all that apply. 1 Avoiding intake of fish 2 Exercising on a hard surface 3 Increasing the intake of vitamin K 4 Avoiding forceful, repetitive movements 5 Maintaining a healthy body mass index (BMI)

4 Avoiding forceful, repetitive movements 5 Maintaining a healthy body mass index (BMI) Forceful and repetitive movements on a hard surface may tear the ligaments and cause permanent damage. Obesity is a modifiable risk factor that contributes to hip and knee OA. It increases mechanical stress on the joints. Regular moderate exercise, which helps with weight management, decreases the risk for disease development and progression. 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 OA.

Which term refers to the joint changes associated with osteoarthritis? 1 Malignant 2 Inflammatory 3 Immunologic 4 Degenerative

4 Degenerative Osteoarthritis occurs commonly after years of stress, or "wear and tear," on weight-bearing joints. This degenerative process causes hypertrophic changes in the joints. Malignant refers to a growth process that is resistant to treatment, such as that seen in cancer. Inflammatory is the term given to a nonspecific immune response that occurs in reaction to any type of bodily injury. Immunologic refers to the immune system, which protects people from or resists disease or infection as a result of the development of antibodies or cell-mediated immunity.

Which action will the nurse include when caring for a patient with osteoarthritis (OA) who is taking sulfasalazine and reports an orange discoloration of the urine? 1 Advise the patient to decrease fluid intake to help the urine return to normal color. 2 Report the urine discoloration to the prescriber immediately since there could be liver impairment. 3 Report the urine discoloration to the prescriber immediately since orange-colored urine could indicate renal impairment. 4 Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern.

4 Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern The nurse should inform the patient that orange-yellow discoloration of the urine often occurs with sulfasalazine, and there is no need for concern. The nurse should advise the patient to take sulfasalazine with food and 8 oz of water rather than decreasing his or her fluid intake. Orange-colored urine does not mean the patient has liver or renal impairment; it is a normal side effect of sulfasalazine.

Which assessment finding may be related to osteoarthritis (OA)? 1 Persistent fever of 100.5°F to 102.0°F for the past 72 hours 2 Severe pain in the hip with leg shortening after a recent fall 3 Joint pain and swelling following activity that is relieved with rest 4 Joint stiffness after rest; stiffness usually subsides 30 minutes after activity is resumed

4 Joint stiffness after rest; stiffness usually subsides 30 minutes after activity is resumed With OA, joint stiffness after rest (especially early-morning stiffness) or stiffness following an immobile period is common. A persistent fever may indicate the presence of infection. Severe hip pain with leg shortening after a fall is characteristic of a hip fracture. Joint pain and swelling following activity that is relieved with rest is common with rheumatoid arthritis.

Which activity pattern will the nurse suggest for a patient with osteoarthritis (OA)? 1 Bed rest with bathroom privileges 2 Daily high-impact aerobic exercise 3 Frequent rest periods with minimal exercise 4 Regular exercise program that involves walking

4 Regular exercise program that involves walking A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with OA. A balance of rest and activity is needed. The patient should not be instructed to maintain bed rest. High-impact aerobic exercises would cause stress to affected joints and further damage. The patient should rest frequently while maintaining a regular exercise program.

Which condition is a complication of gout? 1 Cirrhosis 2 A gastric ulcer 3 A pulmonary embolus 4 Secondary osteoarthritis (OA)

4 Secondary osteoarthritis (OA) Chronic inflammation may cause joint deformity, and cartilage destruction may lead to secondary OA.

Which patient condition may indicate that celecoxib should be prescribed for treatment of osteoarthritis? 1 The patient is taking warfarin. 2 The patient has hyperchlorhydria. 3 The patient has severe arthritic symptomology. 4 The patient does not tolerate traditional nonsteroidal antiinflammatory drugs (NSAIDs).

4 The patient does not tolerate traditional nonsteroidal antiinflammatory drugs (NSAIDs). Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor and is devoid of the side effects of other conventional NSAIDs. However, its use is limited to selected cases in which the benefits outweigh the side effects or when conventional therapy is not tolerated. Its use can be justified in a patient having severe gastrointestinal disturbances due to conventional therapy. Celecoxib should be carefully administered concomitantly with warfarin because it potentiates the anticoagulant effect of warfarin. The medication is also indicated for use in mild, not severe, disease conditions. Patients with hyperchlorhydria can take NSAIDs and do not need celecoxib.

Which instruction will the nurse include when teaching a patient with osteoarthritis (OA) about taking prescribed ibuprofen 800 mg every eight hours for pain? 1 Take ibuprofen on an empty stomach. 2 Expect the stool to appear dark and tarry. 3 Do not take ibuprofen with milk products. 4 Try to take ibuprofen with food.

4 Try to take ibuprofen with food. Ibuprofen is irritating to the stomach lining and should not be taken on an empty stomach. Patients should be taught to take ibuprofen with food, milk, or antacids (if prescribed) to reduce the risk of gastrointestinal bleeding. Taking ibuprofen on an empty stomach raises the risk of irritation. The patient should not be told to expect dark, tarry stools; ibuprofen should be stopped immediately and the prescriber notified if signs of bleeding occur (e.g., tarry stools, bruising, and petechiae). The patient may take ibuprofen with milk products.