Exam 1: Osteoarthritis Questions

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply. 1. hips 2. knees 3. ankles 4. shoulders 5. metacarpals

1, 2 rationale: Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

What should the nurse do to prevent deformities of the knee in a client with an exacerbation of arthritis? Select all that apply. 1. encourage motion of the joint 2. maintain a knee brace on the leg 3. keep the client on a regimen of bed rest 4. maintain joints in functional alignment when resting 5. immobilize the joint with pillows until pain subsides

1, 4 rationale: Exercise of involved joints is important to maintain optimal mobility and prevent buildup of calcium deposits. Functional alignment places the least strain on joints, muscles, and tendons. Immobilization causes loss of joint mobility and contractures. Immobility promotes the development of contractures. Immobilization with pillows promotes the development of contractures.

The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality specific to osteoarthritis? 1. ulnar drift 2. heberden nodes 3. swan-neck deformity 4. boutonnière deformity

2 rationale: Heberden nodules are the bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis. Ulnar drift, swan-neck deformity, and boutonnière deformity occur with rheumatoid arthritis.

During a follow-up visit, a nurse finds that flexion contractures have developed in a client with osteoarthritis (OA). Which factor may have led to this condition? 1. wearing shoes without insoles 2. elevating the legs 8-12 inches 3. using large pillows under the knees or head 4. placing a small pillow under the head in the supine positoin

3 rationale: The use of large pillows under the knees or head may result in flexion contractures that keep the client from straightening the knees fully. A client with OA will have severe pain in the affected joint during or after movement. In this case, the client should be taught to position the joints in the functional position. Wearing shoes without insoles may result in pressure on painful metatarsal joints. The legs may be elevated 8 to 12 inches (20 to 30 cm) to reduce back discomfort associated with OA. A small pillow can be used under the head when the client is in the supine position to reduce discomfort, but the use of other pillows should be avoided.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen for discomfort associated with osteoarthritis and notifies the healthcare provider. Which drug does the nurse expect will most likely be prescribed instead of the ibuprofen? 1. naproxen 2. aspirin 3. ketorolac 4. acetaminophen

4 rationale: Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal antiinflammatory drugs ( NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

Which drug is most appropriate for relieving a painful muscle spasm in the back of a client with osteoarthritis (OA)? 1. tramadol 2. hyaluronate 3. diclofenac epolamine patch 4. cyclobenzaprine hydrochloride

4 rationale: Cyclobenzaprine hydrochloride is a muscle relaxant administered to relieve painful muscle spasms, especially those resulting from OA of the vertebral column. While tramadol is a weak opioid drug that may also be given to relieve pain in clients with OA, it is not as effective against painful muscle spasms. Hyaluronate is a specific injection for knee and hip pain associated with OA. The diclofenac epolamine patch is used in clients with signs and symptoms of knee OA.

A client with arthritis reports receiving several dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? 1. wheat germ and yeast 2. yogurt and blackstrap molasses 3. multiple vitamin supplements in large doses 4. adequate foods in a variety of different foods groups

4 rationale: There is no special diet for arthritis. A balanced diet, consisting of foods from all groups of the MyPlate dietary guidelines, is essential in maintaining nutrition. Limiting the diet to particular foods does not provide all the essential nutrients. If nutritional intake is adequate, large doses of multivitamins are unnecessary and are dangerous.

A client with osteoarthritis is admitted to the hospital for evaluation of a possible hip replacement. To prevent flexion contractures, the nurse recommends that, when in bed, the client should lie in the supine or prone position. The client voices hesitation, stating that these positions are uncomfortable for the knees and hips. What action should the nurse take? 1. Encourage the client to maintain extension for specific periods of time. 2. Allow the client to lie in whatever position is most comfortable. 3. Insert a pillow under the client's knees to relieve discomfort. 4. Place the client in the semi-Fowler position most of the time.

1 rationale: Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi-Fowler's position can cause flexion contractures of the hips.