MED-SURG CH. 43 EAQ QUESTIONS

Which question is most helpful when assisting with collecting data to determine a person's functional status? 1. "Do any of your relatives have osteoporosis?" 2. "How does this problem affect the way you live?" 3. "Have you had any major childhood or adult illnesses?" 4. "What medications are you taking, including over-the-counter medications?"

2. "How does this problem affect the way you live?" Asking how a problem affects the way a patient lives is a means to determine changes in functional status. Asking if relatives have osteoporosis is asking about medical history rather than functional ability. The history of childhood or adult illnesses does not assess functional ability. Questions regarding medication are significant for assessment but do not clarify the patient's ability to function.

The nurse is caring for a patient with progressive systemic sclerosis (PSS). Which is the most appropriate instruction to give to the nursing assistant who will be providing basic care? 1. Accompany the patient when she leaves the unit to smoke. 2. Place a cooling fan in the patient's room to promote comfort. 3. Help the patient to select menu items that promote weight loss. 4. Use a bed cradle to keep linens off the patient's body while in bed.

4. Use a bed cradle to keep linens off the patient's body while in bed. A patient with progressive systemic sclerosis (PSS) may be unable to tolerate anything touching the affected skin. A bed cradle keeps linens off her body. The patient should not smoke because this triggers vasospasm. The patient's environment should be adjusted to prevent chilling, which could provoke vasospasm. A menu that promotes weight loss is not appropriate, since most patients lose weight as a result of esophageal involvement.

The nurse is caring for a patient with rheumatoid arthritis (RA) who has suffered some physical deformities as a result of the disease. The patient is depressed and irritable. The nurse knows that it is important to include which approaches to this patient's care? Select all that apply. 1 . Visit the patient often. 2. Use "tough love" to help the patient. 3. Encourage family support for the patient. 4. Explain the patient's irritability to the family. 5. Refer the patient to a new Internet RA group. 6. Encourage the patient to use anti-anxiety medication.

1 . Visit the patient often. 3. Encourage family support for the patient. 4. Explain the patient's irritability to the family. 5. Refer the patient to a new Internet RA group. Physical deformities related to RA can evoke a sense of loss and can result in depression, irritability, and feelings of helplessness and can harm the patient's interpersonal relationships. Impaired social interaction may increase the patient's feelings of isolation and worsen the negative feelings. The nurse should visit the patient often so the patient does not feel so isolated and lonely, explain the patient's irritability to family and friends, and emphasize the importance of their support to the patient. An internet RA group, if available and if safe, may help the patient socialize and stay involved. "Tough love" is contraindicated, as is encouraging the use of anti-anxiety medications.

A patient has been educated regarding his upcoming magnetic resonance imaging (MRI) study. Which patient statement indicates that the patient understands the instructions provided? 1. "I must lie still for about 30 minutes." 2. "The test cannot be done if I have claustrophobia." 3. "Any pain or discomfort I will have will be minimal." 4. "My pacemaker is okay if it was inserted more than 5 years ago."

1. "I must lie still for about 30 minutes." The patient must understand that he or she will have to lie still for 30 minutes. If the patient has problems with claustrophobia, an order for a sedative can be obtained and the drug given to help alleviate anxiety. The test is painless with no discomfort to the patient. Pacemakers or any implanted devices must be reported to the radiologist regardless of when they were inserted.

The nurse at a long-term care facility has received a report on a newly admitted resident. The resident has been diagnosed with rheumatoid arthritis (RA). The nurse knows that RA is best described in which manner? 1. A chronic, progressive inflammatory disease 2. When bone absorption surpasses bone formation 3. A rare, acute inflammatory disease that primarily affects skeletal muscle 4. Characterized by the degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone

1. A chronic, progressive inflammatory disease RA is a chronic, progressive inflammatory disease. When bone absorption surpasses bone formation, the condition is called osteoporosis. Dermatomyositis and polymyositis are relatively rare acute or chronic inflammatory diseases that primarily affect skeletal muscle. Osteoarthritis is characterized by the degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone.

The nurse is caring for a patient with gout. The patient states that the bed sheets at night cause severe pain when touching the great toe. The nurse recognizes these symptoms as consistent with which stage of gout? 1. Acute gouty arthritis 2. Chronic tophaceous gout 3. Asymptomatic hyperuricemia 4. Asymptomatic intercritical period

1. Acute gouty arthritis There are four stages of gout. Acute gouty arthritis, the second stage, is abrupt and generally occurs at night. The patient is suddenly struck with severe, crushing pain and cannot bear even the lightest touch on the affected joint. The first stage is called asymptomatic hyperuricemia. The third stage is called asymptomatic intercritical period, and the fourth stage is called chronic tophaceous gout.

Connective tissues come in several types, providing support for organs, and a framework for the entire body. Which is an example of loose connective tissue? 1. Adipose 2. Cartilage 3. Tendons 4. Ligaments

1. Adipose Adipose tissue is a type of loose connective tissue. Cartilage is strong supportive tissue. Tendons are dense connective tissue. Ligaments are a type of strong supportive tissue.

A patient is scheduled for magnetic resonance imaging (MRI) for diagnoses of a suspected torn ligament. Which would be appropriate nursing actions? Select all that apply. 1. Ask if the patient is claustrophobic. 2. Determine if the patient has a pacemaker. 3. Inform the patient that the dye will feel warm. 4. Instruct the patient not to eat or drink for 8 hours. 5. Obtain an order for prophylactic antibiotic therapy. 6. Explain that no special postprocedure care is needed.

1. Ask if the patient is claustrophobic. 2. Determine if the patient has a pacemaker. 6. Explain that no special postprocedure care is needed. The nurse needs to determine if the patient has a pacemaker or other implanted device and notify the radiologist. Metal is contraindicated with some MRIs but may not be with newer equipment. If the patient is claustrophobic, sedation may be needed. No special care is needed after the MRI. Dye is not used in an MRI. MRI is noninvasive, therefore a prophylactic antibiotic is not necessary. The patient does not need to remain on nothing by mouth (NPO) status for 8 hours.

Which type of tissue provides support, protection, movement, and manufacturing of blood cells as part of its functions? 1. Bone 2. Tendons 3. Cartilage 4. Ligaments

1. Bone Bone is the hard tissue that provides support, protection, and movement, stores calcium, and manufactures blood cells. Tendons are strong, dense connective tissue that anchors muscles to bones. Cartilage is specialized connective tissue that provides flexible support. Ligaments are bands of connective tissue that connect bones and cartilage, and also support muscles.

A right-handed major league pitcher is being seen with chief complaints of pain and limited mobility in the right shoulder. Which connective tissue disorder is most likely? 1. Bursitis 2. Polymyositis 3. Periarteritis nodosa 4. Carpal tunnel syndrome

1. Bursitis Bursitis is acute or chronic inflammation of the bursa that can be caused by trauma or strain due to excessive use, which would be likely in the right shoulder of a right-handed pitcher. Polymyositis is rare and has the primary symptom of muscle weakness. Periarteritis nodosa is a type of necrotizing vasculitis. Carpal tunnel syndrome affects the wrist.

Which changes in connective tissue occur in the aging process? Select all that apply. 1. Cartilage loses elasticity 2. Water content increases 3. Loss of bone mass and strength 4. Joint changes cause decreased mobility 5. Growth of osteophytes promote callouses 6. Men at higher risk for fractures due to osteoporosis

1. Cartilage loses elasticity 3. Loss of bone mass and strength 4. Joint changes cause decreased mobility Age-related joint changes are caused mainly by changes in cartilage, which loses elasticity. A loss of bone mass and strength occurs due to loss of bone density. Joint changes result in decreased mobility and pain, which can limit independence. Water content decreases, and cartilage may ulcerate causing bony joint surfaces to be unprotected, resulting in osteophytes (bone spurs), not callouses. Women are at higher risk for fractures due to osteoporosis.

The nurse is providing preoperative teaching for a patient who will be having a knee replacement. In explaining what to expect, a continuous passive motion (CPM) machine is discussed. The patient asks about the purpose of using the machine and how it works. Which is accurate information? Select all that apply. 1. Controls the degree of flexion and extension 2. Provides continuous therapy 24 hours per day 3. Improves range of motion and promotes flexibility 4. Usually the therapy begins on postoperative day 3 5. The machine can be used in the postanesthesia care unit 6. Flexion and extension controls are decreased with patient progress

1. Controls the degree of flexion and extension 3. Improves range of motion and promotes flexibility 5. The machine can be used in the postanesthesia care unit CPM controls the degree of flexion and extension by moving the joint through a set range of motion. The movement promotes flexibility. CPM can begin as early as in the postanesthesia unit. The machine is used for specific set intervals rather than continuously without breaks. The therapy would begin before day 3 to improve flexibility and prevent scar tissue formation. The time and degree of flexion and extension are gradually increased rather than decreased.

The patient asks the nurse for information on how to reduce inflammation. The nurse correctly responds that the patient should be sure she is getting the recommended daily value of which vitamin? 1. D 2. C 3. A 4. B12

1. D Vitamin D is thought to play a role in reducing inflammation. Vitamin C boosts the immune system. Vitamin A protects against free radicals. Vitamin B12 is used to detect pernicious anemia.

The patient has come to the clinic for assessment for osteoporosis. The nurse knows that which factors increase the risk for osteoporosis? Select all that apply. 1. Estrogen deficiency 2. Inadequate calcium 3. Corticosteroid therapy 4. Increased physical activity 5. Darker-skinned individuals

1. Estrogen deficiency 2. Inadequate calcium 3. Corticosteroid therapy Estrogen deficiency, inadequate calcium, corticosteroid therapy, and decreased (not increased) physical activity are risk factors for osteoporosis. Individuals with lighter skin are more likely to develop osteoporosis.

A patient is admitted with osteoporosis. The nurse caring for this patient knows that the loss of cortical and trabecular bone in patients with osteoporosis can have which possible net result? 1. Fractures from loss of bone mass 2. Joint loss from loss of bone marrow 3. Weight loss from loss of vital nutrients 4. Infection from loss of white blood cells

1. Fractures from loss of bone mass The loss of trabecular bone in early-stage osteoporosis and the loss of cortical bone later in life have a net result of loss of bone mass, which leaves the patient susceptible to fractures. There is no joint loss from loss of bone marrow or risk for weight loss from loss of vital nutrients. There is also no risk for infection from loss of white blood cells.

The nurse is preparing a teaching plan for a patient who is postmenopausal and has osteoporosis. The nurse knows that it is important to include which information? Select all that apply. 1. Limit intake of alcohol and caffeine. 2. Take at least 1000 IU of vitamin D is needed per day. 3. Avoid activities that might lead to falls and fractures. 4. Use whole milk, as it has more calcium than skim or nonfat milk. 5. Take 1200 to 1500 mg of calcium daily if not on hormone replacements. 6. If taking calcium supplements, increase fluid intake unless told not to by the provider.

1. Limit intake of alcohol and caffeine. 3. Avoid activities that might lead to falls and fractures. 5. Take 1200 to 1500 mg of calcium daily if not on hormone replacements. 6. If taking calcium supplements, increase fluid intake unless told not to by the provider. The patient should limit the intake of alcohol and caffeine and avoid activities that might lead to falls. After menopause, the patient needs 1200 to 1500 mg of calcium daily if not on hormone replacements. If the patient takes calcium supplements, she should increase fluid intake unless told not to by the health care provider. The patient needs 400 IU of vitamin D every day, not 1000. Nonfat and skim milk have as much calcium as whole milk.

A patient is admitted to a surgical unit from the recovery unit after a total hip replacement. The patient reports to the nurse sudden, severe pain in the surgical area. Which should be the nurse's priority action? 1. Notify the provider. 2. Assess the patient's vital signs. 3. Reposition the patient per the health care provider's orders. 4. Teach the patient the use of relaxation techniques or imagery.

1. Notify the provider. Surgical pain is expected; however, a sudden, severe pain in the surgical area may signal prosthesis dislocation. The provider should be immediately notified. Assessment of vital signs is a routine that would not take priority in this scenario. Repositioning the patient is a comfort measure to help with the expected postoperative pain. The use of relaxation techniques or imagery can help the patient deal with the expected postoperative pain.

The erythrocyte sedimentation rate (ESR) is decreased with which condition? 1. Osteoarthritis 2. Rheumatic fever 3. Rheumatoid arthritis 4. Polymyalgia rheumatica

1. Osteoarthritis The ESR determines how much inflammation is in the body and is decreased with osteoarthritis. Osteoarthritis is a breakdown of joint cartilage. The rate is increased with rheumatic fever and rheumatoid arthritis (RA) and is very high with polymyalgia rheumatica. RA is a progressive inflammatory disease.

A patient presents to the clinic complaining of frequent indigestion, dysphagia, dyspnea, weight loss, swelling, and thick skin that is taut and shiny in places. These symptoms are consistent with which disease process? 1. Scleroderma 2. Periarteritis nodosa 3. Ankylosing spondylitis 4. Systemic lupus erythematosus

1. Scleroderma Scleroderma is also known as progressive systemic sclerosis and is named for the characteristic thickening and hardening of the skin. Periarteritis nodosa is a nectrotizing vasculitis that affects small- and medium-sized arteries. Signs and symptoms are skin lesions, hypertension, fever, weight loss, change in urinary pattern, and anemia. Ankylosing spondylitis causes spinal deformities that are not usually disabling; symptoms include low back pain and stiffness that improves with activity. Systemic lupus erythematosus is an autoimmune disease that causes progressive organ damage; its symptoms depend on the damaged organ.

Which laboratory value would the nurse expect to be elevated in a patient with gout? 1. Serum uric acid 2. C-reactive protein (CRP) 3. Red blood cell count (RBCs) 4. Antinuclear antibodies (ANA)

1. Serum uric acid Elevated serum uric acid levels are characteristic of gout. CRP testing detects inflammation in rheumatoid arthritis and lupus. RBC testing detects anemia or polycythemia and determines erythrocytes in blood. ANA testing is used to test for autoimmune diseases such as systemic lupus erythematosis and rheumatoid arthritis.

The nurse is caring for a patient with a ruptured Achilles tendon who is asking about the injury. The nurse should explain which feature about tendons? 1. Tendons anchor muscles to bones. 2. Tendons connect bones and cartilage. 3. Tendons are located where two or more bones are joined. 4. Tendons provide flexible support for part of the adult skeleton.

1. Tendons anchor muscles to bones. Tendons are made up of very strong and dense fibrous connective tissue and anchor muscles to bones. Ligaments connect bones and cartilage and support muscles. A joint is where two or more bones are joined and allow motion and flexibility of the rigid skeleton. Cartilage is a special type of fibrous tissue that provides firm but flexible support for part of the adult skeleton.

Which are examples of dense connective tissue? 1. Tendons, fascia, and dermis 2. Areolar, adipose, and reticular 3. Cartilage, bone, and ligaments 4. Vocal cords, aortic walls, and part of the trachea

1. Tendons, fascia, and dermis Tendons, fascia, and dermis are examples of dense connective tissue. Areolar, adipose, and reticular are examples of loose connective tissue. Cartilage, bone, and ligaments are examples of strong supportive connective tissue. Vocal cords, aortic walls, and part of the trachea are examples of elastic connective tissue.

A patient is being seen at the clinic for treatment of chronic gout symptoms. While being assessed by the nurse, the patient asks what the white nodules are on the index finger. Upon inspection, what would the nurse suspect the nodules are? 1. Tophi 2. Pustules 3. Uremic frost 4. Sebaceous cysts

1. Tophi A patient with an advanced case of gout can have tophi, which are deposits of sodium urate crystals under the skin that appear as white nodules. Pustules are fluid-filled or pus-filled bumps. Uremic frost is a powdery deposit on the skin caused by kidney failure. Sebaceous cysts usually come from infected hair follicles and are not found on a finger.

The nurse is formulating a teaching plan for a patient who had a total hip joint replacement. Which information should be included in the teaching plan for this patient? Select all that apply. 1. Wound care 2. Activities that are permitted 3. Activities that are contraindicated 4. When to return for follow-up care 5. Now it is safe to lean over and tie the shoes 6. Swelling and warmth at the incision line is to be expected

1. Wound care 2. Activities that are permitted 3. Activities that are contraindicated 4. When to return for follow-up care Specifics of the teaching plan depend on which joint was replaced, but all patients need to know: directions for drug therapy and wound care; activities that are permitted and contraindicated; signs and symptoms to be reported to the provider right away; when to return for follow-up care; and sources of assistance such as home health care. The patient should be instructed not to lean over at the waist. Swelling and warmth at the incision line is abnormal and should be reported to the provider.

Which statement made by the patient indicates a need for more teaching regarding the medication regimen for rheumatoid arthritis? 1. "Leflunomide can slow progression of the disease." 2. "I can stop the glucocorticoid-prednisone when I am feeling better." 3. "Celecoxib will help with pain and is less likely to cause a stomach ulcer." 4. "I have to tell my health care provider if I take any new medications or supplements from the health food store."

2. "I can stop the glucocorticoid-prednisone when I am feeling better." More patient education is needed when the patient voiced that prednisone can be stopped when feeling better. Each of the other statements made by the patient demonstrates understanding. Glucocorticoids cannot be abruptly stopped, and the dosage must be tapered. Leflunomide can slow progression of the disease. Celecoxib will decrease pain and is less likely to cause gastrointestinal issues. New medications and some supplements may interact with the medication regimen.

The nurse is providing education on drug classes used to treat rheumatoid arthritis for a patient who was recently diagnosed with this disease. One such drug class are the biologic response modifiers (BRMs), which are immunosuppressive drugs usually given in combination with methotrexate. Which drug is classified as a BRM? 1. Celecoxib 2. Adalimumab 3. Sulfasalazine 4. Hydroxychloroquine

2. Adalimumab Adalimumab is a biologic response modifier. Celecoxib is a cyclo-oxygenase-2 (COX-2) inhibitor. Sulfasalazine, and hydroxychloroquine are disease-modifying antirheumatic drugs (DMARDs).

A patient who is diagnosed with progressive systemic sclerosis (scleroderma) is experiencing Raynaud phenomenon. Which intervention would be most helpful? 1. Using vasoconstrictive drugs 2. Beginning to wear gloves or mittens 3. Beginning a colchicine (Colcrys) regimen 4. Avoiding sardines during the acute phase

2. Beginning to wear gloves or mittens Management of Raynaud phenomenon is to eliminate causes of vasospasm, which is in response to cold. Wearing gloves or mittens helps protect against cold environmental temperatures. Vasoconstrictive drugs would decrease blood flow to the hands. Colchicine is used for treatment of gout. Avoiding sardines and foods high in purines is associated with gout during the acute phase.

A patient has been admitted with progressive systemic sclerosis. The patient's chart states that the patient suffers from CREST syndrome. The nurse knows which are the symptoms of CREST? 1. Calcinosis, Raynaud phenomenon, endovascular spasms, sclerodactyly, and telesectasis 2. Calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis 3. Calcinosis, Raynaud phenomenon, endocarditis, sclerodactyly, and thinning of blood vessels 4. Calcium deficiency, Raynaud phenomenon, endovascular spasms, shortening of the digits, and telangiectasis

2. Calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis The five symptoms of CREST syndrome are calcinosis (calcium deposits in the tissues), not calcium deficiency; Raynaud phenomenon (vascular spasms); esophageal dysfunction, not endovascular spasms or endocarditis; sclerodactyly (scleroderma of the digits), not shortening of the digits; and telangiectasis (dilated superficial blood vessels), not telesectasis or thinning of the blood vessels.

Which connective tissue disorder is due to the median nerve of the wrist becoming compressed? 1. Behget syndrome 2. Carpal tunnel syndrome 3. Systemic lupus erythematosis 4. Progressive systemic sclerosis

2. Carpal tunnel syndrome Carpal tunnel syndrome is due to the median nerve of the wrist being compressed, which causes pain and numbness. Behget syndrome is characterized by oral and genital ulcers, joint pain, and skin lesions. Systemic lupus erythematosis is an autoimmune disease. Progressive systemic sclerosis is a multisystem autoimmune disease.

Salicylates are often used to control the pain of osteoarthritis. The risk for toxicity exists, and symptoms may be atypical in older persons. Which atypical symptom is more likely to be seen in the older adult patient? 1. Tinnitus 2. Confusion 3. Blood in stool 4. Stomach upset

2. Confusion Older adult patients may have atypical symptoms of toxicity that include confusion, agitation, slurring of speech, or seizures. Tinnitis, stomach upset, and gastric bleeding are symptoms of toxicity for any age.

The nurse is conducting a physical examination on an older adult patient. Which finding would alert the nurse that the patient may be suffering from an inflammatory joint disease? 1. Pale 2. Crepitus 3. Old bruise on knee 4. Heart rate 60 beats per minute

2. Crepitus Crepitus is a crackling sound heard upon joint movement and alerts the nurse to the likelihood of fluid within the joint and an inflammatory joint process. Pale color of skin and an old bruise on the knee is not symptomatic of an inflammatory joint disease. A heart rate of 60 is within normal limits. Patients with inflammatory joint disease generally complain of pain with a likely increased heart rate.

The LPN is caring for a patient who has been instructed to collect a 24-hour urine specimen for creatinine. Which is the first step in the process of collecting the specimen? 1. Begin the test in a fasting state. 2. Discard the first morning urine specimen. 3. Collect the urine in a refrigerated container. 4. Include the urine collected at the conclusion of the test.

2. Discard the first morning urine specimen. The first urine specimen of the day should be discarded before beginning the test because its contents will be more concentrated than any subsequent specimen. It is not necessary to begin the test in a fasting state. Although the urine should be collected in a refrigerated container, this action is not the first step in the process. Including the urine collected at the conclusion of the test is the final, not the first, step of the test.

Which joint is the most common source of disability due to osteoarthritis? 1. Hips 2. Knee 3. Spine 4. Shoulders

2. Knee The most common source of major disability because of osteoarthritis is the knee. Osteoarthritis does affect joints under pressure including the hips, spine, and shoulders; however the most common source of major disability is the knee

The nurse is preparing to teach a class on the prevention of osteoarthritis. It is most important that the nurse stress that the patients protect which part(s) of their body? 1. Hip 2. Knee 3. Spine 4. Hands

2. Knee The most common source of major disability is osteoarthritis of the knee; therefore, it is most important that the nurse stress the protection of the knees. However, osteoarthritis does affect the entire body, and patients should be educated to live a healthy lifestyle to prevent osteoarthritis.

Which activity best describes that of an occupational therapist rather than a physical therapist? 1. Assists with gait training after a stroke 2. Modifies the physical environment, restoring self-care 3. Assists mobility to decrease pain while increasing function 4. Teaches walking, and assisting with movement dysfunction

2. Modifies the physical environment, restoring self-care An occupational therapist modifies the environment and restores self-care at work and in the personal life to allow maximal function. Assisting with gait training is performed by a physical therapist. Decreasing pain, increasing mobility and function, using exercise and positioning, as well as using braces and splints are usually performed by a physical therapist.

A patient is to begin the medication alendronate sodium. Which information should be included in the patient teaching? Select all that apply. 1. Take at bedtime (hs). 2. Sit for at least 30 minutes. 3. Take with 6 to 8 ounces of water. 4. Eat food immediately after administration to prevent GI upset. 5. Esophageal stricture would be a contraindication to taking the medication. 6. The medication acts by increasing bone mineral density and impairing bone resorption.

2. Sit for at least 30 minutes. 3. Take with 6 to 8 ounces of water. 5. Esophageal stricture would be a contraindication to taking the medication. 6. The medication acts by increasing bone mineral density and impairing bone resorption. The patient must sit or stand (remain upright) for 30 minutes after taking Fosamax. The medication must be taken with 6 to 8 ounces of water. Fosamax acts by increasing bone mineral density. Difficulty swallowing, such as with esophageal stricture, or not being able to sit up must be reported and are contraindications for using this medication. Instructions are to take upon arising in the morning with water and nothing else by mouth for 30 minutes.

Identify risk factors for osteoporosis. Select all that apply. 1. Obesity 2. Smoking 3. Menopause 4. Playing sports 5. Cushing syndrome 6. Taking corticosteroids

2. Smoking 3. Menopause 5. Cushing syndrome 6. Taking corticosteroids Smoking cigarettes increases the risk for osteoporosis. Low estrogen levels, such as in postmenopausal women, is a risk factor. Cushing syndrome is associated with this condition. Taking corticosteroids, such as prednisone, for long periods is a risk factor. Low body weight rather than obesity is considered to put a patient at risk. Physical activity is believed to help prevent osteoporosis. Regular exercise promotes bone formation.

A patient has been diagnosed with secondary osteoarthritis. The nurse knows that secondary osteoarthritis is related to which factors? Select all that apply. 1. Aging 2. Trauma 3. Anxiety 4. Genetics 5. Infection 6. Work-related stress 7. Corticosteroid therapy

2. Trauma 5. Infection 7. Corticosteroid therapy Secondary osteoarthritis is associated with trauma, infection, corticosteroid therapy, and congenital deformities. Primary osteoarthritis is related to aging and genetics. Anxiety and work-related stress are not specifically related to either primary or secondary osteoarthritis.

The nurse is caring for a patient with rheumatoid arthritis (RA). The registered nurse has explained that pain relief and joint flexibility are goals of the process of therapy. The nurse knows that which exercises may benefit the patient with RA? 1. Walking, aerobics, yoga, jogging, and cycling 2. Yoga, cycling, aquatics, aerobics, and walking 3. Stretching, yoga, walking, cycling, and aquatics 4. Stretching, walking, aerobics, yoga, and cycling

2. Yoga, cycling, aquatics, aerobics, and walking Types of exercises that may benefit the patient with rheumatoid arthritis (RA) include yoga, cycling, aquatics, aerobics, and walking. Stretching and jogging may either be too difficult, not effective, or too harmful.

Which patient needs to increase elemental calcium intake to decrease the risk for osteoporosis? 1. A 22-year-old patient taking 1000 mg per day 2. A 55-year-old patient taking 1500 mg per day 3. A 30-year-old postoopharectomy patient taking 1000 mg per day 4. A 40-year-old patient with hypercalcemia and a history of kidney stones

3. A 30-year-old postoopharectomy patient taking 1000 mg per day A 30-year-old postoopharectomy patient does not have the benefit of estrogen and should be taking 1200 to 1500 mg per day. A 22-year-old patient taking 1000 mg of calcium per day is within recommended guidelines. A 55-year-old patient taking 1200 to 1500 mg per day is also within guidelines. Calcium supplements are contraindicated for the 40-year-old patient with hypercalcemia and a history of kidney stones.

Which is the most serious complication for the postoperative patient with a hip or knee replacement? 1. Infection 2. Hemorrhage 3. Deep vein thrombosis 4. Dislocation of replacement

3. Deep vein thrombosis Deep vein thrombosis is the most serious complication postoperatively as the clot can break off and become a pulmonary embolism, which can be fatal. Infection is serious but can be treated with antibiotics. Observing for signs and symptoms of hemorrhage is important and, if it occurs, needs prompt treatment. Dislocation of replacement may require more surgery, and steps to prevent this complication must be followed.

The nurse is participating in a discharge planning conference for a patient with osteoarthritis. The nurse realizes that the patient may experience which problems at home associated with osteoarthritis? Select all that apply. 1. Acute pain 2. Poor appetite 3. Difficulty caring for self 4. Reduced mobility in the home 5. Difficulty coping with the illness

3. Difficulty caring for self 4. Reduced mobility in the home 5. Difficulty coping with the illness A patient with osteoarthritis is likely to have difficulty with caring for self, reduced mobility, and coping with the illness. Acute pain is less common than chronic pain. Poor appetite is not associated with osteoarthritis.

The nurse is caring for a patient with a connective tissue disorder. The nurse identifies which categories of drugs used to treat this condition? Select all that apply. 1. Opiate agents 2. Antibiotic drugs 3. Glucocorticoid agents 4. Muscle relaxant agents 5. Calcium-enriched agents 6. Nonsteroidal anti-inflammatory drugs (NSAIDs) 7. Disease-modifying antirheumatic drugs (DMRDs)

3. Glucocorticoid agents 6. Nonsteroidal anti-inflammatory drugs (NSAIDs) 7. Disease-modifying antirheumatic drugs (DMRDs) The three categories of drugs used to treat connective tissue disorders are glucocorticoid agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and disease-modifying antirheumatic drugs (DMRDs). NSAIDs are the safest and help relieve pain and reduce inflammation. Opiate agents, antibiotic drugs, muscle relaxant agents, and calcium-enriched agents are not used to treat connective tissue disorders.

A patient had a total hip replacement of the right hip. Which postoperative actions would be appropriate? Select all that apply. 1. Maintain the hip in a flexed position. 2. Place an adductor support between the legs. 3. Limit flexion of the hip to less than 90 degrees. 4. Do not turn the patient onto the operative side. 5. Place a pillow between the lower extremities when lying on the unaffected side. 6. Encourage patient to put on shoes and socks as soon as possible to promote independence.

3. Limit flexion of the hip to less than 90 degrees. 4. Do not turn the patient onto the operative side. 5. Place a pillow between the lower extremities when lying on the unaffected side. The patient should not be turned onto the operative side unless specifically ordered to do so by the surgeon. Flexion of the hip is to be limited to less than 90 degrees. A large pillow should be placed between the patient's legs during turning, when supine, and when lying on the unaffected side. The operative hip must not cross midline. The hip should not be in the flexed position. An abductor rather than adductor support would be used to maintain the hip in position. The patient should not bend to put on shoes and socks for at least 6 weeks and after receiving medical clearance to do so.

The nurse is caring for a patient with rheumatoid arthritis (RA) and notices firm lumps under the skin close to the joints in the patient's knuckles and elbows. The nurse documents these findings using which medical term? 1. Vasculitis 2. Ischemic lesions 3. Metatarsal nodules 4. Rheumatoid nodules

3. Metatarsal nodules Rheumatoid nodules are subcutaneous nodules that are found over bony prominences and are generally found at pressure points, including the hands, fingers, and elbows. Vasculitis with RA is an inflammation of the blood vessels and leads to impairing the blood supply to organs. It does not cause lumps under the skin. Ischemic lesions are brownish spots most often seen around nail beds. Nodules located on metatarsal joints are not rheumatoid nodules.

Which drug is likely to be used to suppress normal immune response and inflammation with connective tissue disorders and also contributes to bone loss with long-term use? 1. Naproxen 2. Cyclosporine 3. Prednisone 4. Hydroxychloroquine sulfate

3. Prednisone Prednisone is used to suppress normal immune response and inflammation in inflammatory and allergic conditions and also contributes to bone loss. Naproxen is an analgesic, antipyretic, and antiinflammatory drug. Cyclosporine suppresses the immune response in rheumatoid arthritis and psoriasis, and it prevents transplant rejection. Hydroxychloroquine sulfate is used for hypersensitive reactions.

A patient diagnosed with rheumatoid arthritis (RA) has developed a cluster of symptoms characterized by a dryness of the mouth, eyes, and vagina. These symptoms, in conjunction with RA, are called by which name? 1. Felty syndrome 2. Caplan syndrome 3. Sjögren syndrome 4. Vasculitis syndrome

3. Sjögren syndrome Some patients with RA develop clusters of symptoms. Sjögren syndrome is characterized by a dryness of the mouth, eyes, and vagina. Caplan syndrome, characterized by rheumatoid nodules in the lungs, occurs most often in coal miners and asbestos workers. Felty syndrome is characterized by liver and spleen enlargement and neutropenia. Vasculitis is inflamed blood vessels.

The LPN is caring for a patient who is scheduled to undergo magnetic resonance imaging. Which statement is the most important information about this patient that should be communicated to the health care provider? 1. The patient is claustrophobic. 2. The patient is experiencing anxiety. 3. The patient has a cardiac pacemaker. 4. The patient is wearing metallic jewelry.

3. The patient has a cardiac pacemaker. The patient may not be able to undergo the test with a cardiac pacemaker; thus notifying the health care provider of the cardiac pacemaker would be the priority. Although the health care provider should know that the patient is claustrophobic or anxious and might have ordered a medication, if necessary, relaying this information to the health care provider would not be the priority. The health care provider does not need to be notified that the patient is wearing metallic jewelry; rather, the nurse needs to remove the jewelry and have it secured for the patient.

Which patient is most likely to suffer from primary gout? 1. 30-year-old male who weighs 185 pounds and drinks 6 beers per week 2. 25-year-old female who weighs 130 pounds and admits to social drinking 3. 40-year-old female who weighs 150 pounds and drinks 3 to 4 alcohol drinks per week 4. 45-year-old male who weighs 280 pounds and drinks 1 to 2 martinis per day

4. 45-year-old male who weighs 280 pounds and drinks 1 to 2 martinis per day The 45-year-old male is most likely to suffer from primary gout due to age, weight, and alcohol consumption. Gout is more prevalent in men 40 to 50 years of age, and the risk increases with obesity and alcohol consumption.

The nurse is caring for an older adult patient with joint pain and limited mobility. The nurse knows that age-related joint changes are related to which factor? 1. Cartilage becoming hardened. 2. An increase in elasticity in cartilage. 3. A decrease in growth of osteophytes. 4. A decrease in water content in cartilage

4. A decrease in water content in cartilage With aging, changes in cartilage include a decrease in water content. The cartilage becomes soft and frayed, and there is a decrease, and not an increase, in elasticity. There is also an increase, not a decrease, in growth of osteophytes (bone spurs).

The nurse is caring for a patient with inflammatory joint pain. The nurse knows that which blood studies help diagnose if a disorder is related to inflammation? Select all that apply. 1. Calcium level 2. Blood cultures 3. Electrolyte count 4. C-reactive protein (CRP) 5. Liver function tests (LFTs) 6. Complete blood count (CBC) 7. Erythrocyte sedimentation rate (ESR)

4. C-reactive protein (CRP) 6. Complete blood count (CBC) 7. Erythrocyte sedimentation rate (ESR) The blood studies performed to help diagnose if a disorder is inflammatory include C-reactive protein (CRP), complete blood count (CBC), and erythrocyte sedimentation rate (ESR). Calcium level, blood cultures, electrolyte count, and liver function tests (LFTs) would not be included.

When caring for a patient after a knee replacement, the nurse assesses tenderness, swelling, redness, warmth, and firm, palpable blood vessels in the operative extremity. The nurse knows these are most likely the signs and symptoms of which disorder? 1. Infection 2. Dislocation 3. Hemorrhage 4. Deep vein thrombosis (DVT)

4. Deep vein thrombosis (DVT) DVT is the most serious postoperative complication of hip and knee replacement surgery. Signs and symptoms of DVT include tenderness, swelling, redness, warmth, and firm, palpable blood vessels called cords. Redness, swelling, pain, and tenderness around the incision are signs of an infection. Sudden, severe pain in the knee may signify a dislocation. Signs and symptoms of hemorrhage include hypotension, tachycardia, and bleeding from the incision site.

Chief Complaint: Pain in right leg, Low back pain, and recent weight gain ADLs: Drinks one glass of wine a day. Watches TV 2-3 hours a day. Hard to decrease work from full-time to part-time Past Medical History: Melanoma, pancreatic cancer, and congestive heart failure. The nurse is conducting a health history on a patient. Which finding from this chart would alert the nurse that the patient may be suffering from a connective tissue disorder? 1. Pain in right leg 2. Recent weight gain 3. Family history of pancreatic cancer 4. Had to decrease work time from full-time to part-time

4. Had to decrease work time from full-time to part-time Needing to decrease work time from full-time to part-time could signal that the patient is having problems with mobility and daily functioning. Pain in the right leg would not necessarily indicate a connective tissue disorder. A recent weight loss, not weight gain, along with the other complaints could indicate a connective tissue disorder. Also, a family history of pancreatic cancer does not predispose the patient to a connective tissue problem.

The nurse is caring for a patient who was admitted with symptoms of rheumatoid arthritis (RA). Which patient symptom is most closely associated with RA? 1. Weight gain 2. Asymmetrical joint changes 3. Joint stiffness at end of day 4. Joint pain aggravated by movement

4. Joint pain aggravated by movement The most common symptom of RA is pain in the affected joints that is aggravated by movement. Other symptoms include morning stiffness lasting more than 1 hour, weakness, easy fatigability, anorexia, weight loss, muscle aches and tenderness, and warmth and swelling of the affected joints. The joint changes are symmetrical, not asymmetrical.

Which assessment after arthroplasty of the right knee is of most concern to the nurse? 1. Pedal pulses palpable bilaterally 2. 1+ edema noted in operative extremity 3. Capillary refill less than 3 seconds in metatarsals 4. Patient rates pain 8/10, 30 minutes after receiving oxycodone

4. Patient rates pain 8/10, 30 minutes after receiving oxycodone The patient rating pain at 8 on a scale of 1 to 10 is indicative of severe pain that has not been relieved as expected with medication. This is the most concerning finding on the assessment. Pedal pulses being palpable bilaterally are an indication of adequate circulation, as this is the most distal peripheral pulse. Some edema is expected in the operative extremity and can be reduced with elevation. Capillary refill less than 3 seconds is reassuring.

The LPN is caring for a patient who is being treated with hydroxychloroquine sulfate. Which priority instruction would the nurse give to the patient who is taking this medication? 1. Instruct the patient to monitor complete blood cell count. 2. Inform the patient about side effects of nausea and vomiting. 3. Instruct the patient to report any episodes of headaches and anorexia. 4. Recommend that the patient visit an ophthalmologist while taking this medication.

4. Recommend that the patient visit an ophthalmologist while taking this medication. Visiting an ophthalmologist while taking this medication is the priority nursing intervention because ocular toxicity can occur with the medication. After the patient has demonstrated an understanding of the importance of visiting an ophthalmologist, the nurse would inform the patient that he or she may experience nausea and vomiting, instruct the patient to report the anorexia and headaches, and advise the patient to monitor complete blood cell count. Bone marrow suppression can occur with prolonged therapy.