NUS111: MOBILITY REVIEW
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men."
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
The nurse is caring for a 69-year-old patient with a history of osteoarthritis (OA) who has just been admitted to the medical unit. The patient asks the nurse what the difference is between OA and rheumatoid arthritis (RA). What is the best response by the nurse? "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." " OA and RA are very similar. OA affects the smaller joints, and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men."
"OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women, whereas OA affects both sexes equally.
A nurse who provides care on a reconstructive orthopedic unit has walked past the room of a patient who is receiving balanced suspension traction for the treatment of a femoral head fracture. The nurse observes a nursing assistant lifting the suspended weights to facilitate positioning a bedpan under the patient. How should the nurse best follow-up this observation? Ensure the nursing assistant knows that such transfers must be performed quickly and efficiently. Assess the patient for the ability to transfer to a commode rather than using a bedpan. Teach the nursing assistant that weights should not be removed from traction, except in an emergency. Teach the nursing assistant to apply temporary weights to compensate for positional changes.
Teach the nursing assistant that weights should not be removed from traction, except in an emergency. Explanation: The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights completely defeats their purpose and may result in injury to the patient.
A client is recovering from an attack of gout. What will the nurse include in the client teaching? Weight loss will reduce purine levels. Weight loss will reduce inflammation. Weight loss will increase uric acid levels and reduce stress on joints. Weight loss will reduce uric acid levels and reduce stress on joints.
Weight loss will reduce uric acid levels and reduce stress on joints. Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss will not reduce purine levels, reduce inflammation, or increase uric acid levels.
A 70-year-old woman has begun treatment for rheumatoid arthritis with nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse should consequently monitor the patient for signs and symptoms of what adverse effect? Cardiovascular (CV) complications Gastrointestinal (GI) bleeding Fatigue and confusion Nausea and vomiting
Gastrointestinal (GI) bleeding Explanation: NSAIDs carry a risk of GI bleeding. They do not commonly cause fatigue, CV complications, confusion, or nausea and vomiting. Reference:
Which condition is the leading cause of disability and pain in the elderly? Osteoarthritis (OA) Rheumatoid arthritis (RA) Systemic lupus erythematous (SLE) Scleroderma
Osteoarthritis (OA) Explanation: OA is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.
A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply. Pneumonia Necrosis of the humerus Skin breakdown Sepsis Delirium
Pneumonia Skin breakdown Sepsis Delirium
A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply. "I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsiplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Both feet warm with capillary refill < 3 seconds
"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsiplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%
The nurse is teaching a client about rheumatic disease. What statement besthelps to explain autoimmunity? "You have inherited your parent's immunity to the disease." "Your symptoms are a result of your body attacking itself." "You have antigens to the disease, but they do not prevent the disease." "You are not immune to the disease causing the symptoms."
"Your symptoms are a result of your body attacking itself." Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other statements do not explain autoimmunity.
A client has been involved in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. Other than the bone, what physical structures could be affected by this injury? All options are correct. muscles nerves blood vessels
All options are correct. Explanation: A fractured bone or other injury can potentially cause dysfunction to the surrounding muscle and injury to the blood vessels and nerves.
The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) Checking the urine for hematuria Palpating peripheral pulses in both lower extremities Testing the stool for occult blood Assessing level of consciousness Assessing pupillary response
Checking the urine for hematuria Palpating peripheral pulses in both lower extremities Testing the stool for occult blood Explanation:
A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse would include which of the following as a causative agent in gout? Thrombocytopenia Hypouricemia Hyperuricemia Hypocalcemia
Hyperuricemia Explanation: Oversecretion of uric acid or a renal defect resulting in decreased excretion of uric acid, or a combination of both occurs in gout. Hyperuricemia occurs. Thrombocytopenia is indicative of systemic lupus erythematosus. Hypercalcemia can cause kidney stones related to gout.
A patient has had rheumatoid arthritis for over 10 years, and the health care provider has now ordered cyclophosphamide (Cytoxan) for treatment of the disease. The nurse must be alert to what side effects of this medication when administering an immunosuppressant? Infection Nystagmus Muscle rigidity Hyperthermia
Infection Explanation: When administering immunosuppressant agents, such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression. Clinical manifestations of infection would be an important assessment for this patient. Nystagmus is a clinical manifestation of multiple sclerosis. Muscle rigidity occurs in Parkinson's disease. Hyperthermia does not occur as a common manifestation when receiving immunosuppressant agents.
A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client? Opioid therapy Ice packs Surgery Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs Explanation: Nonsteroidal anti-inflammatory drugs are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat, rather than ice packs, is used to relieve pain. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional; it is not an intervention specific to relieving pain.
The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? Ankylosing spondylitis Raynaud's phenomenon Reiter's syndrome Sjögren's syndrome
Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? aspirin furosemide colchicine calcium gluconate
colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.
A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply. Risk for infection Impaired physical mobility Risk for injury Urinary incontinence Disturbed body image
Risk for infection Impaired physical mobility Risk for injury
Which of the following would a nurse encourage a client with gout to limit? fluid intake protein-rich foods purine-rich foods carbohydrates
purine-rich foods Explanation: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.
A female patient is sufficiently stable to be transferred from the PACU to the postsurgical unit following her total hip replacement surgery early this morning. When preparing to admit this patient, the nurse on the postsurgical unit should anticipate that the patient will require what positioning? Supine with her knees slightly elevated With her legs slightly abducted In a high Fowler's position with knees elevated With a low head-of-bed and with her knees touching each other
With her legs slightly abducted Explanation: Following total hip replacement surgery, the patient's legs should be slightly abducted. The patient's knees do not need to be elevated, and a high Fowler's position is avoided due to the risk of exceeding 90 degrees of flexion at the waist.
Osteoarthritis is known as a disease that is the most common and frequently disabling of joint disorders. affects young males. requires early treatment because most of the damage seems to occur early in the course of the disease. affects the cartilaginous joints of the spine and surrounding tissues.
is the most common and frequently disabling of joint disorders. Explanation: The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.
A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. skin breakdown wound infection pneumonia diarrhea
skin breakdown wound infection pneumonia
A nurse at a small, rural nursing station that lacks the services of a physical therapist is responsible for planning the care of a local resident who has rheumatoid arthritis. When planning a regimen of physical activity for this patient, what principle should underlie the nurse's choice of interventions? Limiting physical activity slows the progression of rheumatoid disorders. Joints should be splinted whenever physical activity is performed. Active range-of-motion (ROM) exercises can reduce joint stiffness. ROM exercises should be passive (performed by the nurse) whenever possible.
Active range-of-motion (ROM) exercises can reduce joint stiffness. Explanation: Exercise is a fundamental part in the management of rheumatic disorders. Active and active/self-assisted ROM exercises are encouraged because they prevent joint stiffness and increase mobility. Passive ROM is not currently recommended, and splinting should be used with caution due to the possible loss of ROM.
The nurse is assessing a client's knee. The area has a grating sensation. What would this be documented as? Crepitus Shortening False motion Dislocation
Crepitus Explanation: When palpation of the extremity reveals a grating sensation, this is called crepitus. It is caused by the rubbing of the bone fragments against each other. In fractures of long bones, there is actual shortening of the extremity because the contraction of the muscles that are attached distal and proximal to the site of the fracture. Abnormal movement is false motion. With dislocation of a joint, the articular surfaces of the bones forming the joint are not longer in anatomic alignment.
The nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open fracture of the radius. The nurse will assign priority to what nursing diagnosis for this patient? Risk for infection Risk for disuse syndrome Risk for imbalanced nutrition: less than body requirements Risk for powerlessness
Risk for infection Explanation: While all nursing diagnosis may be pertinent to the care of a patient with an open fracture of the radius, the nursing diagnosis that will receive the highest priority is "risk for infection" related to the risks of osteomyelitis and tetanus. The objectives of management are to prevent infection of the wound, soft tissue, and bone, and to promote healing. Another priority diagnosis for a patient with an open fracture would be "risk for peripheral neurovascular dysfunction."
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Dislocation Muscle spasms Subluxation
Compartment syndrome Explanation: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.
