Unit 10 Study
what does calcitonin do?
Lowers blood calcium levels by inhibiting osteoclasts
The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply. a) inflammation b) damage c) abnormal innate and adaptive immune responses d) autoantibodies immune complexes e) susceptibility
a) inflammation b) damage c) abnormal innate and adaptive immune responses d) autoantibodies immune complexes e) susceptibility ALL Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.
A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse? a. Dairy products b. Organ meats c. Raw vegetables d. Shellfish
a. Dairy products Explanation: Primary hyperuricemia may be caused by severe dieting or starvation, excessive intake of foods that are high in purines (shellfish, organ meats), or heredity.
Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indicators of an elevated serum calcium? Select all that apply. a. Muscle weakness b. Tachycardia c. Anorexia and constipation d. Prolonged ST segment e. Shortened QT interval f. Lack of muscle coordination
a. Muscle weakness c. Anorexia and constipation e. Shortened QT interval f. Lack of muscle coordination Hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, incoordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes (eg, shortened QT interval and ST segment, bradycardia, heart blocks), and altered mental states (eg, confusion, lethargy, psychotic behavior)
what is rheumatoid arthritis?
autoimmune disease in which the body's own immune system attacks the body's joints
why should hypercalcemia be treated quickly?
because we worry about cardiac issues like complete heart block, QT interval changes, bradycardia
Metastatic calcification takes place in normal tissues as the result of increased serum calcium levels (hypercalcemia). Anything that increases the serum calcium level can lead to calcification in inappropriate places such as the lung, renal tubules, and blood vessels. What are the major causes of hypercalcemia? a. diabetes mellitus and Paget disease b. hypoparathyroidism and vitamin D intoxication c. hyperparathyroidism and immobilization d. immobilization and hypoparathyroidism
c. hyperparathyroidism and immobilization Metastatic calcification occurs in normal tissues as the result of increased serum calcium levels (hypercalcemia). Almost any condition that increases the serum calcium level can lead to calcification in inappropriate sites such as the lung, renal tubules, and blood vessels. The major causes of hypercalcemia are hyperparathyroidism, either primary or secondary to phosphate retention in renal failure; increased mobilization of calcium from a bone as in Paget disease, cancer with metastatic bone lesions, or immobilization; and vitamin D intoxication. Diabetes mellitus and hypoparathyroidism do not cause hypercalcemia; therefore, they cannot be a cause of metastatic calcification.
what is the first anti-tumor necrosis factor (TNF) agent to be approved for the treatment of RA?
etanercept (Enbrel) aka ETN
what is the viscous fluid in viscosupplementation called?
hyaluronic acid injection
what is a major cause of hypercalcemia?
hyperparathyroidism
what does parathyroid hormone do?
increases blood calcium levels by stimulating osteoclasts
how does hyperparathyroidism cause hypercalcemia?
parathyroid hormone (PTH) pulls Ca from the bone and into the blood
calcium is regulated by which hormones
parathyroid hormone, calcitonin, calcitriol
what interventions might be necessary for pt with acute attack of gout?
probenecid (Benemid), corticosteroid therapy, pain meds, monitor serum uric acid levels
name some medications used in the tx of gout
probenecid (Benemid), febuxostat (Uloric), allopurinol (Zyloprim)
what are modifiable risk factors associated with osteoporosis?
smoking, alcohol, physical inactivity, low calcium intake, vit D deficiency
what is osteomalacia?
softening of the bone due to vitamin D deficiency
what is the main tx for polymyalgia rheumatica (PMR)?
steroid therapy
what does calcitriol do?
stimulates calcium absorption in the GI tract
what is the first line of drug for an adult client with osteoporosis to prevent fractures?
teriparatide (Forteo) and abaloparatide (Tymlos)
describe the relationship between serum phosphate and serum calcium levels
there is an inverse relationship between the two; high calcium = low phosphate, low calcium = high phosphate
how would you position a pt with a spinal tumor post op?
to the side with a pillow between knees
probenecid classification
uricosuric agent
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply A) Computed tomography (CT) B) Angiography C) Magnetic resonance imaging (MRI) D) Ultrasound E) X-ray
A) Computed tomography (CT) C) Magnetic resonance imaging (MRI) D) Ultrasound E) X-ray Explanation: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.
A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply. A) Foods high in vitamin D B) Foods high in calories C) Foods high in protein D) Foods high in calcium E) Foods high in sodium
A) Foods high in vitamin D C) Foods high in protein D) Foods high in calcium Explanation: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.
The home health nurse Is performing a home visit for oncology client discharge 3 days ago after completing treatment for non-Hodgkin lymphoma the nurse's assessment should include examination for the signs and symptoms of what complication? A) Tumor lysis syndrome (TLS) B) Syndrome of inappropriate antiduretic hormone (SIADH) C) Disseminated intravascular coagulation (DIC) D) Hypercalcemia
A) Tumor lysis syndrome (TLS) Feedback: TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. DIC, SIADH and hypercalcemia are less likely complications following this treatment and diagnosis.
A patient is taking low-dose corticosteroids on a long-term basis for COPD. What does prolonged use of corticosteroids put the patient at risk for? A)Adrenal storm B)Adrenal atrophy C)Stunted growth D)Hypothalamic insufficiency
Adrenal atrophy Explanation: Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis and leads to adrenal atrophy from lack of stimulation.
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? A. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B. "OA affects joints on both sides of the body. RA is usually unilateral." C. "OA is more common in women. RA is more common in men." D. "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints."
A. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Rationale: 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.
Which of the following is a function of calcitonin? Select all that apply. A. Reduces bone resorption B. Increases deposition of calcium in bones C. Decreases deposition of phosphorous in bones D. Increases urinary excretion of calcium E. Decreases urinary excretion of phosphate
A. Reduces bone resorption B. Increases deposition of calcium in bones D. Increases urinary excretion of calcium Calcitonin reduces bones resorption, increasing deposition of calcium and phosphorous in the bones, and increases urinary excretion of calcium and phosphate.
A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have? - Developmental disability - Chronic disability - Impaired disability - Acquired disability
Correct Response: Acquired disability
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells? a. probenecid (Benemid) b. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) c. thioguanine (6-thioguanine, 6-TG) d. leucovorin (citrovorum factor or folinic acid [Wellcovorin])
Answer D. Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren't used to treat osteogenic carcinoma.
A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? A. An Asian man whose mobility is limited to a wheelchair B. A Caucasian woman who has low body mass index C. A Caucasian man who has led a sedentary lifestyle D. An African American woman who is slightly obese
B Lack of exercise is a risk factor for osteoporosis but small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis
Though the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82 year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A) Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B) The woman complains of aching and morning stiffness in her neck, shoulder, and pelvis. C) Range of motion in the woman's wrists and ankles is greatest in the morning and decreases over the course of a day. D) The woman's metatarsal joints are inflamed and sensitive to touch.
B) The woman complains of aching and morning stiffness in her neck, shoulder and pelvis. Explanation: Polymyalgia rheumatica is an inflammatory condition of unknown origin characterized by aching and morning stiffness in the cervical regions and shoulder and pelvic girdle areas. Lower limb pain, wrist and ankle stiffness and pain in the joints of the foot would not be as clearly suggestive of polymyalgia rheumatica.
A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? A. prone B. semi-Fowler's position C. side-lying with pillows supporting the shoulders and legs D. supine with pillows under the knees
Correct response: A. Prone Explanation: It is best for the patient with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.
Diagnosis of osteoarthritis is complicated because initial joint changes occur without symptoms. Therefore, a combination of physical assessment and X-ray review is necessary for a diagnosis. Select two signs that, when combined, are sensitive indicators of OA. A. Tender joints B. Osteophytes C. Joint pain D. Enlarged joints E. Joint space narrowing
B. Osteophytes E. Joint space narrowing Standard X-rays of affected joints show osteophytes, the most characteristic feature of OA, and in more advanced disease, joint space narrowing and sclerosis. When these two are combined, a diagnosis of OA is established.
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? Bisphosphonates Calcitonin Selective estrogen receptor modulators Anabolic agents
Bisphosphonates Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.
A nurse is caring for a patient with Paget's disease and is reviewing the patient's most recent laboratory values. Which of the following values is most characteristic of Paget's disease? A) An elevated level of parathyroid hormone and low calcitonin levels B) A low serum alkaline phosphatase level and a low serum calcium level C) An elevated serum alkaline phosphatase level and a normal serum calcium level D) An elevated calcitonin level and low levels of parathyroid hormone
C) An elevated serum alkaline phosphatase level and a normal serum calcium level Patients with Paget's disease have normal blood calcium levels. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increased osteoblastic activity associated with this condition. Alterations in PTH and calcitonin levels are atypical.
A client has been receiving corticosteroids for the past 3 years is admitted for a major surgical procedure. What would be important for the nurse to assess after the client returns from surgery? A. Presence and/or development of a moon face, increased weight, and purple abdominal striation B. Order at a lower does because of stress on the body until after the incisional area has adequately healed then resume previous order before surgery C. Continued order for corticosteroids at or above levels the client was receiving before surgery D. Correct Development of increased problems with mobility secondary to withdrawals from the corticosteroids Feedback
C. Continued order for corticosteroids at or above levels the client was receiving before surgery RATIONALE: One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamicpituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol.
After completing the musculoskeletal health history, the nurse determines that a client is at risk for osteoporosis. Which of the following risk factors were most likely identified in this client? (Select all that apply.) a) Age 65 b) Weight 180 pounds c) Sedentary lifestyle d) Current smoker e) Alcohol intake four drinks per day
CORRECT ANSWER • Age 65 • Current smoker • Sedentary lifestyle • Alcohol intake four drinks per day Explanation: Risk factors for the development of osteoporosis include age over 50 years, current smoker, sedentary lifestyle, and higher than the daily recommended allowance of alcohol intake. Body weight less than 70 kg or 154 pounds increases the client's risk for osteoporosis.
in which position would a patient with a spinal tumor more likely report back pain?
prone position; a pt in the prone position would be more likely to report pain
Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? A) Hyperuricemia B) Increased erythrocyte sedimentation rate C) Elevated serum creatinine D) Decreased platelets
D) Decreased platelets thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.)
The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? A. Reports ability to perform ADLs B. Shows a weight gain of 2 pounds C. Reports decreased joint pain D. Reports increased fatigue
D. Reports increased fatigue Rationale: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen.
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. Hyperphosphatemia Hyperuricemia Hyperkalemia Hypercalcemia
Hyperphosphatemia Hyperuricemia Hyperkalemia When intracellular contents are released into the bloodstream, phosphorus is elevated. This results in an inverse decline in the level of calcium, so hypercalcemia will not occur.
when do the therapeutic effects of HCQ start to appear?
Like with many other DMARDs, you will not feel the effects of HCQ right away. Most people start noticing the effects about six to eight weeks after they start to take the medication, but full benefit may not be apparent for up to three months.
Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? Glucocorticoids Nonsteroidal anti-inflammatory drugs (NSAIDs) Disease-modifying antirheumatic drugs (DMARDS) Tumor necrosis factor (TNF) blockers
Nonsteroidal anti-inflammatory drugs (NSAIDs) Rationale: In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms.
Giant cell arthritis is a comorbid condition of which of the following? -Gout -Pseudogout -Polymyalgia rheumatica -Systemic lupus erythematosus
Polymalgia rheumatica Explanation: A certain percentage of people with polymyalgia rheumatica also develop giant cell arteritis (i.e., temporal arteritis) with involvement of the ophthalmic arteries. This is not an associated outcome of any of the other options.
A patient is admitted with an acute attack of gout. What interventions are essential for this patient? Select all that apply A. Dietary consult B. Probenecid (Benemid) C. Corticosteroid therapy D. Serum uric acid level E. Pain medications
Probenecid (Benemid) Corticosteroid therapy Pain medications Serum uric acid level Steroids may be used in patients who have not had a response to other therapy. They have been shown to decrease inflammation and pain in attacks of gout. Probenecid will assist in the excretion of uric acid, the causative agent. Serum uric acid levels will guide therapy and treatment. A dietary consult can wait until the patient is over the acute, painful period. (ch 39, p. 1079)
what can adalimumab treat?
RA, plaque psoriasis, ankylosing spondylitis, Crohn's, and UC
Which of the following disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? Polymyositis Scleroderma SLE Rheumatoid arthritis
SLE Rationale: The most familiar manifestation of SLE is an acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and the cheeks. This type of rash does not characterize RA, scleroderma, and polymyositis
how is teriparatide (Forteo) administered?
SQ as there is no oral form
what test might be ordered to rule out a tumor when a client is complaining of back pain?
a bone scan is the preferred diagnostic procedure to disclose tumors in a pt with low back pain
what is sensory disability?
a disability of the senses (hearing, vision, touch, scent, taste)
The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply. a) Pain b) Alteration in self-concept c) Fatigue d) Fluid volume deficit e) Fluid and electrolyte imbalance
a) Pain b) Alteration in self-concept c) Fatigue e) Fluid and electrolyte imbalance Explanation: Clients with rheumatic diseases, which typically involve joints and muscles, experience problems with mobility, fatigue, and pain. Because of the limitations of the disease, clients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases.
what test result help confirm an SLE diagnosis?
an above-normal anti-DNA test, positive antinuclear antibody test, positive lupus erythematosus cell test, and decreased total serum complement level
what other risk factors are associated with osteoporosis?
chemotherapy, Cushing's syndrome, chronic steroid use like in pts with lupus, suppression of estrogen with taking tamoxifen
what is developmental disability and what are some examples?
condition that is diagnosed in childhood/birth autism, fetal alcohol syndrome
T/F: viscosupplementation is used to cure osteoarthritis
false, it is not a cure for osteoarthritis
T/F: steroid therapy may be abruptly stopped
false; steroids should be weaned off, not stopped abruptly
what are non-modifiable risk factors associated with osteoporosis?
female, post menopause, late menarche, aging, family hx, Caucasian/Asian race, short stature, previous low-trauma fracture
what does glucosamine do?
glucosamine is used by the body to produce other chemicals that are involved in building tendons, ligaments, cartilage, and the thick fluid that surrounds the joints
if a patient has RA and NSAIDs are not working, what might the RN think might work next?
gold compounds such as auranofin
what does chondroitin do?
it is a vital part of cartilage, giving it elasticity by helping it retain water; it can reduce the activity of enzymes and substances that break down collagen in joints
what are the signs/symptoms an elevated serum calcium?
lethargy, confusion, coma, muscle weakness, hyporeflexia, decreased muscle tone, arrhythmias
what is osteoporosis?
loss of bone mass
what labs might an RN review in osteomalacia?
low vit D, elevated alkaline phosphate (ALP), elevated parathyroid hormone (PTH)
which medication is the most effective to treat rheumatoid arthritis?
methotrexate
name some DMARDs
methotrexate and hydroxychloroquine (aka HCQ)
name drugs used to treat rheumatoid arthritis
methotrexate, hydroxychloroquine aka HCQ, etanercept (Enbrel) aka ETN, adalimumab
what are the dangers of long term steroid use?
muscle atrophy, osteoporosis, hyperglycemia, fluid retention, edema
what is probenecid used for?
to assist in the excretion of uric acid
for a patient with osteomyelitis, what might the labs look like?
elevated WBCs, elevated c-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR), and positive blood/wound cultures
Down syndrome is categorized as a(n) - acute nontraumatic disorder. - developmental disability. - age-related disability. - acquired disability.
Correct Answer: developmental disability.
A 65-year-old client was diagnosed with multiple sclerosis 10 years ago. The client has difficulty ambulating and is seeking a prescription for a wheelchair. The nurse assesses the type of disability the client has is - Age-associated - Developmental - Acquired - Sensory
Correct Response: Acquired
When caring for a client with a new diagnosis of rheumatoid arthritis, the nurse will include all of the following actions in the plan of care except? A. Instruct the client to purchase a firm mattress B. Suggest that the client take a nap in the afternoon C. Teach client to use warm water when bathing D. Suggest exercise with lightweights several times daily
D. Suggest exercise with lightweights several times daily RATIONALE: Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid arthritis. Clients are instructed to avoid stressing joints, to use warm baths to relieve stiffness, and to use a firm mattress.
what is polymalgia rheumatica?
an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips
auranofin adverse effects
renal toxicity, bone marrow suppression, n/v, dermatitis, stomatitis
The nurse is providing community education regarding osteoporosis. What risk factors for osteoporosis need to be included in the teaching? Select all that apply. A. Smoking B. Weight-bearing activities C. Low salt intake D. Alcohol consumption E. Hormones
A. Smoking D. Alcohol consumption E. Hormones Risk factors for osteoporosis include alcohol consumption, smoking, hormones and high salt intake. Weight bearing exercises are recommended to prevent osteoporosis.
what is a cardinal sign that a patient might have a spinal tumor?
back pain, leg pain, change in gait
what is viscosupplementation?
an injection of viscous fluid into a synovial joint to treat arthritis but it is not a cure for osteoarthritis
A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? a) Increased total serum complement levels b) Negative antinuclear antibody test c) An above-normal anti-deoxyribonucleic acid (DNA) test d) Negative lupus erythematosus cell test
c) An above-normal anti-deoxyribonucleic acid (DNA) test Explanation: Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE. pg.1070
A client with an acute attack of gout is being treated with colchicine. The nurse determines that the drug is effective upon finding a. Increased urine output b. Decreased white blood cell count c. Decrease inflammation d. Elevated serum uric acid
c. Decrease inflammation RATIONALE: Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in inflammation which decreasing pain
The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which of the following statements? a) "We need to consume a low-calcium, high-phosphorus diet" b) "Estrogen deficiency increases bone density." c) "We need to increase aerobic exercise" d) We need an adequate amount of exposure to sunshine."
d) We need an adequate amount of exposure to sunshine."
what is acquired disability and what are some examples?
disability that has developed during the person's lifetime examples include car accident and arthritis
what are the side effects of Forteo and Tymlos?
drop in BP, dizziness, nausea, palpitations, pain or swelling at injection site, hypercalcemia which can lead to kidney stones and interfere with heart and brain fx
name some TNF inhibitors used to treat RA
etanercept (Enbrel) aka ETN and adalimumab injections
A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply. A. Monitor gait, balance, and fatigue level with ambulation. B. Encourage intake of dairy products, seafood, nuts, broccoli, and spinach. C. Monitor for fluid overload. D. Monitor for signs and symptoms of diarrhea.
A. Monitor gait, balance, and fatigue level with ambulation. C. Monitor for fluid overload. Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.
The nurse recognizes which disorder as a developmental disability in a patient? - Osteoarthritis - Cerebral palsy - Spinal cord injury - Stroke
Correct Answer: Cerebral palsy
Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. A. Support joints with splints and pillows. B. Provide opportunities for the client to verbalize feelings. C. Provide diversional activities. D. Provide assistive devices for self-feeding.-Assist the client to develop a sleep routine.
Correct response: A. Support joints with splints and pillows. B. Provide opportunities for the client to verbalize feelings. C. Provide diversional activities. Explanation: To manage pain, the nurse maintains normal alignment of extremities as much as possible by supporting the joints with splints and pillows. Diversional activities distract the client's focus from the pain. Providing opportunities for the client to verbalize feelings facilitates coping with pain. Assistive devices for self-feeding help the client meet nutritional needs independently. Assisting the client to develop a sleep routine promotes rest and minimizes fatigue.
The diagnosis of osteoarthritis (OA) depends on evaluation of a number of factors. A nurse understands that the first, and frequently only, sign of symptomatic OA is which of the following?
Degree of limited passive movement OA is typically diagnosed by an overall clinical impression based on the patient's age and history, location of joint abnormalities, and radiographic findings. Limited passive movement can be the first and only physical sign of symptomatic OA.
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? "My legs feel weak." "I have trouble with my balance." "My finger joints are oddly shaped." "I have pain in my hands."
"My finger joints are oddly shaped." Rationale: Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.
A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor? 1- Lumbar sacral strain 2- The development of a skin ulcer from the radiation 3- Hematoma formation 4- Spinal metastasis
4- Spinal metastasis