EAQ Osteoarthritis

CPM Rationale

The nurse should check the cycle and range of motion settings at least once every 8 hours for safety.

Action Rationale

The nurse should remind the patient to stand on the left leg after getting out of bed, which prevents the patient from putting undue pressure on the right leg.

Instructions Rationale

The patient should be taught to use a walker as an ambulatory aid and asked to avoid putting more weight on the affected leg than allowed. The patient should avoid prolonged sitting in a 90-degree position to prevent dislocation of the prosthesis. The patient should be taught to avoid bending the hips more than 90 degrees.

4,000 mg Rationale

The standard ceiling dose of acetaminophen is 4,000 mg each day. However, patients may be at risk for liver damage if they take more than 3,000 mg daily, have alcoholism, or have liver disease.

The nurse identifies which reason for prescribing tranexamic acid (TXA) for a patient before a total hip arthroplasty (THA)? To prevent anemia To prevent infection To prevent vomiting To prevent prosthetic failure

To prevent anemia

The nurse suspects which cause of pain in the vertebral column and hips of a construction worker who is diagnosed with secondary osteoarthritis (OA)? Aging Genetic changes Trauma Obesity

Trauma

The nurse questions which instruction that is listed on a patient education resource related to home care self-management of osteoarthritis? Do not bend at the waist. Turn doorknobs clockwise. Use a small pillow under the head. Use utensils with an extended handle for eating.

Turn doorknobs clockwise

The home health nurse suspects that which patient action contributed to a hip dislocation after a total hip arthroplasty (THA)? Twisting the body when standing. Crossing the legs beyond the midline of the body. Wearing compression stockings. Keeping the leg slightly abducted. Flexing the hip beyond 90 degrees.

Twisting the body when standing. Crossing the legs beyond the midline of the body. Flexing the hip beyond 90 degrees.

Which nonpharmacologic intervention does the nurse suggest to a patient with osteoarthritis? Use a small pillow under the head or neck. Use a large pillow under the knee. Avoid elevating the legs when sleeping. Use moist heating pads that are not heavy. Wear supportive shoes with foot insoles.

Use a small pillow under the head or neck. Use moist heating pads that are not heavy. Wear supportive shoes with foot insoles.

The nurse provides which discharge instruction for a patient who had a total hip arthroplasty (THA)? Use a walker as an ambulatory aid. Cleanse the hip incision with antiseptic solution. Sit up in a firm, supporting chair during the daytime. Perform postoperative exercises such as crossing over of the legs. Avoid bending the hips more than 90 degrees.

Use a walker as an ambulatory aid. Sit up in a firm, supporting chair during the daytime. Avoid bending the hips more than 90 degrees.

Which nursing action is taken to prevent postoperative complications in an older-adult patient who has undergone total hip arthroplasty (THA)? Prohibiting the patient from coughing. Using an abduction pillow to prevent adduction. Measuring the temperature to assess infection. Giving medication for pain only when the patient asks verbally.

Using an abduction pillow to prevent adduction

The nurse identifies that a patient after a total hip arthroplasty is at an increased risk for which complication based on a history of obesity and smoking? Dislocation Infection Hypotension Venous thromboembolism

Venous Thromboembolism

Which instruction does the nurse include in a teaching plan for a patient diagnosed with osteoarthritis (OA)? Begin a running program. Activities such as knitting can slow down joint degeneration. Eating at two cups of yogurt per day can prevent exacerbation. Wear supportive shoes.

Wear supportive shoes

Complication Rationale

When caring for the patient who has undergone a THA, the nurse assesses the patient for pain, rotation, and extremity shortening.

Referral Rationale

When planning emotional support for a patient, the nurse should include referrals for a spiritual leader, religious leader, or a psychological counselor.

The nurse is caring for an older-adult patient with osteoarthritis and recognizes that which patient statement indicates that the patient is using effective coping strategies? "I do not know how long my spouse will be able to take care of me at home." "A transportation bus picks me up from the senior center three times a week so I can play cards." "I help with cooking, but I hurt so badly when I am performing this activity." "I do not know how much longer my neighbor can continue to help clean my house."

"A transportation bus picks me up from the senior center three times a week so I can play cards."

After providing discharge education to a patient who has undergone right total hip arthroplasty (THA), the nurse identifies that which statement indicates the need for further teaching? "I should avoid twisting my body when moving." "I should avoid crossing my legs to be more comfortable." "I should avoid putting more weight on my right leg while walking." "I should avoid adaptive devices when putting on shoes and socks."

"I should avoid adaptive devices when putting on shoes and socks."

After educating a patient with arthritis about joint protection, the nurse identifies that which statement indicates the need for further learning? "I should hold objects using one hand." "I should use a hairbrush with a long handle." "I should turn doorknobs in a clockwise direction every time." "I should use the entire palm of both my hands to get out of bed." "I should bend at my knees rather at my waist."

"I should hold objects using one hand." "I should turn doorknobs in a clockwise direction every time."

Which information does the nurse provide when a patient with osteoarthritis asks about the use of topical capsaicin? "It is a safe over-the-counter (OTC) product." "It works by blocking or modifying substance P and other neurotransmitters for pain." "Expect a burning sensation for a short time after applying it." "Use plastic gloves for application." "Wash hands immediately after applying the substance."

"It is a safe over-the-counter (OTC) product." "It works by blocking or modifying substance P and other neurotransmitters for pain." "Expect a burning sensation for a short time after applying it." "Use plastic gloves for application." "Wash hands immediately after applying the substance."

Which statement made by the nurse to the patient with osteoarthritis regarding joint education is accurate? "Use large pillows under your knees to relieve pressure." "Shoes with flat soles help support the metatarsal joints." "Muscle-strengthening programs help support your joints." "Avoid the use of a pillow behind your head when lying supine."

"Muscle-strengthening programs help support your joints."

After providing a patient with education about the differences between rheumatoid arthritis (RA) and osteoarthritis (OA), the nurse identifies that which statement indicates the need for further teaching? "RA is inflammatory. OA is degenerative." "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in patients older than 60." "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric and is noted in multiple joints."

"The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric and is noted in multiple joints."

The nurse provides which medication education for a patient who receives a prescription for capsaicin cream to treat osteoarthritis? "You may have drowsiness for a short period after applying it." "You may have a burning sensation for a short period after applying it." "You may have increased blood pressure for a short period after applying it." "You may have increased blood sugar levels for a short period after applying it."

"You may have a burning sensation for a short period after applying it."

Which is the standard ceiling dose of acetaminophen (per day) in the treatment of osteoarthritis (OA)?

4,000 mg

Which medication is considered the primary drug of choice for treatment of a patient with osteoarthritis (OA)? Methotrexate (MTX) Adalimumab Acetaminophen Leflunomide

Acetaminophen

Additional Teaching Rationale

Adaptive devices help patients dress without putting any pressure on the site of surgery. Therefore, the nurse recommends the use of assistive or adaptive devices while dressing.

Which is a main cause of primary osteoarthritis (OA)? Aging Obesity Joint injury Heavy manual work

Aging

Which is a factor that may lead to osteoarthritis (OA)? Aging Obesity Genetics Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE)

Aging Obesity Genetics

To prevent complications, which drug needs to be discontinued before a total knee arthroplasty (TKA)? Anticoagulant therapy Antidiabetic agent Antihypertensive medication Antiplatelet medication NSAID

Anticoagulant Therapy Antiplatelet Medication NSAID

Which action does the nurse take to prevent venous thromboembolism (VTE) when providing postoperative care of patient after total hip arthroplasty (THA)? Massage the legs Keep the legs slightly abducted Use the knee gatch on the bed Apply elastic stockings Administer anticoagulant therapy

Apply elastic stockings Administer anticoagulant therapy

Which medication instruction does the nurse provide for a patient who is prescribed lidocaine 5% patches to treat knee pain? Apply the patch on clean, intact skin. Keep the patch in place for 6 hours. Avoid using more than one patch at a time. Obtain a complete blood count before beginning therapy.

Apply the patch on clean, intact skin

Which intervention does the nurse provide to address the complication of dislocation in a patient who has undergone total hip arthroplasty (THA)? Avoids the use of abduction devices. Assesses the patient for extremity shortening. Places pillows on either side of the patient to prevent movement. Keeps the patient's heels off the bed.

Assesses the patient for extremity shortening.

Intervention Rationale

Assessing the patient's response to the machine is very important. This helps understand the effectiveness of the machine on the patient's joint mobility after surgery.

Which is an important nursing intervention when providing care for a patient who is using a continuous passive motion (CPM) machine after a total knee arthroplasty (TKA)? Assessing the patient's response to the machine. Storing the machine on the floor when not in use. Turning on the machine while the patient is having a meal. Placing the controls of the machine in reach when the patient is confused.

Assessing the patient's response to the machine.

The nurse seeks to prevent which complication when instructing a patient who has undergone total joint arthroplasty to deep breathe and cough and to use the incentive spirometer every 2 hours? Infections Atelectasis Pressure ulcers Postural hypotension

Atelectasis

Which action does the nurse take when a patient who take procainamide, a class I antidysrhythmic, receives a prescription for a lidocaine 5% patch to treat osteoarthritis? Instruct the patient to apply the patch at night. Instruct the patient to apply the patch for a small duration. Administer IV fluid and electrolytes before applying the patch. Avoid applying the patch, and inform the primary health care provider.

Avoid applying the patch, and inform the primary health care provider.

When reviewing a postoperative plan of care for a patient who has undergone total hip arthroplasty (THA), the nurse expects to find which intervention that addresses hip dislocation? Avoid hip flexion beyond 90 degrees. Use aseptic technique for wound care. Instruct the patient to perform leg exercises. Instruct the patient to wear compression stockings. Assess for acute pain, rotation, and extremity shortening.

Avoid hip flexion beyond 90 degrees Assess for acute pain, rotation, and extremity shortening

What does the nurse tell a patient about exercising related to self-management of osteoarthritis? Use passive exercise more often than active exercise. Maintain the number of repetitions of each exercise. Avoid medication for mild pain. Avoid resistive exercises when the joints are inflamed.

Avoid resistive exercises when the joints are inflamed.

The nurse provides which discharge instruction for a patient who underwent total hip arthroplasty (THA) and is prescribed anticoagulant therapy? Use an abduction pillow between the legs. Keep heels off the bed. Avoid using a straight razor. Reorient frequently.

Avoid using a straight razor

Osteoarthritis Pain Rationale

Because cartilage does not have a nerve supply, the pain is caused by joint and soft involvement and by spasms of the surrounding muscles.

Which is the characteristic feature of Bouchard nodes? Excess fluid in the joint. Atrophy of the skeletal muscle. Bony nodules at the distal interphalangeal joints. Bony nodules at the proximal interphalangeal joints.

Bony Nodules at the Proximal Interphalangeal Joints

Which test is used to detect osteoarthritis (OA)? C-reactive protein assay X-ray studies Rheumatoid factor assay Antinuclear antibody test MRI

C-Reactive Protein Assay X-Ray Studies MRI

Which drug is used to reduce postoperative pain in a patient after a total knee arthroplasty? Capsaicin Cefazolin Dalteparin Enoxaparin

Capsaicin

Capsaicin Rationale

Capsaicin is a product used for reducing postoperative pain after total knee arthroplasty. It binds to C-fiber receptors and facilitates the release of extra calcium to enter the nerve cells.

Diabetes Mellitus Rationale

Certain metabolic diseases (e.g., diabetes mellitus, Paget disease of the bone) and blood diseases (e.g., hemophilia, sickle cell disease) can also cause joint degeneration.

Which action does the nurse take when caring for a patient who is using a continuous passive motion (CPM) machine after a total knee arthroplasty (TKA)? Allows the patient to take control of the machine. Encourages the use of the CPM machine whenever awake. Checks the cycle and range of motion settings at least once every 8 hours. Stores the machine on the floor when not in use.

Checks the cycle and range of motion settings at least once every 8 hours.

Which dietary supplement may be recommended to treat symptoms associated with osteoarthritis (OA)? Iron Garlic Chondroitin Glucosamine Niacin

Chondroitin Glucosamine

Which parameter is assessed when prescribing tranexamic acid (TXA) to a patient who is undergoing total hip arthroplasty (THA)? Narrowing pulse pressure Decreased hemoglobin Decreased respiratory rate Elevated body temperature

Decreased hemoglobin

Which metabolic disorder may be responsible for the development of joint degeneration in a patient with osteoarthritis? Aging Hemophilia Diabetes mellitus Sickle cell disease

Diabetes Mellitus

Which medication does the nurse expect to find as a prescription for a patient with osteoarthritis? Diclofenac Acetaminophen Methotrexate Leflunomide Azathioprine

Diclofenac Acetaminophen

Prescription Rationale

Diclofenac is an NSAID that is used for a short period for the treatment of osteoarthritis. Acetaminophen is also prescribed for patients with OA. Methotrexate and Leflunomide are useful in the treatment of rheumatoid arthritis. Azathioprine is an immunosuppressant used in the treatment of rheumatoid arthritis.

Tranexamic Acid (TXA) Rationale

For most patients, TXA is used to reduce blood loss during the THA surgical procedure. TXA is an antifibrinolytic agent that improves postoperative hemoglobin and hematocrit and decrease the need for blood transfusions.

When the nurse assesses a patient with osteoarthritis, which finding indicates crepitus? Inflammation near the joint Grating heard when the joint is palpated Enlarged joint with bone hypertrophy Bony nodules at the distal interphalangeal joint

Grating heard when the joint is palpated

Hip Dislocation Rationale

Hip flexion beyond 90 degrees should be avoided because it may lead to dislocation and also causes pain in the hip. Acute pain, rotation, and extremity shortening should be assessed after a THA.

The nurse recalls that which medication that is used to treat osteoarthritis has side effects of black-colored stools dyspepsia, and shortness of breath? Ibuprofen Lidocaine Glucosamine Cyclobenzaprine

Ibuprofen

The nurse reviews the medication profile of a patient with osteoarthritis (OA) and suspects that which drug is the cause of the patient's dark tarry stools and indigestion? Cortisone Lidoderm Ibuprofen Hyaluronate

Ibuprofen

Platelet Rationale

If the platelet count falls below 20,000, spontaneous bleeding could occur. Notifying the health care provider before the LMWH is given is essential. LMWH can cause thrombocytopenia, so it should not be administered when the patient's count is low.

Which finding in a patient's physical assessment may be associated with osteoarthritis? Depression Impaired mobility Altered body image Decreased quality of life

Impaired Mobility

Secondary Osteoarthritis Rationale

Injury to the joints from excessive use, trauma, or other joint disease (e.g., rheumatoid arthritis) predisposes a person to OA. Heavy manual occupations (e.g., carpet laying, construction, farming) cause high-intensity or repetitive stress to the joints.

The nurse includes which consideration of minimally invasive surgery when discussing options with a patient who requires treatment of osteoarthritis? It involves more scarring. It results in a slow recovery. It increases postoperative pain. It enables a shorter hospital stay.

It enables a shorter hospital stay

Which statement is true regarding the pain associated with osteoarthritis? It worsens after rest in early stage of the disease. It is caused by the nerve supply to the cartilage. It diminishes after activity in early stages of the disease. It is caused by the spasms of the surrounding muscles.

It is caused by the spasms of the surrounding muscles

Instruction Rationale

Lidocaine patches should be placed on clean, intact skin. The patch can be kept in place for 12 hours a day. Three patches may be used at a time. A complete blood count is obtained before the patient begins NSAID therapy.

Which parameter is monitored in an older-adult patient with osteoarthritis (OA) who is taking 3,500 mg of acetaminophen daily? Serum glucose Liver enzymes Cardiac function tests Low-density lipoproteins

Liver enzymes

Before administering low-molecular-weight heparin (LMWH) to a patient after a total knee arthroplasty (TKA), which action does the nurse take when noting that the patient's platelet count is 50,000? Notify the health care provider of the platelet count. Administer the prescribed LMWH on schedule. Assess the activated partial thromboplastin time (aPTT). Assess the international normalized ration (INR).

Notify the health care provider of the platelet count

Factors Rationale

OA is a common connective tissue disease characterized by progressive degradation of the cartilage in movable joints. Aging, obesity, and genetic factors are responsible for OA.

Description Rationale

OA is the progressive deterioration and loss of cartilage in a joint. Obesity is a risk factor for osteoarthritis, and it is a degeneration disease process.

The nurse reviews a patient's medical record and recognizes which risk factor for osteoarthritis (OA)? Low body mass index (BMI) Obesity Childbearing age Male sex

Obesity

Which statement may be used to describe osteoarthritis (OA)? Obesity is a risk factor. It is an autoimmune disorder. Its disease process is degenerative. It usually affects the upper extremities first. Its disease pattern is bilateral and symmetric.

Obesity is a risk factor Its disease process is degenerative

Which clinical finding is associated with a diagnosis of early-stage osteoarthritis? Fissures and ulceration Osteophytes in joint space Secondary joint inflammation Opaque and yellowish-brown cartilage

Opaque and yellowish-brown cartilage

Steroid Rationale

Osteonecrosis is bone death secondary to lack of or disruption in blood supply to the affected bone, usually from trauma or chronic steroid therapy.

The nurse reviews the medical records of patients who are in need of hip repair and identifies that which patient is a candidate for minimally invasive surgery? Patient A: Patient is obese Patient B: Patient has osteoporosis Patient C: Patient needs total hip surgery revision Patient D: Patient needs primary total hip arthroplasty

Patient D: Patient needs primary total hip arthroplasty

Which action does the nurse take when assisting a patient who had a right total hip arthroplasty (THA) when getting out of bed? Stands on the left side of the bed when assisting the patient. Reminds the patient to stand on the left leg after getting out of bed. Lifts the patient and assists the patient to stand. Asks the patient to pivot on the right side of the chair.

Reminds the patient to stand on the left leg after getting out of bed.

Which imaging assessment would be ordered for a patient with osteoarthritis? Bubble study Routine x-ray view Specialized x-ray views Nuclear medicine studies MRI

Routine X-Ray View Specialized X-Ray Views MRI

Obesity Rationale

Secondary OA occurs less often than primary disease and can result from joint injury and obesity.

To provide emotional support for a patient with rheumatoid arthritis (RA), the nurse includes which referral in the plan of care? Spiritual leader Anesthesiologist Physical therapist Religious leader Psychological counselor

Spiritual Leader Religious Leader Psychological Counselor

The nurse recognizes that chronic use of which medication used to treat osteoarthritis (OA) puts a patient at risk for osteonecrosis? Capsaicin Chrondroitin Glucosamine Steroid

Steroid

Prevention Rationale

Support stockings provide compression, which helps prevent VTE. Anticoagulants help prevent VTE because they inhibit the formation of the blood clots.

History Rationale

The most potentially life-threatening and commonly occurring complication after total hip arthroplasty is venous thromboembolism (VTE), which include deep vein thrombosis (DVT) and pulmonary embolism (PE). Older-adult patients are especially at increased risk for VTE because of age and decreased circulation before surgery.