Osteoarthritis
A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for what reason?
A)To rule out inflammatory arthritis and gout B)To identify irregular joint space narrowing C)To evaluate for increased density of subchondral bone D)To determine the extent of joint damage Answer: A Joint fluid analysis is used to detect inflammation, bacteria, and uric acid crystals in order to rule out inflammatory arthritis and gout. This test will not provide information on the extent of the joint damaged. This test cannot identify the amount of joint space that has narrowed. This test cannot evaluate bone density
The nurse is providing home care teaching to a client diagnosed with osteoarthritis. Which statement is appropriate for the nurse to include in the teaching session for this client?
A)"When you begin your strengthening exercises, it is appropriate to start with a large weight and work your way down." B)"Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare provider." C)"Stretching all muscle groups for 30 minutes each day has been recommended by the healthcare provider." D)"Water exercises should not be tried because water buoyancy increases force on the joints Answer: B Balance and agility exercises are recommended for clients with osteoarthritis because they help to maintain daily living skills. When beginning strengthening exercises, clients should start with a low weight and work their way up. Water exercise is beneficial because the buoyancy of the water decreases the force on the joints. The client should stretch all muscle groups for 10 minutes each day. Overstretching is contraindicated
Mrs. Kingsley is a 64-year-old African American woman who has returned to the healthcare provider's office for follow-up of the osteoarthritic condition of her knees. Although both knees are affected, today her left knee is more swollen than the right knee. During your assessment, Mrs. Kingsley asks you, "If I am losing the cartilage in my knees, why do my knees look larger?" What would be an appropriate response?
A)Although the cartilage is destroyed, you may be building up more bone in the knee. B)Since your condition has progressed, your knees have developed contractures and this increases the size of the knees. C)As your joint cartilage reduces, with exercise, muscle mass increases, which makes the knees look larger. D)With osteoarthritis, sometimes inflammation increases the size of your knees or fluid build-up occurs. Answer: D Inflammation causes swelling of the knee joint, which makes the joint appear larger. Joint effusion or fluid build-up may also occur. An increase in bone or muscle tissue does not occur in osteoarthritis. Flexion contractures may develop with osteoarthritis of the knee joint, but this will not result in an increase in the size of the joint.
Which interventions support effective management of chronic pain that is experienced by a client with osteoarthritis? (Select all that apply.)
A)Applying cool compresses to painful joints to reduce inflammation B)Using firm support in chairs and mattresses to properly align the body C)Limiting isometric exercises to reduce strain on the joints D)Encouraging resting painful joints E)Teaching proper posture and good body mechanics for activities of mobility Answers: B, D, E Chronic pain is frequently associated with osteoarthritis. When joints are painful, they should be rested. The rest should be balanced with periods of activity, which will reduce joint stiffness. Using proper posture and good body mechanics places the body in proper alignment and offers the joints a neutral platform to perform ROM activities. Firm chairs and mattresses assist the body in proper alignment. Heat should be applied to painful joints, which will increase joint mobility. Cool compresses may increase joint pain and will limit joint mobility. Isometric exercises strengthen muscle groups, which is important to provide additional strength in movement. Strong muscles will reduce strain on joints.
The nurse is planning care for a client with osteoarthritis. Which potential problem is priority for the nurse to address? (Select all that apply.)
A)Chronic pain B)Fluid volume deficit C)Impaired skin integrity D)Impaired cardiac output E)Impaired physical mobility Answers: A, E Chronic pain and impaired physical mobility are priority potential problems for the nurse to address when planning care for a client diagnosed with osteoarthritis. Skin integrity, fluid volume deficit, and cardiac output are not potential problems for the nurse to address when planning care for a client diagnosed with osteoarthritis
The nurse is providing education at a community health fair about osteoarthritis. Which are the general clinical manifestations associated with osteoarthritis that the nurse should include when providing this education? (Select all that apply.)
A)Crepitus with movement of joint B)Abrupt onset C)Mild fever D)Joint pain with activity E)Pain and stiffness at night Answers: A, D, E Joint pain with activity, grating or crepitus noted with movement, and pain and stiffness with prolonged inactivity are general manifestations of osteoarthritis. Mild fever is associated with rheumatoid arthritis, not osteoarthritis. General manifestations of osteoarthritis include a gradual onset, not an abrupt onset.
Mrs. Gladek is a 70-year-old White woman who has experienced progressive symptoms of osteoarthritis over the past 5 years. In addition to taking prescribed analgesics and anti-inflammatory medications, she is discussing interventions that she implemented into her daily lifestyle to manage her disease condition. Which activity would you suggest to Mrs. Gladek to provide additional exercise opportunities for her
A)Doubles tennis for older adults B)Meditation C)Interval training to jog a 5K D)Water aerobic activities Answer: D
The nurse is providing education about home care for a client with osteoarthritis of the knees. Which information should the nurse include during this educational session? (Select all that apply.)
A)Encouraging heavy lifting to maintain muscle strength B)Installing handrails in bathroom C)Taking pain medications as ordered D)Continuing activity with repetitive movement E)Using assistive devices to minimize stress placed on affected joint Answers; B, C, E Taking pain medications as ordered will assist with pain management and allow the client to participate in daily activities. Installing handrails in the bathroom is information that the nurse should include when educating a client, for this will keep the client safe at home. The nurse should educate the client on the importance of using assistive devices to minimize joint stress. The nurse should instruct the client to avoid repetitive movement and to avoid heavy lifting, for these actions will increase pain and joint degeneration and will not improve physical mobility.
A nurse is providing a preventive teaching discussion with a client at risk for osteoarthritis. Which guideline should be included in this discussion related to exercise?
A)Exercise is not recommended B)If there is pain with exercise, keep going, this is building muscle C)Participate in regular exercise, including walking or swimming D)Perform heavy weightlifting exercises three times per week Answer: C Participating in regular exercise like walking, jogging, swimming and cycling can keep joints strong and functional. Heavy weightlifting is not recommended for a client with OA and may actually lead to further joint breakdown. Recommending exercise is proven to prevent OA; it should not be discouraged. If pain is experienced with exercise, the client should stop and rest; continuing may build muscle, but will break down the joint cartilage.
Which health promotion activities support a healthy lifestyle for clients with osteoarthritis? Select all
A)Increase dietary intake of calcium B)Maintain a normal weight C)Use assistive devices as needed D)Limit participation in ROM exercises E)Use soft chairs and recliners for rest Answers: B, C Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab bars, a shower chair, or long-handled grippers help the client to maintain an independent lifestyle in safety. ROM exercises assist the client to maintain maximal use of joint mobility and are an important component in the exercise plan. Although calcium intake is essential to prevent osteoporosis, especially in older adults, increasing calcium in the daily intake does not have a positive effect on osteoarthritis. Chairs and mattresses should provide support and help to maintain normal body alignment. Soft chairs and recliners do not provide such support.
Which surgical treatment can be used to realign a joint that is affected by osteoarthritis?
A)Joint biopsy B)Joint arthroplasty C)Arthroscopy D)Osteotomy Answer: D An osteotomy is an incision into or through the bone that can realign or shift the joint load into a better aligned point or toward a less damaged part of the joint. A joint arthroplasty reconstructs or replaces the affected joint when it is severely damaged and pain seriously alters lifestyle. An arthroscopy is used to debride the rough and irregular damaged cartilage. Although fluid may be aspirated from a joint for analysis, joint cartilage is not biopsied to realign a joint affected by osteoarthritis
A client diagnosed with osteoarthritis of the hands presents with bony lumps on the end joints of her digits. How will the nurse document this finding in the medical record?
A)Lymph node swelling B)Bouchard nodes C)Osteoblasts D)Heberden nodes Answer: D Heberden nodes are bony lumps occurring at the end joint of the digits in a client with OA. Bouchard nodes occur in the middle joint of the digits. Osteoblasts are cells that form new bone. Lymph node swelling does not occur in the hands.
A client complains of knee pain during an appointment at a medical clinic. After reviewing the client's medical record, the nurse notes the client has been taking over-the-counter NSAIDs, with no pain relief. The nurse can anticipate the healthcare provider writing a prescription for what medication at discharge?
A)Morphine sulfate B)Celecoxib (Celebrex) C)Acetaminophen (Tylenol) D)Naproxen (Aleve) Answer: B Celecoxib (Celebrex) is a prescription NSAID, COX-2 inhibitor that relieves pain associated with osteoarthritis. Naproxen (Aleve) does relieve pain and stiffness associated with osteoarthritis; however, it is an OTC NSAID, which has not provided relief for the client. Acetaminophen is a first-line therapy for pain; however, it is OTC and not providing client relief. Morphine sulfate is used for clients experiencing moderate to severe pain, but should not be used before trying celecoxib.
The nurse is providing education to a community group about developing osteoarthritis. What joints, commonly affected, will the nurse include in the educational session?
A)Neck, shoulders, and ankles B)Ankles, feet, and spine C)Hands, knees, and hips D)Knees, feet, and spine Answer: C Hands, knees and hips are the most commonly affected joints of OA. Feet, spine, neck, shoulders, and ankles are not the most common locations.
The nurse is planning care for a client with osteoarthritis of the hips. Which intervention will assist in addressing the potential problem of physical mobility?
A)Recommend a local support group for the client and spouse. B)Teach active and passive range of motion exercises. C)Educate the client about proper skin care. D)Encourage the client to avoid all physical activity. Answer: B Teaching active and passive range of motion exercises will assist in addressing the potential problem of physical mobility with a client with osteoarthritis. Encouraging the client to avoid all physical activity does not address the potential problem of physical mobility for a client with osteoarthritis. The client should be encouraged to exercise to develop supportive muscles and tendons. Recommending a local support group for the client and spouse and educating the client about proper skin care do not address the potential problem of physical mobility for a client with osteoarthritis.
A client experiencing severe pain that cannot be managed through pain medications or nonpharmacologic therapy may need surgical intervention. Which surgical treatments will the nurse include in the teaching session with other members of the healthcare team? (Select all that apply.)
A)Serum hyaluronic acid B)Osteotomy C)Arthroplasty D)Joint fusion Answers: B, C, D Arthroplasty, osteotomy, and joint fusion are all surgical interventions indicated for a client with osteoarthritis. Serum hyaluronic acid is a diagnostic blood test for knee osteoarthritis and is not a surgical treatment. Cortisone therapy is not a surgical treatment; it is injected into the inflamed joint.
Which diagnostic test will best determine the cause of joint damage with osteoarthritis?
A)Synovial fluid analysis B)Joint x-ray C)Electromyogram (EMG) D)MRI of joint Answer: A Analyzing the synovial fluid of the involved joint helps to determine the cause of joint damage, which may include inflammatory arthritis and gout. This distinction will determine the factors of treatment. An EMG analyzes the strength of muscle contraction. It does not provide any information about joint mobility. An MRI of the affected joint determines the extent of joint damage but does not differentiate causes of the damage. An x-ray of the joint determines the presence of osteoarthritis and the potential presence of joint complications.
The nurse is providing education to a client who is scheduled for an osteotomy. Which information should the nurse include about this procedure?
A)The procedure will stop osteoarthritis from progressing. B)Realignment of the joint will occur. C)The joint will be reconstructed. D)Excess debris will be flushed out. Answer: B An osteotomy is performed to realign the joint or to shift the joint load toward areas of less cartilage damage.An osteotomy will not stop the process of osteoarthritis.Joint arthroplasty, not an osteotomy, is a procedure that reconstructs the joint.Arthroscopy, not an osteotomy, is a procedure used to debride the joint by smoothing rough cartilage and flushing out excess debris.