Osteoarthritis Review Questions

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a. Limited passive movement b. Limb shortening c. Joint enlargement d. Joint instability

a. Limited passive movement Explanation: Limited passive movement can be the first and only physical sign of symptomatic OA. Physical assessment of the musculoskeletal system reveals joint enlargement, joint instability, and limb shortening.

A 47-year-old client with osteoarthritis and hypertension is diagnosed with breast cancer. The client tells the nurse that her mother also suffered from osteoarthritis and hypertension, and she developed breast cancer at the age of 51 years. The nurse should recognize that this client's health status may be the result of what phenomenon? a. Autosomal recessive inheritance b. X-linked inheritance c. Multifactorial inheritance d. Autosomal dominant inheritance

c. Multifactorial inheritance Explanation: Many birth defects and common health conditions, such as heart disease, high blood pressure, cancer, osteoarthritis, and diabetes, occur as a result of interactions of multiple gene mutations and environmental influences. Thus, they are called multifactorial or complex conditions. Multifactorial conditions are partly caused by genes and run along family lines and in people of the same sex. The other answers are incorrect because X-linked conditions, autosomal recessive conditions, and autosomal dominant conditions are not caused by the interactions of multiple gene mutations and environmental influences.

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? a. joint stiffness that increases with activity b. erythema and edema over the affected joint c. fever and malaise d. anorexia and weight loss

a. joint stiffness that increases with activity Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that increases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.

A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has? a. Rheumatoid arthritis b. Inflammatory arthritis c. Osteoarthritis d. Necrotizing arthritis

c. Osteoarthritis Explanation: Osteoarthritis is an obesity-related musculoskeletal condition. Rheumatoid arthritis, inflammatory arthritis, and necrotizing arthritis are not obesity-related conditions.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? a. detection of systemic complications b. prevention of joint deformity c. strategies for remaining active d. disease-modifying antirheumatic drug therapy

c. strategies for remaining active Explanation: The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

A patient comes into the clinic frequently with complaints of pain. What would the nurse recognize as chronic benign pain in a patient? a. Sickle cell crisis b. A migraine headache c. An exacerbation of rheumatoid arthritis d. Low back pain

d. Low back pain Explanation: Acute pain differs from chronic pain primarily in its duration. For example, tissue damage as a result of surgery, trauma, or burns produces acute pain, which is expected to have a relatively short duration and resolve with normal healing. Chronic pain is subcategorized as being of cancer or noncancer origin and can be time limited (e.g., may resolve within months) or persist throughout the course of a person's life. Examples of noncancer pain include peripheral neuropathy from diabetes, back or neck pain after injury, and osteoarthritis pain from joint degeneration.

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client? a. Urgent b. Emergent c. Elective d. Required

c. Elective Explanation: Elective surgery means that the client should have the surgery even though failure to have the surgery is not catastrophic. Urgent surgery means that prompt attention is required within 24 to 30 hours. Required surgery means that the client needs to have surgery within a few weeks or months. Emergent surgery means that the client requires immediate attention for a life-threatening disorder without delay.

A client who has been diagnosed with osteoarthritis asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response? a. A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities. b. The client should discuss this concern with the health care provider. c. Hand and finger deformities are associated with the development of rheumatoid arthritis. d. It's impossible to determine at the time of diagnosis how the disease will progress.

c. Hand and finger deformities are associated with the development of rheumatoid arthritis. Explanation: The nurse should explain to the client that joint deformities occur with rheumatoid arthritis, not osteoarthritis. Osteoarthritis typically follows a pattern of cartilage destruction and increased pain. The nurse is part of the interdisciplinary health care team and is capable of answering the client's questions about the typical progression of disease.

The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? a. Clients will have an ulnar deviation. b. Clients may develop Heberden nodes. c. Clients will develop boutonniere deformity. d. Clients may have swan neck deformity.

Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? a. Install safety devices in the home. b. Wear worn, comfortable shoes. c. Get help when lifting objects. d. Wear protective devices when exercising.

a. Install safety devices in the home. Explanation: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises.

Which is the leading cause of disability and pain in the elderly? a. Osteoarthritis (OA) b. Rheumatoid arthritis (RA) c. Systemic lupus erythematosus (SLE) d. Scleroderma

a. Osteoarthritis (OA) Explanation: Osteoarthritis 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 client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? a. Take the medication with food to avoid stomach upset. b. Take the medication on an empty stomach in order to increase effectiveness. c. Inform the health care provider if there is ringing in the ears. d. Since the medication is able to be obtained over the counter, it has few side effects.

a. Take the medication with food to avoid stomach upset. Explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. Ibuprofen is available over the counter, but it still has side effects. Aspirin is known to cause ringing in the ears, not NSAIDs.

A clinic nurse assesses a client with diabetes who reports taking naproxen (Aleve) and the herb bilberry for osteoarthritis. To assess for an adverse reaction between naproxen and bilberry, the nurse asks the client a. "Have you been constipated?" b. "Do you bleed easily?" c. "Has your blood sugar been elevated more than usual?" d. "Have you noticed an increase in your pain levels?"

b. "Do you bleed easily?" Explanation: Naproxen, a nonsteroidal anti-inflammatory drug, with the herb bilberry may enhance a client's risk for bleeding. Diarrhea, constipation, or both are frequent adverse reactions to naproxen but not bilberry. Bilberry may cause hypoglycemia. Naproxen does not. There should not be an increased level of pain as a result of the interaction of naproxen and bilberry.

A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize? a. The client will recover from OA within 6 months. b. The client will express satisfaction with the ability to perform ADLs. c. The client will deny signs or symptoms of OA. d. The client will adhere to the prescribed plan of care.

b. The client will express satisfaction with the ability to perform ADLs. Explanation: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care; adherence is of little benefit if the regimen has no effect on the client's functional status.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? a. joint pain that increases with rest b. early morning stiffness c. small joint involvement d. subcutaneous nodules

b. early morning stiffness Explanation: Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.

The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis? a. Clients will have an ulnar deviation. b. Clients may have swan neck deformity. c. Clients may develop Heberden nodes. d. Clients will develop boutonniere deformity.

c. Clients may develop Heberden nodes. Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? a. "Do all your chores after performing morning exercises to loosen up." b. "Do all your chores in the evening, when pain and stiffness are least pronounced." c. "Do all your chores in the morning, when pain and stiffness are least pronounced." d. "Pace yourself and rest frequently, especially after activities."

d. "Pace yourself and rest frequently, especially after activities." Explanation: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a. "Use your continuous passive motion machine for 2 hours each day." b. "You will receive IV antibiotics for 3 to 6 weeks." c. "You need to limit the amount of protein and calcium in your diet." d. "You need to perform weight-bearing exercises twice a week."

b. "You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

The nurse provides teaching to a client with osteoarthritis (OA). Which statement(s) indicate that teaching about pain management and functional ability were effective? Select all that apply. a. "I will increase the amount of walking I do every day." b. "I will spend more time resting." c. "I will take the pain medication after exercising." d. "I will need to lose some weight." e. "I will avoid using a cane to walk."

a. "I will increase the amount of walking I do every day." d. "I will need to lose some weight." Explanation: Pain management and optimal functional ability are the major goals of nursing interventions. With those goals in mind, nursing management of the client with OA includes pharmacologic and nonpharmacologic approaches as well as education. Weight loss is an important approach to lessen pain and disability caused by OA. Exercises such as walking should be begin in moderation and gradually increase. A sedentary lifestyle contributes to the development of OA so resting would not be encouraged. Canes or other assistive devices for ambulation should be considered, and any stigma about the use of these devices should be explored. Clients should plan daily exercise for a time when the pain is least severe or plan to use an analgesic agent before exercising.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? a. Avoid the use of topical analgesics b. Encourage weight loss and an increase in aerobic activity c. Provide an analgesic after exercise d. Assess for gastrointestinal complications associated with COX-2 inhibitors

b. Encourage weight loss and an increase in aerobic activity Explanation: Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methyl salicylate may be used for pain management.

An elderly client with chronic osteoarthritis has difficulty ambulating and is seeking a prescription for a walker. How should the nurse categorize the client's disability? a. developmental b. acquired c. age-associated d. sensory

b. acquired Explanation: Acquired disabilities may be progression of a chronic disorder, such as arthritis. Developmental disabilities are those disabilities that occur any time from birth to 22 years and may result in impairment of physical or mental health, cognition, speech, language, or self-care. Sensory disabilities affect hearing or vision. Age-related disabilities are conditions from age, not a chronic disease.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? a. obesity b. age c. trauma d. congenital deformity

b. age Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

An elderly woman diagnosed with osteoarthritis has been referred for care. The client has difficulty ambulating because of chronic pain. When creating a nursing care plan, what intervention will best promote the client's mobility? a. Encourage the client to push through the pain in order to gain further mobility. b. Administer an analgesic as prescribed to facilitate the client's mobility. c. Have another person with osteoarthritis visit the client. d. Motivate the client to walk in the afternoon rather than the morning.

b. Administer an analgesic as prescribed to facilitate the client's mobility. Explanation: At times, mobility is restricted because of pain, paralysis, loss of muscle strength, systemic disease, an immobilizing device (e.g., cast, brace), or prescribed limits to promote healing. If mobility is restricted because of pain, providing pain management through the administration of an analgesic will increase the client's level of comfort during ambulation and allow the client to ambulate. Motivating the client or having another person with the same diagnosis visit is not an intervention that will help with mobility. The client should not be encouraged to "push through the pain."

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment? a. Swelling, joint pain, and tenderness on palpation b. Joint pain, crepitus, Heberden's nodes c. Tophi, enlarged joints, Bouchard's nodes d. Hot, inflamed joints; crepitus; joint pain

b. Joint pain, crepitus, Heberden's nodes Explanation: Clinical findings for osteoarthritis include joint pain, crepitus, Heberden's nodes (bony growths at the distal interphalangeal joints), Bouchard's nodes (growths involving the proximal interphalangeal joints), and enlarged joints. The joint pain occurs with movement and is relieved by rest. As the disease progresses, pain may also occur at rest. Bouchard's nodes involve the proximal interphalangeal joints. Hot, inflamed joints rarely occur in osteoarthritis. Tophi are deposits of sodium urate crystals that occur in chronic gout — not osteoarthritis. Swelling, joint pain, and tenderness on palpation occur with a sprain injury.

A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area? a. Muscles b. Joints c. Ligaments d. Bones

b. Joints Explanation: History and physical findings associated with age-related changes of the joints include diminished range of motion, loss of flexibility, stiffness, and loss of height. History and physical findings associated with age-related changes of bones include loss of height, posture changes, kyphosis, flexion of hips and knees, back pain, osteoporosis, and fracture. History and physical findings associated with age-related changes of muscles include loss of strength, diminished agility, decreased endurance, prolonged response time (diminished reaction time), diminished tone, a broad base of support, and a history of falls. History and physical findings associated with age-related changes of ligaments include joint pain on motion that resolves with rest, crepitus, joint swelling/enlargement, and degenerative joint disease (osteoarthritis).

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a. Exercising in the evening before going to bed is beneficial. b. The time of day when exercise is performed isn't important. c. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. d. Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy.

c. Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Explanation: A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client? a. Depression b. Inadequate pain control c. Drug interactions d. Chronic illness

c. Drug interactions Explanation: Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this client because of the client's age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.

A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor? a. The client is 58 years old. b. The client has a 30 pack-year smoking history. c. The client's body mass index is 34 (obese). d. The client has primary hypertension.

c. The client's body mass index is 34 (obese). Explanation: Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a client who is 58 years old would not yet face a significantly heightened risk.

Osteoarthritis is known as a disease that a. requires early treatment because most of the damage seems to occur early in the course of the disease. b. affects young males. c. is the most common and frequently disabling of joint disorders. d. affects the cartilaginous joints of the spine and surrounding tissues.

c. 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 severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? a. Arthrodesis b. Osteotomy c. Hemiarthroplasty d. Total arthroplasty

d. Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.