Patho Ch 36 Dynamic Study Module Chronic Musculoskeletal Disorders
Which statement best describes a herniated disc? "A disc between two vertebra ruptures, allowing the fluid in the disc to leak out and the inner layer seeps through the outer layer." "A vertebra is fractured, allowing the fluid in the bone to leak out and compress the nerve." "The nerves between two vertebra are severed causing impaired mobility." "A vertebra moves out of alignment, allowing the disc to compress the nerves."
"A disc between two vertebra ruptures, allowing the fluid in the disc to leak out and the inner layer seeps through the outer layer." A herniated or ruptured disc occurs when a disc between two vertebra ruptures, allowing the fluid in the disc to leak out and impinge on and irritate nearby nerves. Herniation occurs when the inner layer seeps through a compromised outer layer. A herniated disc is not a fractured vertebra or a misaligned vertebra. While nerves can be impacted, a herniated disc is not severed nerves.
A patient is diagnosed with Paget disease. Which explanation should the nurse include when teaching the patient about this health problem? "Bone tissue is destroyed by an inflammatory process, forcing the body to make new bone tissue that is weak and brittle." "Bone tissue is weakened by a bacteria that causes new bone tissue to become weak and brittle." "Bone tissue is resorbed faster than usual, so the body tries to make new bone tissue too quickly, and it becomes weak and brittle." "Bone tissue is not supplied with enough calcium and vitamin D from your diet, and new bone tissue is weak and brittle."
"Bone tissue is resorbed faster than usual, so the body tries to make new bone tissue too quickly, and it becomes weak and brittle." With Paget disease, bone tissue is resorbed faster than usual; the body compensates by accelerating the creation of new bone. This new bone tissue is weak, brittle, and easily fractured. Paget disease is believed to be a genetic disorder or caused by a virus, not bacteria. Paget disease is not caused by an inflammatory process or a dietary deficency of calcium or vitamin D.
A patient with newly diagnosed rheumatoid arthritis (RA) asks how the disease is treated. Which response should the nurse make to this patient? "Heat therapy will help to relieve the pain and will help improve mobility." "Disease-modifying antirheumatic drugs are used to relieve disease-related symptoms." "It is best to focus on rest and therapy to help stop disease progression." "There are medications to help with the pain, but there are no medications to slow disease progression."
"Disease-modifying antirheumatic drugs are used to relieve disease-related symptoms." Rheumatoid arthritis (RA) is treated with disease-modifying antirheumatic drugs (DMARDs) to relieve disease-related symptoms and slow disease progression. Medications can be used for pain, and DMARDS can slow progression. Rest, therapy, and heat therapy are used to treat RA, but medications are needed to slow progression and improve mobility.
A pregnant woman experiencing back discomfort has an increased concave appearance of the spinal column. Which explanation should the nurse provide about this finding? "Pregnancy can cause the spine to degenerate due to pressure on the upper back." "Pregnancy can cause the spine to change alignment due to the fetus." "Pregnancy can cause the spine to change alignment laterally due to the weight of the fetus." "Pregnancy can cause the spine to herniate due to pressure on the upper back."
"Pregnancy can cause the spine to change alignment due to the fetus." With lordosis, the spinal column is more concave and is seen frequently in individuals who are pregnant or obese. It is not a degenerative change, nor is it a herniation of the disc. Lateral change in alignment is called scoliosis. Kyphosis is a deformity that changes the shape of the vertebrae in the upper back. It is more common in older adults because they are prone to health problems such as osteoporosis, disc degeneration, and cancer of the spine and they may be more likely to have had cancer treatments such as radiation and chemotherapy. There is no treatment for kyphosis, but surgery might be needed if disc herniation or spinal cord compression occurs.
A patient with osteoarthritis (OA) asks why the joints are stiff, inflamed, and swollen. Which response should the nurse make to this patient? "The symptoms of OA are often caused by changes in the cartilage and bone spurs, which contribute to pain, stiffness, inflammation, and swelling." "The symptoms of OA are caused by infections in the joints that cause pain, stiffness, inflammation, and swelling." "The symptoms of OA are caused by an autoimmune response that causes pain, stiffness, inflammation, and swelling." "The symptoms of OA are caused by a decrease in bone density that causes pain, stiffness, inflammation, and swelling."
"The symptoms of OA are often caused by changes in the cartilage and bone spurs, which contribute to pain, stiffness, inflammation, and swelling." Changes in the physiology of the joint (synovium and cartilage), as well as bone spurs (particles that break off the joint irritate the synovial tissue), cause pain, stiffness, inflammation, and swelling that are characteristic of OA. OA is not not caused by infections. OA is not an autoimmune disease. OA is not caused by a decrease in bone density. Additional information about osteoarthritis (OA) includes: OA is the most common form of arthritis, affecting 50% of the world's population age 65 years and older. The disorder develops as wear and tear on the joints breaks down the cartilage in the joint, causing bone to rub on bone. OA is the most common cause of disability in older adults and can affect any joint in the body, especially the hands, knees, and hips. Older age is a risk factor for OA. OA rarely occurs in individuals under the age of 40. At least 80% of individuals over age 55 have some x-ray evidence of the disorde
A patient is surprised to learn of having a herniated disc because of the absence of pain. Which response should the nurse provide to this patient? "The symptoms you will have are related to the severity and location of the herniated disc." "The lack of pain is caused by nerve damage due to the herniated disc." "A herniated disc cannot cause pain because there are no nerves in the disc." "The herniated disc cuts off blood supply to the nerve so pain cannot be transmitted."
"The symptoms you will have are related to the severity and location of the herniated disc." Clinical manifestations of a herniated disc will depend on the severity and location of the herniation. If the herniated disc is not compressing a nerve, the patient may have no pain. When a nerve is involved, pain, numbness, tingling, and muscle weakness may be present. The disc does not cut off blood supply, but does impact the nerve's ability to transmit signals, resulting in weakness. Lack of pain means a nerve is not involved in the herniation. A herniated disc can cause pain when it impacts a nerve.
The parents of a child with juvenile idiopathic arthritis (JIA) ask what treatment will do for the health problem. Which response should the nurse provide to the parents? "Treatment of JIA is focused on reducing pain, decreasing bone formation, and supporting developmental milestones." "Treatment of JIA is focused on reducing pain, improving mobility, and supporting developmental growth." "Treatment of JIA is focused on reducing pain, increasing bone resorption, and supporting developmental growth." "Treatment of JIA is focused on decreasing osteomalacia, improving bone mobility, and supporting developmental growth."
"Treatment of JIA is focused on reducing pain, improving mobility, and supporting developmental growth." The treatment of juvenile idiopathic arthritis (JIA) is focused on reducing pain, improving mobility, and supporting developmental growth to promote a healthy child who can function as normally as possible. Treatment for JIA is not about decreasing bone formation, osteomalacia, or increasing bone resorption.
A patient with ankylosing spondylitis is experiencing increased spinal stiffness and asks why this is occurring. Which response should the nurse make to this patient? "With ankylosing spondylitis, the bones degenerate and you lose function." "With ankylosing spondylitis, the vertebrae fuse and decrease your mobility." "With ankylosing spondylitis, the bones narrow the spinal column and impede blood flow." "With ankylosing spondylitis, the vertebrae collapse and cause nerve compression."
"With ankylosing spondylitis, the vertebrae fuse and decrease your mobility." With ankylosing spondylitis, bony overgrowth causes the vertebrae to fuse and limit mobility. It is not a degeneratative disorder. The bones do not collapse or narrow the spinal column.
The nurse is performing musculoskeletal screening tests during a community health clinic. Which person should the nurse identify as most at risk for a herniated or ruptured disc? A 50-year-old man who works as a receptionist A 25-year-old man who works lifting construction materials A 48-year-old man who smokes A 45-year-old overweight man who smokes
A 45-year-old overweight man who smokes Risk factors for a herniated or ruptured disc include age, excessive weight, smoking, regular heavy lifting, and male gender. The 45-year-old man has age, weight, gender, and smoking as major risk factors. The 50-year-old man has age and gender as risk factors. The 25-year-old man has lifting heavy materials and gender as risk factors. The 48-year-old man has age, smoking, and gender as risk factors.
The nurse is caring for an older female patient with osteoporosis. Which complication should the nurse identify as being related to the patient's health problem? Unintentional 10-lb weight loss A hip fracture of unknown etiology Joint stiffness of the arms and legs Wrist tenderness upon palpation
A hip fracture of unknown etiology Osteoporosis is characterized by increased risk for fractures, typically of the hips, wrists, and the spine. Tenderness or joint pain is indicative of rheumatoid arthritis. Osteoporosis does not cause weight loss. Joint stiffness of the arms and legs is associated with osteoarthritis.
The nurse is planning to screen students for scoliosis. Which test should the nurse use first? Adam forward bend test X-rays to measure curvature of the spine Palpation for spongy joints Scoliometer for kyphosis
Adam forward bend test One of the primary screening tests for scoliosis is the Adam forward bend test, in which the individual leans forward at the waist with the arms hanging straight down. A scoliometer is used during the Adam test to measure a rib hump if one is noted; it is not for kyphosis. X-rays would be done at a hospital or clinical site. Palpation of spongy joints is associated with rheumatoid arthritis.
A patient experiences back pain and stiffness that begins in the lower back and moves to the entire back area. Which health problem should the nurse suspect is causing the patient's symptoms? Sarcoidosis Systemic lupus erythematosus Rheumatoid arthritis Ankylosing spondylosis
Ankylosing spondylosis Ankylosing spondylosis includes persistent lower back pain, morning stiffness, and generalized fatigue. This risk factors are not consistent with rheumatoid arthritis, sarcoidosis, or systemic lupus erythematosus.
A patient is experiencing joint stiffness and pain in both knees and ankles, which are spongelike and tender to touch. Which diagnostic test should the nurse expect to be prescribed for this patient? Anti-CCP blood test Complement C3 and C4 blood test MRI of the spine and sacroiliac joints Antinuclear antibodies (ANA) blood test
Anti-CCP blood test The patient has signs and symptoms consistent with rheumatoid arthritis. A positive anti-CCP blood test is used to confirm the diagnosis of this condition. An MRI of the spine and sacroiliac joints is indicated for ankylosing spondylosis. Antinuclear antibodies (ANA) and complement C3 and C4 blood tests are used to help diagnose systemic lupus erythematosus.
A patient with symptoms of rheumatoid arthritis (RA) has a negative rheumatoid factor (RF). Which diagnostic test should the nurse expect to be prescribed to diagnose RA in this patient? Anti-CCP test White blood count C-reactive protein Erythrocyte sedimentation rate
Anti-CCP test The patient has signs and symptoms consistent with rheumatoid arthritis (RA). A positive anti-CCP blood test is used to confirm the diagnosis of this condition. Thirty percent of patients with RA test negative for RF. White blood cells (WBC) can be normal in patients with RA. Erythrocyte sedimentation rate (ESR) and C-reactive protein are used to assess inflammation, but they are not specific to RA.
Which health problem is least likely to be linked to the development of osteoporosis? Bone injuries from sports in youth Chronic kidney disease Use of anticonvulsants Family history of osteoporosis
Bone injuries from sports in youth Physical activity throughout life is helpful in preventing osteoporosis; broken bones in youth are not a risk factor. Risk factors for osteoporosis include a family history of osteoporosis; use of certain medications, such as anticonvulsants; and certain chronic diseases, including kidney disease.
The nurse reviews information about osteoarthritis (OA) before planning care for a patient. Which change in the integrity of the bone is responsible for the pain, stiffness, and swelling associated with OA? Nerve inflammation Bone spurs Decreased bone density Antibodies attacking the joint
Bone spurs Bone spurs (particles that break off the joint irritate the synovial tissue) cause pain, stiffness, inflammation, and swelling that are characteristic of OA. Decreased bone density is associated with a metabolic bone disorder. OA is not related to nerve involvement. Antibodies attacking the joint is related to rheumatoid arthritis (RA).
A nurse is teaching a class on metabolic bone diseases. Which factor should the nurse include as increasing the risk for osteopenia? Hispanic descent Chronic eating disorders Regular exercise program African descent
Chronic eating disorders Risk factors of osteopenia include chronic eating disorders or issues with metabolism that alter the intake and absorption of vitamins and minerals needed for bone growth and strength. Regular exercise and being of African or Hispanic descent are not risk factors.
A school-age male patient is experiencing joint inflammation of the hips and knees and has the presence of an HLA-B27 gene documented in the medical record. Which type of juvenile idiopathic arthritis should the nurse suspect this patient is experiencing? Enthesitis-related juvenile idiopathic arthritis Psoriatic juvenile idiopathic arthritis Systemic juvenile idiopathic arthritis Oligoarticular juvenile idiopathic arthritis
Enthesitis-related juvenile idiopathic arthritis Enthesitis-related juvenile idopathic arthritis is associated with tenderness at the bone-tendon or bone-ligament junction. It usually affects the hips, knees, and feet, is more common in males between the ages of 8 and 15 years, and is associated with the HLA-B27 gene. Joint inflammation is involved in all forms of juvenile idiopathic arthritis. Psoriatic juvenile idiopathic arthritis, oligoarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis are not associated with a specific gene expression or mutation.
A patient with a spondyloarthropathies asks how the health problem is treated. Which treatments should the nurse respond as being used for this health problem? Disease-modifying antirheumatic drugs (DMARDs) Low-dose oral corticosteroids Intra-articular steroid injection administration NSAIDs and stretching exercises
NSAIDs and stretching exercises The goals of treatment for spondyloarthropathies are to relieve pain and stiffness as well as maintain posture; therefore, NSAIDs and stretching exercises are used. Corticosteroids, intra-articular steroid injection administration, and DMARDs are used for rheumatoid arthritis.
A patient is diagnosed with a herniated disc. Which treatment should the nurse suspect will be started first? Nonsteroidal anti-inflammatory drug (NSAID) Epidural injection Discectomy Laminectomy
Nonsteroidal anti-inflammatory drug (NSAID) Treatment of a herniated disc begins with NSAIDs to reduce pain and swelling. Epidural injections, laminectomy, and discectomy are not first-line treatments. The possible surgical treatments for a herniated disc include: A laminectomy to remove the lamina, or the part of the vertebra that covers the spinal canal. This enlarges the spinal canal and relieves pressure on the associated nerves. Adiscectomy to remove all or part of the herniated disc. Muscles and other tissues are dissected away from the spine to allow for surgical exposure of the ruptured disc. Spinal fusion to join two or more vertebrae together using bone grafts, screws, and rods. This prevents motion between the two vertebrae and reduces pain.
A nurse is participating in a community health education program about osteoarthritis (OA). Which variable should the nurse emphasize is the greatest risk factor for developing this health problem? Previous joint injury Repetitive motions Diabetes Older age
Older age Older age is the greatest risk factor for developing OA. Previous joint injury, repetitive motions, and diabetes are also risk factors for OA development, but they are not the greatest risk factor. Risk factors for osteoarthritis (OA) include: Obesity Individuals born with malformed joints (bow legs, unequal leg length) Defective cartilage Diabetes Hypothyroidism Gout Paget disease Joint injuries from sports, trauma, or repetitive use
A patient with back pain is identified as being at risk for a herniated or ruptured disc. Which risk factor should the nurse instruct the patient to modify to reduce the risk for this health problem? Overweight Tall height Diagosed bone disorder Gender
Overweight The patient is capable of losing weight to decrease the risk of developing a herniated or ruptured disc. Height, diagnosis of a bone disorder, and gender cannot be modified. Risk factors for herniated discs include the following: Age between 30 and 50 years Excess weight Regular heavy lifting, bending, and twisting Previous back problems Smoking Male gender Tall height Bone disorder Degenerative disc disorders
A 32-year-old woman is diagnosed with rheumatoid arthritis (RA). Which finding should the nurse expect to see documented in the patient's medical record? Decreased rheumatoid factor Decreased erythrocyte sedimentation rate (ESR) Presence of human leukocyte antigen (HLA)-DR4 Defect in purine metabolism
Presence of human leukocyte antigen (HLA)-DR4 Genetic factors are believed to account for 50% of the risk of developing RA; approximately 60% of patients with the disease in the United States have been found to carry a specific genetic marker of the human leukocyte antigen (HLA)-DR4 cluster. Rheumatoid factor would be increased in the patient and ESR would be increased due to inflammation. Risk factors for gouty arthritis include a likely genetic defect in purine metabolism.
A patient with osteoarthritis (OA) is experiencing swelling in the affected joints and difficulty moving the limbs. Which risk factor should the nurse explain to the patient that contributes to the development of this health problem? Repeated use of weight-bearing joints Ingestion of purine-rich substances Chronic inflammation of peripheral joints Psoriasis
Repeated use of weight-bearing joints One cause for OA is repeated use of weight-bearing joints. Rheumatoid arthritis is a chronic inflammation of peripheral joints. Psoriasis is associated with psoriatic arthritis and is typically found in wrists, knees, ankles, and toes. Ingestion of purine-rich substances is contraindicated in gouty arthritis.
The nurse is caring for a patient with ankylosing spondylosis. Which clinical manifestation should the nurse expect to assess in this patient? Increased spinal mobility Accentuated lateral thoracic curve Limited mobility of the back from spinal fractures Report of low back pain radiating to the hips and down the legs
Report of low back pain radiating to the hips and down the legs Clinical manifestations of ankylosing spondylosis include lower back pain that radiates to the buttocks, hips, or down the legs. An accentuated lateral thoracic curve is associated with scoliosis. Spinal fusion, not fractures, is a clinical manifestation of ankylosing spondylosis. Decreased spinal mobility, not increased, is associated with ankylosing spondylosis.
A patient is experiencing joint swelling and inflammation in both wrists and knees. Which disease should the nurse suspect is causing the patient's symptoms? Osteoporosis Rheumatoid arthritis Osteoarthritis Spinal stenosis
Rheumatoid arthritis Rheumatoid arthritis (RA) is associated with joint swelling, stiffness, warmth, tenderness, and pain that affects more than one joint and is bilateral, or affects both sides and the same body joints. Spinal stenosis would not cause joint inflammation. Osteoarthritis is wear and tear on weight-bearing joints, and is not necessarily bilateral in nature. Osteoporosis is weak, brittle bones.
A female patient experiences joint swelling that is warm to the touch, stiffness, and pain on both sides of the body. For which autoimmune disorder should the nurse expect laboratory tests to be prescribed for this patient? Rheumatoid arthritis Osteoarthritis Psoriatic arthritis Gouty arthritis
Rheumatoid arthritis Rheumatoid arthritis (RA) is thought to be an autoimmune disorder. Osteoarthritis (OA) is caused by repeated use of weight-bearing joints. Ingestion of purine-rich substances is associated with gouty arthritis. Psoriasis is associated with psoriatic arthritis.
The nurse palpates boggy, spongelike areas over a patient's both wrists. Which condition should the nurse suspect in the patient? Rheumatoid arthritis (RA) Paget disease Osteoarthritis (OA) Psoriatic arthritis
Rheumatoid arthritis (RA) With rheumatoid arthritis (RA), the joints feel "boggy," or spongelike, when palpated. Psoriatic arthritis is associated with scaly skin, stiffness, and pain in the joint. Osteoarthritis (OA) is caused by joint wear and tear and does not need to be bilateral. Paget disease is a metabolic bone disorder that causes weak, brittle bones.
A parent is concerned because the school nurse had her child bend forward during a health screening and recommended a follow-up with their healthcare provider. Which condition should the nurse suspect was being screened? Scoliosis Osteopenia Juvenile arthritis Kyphosis
Scoliosis One of the primary screening tests for scoliosis is the Adam forward bend test, in which the individual leans forward at the waist with the arms hanging straight down. Screening by bending forward is not used for osteopenia, juvenile arthritis, and kyphosis.
Which term should be used to describe this spinal deformity? Picture of a girl with curvature of the spine, taken from the back. Clothes that fit at an angle, such as her shorts, and anatomic asymmetry of the back indicate spinal irregularities. Herniated disc Kyphosis Lordosis Scoliosis
Scoliosis Scoliosis is a lateral, or sideways, curvature of the spine; it can be C-shaped or S-shaped. A herniated or ruptured disc occurs when a disc between two vertebra ruptures. The spinal column is more concave with lordosis; it is seen frequently in individuals who are pregnant or obese. Kyphosis, which is common in older adults, is characterized by a spinal column that is convex.
A middle-aged patient experiences numbness and weakness in the right leg with bouts of radiating pain that is relieved when the back is flexed. For which disorder should the nurse assess this patient? Scoliosis Osteoporosis Spinal stenosis Rheumatoid arthritis
Spinal stenosis Numbness, weakness, cramping, and pain radiating down a leg, but relieved by flexing the lower back, is related to spinal stenosis, which is seen most often in both men and women over the age of 50. Osteoporosis is related to weak, brittle bones, but is not relieved by flexing the back. Rheumatoid arthritis (RA) is bilateral symmetrical inflammation of the joints. Scoliosis is lateral misalignment of the spine.
A child is experiencing inflammation of two joints, a skin rash, a fever lasting 3 weeks, and enlarged lymph nodes. For which disorder should the nurse assess this patient? Oligoarticular juvenile idiopathic arthritis Systemic juvenile idiopathic arthritis Psoriatic juvenile idiopathic arthritis Polyarticular juvenile idiopathic arthritis
Systemic juvenile idiopathic arthritis Systemic juvenile idiopathic arthritis is associated with inflammation in one or more joints, high fever lasting longer than 2 weeks, skin rash, inflammation of the heart or lungs, anemia, and enlarged lymph nodes, liver, or spleen. These are systemic signs in the body that go beyond joint inflammation and are involved in all forms of juvenile idiopathic arthritis. Psoriatic juvenile idiopathic arthritis, oligoarticular juvenile idiopathic arthritis, and polyarticular juvenile idiopathic arthritis do not have systemic signs, but manifestations that are more localized.
