Unit 14 Pathophysiology Prep U Chs 47, 48 and 50

The nurse is assessing a client's risk for osteoarthritis. Which factor places the client at greatest risk for this condition?

Age

Osteomyelitis is an infection of the bone. Chronic osteomyelitis is complicated by a piece of infected dead bone that has separated from the living bone. How long does the initial intravenous antibiotic therapy last for chronic osteomyelitis?

6 weeks

A client who has developed RA can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response?

A T-cell mediated response to an immunologic trigger, such as a microbial agent

Which client should be seen first?

A client whose sprain included an avulsion (separation) of the medial femoral condyle.

While explaining the physiology behind systemic sclerosis (scleroderma), the nurse would mention which development as a hallmark of this disease?

Activation of fibroblasts, resulting in fibrosis

When a nurse is administering medications to a client with RA, which medication interferes with tumor necrosis factor?

Adalimumab

In what anatomical areas are irregularly shaped bones located?

Ankles and wrists

The nurse is reviewing a lab report that documents the presence of HLA-B27 antigen. The nurse interprets this as being linked to which disorder?

Ankylosing spondylitis (AS)

A client presents with arthralgia and arthritis. Which is the priority nursing intervention?

Assessing the client's pain and history of treating it

A nurse is caring for a client who has systemic lupus erythematosus. Which of the following causes the disease?

Autoimmune process

When teaching a client with rheumatoid arthritis, which factor doe the nurse explain is an underlying cause of this disease?

Autologous antibodies

When a nurse is caring for a client newly diagnosed with systemic lupus erythematosus, which behavior will best help prevent exacerbations of the disease?

Avoiding UV light

A nurse is teaching a client about psoriatic arthritis about treatment. Which statement should be included?

Biologic response modifiers are beneficial in controlling the disease.

When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider will include which statement?

Blocks the production of uric acid by the body

Scleroderma is an autoimmune disease of CT that is characterized by hardening of the skin. What symptoms do most people with scleroderma develop?

Calcinosis and Raynaud phenomenon

A client asks the nurse if drinking more milk will prevent the release of calcium from her bones. The best response by the nurse would be that the release of calcium from the bone into the extracellular fluid is regulated by:

Calcitonin

The client had a full cast applied for a left humerus fracture in the ED 3 hours ago and now complains of increased pain at the site. The client cannot feel the pressure applied to the nail beds when the nurse tests capillary refill pressure, which is found to be 4.5 seconds. What action should the nurse take?

Call for assistance and prepare to split the client's cast immediately.

A client presents to the ED following an accident where he fell off a chair. The client reports initial hip numbness followed by increasing pain and muscle cramping. Which type of injury does the triage nurse suspect?

Closed hip fracture

An active 9-year-old is being discharged from the ED following cast placement for a sports injury. The nurse should emphasize that the parents should bring the child back to the ED if they note which post-case assessment findings?

Cold, pale toes on the side of the cast. Client complaining of tingling and numbness in the casted leg.

Juvenile dermatomyositis is a chronic inflammatory myopathy that commonly manifests systemically. What is the treatment of choice for this myopathy?

Corticosteroids

The nurse performing a musculoskeletal assessment of a client with osteoarthritis would evaluate the presence of which finding as being a normal expectation?

Crepitus and grinding

A football player sustains a suspected hyaline cartilage injury and is awaiting results of a CT scan. Select the statement that best describes the healing process for hyaline cartilage.

Does not heal after injury

A client who has involved in an automobile accident experienced major trauma and sustained a fractured femur. The nurse notices the following changes 4 hours after admission to the critical care unit: -Disorientation -Dyspnea (difficulty breathing) -Tachycardia (fast heart rate) -Low-grade temperature -Diaphoresis (sweating) -Substernal chest pain The nurse suspects:

Fat embolism syndrome (FES)

Which type of cartilage is found in the symphysis pubis?

Fibrocartilage

When caring for a client with AS, in which position does the nurse place the client for sleep?

Flat with one pillow

When caring for a client with AS, the nurse tells the client that stiffness can be relieved by which intervention?

Gentle exercise

Reiter syndrome is a reactive arthropathy. Reiter syndrome is associated with which disease?

Gonorrhea

A nurse admitting a client to the ED with a suspected fracture notes a deep abrasion with bruising. The client reports receiving a hard tackle during a football game. Which grade of tissue damage accompanies this fracture?

Grade 2

A nurse is caring for a client undergoing antineoplastic chemotherapy for acute leukemia. Which diagnostic study does the nurse monitor to detect the consequences of the rapid lysis of cancer cells?

Hyperuricemia

A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have RA. Which statement by the client correlates with the diagnosis of RA?

I'm having a hard time opening doors since it hurts so bad. Look I didn't button all my shirt buttons...it hurts too much and look at the swelling in my hands. Look how my hand is deformed. My doctor calls it hyperextension.

A 30-year-old client has been diagnosed with AS. Which etiology is responsible for this health problem?

Immune response

Following a fracture, the nurse is educating the client and his family about bone healing. The nurse begins by stating:

In order to initiate the cellular events essential to bone healing, within a day or so, your body will develop a blood clot at the fracture site.

The elderly nursing home resident has a fractured humerus. In order to promote healing, the physician recommends:

Including fish in the diet on a routine basis.

Select the major stimulus for calcitonin synthesis and release.

Increased serum calcium

A client who has recently been diagnosed with polymyositis asks the nurse how this problem arose. The nurse tells the client that the underlying cause of this disorder is:

Inflammation and immune mechanisms

A client with OA states that every morning "it gets harder and harder to loosen up." The client's main therapy to this point is the use of over-the-counter nonsteroidal anti-inflammatories. These drugs reduce the client's pain by:

Inhibiting prostaglandin synthesis

Which areas of the body are typically affected by gout?

Instep, metatarsals, heel

Which statements are true regarding red bone marrow?

It is primarily present in the vertebrae, ribs and sternum. It is the primary type of bone marrow found in infants. It is the site of blood cell formation.

In general, how are children affected by a rheumatic disease such as juvenile idiopathic arthritis (JIA)?

It's characterized by synovitis and can influence epiphyseal growth, stunting growth.

Which are potential causes of OA?

RA, posttraumatic disorders, metabolic disorders, collagen disorders

Which disease in children presents with an inflammatory myopathy primarily involving skin and muscle with a heliotrope rash around the eyes?

Juvenile dermatomyositis

What would be the best treatment option for a soft-tissue contusion on the right ankle?

Keep the ankle elevated for the first 24 hours.

Where do overuse injuries commonly occur?

Knees

A 6-year-old child has developed idiopathic osteonecrotic disease of the proximal femoral epiphysis. The health care provider would document this finding as which diagnosis?

Legg-Calve-Perthes disease

A basketball player fell awkwardly, a mishap that has resulted in a tear to the anterior cruciate ligament. What characteristic of ligaments makes them particularly susceptible to injury?

Ligaments are incapable of stretching when exposed to unusual stress.

A client has been diagnosed with scleroderma. Which assessment finding does the nurse expect?

Raynaud phenomenon

Ankylosing spondylitis is worse when:

Lying down

A client has a transverse fracture of the left humerus. Which assessment indicates a developing complication?

New onset of shortness of breath.

What is the term used to refer to the failure of bone to heal before the process of bone repair stops?

Nonunion

When a nurse is assessing a client with osteoarthritis, which factor poses a risk for the disease?

Obesity

A 10-year-old boy's parents states that the child has JIA, which predominantly affects the child's knees and ankles. The nurse would classify and document this as which type of JIA?

Oligoarticular

A client reports increasing pain at the back of the ankle over the past 2 weeks. The client states being generally healthy, despite having just completed a course of antibiotics for an infection 6 weeks prior for Chlamydia trachomatis. This client is likely experiencing which type of reaction?

Reactive arthritis

A client presents with a "spur" on the joint. The client asks, "Why did this happen? I guess I didn't exercise enough." Which pathophysiologic mechanism of OA should the nurse explain to this client?

Osteophyte formation and erosion of cartilage.

A 13-year-old girl and her father have come to ED for assessment of the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, but later in the interview it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny, and had been keeping her awake at night for a week or so before the game. Which condition might be the cause of the girl's symptoms?

Osteosarcoma

A feature of RA that differentiates it from other forms of inflammatory arthritis is the development of which physiologic abnormality?

Pannus tissue - vascular granulation tissue

Which hormone increases the number and resorptive function of "bone chewing" cells?

Parathyroid hormone

Bones are covered, except a their articular ends, by what membrane?

Periosteum

A client was diagnosed with Salmonella 1 week ago and is now experiencing joints that are warm, swollen, and tender; fever; and weight loss. What is the most likely interpretation of these manifestations?

Reactive arthritis

Elevated erythrocyte sedimentation rate (ESR) is associated with which disorder?

Polymyalgia rheumatica

Giant cell arteritis is a comorbid condition of:

Polymyalgia rheumatica

A client diagnosed with arthritis had a recent infection. Which intervention is necessary to determine if the client has bacterial arthritis?

Positive culture of synovial fluid

A young adult client presents with "stiffening of the spine." Which diagnostic lab result leads the health care worker to diagnose AS?

Presence of the HLA-B27 allele marker

A client with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this client's bone cancer?

Prevention of pathologic fractures and survival with maximum functioning

A client with a recent fracture visits the doctor's office to monitor bone healing. X-ray reveals new calcium deposits at the fracture site with the fracture line still evident. At which stage in the healing process is this fracture?

Reparative phase

A young adult client who is a competitive skier complains of knee pain when climbing stairs or sitting with the knees bent. What will the nurse teach the client about the diagnosis of chondromalacia?

Rest and isometric exercises followed by ice are effective treatment measures. Chondromalacia is the softening and breakdown of the cartilage on the underside of the knee.

To maintain adequate serum calcium levels, what does parathyroid hormone reduce?

Serum phosphate levels

Which statements are considered physiologic characteristics of immature or woven bone?

Serves as temporary scaffolding for support, has low tensile strength, and is found in parts of a healing fracture.

The irregularly shaped bones of the wrist are which type of bone:

Short bone

A nurse is caring for a client with RA. For which of these extra-articular manifestations does the nurse assess?

Splenomegaly, Lymphadenopathy and Elevated erythrocyte sedimentation rate (ESR)

The nurse is providing client education related to intra-articular corticosteroid injections. What instruction should the nurse include?

The injections will be given 3 to 4 times per year because they can increase joint destruction.

A 50-year-old male has been diagnosed with contiguous spread osteomyelitis of the right hip acetabulum. What would be an expected treatment for this condition?

Surgical arthroplasty and parenteral antimicrobial agents.

There are two types of joints in the human body. There are synarthroses and synovial joints. Synarthroses joints are further broken down into three types of joints. What type of joint occurs when bones are connected by hyaline cartilage?

Synchondroses

A client is diagnosed with a strained back. Which instructions should the nurse provide to the client?

Take ibuprofen for pain, bend knees to pick up objects and reduce activity for a few days. *cold packs

Seronegative spondyloarthropathy involves:

The axial skeleton and an abnormal autoimmune response

What would the nurse include in the teaching plan for a client who asks, "What is a subluxation?"

The bone is partially out of the joint when it is subluxated.

The endocrinologist knows the student understands calcitonin when the student states which of the following?

The major stimulus for calcitonin synthesis and release is an increase in serum calcium.

A nurse is caring for a client who has developed vasculitis as a result of a rheumatology disorder. Which factor does the nurse expect to uncover in assessing this client?

Ulcers of the lower extremities

A newly admitted client's health record states that the client's health history includes tubercular osteomyelitis. Where is the most likely anatomical site of this infection?

Vertebrae

A pathologic stress fracture occurs in bones subjected to which type of stress?

Weakening by disease