ms questions patho final
A 60-year-old woman has pain when moving her fingers and asks you if this is just due to aging. What s your best response? "joint pain with functional limitations is a normal change that affects all people to some extent." "joint pain that develops with age is usually do to prior trauma." "This is a symptom of systemic arthritis that affects all joints as the disease progresses." "Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function."
"Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function." cartilage destruction in the joints affects the majority of those affected by the age of 40. When this destruction is symptomatic, OA is said to be present. Degenerative changes cause symptoms after age 50-60, but more than half of people over age 65 have x-ray evidence of OA. Joint pain and functional disability are not normal.
A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology? "Genetic predisposition is very likely." "The disease is most common in those under 30." "Exposure to workplace chemicals is a causative agent." "Environment is the biggest contributing factor to the development of RA."
"Genetic predisposition is very likely." The cause of RA is uncertain but evidence points to genetic predisposition. The disease usually occurs later in life.
A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply. "Every time I get something out of the freezer, my hands turn reddish purple in color." "I'm having a hard time opening doors since it hurts so bad." "Just look at my face. It looks like I have varicose veins on my cheeks." "Look how my hand is deformed. My doctor calls it hyperextension." "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands."
"I'm having a hard time opening doors since it hurts so bad." Rheumatoid arthritis (RA) joint involvement usually is symmetric and polyarticular. Pain with turning door knobs, opening jars, and buttoning shirts is commonly reported due to swelling of the wrists and small joints of the hand. Hyperextension of the PIP joint and partial flexion of the distal interphalangeal (DIP) joint is called a swan neck deformity. As the RA inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia. With osteoarthritis (OA), joint changes result from the inflammation caused when the cartilage attempts to repair itself, creating osteophytes or spurs. Raynaud phenomenon (a vascular disorder characterized by reversible vasospasm of the arteries supplying the fingers) and telangiectasia (dilated skin capillaries) are characteristic of scleroderma.
A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client? "In a lot of cases, clients with gout are able to control their symptoms through physiotherapy." "It's important that you have your bloodwork drawn weekly and that you adjust your diet." "Your doctor will likely prescribe acetaminophen with codeine to manage your pain." "Losing some weight and reducing your alcohol intake will likely be beneficial."
"Losing some weight and reducing your alcohol intake will likely be beneficial." For many clients with gout, changes in lifestyle may be needed, such as maintenance of ideal weight, moderation in alcohol consumption, and avoidance of purine-rich foods. Weekly blood work is not necessary and NSAIDs are preferred to opioids for pain management. Physiotherapy is not a major treatment modality for gout.
A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make? "Lupus is more common in white people." "Drug-induced lupus requires lifelong treatment." "Lupus is a disease of older individuals." "More women than men are affected by lupus."
"More women than men are affected by lupus." There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.
A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "To prevent cartilage atrophy, slowly and gradually resume exercising." "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed."
"To prevent cartilage atrophy, slowly and gradually resume exercising." Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.
The nurse determines that additional client education is needed when a client with gout makes which statement? "I should avoid eating shellfish to decrease the risk of an episode." "When I have an exacerbation of my symptoms, a glass of red wine will be helpful." "Increasing my intake of water each day will help stop the symptoms." "I will plan to eat more white meat rather than red meat."
"When I have an exacerbation of my symptoms, a glass of red wine will be helpful." The statement about drinking alcohol to decrease the symptoms would need more follow-up, since it is a strong contributor to an exacerbation of gout. The other statements are valid.
The nursing student who is studying about osteoporosis correctly identifies which female to be at highest risk for suffering a fracture? A 25-year-old whose mother suffers from osteoporosis A 68-year-old who gets bumped several times while riding the bus A 55-year-old who takes estrogen supplements A 40-year-old who walks 20 minutes three times a week
A 68-year-old who gets bumped several times while riding the bus Osteoporosis is often a silent disorder. Typically, the fractures occur with less force than usual, such as when a postmenopausal female is in a crowded area and is slightly pushed; enough pressure could cause the woman to sustain a fracture. The other women are not at a high risk for a fracture.
A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease? Infectious process Genetic disorder Autoimmune process Ischemic response
Autoimmune process The cause of SLE is unknown. It is characterized by the formation of autoantibodies and immune complexes.
A client sustains a musculoskeletal injury of the right foot. In addition to pain, which manifestations would accompany a fracture? Select all that apply. A: Deformity of the affected part B: Abnormal mobility C: Heat D: Joint locking E: Swelling F: Loss of function
A,B,E,F, Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, discoloration, deformity, and abnormal mobility (or false motion), which occurs when the affected part bends across the break. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, whereas a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and limited movement. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. A loose body is a small piece of bone or cartilage in the joint, which can cause clicking and locking of the joint.
Which female patients are at risk for developing osteoporosis? (select all that apply) A: 58, Native American, started menopause prematurely B: 62, African American, estrogen therapy C: 68, white, underweight and inactive D: 60, white, aerobics instructor E: 55, Asian, cigarette smoker
A,C,E risk factors for osteoporosis include age greater than 65, white or Asian, cigarette smoker, low body weight, inactive lifestyle, and postmenopausal estrogen deficiency.
An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health? A: Immunologically mediated joint inflammation B: Cytokine release following mechanical joint injury C: A mismatch between bone resorption and remodeling D: Excessive collagen production and deposition
A: Immunologically mediated joint inflammation The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Paget disease is caused by abnormal bone resorption and remodeling, whereas collagen deposition underlies scleroderma. Osteoarthritis is believed to be initiated by mechanical injury and subsequent cytokine release.
Which clients should the nurse assess to determine if they have premature osteoporosis? Clients who run daily. Anyone under the age of 20. Anyone over the age of 70. Anyone with an eating disorder.
Anyone with an eating disorder. Having an eating disorder places clients at increased risk due to malabsorption of medications and nutrients.
As the nurse of an 89 year old woman on bedrest, which of the following actions can you take to decrease risks associated with clot formation and skin breakdown? Elevate the head of the bed to 30 degrees Assess carotid pulses at the same time Assist with passive leg exercises Limit fluid intake.
Assist with passive leg exercises Assisting with passive leg exercises helps encourage blood flow, and repositioning and exercising the legs decreases the risk of pressure injury on bony prominence of the leg. Checking the carotid pulse does not decrease associated risks, and palpating the left and right carotid arteries at the same time is contraindicated. Skin that is too dry or too moist can contribute to skin breakdown, so you want to encourage adequate hydration. Elevating the head of bed 30 degrees may assist with respiration, but not preventing clot formation and skin breakdown.
The client with a suspected diagnosis of osteoarthritis asks the health care provider, "How will this diagnosis be confirmed?" Which response is most appropriate? A: Aspiration of the joint with biopsy sent to laboratory B: Physical examination and x-ray studies C: Bone marrow aspiration of the pelvis D: Exercise trials to monitor angle of joint movements
B: Physical examination and x-ray studies The diagnosis of osteoarthritis usually is determined by history and physical examination, x-ray studies, and laboratory findings that exclude other diseases. The other options would not identify the disease.
What is a priority concern for a client who has a hip dislocation? Pain Blood supply to the femoral head Tendonitis Edema
Blood supply to the femoral head The major cause for concern for a client with a hip dislocation is that the dislocated position puts tension on the blood supply to the femoral head and avascular necrosis may result. Restoring or preserving circulation is the priority. Tendonitis and edema are not usually a concern. Pain is a secondary concern.
A patient experienced an open fracture at the humerus 2 weeks ago and is having increased pain in the fracture site. Which testing would help identify the causative agent of osteomyelitis? X ray WBC and ESR CT scan Bone biopsy
Bone biopsy large doses of antibiotics are needed to treat the causative agent. The causative agent must be identified. This can be done by obtaining a biopsy of the soft tissue around the site.
What is most likely to cause the pain associated with OA in the later stages? Crepitation Bone surfaces rubbing together Herberden's nodes Bouchard's nodes
Bone surfaces rubbing together the pain in later OA is caused by bone surfaces rubbing together after the articular cartilage has deteriorated. Crepitation occurs earlier with loose particles in the joint cavity. Bouchard and Herberden's nodes are tender and occur as joint space decreases as early as age 40.
When assessing a client with rheumatoid arthritis, which statement about joint involvement is most accurate? A: The joint involvement is usually diagnosed at the time of a fracture following an accident. B: If the hands are involved, it usually only occurs in the dominant hand in the distal interphalangeal joint. C: Involvement is symmetric and polyarticular, initially starting in the fingers, hands, and wrists. D: Involvement usually attacks the entire spinal column with the lumbar region being the most involved area.
C: Involvement is symmetric and polyarticular, initially starting in the fingers, hands, and wrists. Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular. Any diarthrodial joint can be involved. Spinal involvement usually is limited to the cervical region. In the hands, there is usually bilateral and symmetric involvement of the proximal interphalangeal joint. Progressive joint destruction may lead to subluxation (dislocation) and instability of the joint with limited movement.
Which clients with rheumatoid arthritis (RA) will the nurse prioritize to assess first? Client with articular symptoms of RA Client with systemic lupus erythematosus (SLE) and chest pain Client with a "butterfly" rash on the face Client with RA and vasculitis
Client with systemic lupus erythematosus (SLE) and chest pain The client with SLE and chest pain is the priority client to assess. Pericarditis and other cardiac problems are possible. Articular symptoms of rheumatoid arthritis are pain and stiffness; this is not a priority from the clients presented. The client with a butterfly rash is not presenting with any other symptoms and is not a priority. The client with RA and vasculitis would be the second client the nurse would prioritize to assess.
A 16-year-old male football player suffered a fracture of his radius and ulna. Assessment of the fracture includes the following data: (1) the fracture does not protrude through the skin, and (2) both bones broke completely through into two pieces. Select the best description of the injury. Closed greenstick fracture Closed comminuted fracture Thromboemboli Open spiral fracture
Closed comminuted fracture Closed comminuted fracture is a closed fracture because it does not break through the skin. It is comminuted because it broke cleanly into two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. Thromboemboli is a clot, not a fracture.
What term describes an injury to the soft tissue of the body? Tendon rupture Ligament tear Fracture Contusion
Contusion Soft tissue injury from trauma is termed a contusion. A fracture describes bone breakage. Ligaments and tendons are not classified as soft tissue.
A client recently diagnosed with rheumatoid arthritis (RA) tells the nurse she is glad there is nothing "really wrong with her" besides some joint swelling. Which information should the nurse tell the client about RA? A: "The disease can be reversed with medication and exercise." B: "Myocardial infarction develops in clients who have had the disease for an extended period." C: "Joint involvement is typically the only manifestation of the disease in most clients." D: "Extra-articular manifestations may include anemia and deformities of the affected joints."
D: "Extra-articular manifestations may include anemia and deformities of the affected joints." Although characteristically a joint disease, RA can affect a number of other tissues, including red blood cells, blood vessels, lungs, and heart. Treatment goals for a person with RA are to prevent and/or reduce the pain, decrease stiffness and swelling, maximize mobility, and possibly halt the progression, but not cure the disease. RA can be associated with different types of anemia, including anemia of chronic inflammation and iron deficiency anemia. When someone has an RA flare-up, the immune response causes inflammation in the joints and other tissues. Chronic inflammation can lower the production of red blood cells in bone marrow.
Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)? A: A history of thromboembolic events and varicose veins B: Dysmenorrhea and recent spontaneous abortion C: Chronic nausea and vomiting that is unresponsive to antiemetics D: Joint pain and proteinuria
D: Joint pain and proteinuria Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage.
Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)? Low red blood cell count Elevated anti-nuclear antibodies (ANA) Decreased rheumatoid factor An abnormal serum SLE assay
Elevated anti-nuclear antibodies (ANA) While there is no laboratory finding that will provide a definite diagnosis of SLE, the ANA is elevated in 95% of untreated SLE. In most cases, a positive ANA test indicates that the immune system has launched a misdirected attack on the body's own tissue — in other words, an autoimmune reaction
Which assessment finding is a positive outcome of treatment with diet and exercise for hypercholesterolemia? ncreased high-density lipoproteins Increased blood glucose levels Increased low-density lipoproteins Lowered high-density lipoproteins
Increased high-density lipoproteins Exercise and diet control in clients with hypercholesterolemia should result in a lowering of the low-density lipoproteins and an increase in the high-density lipoproteins. The other answers are not positive outcomes expected with this treatment.
The nurse is assessing a female client's risk for osteoporosis. Which factor places this client at greatest risk? Menopause Obesity Black race Male gender
Menopause Numerous studies have shown that bone mass loss occurs with aging regardless of sex, race, or body size. However, after menopause there is a rapid decline in bone mass due to estrogen deficiency. Therefore, menopause places this client at greater risk than gender, race, and body size.
A patient is seen in an outpatient clinic for a sudden inflammation and severe pain in the great toe. A diagnosis of gouty arthritis is based on: Family history of gout Monosodium urate crystals found in synovial fluid Elevated serum uric acid levels Elevated urine uric acid levels
Monosodium urate crystals found in synovial fluid The definitive diagnosis Is established by finding needle-like monosodium urate crystals in the inflamed joint or tophus. Although there is a familial component, environmental and genetic factors both factor in with gout. Hyperuricemia and high serum levels of uric acid may also be related to drugs or exist as an asymptomatic abnormality.
Which description is more characteristic of OA when compared to RA? Morning joint stiffness lasts 1 to several hours Most commonly occurs in women Not systemic or symmetric Rheumatoid Factor (RF) positive
Not systemic or symmetric OA is not systemic or symmetric. Morning joint pain resolves in about 30 minutes. In RA patients are RF positive, and occurs in women more than men. In RA joint stiffness may last 1 hour - all day.
The nurse is conducting a health promotion class on osteoarthritis (OA). Which statement should the nurse include? Obesity is a strong risk factor for developing OA. Young women have a higher risk than young men of developing OA. Eating a diet low in calcium is the only contributing risk factor to OA. There is no hereditary link to the development of OA.
Obesity is a strong risk factor for developing OA. Obesity is a strong risk factor for OA of the knee in women, and a contributory biomechanical factor in the pathogenesis of the disease. Young men have a higher risk, but after middle age, women are more at risk for developing OA. The statements regarding heredity and diet are not true.
While getting up out of bed for the first time after surgery, a client reports feeling dizzy and faint. Which condition is the client most likely experiencing? Virchow triad Increase in blood volume Orthostatic intolerance Anemia
Orthostatic intolerance Orthostatic intolerance may occur in clients that have been on prolonged bed rest and results in symptoms of tachycardia, nausea, diaphoresis, and sometimes syncope or fainting. When there is a change in position a decrease (not an increase) in central blood volume occurs as blood is displaced to the lower extremities. Virchow triad refers to the three factors that predispose a client to venous thrombosis. There is no reason to believe this client is anemic, which generally presents with shortness of breath.
What describes the manifestations of OA? Pain and immobility are aggravated by falling barometric pressure. Joint stiffness is seen with fatigue, anorexia, and weight loss. Joint stiffness follows period of inactivity Smaller joints affected first
Pain and immobility are aggravated by falling barometric pressure. Barometric pressure is the weight of the atmosphere that surrounds us. Barometric pressure often drops before bad weather. Lower air pressure pushes less against the body, allowing tissues to expand. Expanded tissues can put pressure on joints and cause pain. Pain and immobility of OA may be aggravated by falling barometric pressure. OA affects weight-bearing joints such as knees and hips. Joint stiffness resolves within half an hour. C is indicative of RA.
When assessing a client with acute gout, for which of these signs and symptoms does the nurse assess? Select all that apply. Redness and swelling of the affected joint Pain and swelling in one joint Intake of alcohol Obesity A report by the client that the pain began during the workday
Redness and swelling of the affected joint Pain and swelling in one joint Intake of alcohol Obesity The typical acute attack of gout is monoarticular and usually affects the first metatarsophalangeal joint. Acute gout often begins at night and may be precipitated by excessive exercise, certain medications or foods, alcohol, or dieting. The onset of pain typically is abrupt, and redness and swelling are observed.
A nurse is caring for a client admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which disease process? Scleroderma Systemic lupus erythematosus (SLE) Rheumatoid arthritis (RA) Sarcoidosis
Systemic lupus erythematosus (SLE) In SLE, the acute skin lesions include the classic malar or "butterfly" rash on the nose and cheeks
The nurse assesses the neurovascular status of a client who had surgery to repair a fractured hip. Which assessment data for the affected leg indicates that the client has developed a neurologic complication? Tingling sensations Ruddy skin color Cool skin temperature Nonpitting edema
Tingling sensations Complications of fractures include compartment syndrome (when swelling after the injury impairs blood and nerve function), delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset. The neurologic assessment includes sensation and the ability to move the toes. Vascular assessment includes capillary refill, edema, and temperature of the distal extremity.
An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects? Sodium and potassium levels Cognition and coping skills Weight and nutritional status Oxygenation and respiratory status
Weight and nutritional status Anorexia is a common extra-articular symptom of rheumatoid arthritis. Consequently, there is a need to monitor the client's nutritional status and intake. Cognition, respiratory status, and electrolytes are not typically affected.
A client with a fractured clavicle is told that the bone will heal well if immobilized for the next 6 to 8 weeks, but there will be a large "bump" where the break occurred. This bump will be caused by: accumulation of dead white cells. formation of a bony callus. localized infection. formation of scar tissue.
formation of a bony callus. The bony callus is still present due to the misalignment of the ends of the bone (occurs only with clavicle or improperly placed healing). This is not formed by scar tissue and is not the result of scarring or dead white cells.
A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to: a limited access to fluids while hospitalized. saturation of urine with calcium salts. increased urine levels of citrate. frequency of urination.
saturation of urine with calcium salts. Saturation of urine with calcium salts increases the risk for the development of calcium-containing kidney stones. Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation. Fluid intake is not likely to be limited but regardless, it would not contribute to kidney stone formation. Urinary frequency is not a factor in kidney stone formation.