MSK

The occupational health nurse is teaching a class on the risk factors for developing osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA? 1. Being overweight. 2. Increasing age. 3. Previous joint damage. 4. Genetic susceptibility.

1

Which foods should the nurse recommend to a client when discussing sources of dietary calcium? 1. Yogurt and dark-green, leafy vegetables. 2. Oranges and citrus fruits. 3. Bananas and dried apricots. 4. Wheat bread and bran.

1

The client must take three (3) grams of calcium supplement a day. The medication comes in 500 mg/tablets. How many tablets will the client need to take daily?_______

6

A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will need to monitor: a. blood pressure. b. blood glucose. c. erythrocyte count. d. lymphocyte count.

A

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage?* A. Hydroxychloroquine (Plaquenil) B. Lefluomide (Arava) C. Sulfasalazine (Azulfidine) D. Methylprednisolone (Medrol)

A

The nurse is instructing a 65-year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be to: a-Exercise doing weight bearing activities. b-Exercise to reduce weight. c-Avoid exercise activities that increase the risk of fracture. d-Exercise to strengthen muscles and thereby protect bones.

A

What is the best way to diagnose osteoporosis: a. Bone density Scan b. MRI c. X-Ray d. CT Scan

A

When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with: a. a warm bath followed by a short rest. b. a 10-minute routine of isometric exercises. c. stretching exercises to relieve joint stiffness. d. active range-of-motion (ROM) exercises.

A

A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While assisting the patient with her morning routine, the patient verbalizes a pain rating of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing interventions can you provide to this patient to help alleviate pain and stiffness? Select-all-that-apply:* A. Exercise the affected joints B. Assist the patient with a warm shower or bath C. Perform deep massage therapy to the wrist joints D. Assist the patient with applying wrist splints

BD

A 58-year-old woman who has been menopausal for 5 years is diagnosed with osteoporosis following densitometry testing. The woman has been concerned about her risk for osteoporosis because her mother has the condition. In teaching the woman about her osteoporosis, the nurse explains that a. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption. b. estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c. even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. d. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

C

A nurse is conducting a health screening among females at the mall to assess those who are at risk for developing osteoporosis. Which of the following questions is most appropriate to be asked by the nurse in relation to development of osteoporosis? a) at what age did you have your menstruation? b) did you have any fracture? c) are you taking corticosteroids? d) are you on the diet high in vitamin D?

C

A patient is hospitalized with an acute attack of primary gout, which is affecting the left great toe and ankle. The outcome that the nurse determines as most important is that the patient: a. maintains a purine-free diet. b. experiences no evidence of tophi. c. expresses satisfactory pain relief. d. has minimal functional loss in joints.

C

A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrists, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time is to: a. maintain a positive self-image. b. perform activities of daily living independently. c. achieve satisfactory control of pain. d. make a successful adjustment to disease progression.

C

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? a. The patient has experienced a recent 5-pound weight loss. b. The patient's erythrocyte sedimentation rate (ESR) has increased. c. The patient's blood glucose is 166 mg/dl. d. The patient has no improvement in symptoms.

C

Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? a-Take the medication in the morning with meals. b-Take the medication 2 hours before bedtime. c-Take the medication with a glass of water after rising in the morning. d-Take the medication during lunch.

C

Alendronate is used in treatment of osteoporosis because it? a. Decreases inflammation b. Has calcium c. Inhibits osteoclastic activity d. Promotes osteoclastic activity

C

A client with osteoporosis is asking the nurse regarding the use of Salmon calcitonin (Miacalcin) nasal spray. The nurse tells the client to do the following, except? a-Delivery system contains enough medication for at least 30 doses. Discard any unused solution after 30 doses. b-If you do not feel the spray while using it, repeat the dose on the other nostrils. c-Miacalcin is usually given as one spray per day into only one of your nostrils. d-Take extra vitamin D while you are using Miacalcin.

B

A patient with fibromyalgia syndrome (FMS) tells the nurse, "I don't know why the doctor has prescribed amitriptyline (Elavil) for me. I don't feel depressed, just tired and achy." The most appropriate response by the nurse is, "The Elavil... a. is ordered to prevent depression from occurring." b. will improve the quality of your sleep at night." c. relaxes your muscles and helps prevent spasm." d. has antiinflammatory actions to reduce joint pain."

B

Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse teaches the patient that a )the drug must be taken with food to prevent GI side effects. b )bisphosphonates prevent calcium from being taken from the bones. c )lying down after taking the drug prevents light-headedness and dizziness. d )taking the drug with milk enhances the absorption of calcium from the bowel.

B

An assessment finding that alerts the nurse to the presence of osteoporosis in a middle-aged patient is a. the presence of bowed legs. b. measurable loss of height. c. an aversion to dairy products. d. statements about frequent falls.

B

Identify which patient below is at MOST risk for developing gout:* A. A 56 year old male who reports consuming foods low in purines. B. A 45 year old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin. C. A 39 year old female hospitalized with bulimia that has a BMI of 24. D. A 27 year old female with ulcerative colitis.

B

Postmenopausal women are more prone to suffer from osteoporosis due to? a. Decreased testosterone b. Decreased estrogen c. Increased estrogen d. Increased testosterone

B

The biologic agent anakinra (Kineret) is prescribed for a patient who has moderately severe rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about: a. symptoms of gastrointestinal (GI) irritation or bleeding. b. self-administration of subcutaneous injections. c. taking the medication with at least 8 oz of fluid. d. avoiding concurrently taking aspirin or NSAIDs.

B

When the nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex), which information is most important to communicate to the health care provider? a. The platelet count is 130,000/μl. b. The white blood cell count (WBC) is 1500/μl. c. The blood glucose is 130 mg/dl. d. The potassium is 5.2 mEq/L.

B

You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis?* A. Potassium 3.2 mEq/L B. Hemoglobin 7 g/dL C. Sodium 135 mEq/L D. WBC count 6,500

B

\The client diagnosed with RA is receiving care through a nurse practitioner clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits? a. Perform joint x-rays to determine progression of the disease b. Send blood to the lab for an erythrocyte sedimentation rate (ESR) c. Recommend the flu and pneumonia vaccines d. Assess the client for increasing joint involvement

C

The daily requirement of calcium for an adult woman is a. 2500mg b. 600mg c. 2000mg d. 1200mg

D

When counseling an older patient about ways to prevent fractures, which information will the nurse include? a. Tacking down scatter rugs in the home is recommended. b. Occasional weight-bearing exercise will improve muscle and bone strength. c. Most falls happen outside the home. d. Buying shoes that provide good support and are comfortable to wear is recommended.

D

Which intervention has the highest priority when caring for a client diagnosed with RA? a. Encourage the client to ventilate feelings about the disease process b. Discuss the effects of disease on the client's career and other life roles c. Instruct the client to perform most important activities in the morning d. Teach the client the proper use of hot and cold therapy to provide pain relief

D

Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? a-A female patient being treated for high blood pressure with an ACE inhibitor. b-A patient who is allergic to iodine/shellfish. c-A patient on a calorie restricted diet. d-A patient on bed rest who must maintain a supine position

D

Which psychosocial problem would be priority for a client diagnosed with RA? a. Alteration in comfort b. Ineffective coping c. Anxiety d. Altered body image

D

The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse expect the client to exhibit? 1. Severe bone deformity. 2. Joint stiffness. 3. Waddling gait. 4. Swan neck fingers

2

The female client diagnosed with osteoporosis tells the nurse that she is going to perform swim aerobics for 30 minutes every day. Which response would be most appropriate by the nurse? 1. Praise the client for committing to do this activity. 2. Explain that walking 30 minutes a day is a better activity. 3. Encourage the client to swim every other day instead of daily. 4. Discuss that sedentary activities help prevent osteoporosis.

2

Which client goal would be most appropriate for a client diagnosed with OA? 1. Perform passive range-of-motion exercises. 2. Maintain optimal functional ability. 3. Client will walk three (3) miles every day. 4. Client will join a health club.

2

During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (Select all that apply.) a. sleep disturbances. b. multiple tender points. c. urinary frequency and urgency. d. cardiac palpitations and dizziness. e. multijoint pain with inflammation and swelling. f. widespread bilateral, burning musculoskeletal pain.

ABCF

A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? SELECT ALL THAT APPLY a)"It's common in females after menopause." b) "It's a degenerative disease characterized by a decrease in bone density." c) "It's a congenital disease caused by poor dietary intake of milk products." d) "It can cause pain and injury." e) "Passive range-of-motion exercises can promote bone growth." f) "Weight-bearing exercise should be avoided."

ABD

During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply:* A. "Does the pain and stiffness tend to be the worst before bedtime?" B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" D. "Is your pain and stiffness aggravated by extreme temperature changes?"

BC

Identify methods to specifically prevent osteoporosis in postmenopausal women (Select all that apply)? a-Eating more beef. b-Eating 8 oz. of yogurt daily. c-performing weight bearing exercises. d-Spending 15 minutes in the sun each day. e-Taking postmenopausal estrogen replacement.

BC

A 20-year-old patient with a 6-year history of muscular dystrophy is hospitalized with a respiratory tract infection. Which nursing action will be included in the plan of care? a. Logroll the patient every 1 to 2 hours. b. Teach the patient about the muscle biopsy procedure. c. Provide the patient with a pureed diet. d. Assist the patient with active range-of-motion (ROM) exercises.

D

Intervention to prevent osteoporosis in women should start at which age? a. 60-70 years b. 50-55 years c. 45-55 years d. 20-35 years

D

Which of these is a risk factor for osteoporosis a-Age b-Obesity c-Smoking d-Family history e-All of the above

E

True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60.* True False

False

The nurse is discussing the importance of an exercise program for pain control to a client diagnosed with OA. Which intervention should the nurse include in the teaching? 1. Wear supportive tennis shoes with white socks when walking. 2. Carry a complex carbohydrate while exercising. 3. Alternate walking briskly and jogging when exercising. 4. Walk at least 30 minutes three (3) times a week.

1

The nurse is teaching a class to pregnant teenagers. Which information is most important when discussing ways to prevent osteoporosis? 1. Take at least 1200 mg of calcium supplements a day. 2. Eat foods low in calcium and high in phosphorus. 3. Osteoporosis does not occur until around age 50 years. 4. Remain as active as possible until the baby is born.

1

Which intervention is an example of a secondary nursing intervention when discussing osteoporosis? 1. Obtain a bone density evaluation test. 2. Perform non-weight-bearing exercises regularly. 3. Increase the intake of dietary calcium. 4. Refer clients to a smoking cessation program.

1

Which signs/symptoms would make the nurse suspect that the client has developed osteoporosis? 1. The client has lost one (1) inch in height. 2. The client has lost 12 pounds in the last year. 3. The client's hands are painful to the touch. 4. The client's serum uric acid level is elevated.

1

19. Which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub? 1. Physiatrist. 2. Social worker. 3. Physical therapist. 4. Counselor.

3

The client diagnosed with OA is a resident in a long-term care facility. The resident is refusing to bathe because she is hurting. Which instruction should the nurse give the unlicensed nursing assistant? 1. Allow the client to stay in bed until the pain becomes bearable. 2. Tell the assistant to give the client a bed bath this morning. 3. Try to encourage the client to get up and go to the shower. 4. Notify the family that the client is refusing to be bathed.

3

The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis? 1. X-ray of the femur. 2. Serum alkaline phosphatase. 3. Dual-energy x-ray absorptiometry (DEXA). 4. Serum bone Gla-protein test.

3

The client is complaining of joint stiffness, especially in the morning. Which diagnostic tests would the nurse expect the health-care provider to order to R/O osteoarthritis? 1. Full body magnetic resonance imaging scan. 2. Serum studies for synovial fluid amount. 3. X-ray of the affected joints. 4. Serum erythrocyte sedimentation rate (ESR).

3

The client is taking calcium carbonate (Tums) to help prevent further development of osteoporosis. Which teaching should the nurse implement? 1. Encourage the client to take Tums with at least eight (8) ounces of water. 2. Teach the client to take Tums with the breakfast meal only. 3. Instruct the client to take Tums 30 to 60 minutes before a meal. 4. Discuss the need to get a monthly serum calcium level.

3

The nurse is admitting the client with OA to the medical floor. Which statement by the client indicates an alternative form of treatment for OA? 1. "I take medication every two (2) hours for my pain." 2. "I use a heating pad when I go to bed at night." 3. "I wear a copper bracelet to help with my OA." 4. "I always wear my ankle splints when I sleep."

3

The nurse is discussing osteoporosis with a group of women. Which factor will the nurse identify as a nonmodifiable risk factor? 1. Calcium deficiency. 2. Tobacco use. 3. Female gender. 4. High alcohol intake.

3

The 84-year-old client is a resident in a long-term care facility. Which intervention should be implemented to help prevent complications secondary to osteoporosis? 1. Keep the bed in the high position. 2. Perform passive range-of-motion exercises. 3. Turn the client every two (2) hours. 4. Provide nighttime lights in the room.

4

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client? 1. Take the medication on an empty stomach. 2. Make sure the client tapers the medication when discontinuing. 3. Apply the medication topically over the affected joints. 4. Notify the health-care provider if vomiting blood.

4

The client diagnosed with osteoporosis asks the nurse, "Why does smoking cigarettes cause my bones to be brittle?" Which response by the nurse would be most appropriate? 1. "Smoking causes nutritional deficiencies that contribute to osteoporosis." 2. "Tobacco causes an increase in blood supply to the bones, causing osteoporosis." 3. "Smoking low-tar cigarettes will not cause your bones to become brittle." 4. "Nicotine impairs the absorption of calcium, causing decreased bone strength."

4

The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem would the nurse identify? 1. Severe pain. 2. Body-image disturbance. 3. Knowledge deficit 4. Depression.

4

The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray. Which assessment data would indicate an adverse effect of the medication? 1. The client complains of nausea and vomiting. 2. The client is drinking two (2) glasses of milk a day. 3. The client has a runny nose and nasal itching. 4. The client has had numerous episodes of nosebleeds.

4

A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You've provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication?* A. "This medication will help relieve the inflammation and pain during an acute attack." B. "It is important I have regular eye exams while taking this medication." C. "I will not take large doses of vitamin C supplements while taking this medication." D. "Allopurinol decreases the production of uric acid."

A

A patient started Alendronate (Fosamax) once a week for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient? a-"I should take the drug with a meal to prevent stomach irritation". b-"This drug will prevent further bone loss and increase my bone density". c-"I need to sit or stand upright for at least 30 minutes after taking the drug". d-"I will still need to take my calcium supplements while taking this new drug ".

A

A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management? a. The patient takes one aspirin a day prophylactically to prevent angina. b. The patient sleeps about 8 to 10 hours every night. c. The patient generally drinks about 3 quarts of juice and water daily. d. The patient usually eats beef once or twice a week.

A

A patient with an acute attack of gout is treated with colchicine. The nurse determines that the drug is effective upon finding: a. relief of joint pain. b. increased urine output. c. elevated serum uric acid. d. decreased white blood cells (WBC).

A

The 20 year old female client diagnosed with advanced unremitting RA is being admitted to receive a regimen of immunosuppressive medications. Which question should the nurse ask during the admission process regarding the medications? a. "Are you sexually active, and if so, are you using birth control?" b. "Have you discussed taking these drugs with your parents?" c. "Which arm do you prefer to have an IV in for 4 days?" d. "Have you signed an informed consent for investigational drugs?"

A

The client with RA has nontender movable nodules in subcutaneous tissue over the elbows and shoulders. Which statement is the best explanation for the nodules? a. The nodules indicate a rapidly progressive destruction of the affected tissue b. The nodules are small amounts of synovial fluid that have become crystallized c. The nodules are lymph nodes that have proliferated to try to fight the disease d. The nodules present a favorable prognosis and mean the client is better

A

The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? a. The patient sleeps with two pillows under the head. b. The patient has been taking 16 aspirins daily. c. The patient requires a 2 hour midday nap. d. The patient sits on a stool when preparing meals.

A

The nurse determines that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium? a. Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk b. Two-egg omelet with American cheese, one slice of whole-wheat toast, and a half grapefruit c. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple d. Chicken stir-fry with bok choy, onions, and snap peas and one cup of steamed brown rice

A

Which information obtained during the nurse's assessment of the patient's nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient is 5 ft 2 in and weighs 180 lb. b. The patient prefers whole milk to nonfat milk. c. The patient dislikes fruits and vegetables. d. The patient takes a multivitamin daily.

A

You are providing a free clinic seminar to participants about gout. Which statement by a participant about the occurrence of gout is correct?* A. "Gout attacks tend to awake the person out of their sleep in the middle of the night." B. "The pain felt with gout tends to be intense during the first 30 minutes." C. "It is best for a patient experiencing gout to tightly bandage the affected extremity." D. "Typically acute gout attacks are predictable and tend to occur once or twice a week."

A

A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply:* A. Rheumatoid factor B. Uric acid level C. Erythrocyte sedimentation D. Dexa-Scan E. X-ray imaging

ACE

During a home health visit you are helping a patient with gout identify foods in their pantry they should avoid eating. Select all the foods below the patient should avoid:* A. Sardines B. Whole wheat bread C. Sweetbreads D. Crackers E. Craft beer F. Bananas

ACE

You're developing a nursing care plan for a patient with gout present in the right foot. What specific nursing interventions will you include in this patient's plan of care? Select all that apply:* A. Encourage fluid intake of 2-3 liter per day. B. Provide patient with foods high in purine with each meal daily. C. Place patient's right foot in a foot board while patient is in bed. D. Administer PRN dose of Aspirin for a pain rating greater than 5 on 1-10 scale. E. Apply alternating cold and warm compresses to right foot as tolerated by the patient daily

ACE

A 50 - year - old African American woman visits your office for an annual examination. She takes inhaled steroids and Beta- agonists for mild intermittent asthma. Her past medical history is negative for any fracture. She has no family history of osteoporosis. She exercises regularly. Her menses are regular. Based on her history, what are your recommendations for osteoporosis prevention and screening? (A) Take 800 mg of calcium and 800 IU vitamin D daily (B) Take 1200 mg of calcium and 400 IU vitamin D daily (C) Bone mineral density (BMD) screening (D) Begin calcitonin therapy to increase bone density (E) Begin alendronate therapy to increase bone density

B

A patient is post-op from surgery. The patient has a history of gout. While performing a head-to-toe assessment, you assess the patient for signs and symptoms of gout. As the nurse, you know that gout tends to start at what site?* A. Elbow B. Big toe C. Thumb or index finger D. Knees

B

The client diagnosed with RA has developed swan-neck fingers. Which referral would be the most appropriate for the client? a. Physical therapy b. Occupational therapy c. Psychiatric counselor d. Home health nurse

B

The client diagnosed with RA who has been prescribed Plaquenil, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach? a. Explain that the less medication loses its efficacy after a few months b. Continue to have regular eye exams while taking the medication c. Have yearly MRIs to follow the progress d. Discuss that the drug is taken for 3 weeks and then stopped for a week

B

The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "That drug has too many side effects; I would rather wait until my joint problems are worse before beginning any drugs." The most appropriate response by the nurse is: a. "You should tell the doctor how you feel so the two of you can make a decision together." b. "It is important to start methotrexate early in order to decrease the joint damage." c. "Methotrexate is not expensive and will be cheaper to take than other possible drugs." d. "Methotrexate is very effective and has no more side effects than the other available drugs."

B

The nurse knows that a 60-year-old female client's susceptibility to osteoporosis is most likely related to: a-Lack of exercise. b-Hormonal disturbances. c-Lack of calcium. d-Genetic predisposition

B

When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to: a. stand rather than sit when performing household chores. b. avoid activities that require continuous use of the same muscles. c. strengthen small hand muscles by wringing sponges or washcloths. d. protect the knee joints by sleeping with a small pillow under the knees.

B

When teaching range-of-motion exercises to a patient who is having an acute exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both hands, the nurse teaches the patient that: a. affected joints should not be exercised when pain is present. b. cold applications before exercise will decrease joint pain. c. exercises should be performed passively by someone other than the patient. d. regular walking may substitute for range-of-motion (ROM) exercises on some days.

B

You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct?* A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." C. "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." D. "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

B

You are teaching a patient with osteopenia. What is important to include in the teaching plan? a )Lose weight. b )Stop smoking. c )Eat high protein diet. d )Start swimming for exercise.

B

Which female patients are at risk for developing osteoporosis (Select all that apply) ? a-60 year old white aerobic instructor. b-55 year old Asian American cigarette smoker. c-62 year old African American on estrogen therapy. d-68 year old white who is underweight and inactive e-58 year old Native American who started menopause prematurely.

BDE

Disease-modifying antirheumatic drugs (DMARDS) are used to treat rheumatoid arthritis. Select-all-the drugs below that are DMARDS:* A. Dexamethasone (Decadron) B. Hydroxychloroquine (Plaquenil) C. Teriparatide (Forteo) D. Calcitonin E. Leflunomide (Arava) F. Methotrexate (Trexall)

BEF

During the 1000 medication pass, your patient reports to you that he is having muscle pain and tingling in his fingers and toes. You note that the patient also has a grayish color to his lips. You immediately notify the doctor. In addition, you would hold which medication that is scheduled to be administered at 1000?* A. Ibuprofen B. Prednisone C. Colchicine D. Aspirin

C

Gout is a type of arthritis that occurs due to the accumulation of ____________ in the blood that causes needle-like crystals to form around the joints.* A. purines B. creatinine C. uric acid D. amino acids

C

Identify the correct sequence in how rheumatoid arthritis develops:* A. Development of pannus, synovitis, ankylosis B. Anklyosis, development of pannus, synovitis C. Synovitis, development of pannus, anklyosis D. Synovitis, anklyosis, development of pannus

C

The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient, the most important information for the nurse to communicate to the health care provider is that the patient has: a. a history of infectious mononucleosis as a teenager. b. a family history of age-related macular degeneration of the retina. c. been trying to have a baby before her disease becomes more severe. d. been using large doses of vitamins and health foods to treat the RA.

C

When assessing the musculoskeletal system, the nurse's initial action will usually be to a. have the patient move the extremities against resistance. b. feel for the presence of crepitus during joint movement. c. observe the patient's body build and muscle configuration. d. check active and passive range of motion for the extremities.

C

Which client problem is priority for a client diagnosed with RA? a. Activity intolerance b. Fluid and Electrolyte balance c. Alteration in comfort d. Excessive nutritional intake

C

Which patient would be at greatest risk for developing osteoporosis? a )A 73-year-old man who has five alcoholic drinks per week and limits sun exposure to prevent recurrence of skin cancer. b )An 84-year-old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine (Synthroid). c )A 69-year-old woman who had a renal transplant 5 years ago and has been taking prednisone to prevent organ rejection. d )A 55-year-old woman who recently had a hysterectomy with bilateral salpingo-oophorectomy and refuses estrogen therapy.

C

A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate? a. "Your family may need some help to understand the impact of your rheumatoid arthritis." b. "You may need to see a family therapist for some help." c. "Perhaps it would be helpful for you and your family to get involved in a support group." d. "Tell me more about the situations that are causing stress."

D

A 75 year old male is admitted for chronic renal failure. You note that the patient has white/yellowish nodules on the helix of the ear and fingers. The patient reports they are not painful. As you document your nursing assessment findings, you will document this finding as? A. Nodosa B. Keloid C. Dermoid D. Tophi

D

A home health patient with rheumatoid arthritis (RA) complains to the nurse about having chronically dry eyes and a dry mouth. Which action by the nurse is most appropriate? a. Have the patient withhold the daily methotrexate (Rheumatrex) until talking with the health care provider. b. Reassure the patient that dry eyes and mouth are very common with RA. c. Teach the patient to use an antiseptic mouth wash tid. d. Suggest that the patient start using over-the-counter (OTC) artificial tears.

D

It is important a patient with gout avoid medications that can increase uric acid levels. Which medication below is NOT known to increase uric acid levels?* A. Aspirin B. Niacin C. Cyclosporine D. Tylenol

D

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. When the patient has a follow-up visit 1 month later, the nurse recognizes that the patient's response to the treatment may be best evaluated by: a. blood glucose testing. b. liver function tests. c. serum electrolyte levels. d. C-reactive protein level.

D

The client recently diagnosed with RA is prescribed aspirin, an NSAID medication. Which comment by the client would warrant immediate intervention by the nurse a. "I always take the aspirin with food" b. "If I have dark stools, I will call my HCP" c. "Aspirin will not cure my arthritis" d. "I am having some ringing in my ears"

D

The client with early-stage RA is being discharged from the outpatient clinic. Which discharge instructions should the nurse teach regarding the use of NSAIDs? a. Take an over-the-counter medication for the stomach b. Drink a full glass of water with each pill c. If a dose is missed, double the medication at the next dosing time d. Avoid taking the NSAID on an empty stomach

D

The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention? a. The client complains of joint stiffness and the knees feel warm to the touch b. The client has experienced one kg weight loss and is very tired c. The client requires a heating pad applied to the hips and back to sleep d. The client is crying, has a flat facial affect, and refuses to speak to the nurse

D

The nurse should include which of the following client teachings for prevention of rapid progression of osteoporosis? a) avoid taking skim milk b) avoid taking protein-rich foods c) avoid calcium supplement d) avoid alcohol

D

Which of the following medical conditions or med- ications can lead to secondary osteoporosis? (A) Hypothyroidism (B) Zinc deficiency (C) Type 2 diabetes mellitus (D) Gonadotropin- releasing hormone (GnRH) agonists (E) Angiotensin- converting enzyme (ACE) inhibitors

D