Chapter 21: Bone and Joint Problems
A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? a. Avoid foods high in purine. b. Encourage the client to take in 1 L of fluid daily. c. Consume one glass of red wine daily. d. Recommend that the client eat 12 to 16 ounces of foods high in protein such as red meat.
ANS: A A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol and only have 4 to 6 ounces of foods high in protein daily.
Which assessment is typical for a client with osteoarthritis (OA)? a. Narrow joint spaces with crepitus b. Effects in symmetrical joints c. Morning stiffness for at least an hour d. Swelling from excess synovial fluid
ANS: A The joint of an older adult with OA is narrower than a normal joint, and as the disease advances, crepitus is palpable over the joint. The joint narrows as it degenerates, and crepitus occurs as the articulating surfaces of the bone abnormally move against each other. Disease in symmetrical joints is characteristic of RA. Morning stiffness lasting for 1 hour or more is characteristic of polymyalgia rheumatica. Swelling from excessive synovial fluid is characteristic of RA.
Which is a healthy practice recommended for a person at risk for Osteoarthritis (OA)? a. Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert b. Long-term estrogen administration as adjunct therapy c. A bisphosphonate medication taken with a snack just before bedtime d. Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fiber bun at lunch; cocktails before dinner; steak with brown rice, celery, and red wine for dinner
ANS: A These foods in these quantities supply 1204 mg of calcium. Administering estrogen can increase the risk of cancer and heart disease. Because of the seriousness of the risk for esophageal erosion, bisphosphonates must be taken with a full glass of water on an empty stomach after awakening. Afterward, the client must sit upright and refrain from eating or drinking for 30 minutes Alcohol and high amounts of protein and salt inhibit calcium uptake, whereas caffeine, excess fiber, and phosphorus (in the cola) promote calcium excretion.
Which of the following is a true statement about joints in older adults? a. Osteoarthritis (OA) is an inflammatory joint disorder. b. Surgical joint replacement can effectively manage OA pain. c. Joint damage in OA is reversed with medication. d. Very old clients should avoid joint replacement surgery.
ANS: B Surgical joint replacement can effectively manage OA-related pain. OA is a degenerative joint disease, whereas rheumatoid arthritis (RA) is an inflammatory process. Medications are used to control the pain of OA. The joint damage cannot be reversed except through joint replacement surgery. Surgical joint replacements are recommended even for those who are very old.
The nurse prepares an older adult diagnosed with osteoarthritis (OA) for discharge. Which instruction does the nurse include in client teaching to maintain safety for this client? a. Take ibuprofen rather than opioid analgesics. b. Increase rest periods to slow disease progression. c. Report joint instability to the health care provider. d. Avoid stretching the affected joint during exercise.
ANS: C As OA progresses, the joint deteriorates and can become unstable, thereby increasing the risk of falls. The joint stability will not improve without physical therapy or surgery; therefore, the client needs to report instability to the health care provider. Although ibuprofen is much less likely to cause dizziness, hypotension, or sedation, nonsteroidal anti-inflammatory agents such as ibuprofen are poor analgesic choices for older adults; they can aggravate hypertension and impair renal blood flow. The nurse avoids recommending increased rest because rest contributes to stiffness. Stretching is an important form of exercise for older adults with OA; it helps maintain joint flexibility and range of motion.
Which of the following nursing interventions are suitable as a last resort treatment for gout? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Liquid paraffin hand baths c. Colchicine by mouth d. Hyaluronic acid injections
ANS: C Colchicine is indicated in the treatment of an acute gout attack when other interventions have failed to manage the pain. NSAIDs can be used in pain management in all forms of arthritis. Liquid paraffin hand baths can be used to relieve pain in OA and RA. Hyaluronic acid injections are used by some to relieve the pain of OA in the knee. Salicylates should not be used in gout because they can exacerbate an attack.
A nurse plans for the discharge of a 75-year-old client diagnosed with of osteoporosis. Which of these actions would the nurse consider first to best address safety needs? a. Avoid stressful situations. b. Schedule an annual DXA/DEXA scan. c. Remove clutter from the floors of the home. d. Encourage consumption of a high-protein diet.
ANS: C Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with a falls. There is no evidence that stress impacts osteoporosis. The recommendation for a DXA/DEXA scan is every 2 years. There is no evidence that a high protein diet is important for an individual with osteoporosis.
Which of the following statements is true about rheumatoid arthritis (RA)? a. Strikes unilaterally. b. Affects more men than women. c. Can affect body systems other than the joints. d. Morning stiffness in RA lasts less than 30 minutes.
ANS: C RA is a systemic disease and can affect body systems other than joints; this statement is true. Women are affected more often than men. RA strikes the same parts of the body on both sides and affects joints in a symmetrical pattern. RA can affect body systems other than joints and can cause general fatigue and malaise and attack systems other than joints. Morning stiffness in RA it lasts longer than 30 minutes.
The nurse sees an older adult diagnosed with osteoarthritis (OA) who presents with a low-grade fever. The client tells the nurse that the pain is changing; it is worse at night and in the shoulder muscles. Which of the following does the nurse perform to prevent complications of this client's condition? a. Assess all joints for swelling and redness. b. Obtain blood specimens for blood cultures. c. Direct the client to report temporal or scalp pain. d. Direct the client to apply moist heat for 20 minutes.
ANS: C The older adult exhibits clinical indicators of polymyalgia rheumatica (PMR), and a serious complication of PMR is giant cell arteritis (GCA). The nurse instructs the client to report scalp and temporal pain because they are early indicators of GCA. As a complication of PMR, the client exhibits clinical indicators of PMR that include severe pain and stiffness of muscles, including the back, buttocks, and thighs. PMR is not a disease that affects the joints. Blood cultures are not indicated for PMR because it is not an infection. Because PMR is an autoimmune, inflammatory disorder, applying heat is more likely to aggravate the client's condition. Effective treatment for PMR includes low-dose steroids. However, low-dose steroids are unrelated to preventing complications of PMR.
An older woman seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia. To achieve the woman's goal, which of the following client teachings should the nurse provide to enhance the activity of the osteoblasts? a. Limit sodium intake. b. Refrain from alcohol use. c. Eat high-fiber foods. d. Engage in weight-bearing exercise
ANS: D In osteopenia, bone metabolism is unbalanced because the action of osteoclasts is greater than the action of osteoblasts. To treat osteopenia effectively, the balance between the activities of the bone cells must be shifted to more osteoblast (bone-building) activity; increasing osteoblast activity helps reduce bone loss and, at the same time, helps gain bone density. Weight-bearing exercise stimulates osteoblasts to build bone through the application of opposing forces on the bone and helps achieve the woman's goal by increasing physical activity (to stem bone loss) and by generating more bone (to gain bone density). Sodium impairs calcium absorption; therefore, the nurse instructs her to limit sodium intake to reduce bone loss. Alcohol impairs calcium absorption; therefore, the nurse instructs her to avoid alcoholic beverages. Fiber inhibits calcium absorption.
Which of the following characteristics of rheumatoid arthritis (RA) are unlike those of osteoarthritis (OA)? a. Myalgia and stiffness b. Joint pain that is curable c. Crepitus and instability d. Systemic and symmetrical
ANS: D OA is not a systemic disease, nor does it affect joints symmetrically. Myalgia and stiffness are characteristics of PMR; however, myalgia is uncharacteristic of RA and OA. Joint pain is characteristic of both RA and OA, but only OA is curable through joint replacement. RA is a systemic disease and affects joints symmetrically; therefore, these are clinical indicators of OA, not RA.
After living with osteoporosis for 2 years, an older adult's bone density scan shows no improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult? a. Add tai chi or yoga exercises. b. Instruct the client to drink fortified milk. c. Increase weight-bearing exercises. d. Review the client's daily nutritional habits.
ANS: D Reviewing the older adult's nutritional habits can reveal clues about potential dietary contributors to bone loss from excessive sodium, alcohol, caffeine, or carbonated beverage intake. In addition, the nurse also confirms that the client avoids smoking and a sedentary lifestyle that contribute to bone loss. Tai chi or yoga, drinking fortified milk, and increasing weight-bearing exercises can all help increase bone density.
Which of the following is a true statement about osteoporosis? a. Osteoporosis is indicative of an underlying health problem. b. The most common site for related fractures is in long bones. c. Men of all races have the highest risk for osteoporosis. d. A high risk of death follows an osteoporosis-related fracture.
ANS: D The most serious outcomes of osteoporosis are fractures and are associated with high mortality. Osteoporosis can be a natural-occurring consequence of aging. The vertebrae, pelvis, and wrist are the most frequent sites for OA fractures. In developed countries only 2% to 8% of men and 9% to 38% of the women are diagnosed with osteoporosis.
