Musculoskeletal NCLEX style questions

Which term is used to describe a round, benign cyst, often found on a wrist or foot joint or tendon?

Ganglion Cyst

The incidence of what type of fracture is highest in older adults?

Hip

A patient is brought to the emergency department (ED) via ambulance after a motor vehicle crash. What condition does the nurse assess for first?

Respiratory distress

Which condition may be detected by using the drop arm test?

Rotator cuff injury

What does the nurse teach a patient with osteomalacia (aka Ricketts) to include in the daily diet?

Vitamin D Osteomalacia causes softening of the bone due to the decrease in vitamin D in the body. The patient with osteomalacia should include vitamin D in the diet because it promotes the absorption of calcium and phosphorus from the small intestine. The bone accounts for 99% of the calcium and 90% of the phosphorus in the body.

The nursing instructor asks a nursing student to identify risk factors that are shared by clients who have osteoporosis or osteomalacia. Which statement by the student is correct? A. "High alcohol intake is a risk factor for both conditions." B. "A history of smoking is a risk factor for both conditions." C. "Inadequate exposure to sunlight is a risk factor for both conditions." D. "Being homeless is a risk factor for both conditions."

"High alcohol intake is a risk factor for both conditions."

The nurse is assessing four clients with musculoskeletal disorders. The nurse should assess the client with which laboratory result first? a. Serum alkaline phosphatase (ALP): 108 units/L b. Serum aspartate aminotransferase (AST): 26 units/L c. Serum calcium: 10.2 mg/dL d. Serum phosphorus: 2 mg/dL

ANS: D A normal serum phosphorus level is 3 to 4.5 mg/dL; a level of 2 mg/dL is low, and this client should be assessed first. The values for serum ALP, AST, and calcium are all within normal ranges. (phosphorus is close to potassium ranges)

Which of the following observations by the nurse warrants further investigation to determine if the client has rheumatoid arthritis (RA)? Complaints of pain with movement Negative family history Complaints of prolonged morning stiffness lasting for 1 hour Occasional use of NSAIDS for aches and pains

Answer: Complaints of prolonged morning stiffness lasting for 1 hour Rationale: Prolonged morning stiffness is associated with RA. Occasional use of NSAIDS is not by itself a direct link to RA. Pain with movement is more likely associated with degenerative joint disease. Negative family history indicates the client does not have an elevated risk for RA.

A patient has had surgery for carpal tunnel syndrome (CTS). What does the nurse teach the patient before discharge?

Check neurovascular status of the fingers every hour.

The patient presents with contracture deformities of the hand and complains of severe pain. What musculoskeletal disorder does this patient manifest? 1. Rheumatoid arthritis 2. Osteomyelitis 3. Osteoporosis 4. Ankylosing spondylitis

Correct Answer: 1 Rationale The pattern of joint involvement in rheumatoid arthritis (RA) is typically polyarticular and symmetric. The proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the fingers, wrists, knees, ankles, and toes are most frequently involved, although RA can affect any joints.

A 50-year-old female patient is concerned that she will develop osteoporosis because both her maternal aunts have been diagnosed with the disorder. The nurse would suggest which intervention? 1. Prophylactic nonsteroidal anti-inflammatory medication 2. A DEXA test 3. Prescription for risedronate (Actonel) 4. Increase daily intake of calcium

Correct Answer: 2 Rationale Assessment of bone mass is the primary measurement for osteoporosis. The bone mineral density test, or DEXA test, uses a technique that measures any skeletal site and then compares bone density values with other values in a reference population of the same age, race, and gender.

A nurse provides discharge teaching for a client who had a total hip replacement. Which activities to avoid identified by the client indicate an understanding of the teach?

Crossing the legs. Sitting in a low chair.

When the first class of drugs ((DMARDs) prescribed for rheumatoid arthritis FAILS, the nurse anticipates which category of drugs will be prescribed? A. Nonsteroidal anti-inflammatory B. Disease modifying antirheumatic C. Salicylates D. Biologic response modulators

D: Disease modifying antirheumatic drugs (DMARDs) are the first drugs used to try to reduce joint clinical manifestations in rheumatoid arthritis. Biologic response modulators (**examples adalimumab& infliximab**) have a 66% success rate AFTER failure with DMARDs.

The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the physician will request which medication? A. Ascorbic acid (vitamin C) B. Ergocalciferol (calciferol) C. Phenytoin (Dilantin) D. Prednisone (Deltasone)

Ergocalciferol (calciferol)

A diabetic older adult patient who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the health care provider will request which medication?

Levofloxacin The patient's symptoms indicate a possible right knee infection, so the first action will be to start antibiotic therapy, especially because the patient is diabetic and is at greater risk for infection.

A client with osteoporosis is prescribed raloxifene (Evista). What should the nurse monitor in the client? Check serum creatinine Monitor urinary calcium Monitor liver function tests Observe for anxiety and drowsiness

Monitor liver function tests Raloxifene increases the risk for hepatic disease. Therefore the liver function test is monitored in a client who is prescribed this drug. Serum creatinine is checked in a client who is prescribed zoledronic acid. Urinary calcium is monitored in a client who is prescribed calcium supplements. Anxiety and drowsiness is observed in a client who is prescribed risedronate.

A patient has undergone a kyphoplasty (Use of a balloon in the vertebral body to contain bone cement). What discharge teaching does the nurse provide to the patient and family?

Monitor the puncture site for infection. Nursing intervention: Applying ice pack to the insertion site

Which procedure does the nurse anticipate for the patient with suspected muscular dystrophy?

Muscle biopsy Muscle biopsy is done for the diagnosis of atrophy or inflammation (such as muscular dystrophy or polymyositis).

The x-ray report of a patient shows a fracture at the femur. The nurse anticipates that which type of traction will be prescribed to reduce muscle spasm and tissue damage?

Russell's traction

A patient is taking Calcitonin for osteoporosis. The patient should be monitored for? A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia

The answer is C. Calcitonin is made from salmon calcitonin and acts like the hormone calcitonin which is produced naturally by the thyroid gland. It decreases osteoclast activity, which can decrease calcium levels. Therefore, the patient is at risk HYPOcalcemia. (TONIN IT DOWN)

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

The answer is D. Tophi are white/yellowish nodules that are urate crystals. They start to form together in large masses and can be found under the skin (helix ears, elbows, fingers, toes etc.), joints, bursae, bones, which can lead to bone deformity and joint damage. Patients with chronic renal failure are at risk for chronic gout due to the kidney's inability to remove uric acid remove the body.

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. Chicken Livers D. Crackers E. Craft beer F. Bananas

The answers are A, C, and E. A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys), and alcohol (especially beer).

A 25-year-old patient sustains a fractured hip and experiences hypoxemia, dyspnea, and tachypnea. What complication due to fracture should the nurse suspect from these findings?

The patient may have fat embolism syndrome (FES).

The drop arm test is used to assess patients with suspected: cervical injury. rotator cuff injury. impingement syndrome. malingering.

rotator cuff injury Explanation: Rotator cuff injury is one of the most common causes of shoulder pain. The rotator cuff is composed of 4 muscles. The one most susceptible to injury is the supraspinatus. Consequently, this is the one most commonly torn. To assess whether the supraspinatus muscle is intact, the drop arm test is performed. The patient is asked to abduct his affected arm laterally to 90 degrees. He is then asked to slowly lower it to his side. A positive test is noted when the arm "drops". This usually indicates that the supraspinatus is injured.

The nurse is assessing a client's left leg for neurovascular changes following a total left knee replacement. Which of the following are expected normal findings? Select all that apply. 1. Reduced edema of the left knee. 2. Skin warm to touch. 3. Capillary refill response. 4. Moves toes. 5. Pain absent. 6. Pulse on left leg weaker than right leg.

1, 2, 3, 4. Postoperatively, the knee in a total knee replacement is dressed with a compression bandage and ice may be applied to control edema and bleeding. Recurrent assessment by the nurse for neurovascular changes can prevent loss of limb. Normal neurovascular findings include: color normal, extremity warm, capillary refill less than 3 seconds, moderate edema, tissue not palpably tense, pain controllable, normal sensations, no paresthesia, normal motor abilities, no paresis or paralysis, and pulses strong and equal.

A postmenopausal client is scheduled for a DEXA scan. To plan for the client's test, what should the nurse communicate to the client? 1. Request that the client remove all metal objects on the day of the scan. 2. Instruct the client to consume foods and beverages with a high content of calcium for 2 days before the test. 3. Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. Tell the client that she should report any significant pain to her physician at least 2 days before the test.

1. Metal will interfere with the test. Metallic objects within the examination field, such as jewelry, earrings, and dental amalgams, may inhibit organ visualization and can produce unclear images. Ingesting foods and beverages days before the test will not affect bone mineral status. Short-term calcium gluconate intake will also not influence bone mineral status. The client may already have had chronic pain as a result of a bone fracture or from osteoporosis.

A patient with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? 1 Check the dorsalis pedis pulses. 2 Immobilize the left leg with a splint. 3 Administer the prescribed analgesic.

1. Check the dorsalis pedis pulses. The first action should be to assess the circulatory status of the leg because the patient is at risk for acute compartment syndrome (ACS), which can begin as early as 6-8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised. Immobilization will be needed, but the nurse must assess the patient's condition first. Administering an analgesic and placing a dressing on the affected area should both be done after the nurse has assessed the patient.

What is the major concern related to pelvic injury? 1 Loss of blood volume 2 Avascular necrosis (AVN) 3 Risk for developing pneumonia 4 Risk for neurologic dysfunction

1. Loss of blood volume Pelvic injury most commonly results in venous oozing or arterial bleeding. Loss of blood volume due to pelvic injury leads to hypovolemic shock. AVN may cause death and necrosis of bone tissue, resulting in pain and decreased mobility. This problem is most likely seen in patients with displaced fractures of the femur. Chest trauma might increase the risk for developing pneumonia. Neurologic dysfunction can be seen when trabecular, or cancellous, bone within the vertebra becomes weakened and causes the vertebral body to collapse, resulting in compression fractures.

A football player is admitted to the emergency department with a sprained ankle. What emergency care is needed for the client with this type of injury? 1) Do not apply a splint below the injury. 2) Use elastic wrap for the first 24 to 48 hours. 3) Do not apply a splint above the injury. 4) Apply warm compresses for the first 24 hours.

2) Use elastic wrap for the first 24 to 48 hours. As part of emergency care for a client with sports-related injury, compression measures such as elastic wrap should be used for the first 24 to 48 hours. A splint may be applied above and below the injury to immobilize the joint. Ice is applied intermittently for the first 24 to 48 hours. Later, heat can be used.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? 1. At bedtime. 2. On arising. 3. Immediately after a meal. 4. On an empty stomach.

3. Drugs that cause gastric irritation, such as ibuprofen, are best taken after or with a meal, when stomach contents help minimize the local irritation. Taking the medication on an empty stomach at any time during the day will lead to gastric irritation. Taking the drug at bedtime with food may cause the client to gain weight, possibly aggravating the osteoarthritis. When the client arises, he is stiff from immobility and should use warmth and stretching until he gets food in his stomach.

Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? 1. Anemia. 2. Osteoporosis. 3. Weight loss. 4. Local joint pain.

4. Osteoarthritis is a degenerative joint disease with local manifestations such as local joint pain, unlike rheumatoid arthritis, which has systemic manifestation such as anemia and osteoporosis. Weight loss occurs in rheumatoid arthritis, whereas most clients with osteoarthritis are overweight.

A 70-year-old male patient who underwent open reduction internal fixation (ORIF) surgery experiences a seizure after 24 hours. Which drug can cause seizures related to its toxic metabolites? 1 Tramadol 2 Ketorolac 3 Morphine 4 Meperidine

4. Meperidine (Demerol) Meperidine should not be used for pain management. Its toxic metabolites cause seizures and other adverse drug events, especially among older adults. Tramadol, ketorolac, and morphine are all employed in the management of post-operative pain. These do not cause any adverse reactions if administered in safely tolerated amounts.

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.) a. Adherence to the antibiotic regimen b. Correct intramuscular injection technique c. Eating high-protein and high-carbohydrate foods d. Keeping daily follow-up appointments e. Proper use of the intravenous equipment

A, C, E The client going home with chronic osteomyelitis will need long-term antibiotic therapy—first intravenous, then oral. The client needs education on how to properly administer IV antibiotics, care for the IV line, adhere to the regimen, and eat a healthy diet to encourage wound healing. The antibiotics are not given by IM injection. The client does not need daily follow-up.

A student nurse learns about changes that occur to the musculoskeletal system due to aging. Which changes does this include? (Select all that apply.) a. Bone changes lead to potential safety risks. b. Increased bone density leads to stiffness. c. Osteoarthritis occurs due to cartilage degeneration. d. Osteoporosis is a universal occurrence. e. Some muscle tissue atrophy occurs with aging.

ANS: A, C, E Many age-related changes occur in the musculoskeletal system, including decreased bone density, degeneration of cartilage, and some degree of muscle tissue atrophy. Osteoporosis, while common, is not universal. Bone density decreases with age, not increases.

A client is undergoing computed tomography (CT) of a joint. What action by the nurse is most important before the test? a. Administer sedation as prescribed. b. Assess for seafood or iodine allergy. c. Ensure that the client has no metal on the body. d. Provide preprocedure pain medication.

ANS: B Because CT uses iodine-based contrast material, the nurse assesses the client for allergies to iodine or seafood (which often contains iodine). The other actions are not needed.

The nurse is caring for a client with a fractured fibula. Which assessment prompts immediate action by the nurse? a. Reported pain of 4 on a scale of 0 to 10 b. Numbness and tingling in the extremity c. Swollen extremity where the injury occurred d. Reports of being cold in bed

ANS: B The client with numbness and tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the temperature of the room.

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia

ANS: C The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene.

The nurse sees several clients with osteoporosis. For which client would Fosamax not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up

ANS: D Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.

Prednisone 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.

Answer: D Rationale: ****C-reactive protein is a marker for inflammation****, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored for patients receiving steroids.

The nurse prepares to perform a neurovascular assessment on a patient with closed multiple fractures of the right humerus. Which technique does the nurse use?

Assess sensation of the right upper extremity. Assessing sensation of the right upper extremity is part of a focused neurovascular assessment for the patient with multiple fractures of the right humerus. Inspecting the abdomen and auscultating lung sounds of the patient with multiple fractures are not part of a focused neurovascular assessment. Because the patient does not have a head injury, assessing the patient's level of consciousness and ability to follow commands is not part of a focused neurovascular assessment.

A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.) a. Cut down on tobacco product use. b. Limit alcohol to two drinks a day. c. Strengthening exercises are important. d. Take recommended calcium and vitamin D. e. Walk 30 minutes at least 3 times a week.

C, D, E Lifestyle changes can be made to decrease the occurrence of osteoporosis and include strengthening and weight-bearing exercises and getting the recommended amounts of both calcium and vitamin D. Tobacco should be totally avoided. Women should not have more than one drink per day.

The nurse studying osteoporosis learns that which drugs can cause this disorder? REMEMBER SECONDARY OSTEOPOROSIS CAN BE CAUSED BY MEDICATIONS (Select all that apply.) a. Antianxiety agents b. Antibiotics c. Barbiturates d. Corticosteroids e. Loop diuretics

C, D, E Several classes of drugs can cause secondary osteoporosis, including barbiturates, corticosteroids, and loop diuretics. Antianxiety agents and antibiotics are not associated with the formation of osteoporosis.

Which does a closed reduction involve?

Closed reduction involves applying a manual pull or traction to move the ends of a fractured bone to realign them. This is the most common nonsurgical method for managing a simple fracture.

Radiographic assessment of a patient with femoral fracture reveals spotty and diffuse osteoporosis. The patient gives a history of excessive sweating, intense burning pain, and edema. Which side effect of fractures does the nurse suspect?

Complex regional pain syndrome (CRPS) CRPS is actually a dysfunction of the central and peripheral nervous systems that leads to severe, chronic pain. Spotty and diffuse osteoporosis can be seen on x-ray examination, which is characteristic of CRPS. The symptoms may include intense burning pain, muscle spasms, and raised temperature. **the priority intervention in CRPS management is pain relief so that the patient can resume normal activities** CRPS might necessitate the use of an implanted device to block pain perception.

The nurse is changing a patient's stump dressing. How would the nurse document this dressing technique? 1. Figure-of-eight bandage 2. Binder wrapping 3. Splinting 4. Bivalving

Correct Answer: 1 Rationale: Compression wrapping of the extremity helps to prevent edema. Figure-of-eight bandaging starts at the distal stump (after the bandage is anchored around the waist) and is wrapped back toward the waist.

The nurse is planning care for a patient who had an above-the-knee amputation 2 days ago. Which position should the nurse include in this patient's plan of care? 1. Sims' position as tolerated 2. Flat in bed 3. High Fowler's position with the stump elevated

Correct Answer: 2 Rationale 1: Sims' position is side-lying and would likely be uncomfortable for the patient. Rationale 2: Lying flat in bed keeps the hip extended, which helps to prevent contracture. Rationale 3: After 24 hours, the stump should not be elevated.

The nurse is discussing the symptomology of osteoarthritis (OA) with a patient. The nurse would describe which common initial symptom of the disease? 1. A fine red rash on the elbow that is constant 2. Painful stiffness in the joints of the fingers 3. Popping sensation in the wrist joint when typing 4. Knee pain when the leg is at rest

Correct Answer: 2 Rationale The onset of osteoarthritis (OA) is gradual and progressive. The symptoms that are noticed first are pain and stiffness in the affected joint or joints.

A patient is receiving a series of diagnostic tests to confirm the diagnosis of osteoarthritis (OA). The nurse would interpret which results as supporting the diagnosis of OA? Select all that apply. 1. Presence of antinuclear antibodies in blood 2. Asymmetrical joint cartilage loss seen on X-ray 3. Increased erythrocyte sedimentation rate (ESR) in blood 4. Bone spurs visible on computed tomography (CT) 5. Increased bone density in Dexa scan

Correct Answer: 2,3,4,5 Rationale 1: The presence of antinuclear antibodies in blood is reflective of RA, not OA. Rationale 2: Asymmetrical joint cartilage loss is a positive diagnostic result for OA. Rationale 3: Increased ESR is a positive diagnostic result for OA. Rationale 4: Bone spurs are a positive diagnostic result for OA. Rationale 5: Increased bone density is a positive diagnostic result for OA.

The nurse is preparing a flyer on rheumatoid arthritis (RA) for distribution during a community health fair. Which information should the nurse include? Select all that apply. 1. Rheumatoid arthritis typically affects weight-bearing joints. 2. Onset generally occurs between 30 and 40 years of age. 3. Rheumatoid arthritis is the most common form of arthritis. 4. Women are more likely to be affected than men. 5. Rheumatoid arthritis appears to have a genetic component.

Correct Answer: 2,4,5 Rationale 1: RA most often affects the joints of the hands and feet. Osteoarthritis affects weight-bearing joints. Rationale 2: RA can occur at any age, with the peak incidence between ages 30 and 40. Rationale 3: Osteoarthritis (OA) is the most common form of arthritis. Rationale 4: RA affects three times more women than men worldwide. Rationale 5: RA is thought to be an autoimmune disorder that not only involves tissue hypersensitivity but also has a genetic component.

The nurse is instructing a patient on foods high in calcium. The nurse knows the teaching was effective when the patient chooses which foods for a meal? Select all that apply. 1. Chicken 2. Kale 3. Bananas 4. Salmon 5. Low-fat milk

Kale, Salmon and Milk are foods high in calcium, Chicken is high in protein Bananas are high in potassium

A diabetic patient is admitted to the health care facility with a foot ulcer. The nurse teaches wound care to the patient and the caregiver to prevent the risk for which condition?

Osteomyelitis The diabetic patient with a foot ulcer is at high risk for osteomyelitis or bone infection. Diabetes also slows down the healing process. As a person ages, the cartilages at the synovial joints lose their elasticity and become compressible which leads to osteoarthritis. Joint dislocations and joint traumas also lead to osteoarthritis. Osteoporosis may occur due to age-related bone loss, or decreased intake of calcium and vitamin D. Osteomalacia or softening of the bone is caused by the deficiency of vitamin D in the body.

What is the medical term for the bone disease caused by reduced blood flow to the bones in the joints?

Osteonecrosis

According to the World Health Organization, a patient with a bone mineral density T-score of less than -2.5 should be reported as having

Osteoporosis

A patient is admitted to the same day surgery unit following a meniscectomy. What does post operative care for this patient include?

Perform neurovascular checks every hour for the first few hours and then every 4 hours. Check the surgical dressing for bleeding. Teach about signs and symptoms of infection.

Which of the following should the nurse provide when explaining therapeutic measures to a client prescribed methotrexate (Rheumatrix) for rheumatoid arthritis (RA)? Fluids are restricted to prevent formation of edema in the joints. Drug doses will be adjusted for optimum effect at the lowest dose once relief has been established. Six months of therapy will be adequate to stop disease progression. Relief of symptoms will be assessed within 1 week of starting medication. Drug doses will be adjusted for optimum effect at the lowest dose once relief has been established.

Rationale: Methotrexate takes several weeks to effect relief. Once relief is obtained, the dose is adjusted to achieve maximum response at the lowest dose. If the drug is discontinued, the symptoms will reappear. Fluids are not restricted.

A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication: A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes. B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes. C. with food but to avoid giving this medication with dairy products. D. on an empty stomach with a full glass of juice or milk.

The answer is A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)

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."

The answer is A. Allopurinol is used to PREVENT gout attacks....not treat an acute attack. NSAIDs and Colchicine are best for treating the inflammation and pain during a gout attack. Allopurinol can cause vision changes, therefore the patient should receive annual eye exams along with avoiding large doses of vitamin C due to the risk of renal calculi formation.

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.

The answer is B. Most patients tend to have an acute attack of gout that begins in the big toe. Remember that patients who have a history of gout or who are experiencing a hospitalization (due to the physical stress on the body) are at risk for an acute gout attack. Therefore, the nurse should assess the patient for this during the head-to-toe assessment

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

The answer is D. Options A, B, and C increase uric acid. Option D does not.

Which patient below is NOT at risk for osteoporosis? A. A 50 year old female whose last menstrual period was 7 years ago. B. A 45 year old male patient who has been taking glucocorticoids for the last 6 months. C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28. D. A 35 year old female who has a history of seizures and takes Dilantin regularly.

The answer is: C. All these patients are at risk for osteoporosis except the patient in option C. Remember the risk factors include: older age (45+), being a woman, Caucasian or Asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), REGULAR alcohol usage, smoking, sedentary lifestyle, BMI <19, family history. Option C is not at risk.

A nurse is performing an admission health history and physical assessment for a client who has severe rheumatoid arthritis. When assessing the client's hands, the nurse identifies that they are similar to the hand in the illustration. What should the nurse document in the medical record when describing this typical physiologic change associated with rheumatoid arthritis?

Ulnar drift

The nurse is teaching a client newly diagnosed with osteoporosis about dietary and lifestyle interventions to decrease risk factors for osteoporosis. Which is the best way to decrease the risk for osteoporosis? A. Increase nutritional intake of calcium. B. Engage in high-impact exercise, such as running. C. Increase nutritional intake of phosphorus. D. Walk for 30 minutes three times a week.

Walk for 30 minutes three times a week. Walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. Walking is a safe way to promote weight-bearing and muscle strength.

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis? A. Consuming 12 ounces of carbonated beverages daily B. Working at a desk and playing the piano for a hobby C. Having a hysterectomy and taking estrogen replacement therapy D. Consuming one alcoholic drink per week

Working at a desk and playing the piano for a hobby