Registered Nurse RN & Lippincott Musculoskeletal Test Bank, Musculoskeletal Health Problems ALL COMBINED

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 3. "The procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 5. "You will need to wear a compression bandage for several days after the procedure." An arthrocentesis is performed to aspirate excess synovial fluid, pus, or blood from a joint cavity to relieve pain or to diagnosis inflammatory diseases such as rheumatoid arthritis. A local agent may be used to decrease the pain of the needle insertion through the skin and into the joint cavity. Aspiration of the fluid into the syringe can be very painful because of the size and inflammation of the joint. Usually a steroid medication is injected locally to alleviate the inflammation; a compression bandage is applied to help decrease swelling; and the client is asked to rest the joint for up to 24 hours afterwards to help relieve the pain and promote rest to the inflamed joint. The client may experience pain during this time until the inflammation begins to resolve and swelling decreases.

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream? 1. "I always wash my hands right after I apply the cream." 2. "After I apply the cream, I wrap my knee with an elastic bandage." 3. "I keep the cream in the cabinet above the stove in the kitchen." 4. "I also use the same cream when I get a cut or a burn."

1. "I always wash my hands right after I apply the cream." Capsaicin cream, which produces analgesia by preventing the reaccumulation of substance P in the peripheral sensory neurons, is made from the active ingredients of hot peppers. Therefore, clients should wash their hands immediately after applying capsaicin cream if they do not wear gloves, to avoid possible contact between the cream and mucous membranes. Clients are instructed to avoid wearing tight bandages over areas where capsaicin cream has been applied because swelling may occur from inflammation of the arthritis in the joint and lead to constriction on the peripheral neurovascular system. Capsaicin cream should be stored in areas between 59 ° F and 86 ° F (15 ° C and 30 ° C). The cabinet over the stove in the kitchen would be too warm. Capsaicin cream should not come in contact with irritated and broken skin, mucous membranes, or eyes. Therefore it should not be used on cuts or burns.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. "I will take my vitamins while I'm on this drug." Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. Methotrexate is considered teratogenic.

2. A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which nursing diagnosis would be most appropriate? 1. Activity intolerance related to fatigue and pain. 2. Self-care deficit related to increasing joint pain. 3. Ineffective coping related to chronic pain. 4. Disturbed body image related to fatigue and joint pain.

1. Activity intolerance related to fatigue and pain. Based on the client's complaints, the most appropriate nursing diagnosis would be Activity intolerance related to fatigue and pain. Nursing interventions would focus on helping the client conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit related to the activity intolerance and increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may develop ineffective coping or body image disturbance as the disorder becomes chronic with increasing pain and fatigue.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 4. Adults who possess the genetic link, specifically HLA-DR4. Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy? 1. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions. 2. Contact the physician to determine if an alternative examination could be scheduled. 3. Provide a dose of acetaminophen (Tylenol). 4. Cancel the examination because of the hard X-ray table.

1. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions. Shorter sessions will allow the client to rest between the sessions. Changing the physician's order to a different examination will not provide the information needed for this client's treatment. Acetaminophen is a nonopioid analgesic and an antipyretic, not an anti-inflammatory agent. Thus, it would not help this client avoid the adverse effects of a lengthy X-ray examination. Although the X-ray table is hard, there are other options for making the client comfortable, rather than canceling the examination.

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which of the following activities should the nurse instruct the client to avoid? 1. Crossing the legs while sitting down. 2. Sitting on a raised commode seat. 3. Using an abductor splint while lying on the side. 4. Rising straight from a chair to a standing position.

1. Crossing the legs while sitting down. Any activity or position that causes flexion, adduction, or internal rotation of greater than 90 degrees should be avoided until the soft tissue surrounding the prosthesis has stabilized, at approximately 6 weeks. Crossing the legs while sitting down can lead to dislocation of the femoral head from the hip socket. Sitting on a raised commode seat prevents hip flexion and adduction. Using an abductor splint while side-lying keeps the hip joint in abduction, thus preventing adduction and possible dislocation. Rising straight from a chair to a standing position is acceptable for this client because this action avoids hip flexion, adduction, and internal rotation of greater than 90 degrees.

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure. 2. Administer preoperative medication 1 hour before surgery. 3. Instruct the client to immobilize the knee for 2 days after the surgery. 4. Assess the site for bleeding. 5. Offer pain medication.

1. Explain the procedure. 4. Assess the site for bleeding. 5. Offer pain medication. To prepare a client for an arthrocentesis, the nurse should tell the client that a local anesthetic administered by the physician will decrease discomfort. There may be bleeding after the procedure, so the nurse should check the dressing. The client may experience pain. The nurse should offer pain medication and evaluate outcomes for pain relief. Because a local anesthetic is used, the client will not require preoperative medication. The client will rest the knee for 24 hours and then should begin range-of-motion and muscle strengthening exercises.

A postmenopausal client is scheduled for a bone-density 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. Request that the client remove all metal objects on the day of the scan. 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.

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching? 1. "Performing range-of-motion exercises will increase my joint mobility." 2. "Exercise helps to drive synovial fluid through the cartilage." 3. "Joint swelling should determine when to stop exercising." 4. "Exercising in the outdoors year-round promotes joint relaxation."

2. "Exercise helps to drive synovial fluid through the cartilage." Weight-bearing exercise plays a very important role in stimulating regeneration of cartilage, which lacks blood vessels, by driving synovial fluid through the joint cartilage. Joint mobility is increased by weight-bearing exercises, not range-of-motion exercises, because surrounding muscles, ligaments, and tendons are strengthened. Pain is an early sign of degenerative joint bone problems. Swelling may not occur for some time after pain, if at all. Osteoarthritic pain is worsened in cold, damp weather; therefore, exercising outdoors is not recommended year round in all settings.

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Possible retinal degeneration. Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

A client with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube at the incision site. Her husband asks, "Why does she have this tube inserted in her hip?" Which of the following responses would be best? 1. "The tube helps us to detect a wound infection early on." 2. "This way we won't have to irrigate the wound." 3. "Fluid won't be allowed to accumulate at the site." 4. "We have a way to administer antibiotics into the wound."

3. "Fluid won't be allowed to accumulate at the site." The primary purpose of the drainage tube is to prevent fluid accumulation in the wound. Fluid, when it accumulates, creates dead space. Elimination of the dead space by keeping the wound free of fluid greatly enhances wound healing and helps prevent abscess formation. Although the characteristics of the drainage from the tube, such as a change in color or appearance, may suggest a possible infection, this is not the tube's primary purpose. The drainage tube does not eliminate the need for wound irrigation or provide a way to instill antibiotics into the wound.

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit? 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to 15 minutes per application is the maximum time for cold applications."

3. "Heat-producing liniments can be used with other heat devices." Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend? 1. A desk-type swivel chair. 2. A padded upholstered chair. 3. A high-backed chair with armrests. 4. A recliner with an attached footrest.

3. A high-backed chair with armrests. A high-backed straight chair with armrests is recommended to help keep the client in the best possible alignment after surgery for a femoral head prosthesis placement. Use of this type of chair helps to prevent dislocation of the prosthesis from the socket. A desk-type swivel chair, padded upholstered chair, or recliner should be avoided because it does not provide for good body alignment and can cause the overly flexed femoral head to dislocate.

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. Immediately after a meal. 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.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.

A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect:. 1. Internal rotation. 2. Muscle flaccidity. 3. Shortening of the affected leg. 4. Absence of pain in the fracture area.

3. Shortening of the affected leg. With an intracapsular hip fracture, the affected leg is shorter than the unaffected leg because of the muscle spasms and external rotation. The client also experiences severe pain in the region of the fracture.

The nurse is caring for an older adult male who had open reduction internal fixation (ORIF) of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab results. The nurse should report which of the following lab results to the physician? 1. Hematocrit (Hct): 40% (0.4). 2. Serum glucose: 120 mg/dL (6.7 mmol/L). 3. Troponin: 1.4 mcg/L (1.4 μg/L). 4. Erythrocyte sedimentation rate (ESR): 22 mm/h.

3. Troponin: 1.4 mcg/L (1.4 μg/L). Troponin is a cardiac biomarker and is normally almost undetectable in the blood. A level of 1.4 means there has likely been some damage to the heart muscle. Though serum glucose (normal 60 to 100 mg/dL [3.3 to 5.5 mmol/L]) and ESR (normal is less than 20 for males greater than 50 years old) are slightly elevated, this could be explained by normal stress and inflammatory response to surgery. The hematocrit is low (normal 40 to 45 [0.4 to 0.5] for men) but also not unexpected for a client following surgery.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate? 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. "Every person is different. What works for one client may not always be effective for another." The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. "Take a warm tub bath or shower before exercising. This may help with your discomfort." Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching? 1. Pushing with palms when rising from a chair. 2. Holding packages close to the body. 3. Sliding objects. 4. Carrying a laundry basket with clinched fingers and fists.

4. Carrying a laundry basket with clinched fingers and fists. Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

When teaching a client with an extracapsular hip fracture scheduled for surgical internal fixation with the insertion of a pin, the nurse bases the teaching on the understanding that this surgical repair is the treatment of choice. Which of the following explains the reason? 1. Hemorrhage at the fracture site is prevented. 2. Neurovascular impairment risk is decreased. 3. The risk of infection at the site is lessened. 4. The client is able to be mobilized sooner.

4. The client is able to be mobilized sooner. Insertion of a pin for the internal fixation of an extracapsular fractured hip provides good fixation of the fracture. The fracture site is stabilized and fractured bone ends are well approximated. As a result, the client is able to be mobilized sooner, thus reducing the risks of complications related to immobility. Internal fixation with a pin insertion does not prevent hemorrhage or decrease the risk of neurovascular impairment, potential complications associated with any joint or bone surgery. It does not lessen the client's risk of infection at the site.

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 tend 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. "Gout attacks tend to awake the person out of their sleep in the middle of the night." This is the only correct statement about gout. Option B is wrong because the pain felt with gout tends to intensify within 4-24 hours (not 30 minutes). Option C is wrong because any type of pressure (even the pressure of bed linens) can majorly increase the pain felt with gout. Option D is wrong because gout attacks come on suddenly and may only occur once and tend to have several months or a year between attacks.

A patient with severe rheumatoid arthritis is scheduled for a procedure called an arthrodesis. The nursing student you are precepting asks what type of procedure this is. Your response is: A. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together." B. "It is a procedure that involves replacing the joint with an artificial one." C. "It is a procedure where the surgeon goes in with a scope and cleans out the affected joint." D. "It is a procedure where the synovium is completely removed within the joint, which helps decrease inflammation of the joint.

A. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together." An arthrodesis (also called joint fusion) is where the affected joint is removed and the bones within it are fused together. Option B describes a joint replacement. Option C is known as a surgical cleaning. Option D is known as a synovectomy.

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. "This medication will help relieve the inflammation and pain during an acute attack." 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 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure? A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.

Which patients below are at risk for developing osteoarthritis? Select-all-that-apply: A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

A. A 65 year old male with a BMI of 35. C. A 55 year old male with a history of repeated right knee injuries. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.

Your patient is scheduled for a DEXA scan this morning. The patient is having heartburn and requests a PRN medication to help with relief. Which medications can the patient NOT have at this time? A. Calcium Carbonate B. Bismuth Salicylate C. Milk of Magnesia d. Famotidine

A. Calcium Carbonate Before a DEXA scan, which is a bone density test, the patient should not take any type of calcium supplements (calcium carbonate (TUMs) or vitamins containing calcium.

You're caring for a patient who has experienced a fracture to the right arm that is represented in Figure 3. What nursing intervention will you take with this type of fracture? A. Cover the fracture with a sterile dressing B. Place the arm below the heart level. C. Attempt bone reduction by manually readjusting the bone. D. Place a tight compression bandage over the fracture.

A. Cover the fracture with a sterile dressing Figure 3 represents a compound fracture (also called an open fracture). Due to the nature of this fracture, the patient is at major risk for infection because the skin is no longer intact. Therefore, the nurse should cover the fracture site with a sterile dressing. NEVER attempt a bone reduction. In addition, avoid a tight compression bandage due to the development of ischemia. Instead, you would want to immobilize the extremities and splint it.

During an outpatient visit you are assessing the patient's understanding about the signs and symptoms associated with osteoporosis. Select all of the signs and symptoms stated by the patient that are correct: A. Dowager's Hump B. Loss of 0.5 inches in height compared to young adult height C. Swelling and warmth at the bone site D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine

A. Dowager's Hump D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine Option B is wrong because there is normally a loss of 2-3 inches in height compared to the patient's height in young adulthood. Option C is wrong because the bone site will not present as warm or swollen (most patients are asymptomatic).

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.

A. Encourage fluid intake of 2-3 liter per day. C. Place patient's right foot in a foot board while patient is in bed. E. Apply alternating cold and warm compresses to right foot as tolerated by the patient daily. These options are correct nursing intervention for this patient. Option B is wrong because the patient should consume food LOW in purines (remember purines increase uric acid levels). Option D is wrong because patient should AVOID aspirin. Aspirin (even low doses) increase uric acid levels.

Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care? A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. B. Positioning the cast at heart level with pillows. C. Checking the color and temperature of the right foot. D. Using a hair dryer on the cool setting to help with drying.

A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop.

You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition: A. Herberden's Node B. Morning stiffness for less than 30 minutes C. Soft, tender, warm joints D. Fever E. Anemia F. Hard and bony joints G. Crepitus H. Bouchard's Node

A. Herberden's Node B. Morning stiffness for less than 30 minutes F. Hard and bony joints G. Crepitus H. Bouchard's Node These are common findings found in osteoarthritis. Options C, D, and E are found in rheumatoid arthritis.

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. Hydroxychloroquine (Plaquenil) This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply: A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

A. Morning stiffness greater than 30 minutes C. Fever and Anemia D. Symmetrical joint involvement These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.

________________ is a form of arthritis that is an autoimmune condition that causes inflammation within the joints, specifically the synovium. A. Rheumatoid arthritis B. Osteoarthritis

A. Rheumatoid arthritis Rheumatoid arthritis is an autoimmune condition that causes inflammation of the synovium. Osteoarthritis is a type of arthritis that causes deterioration of the articular hyaline cartilage of the bone.

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

A. Rheumatoid factor C. Erythrocyte sedimentation E. X-ray imaging These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis.

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

A. Sardines C. Sweetbreads E. Craft beer A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer).

Your patient attempts to sit down in the bedside chair after ambulating in the hallway with crutches. What finding requires you to re-educate the patient on how to sit down in the chair correctly while using crutches? A. The patient places both crutches on the non-injured side before sitting down in the chair. B. The patient backs up to the chair's seat until he feels it with his non-injured leg and stops. C. The patient keeps the injured leg extended out in front of him while sitting down. D. The patient holds both crutches on one side and reaches for the hand grips on the crutches and places weight on them while sitting down.

A. The patient places both crutches on the non-injured side before sitting down in the chair. This requires re-education because the patient should place both crutches on the INJURED SIDE (NOT the non-injured side) before sitting down in the chair. The crutches will help provide weight support to the injured side while sitting down.

Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH (parathyroid hormone) it causes: A. the body to increase the calcium levels by stimulating the osteoclast activity B. the body to decrease the calcium levels by inhibiting osteoclast activity C. the body to increase the calcium levels by stimulating osteoblast activity D. the body to decrease the calcium levels by inhibiting osteoblast activity.

A. the body to increase the calcium levels by stimulating the osteoclast activity When the calcium levels are low this stimulates the parathyroid gland to secrete PTH, which stimulates osteoCLAST activity. Remember osteoCLASTS break down the bone matrix within the spongy bone. This will cause calcium to enter the blood stream, hence increasing calcium levels.

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?"

B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

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. "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." During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health.

Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately? A. "It is really itchy inside my cast!" B. "My pain is so severe that it hurts to stretch or elevate my arm." C. "I can feel my fingers and move them." D. "I've been using ice packs to reduce swelling."

B. "My pain is so severe that it hurts to stretch or elevate my arm." This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia (remember fascia doesn't expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P's. (pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia)

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. A 45 year old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin. Gout is due to high levels of uric acid in the blood. This can either be due to the kidney's inability to excrete uric acid out of the body or the body is producing too much uric acid. Some causes that can lead to increased uric acid levels include: being overweight (BMI >25 is considered overweight), usage of aspirin or diuretics (thiazides (hydrochlorothiazide) or loop), HIGH consumption of purines, dehydration, renal problems. Option B is the only patient MOST at risk for developing gout.

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

B. Assist the patient with a warm shower or bath D. Assist the patient with applying wrist splints During flare-ups of RA the joint should be rested (not exercised) and should not be deep massaged because this can further damage the joint (in addition cause the patient more pain). Heat therapy, like a warm shower or bath, will help alleviate the stiffness. Furthermore, cold therapy can be used to reduce the inflammation along with splinting the affected joints to protect and rest them.

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. Big toe 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.

Figure 3 represents what type of bone fracture: This a fractured bone that breaks through the skin. A. Closed Fracture B. Compound Fracture C. Greenstick Fracture D. Transverse Fracture

B. Compound Fracture

A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture? A. Spiral B. Greenstick C. Oblique D. Transverse

B. Greenstick This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult.

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

B. Heberden's Nodes Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

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. Hemoglobin 7 g/dL Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient's signs and symptoms above are classic findings in anemia.

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)

B. Hydroxychloroquine (Plaquenil) E. Leflunomide (Arava) F. Methotrexate (Trexall) These are DMARDs that can be prescribed for RA. Option A is a corticosteroid. Option C and D are sometimes prescribed in osteoporosis.

A 85 year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg's shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do FIRST after confirming the patient is safe and stable? A. Apply an ice pack covered with a towel to the site. B. Immobilize the fracture with a splint. C. Administer pain medication. D. Elevate the extremity above heart level.

B. Immobilize the fracture with a splint. After confirming the patient is safe and stable, the nurse would immobilize the fracture with a splinting device. This will prevent the accidental movement of the extremity by the patient. Immobilization is important because it prevents further pain or bleeding along with more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized but moved after it has been fractured this can affect the healing process.

Select all the risk factors for developing osteoarthritis: A. Malnutrition B. Obesity C. Manual labor jobs D. Premature birth E. Older age F. Diabetes

B. Obesity C. Manual labor jobs E. Older age These are risk factors for developing OA. In addition, repeated joint injuries and genetics can play a role in developing OA.

Your patient has arthritis that affects the weight-bearing joints such as the hands, knees, hips, and spine. This type of arthritis is most likely: A. Rheumatoid arthritis B. Osteoarthritis

B. Osteoarthritis Osteoarthritis is a form of arthritis that causes deterioration of the articular hyaline cartilage of the bones. It affects the weight-bearing joints. This can include the hands, knees, hips, and spine because these joints experience a lot of stress.

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

B. Osteophytes C. Sclerosis of the bone The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

Select all the signs and symptoms that will present in compartment syndrome? A. Capillary refill less than 2 seconds B. Pallor C. Pain relief with medication D. Feeling of tingling in the extremity E. Affected extremity feels cooler to the touch than the unaffected extremity

B. Pallor D. Feeling of tingling in the extremity E. Affected extremity feels cooler to the touch than the unaffected extremity These symptoms may present with compartment syndrome. Option A and C are normal findings. Remember in compartment syndrome nerve and blood vessel function is being compromised, so expect signs and symptoms that occur when these structures are affected.

____________ affects the joints in a symmetrical fashion. A. Osteoarthritis B. Rheumatoid arthritis

B. Rheumatoid arthritis RA affects the joints in a symmetrical fashion. It is UNsymmetrical in OA. RA most commonly affects the fingers and wrist but can also affect the neck, shoulders, elbows, ankles, knee, and feet.

Which statement is FALSE concerning rheumatoid arthritis? A. Rheumatoid arthritis most commonly affects the fingers and wrist. B. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. C. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). D. Ankylosis can occur in severe cases of rheumatoid arthritis.

B. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. This statement is false. It should say that, "Rheumatoid arthritis is different from osteoarthritis in that it DOES (not doesn't) affect other systems of the body. RA is systemic, while OA only affects the joints. This is why a fever and anemia can present in RA.

A patient needs to go up the stairs while using crutches. What finding by the nurse demonstrates the patient understands how to ambulate upstairs with crutches? A. The patient moves the crutches forward up the step, then the injured and non-injured leg. B. The patient moves the non-injured leg forward onto the step and then the moves the injured leg and crutches up. C. The patient moves the injured leg forward onto the steps, then moves the crutches, and then moves the non-injured leg. D. The patient moves the crutches and non-injured leg forward to the step together, and then the non-injured leg.

B. The patient moves the non-injured leg forward onto the step and then the moves the injured leg and crutches up. The patient will move the non-injured leg forward onto the step and then will move the injured leg and crutches up.

While your patient is ambulating with crutches he moves both crutches forward along with the injured leg and then moves the non-injured forward. When you document you will note that the patient used what type of gait while ambulating with crutches? A. Two-point gait B. Three-point gait C. Four-point gait D. Swing-to-gait

B. Three-point gait This describes the three-point gait while using crutches.

A patient is newly diagnosed with osteoarthritis. Which medication below is NOT ordered to treat this condition? A. NSAIDs B. Intra-articular corticosteroids C. DMARDs D. Glucosamine

C. DMARDs DMARDs (disease-modifying antirheumatic drugs) are ordered in rheumatoid arthritis NOT osteoarthritis. These drugs suppress the immune system from attacking the joint along with helping slow down the destruction of the disease on the joints and bones. All the other options are drugs that can be prescribed in OA.

A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication? A. Compartment Syndrome B. Osteomyelitis C. Fat embolism D. Hypovolemia

C. Fat embolism Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status.

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

C. Hypocalcemia 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.

Figure 1 represents what type of bone fracture: This is a fracture that is slanted across the bone shaft. A. Transverse Fracture B. Spiral Fracture C. Oblique Fracture D. Compound Fracture

C. Oblique Fracture

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C. Oral corticosteroids Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

Bones play an important role in the body. Which of the following in NOT a function performed by the bones? A. Provide protection and support for the organs. B. Give the body shape. C. Secrete the hormone calcitonin and store blood cells. D. Store calcium and phosphorus.

C. Secrete the hormone calcitonin and store blood cells. Bones (specifically bone marrow) are responsible for red blood cell, platelet, and white blood cell production. In addition, it stores blood cells and minerals, such as calcium and phosphorous. Calcitonin is secreted by the thyroid gland NOT the bones. However, calcitonin causes osteoclast activity to be inhibited, but is not secreted by the bone.

While using crutches the patient moves both crutches forward and then moves both legs forward past the placement of the crutches. This is known as the: A. Two-point gait B. Swing-to-gait C. Swing-through-gait D. Three-point gait

C. Swing-through-gait This description is known as the swing-through-gait. The key word to let you know it is the swing-through-gait is that the patient moves both legs PAST the placement of the crutches. It would have been the swing-to-gait if both legs moved forward to the same point as the crutch placement.

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. Synovitis, development of pannus, anklyosis he body attacks (specifically the WBCs) the synovium of the joint. The synovium becomes inflamed and this process is called synovitis. The inflammation of the synovium leads to thickening and the formation of a pannus, which is a layer of vascular fibrous tissue. The pannus will grow so large it will damage the bone and cartilage within the joint. The space in between the joints will disappear and anklyosis will develop, which is the fusion of the bone.

During a head-to-toe assessment of a patient with arthritis, you note bony outgrowths on the proximal interphalangeal joint. These outgrowths are known as __________ and occur in ______________. A. Heberden's Node, osteoarthritis B. Bouchard's Node, rheumatoid arthritis C. Heberden's Node, rheumatoid arthritis D. Bouchard's Node, osteoarthritis

D. Bouchard's Node, osteoarthritis Bouchard's Node are bony outgrowths on the proximal interphalangeal joint (middle joint of the finger and occur in osteoarthritis). Heberden's Node occur on the distal interphalangeal joint (finger joint closet to the fingernail).

You're demonstrating how to ambulate while using crutches to a group of pre-op patients, who will need to use crutches after surgery. You ask one of the group participants to demonstrate the four-point gait using the crutches. Which demonstration by the participant demonstrates they understood the demonstration you provided earlier? A. The participant moves both crutches forward and then moves both legs past the placement of the crutches. B. The participant moves both crutches and injured leg forward together, and then moves the non-injured leg forward. C. The participant moves both the right crutch and left foot forward together, and then moves the left crutch and right foot forward together. D. The participant moves the right crutch, then moves the left foot, then moves the left crutch, and then moves the right foot.

D. The participant moves the right crutch, then moves the left foot, then moves the left crutch, and then moves the right foot. The four-point gait is where the person moves the right crutch, then moves the left foot, then moves the left crutch, and then moves the right foot.

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. Tylenol Option A-C increase uric acid. Option D does not.

True or False: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the compact bone.

FALSE Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the SPONGY (not compact) bone. The compact bone is the outside part of the bone, and the spongy bone is found inside the compact bone. It contains a matrix of pore-like components such as protein and minerals...this starts to thin and becomes more porous in osteoporosis.

True or False: Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion.

False Osteoarthritis is the most common type of arthritis that develops due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone. This can lead to bone break down and osteophytes formation (bone spurs).

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

False Yes, RA tends to affect women more than men BUT it can affect all ages...most commonly 20-60 years old.

The nurse is assessing the home environment of an elderly client who is using crutches during the postoperative recovery phase after hip pinning. Which of the following would pose the greatest hazard to the client as a risk for falling at home? 1. A 4-year-old cocker spaniel. 2. Scatter rugs. 3. Snack tables. 4. Rocking chairs.

2. Scatter rugs. Although pets and furniture, such as snack tables and rocking chairs, may pose a problem, scatter rugs are the single greatest hazard in the home, especially for elderly people who are unsure and unsteady with walking. Falls have been found to account for almost half the accidental deaths that occur in the home. The risk of falls is further compounded by the client's need for crutches.

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheumatoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation? 1. Intra-articular corticosteroid injections are used to treat osteoarthritis. 2. Oral corticosteroids can be used in osteoarthritis. 3. A systemic effect is needed in osteoarthritis. 4. Rheumatoid arthritis and osteoarthritis are two similar diseases.

1. Intra-articular corticosteroid injections are used to treat osteoarthritis. Corticosteroids are used for clients with osteoarthritis to obtain a local effect. Therefore, they are given only via intra-articular injection. Oral corticosteroids are avoided because they can cause an acceleration of osteoarthritis. Rheumatoid arthritis and osteoarthritis are two different diseases.

A client with osteoporosis needs education about diet and ways to increase bone density. Which of the following should be included in the teaching plan? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. 4. Try swimming as a good exercise to maintain bone mass. 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. A diet with adequate amounts of vitamin D aids in the regulation, absorption, and subsequent utilization of calcium and phosphorus, which are necessary for the normal calcification of bone. Figs, broccoli, and almonds are very good sources of calcium. Moderate intake of alcohol has no known negative effects on bone density but excessive alcohol intake does reduce bone density. Swimming, biking, and other non- weight-bearing exercises do not maintain bone mass. Walking and running, which are weight-bearing exercises, do maintain bone mass. The client should eat a balanced diet but does not need to avoid the use of high-fat foods.

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. Early morning stiffness. 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.

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. Local joint pain. 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 client in a double hip spica cast is constipated. The surgeon cuts a window into the cast. Which of the following outcomes should the nurse anticipate?. 1. The window will allow the nurse to palpate the superior mesenteric artery. 2. The window will allow the surgeon to manipulate the fracture site. 3. The window will allow the nurses to reposition the client. 4. The window will provide some relief from pressure due to abdominal distention as a result of constipation.

4. The window will provide some relief from pressure due to abdominal distention as a result of constipation. The hip spica cast is used for treatment of femoral fractures; it immobilizes the affected extremity and the trunk securely. It extends from above the nipple line to the base of the foot of both extremities in a double hip spica. Constipation, possible due to lack of mobility, can cause abdominal distention or bloating. When the spica cast becomes too tight due to distention, the cast will compress the superior mesenteric artery against the duodenum. The compression produces abdominal pain, abdominal pressure, nausea, and vomiting. The nurse should assess the abdomen for decreased bowel sounds, not the superior mesenteric artery. The surgeon cannot manipulate a fracture through a small window in a double hip spica cast. The nurse cannot use the window to aid in repositioning because the window opening can break and cause cast disruption.

Which patient below is presenting with signs and symptoms of rheumatoid arthritis? Select all that apply: A. A 35 year old patient who has severe morning stiffness for 45 minutes. B. A 45 year old male with crepitus in the right knee. C. A 30 year old female with warm, red, soft joints on the hands and wrist. D. A 40 year old male whose x-ray imaging results showed osteophytes formation and decreased joint space in the left knee.

A. A 35 year old patient who has severe morning stiffness for 45 minutes. C. A 30 year old female with warm, red, soft joints on the hands and wrist. These are common findings in RA. However, options B and D are found in OA.

Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention? A. The weights are freely hanging on the floor. B. Pin sites are free from drainage. C. Patient uses the overhead trapeze bar to move around in the bed. D. Patient's extremities have a capillary refill of less than 2 seconds.

A. The weights are freely hanging on the floor. Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings.

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.

A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes. 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 with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient: A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

B. Water aerobics C. Weight Lifting E. Walking The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

Your patient will be using crutches for mobility. After educating the patient on how to adjust the crutches to fit correctly, you assess how well the patient understood the instructions. What findings demonstrate that the crutches were adjusted correctly by the patient? Select all that apply: A. The hand grips of the crutches are even with the mid-forearm. B. When the patient grips the hand grips of the crutches the elbow bends at about 30 degrees. C. The patient has a 2-3 finger width distance between the axillae and crutch rest pad. D. The patient places weight on the axillae rather than the hands while ambulating.

B. When the patient grips the hand grips of the crutches the elbow bends at about 30 degrees. C. The patient has a 2-3 finger width distance between the axillae and crutch rest pad. Properly fitted crutches should be a 2-3 finger width (about 1-1.5 inches) distance between the axillae (armpit area) and the crutch rest pads during ambulation. This prevents damaging the nerves that are located in the axillae during ambulation. In addition, when the patient grips the hand grips of the crutches the elbow should slightly bend at about 30 degrees. Option A is wrong because the hand grips of the crutches should be even with the hip line (not the mid-forearm), and option D is wrong because the patient should place weight on the HANDS while ambulating NOT the axillae area (this can cause nerve damage).

You are assessing the diagnostic testing results for a patient that has rheumatoid arthritis. What result is NOT an indicator of this disease? A. Elevated erythrocyte sedimentation B. X-ray imaging showing osteophyte formation C. Positive c-reactive protein D. Positive rheumatoid factor

B. X-ray imaging showing osteophyte formation This is found in osteoarthritis NOT rheumatoid arthritis. Osteophytes (bones spurs) are only found in OA.

While going down the stairs with crutches the patient will move the crutches down onto the step followed by? A. moving the non-injured leg down onto the step. B. moving the injured leg down onto the step. C. moving both legs down onto the step.

B. moving the injured leg down onto the step. When going down the stairs with crutches, the patient will move the crutches down first onto the step followed by moving the INJURED leg and then the patient will move the non-injured leg down.

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.

C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28. 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.

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. Colchicine The signs and symptoms presenting in this patient are classic signs of Colchicine toxicity. Therefore, the nurse should not administer Colchicine. This medication can also cause GI upset and neutropenia.

You're observing your patient using crutches. She is using the three-point gait. Which finding requires you to re-educate the patient on how to use the crutches? A. There is a 1.5 inch gap between the axillae and crutch rest pad during ambulation with the crutches. B. The patient starts in the tripod position before ambulating with the crutches. C. The patient leans on the crutch rest pads during ambulation. D. The patient does not let the injured leg touch the ground while ambulating with the crutches.

C. The patient leans on the crutch rest pads during ambulation. The patient should NOT let the axillae (arm pits) rest or lean on the crutch rest pads during ambulation because this could cause nerve damage. The patient should exert weight on the hand grips while ambulating.

Your patient is prescribed to use crutches for ambulation. The patient can bear partial weight and needs to be taught how to use the two-point gait while using crutches. Which description below best describes this type of gait with crutches? A. The patient moves both crutches forward and then moves both legs forward to the same point as the crutches. B. The patient moves the right crutch (injured side), then moves the left foot (non-injured side), then moves the left crutch (non-injured side), and then moves the right foot (injured side). C. The patient moves both the right crutch (injured side) and left foot (non-injured side) forward together, and then moves the left crutch (non-injured side) and right foot (injured side) forward together. D. The patient moves both crutches and injured leg forward together, and then moves the non-injured leg forward.

C. The patient moves both the right crutch (injured side) and left foot (non-injured side) forward together, and then moves the left crutch (non-injured side) and right foot (injured side) forward together. The two-point gait is where the patient moves both the right crutch (injured side) and left foot (non-injured side) forward TOGETHER, and then moves the left crutch (non-injured side) and right foot (injured side) forward TOGETHER.

During discharge teaching to a patient at risk for developing osteoporosis, you discuss the types of exercise the patient should perform. Which type of exercise is not the best to perform to prevent osteoporosis? A. Tennis B. Weight-lifting C. Walking D. Hiking

C. Walking Low-impact exercises are not as beneficial in building bone mass as compared to weight-bearing exercises such as tennis, lifting weights, and hiking etc. The patient should perform exercises that put stress on the bones against gravity, which will help increase bone strength and build muscle.

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. uric acid In gout, uric acid accumulates in the blood, which leads to the formation of needle-like crystal around the joints.

Figure 2 represents what type of bone fracture: The fractured bone is broken into many fragments (3 or more). A. Open Fracture B. Greenstick Fracture C. Oblique Fracture D. Comminuted Fracture

D. Comminuted Fracture

________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix. A. Osteocytes, osteoclasts B. Osteoclasts, osteoblasts C. Osteocytes, osteoblasts D. Osteoblasts, osteoclasts

D. Osteoblasts, osteoclasts OsteoBLASTS are found within the spongy bone and are responsible for building up the bone matrix, while osteoCLASTS, which are also found in the spongy bone as well, breakdown the bone matrix.

What is a late sign of compartment syndrome? A. Paralysis B. Pain C. Paresthesia D. Pulselessness

D. Pulselessness

You're caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient's care? A. Risk for skin breakdown B. Knowledge deficient regarding disease process C. Limited mobility D. Risk for falls

D. Risk for falls When assessing the options you want to select the option that is a priority for this patient and risk for falls is the priority. The patient is at risk for falls due to severe kyphosis, which is common in severe osteoporosis (also called Dowager's Hump). This deformity of the spine limits mobility and increases the chances of falls In addition, it is important the nurse takes precautions in preventing falls because the patient will most likely experience a fracture due to severe osteoporosis.

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. Tophi 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.

True or False: When using the swing-to gait with crutches, the patient will move both crutches forward, and then will move both legs forward to the same point as the crutches.

The answer is true. This description describes the swing-to-gait.