Osteoarthritis

b

A client complains of knee pain during an appointment at a medical clinic. After reviewing the client​'s medical​ record, the nurse notes the client has been taking​ over-the-counter NSAIDs, with no pain relief. The nurse can anticipate the healthcare provider writing a prescription for what medication at ​discharge? a Naproxen​ (Aleve) b Celecoxib​ (Celebrex) c Morphine sulfate d Acetaminophen​ (Tylenol)

c Rationale Heberden nodes are bony lumps occurring at the end joint of the digits in a client with OA. Bouchard nodes occur in the middle joint of the digits. Osteoblasts are cells that form new bone. Lymph node swelling does not occur in the hands.

A client diagnosed with osteoarthritis of the hands presents with bony lumps on the end joints of her digits. How will the nurse document this finding in the medical​ record? a Bouchard nodes b Osteoblasts c Heberden nodes d Lymph node swelling

b

Prior to the discharge of a client with osteoarthritis, the priority topic for the nurse to teach the client and the client�s family is: a fluid requirements for the client. b signs and symptoms of infection. c nutritional needs of the client. d administration of IV antibiotics.

d

Which surgical treatment can be used to realign a joint that is affected by​ osteoarthritis? a Arthroscopy b Joint arthroplasty c Joint biopsy d Osteotomy

b

The nurse collects data from a client with suspected osteoarthritis and confirms which manifestations of osteoarthritis? a Elevated sedimentation rate b Dull, aching pain in the joints c Elevated white blood cell count d Positive rheumatoid factor

a

The nurse is caring for a client with osteoarthritis and is making suggestions about obtaining assistive devices to aide in activities of daily living. The nurse is assisting the client to meet which goal? a Prolong independence. b Decrease painful stimuli. c Prevent contractures. d Maintain a safe environment.

b

The nurse is planning care for a client with osteoarthritis of the hips. Which intervention will assist in addressing the potential problem of physical​ mobility? a Encourage the client to avoid all physical activity. b Teach active and passive range of motion exercises. c Recommend a local support group for the client and spouse. d Educate the client about proper skin care.

a,b

The nurse is planning care for a client with osteoarthritis. Which potential problem is priority for the nurse to​ address? ​(Select all that​ apply.) a Chronic pain b Impaired physical mobility c Impaired cardiac output d Fluid volume deficit e Impaired skin integrity

a,b,c

The nurse is providing education about home care for a client with osteoarthritis of the knees. Which information should the nurse include during this educational​ session? ​(Select all that​ apply.) a Taking pain medications as ordered b Installing handrails in bathroom c Using assistive devices to minimize stress placed on affected joint d Encouraging heavy lifting to maintain muscle strength e Continuing activity with repetitive movement

a Rationale: Age is a risk factor for developing primary osteoarthritis. Trauma, endocrine disorders, and joint instability are risks for developing secondary osteoarthritis

The nurse is teaching a client about osteoarthritis and the risk factors for developing the disease. The nurse includes what information about primary osteoarthritis risks? a Age b Trauma c Endocrine disorders d Joint instability

a,b,c

A client experiencing severe pain that cannot be managed through pain medications or nonpharmacologic therapy may need surgical intervention. Which surgical treatments will the nurse include in the teaching session with other members of the healthcare​ team? ​(Select all that​ apply.) a Arthroplasty b Osteotomy c Joint fusion d Cortisone therapy e Serum hyaluronic acid

c

A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for what​ reason? a To identify irregular joint space narrowing b To determine the extent of joint damage c To rule out inflammatory arthritis and gout d To evaluate for increased density of subchondral bone

d

A nurse is providing a preventive teaching discussion with a client at risk for osteoarthritis. Which guideline should be included in this discussion related to​ exercise? a Exercise is not recommended b Perform heavy weightlifting exercises three times per week c If there is pain with​ exercise, keep​ going, this is building muscle d Participate in regular​ exercise, including walking or swimming

a,d,e A. Heberdens nodules are large nodules on the distal interphalangeal joints of the hands and feet of a client with OA B. swelling of all joints is a manifestation of RA, local is OA C. A small body frame is a risk for RA. Obesity is a factor for OA D. duh E. duh

ATI: A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (select all that apply) a. heberdens nodules b. swelling of all joints c. small body frame d. enlarged joint size e. limp when walking

a,b,c,e Tub baths increase risk for fall/strain

ATI: A nurse is providing information to a client who has OA of the hip and knee. Which of the following information should the nurse include? (select all that apply) a. apply heat to joints to alleviate pain b. ice inflamed joints following activity c. install an elevated toilet seat d. take tub baths e. complete high-energy activities in the morning

c Rationale: Aspirin therapy is continuous and is effective only if therapeutic blood levels are reached. It is not taken intermittently. The other statements are appropriate self-care measures when taking aspirin for osteoarthritis.

An obese client with degenerative joint disease is being managed with aspirin therapy. The nurse determines that additional teaching is needed when which client statement is made? a "I use heat sometimes to help reduce my pain and stiffness." b "I frequently examine my stools for bleeding." c "I take my aspirin when I have extreme pain or stiffness." d "I started an exercise program to lose weight."

b,d Rationale: Heat, not ice, can be applied to the area, and moist heat is most effective at reducing pain and inflammation. A common approach to physical therapy includes paraffin wax treatments, where the client inserts the painful joint into warm liquid paraffin, which holds in the heat for an extended period of time and can be very comforting. Joints tend to stiffen and become more painful during periods of inactivity, so a moderate activity plan can help to prevent this. NSAIDs may be administered, but this is pharmacological treatment, not non-pharmacological treatment. X-rays may be performed for diagnosis, but do not treat the pain.

Non-pharmacological pain management for a client with osteoarthritis include: (Select all that apply.) a X-rays b Moderate activity plan c NSAIDs d Application of moist heat e Ice pack to the most painful area

b Rationale ​Hands, knees and hips are the most commonly affected joints of OA.​ Feet, spine,​ neck, shoulders, and ankles are not the most common locations.

The nurse is providing education to a community group about developing osteoarthritis. What​ joints, commonly​ affected, will the nurse include in the educational​ session? a ​Knees, feet, and spine ​b Hands, knees, and hips c ​Neck, shoulders, and ankles ​d Ankles, feet, and spine

a

The nurse is providing home care teaching to a client diagnosed with osteoarthritis. Which statement is appropriate for the nurse to include in the teaching session for this​ client? ​a "Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare​ provider." ​b "Stretching all muscle groups for 30 minutes each day has been recommended by the healthcare​ provider." ​c "Water exercises should not be tried because water buoyancy increases force on the​ joints." d ​"When you begin your strengthening​ exercises, it is appropriate to start with a large weight and work your way​ down."

a,c,d Rationale Joint pain with​ activity, grating or crepitus noted with​ movement, and pain and stiffness with prolonged inactivity are general manifestations of osteoarthritis. Mild fever is associated with rheumatoid​ arthritis, not osteoarthritis. General manifestations of osteoarthritis include a gradual​ onset, not an abrupt onset.

The nurse is providing education at a community health fair about osteoarthritis. Which are the general clinical manifestations associated with osteoarthritis that the nurse should include when providing this​ education? ​(Select all that​ apply.) a Pain and stiffness at night b Mild fever c Joint pain with activity d Crepitus with movement of joint e Abrupt onset

b

The nurse is providing education to a client who is scheduled for an osteotomy. Which information should the nurse include about this​ procedure? a The procedure will stop osteoarthritis from progressing. b Realignment of the joint will occur. c Excess debris will be flushed out. d The joint will be reconstructed.

c Rationale: Clients with OA have difficulty with some aspects of getting dressed, particularly putting on socks. The nurse would suggest an assistive device to help the client so that the skin of the feet remains intact. Driving to the office and combed hair are signs that the client is functioning independently. A wrinkled shirt may or may not mean a self-care deficit. A dirty shirt would be more concerning than a wrinkled one.

The nurse selects the nursing diagnosis of self-care deficit for a client with osteoarthritis based on what observation? a The client drove to the office. b The client's hair is combed. c The client is wearing loafers without socks. d The client's shirt is wrinkled.

c,d,e Common risk factors for osteoarthritis include​ obesity, overuse of joints from sports injuries or strenuous​ activities, and affecting​ weight-bearing joints. Rheumatoid arthritis is thought to be an autoimmune disorder. Ingestion of large amounts of purines is a risk factor for gout.

What are the common risk factors for​ osteoarthritis? ​(Select all that​ apply.) a Autoimmune disorder b Ingestion of large amounts of purine c Activities affecting​ weight-bearing joints d Overuse of joints from sports or strenuous activities e Obesity

d

Which diagnostic test will best determine the cause of joint damage with​ osteoarthritis? a Electromyogram​ (EMG) b MRI of joint c Joint​ x-ray d Synovial fluid analysis

c,d Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab​ bars, a shower​ chair, or​ long-handled grippers help the client to maintain an independent lifestyle in safety. ROM exercises assist the client to maintain maximal use of joint mobility and are an important component in the exercise plan. Although calcium intake is essential to prevent​ osteoporosis, especially in older​ adults, increasing calcium in the daily intake does not have a positive effect on osteoarthritis. Chairs and mattresses should provide support and help to maintain normal body alignment. Soft chairs and recliners do not provide such support.

Which health promotion activities support a healthy lifestyle for clients with​ osteoarthritis? ​(Select all that​ apply.) a Increase dietary intake of calcium b Use soft chairs and recliners for rest c Maintain a normal weight d Use assistive devices as needed e Limit participation in ROM exercises

a,c,e Chronic pain is frequently associated with osteoarthritis. When joints are​ painful, they should be rested. The rest should be balanced with periods of​ activity, which will reduce joint stiffness. Using proper posture and good body mechanics places the body in proper alignment and offers the joints a neutral platform to perform ROM activities. Firm chairs and mattresses assist the body in proper alignment. Heat should be applied to painful​ joints, which will increase joint mobility. Cool compresses may increase joint pain and will limit joint mobility. Isometric exercises strengthen muscle​ groups, which is important to provide additional strength in movement. Strong muscles will reduce strain on joints.

Which interventions support effective management of chronic pain that is experienced by a client with​ osteoarthritis? ​(Select all that​ apply.) a Teaching proper posture and good body mechanics for activities of mobility b Limiting isometric exercises to reduce strain on the joints c Encouraging resting painful joints d Applying cool compresses to painful joints to reduce inflammation e Using firm support in chairs and mattresses to properly align the body