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NUR243 - Medical-Surgical II > Chapter 69: Arthritis > Flashcards

Chapter 69: Arthritis Flashcards

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USMLE® Step 1 flashcards
1
Q

inflammation of a joint

A

arthritis

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2
Q

Does arthritis affect more men or women?

A

women

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3
Q

A slow progressive noninflammatory disorder of the diarthrodial joints.

A

osteoarthritis

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4
Q

T/F

Osteoarthritis is a normal part of aging.

A

false

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5
Q

T/F

Decreased estrogen at menopause may contribute to the increased incidence of OA in aging women.

A

true

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6
Q

In the early stages of OA, what relieves joint pain?

A

rest

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7
Q

a grating sensation caused by loose cartilage particles in the joint cavity

A

crepitation

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8
Q

Crepitation is common in patients with __________ OA.

A

knee

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9
Q

T/F

Rheumatoid arthritis usually affects joints on 1 side of the body, rather than in pairs.

A

false; osteoarthritis

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10
Q

T/F

Fatigue, fever, and organ involvement are present in osteoarthritis.

A

false; they are not present

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11
Q

Which diagnostic study confirms osteoarthritis disease and stage of joint damage?

A

x-ray

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12
Q

T/F

In osteoarthritis, the fluid is clear yellow with little or no sign of inflammation.

A

true

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13
Q

Which laboratory tests and biomarkers are used to diagnose osteoarthritis?

A

no laboratory tests or biomarkers can be used to diagnose OA

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14
Q

T/F

Osteoarthritis is curable.

A

false

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15
Q

drugs thought to slow the progression of osteoarthritis or support joint healing

A

disease-modifying osteoarthritis drugs (DMOADs)

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16
Q

What is the first-line treatment for osteoarthritis?

A

NSAIDs

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17
Q

A chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial joints.

A

rheumatoid arthritis

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18
Q

X-ray is the most useful tool in diagnosing rheumatoid arthritis.

A

false; bone scans

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19
Q

T/F

Biologic response modifiers are used to slow down the progression of rheumatoid arthritis.

A

true

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20
Q

a type of arthritis characterized by elevation of uric acid and the deposit of uric acid crystals in 1 or more joints

A

gout

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21
Q

__________ occurs when either the kidney cannot excrete enough uric acid or there is too much for the kidneys to handle effectively.

A

gout

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22
Q

T/F

Secondary hyperuricemia is genetic.

A

false; primary hyperuricemia

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23
Q

What breaks down uric acid into water-soluble products for elimination in urine?

A

uricase

24
Q

__________ hyperuricemia may be caused by conditions that increase uric acid production or decrease uric acid excretion or drugs that stop uric acid excretion.

A

secondary

25
Q

T/F

Not everyone with high uric acid levels develops gout.

A

true

26
Q

What is the most common initial problem of gout?

A

inflammation of the big toe

27
Q

T/F

Excess uric acid excretion may lead to stone formation in the kidneys or urinary tract.

A

true

28
Q

normal uric acid levels

A

2.7-8.5 mg/dL

29
Q

What is the gold standard for diagnosis of gout?

A

synovial fluid aspiration

30
Q

Which finding would the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?

a. Presence of Heberden‘s nodules

b. Discomfort with joint movement

c. Redness and swelling of the knee joint

d. Stiffness that increases with movement

A

b. Discomfort with joint movement

31
Q

The nurse is assessing a patient with osteoarthritis who uses naproxen (Naprosyn) for pain management. Which assessment finding would the nurse recognize as likely to require a change in medication?

a. The patient has gained 3 pounds.

b. The patient has dark-colored stools.

c. The patient‘s pain affects multiple joints.

d. The patient uses capsaicin cream (Zostrix).

A

b. The patient has dark-colored stools.

32
Q

The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA.

Which patient statement a need for additional teaching?

a. “A shower in the morning will help relieve stiffness.”

b. “I can exercise every day to help maintain joint mobility.”

c. “I will take 1 gram of acetaminophen (Tylenol) every 4 hours.”

d. “I can use a cane to decrease the pressure and pain in my hip joint.”

A

c. “I will take 1 gram of acetaminophen (Tylenol) every 4 hours.”

33
Q

The nurse would anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?

a. Prednisone

b. Adalimumab (Humira)

c. Capsaicin cream (Zostrix)

d. Sulfasalazine (Azulfidine)

A

c. Capsaicin cream (Zostrix)

34
Q

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action would the nurse take?

a. Draw blood for rheumatoid factor analysis.

b. Teach the patient about injections for the nodules.

c. Assess the nodules for skin breakdown or infection.

d. Discuss the need for surgical removal of the nodules.

A

c. Assess the nodules for skin breakdown or infection.

35
Q

Which action would the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

a. Instruct the patient to purchase a soft mattress.

b. Teach the patient to use cool water when bathing.

c. Encourage the patient to take a nap in the afternoon.

d. Suggest exercise with light weights several times daily.

A

c. Encourage the patient to take a nap in the afternoon.

36
Q

A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action would the nurse take?

a. Ask the HCP about discontinuing methotrexate.

b. Suggest the patient use preservative free artificial tears.

c. Remind the patient that RA is a chronic health condition.

d. Teach the patient about adverse effects of the RA medications.

A

b. Suggest the patient use preservative free artificial tears.

37
Q

Which information would the nurse include when teaching a patient who has an exacerbation of rheumatoid arthritis?

a. Affected joints should not be exercised when pain is present.

b. Applying cold packs before exercise may decrease joint pain.

c. Exercises should be performed passively by someone other than the patient.

d. Walking may substitute for range-of-motion (ROM) exercises on some days.

A

b. Applying cold packs before exercise may decrease joint pain.

38
Q

Which laboratory result would the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis?

a. Blood glucose

b. C-reactive protein

c. Serum electrolytes

d. Liver function tests

A

b. C-reactive protein

39
Q

Which suggestion would the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?

a. Strengthen small hand muscles by wringing out sponges or washcloths.

b. Protect the knee joints by sleeping with a small pillow under both knees.

c. Stand rather than sit when performing daily household and yard chores.

d. Limit the number of exercise repetitions during periods of acute inflammation.

A

d. Limit the number of exercise repetitions during periods of acute inflammation.

40
Q

How would the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day?

a. A brief routine of isometric exercises

b. A warm shower followed by a short rest

c. Active range-of-motion (ROM) exercises

d. Stretching exercises to relieve joint stiffness

A

b. A warm shower followed by a short rest

41
Q

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information would the nurse include in teaching the patient about this drug?

a. Avoiding aspirin use

b. Giving subcutaneous injections

c. Taking the medication with water

d. Recognizing gastrointestinal bleeding

A

b. Giving subcutaneous injections

42
Q

A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response would the nurse make?

a. “You need to see a family therapist for some help with stress.”

b. “Tell me more about the situations that are causing you stress.”

c. “Perhaps it would be helpful for your family to be in a support group.”

d. “Your family should understand the impact of your rheumatoid arthritis.”

A

b. “Tell me more about the situations that are causing you stress.”

43
Q

Which finding would indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout?

a. Reduced joint pain

b. Increased urine output

c. Elevated serum uric acid

d. Increased white blood cells

A

a. Reduced joint pain

44
Q

A patient with gout has a new prescription for losartan (Cozaar). What would the nurse plan to monitor?

a. Blood glucose

b. Blood pressure

c. Erythrocyte count

d. Lymphocyte count

A

b. Blood pressure

45
Q

A patient who takes multiple medications develops acute gout arthritis. Which medication would the nurse discuss with the health care provider before administering?

a. sertraline (Zoloft)

b. famotidine (Pepcid)

c. hydrochlorothiazide

d. oxycodone (Roxicodone)

A

c. hydrochlorothiazide

46
Q

A patient with hypertension and gout has a red, painful right great toe. Which action would the nurse include in the plan of care for this patient?

a. Use a footboard to hold up the bedding.

b. Gently palpate the toe to assess swelling.

c. Use pillows to keep the right foot elevated.

d. Teach the patient to avoid acetaminophen (Tylenol).

A

a. Use a footboard to hold up the bedding.

47
Q

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, “My arthritis isn‘t that bad yet. The side effects of methotrexate are worse than the arthritis.” Which information would be most important for the nurse to provide?

a. “Methotrexate is less expensive than some of the newer drugs.”

b. “It will take 4-6 weeks to see the therapeutic effects of the methotrexate.”

c. “It is important to start methotrexate early to decrease the extent of joint damage.”

d. “Methotrexate is effective and has fewer side effects than some of the other drugs.”

A

c. “It is important to start methotrexate early to decrease the extent of joint damage.”

48
Q

Which assessment information would indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

a. The patient has joint pain and stiffness.

b. The patient‘s fasting blood glucose is 90 mg/dL.

c. The patient has experienced a recent 5-pound weight gain.

d. The patient‘s erythrocyte sedimentation rate (ESR) has increased.

A

b. The patient‘s fasting blood glucose is 90 mg/dL.

49
Q

The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed?

a. The patient takes a 2-hour nap each day.

b. The patient has been taking 16 aspirins each day.

c. The patient sits on a stool while preparing meals.

d. The patient sleeps with two pillows under the head.

A

d. The patient sleeps with two pillows under the head.

50
Q

A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient‘s home routine would the nurse understand indicates a need for teaching regarding gout management?

a. The patient sleeps 8-10 hours each night.

b. The patient usually eats beef once a week.

c. The patient takes one aspirin a day to prevent angina.

d. The patient usually drinks about 3 quarts water each day.

A

c. The patient takes one aspirin a day to prevent angina.

51
Q

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis would the nurse identify as a likely adverse effect of the medication?

a. Blurred vision

b. Joint tenderness

c. Abdominal cramping

d. Elevated blood pressure

A

a. Blurred vision

52
Q

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information would the nurse report to the health care provider?

a. The patient had a history of infectious mononucleosis as a teenager.

b. The patient is trying to get pregnant before her disease becomes more severe.

c. The patient has a family history of age-related macular degeneration of the retina.

d. The patient has been using large doses of vitamins and health foods to treat the RA.

A

b. The patient is trying to get pregnant before her disease becomes more severe.

53
Q

A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider?

a. Rheumatoid factor is positive.

b. Fasting blood glucose is 90 mg/dL.

c. The white blood cell count is 1500/L.

d. The erythrocyte sedimentation rate is increased.

A

c. The white blood cell count is 1500/L.

54
Q

Which patient seen by the nurse in the outpatient clinic is most likely to need teaching about ways to reduce the risk for osteoarthritis (OA)?

a. A 56-yr-old man who has a sedentary office job

b. A 38-yr-old man who plays on a summer softball team

c. A 38-yr-old woman who is newly diagnosed with diabetes

d. A 56-yr-old woman who works on an automotive assembly line

A

d. A 56-yr-old woman who works on an automotive assembly line

55
Q

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information would the nurse discuss with the health care provider for an urgent change in the treatment plan?

a. Knee crepitation is noted with normal knee range of motion.

b. Patient reports embarrassment about having Heberden‘s nodes.

c. Patient‘s knee pain while golfing has increased over the last year.

d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

A

d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

NUR243 - Medical-Surgical II (15 decks)

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