Exam 2: Chapter 26 Flashcards
After first managing the pain being experienced by the client with gout, the treatment focuses
on:
a. strengthening the affected joints through a controlled exercise plan.
b. minimizing joint disfigurement by using therapeutic splinting.
c. preventing systemic involvement by altering the client’s diet.
d. managing chronic pain by taking regular doses of salicylates.
ANS: C
After the acute attack, the goal is to prevent systemic spread of the disease. This may be done by avoiding drugs or foods that are high in purine and alcohol, both of which increase uric
acid levels. Exercise and splinting are not effective in achieving the goal and salicylates should be avoided since they will affect the effectiveness of the prescribed medications for
gout.
A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching?
a. Avoid foods high in purine.
b. Encourage the patient to take in 1 L of fluid daily.
c. Consume one glass of red wine daily.
d. Recommend that the patient eat 12-16 ounces of foods high in protein such as red
meat.
ANS: A
A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol, and only have 4-6 ounces of foods high in protein
daily.
Which of the following manifestations would a nurse expect in a 70-year-old patient who has
the diagnosis of osteoarthritis?
a. Swan neck deformity of the hand
b. Subluxation of the fingers
c. Heberden’s nodes on the distal phalanges
d. Enlarged great toe
ANS: C
Herbeden’s nodes are common in osteoarthritis. As the disease progresses, osteophytes
develop in the joints of the fingers. Swan neck deformity and subluxation of the fingers are
common in RA. An enlarged great toe is characteristic of gout.
A nurse is planning an educational session on osteoporosis to be given at a senior center.
Which of the following should be discussed as preventive measures for osteoporosis?
a. Following a diet with adequate amounts of calcium and vitamin D
b. Increasing the intake of beverages containing phosphorus
c. Having a yearly dual-energy X-ray absorptiometry DXA (or DEXA) scan
d. Including isometric exercise for at least 30 minutes three times per week
ANS: A
A diet with adequate amounts of calcium and vitamin D is important in preventing osteoporosis. Phosphorous is not recommended for osteoporosis prevention. The
recommendation for DXA/DEXA scan is every 2 years. Exercise recommendations are for
weight-bearing exercise.
A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic.
Which of the following findings by the nurse is considered a risk factor for osteoporosis?
a. The woman is obese and has hip pain with ambulation.
b. The woman drinks three glasses of skim milk daily.
c. The woman eats three to five servings of shrimp and liver per week.
d. The woman has been taking corticosteroids for 10 years because of chronic
pulmonary disease.
ANS: D
Bone loss is rapid in individuals who take steroids for extended periods of time.
A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis.
Which of these actions would the nurse consider first?
a. Avoid stressful situations.
b. Schedule an annual DXA/DEXA scan.
c. Remove clutter from the floors of the home.
d. Encourage consumption of a high-protein diet.
ANS: C
Individuals with osteoporosis are very high risk for falls. The most serious health
complication of osteoporosis is the morbidity and mortality associated with a fall. There is no
evidence that stress impacts osteoporosis. The recommendation for a DXA/DEXA scan is
every 2 years. There is no evidence that a high-protein diet is important for an individual with
osteoporosis.
Kyphosis in the older adult can be a result of which of the following?
a. Osteoarthritis
b. Rheumatoid arthritis
c. Osteoporosis
d. Gout
ANS: C
Kyphosis is a common presentation in osteoporosis. Individuals can lose as much as 3 cm or more in height and develop a “c” shape to the vertebral column.
A nursing student is preparing a presentation on arthritis. The nursing student knows that differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that: (Select all
that apply.)
a. both OA and RA have an acute onset in older adults.
b. OA is a localized process, whereas RA may be systemic.
c. OA usually impacts distal interphalangeal joints; RA impacts proximal
interphalangeal joints.
d. both OA and RA present with joint stiffness lasting 20-30 minutes after rest.
e. initial treatment of both OA and RA is usually nonpharmacological using heat or
exercise.
ANS: B, C
OA has an insidious presentation, and RA has an acute presentation. OA presents with joint
stiffness, which resolves in less than 20 minutes, and RA presents with joint stiffness that lasts
more than 20-30 minutes. OA is initially treated with nonpharmacological treatments such as
heat or exercise, and RA is treated with medications disease-modifying antirheumatic drugs
(DMARDs) immediately after diagnosis.
A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? (Select all that apply.)
a. Rest the joint during the acute gout attack.
b. Take acetylsalicylic acid (aspirin, or ASA) to relieve pain.
c. Increase fluid intake to 2 L/day.
d. Avoid foods high in purine.
e. Avoid alcoholic beverages.
ANS: A, C, D, E
Individuals who are having an acute attack of gout should not take salicylates for pain. ASA is
a salicylate.
A patient is diagnosed with osteoporosis. Which statements should the nurse include when
teaching the client about the disease? (Select all that apply.)
a. Osteoporosis is common in females after menopause.
b. Osteoporosis is a degenerative disease characterized by a decrease in bone density.
c. The disease is congenital, caused by poor dietary intake of dairy products.
d. Osteoporosis can cause pain and injury.
e. Passive range of motion can prevent osteoporosis.
ANS: A, B, D
Osteoporosis is not a congenital disease. While a low intake of calcium is a factor, there are
dietary sources of calcium other than dairy products. Passive range of motion cannot prevent
osteoporosis.
A nurse is teaching a group of 65-year-old patients about reducing the risk of osteoarthritis.
Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis?
(Select all that apply.)
a. Female sex
b. History of joint injuries
c. Advancing age
d. Drinking one cup of regular coffee a day
e. Obesity
ANS: B, E
Gender and advancing age are nonmodifiable risk factors for osteoarthritis. There is no evidence that coffee or caffeine has any relationship to the development of osteoarthritis.
Which of the following is a true statement about osteoporosis (OA)?
a. OA is indicative of an underlying health problem.
b. The most common site for OA fractures is in long bones.
c. African American women have the highest risk for OA.
d. A high risk of death follows an OA-related fracture.
D - A high risk of death follows an OA-related fracture.
Which is a healthy practice recommended for a person at risk for osteoporosis?
a. Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert
b. Long-term estrogen administration as adjunct therapy
c. A bisphosphonate medication taken with a snack just before bedtime
d. Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fiber bun at lunch; cocktails before dinner; steak with brown rice, celery, and red wine for dinner
A - Milk and orange juice at breakfast; cheese pizza at lunch; spaghetti served with spinach covered with melted cheese for dinner; and ice cream for dessert
Which of the following is a true statement about joints in older adults?
a. Osteoarthritis (OA) is an inflammatory joint disorder.
b. Surgical joint replacement can cure OA.
c. Joint damage in OA is reversed with medication.
d. Very old patients should avoid joint replacement surgery.
B - Surgical joint replacement can cure OA.
Which of the following statements is true about rheumatoid arthritis (RA)?
a. RA strikes unilaterally.
b. RA affects more men than women.
c. RA can affect body systems other than the joints.
d. Morning stiffness in RA lasts less than 30 minutes.
C - RA can affect body systems other than the joints.
