HESI - Osteoporosis + Musculoskeletal

Question 1

The client sustains a Colles’ fracture while on a hiking vacation in the mountains. She received care at a local emergency care center, where asked if she has ever been screened for osteoporosis. When the client replies, “No.”, the healthcare provider (HCP) recommends that her primary provider conduct the screening after she returns home.

During the intake assessment and interview, what information indicates that the client has an increased risk for osteoporosis? (Select all that apply. One, some, or all options may be correct.) Select all that apply

Recent death of her husband of 30 years.

Gave birth to her first and only child at age 30.

Low body weight, thin build

Parent with history of osteoporosis

High alcohol intake

Answer 1

Low body weight, thin build

Parent with history of osteoporosis

High alcohol intake

Question 2

The client is seen by the healthcare provider (HCP), who recommends osteoporosis screening since they are at risk for osteoporosis. The nurse meets with the client to provide client teaching. The client tells the nurse that they played a lot of sports as a child and teenager. The client states, “I guess I just put too much stress on my bones over the years.”

How should the nurse respond?

Excessive wear and tear during the growth years can weaken your bones as an adult.

Being active in sports only increases the risk for osteoporosis if your bones break a lot.

Brittle bones are primarily inherited and are not often affected by your level of activity.

Participating in sports activities often helps the bones become stronger and denser.

Answer 2

Participating in sports activities often helps the bones become stronger and denser.

Question 3

Which aspect of the client’s medication history is most likely to impact the client’s risk for osteoporosis?

Chronically low calcium and/or Vitamin D intake

Took an antidepressant for 6 months immediately following spouse’s death.

Began treatment for hyperlipidemia with simvistatin 6 months ago.

Has occasionally taken ibuprofen for lower back pain for the last 2 years.

Answer 3

Chronically low calcium and/or Vitamin D intake

Question 4

The nurse calls to schedule the client’s appointment for dual energy x-ray absorptiometry (DEXA) of the hip and spine. An appointment is available in 30 minutes or the next available appointment is in 3 weeks.

What action should the nurse implement?

Advise the client that an immediate appointment will not allow adequate time to maintain NPO status before the test.

Provide the client with the available choices of appointment times and allow the client to select the desired appointment.

Schedule the client for the immediate appointment so that emergency treatment can be started, based on the test results.

Instruct the client that it may be desirable to have a family member available following the test to drive her home.

Answer 4

Provide the client with the available choices of appointment times and allow the client to select the desired appointment.

The nurse should promote client autonomy by offering the client safe, reasonable choices. Since no special preparation is needed prior to the test, the client may choose to have the test completed immediately. Even though the client has recently experienced a fracture this is not an emergency situation, so the client may prefer to wait for the appointment in 3 weeks.

Question 5

After the appointment for DEXA is scheduled, the client reminds the nurse that she has a number of food allergies, including shellfish, red food color, peanuts, and strawberries.

What information should the nurse provide the client concerning the effects of food allergies on osteoporosis screening?

Advise the client that an ultrasound or CT scan may need to be prescribed, rather than the scheduled DEXA.

Reassure the client that there are no dyes or products containing iodine used during a DEXA.

Advise the client that her allergy to multiple food products increases her risk for hypersensitivity to the medication used during the test.

Contact the DXA technician to ensure that the contrast medium used does not contain any of these allergens.

Answer 5

Reassure the client that there are no dyes or products containing iodine used during a DEXA.

DEXA is a non-invasive procedure that does not involve the use of any dyes or cleansing agents that might contain allergens such as iodine.

Question 6

The client returns to the office 1 month later to discuss the results of the DEXA test with the provider and learns that the T-score (- 1.0) indicates osteopenia. The client states, “I guess I am not having any symptoms because I don’t have osteoporosis yet.”
Question 6 of 28

How should the nurse respond?

Both terms mean the same thing, so you do have osteoporosis.

Many persons with osteoporosis do not have any symptoms.

Weakness and fatigue often increase as the condition worsens.

You are fortunate that you are not having any symptoms yet.

Answer 6

Many persons with osteoporosis do not have any symptoms.

Osteoporosis is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a fracture

Question 7

Osteoporosis is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a ____________

Answer 7

fracture

Question 8

Further conversation with the client reveals that they have been experiencing lower back pain off and on for the last 2 years. The client takes ibuprofen occasionally for the pain.

What action should the nurse implement first upon learning of this problem?

Reassure the client that her lower back pain is the result of her osteopenia.

Teach the client exercises that will strengthen her abdominal muscles.

Determine if the client’s PRN use of ibuprofen provides adequate pain relief.

Ask the client if she has discussed this symptom with her healthcare provider.

Answer 8

Ask the client if she has discussed this symptom with her healthcare provider.

Lower back pain can be the result of many problems. The healthcare provider should first evaluate the cause of the pain before the nurse provides client teaching regarding exercises or pain management.

Question 9

In addition to evaluating for the presence of subjective symptoms, what assessment technique should the nurse include in the ongoing assessment of the client’s bone density?

Record her grip strengths.

Perform an Allen’s test.

Observe her feet and toes.

Measure her height.

Answer 9

Measure her height.

Persons with osteoporosis often loose height over time as the vertebrae are compressed.

Question 10

Persons with osteoporosis often loose _________ over time as the vertebrae are compressed.

Answer 10

height

Question 11

The client’s healthcare provider recommends a regimen of exercise and diet. The nurse meets with the client to provide osteopenia related teaching. The client and the nurse discuss the need for adequate calcium intake.

To increase the client’s dietary intake of calcium, which snack should the nurse recommend?

A large apple.

A cup of fruit-flavored yogurt.

Twenty cheese-flavored crackers.

An ounce of low-fat cream cheese on a bagel.

Answer 11

A cup of fruit-flavored yogurt.

Question 12

The client tells the nurse that she started taking a 500 mg calcium supplement daily after she stopped her post-hysterectomy estrogen therapy.
Question 10 of 28

What instruction(s) should the nurse provide? (Select all that apply. One, some, or all options may be correct.)

Try to take 1 tablet with each meal.

500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day.

As long as your vitamin supplement also contains Vitamin D, you will be receiving adequate supplementation.

By taking 3 of your calcium tablets each day you will receive adequate amounts of calcium for your needs.

Any additional calcium supplementation could cause you to have harmful symptoms of calcium toxicity.

Answer 12

Try to take 1 tablet with each meal.

500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day.

Question 13

The client tells the nurse that she loves to hike and that she walks 2 miles every weekend to stay in shape.

How should the nurse respond?

It sounds as if your long walks provide plenty of weight-bearing exercise.

It is important to increase the frequency of your walks to at least five times per week.

Walking more than a mile at one time is likely to increase your risk for another fracture.

The best way to increase your bone strength is by lengthening your weekly walk by another mile.

Answer 13

It is important to increase the frequency of your walks to at least five times per week.

Regular exercise, walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. In addition, regular exercise improves muscle strength and coordination, reducing the client’s risk for falls.

Question 14

A repeat DXA the following year indicates a progression from osteopenia to osteoporosis. The client states adhering to a calcium rich dietary and a faithful exercise regimen.

To help determine why osteoporosis has developed, what question should the nurse ask the client?

What medications have you taken during the last year?

How many hours of sleep do you get per night?

Have you experienced any infections recently?

Do your hands or feet ever swell when you exercise?

Answer 14

What medications have you taken during the last year?

Medications can contribute to the loss of bone density.

Question 15

The client reports having ulcerative colitis and experienced an acute exacerbation during the past year. The client states that it has taken a number of medications over the last year to manage the ulcerative colitis.

Which medication is most likely to have contributed to the decrease in the client’s bone density?

Diphenoxylate, an antidiarrheal, taken prior to the acute exacerbation for occasional episodes of diarrhea.

Sulfasalazine, an antiinflammatory sulfonamide, administered during the acute exacerbation.

Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following.

Propantheline, an anticholinergic, administered during the acute exacerbation.

Answer 15

Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following.

Corticosteroid-induced osteoporosis is an important concern for patients who receive corticosteroid treatment for prolonged periods (longer than 3 months).

Question 16

The healthcare provider prescribes alendronate PO once a week. The nurse instructs the client to select a specific day of the week when she can take the medication first thing in the morning. The client states, “Is that really necessary? I’m not much of a morning person.”

Which response(s) are appriopriate? (Select all that apply. One, some, or all options may be correct.) Select all that apply

The medication is much better absorbed when taken on an empty stomach.

Increased nausea often occurs when the medication is taken late in the day.

You may prefer to take the medication with a specific meal once a week.

It is important to have a weekly routine so you won’t forget to take the medication.

Make sure you remain upright for at least ½ hour after taking the medication.

Answer 16

The medication is much better absorbed when taken on an empty stomach.

Make sure you remain upright for at least ½ hour after taking the medication.

Question 17

Six weeks after starting the medication [alendronate] , the client leaves a message for the nurse that she is experiencing increasingly frequent and severe heartburn.

What action should the nurse take?

Advise the client to go to the emergency department immediately.

Ask the client to describe her method of alendronate administration.

Instruct the client to use an antacid PRN 2 hours after her alendronate dose.

Reassure the client that heartburn is a common side effect of alendronate.

Answer 17

Ask the client to describe her method of alendronate administration.

After taking a dose of alendronate the client must remain in an upright position for 30 minutes to prevent esophageal irritation and erosion.

Question 18

After taking a dose of alendronate the client must remain in an __________ position for 30 minutes to prevent esophageal irritation and erosion.

Answer 18

upright

Question 19

A Complication Occurs
Three weeks later, the client goes to the emergency department of the local medical center, where she reports that she fell off a ladder the previous day and is experiencing increasing pelvic tenderness. The X-ray reveals a pelvic fracture, and the client is transferred to the orthopedic unit for fracture management. While being admitted to the orthopedic unit, the client develops chest pain. Her vital signs are Temperature, 99.8° F (37.6° C), Pulse 122, Respirations 40, Blood Pressure 110/74. While obtaining the client’s vital signs, the nurse notes that the client is pale and has petechiae on her anterior chest and neck.

What action should the nurse implement first?

Apply oxygen via mask.

Observe for hematuria.

Measure abdominal girth.

Administer an analgesic.

Answer 19

Apply oxygen via mask.

The client’s vital signs and manifestations indicate that fat embolization syndrome has occurred. Typical symptoms include chest pain, tachycardia, tachypnea, dyspnea, pallor, and petechiae on the anterior chest, neck, and axilla. Symptoms are the result of poor oxygenation, so the nurse’s first interventions should include measures to improve oxygenation, such as the application of oxygen.

Question 20

After taking initial action, the nurse notes that the client is becoming cyanotic and appears restless, anxious, and disoriented with a decreasing SaO2.

What is the priority nursing action?

Prepare the client for a blood transfusion.

Initiate cardiopulmonary resuscitation.

Ensure that intubation equipment is readily available.

Position the client on her right side with her head down.

Answer 20

Ensure that intubation equipment is readily available.

The fat globules transported to the lungs can result in acute respiratory distress syndrome (ARDS). Acute deterioration of respiratory function may require intubation or intermittent positive pressure ventilation if satisfactory PaO2 cannot be obtained with supplemental O2 alone. The nurse should ensure that this emergency equipment is readily available.

Question 21

The client’s condition stabilizes after initial treatment with oxygen and IV fluids. Mechanical ventilation is not needed, but the healthcare provider prescribes a transfer to the critical care unit, where the client can be more closely monitored for the next 24 hours. The house supervisor notifies the orthopedic unit charge nurse that no beds are available in the critical care unit and there are no clients stable enough to be transferred out of the critical care unit. The supervisor also notifies the healthcare provider, who agrees that the client can remain on the orthopedic unit if one-to-one care is received.
While arrangements are being made for one-to-one care, the nurse currently assigned requests assistance with other client care responsibilities and provides a report about the clients. An RN and two LPNs are working on the unit.

Which reported information indicates the need to assign the client to the RN?

There is no drainage in the hemovac drain of a client 2 days following an open reduction and internal fixation of the hip.

Six hours following a hip arthroplasty, the client’s autotransfusion collection device is full of sanguinous drainage.

Twenty-four hours following a vertebral khyphoplasty, a client needs the surgical dressing changed.

Twelve hours following a knee arthroplasty, a client reports pain when using the prescribed continuous passive motion device.

Answer 21

Six hours following a hip arthroplasty, the client’s autotransfusion collection device is full of sanguinous drainage.

This client is experiencing a large amount of postoperative drainage and may require a transfusion, as well as close monitoring. The acuity of this client requires the expertise of the RN for assessment and transfusion management.

Question 22

The supervisor agrees to send additional nursing staff to the unit so that the client can receive one-to-one care.

Arrangements should be made for which nurse to provide care for the client?

An experienced critical care RN who is scheduled off for the day.

An experienced orthopedic unit RN who is scheduled off for the day.

A graduate nurse serving a critical care internship who is at work but does not have a client care assignment.

An experienced orthopedic LPN who is already at work and has requested to work overtime whenever possible.

Answer 22

An experienced critical care RN who is scheduled off for the day.

Fat embolism syndrome can quickly deteriorate and requires a high level of critical care expertise to effectively assess for subtle changes in the client’s status.

Question 23

Pelvic Fracture Management
The client’s respiratory status gradually improves and one-on-one monitoring is no longer required. The client’s pelvic fracture involves a weight-bearing aspect of the pelvis, and the client is receiving traction with a pelvic sling.

In the planning of the client’s care, which problem has the highest priority?

Fatigue.

Acute pain.

Sleep pattern disturbance.

Impaired physical mobility.

Answer 23

Acute pain.

Pelvic fractures can be extremely painful, impacting all aspects of the client’s well-being and contributing to fatigue, sleep pattern disturbance, and impaired physical mobility.

Question 24

The nurse also includes “Risk for peripheral neurovascular dysfunction” in the plan of care.

Which nursing action should be implemented to address this potential problem?

Assign an LPN to take the client’s vital signs every 2 hours.

Observe the client’s pupillary response to light every 8 hours.

Measure and compare calf circumferences every 12 hours.

Assess for sensation and movement of the feet every 4 hours.

Answer 24

Assess for sensation and movement of the feet every 4 hours.

Diminished sensation and movement of the feet, along with diminished pedal pulses, pallor, and pain indicate impaired peripheral neurovascular function. pp. 1033

Question 25

Since the client’s respiratory status has stabilized, she undergoes an open reduction and internal fixation of the pelvis. Following surgery, the client receives patient-controlled analgesia for 24 hours. When this prescription is discontinued, a new prescription is written for Morphine 2 mg every 4 hours PRN.
The nurse caring for the client is concerned about the amount of opioid analgesics that the client has received since her fracture occurred. The nurse administers a dose of normal saline IV the next time the client requests pain medication and reports to the charge nurse that the client indicates that she is pain free.

What action should the charge nurse implement?

Request that a social worker meet with the client to arrange drug abuse counseling.

Discuss the implications of placebo use with the nurse who administered the saline.

Notify the surgeon that this technique has reduced the client’s need for Morphine.

Encourage the nurse to continue the placebo use, alternating with the Morphine.

Answer 25

Discuss the implications of placebo use with the nurse who administered the saline.

The use of placebos has both ethical and legal implications, violates the nurse-patient relationship, and deprives patients of more appropriate methods of assessment or treatment.

Question 26

The charge nurse later overhears the nurse conversing with another staff member in the break room. The nurse states that the client is dependent on her pain meds and that her healthcare provider is a “quack” who has caused the client’s drug addiction.

What action should the charge nurse take?

Encourage the nurse to visit with the client’s daughter to share these concerns.

Meet privately with the nurse at once to discuss the conversation that was overheard.

Quietly leave the area and allow the nurse to ventilate these concerns in the break room.

Immediately confront the nurse in the break room about the negative remarks.

Answer 26

Meet privately with the nurse at once to discuss the conversation that was overheard.

The nurse is engaging in slander of the healthcare provider. The charge nurse must end the break room conversation and discuss the nurse’s behavior. This should be conducted in a private setting to maintain the nurse’s right to privacy. Through teamwork and collaboration the nurse should value the expertise of each interprofessional member.

Question 27

One week following surgery, the client is discharged and goes to stay with her daughter to complete her surgical recovery. During her next visit to her healthcare provider, she receives a prescription for daily subcutaneous injections of teriparatide, parathyroid hormone, to treat her osteoporosis.

In providing client teaching, the nurse discusses the need for periodic monitoring of which diagnostic serum lab value?

Harding, M.M. (2020) Lewis’s Medical-Surgical Nursing. (11th ed.) St. Louis, Missouri: Elsevier

Calcium.

Potassium.

Platelet count.

Hemoglobin.

Answer 27

Calcium.

PTH is the primary regulator of calcium and phosphate metabolism in bone and kidney, and the administration of PTH can result in increased serum calcium levels. Serum calcium levels, alkaline phosphatase, and uric acid should be monitored periodically during treatment.

Question 28

The nurse also discusses the adverse effects of the medication. [teriparatide, parathyroid hormone]

The nurse stresses the importance of reporting which problem?

Headache.

Dyspepsia.

Rhinitis.

Bone pain.

Answer 28

Bone pain.

The client should be instructed to report bone pain and unexplained leg cramps, which may be indications of altered serum calcium levels.

Question 29

The nurse observes the client as she demonstrates the procedure for subcutaneous self-injection. The client performs the procedure correctly but states that she feels very nervous about giving herself a daily injection.

What action should the nurse take?

Consult with the healthcare provider about a prescription for a different route of medication administration.

Encourage the client to practice the injection technique again under the supervision of the nurse.

Suggest that the client come to the provider’s office to receive the injections for the duration of the treatment.

Perform another demonstration of the injection procedure so the client can carefully observe the steps.

Answer 29

Encourage the client to practice the injection technique again under the supervision of the nurse.

Question 30

Further conversation reveals that the client is also worried about experiencing another fracture.

How should the nurse respond?

Your daughter is nearby in case you need help in the future.

How do you envision your lifestyle in the years ahead?

Try not to worry about that right now while you are still healing.

Most people your age have some health problem to cope with.

Answer 30

How do you envision your lifestyle in the years ahead?

Question 31

The client decides to attempt the self-injections at home, beginning the following day. A week later, she calls the nurse to report that she is able to administer the injections and has also taught her daughter how to perform the injection. The client states, “It is so comforting to be able to stay with my daughter while I recover. I hope I am not a burden to her.”

How should the nurse respond?

What other responsibilities does your daughter have?

Why would your daughter find you to be a burden?

I am sure your daughter is glad to be able to help you.

It sounds as if your daughter has been really helpful.

Answer 31

It sounds as if your daughter has been really helpful.

Question 32

You are a nurse working in the Rheumatic Disorders Clinic. This morning, a new client, Mrs. Mitchell arrives and needs an admission interview. You begin by asking her reason for seeking care.

Mrs. Mitchell has been experiencing joint pain in both of her hands and both of her knees for several months. Two weeks ago, she saw her healthcare provider (HCP), who prescribed an NSAID for pain relief and referred her to your clinic for further evaluation and follow up. The HCP believes that Mrs. Mitchell may be suffering from joint damage due to rheumatoid arthritis.

Rheumatoid arthritis has systemic manifestations, but primarily involves the joints. It begins with symmetric joint stiffness and pain. Symptoms are most intense in the morning and they are reduced as the day progresses. Joint symptoms are the result of which underlying cause in persons with rheumatoid arthritis?

thrombosis

bleeding

inflammation

infection

Answer 32

inflammation

With rheumatoid arthritis, joint symptoms are a result of a synovitis (inflammation of the synovial membranes) of involved joints. Joints are swollen, tender, and warm. Rheumatoid arthritis is a chronic disease with symptoms that are persistent, but fluctuate in severity, with periods of “remission” and periods of active disease (flare-ups). Although the exact etiology is unclear, an autoimmune component and a genetic predisposition are thought to be involved. Infection, caffeine use, and cigarette smoking may play a role.

Question 33

Because this is Mrs. Mitchell’s first visit to the clinic, a thorough history is important.

Rheumatoid arthritis is a chronic systemic autoimmune disease of the synovial joints. In contrast to osteoarthritis, the joints are intensely inflamed. It may begin subtly at age 30-40 with a low grade fever, malaise and early morning joint pain and stiffness. The most commonly affected joint is where the fingers meet the hand. The wrist, elbow, shoulder and ankle are commonly affected. You ask specific questions about her joint complaints.

Mrs. Mitchell is being evaluated for possible rheumatoid arthritis. A diagnosis of rheumatoid arthritis is usually based on symptoms. Common laboratory blood tests can also be done to detect inflammation, as well as bone and joint-related diseases.

Although overall symptoms vary, all clients with rheumatoid arthritis experience joint symptoms. Which of the following symptoms would you expect to assess in persons diagnosed with rheumatoid arthritis?
Select all that apply

Unilateral joint involvement

Joint swelling

Joint pain

Joint stiffness with inactivity

Limited joint motion

Pain relief with joint movement

Multiple joint involvement

Answer 33

Joint swelling

Joint pain

Joint stiffness with inactivity

Limited joint motion

Multiple joint involvement

Question 34

Rheumatoid arthritis can cause signs/symptoms that are not joint-related. Which of the following assessment questions are relevant, given Mrs. Mitchell’s possible diagnosis of rheumatoid arthritis?
Select all that apply

“Have you experienced weight changes?”

“Have you experienced fevers?”

“Have you experienced a change in energy level?”

“Has your appetite changed?”

“Have you had a rash?”

Answer 34

“Have you experienced weight changes?”

“Have you experienced fevers?”

“Have you experienced a change in energy level?”

“Has your appetite changed?”

Question 35

After taking Mrs. Mitchell’s history, you ask her if she has any questions or concerns.

Mrs. Mitchell hesitates, then tearfully answers, “One of my neighbors has rheumatoid arthritis, and she had to stop working. I’m afraid I will have to stop working too. Typing is a big part of my job, and the aspirin that my HCP prescribed hasn’t helped the pain in my hands.”

patient review image
How would you best respond to Mrs. Mitchell’s concern about the possible diagnosis of rheumatoid arthritis?

“Yes, rheumatoid arthritis can sometimes be crippling. Sometimes people become disabled.”

“I wouldn’t worry about that now. Let’s try to control your symptoms.”

“You probably don’t have rheumatoid arthritis.”

“Rheumatoid arthritis can cause serious joint problems, but there are many effective treatments that do control symptoms.”

Answer 35

“Rheumatoid arthritis can cause serious joint problems, but there are many effective treatments that do control symptoms.”

Question 36

You consider Mrs. Mitchell’s health history data. At 50 years of age, Mrs. Mitchell falls within the peak onset period for development of rheumatoid arthritis (35-50 years).

Rheumatoid arthritis is more common in women.

You assist the HCP with an assessment of Mrs. Mitchell’s joints. Joints commonly affected with rheumatoid arthritis include which of the following? Select all that apply

Proximal interphalangeal joints

Distal interphalangeal joints

Metacarpophalangeal joints

Wrist joints

Elbow joints

Knee joints

Ankle joints

Answer 36

Proximal interphalangeal joints

Metacarpophalangeal joints

Wrist joints

Elbow joints

Knee joints

Ankle joints

Question 37

After a thorough examination, the HCP tells Mrs. Mitchell that it appears she has early rheumatoid arthritis.

Mrs. Mitchell has soft tissue swelling and tenderness in more than three joints (with hand joints affected), bilateral joint involvement, and morning stiffness that persists for an hour or more. These are criteria that support a diagnosis of rheumatoid arthritis. Blood tests are prescribed for further confirmation, and to evaluate Mrs. Mitchell’s overall health status.

Which blood test results are consistent with a diagnosis of active rheumatoid arthritis?
Select all that apply

Decreased white blood cell count (WBC)

Decreased red blood cell count (RBC)

Increased platelet count

Positive rheumatoid factor (RF)

Increased erythrocyte sedimentation rate (ESR)

Increased C-reactive protein (CRP)

Answer 37

Decreased red blood cell count (RBC)

Increased platelet count

Positive rheumatoid factor (RF)

Increased erythrocyte sedimentation rate (ESR)

Increased C-reactive protein (CRP)

Question 38

The HCP prescribes a high dose of aspirin (extended release) for Mrs. Mitchell, 800 mg four times a day. A low dose of prednisone (10 mg per day) is also prescribed.

The HCP tells Mrs. Mitchell that another drug may be added after blood test results are evaluated.

Mrs. Mitchell has some questions about aspirin. She wants to know how aspirin will help. Your reply is based on the knowledge that aspirin reduces joint pain through which of the following effects: Select all that apply

antiinfective

analgesic

antipyretic

antidepressant

antiplatelet

antiinflammatory

Answer 38

analgesic
antiinflammatory

Question 39

You give Mrs. Mitchell further information about aspirin. Which of the following instructions concerning aspirin are correct?
Select all that apply

Aspirin tablets can be crushed and mixed with milk to avoid gastrointestinal irritation

Enteric-coated aspirin should be taken

Periodic blood tests may be required

Relief of symptoms may not be felt for a few weeks

Use sunscreen when going outside since skin may burn more easily

Answer 39

Enteric-coated aspirin should be taken

Periodic blood tests may be required

Relief of symptoms may not be felt for a few weeks

Question 40

Because Mrs. Mitchell will be taking a large dose of aspirin, she will be at risk for aspirin toxicity. Which of the following are signs/symptoms of aspirin toxicity and should be reported?
Select all that apply

Changes in hearing

Loss of taste sensation

Increased tendency to bruise

Confusion

Answer 40

Changes in hearing

Increased tendency to bruise

Confusion

Question 41

Hydroxycloroquine by itself does not slow disease progression but early use can improve long term outcomes. It has a delayed onset and full therapeutic effects take 3-6 months to develop. This medication has a number of side effects, and it can have rare but serious adverse effects. You should instruct Mrs. Mitchell to report which of the following?
Select all that apply

Blurred vision

Dizziness

Stomatitis

Rash

Gastrointestinal distress

Answer 41

Blurred vision

Dizziness

Rash

Gastrointestinal distress

Question 42

Although drug therapy is important for persons with rheumatoid arthritis, nonpharmacologic interventions are of equal importance. You provide Mrs. Mitchell with some general guidelines. Which suggestions should be included in the instructions for Mrs. Mitchell?
Select all that apply

“Quit your job so you can rest your fingers.”

“Use relaxation techniques.”

“Avoid wearing high-heeled shoes.”

“Try applying moist heat to joints to help ease discomfort.”

“Rest in bed as much as possible.”

“If poor appetite becomes a problem, eat several small meals a day rather than three large meals.”

Answer 42

“Use relaxation techniques.”

“Avoid wearing high-heeled shoes.”

“Try applying moist heat to joints to help ease discomfort.”

“If poor appetite becomes a problem, eat several small meals a day rather than three large meals.”

Question 43

Which surgical procedure is performed to repair and replace a joint?

Synovectomy

Arthroplasty

Tenorrhaphy

Arthrodesis

Answer 43

Arthroplasty

Arthroplasty involves surgical reconstruction/replacement of a joint.