MULTIPLE CHOICE
1. 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
ANS: B
Initi...
Harding : Lewis’s Medical -Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. 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 sw elling of the knee joint d. Stiffness that increases with movement ANS: B Initial symptoms of OA include pain with joint movement. Heberden‘s nodules occur on the fingers. Redness of the joint is associated with inflammatory arthritis such as rheumatoid arthr itis. Stiffness in OA is worse right after the patient rests and decreases with joint movement. DIF: Cognitive Level : Understand (Comprehension) TOP: Nursing Process : Assessment MSC: NCLEX: Physiological Integrity 2. The nurse is assessing a patient with osteoar thritis 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 multi ple joints. d. The patient uses capsaicin cream (Zostrix). ANS: B Dark -colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. The patient‘s ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Capsaicin cream is often used along with oral medications. DIF: Cognitive Level : Apply (Appl ication) TOP: Nursing Process : Assessment MSC: NCLEX: Physiological Integrity 3. 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 he lp 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.” ANS: C No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily to decrease the risk for liver damage. Regular exercise, moist heat, and supportive equipment are recommended for OA management. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Evaluation MSC: NCLEX: Physiological Integrity 4. 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) ANS: C Capsaicin cream blocks the transmi ssion of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with rheumatoid arthritis. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Planning MSC: NCLEX: Physiological Integrity 5. 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. ANS: C Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor, and injection is not needed. Rheumatoid nodules are usually not removed surgically be cause of a high probability of recurrence. DIF: Cognitive L evel: Apply (Application) TOP: Nursing Process : Implementation MSC: NCLEX: Physiological Integrity 6. Which action would the nurse include in the plan of care for a patient with a new diagnosis of rheuma toid 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. ANS: C Adequate rest hel ps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress. When the disease is stabilized, a physical therapist usually develops a therapeutic exercise p rogram that includes exercises that improve flexibility and strength of affected joints, as well as the patient‘s general endurance. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Planning MSC: NCLEX: Physiological Integrity 7. A patient with rh eumatoid 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 c hronic health condition. d. Teach the patient about adverse effects of the RA medications.
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