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MED/SURG FINAL EXAM WITH CORRECT ANSWERS (Lewis Chapters 14-16, 23-24, 41-50, 63-65)
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MED/SURG FINAL EXAM WITH CORRECT ANSWERS (Lewis Chapters 14-16, 23-24, 41-50, 63-65)
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MED/SURG FINAL (Lewis Chapters 14-16, 23-24, 41-50, 63-65)
1. A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would expect to be present on examination of the patient's knee is
a. Heberden's nodules.
b. redness and swelling of the knee joint.
c. pain upon joint movement.
d. stiffness that increases with movement. Answer: C
Rationale: Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA), and stiffness in OA is worse right after the patient rests and decreases with joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694
Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening patients at a community center, the nurse will plan to teach ways to reduce risk factors for osteoarthritis to a
a. 24-year-old man who participates in a summer softball team.
b. 36-year-old woman who is newly diagnosed with diabetes mellitus.
c. 49-year-old woman who works on an automotive assembly line.
d. 56-year-old man who is a member of a construction crew. Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky.
Cognitive Level: Application Text Reference: p. 1694
Nursing Process: Planning NCLEX: Physiological Integrity 3. The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient with osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use that the drug does not seem to be effective in controlling the pain. The nurse should teach the patient that a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of variations in individual response to the drugs.
b. it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood.
c. if NSAIDs are not effective in controlling symptoms, corticosteroids are the next drug of choice.
d. adding a twice-daily aspirin to the naproxen may improve the effectiveness of the drug.
Answer: A
Rationale: Individual responses to NSAIDs can vary, so the health care provider may prescribe a different NSAID. Full effectiveness of NSAIDs occurs in 2 to 3 weeks. Corticosteroids are usually reserved for use in RA. Patients are instructed to avoid aspirin when taking NSAIDs because of the increased risk for bleeding and gastrointestinal irritation.
Cognitive Level: Application Text Reference: p. 1697
Nursing Process: Implementation NCLEX: Physiological Integrity
4. When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae about management of the condition, the nurse determines that additional instruction is needed when the patient says,
a. "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
b. "A warm shower in the morning will help relieve the stiffness I have when I get up."
c. "I should try to stay active throughout the day to keep my joints from becoming stiff."
d. "I should take no more than 1 g of acetaminophen four times a day to control the pain."
Answer: C
Rationale: Protection and avoidance of joint stressors are recommended for patients with OA, so this patient should alternate periods of rest with necessary activity. The other patient statements indicate that teaching has been effective.
Cognitive Level: Application Text Reference: pp. 1696, 1701
Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance 5. A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The best response by the nurse is that
a. progression of OA can be prevented with a regimen of exercise, diet, and drugs.
b. OA is an inflammatory process with periods of exacerbation and remission.
c. joint degeneration with pain and deformity occurs with OA by age 60 to 70.
d. OA is common with aging, but usually it is localized and does not cause deformity. Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although exercise, diet, and drugs can help to decrease symptoms and slow disease progression, they will not prevent progression of the disease. OA is progressive and does not have exacerbations and remissions, which are typical of RA. Joint degeneration and pain occur later in OA; joint deformity is not a common symptom.
Cognitive Level: Application Text Reference: pp. 1701, 1704
Nursing Process: Implementation NCLEX: Physiological Integrity
6. A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to teach the patient about the use of
a. prednisone (Deltasone).
b. capsaicin cream (Zostrix).
c. sulfasalazine (Azulfidine).
d. doxycycline (Vibramycin). Answer: B
Rationale: Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA.
Cognitive Level: Application Text Reference: p. 1696
Nursing Process: Planning NCLEX: Physiological Integrity
7. A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches the patient that the most beneficial measure to protect the joints is to
a. use a wheelchair to avoid walking as much as possible.
b. sit in chairs that do not cause the hips to be lower than the knees. c. use a walker for ambulation to relieve the pressure on the hips.
d. eat according to a weight-reduction diet to obtain a healthy body weight. Answer: D
Rationale: Because the patient's major risk factor is obesity, the nurse should teach the patient that weight loss is the best way to reduce stress on the hips. Avoiding activity by sitting in a wheelchair would
likely increase the patient's weight; moderate activity is recommended for patients with OA. Sitting with the hips higher than the knees and using a walker would be recommended but are not as helpful as weight loss for this obese patient.
Cognitive Level: Application Text Reference: p. 1701
Nursing Process: Implementation NCLEX: Physiological Integrity
8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient, the most important information for the nurse to communicate to the health care provider is that the patient has
a. a history of infectious mononucleosis as a teenager.
b. a family history of age-related macular degeneration of the retina.
c. been trying to have a baby before her disease becomes more severe.
d. been using large doses of vitamins and health foods to treat the RA. Answer: C
Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.
Cognitive Level: Application Text Reference: p. 1699
Nursing Process: Assessment NCLEX: Physiological Integrity
9. A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrists, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time
is to
a. maintain a positive self-image.
b. perform activities of daily living independently.
c. achieve satisfactory control of pain.
d. make a successful adjustment to disease progression. Answer: C
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