Chapter 18: Bone and Joint Problems My Nursing Test Banks

Chapter 18: Bone and Joint Problems

Test Bank

MULTIPLE CHOICE

1. 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.

ANS: D

One-third of all persons who have an OA-related fracture die within 1 year. OA can be a natural-occurring consequence of aging. The vertebrae, pelvis, and wrist are the most frequent sites for OA fractures. The risk of OA is much lower for African-American women than it is for those of other races. Thin women of northern European descent are at the highest risk.

PTS:1DIF:RememberREF:3-7

TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. Which is a healthy practice recommended for a person at risk for OA?

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.

Alendronate (Fosamax) 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

ANS: A

These foods in these quantities supply 1204 mg of calcium. Administering estrogen can increase the risk of cancer and heart disease. Alendronate (Fosamax) must be taken with a full glass of water on an empty stomach after awakening. Afterward, the patient must sit upright and refrain from eating or drinking for 30 minutes. Alcohol and high amounts of protein and salt inhibit calcium uptake, whereas caffeine, excess fiber, and phosphorus (in the cola) promote calcium excretion.

PTS:1DIF:UnderstandREF:4-7| 24

TOP: Nursing Process: Assessment MSC: Physiological Integrity

3. Which of the following is a true statement about joints in older adults?

a.

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.

ANS: B

Surgical joint replacement can cure OA and is the only cure for the disease. OA is a degenerative joint disease, whereas rheumatoid arthritis (RA) is an inflammatory process. Medications are used to control the pain of OA. The joint damage cannot be reversed except through joint replacement surgery. Surgical joint replacements are recommended even for those who are very old.

PTS:1DIF:UnderstandREF:3-7

TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. Which of the following statements is true about RA?

a.

Strikes unilaterally.

b.

Affects more men than women.

c.

Can affect body systems other than the joints.

d.

Glucosamine can be helpful for patients in the first 2 years of RA.

ANS: C

RA can affect body systems other than joints; this statement is true. Women are affected more often than men. RA strikes the same parts of the body on both sides and affects joints in a symmetrical pattern. Patients with RA can have remissions and exacerbations. Unlike OA, however, RA has a highly variable course, which may include remissions, as well as exacerbations. RA can affect body systems other than joints and can cause general fatigue and malaise and attack systems other than joints. Glucosamine can be helpful for patients in the first 2 years of RA. Conventional therapy for RA includes a complex regimen of medications. Glucosamine has not been proven to offer significant relief from RA.

PTS:1DIF:UnderstandREF:10-11

TOP: Nursing Process: Assessment MSC: Physiological Integrity

5. Which of the following nursing interventions are suitable for a patient who has gout?

a.

Nonsteroidal antiinflammatory drugs (NSAIDs)

b.

Liquid paraffin hand baths

c.

Colchicine (Colsalide) by mouth

d.

Hyaluronic acid injections

ANS: C

Colchicine is indicated in the treatment of an acute gout attack. NSAIDs can be used in pain management in all forms of arthritis. Liquid paraffin hand baths can be used to relieve pain in OA and RA. Hyaluronic acid injections are used by some to relieve the pain of OA in the knee. Salicylates should not be used in gout because they can exacerbate an attack.

PTS:1DIF:UnderstandREF:11-15

TOP: Nursing Process: Assessment MSC: Physiological Integrity

6. An OA-related fall necessitated hip replacement surgery for an older woman who is entering a rehabilitation facility. Which of the following is the nurses priority goal during this womans rehabilitation?

a.

Incorporate whole grains into her diet.

b.

Recapture preoperative mobility status.

c.

Keep the surgical wound clean and dry.

d.

Tell her to take two steps into the walker.

ANS: B

Only 40% of people who have an OA-related fracture recuperate to their prefall mobility status; therefore the most important goal for the nurse is to plan care designed to restore her baseline mobility status. This comprehensive goal encompasses nutrition, exercise, rest, and physical therapy and prevents postoperative complications, such as atelectasis and pneumonia, impaired skin integrity, constipation, and dehydration, which can plague older adults. Increasing dietary fiber and nutrient-dense foods is an intervention to help maintain regular bowel habits and to repair and build tissue; it is integral to postoperative and rehabilitative care for an older adult but is not the highest priority. Preventing infection and promoting skin integrity are integral to postoperative and rehabilitative care for an older adult. Instructing the older adult about properly using a walker is an intervention and part of the primary goal of restoring preoperative mobility.

PTS: 1 DIF: Analyze REF: 3-15 TOP: Nursing Process: Planning

MSC: Physiological Integrity

7. An older woman seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia. To achieve the womans goal, which of the following patient teachings should the nurse provide to enhance the activity of the osteoblasts?

a.

Limit sodium intake.

c.

Eat high-fiber foods.

b.

Refrain from alcohol use.

d.

Exercise with weights.

ANS: D

In osteopenia, bone metabolism is unbalanced because the action of osteoclasts is greater than the action of osteoblasts. To treat osteopenia effectively, the balance between the activities of the bone cells must be shifted to more osteoblast (bone-building) activity; increasing osteoblast activity helps reduce bone loss and, at the same time, helps gain bone density. Lifting weights stimulates osteoblasts to build bone through the application of opposing forces on the bone and helps achieve the womans goal by increasing physical activity (to stem bone loss) and by generating more bone (to gain bone density). Sodium impairs calcium absorption; therefore the nurse instructs her to limit sodium intake to reduce bone loss. Alcohol impairs calcium absorption; therefore the nurse instructs her to avoid alcoholic beverages. Fiber inhibits calcium absorption.

PTS: 1 DIF: Analyze REF: 3-15 TOP: Nursing Process: Planning

MSC: Physiological Integrity

8. An older adult who has OA receives a prescription for alendronate (Fosamax). Which instruction should the nurse include in patient teaching?

a.

Use with a bisphosphonate medication.

b.

Is available for oral use.

c.

Take this medication for up to 2 years.

d.

Consume up to 600 mg of calcium daily.

ANS: B

Fosamax is available for oral use. This medication is bisphosphonate therapy. No time limit on administration exists. The nurse instructs the patient to consume 1200 mg of calcium daily.

PTS: 1 DIF: Apply REF: 4-8 TOP: Teaching/Learning

MSC: Physiological Integrity

9. After living with OA for 2 years, an older womans bone density scan shows no improvement, despite consistent bisphosphonate therapy. Which intervention should the nurse implement to reduce bone loss for this older adult?

a.

Add tai chi or yoga exercises.

b.

Instruct her to drink fortified milk.

c.

Increase weight-bearing exercises.

d.

Review her daily nutritional habits.

ANS: D

Reviewing the older adults nutritional habits can reveal clues about potential dietary contributors to bone loss from excessive sodium, alcohol, caffeine, or carbonated beverage intake. In addition, the nurse also confirms that the patient avoids smoking and a sedentary lifestyle that contribute to bone loss. Tai chi or yoga, drinking fortified milk, and increasing weight-bearing exercises can all help increase bone density.

PTS: 1 DIF: Apply REF: 4-14 TOP: Nursing Process: Planning

MSC: Physiological Integrity

10. Which assessment is typical for a patient with OA?

a.

Narrow joint spaces with crepitus

b.

Effects in symmetrical joints

c.

Morning stiffness for at least an hour

d.

Swelling from excess synovial fluid

ANS: A

The joint of an older adult with OA is narrower than a normal joint, and as the disease advances, crepitus is palpable over the joint. The joint narrows as it degenerates, and crepitus occurs as the articulating surfaces of the bone abnormally move against each other. Disease in symmetrical joints is characteristic of RA. Morning stiffness lasting for 1 hour or more is characteristic of polymyalgia rheumatica. Swelling from excessive synovial fluid is characteristic of RA.

PTS:1DIF:RememberREF:8-9

TOP: Nursing Process: Assessment MSC: Physiological Integrity

11. The nurse prepares an older man who has OA for discharge. Which instruction does the nurse include in patient teaching to maintain safety for this man?

a.

Take ibuprofen (Motrin) rather than opioid analgesics.

b.

Increase rest periods to slow disease progression.

c.

Report joint instability to the health care provider.

d.

Avoid stretching the affected joint during exercise.

ANS: C

As OA progresses, the joint deteriorates and can become unstable, thereby increasing the risk of falls. The joint stability will not improve without physical therapy or surgery; therefore the patient needs to report instability to the health care provider. Although ibuprofen is much less likely to cause dizziness, hypotension, or sedation, nonsteroidal antiinflammatory agents such as ibuprofen are poor analgesic choices for older adults; they can aggravate hypertension and impair renal blood flow. The nurse avoids recommending increased rest because rest contributes to stiffness. Stretching is an important form of exercise for older adults with OA; it helps maintain joint flexibility and range of motion.

PTS: 1 DIF: Apply REF: 7-10 TOP: Teaching/Learning

MSC: Safe, Effective Care Environment

12. The nurse sees an older woman with OA and a low-grade fever. The patient tells the nurse that her pain is changing; it is worse at night and in her shoulder muscles. Which of the following does the nurse perform to prevent complications of this patients condition?

a.

Assess her joints for swelling and redness.

b.

Obtain blood specimens for blood cultures.

c.

Direct her to report temporal or scalp pain.

d.

Tell her to apply moist heat for 20 minutes.

ANS: C

The older adult exhibits clinical indicators of polymyalgia rheumatica (PMR), and a serious complication of PMR is giant cell arteritis (GCA). The nurse instructs the patient to report scalp and temporal pain because they are early indicators of GCA. As a complication of PMR, the patient exhibits clinical indicators of PMR that include severe pain and stiffness of muscles, including the back, buttocks, and thighs. PMR is not a disease that affects the joints. Blood cultures are not indicated for PMR because it is not an infection. Because PMR is an autoimmune, inflammatory disorder, applying heat is more likely to aggravate the patients condition. Effective treatment for PMR includes low-dose steroids. However, low-dose steroids are unrelated to preventing complications of PMR.

PTS:1DIF:ApplyREF:10

TOP: Nursing Process: Implementation MSC: Physiological Integrity

13. Which of the following characteristics of RA are unlike those of OA?

a.

Myalgia and stiffness

c.

Crepitus and instability

b.

Joint pain that is curable

d.

Systemic and symmetrical

ANS: D

OA is not a systemic disease, nor does it affect joints symmetrically. Myalgia and stiffness are characteristics of PMR; however, myalgia is uncharacteristic of RA and OA. Joint pain is characteristic of both RA and OA, but only OA is curable through joint replacement. RA is a systemic disease and affects joints symmetrically; therefore these are clinical indicators of OA, not RA.

PTS:1DIF:UnderstandREF:4-11

TOP: Nursing Process: Assessment MSC: Physiological Integrity

MULTIPLE RESPONSE

1. An older man who has hyperuricemia complains of severe pain in the right ankle. Which instructions should the nurse include in patient teaching to enhance the action of the medication the patient takes for his condition? (Select all that apply.)

a.

Avoid dehydration by drinking water.

b.

Take aspirin when joints are red and hot.

c.

Comply with antihypertensive diuretic regimen.

d.

Avoid game meat, asparagus, and alcohol.

ANS: A, B, D

Because this individual exhibits an acute attack in the ankle from hyperuricemia, the goal of therapy is to prevent another attack. To decrease uric acid production, the prophylactic medication of choice for gouty arthritis is colchicine (Colsalide). To enhance the action of this medication and to further reduce this patients risk of another attack, the nurse instructs the patient to avoid game meat and asparagus, because they contain purine, and to avoid alcohol, because it increases uric acid production. The nurse instructs the patient to drink 2 liters of water daily to facilitate uric acid excretion and to prevent the crystallization of uric acid in the renal tubules. The nurse also instructs this individual to avoid aspirin because it increases the risk of an acute attack and counteracts the benefit of uric acid prophylaxis. Antihypertensive therapy helps reduce the risk of another attack, but when diuretic agents are used for antihypertensive therapy, the potential benefit for gout prophylaxis is blunted because diuretics increase the risk of gouty attacks.

PTS: 1 DIF: Analyze REF: 11-15 TOP: Teaching/Learning

MSC: Physiological Integrity

2. An older man who has chronic obstructive lung disease has muscle wasting and poor skin integrity as a result of a long-term therapeutic regimen. Which patient teaching should the nurse use to help reduce his risk of falls? (Select all that apply.)

a.

Take calcium carbonate (Caltrate) 600 mg with meals.

b.

Take omeprazole (Prilosec) before breakfast.

c.

Participate in a progressive regular exercise program.

d.

Avoid crowds and people with contagious illnesses.

e.

Consume a well-balanced diet that is high in calories.

f.

Perform gentle skin cleansing with an emollient lotion.

ANS: C, E

Participating in a regular exercise program is an important nursing intervention to help prevent the risk of falls for this older adult who has clinical indicators of complications from steroid therapy. Steroids are a common therapeutic regimen used during exacerbations of chronic obstructive pulmonary disease (COPD). When needed on a long-term basis, steroids can ravage the skin and the musculoskeletal system of the patient, causing muscle wasting and OA. Thus this man is likely to have below-normal bone density; therefore the nurse instructs him to participate in regular, progressive exercises and pulmonary rehabilitation to build cardiopulmonary reserve, muscle bulk, and bone density to help reduce the risk of falls. The nurse also instructs the patient to eat a high-calorie, well-balanced diet to provide the body with substrate for tissue building and repair. A higher amount of calories than usual are required because patients with COPD work hard to breathe, and this work requires more calories to prevent tissue atrophy. A well-balanced diet helps prevent the risk of falls by supplying the body with sufficient fuel to sustain activity and by increasing bone and muscle density to maintain balance and coordinated movement. Although this man is at risk for below-normal bone density, the nurse instructs the patient to take up to 500 mg of calcium because the system cannot absorb more than 500 mg at a time. To protect the gastrointestinal tract, administering a proton-pump inhibitor is a reasonable nursing intervention for a patient with a history of taking steroids; however, this intervention is not directly related to reducing the risk of falls. Avoiding sick people is a reasonable nursing intervention to prevent the risk of infection for an individual with COPD. The nurse instructs this older adult to cleanse the skin gently and to apply an emollient lotion to maintain skin integrity.

PTS: 1 DIF: Analyze REF: 4-15| 24 TOP: Teaching/Learning

MSC:Health Promotion and Maintenance

3. The nurse identifies which risk factor(s) for OA? (Select all that apply.)

a.

Men

c.

Old age

b.

African Americans

d.

Steroid use

ANS: C, D

Older adults and steroid use have been identified as risk factors for the development of OA. Women are more prone. Caucasians and Asian Americans are more at risk.

PTS:1DIF:UnderstandREF:23

TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. The nurse is educating an older woman on foods high in calcium. Which foods should the nurse include? (Select all that apply.)

a.

Chinese cabbage

c.

Cheese pizza

b.

Soy milk

d.

Whole wheat

ANS: A, B, C

Chinese cabbage, soy milk, and cheese pizza have all been identified as foods that are high in calcium. Whole wheat bread contains calcium; however, it is not a high calciumrich food.

PTS: 1 DIF: Understand REF: 24 TOP: Teaching/Learning

MSC:Health Promotion and Maintenance

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