Question 1

An older female adult with osteoarthritis is seen by the nurse.She has a low-grade fever, and she tells the nurse that her pain is changing: it is worse at night and in her shoulder muscles.What should the nurse do to determine if the older person is now experiencing polymyalgia rheumatica (PMR) rather than an exacerbation of her osteoarthritis?
A)Assess the patient's joints for swelling and redness.
B)Obtain blood specimens for blood cultures.
C)Direct the patient to report pain in the neck and upper arms, possibly evolving to the pelvic and pectoral girdles.
D)Tell the patient to apply moist heat for 20 minutes.

Accepted Answer

The symptoms described by the patient, such as shoulder muscle pain that is worse at night and presence of fever, are suggestive of polymyalgia rheumatica (PMR). The nurse should ask specifically about the presence of pain in the neck and upper arms, which may be evolving to the pelvic and pectoral girdles, as this is a key feature of PMR. Assessing the patient's joints for swelling and redness may be useful in diagnosing osteoarthritis but would not differentiate between osteoarthritis and PMR. Obtaining blood specimens for blood cultures is not necessary in this case as there are no signs or symptoms of infection. Telling the patient to apply moist heat for 20 minutes may provide symptomatic relief but does not help in diagnosing PMR.

Question 2

Which of the following assessments is typical for an older person with osteoarthritis (OA)?
A)Narrow joint spaces with crepitus
B)Effects occurring in symmetrical joints
C)Morning stiffness for at least an hour
D)Swelling from excess synovial fluid

Accepted Answer

Narrow joint spaces with crepitus are a typical finding in older individuals with osteoarthritis as the condition leads to the loss of cartilage and the narrowing of joint spaces. Symmetrical joint involvement, morning stiffness for at least an hour, and swelling from excess synovial fluid are more typical of rheumatoid arthritis.

Question 3

An osteoporosis-related fall necessitated hip-replacement surgery for an older female adult who is entering a rehabilitation facility.Which of the following goals is the nurse's priority during this woman's rehabilitation?
A)Tell the patient to eat whole grains, fruits, and vegetables.
B)Recapture the patient's preoperative mobility status.
C)Keep the patient's surgical wound clean and dry.
D)Tell the patient to take two steps into the walker.

Accepted Answer

The priority goal for the nurse during the rehabilitation of the older adult after hip replacement surgery is to recapture the patient's preoperative mobility status. This is important for the patient to regain independence and prevent any further falls. The other options are also important, but they are not the priority in this situation. Eating a healthy diet can help promote healing, keeping the surgical wound clean and dry can prevent infection, and instructing the patient to use a walker is important for safety, but all of these goals can be addressed once the patient's mobility status has been addressed.

Question 4

An older male adult who has hyperuricemia complains of severe pain in the right ankle.Which instruction should the nurse include in patient teaching to enhance the action of medication the patient takes for his condition?
A)Avoid dehydration by drinking water.
B)Take aspirin when joints are red and hot.
C)Comply with antihypertensive diuretic regimen.
D)Avoid beef kidneys, asparagus, and alcohol.

Accepted Answer

Hyperuricemia is caused by uric acid buildup in the blood, which results in crystal formation around joints and other tissues, causing pain and inflammation. Foods high in purines, such as beef kidneys and asparagus, can increase uric acid levels and worsen symptoms. Alcohol can also increase uric acid levels and should be avoided. Therefore, avoiding these foods and alcohol is important in managing hyperuricemia. Drinking water helps to flush out excess uric acid, but this alone may not enhance the action of the medication. Aspirin may actually worsen hyperuricemia symptoms and should not be taken for this condition. Complying with an antihypertensive diuretic regimen is important in managing blood pressure but may not directly enhance the action of medication for hyperuricemia.

Question 5

Which statement about joints in older persons is true?
A)Osteoarthritis is an inflammatory joint disorder.
B)Surgical joint replacement can cure osteoarthritis.
C)Joint damage in osteoarthritis is reversed with medication.
D)Very old persons should avoid joint replacement surgery.

Accepted Answer

Surgical joint replacement can provide significant relief from the symptoms of osteoarthritis by replacing the damaged joint with an artificial one, although it does not "cure" the underlying disease process. It is a common and effective treatment for severe osteoarthritis, even in older individuals, when other treatments have failed to provide relief. Age alone is not a contraindication for joint replacement surgery; the decision is based more on the individual's overall health, activity level, and the severity of joint damage.

Question 6

Which of the following statements about osteoporosis is true?
A)Osteoporosis is indicative of an underlying health problem.
B)The most common site for osteoporosis fractures is in the long bones.
C)Women who are of African descent have the highest risk for osteoporosis.
D)A high risk of death follows an osteoporosis-related hip fracture.

Accepted Answer

A high risk of death follows an osteoporosis-related hip fracture. This is due to the complications that can arise from the fracture, such as pneumonia and blood clots. Osteoporosis itself is not indicative of an underlying health problem, and the most common site for osteoporosis fractures is in the spine, not the long bones. While Caucasian and Asian women have a higher risk for osteoporosis, women of African descent still have a significant risk as well.

Question 7

Which statement about rheumatoid arthritis (RA) is true?
A)Rheumatoid arthritis strikes different parts of the body unilaterally.
B)Patients with rheumatoid arthritis have no remissions and exacerbations.
C)Rheumatoid arthritis affects only joints.
D)It is considered an autoimmune disease, in which products from the inflamed lining of the joint invade and destroy the cartilage and bone within the joint.

Accepted Answer

Rheumatoid arthritis is considered an autoimmune disease, in which the immune system attacks the joints, resulting in inflammation and destruction of the cartilage and bone within the joint. It can also affect other parts of the body besides joints, such as the lungs and blood vessels. RA has periods of remissions and exacerbations, and often affects joints bilaterally.

Question 8

An older female adult seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia.To achieve the woman's goal, which teaching should the nurse provide to enhance the activity of osteoblasts?
A)Limit sodium intake.
B)Refrain from alcohol use.
C)Eat high-fibre foods.
D)Exercise with weights.

Accepted Answer

Exercise, particularly weight-bearing activities, increases osteoblast activity, which can help prevent further bone loss or even stimulate new bone growth. Limiting sodium intake, refraining from alcohol use, and eating high-fibre foods are all important for overall bone health, but they do not specifically enhance osteoblast activity.

Question 9

Which of the following represents characteristics of rheumatoid arthritis (RA) that are unlike osteoarthritis (OA)?
A)RA involves myalgia and stiffness.
B)RA involves joint pain, and it is curable.
C)RA involves crepitus and instability.
D)RA is systemic and symmetrical.

Accepted Answer

Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects multiple joints symmetrically. This is unlike osteoarthritis (OA), which is a degenerative joint disease that affects individual joints and is not systemic. Myalgia, stiffness, joint pain, crepitus, and instability can occur in both RA and OA. However, RA is not curable, while OA can be managed but not cured.

Question 10

After living with osteoporosis for two years, an older female adult's bone density scan shows no improvement.Which intervention should the nurse implement to reduce bone loss for this older person?
A)Add tai chi or yoga exercises.
B)Instruct her to drink fortified milk.
C)Increase weight-bearing exercise.
D)Review her daily nutritional habits.

Accepted Answer

The answer of After living with osteoporosis for two years,...

Question 11

Which one of the following is a suitable nursing intervention for an older person who has gout?
A)Vitamin D 400-1000 international units (IU)
B)Liquid paraffin hand baths and disease-modifying antirheumatic drugs
C)A diet low in purines
D)Aspirin 500 mg daily

Accepted Answer

Gout is caused by the buildup of uric acid, which is a byproduct of purines found in certain foods. Therefore, a diet low in purines can help manage the symptoms and prevent flare-ups. Vitamin D and aspirin are not specific interventions for gout, and liquid paraffin hand baths and disease-modifying antirheumatic drugs are more appropriate for conditions such as rheumatoid arthritis.

Question 12

The nurse prepares an older male person who has osteoarthritis (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.

Accepted Answer

Reporting joint instability to the health care provider is important for this patient with OA because it can lead to falls and injuries. It is also important to discuss pain management options with the healthcare provider, rather than making medication decisions independently. Increasing rest periods may provide temporary relief but it is not necessarily effective for slowing disease progression. Exercise is important for maintaining joint mobility, but the patient should avoid overstretching or causing further damage to the affected joint.

Question 13

Which of the following 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)Steak with brown rice, celery, and red wine for dinner
D)Coffee, raisin bran and milk, and sausage at breakfast; a can of cola and a hot dog on a high-fibre bun at lunch; and a cocktail before dinner

Accepted Answer

A diet high in calcium and vitamin D, found in dairy products and leafy greens like spinach, can help improve bone health and reduce the risk of osteoporosis. Avoiding excessive caffeine and alcohol intake, as well as smoking, is also recommended. Hormone therapy (such as estrogen administration) carries risks and benefits and should be discussed with a healthcare provider. Option C contains red meat, which has been associated with increased risk for osteoporosis, and option D contains high amounts of caffeine and sugary beverages, which can also contribute to bone loss.

Quiz 18: Bone and Joint Health

Which of the following assessments is typical for an older person with osteoarthritis (OA) ?

An osteoporosis-related fall necessitated hip-replacement surgery for an older female adult who is entering a rehabilitation facility.Which of the following goals is the nurse's priority during this woman's rehabilitation?

An older male adult who has hyperuricemia complains of severe pain in the right ankle.Which instruction should the nurse include in patient teaching to enhance the action of medication the patient takes for his condition?

Which statement about joints in older persons is true?

Which of the following statements about osteoporosis is true?

Which statement about rheumatoid arthritis (RA) is true?

An older female adult seeks advice from the nurse about preventing further bone loss after being diagnosed with osteopenia.To achieve the woman's goal, which teaching should the nurse provide to enhance the activity of osteoblasts?

Which of the following represents characteristics of rheumatoid arthritis (RA) that are unlike osteoarthritis (OA) ?

After living with osteoporosis for two years, an older female adult's bone density scan shows no improvement.Which intervention should the nurse implement to reduce bone loss for this older person?

Which one of the following is a suitable nursing intervention for an older person who has gout?

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

Which of the following is a healthy practice recommended for a person at risk for osteoporosis?