Question 1

Rheumatoid arthritis:

Accepted Answer

Rheumatoid arthritis is an inflammatory condition that includes systemic manifestations as well as the characteristic rheumatoid joint deformity.Diagnosis is made based on physical findings,including evidence of inflammation as verified by elevated erythrocyte sedimentation rate (ESR)and C-reactive protein (CRP).Rheumatoid factor (RF)is an antibody found in the blood that is associated with rheumatoid arthritis but may not be positive in the early stages of the disease.Pannus,a proliferation of tissue in the synovial space,can be observed on x-ray studies after the disease has progressed.Osteomalacia,not rheumatoid arthritis,is caused by a deficiency of vitamin D.Osteoporosis,not rheumatoid arthritis,is characterized by a loss in bone mass leading to compromised bone strength.

Question 2

An elderly patient is being discharged from the hospital after an acute exacerbation of gout.The nurse reviews instructions for allopurinol (Zyloprim)with him.The nurse knows that this medication:

Accepted Answer

Gout is an inflammatory joint disease linked to faulty purine metabolism in which uric acid is overproduced or underexcreted.Allopurinol acts as a uric acid synthesis inhibitor to lower the formation of uric acid.The other options are all incorrect because allopurinol does not act in this manner.Some other medications used to treat gout,such as probenecid and sulfinpyrazone,increase the excretion of uric acid.

Question 3

A 68-year-old female patient has a history of osteoporosis.She is on your surgical ward because of her recent wrist surgery.She is on the following medications: heparin 5000 units subcutaneously q12hr,Tums (calcium carbonate)1 tablet after meals and at bedtime,calcitonin 100 international units IM every morning,and Premarin (estrogen)0.3 mg PO,every morning.In writing your care plan,you identify risk for injury related to demineralization of bone.Which medication would be most likely to interfere with her bone integrity?

Accepted Answer

Long-term use of heparin can cause secondary osteoporosis.Premarin is a form of estrogen,which is used to treat osteoporosis.Although the exact mechanism is not known,calcitonin slows bone resorption and treats osteoporosis-related pain.Tums are calcium.

Question 4

A nurse is making a visit to the home of an 88-year-old client.The nurse reviews safety measures with the client and screens the home environment for potential hazards that could precipitate a fall.The nurse urges the client to eliminate:

Accepted Answer

Having throw rugs in the home environment increases the risk of the client tripping over the rugs and falling.Choices A,B,and D are all incorrect because these are measures that the nurse wants to encourage; using assistive devices,such as canes,and improving the environment with safety measures,such as railings and improved lighting at night,will decrease the fall risk for older clients in the home.

Question 5

A nurse in the geriatric outpatient clinic frequently receives questions from clients about exercise.The nurse answers their questions based on the knowledge that regular exercise:

Accepted Answer

Exercise is especially important for older clients.Exercise slows muscle atrophy that occurs with normal aging and promotes flexibility and strength,which improves mobility and decreases the likelihood of falls.Weight-bearing exercises help build bone strength and prevent osteoporosis.It is important that clients with rheumatoid arthritis follow an exercise program to maintain range of motion in joints.

Question 6

Parkinson's disease is characterized by which alteration in gait?

Accepted Answer

Parkinson's disease is characterized by a stooped posture and a short,rapid,shuffling gait,uncontrollable propulsions,or retropulsion.Ataxia is characterized by a wide-based gait with frequent side-stepping.A spastic,shuffling gait is characteristic of spondylotic cervical myelopathy.A waddling gait is characteristic of osteomalacia.

Question 7

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia.She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions.The nurse caring for the woman develops a care plan that includes the diagnosis Risk for falls.A priority nursing intervention for this client is to:

Accepted Answer

Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient.Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury.Maintaining a patient on bedrest can lead to deconditioning and actually contribute to falls.Assessing the client's dietary intake of calcium is a good intervention for this age group,but it is not a priority and will not prevent falls.

Question 8

You are answering your elderly client's questions about diet,exercise,and bone integrity.Which exercise would you inform her is the least effective in preventing bone demineralization?

Accepted Answer

Weight-bearing and resistive exercises help maintain bone mass.The only exercise listed above that is neither weight bearing nor resistive is swimming.

Question 9

You are performing discharge teaching for your elderly client with rheumatoid arthritis.Which client statement indicates a knowledge deficit?

Accepted Answer

Use of dietary supplements is not recommended in patients with rheumatoid arthritis because of potential unknown interactions with a complex drug regimen.Resting joints is as important as exercise in rheumatoid arthritis,thereby maintaining the ability to perform activities of daily living.Maintaining a balanced diet is advised with all chronic illnesses.

Question 10

Who is at greatest risk for developing osteoporosis?

Accepted Answer

Thin,white postmenopausal women of northern European descent are at greatest risk for developing osteoporosis.

Question 11

In planning your discharge teaching for a client with osteoporosis,which precautions should you encourage her to take?

Accepted Answer

Falls prevention education is critically important in a client with osteoporosis due to the increased risk for fracture.Removing clutter from the environment reduces the risk of falls.Stress is not directly related to osteoporosis.The recommended frequency for a bone density study is once for all persons older than age 65 and for those younger who have at least one risk factor.The recommended diet for a patient with osteoporosis is an adequate intake of calcium and vitamin D and limiting factors that inhibit calcium absorption such as alcohol,protein,and salt.

Quiz 15: Mobility