Deck 72: Pharmacotherapy of Bone and Joint Disorders

Question 1

The nurse should instruct a client with the initial stages of osteoarthritis to engage in low-impact exercise and take:

A)opioid analgesics.
B)glucosamine and chondroitin agents.
C)acetaminophen.
D)high anti-inflammatory doses of aspirin.

Answer 1

acetaminophen.

Question 2

Normally,serum calcium level is maintained by:

A)Folic acid and thyroxine.
B)Vitamin C and prolactin.
C)Vitamin B₁₂ and aldosterone.
D)Vitamin D and parathyroid hormone.

Answer 2

Vitamin D and parathyroid hormone.

Question 3

Which most important for the nurse to ask the client who has been diagnosed with osteoporosis?

A)"How much weight have you gained in the last year?"
B)"How many dairy products do you consume per day?"
C)"Does someone in your household smoke?"
D)"What would you estimate your cholesterol intake to be?"

Answer 3

"How many dairy products do you consume per day?"

Question 4

The recommended dietary allowance for calcium in the normal healthy adult is:

A)1,600-2,000 mg per day.
B)1,000-1,200 mg per day.
C)200-600 mg per day.
D)2,400-2,800 mg per day.

Question 5

What would the nurse identify as a priority diagnosis for a client with osteoporosis?

A)Activity Intolerance related to inadequate nutrition and anemia
B)Injury,Risk for related to loss of bone calcium
C)Infection,Risk for related to impaired host defenses
D)Constipation related to side effects of calcium replacement therapy

Question 6

A client has been prescribed allopurinol (Zyloprim)for gout.The purpose of this medication is to:

A)relieve the inflammation caused by this disease process.
B)reduce the formation of uric acid.
C)help the body excrete excess uric acid.
D)prevent the joint damage associated with this disease.

Question 7

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil).The nurse should caution the client to:

A)report blurred vision or decreased reading ability immediately.
B)continue taking a glass of red wine before dinner to reduce cardiovascular risk.
C)take this drug with an antacid to decrease stomach distress.
D)expose skin to sunlight for at least 20 minutes every day to help with bone formation.

Question 8

The nurse is teaching a client about taking risedronate (Actonel)for osteoporosis.Which statement by the client indicates a need for further teaching?

A)"I will wait at least 30 minutes before eating."
B)"I will take the medication first thing in the morning,with water."
C)"I can return to bed while I wait for the medication to work."
D)"I will report difficulties with heartburn."

Question 9

A client has a serum calcium level of 12.0 mg/dL.The nurse suspects that the client is experiencing a pathophysiological process such as:

A)osteomalacia.
B)metastatic bone tumor.
C)hypoparathyroidism.
D)chronic renal disease.

Question 10

The nurse,instructing a client on the prevention of osteoporosis,includes the importance of maintaining a normal serum calcium level because:

A)calcium influences the contraction of skeletal muscle.
B)calcium ions assist in blood clotting.
C)appropriate nerve conduction depends on an adequate calcium level.
D)the support provided by bones is important for the structural integrity of the body.

Question 11

A calcium supplement has been added to a client's drug regimen.The nurse should advise the client to:

A)Decrease intake of dairy products to prevent hypercalcemia.
B)Increase consumption of fruits and vegetables high in vitamin C.
C)Avoid taking calcium supplements with bran or whole-grain cereal.
D)Increase consumption of lean meats for additional protein intake.

Question 12

The nurse is planning an educational program for a group of senior citizens on the importance of calcium intake.The nurse will explain that approximately 50% of the calcium in the body participates in intracellular functions and is:

A)nonionized.
B)bound to albumin.
C)complexed.
D)ionized.

Question 13

A client with a calcium imbalance has an elevated calcitonin level.The nurse recognizes that the secretion of calcitonin is increased when the client experiences:

A)hypocalcemia.
B)hypothyroidism.
C)hyperthyroidism.
D)hypercalcemia.

Question 14

A client is being treated for type 2 diabetes mellitus,tuberculosis,and rheumatoid arthritis.The nurse would be most concerned about this patient being treated with which medication?

A)Etanercept (Enbrel)
B)Hydroxychloroquine (Plaquenil)
C)Methotrexate (Rheumatrex)
D)Sulfasalazine (Azulfidine)

Question 15

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil).To encourage compliance,the nurse should advise the client to expect the effects of this drug to begin within:

A)3-6 days.
B)6-9 months.
C)7 days.
D)4-6 weeks.

Question 16

For which symptom is it critical for the nurse to monitor when caring for a client with hypoparathyroidism?

A)Decreased peristalsis
B)Tetany
C)Weakness
D)Vomiting

Question 17

A client with osteoporosis has been prescribed raloxifene (Evista).Which the nurse ask to determine the client's risks for complications with this drug?

A)"Have you ever had esophageal or ulcer disease?"
B)"Do you have a history of abnormal breast biopsies?"
C)"Have you ever had or been treated for blood clots?"
D)"Have you ever had any broken bones?"

Question 18

The nurse is instructing a mother to encourage her school-age children to play out of doors because it will help reduce the risk of osteomalacia by:

A)increasing renal perfusion,which helps to activate vitamin D.
B)increasing the level of an inactive form of vitamin D in the blood.
C)increasing osteoblastic activity to maintain calcium in the bone.
D)enhancing activation of the parathyroid hormone.

Question 19

The nurse is concerned that a client is at risk for the development of hypocalcemia because of which health problem?

A)Renal disease
B)Osteoporosis
C)Osteoarthritis
D)Cardiac damage

Question 20

A client is prescribed a disease-modifying antirheumatic agent.What will the nurse explain as the mechanism of action for this medication?

A)Provides rapid relief of symptoms
B)Prevents the need for orthopedic surgery
C)Reduces damage and delays disease progression
D)Allows the client to be more active

Question 21

A client is prescribed colchicine (Colcrys)for gout.The nurse discusses possible adverse effects of this therapy,including: Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)nausea and vomiting.
B)abdominal pain.
C)diarrhea.
D)constipation.
E)muscle pain.

Question 22

A client with osteoarthritis does not want to use medication for pain control.What can the nurse suggest to improve the symptoms of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Begin a walking program.
B)Perform exercises to strengthen the quadriceps muscle.
C)Discuss the use of a brace with the health care provider.
D)Consider losing weight.
E)Schedule joint replacement surgery as soon as possible.

Question 23

Which clients would the nurse identify as needing 1,300 mg of calcium per day? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Client age 15
B)Pregnant client age 17
C)Client age 30
D)Client age 53
E)Client age 83

Question 24

When planning care for a client,the nurse will include interventions to address factors that predispose the client to developing gout,including: Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)taking a prescribed thiazide diuretic.
B)taking aspirin every day.
C)drinking four beers every night.
D)receiving treatment for polycythemia.
E)being diagnosed with heart failure.

Question 25

The nurse determines that teaching about gout has been effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I should increase my fluid intake to 2 to 4 liters every day."
B)"I should avoid eating salmon,sardines,organ meats,alcohol,mushrooms,legumes,and oatmeal."
C)"I should notify my health care provider if my pain gets worse."
D)"I should weigh myself every day and notify my health care provider if I gain over 2 lbs in a day."
E)"I will expect to experience flank pain when taking this medication."

Question 26

A client who is experiencing no symptoms of a low calcium level asks why calcium is important.How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Calcium is needed to keep the nervous system working properly."
B)"Calcium is used by the body to make the muscles move."
C)"Calcium is used in the blood to help with clotting."
D)"Calcium maintains the normal respiratory rate."
E)"Calcium is needed to control blood glucose levels."

Question 27

While conducting a physical assessment,the nurse is concerned that the client,who is taking a bisphosphonate,is showing signs of osteonecrosis of the jaw.What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Jaw pain and swelling
B)Several loose teeth
C)Elevated blood pressure
D)Oral lesions
E)Difficulty swallowing

Question 28

A client is diagnosed with a vitamin D deficiency.To aid in the correction of this deficiency,the nurse instructs the client to: Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)spend 15 minutes a day in the sun without sunscreen.
B)increase the intake of milk.
C)increase intake of vitamin-enriched foods.
D)increase intake of red meat.
E)increase intake of leafy greens.