ONCB Metabolic/Inflammatory/Tumors Practice Exam 50 Questions with Verified Answers
Category: Metabolic bone disorders
A nurse is caring for a
... [Show More] 58-year-old female patient. Which of the following should the nurse recognize as a risk factor for development of osteomalacia in this patient?
a. Excessive sunlight exposure
b. Gastric bypass surgery
c. Unmanaged hypertension
d. Sickle cell disease - CORRECT ANSWER b. Gastric bypass surgery
Rationale: Osteomalacia primarily results from conditions related to vitamin D disturbances, including malabsorption syndromes that result from procedures such as gastric bypass surgery. It can also occur from inadequate sunlight exposure. It is not related to hypertension or sickle cell disease.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
Category: Metabolic bone disorders
In providing education for a child with hypoparathyroidism, a nurse should identify the risk for which of the following complications?
a. Diplopia
b. Acute dystonia
c. Tardive dyskinesia
d. Dental abnormalities - CORRECT ANSWER d. Dental abnormalities
Rationale: Dental abnormalities such as caries, enamel hypoplasia, pitting, and delayed eruption of teeth can occur as complications of hypoparathyroidism. The other listed conditions are not associated with hypoparathyroidism.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389
Category: Metabolic bone disorders
A patient is suspected to have Paget's disease. The patient asks the nurse how this diagnosis will be confirmed. The nurse replies, "This diagnosis is confirmed with
a. radiological findings."
b. urine testing."
c. blood testing."
d. MRI findings." - CORRECT ANSWER a. radiologic findings
Rationale: Primary diagnosis of Paget's disease is confirmed with radiological findings. Early phases are marked by the presence of osteolytic lesions, mostly in the skull and long bones. Adjoining overgrowth of bone appears coarse and irregular in shape. After symptoms are identified, x-rays show a characteristic mosaic pattern. Radioactive bone scan can assist with diagnosis. Although urine and blood testing are performed, results do not provide a definitive diagnosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390
Category: Metabolic bone disorders
A nurse is providing a class at the senior center about risk factors for osteoporosis. Which of the following should the nurse include in the discussion?
a. Increased body weight
b. Decreased protein intake
c. Caffeine intake
d. Use of nonsteroidal anti-inflammatory drugs - CORRECT ANSWER c. caffeine intake
Rationale: Intake of caffeine and alcohol increases the risk of osteoporosis. Use of certain drugs, such as corticosteroids, heparin, anticonvulsants, and immunosuppressants, also increases disease risk. A high-protein diet and small body/low weight are additional risk factors.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
Category: Metabolic bone disorders
When reviewing laboratory results for a patient with hypoparathyroidism, a nurse should expect which of the following?
a. Increased serum phosphate
b. Increased serum calcium
c. Decreased serum magnesium
d. Decreased serum chloride - CORRECT ANSWER a. Increased serum phosphate
Rationale: Serum phosphate is increased, typically greater than 5.4 mg/dL. Serum calcium is decreased, while serum chloride and serum magnesium are both increased.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389
Category: Metabolic bone disorders
A 65-year-old Caucasian female sustained a right wrist fracture from a fall in her garden. During her follow-up appointment in the orthopaedic clinic, she tells the nurse, "I am glad I don't have osteoporosis like my neighbor." What should be the nurse's MOST appropriate response?
a. "You are so lucky it was your wrist and not your hip."
b. "When is the last time you had a bone mineral density test?"
c. "You should be sure the paths are clear in your garden."
d. "Because you are active outdoors, you are not at risk for osteoporosis." - CORRECT ANSWER b. "When is the last time you had a bone mineral density test?"
Rationale: Wrist fractures are a type of fragility fracture experienced as a complication of osteoporosis. Age, sex, and ethnicity place this patient at risk for this disease. Bone mineral density testing is used to evaluate for the presence of osteoporosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 379-380
Category: Metabolic bone disorders
A 2-year-old child has been diagnosed with rickets. When talking with the child's parents, the nurse should tell them the disease can affect all bones but the most common deformities are located in the
a. spine and lower extremities.
b. feet and hands.
c. upper extremities.
d. pelvic girdle. - CORRECT ANSWER a. spine and lower extremities
Rationale: The most common deformities occur in the spine and long bones of the lower extremities, possibly leading to deformity and the need for surgical intervention.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 385
Category: Metabolic bone disorders
The nurse is providing education on musculoskeletal conditions at a community center. The nurse should include discussion of the critical need for adequate vitamin D intake to decrease risk for:
a. Paget's disease.
b. osteomyelitis.
c. osteomalacia.
d. systemic sclerosis. - CORRECT ANSWER c. osteomalacia
Rationale: Osteomalacia is often due to inadequate intake of vitamin D. It can also be related to abnormal metabolism of vitamin D due to hepatic or renal disease and the side effect of medications used to treat these diseases. Vitamin D is not a factor in the other listed diseases.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
Category: Metabolic bone disorders
In assessing a patient, which of the following findings should the nurse identify as suggestive of a diagnosis of hypoparathyroidism?
a. Newly negative Trousseau's phenomenon
b. Hypoactive deep tendon reflexes (DTRs)
c. Bradycardia
d. Newly positive Chvostek's sign - CORRECT ANSWER d. Newly positive Chvostek's sign
Rationale: Positive Chvostek's sign is ipsilateral contraction of the facial muscles elicited by tapping the facial nerve just anterior to the ear. This sign cannot be considered diagnostic of hypoparathyroidism unless it was known to be previously absent. Other findings may include positive Trousseau's phenomenon and hyperactive DTRs. Tachycardia can occur if hypoparathyroidism is left untreated.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389
Category: Metabolic bone disorders
The nurse is providing education about Paget's disease for a newly diagnosed patient and his family. Which of the following should the nurse identify as a possible result of this disease?
a. Hearing loss
b. Hyperkinetic gait
c. Increased gastric motility
d. Femoral neck deformity - CORRECT ANSWER a. Hearing loss
Rationale: Bone deformities of the skull are associated with Paget's disease. They can cause pressure on cranial nerves, leading to hearing loss, vertigo, and vision problems. The patient with Paget's disease may develop a waddling gait; a hyperkinetic gait is associated with forms of chorea (e.g., Huntington's disease). Increased gastric motility is associated with hypoparathyroidism, while femoral neck deformity is associated with osteomalacia.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390
Category: Metabolic bone disorders
The nurse is caring for a patient with primary hyperparathyroidism. Which of the following should the nurse expect as a symptom of this patient's hypercalcemia?
a. Diarrhea
b. Nausea
c. Dry, flaky skin
d. Brittle nails - CORRECT ANSWER b. Nausea
Rationale: Hypercalcemia may result in nausea, vomiting, and constipation because of the diminished contractility of the muscular walls of the GI tract. Dry, flaky skin and brittle nails are symptoms of hypocalcemia.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 387
Category: Metabolic bone disorders
The nurse is providing staff education about Paget's disease. The nurse should identify the early osteolytic lesions of Paget's disease as most commonly affecting the
a. skull and long bones.
b. long bones and hands.
c. hands and vertebrae.
d. vertebrae and skull. - CORRECT ANSWER a. skull and long bones
Rationale: Characteristic lesions of early Paget's disease affect the skull and long bones most commonly.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390
Category: Metabolic bone disorders
The nurse is speaking with female athletes at the local high school. To decrease their risk of developing osteoporosis, the nurse should recommend which of the following?
a. Calcium intake of at least 1800 mg per day
b. A regular regimen of weight-bearing exercise
c. Decreased caloric intake to maintain ideal body weight
d. Involvement in tai chi or yoga for flexibility - CORRECT ANSWER b. A regular regimen of weight-bearing exercise
Rationale: An appropriate, regular weight-bearing exercise regimen will decrease risk of osteoporosis. Recommended daily calcium intake for adolescent females is 1300 mg. A balanced diet is needed, with appropriate caloric intake based on activity level. Flexibility exercises will not have a positive effect on bone mineral density.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379, 381
Category: Metabolic bone disorders
A 2-month-old child develops rickets. The child's mother asks why her child developed rickets. The nurse's response should be based on understanding of the impact of which of the following?
a. Parents' vegetarian diet
b. Child's poor vitamin C intake
c. Child's recent treatment with corticosteroids
d. Parents' residence in southern U.S. - CORRECT ANSWER a. Patients' vegetarian diet
Rationale: Rickets results from deficient bone mineralization due to inadequate calcium deposition. This is related also to a vitamin D deficiency. Children of vegetarian parents, or of parents who avoid milk products, are at increased risk of developing rickets.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 385
Category: Metabolic bone disorders
In discussing risk factors for osteoporosis with a group of women at a community center, a nurse should identify which of the following as most likely contributing to the development of the disease?
a. Hypertension
b. Hyperlipidemia
c. Anorexia nervosa
d. Sleep apnea - CORRECT ANSWER c. Anorexia nervosa
Rationale: Anorexia nervosa creates a nutritional imbalance, affecting the body's abilities to build and maintain bone quality and strength.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
Category: Metabolic bone disorders
A patient recently diagnosed with osteoporosis is prescribed alendronate (Fosamax®). Before the patient starts taking the medication, the nurse should encourage the patient to complete
a. cardiac evaluation.
b. renal function testing.
c. bone densitometry.
d. dental evaluation. - CORRECT ANSWER d. dental evaluation
Rationale: Incidence of osteonecrosis of the jaw (ONJ) has increased since patients began taking bisphosphonates such as alendronate in 2003. Extensive dental evaluation is now recommended before initiation of bisphosphonate therapy.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 381
Category: Metabolic bone disorders
A patient diagnosed with osteomalacia is scheduled for assessment of vitamin D values in the blood. The nurse should know vitamin D is most effectively measured in which of the following months?
a. June
b. July
c. August
d. September - CORRECT ANSWER d. September
Rationale: Vitamin D levels are most effectively measured from September through March due to the long-term effect of fat-soluble vitamin D properties of both dietary and vitamin D synthesis in the skin during sunlight exposure.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
Category: Metabolic bone disorders
An 80-year-old patient has been diagnosed with osteoporosis. The patient's daughter asks the nurse how her mother got this disease. Which of the following should the nurse identify as a risk factor for this patient's development of osteoporosis?
a. History of thyroid disease
b. Onset of menarche at age 11
c. History of obesity
d. Onset of menopause at age 58 - CORRECT ANSWER a. History of thyroid disease
Rationale: Chronic health conditions such as thyroid disease, endocrine disorders, and renal failure are risk factors for development of osteoporosis. Onset of menarche at age 13 or later is considered a risk factor for osteoporosis, as is early menopause. Thin persons are at greater risk of osteoporosis than persons who are obese.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 379-380
Category: Metabolic bone disorders
The nurse is reviewing the complications of hyperparathyroidism with a group of newly licensed nurses during their orientation. Which of the following conditions should the nurse include?
a. Seizure activity
b. Cardiac dysrhythmias
c. Delirium
d. Osteoporosis - CORRECT ANSWER d. Osteoporosis
Rationale: Hyperparathyroidism causes bones to become brittle due to osteoporosis. The other conditions are possible complications of the hypocalcemia (low serum calcium) of hypoparathyroidism.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 386
Category: Metabolic bone disorders
The nurse is presenting a case study about a patient with Paget's disease at the unit staff meeting. In discussing the patient's perioperative course after undergoing total hip arthroplasty, the nurse should identify increased bleeding risk due to
a. removal of osteolytic lesions.
b. hypervascularity of affected bone.
c. diminished bone activity.
d. calcification of involved bone. - CORRECT ANSWER b. hypervascularity of affected bone
Rationale: Medication administered during the postoperative period may increase the risk of bleeding due to excessive hypervascularity of affected bone in Paget's disease. Osteolytic lesions are identified on x-ray in early disease but they are not removed. With Paget's disease, bone activity is increased. Bone calcification is a chronic result of Paget's disease but does not increase bleeding risk.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 390-391
Category: Musculoskeletal tumors
After x-rays confirm a femoral mid-shaft fracture, a patient is also diagnosed with a small, isolated, asymptomatic endochondroma of the distal femur. When the patient's family asks the nurse about possible treatment, the nurse should confirm the surgeon's plan as discussed with the patient should include which of the following?
a. Schedule radiofrequency ablation.
b. Plan injection of high-dose steroids.
c. Follow with serial x-rays.
d. Plan surgical excision. - CORRECT ANSWER c, Follow with serial x-rays
Rationale: For isolated, asymptomatic endochondroma, the plan of care typically includes follow up with serial x-rays. Most lesions will need no surgical intervention unless growth is noted. Other identified treatments are likely with different benign lesions.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 425
Category: Musculoskeletal tumors
A patient is determined to have bone metastasis following a diagnosis of prostate cancer. Which of the following medications should the nurse know may be prescribed for this patient to reduce pain and decrease the potential for pathological fractures?
a. Teriparatide (Forteo®)
b. Calcitonin (Miacalcin®)
c. Raloxifene (Evista®)
d. Zoledronic acid (Reclast®) - CORRECT ANSWER d. Zoledronic acid (Reclast)
Rationale: The use of bisphosphonates to help reduce the risk of pathological fractures (except in spinal cord compression) is now recommended for patients with bone metastasis. Zoledronic acid has been show to significantly decrease osteoclastic activity and help relieve the pain of bone metastasis. Other listed medications are not bisphosphonates.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 441
Category: Musculoskeletal tumors
A 13-year-old male presents with fever, anemia, leukocytosis, and increased erythrocyte sedimentation rate (ESR). The nurse should know bone marrow biopsy is likely to confirm the presence of which of the following?
a. Osteosarcoma
b. Ewing's sarcoma
c. Multiple myeloma
d. Schwannoma - CORRECT ANSWER b. Ewing's sarcoma
Rationale: Ewing's sarcoma is often confused with osteomyelitis as affected patients typically present with fever, anemia, leukocytosis, and increased ESR. Diagnosis is by bone marrow biopsy.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 431
Category: Musculoskeletal tumors
A nurse is reviewing diagnostic results for a patient with suspected multiple myeloma. Which of the following results should the nurse expect for this patient?
a. X-ray report of multiple lytic lesions
b. Pathology report of spindle-shaped tumor
cells
c. X-ray report of "ground glass" appearance
d. Pathology report of densely packed small cells with round nuclei - CORRECT ANSWER a. X-ray report of multiple lytic lesions
Rationale: X-rays of bones affected by multiple myeloma will show multiple lytic lesions. "Ground glass" tumor appearance is associated with fibrous dysplasia (ossifying fibroma). Spindle-shaped cells are typical of numerous tumors but not of multiple myeloma, which is characterized by uncontrolled proliferation of highly differentiated B-lymphocytes. Small cells with round nuclei are typical of Ewing's sarcoma.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 442
Category: Musculoskeletal tumors
A young child and his parents are seen in the clinic. After assessment by the provider, a malignancy is suspected. The nurse should recognize which of the following as the MOST common primary malignant bone tumor in children?
a. Hemangioma
b. Mesenchymal chondrosarcoma
c. Osteosarcoma
d. Multiple myeloma - CORRECT ANSWER c. Osteosarcoma
Rationale: Osteosarcoma is the most common malignant bone tumor in children, occurring slightly more often in boys than in girls (1.5/1).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 430
Category: Musculoskeletal tumors
A patient questions the many laboratory tests that have been ordered to aid in diagnosis of his suspected musculoskeletal tumor. A nurse should explain that analysis for Bence-Jones protein in the urine is performed to rule out which of the following conditions?
a. Osteosarcoma
b. Multiple myeloma
c. Malignant lymphoma of the bone
d. Epithelioid sarcoma - CORRECT ANSWER b. Multiple myeloma
Rationale: Abnormal proteins in blood and urine, including Bence-Jones protein, are considered diagnostic of multiple myeloma.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 442
Category: Musculoskeletal tumors
The nurse is caring for an adult patient with soft tissue sarcoma. When the patient asks about treatment options, the nurse's response should be based on the knowledge that for the majority of affected patients, chemotherapy has
a. enabled rapid return to usual activities.
b. provided local control of the tumor.
c. been administered weekly for tumor management.
d. shown no increase in cure rate. - CORRECT ANSWER d. show no increase in cure rate
Rationale: Chemotherapy for sarcomas is being evaluated continually in an attempt to find the best combination of drugs. In the majority of adults with soft tissue sarcomas, however, chemotherapy has shown no increase in the cure rate.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 438
Category: Musculoskeletal tumors
A patient with osteosarcoma is scheduled to begin chemotherapy. The nurse should discuss the patient's increased risk for infection related to which of the following hematopoietic changes?
a. Neutropenia
b. Leukocytosis
c. Thrombocytopenia
d. Anemia - CORRECT ANSWER a. Neutropenia
Rationale: Hematopoietic changes in response to chemotherapy may include neutropenia, leukopenia, and thrombocytopenia. Infection control precautions must be implemented for the patient who is neutropenic.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 439
Category: Musculoskeletal tumors
A patient with a previous diagnosis of breast cancer now has been diagnosed with bony metastasis. The nurse should know the metastasis MOST likely occurred by
a. direct extension of the primary tumor.
b. hematogenous spread of the primary tumor.
c. lymphatic dissemination.
d. lytic dissemination. - CORRECT ANSWER c. lymphatic dissemination
Rationale: Lymphatic dissemination is a typical path for bone metastasis from breast cancer.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 440
Category: Musculoskeletal tumors
Following excision of a bony lesion, a patient undergoes reconstruction with allograft (cadaveric human bone) and rigid internal fixation. As part of the patient's discharge instructions, the nurse should include the need to remain non-weight-bearing for
a. 6-12 weeks.
b. 14-16 weeks.
c. 5-6 months.
d. 9-12 months. - CORRECT ANSWER a. 6-12 weeks
Rationale: Following reconstruction with allograft, the patient must remain non-weight-bearing for 6-12 weeks.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 436
Category: Inflammatory disorders
A patient is diagnosed with early rheumatoid arthritis (RA). In performing a physical assessment, the nurse should recognize which of the following as a sign of early disease in the hands?
a. Boutonniere deformity
b. Swan-neck deformity
c. Ulnar deviation
d. Spindle-shaped fingers - CORRECT ANSWER d. Spindle-shaped fingers
Rationale: Spindle-shaped fingers are a sign of early disease. The other signs are characteristic of later RA.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
Category: Inflammatory disorders
A patient is being discharged after diagnosis with rheumatic fever. The nurse should provide teaching on which of the following medications prescribed for home use?
a. Methotrexate
b. Allopurinol
c. Aspirin
d. Hyaluron - CORRECT ANSWER c. aspirin
Rationale: Salicylates such as aspirin are indicated for routine treatment of inflammation in patients with rheumatic fever. The other medications are not appropriate for treatment of this condition.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 353
Category: Inflammatory disorders
A patient is being seen in the clinic for suspected ankylosing spondylitis. The nurse should recognize which of the following symptoms as most frequently associated with this disorder?
a. Tender joints in feet and lower back with restricted back motion
b. Pain in shoulder that is aggravated by repetitive movements
c. Popping sounds with movement, and palpable nodules
d. Fever, elevated white blood cell count, and pain with compression - CORRECT ANSWER a. Tender joints in feet and lower back with restricted back motion
Rationale: The patient with ankylosing spondylitis (AS) has discomfort and stiffness in the spine, with restricted back motion. Pain also may occur at the plantar fascia and Achilles tendon insertions into the calcaneus. The other descriptions are not associated with AS.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 360
Category: Inflammatory disorders
A patient has silver scales on patches of bright red skin on the elbows, legs, and face. The patient's joints are swollen and nails are pitted, ridged, and discolored. Based on the likely diagnosis, a nurse should expect to
a. begin treatment immediately to obtain a cure of the condition.
b. control symptoms and begin treatment to suppress the condition.
c. consult dermatology for likely skin grafting.
d. begin antifungal treatment. - CORRECT ANSWER b. control symptoms and begin treatment to suppress the condition.
Rationale: Early treatment will slow progression of psoriatic arthritis, the condition exhibited by this patient. Medications such as NSAIDs may be used to control symptoms until disease-modifying agents can have effects.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
Category: Inflammatory disorders
A patient diagnosed with systemic lupus erythematosus (SLE) asks the nurse, "I have read about possible organ damage from lupus. What organ is affected most often?" The nurse should identify which of the following?
a. Liver
b. Pancreas
c. Lung
d. Kidney - CORRECT ANSWER d. Kidney
Rationale: The kidney is the most common organ affected by SLE. About 75% of patients with SLE develop renal disease, usually within the first 2 years after diagnosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 368
Category: Inflammatory disorders
The patient previously diagnosed with fibromyalgia syndrome tells the nurse that she has not exercised for several years. Which of the following should the nurse suggest?
a. Jogging every other day
b. Use of stair-stepper 10 minutes daily
c. Low-impact aerobic exercise three times a week
d. Weight-lifting every other day - CORRECT ANSWER c. Low-impact aerobic exercise three times a week
Rationale: The patient with fibromyalgia syndrome should exercise at the highest level possible without worsening symptoms. The patient should begin with gentle, warm-up flexibility exercises and progress to stretching. Low-impact aerobic exercise is encouraged three times a week. The other identified activities have greater intensity or frequency than is warranted for this patient.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 373
Category: Inflammatory disorders
The nurse is reviewing the medications of a patient with gout. The nurse should recognize that use of which of the following medications could have contributed to the development of gout?
a. Hydrochlorothiazide (HCTZ)
b. Atenolol (Tenormin®)
c. Metformin (Glucophage®)
d. Esomeprazole (Nexium®) - CORRECT ANSWER a. Hydrochlorothiazide (HCTZ)
Rationale: Use of certain common drugs can contribute to development of secondary gout. These medications include thiazide diuretics, salicylates, nicotinic acid, and alcohol.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 354
Category: Inflammatory disorders
A patient newly diagnosed with rheumatoid arthritis asks the nurse about the difference between RA and osteoarthritis. The nurse should tell the patient RA is marked by
a. morning stiffness of less than 1 hour.
b. joint laxity.
c. symmetric joint swelling.
d. asymmetric joint inflammation. - CORRECT ANSWER c. symmetric joint swelling
Rationale: Symmetric joint involvement is typical of RA. Swelling generally lasts more than 2 hours. Asymmetric joint involvement is characteristic of osteoarthritis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342
Category: Inflammatory disorders
A patient presents at the clinic with complaints of intermittent vasospasms and erythema of the fingertips, as well as difficulty in swallowing. A nurse should suspect the patient has
a. reactive arthritis.
b. systemic lupus erythematosus.
c. polymyalgia rheumatica.
d. systemic sclerosis. - CORRECT ANSWER d. systemic sclerosis
Rationale: Systemic sclerosis is a multisystem disease affecting the microvasculature and connective tissue, causing alterations in the skin and in a variety of internal organs. It is often accompanied by CREST syndrome: calcinosis, Raynaud's phenomenon (intermittent vasospasm of fingertips), esophageal dysmotility, sclerodactyly, and telangiectasias.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 364
Category: Inflammatory disorders
A patient has been diagnosed with fibromyalgia syndrome. The nurse should provide education on which of the following medications prescribed to increase the effectiveness of the nonsteroidal anti-inflammatory medication being taking by this patient?
a. Tricyclic antidepressant
b. Corticosteroid
c. Antimalarial agent
d. Salicylate - CORRECT ANSWER a. Tricyclic antidepressant
Rationale: NSAIDs have not proven beneficial when used alone, but their use with a tricyclic antidepressant may improve effectiveness.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 373
Category: Inflammatory disorders
A 28-year-old woman presents with complaints of transitory joint pain, especially in her hands, wrists, and knees. She tells the nurse she also has been experiencing weakness, intermittent fever, fatigue, and mood swings. The nurse should recognize these symptoms are consistent with development of
a. osteomalacia.
b. systemic lupus erythematosus.
c. polymyalgia rheumatica.
d. systemic onset rheumatoid arthritis. - CORRECT ANSWER b. systemic lupus erythematosus.
Rationale: The described symptoms are consistent with SLE. The patient also may complain of hair loss, rash, pleuritic chest pain, migraine headaches, visual disturbances and photosensitivity, cognitive dysfunction ("lupus fog"), and sores in the mouth.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 369-370
Category: Inflammatory disorders
A patient is receiving an infusion of infliximab (Remicade®) for treatment of rheumatoid arthritis. When the patient begins to complain of headache, body ache, and chills, the nurse should
a. administer Solu-Medrol® solution.
b. use subcutaneous administration instead.
c. slow the infusion rate.
d. call the Rapid Response Team. - CORRECT ANSWER c. slow the infusion rate
Rationale: Slowing the infusion rate and administering diphendydramine (Benadryl®) can help with the clinical syndrome of fever, chills, body aches, and headaches that may accompany administration of infliximab. Although Solu-Medrol can be used to treat RA, it is not administered to counteract reactions to infliximab. Infliximab is only given by infusion. The RRT is not needed in this situation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 343
Category: Inflammatory disorders
A 3-year-old has juvenile arthritis. In discussing activities with the parents that will encourage the child to exercise small and large muscles, the nurse should identify which of the following as effective in meeting this goal based on the patient's developmental level?
a. Blocks
b. Board games
c. Collections
d. Bicycling - CORRECT ANSWER a. Blocks
Rationale: For toddlers with arthritis, activities such as blocks, puzzles, and art projects will encourage the use of small and large muscles. Other activities are appropriate to older children.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 339
Category: Inflammatory disorders
An adult patient with rheumatoid arthritis (RA) has numerous joint deformities as a result of disease progression. A nurse should recognize which of the following as a "zigzag" deformity of the wrist?
a. Swan-neck deformity
b. Boutonniere deformity
c. Ulnar deviation
d. Phalangeal retraction - CORRECT ANSWER c. Ulnar deviation
Rationale: The "zigzag" wrist deformity common to RA is ulnar deviation. Swan-neck and boutonniere deformities, as well as phalangeal retraction, occur in the fingers.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 340
Category: Inflammatory disorders
A patient previously diagnosed with rheumatoid arthritis (RA) is seen in the clinic. Which of the following should the nurse expect to see documented in the patient's medical record?
a. Early involvement of small joints
b. Few white cells in the synovial fluid
c. Presence of Heberden's nodes
d. Asymmetric narrowing of the joint space
Incorrect - CORRECT ANSWER a. Early involvement of small joints
Rationale: The small joints (PIPs, MCPs, MTPs) are involved first in RA; other affected joints include the wrists, knees, and cervical spine. The other options are characteristic of osteoarthritis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342
Category: Inflammatory disorders
In reviewing the planned treatment with a patient diagnosed with polymyalgia rheumatica, a nurse should discuss which of the following as the drug of choice?
a. Disease-modifying agent
b. Corticosteroid
c. Antimalarial agent
d. Nonsteroidal anti-inflammatory drug (NSAIDs) - CORRECT ANSWER b. corticosteroids
Rationale: Corticosteroids are the drug of choice for treatment of PMR. Currently no data document steroid-sparing effects of other medications for this condition.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 351
Category: Inflammatory disorders
A patient in the clinic is being assessed for presence of Lyme disease. The nurse should know early disease is characterized by the presence of
a. erythema migrans.
b. variable heart block.
c. nerve palsy.
d. sleep disturbances. - CORRECT ANSWER a. erythema migrans
Rationale: The typical Lyme disease rash, known as erythema migrans, is characteristic of early localized disease (stage 1). Cardiac and neurologic involvement are typical of later stages of the disease.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 357
Category: Inflammatory disorders
The nurse is providing education for a patient diagnosed with reactive arthritis. The nurse should instruct the patient to avoid alcohol, particularly because of which of the following medications prescribed for this disorder?
a. Indomethacin (Indocin®)
b. Corticosteroid eye drops
c. Topical skin cream
d. Methotrexate (Rheumatrex®) - CORRECT ANSWER d. Methotrexate (Rheumatrex®)
Rationale: The nurse should instruct the patient on the safe use of all medications, including the avoidance of alcohol while taking methotrexate.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 362
Category: Inflammatory disorders
A nurse's education of a patient with suspected gout should be based on the understanding that the only method for definitive diagnosis of gout is
a. performance of foot x-rays.
b. assessment of rheumatoid factor.
c. performance of a bone scan.
d. analysis of synovial fluid. - CORRECT ANSWER d. analysis of synovial fluid
Rationale: Synovial fluid demonstrates the characteristic needle- or rod-shaped monosodium urate crystals that are typical of gout. Elevated serum urate is of limited value in establishing the diagnosis because about 30% of patients have normal values at the time of an acute gout attack.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 355
Category: Inflammatory disorders
A patient is diagnosed with polymyositis. Which of the following should be most important for the nurse to include in patient education?
a. Skin protection strategies
b. Good sleep practices
c. Aspiration precautions
d. Balance of rest and activity - CORRECT ANSWER c. Aspiration precautions
Rationale: Patients with PM often complain of difficulty swallowing and describe regurgitation of food. Education should include aspiration precautions for patient safety.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 368 [Show Less]