Medical-Surgical B Exam 2023 with complete solutions(graded A+)

Rank in order the sequence of events leading to joint destruction in secondary osteoarthritis (OA) beginning with the effect of an injury to the cervical spine. A. Exacerbation of abdominal tissue growth B. Bony articular surfaces in joint exposed C. Fragile, soft, dull joint cartilage develops D. Irregular joint motion, stiffness, and pain C. Fragile, soft, dull joint cartilage develops A. Exacerbation of abdominal tissue growth D. Irregular joint motion, stiffness, and pain B. Bony articular surfaces in joint exposed A precipitating factor, such as trauma to the spine, leads to the development of OA by damaging the cartilage. Joint destruction begins with the development of dull, soft, less elastic, and more fragile cartilage. Because the body is unable to repair the cartilage fast enough, the cartilage develops fissures and erosion and, in so doing, becomes thinner, leading to the formation of osteophytes and cartilage at the joint margins. The formation of abnormal tissue leads to abnormal joint movement. Pain and stiffness increase as the bony surfaces of the joint are exposed. Ch. 65 Pre-Assessment #1 The nurse is assessing a patient who is complaining of joint pain and stiffness. Which assessment does not differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA)? A. Symmetry of joint effect B. Duration of joint stiffness C. Space between the bones D. Erythrocyte sedimentation rate C. Space between the bones Both OA and RA manifest with narrowed joint spaces so this is not a valid assessment to help differentiate between the two disorders. The remaining options are patient assessments that facilitate differentiation of OA and RA because symmetric joints are affected in RA but not in OA; stiffness resolves in less than 30 minutes with OA but not RA; and a patient with RA, but not OA, is likely to have elevated erythrocyte sedimentation levels indicating inflammation. Ch. 65 Pre-Assessment #2 A 75-year-old female patient complains about morning stiffness and increasing joint pain in her right hip. What is the best initial drug therapy for her? A. aspirin B. naproxen (Aleve) C. ibuprofen (Motrin) D. acetaminophen (Tylenol) D. acetaminophen (Tylenol) For patients with osteoarthritis who have mild to moderate pain, the initial drug of choice is acetaminophen. Ch. 65 Pre-Assessment #3 Which of the following laboratory values would probably be found in a patient with osteoarthritis (OA)? A. Decreased RBCs B. Increased WBCs C. Clear yellow synovial fluid D. Increased C-reactive protein E. Increased erythrocyte sedimentation rate C. Clear yellow synovial fluid Normally there are no laboratory abnormalities or biomarkers for OA. Clear yellow fluid is normal synovial fluid. Ch. 65 Pre-Assessment #4 A patient who has ankylosing spondylitis (AS) asks the nurse for help in choosing suitable activities for maintaining good posture. Which exercise should the nurse advise the patient to avoid? A. Do stomach crunching B. Stand on a single leg C. Face wall and push off D. Stretch the lower back A. Do stomach crunching The nurse advises a patient who has AS to avoid stomach crunches because they involve spinal flexion, which over the long term can aggravate pulmonary complications by decreasing the thoracic cage. The help strengthen the same muscles, the nurse encourages exercises to strengthen the upper and lower back such as leg lifts in the prone position because in the prone position the back is supported to prevent flexion. The remaining options can be suitable exercises for this patient, standing on one leg promotes core strength, pushing off a wall strengthens back muscles, and stretching the lower back helps maintain joint flexibility. Ch. 65 Pre-Assessment #5 The incidence of Lyme disease is very high in a Pennsylvania county, so the public health nurse provides community education to increase the number of patients who seek health care promptly after a tick bite. Which information should the nurse provide in community teaching people who are at risk for a tick bite? A. The best therapy for the acute illness is an IV antibiotic. B. Check for an enlarging reddened area with a clear center. C. Antibiotics will prevent Lyme disease if taken for 10 days. D. Surveillance is necessary during the summer months only. B. Check for an enlarging reddened area with a clear center. Following a tick bite, individuals should mark the area with a pen and watch for a reddened lesion that enlarges within 2 to 30 days after the bite, develops a clear center, has a bright red border, and is accompanied by flu-like symptoms and migrating joint and muscle pain. When Lyme disease is confirmed, oral doxycycline (Vibramycin) can be effective if started within 3 days of the bite, and 2 to 3 weeks of antibiotic therapy is usually effective. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors. Ch. 65 Pre-Assessment #6 In comparing connective tissue disorders, which disorder is most likely to result in patient injury, affect pulmonary function, and increase the patient's risk of infection as a result of the indicated drug therapy? A. Polymyositis (PN) B. Sjogren's Syndrome (SS) C. Systemic sclerosis (scleroderma) D. Systemic lupus erythematousus (SLE) A. Polymyositis (PN) PN is an inflammatory disease of striated muscle, resulting in muscle weakness that increases the patient's risk of falls and injury. In addition, most patients with PN develop interstitial lung disease, which can impair pulmonary function. The risk of infection increases during therapy with corticosteroids because these drugs suppress the immune response to potential pathogens. Ch. 65 Pre-Assessment #7