|ACTUAL QUESTIONS AND VERIFIED
Question 1
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
CORRECT ANSWER
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
1
,Question 2
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
CORRECT ANSWER
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
Question 3
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)
2
,D. acetaminophen (Tylenol)
CORRECT ANSWER
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
Question 4
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
CORRECT ANSWER
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
3
, Question 5
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
CORRECT ANSWER
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
Question 6
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.
4
Question 1
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
CORRECT ANSWER
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
1
,Question 2
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
CORRECT ANSWER
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
Question 3
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)
2
,D. acetaminophen (Tylenol)
CORRECT ANSWER
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
Question 4
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
CORRECT ANSWER
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
3
, Question 5
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
CORRECT ANSWER
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
Question 6
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.
4
