MED/SURG FINAL (Lewis Chapters
14-16, 23-24, 41-50, 63-65)
1. A 60-yr-antique patient has osteoarthritis (OA) of the left knee. A finding that the nurse might
anticipate to be present on exam of the affected person's knee is
a. Heberden's nodules.
B. Redness and swelling of the knee joint.
C. Ache upon joint movement.
D. Stiffness that increases with movement. - ANS-Answer: C
Rationale: Initial signs and symptoms of OA consist of pain with joint movement. Heberden's
nodules arise at the arms. Redness of the joint is extra strongly associated with rheumatoid
arthritis (RA), and stiffness in OA is worse right after the affected person rests and reduces with
joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694
Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening sufferers at a network center, the nurse will plan to train methods to reduce
risk elements for osteoarthritis to a
a. 24-yr-antique guy who participates in a summer season softball team.
B. 36-12 months-old lady who is newly identified with diabetes mellitus.
C. Forty nine-yr-vintage woman who works on an car meeting line.
D. 56-yr-old guy who is a member of a construction crew. - ANS-Answer: C
Rationale: OA is much more likely to arise in women due to estrogen discount at menopause
and in people whose paintings includes repetitive actions and lifting. Moderate workout, which
include softball, reduces chance for OA. Diabetes isn't a risk issue for OA. Working on a
production group would involve nonrepetitive paintings and for this reason might now not be as
volatile.
Cognitive Level: Application Text Reference: p. 1694
Nursing Process: Planning NCLEX: Physiological Integrity
three. The fitness care provider has prescribed naproxen (Naprosyn) two times every day for a
patient with osteoarthritis (OA) of the arms. The affected person tells the nurse after three
weeks of use that the drug does now not appear to be effective in controlling the ache. The
nurse ought to teach the patient that
a. Some other kind of nonsteroidal antiinflammatory drug (NSAID) can be indicated because of
variations in individual response to the medication.
,B. It could take up to 4 to 6 weeks for NSAIDs to reach healing stages in the blood.
C. If NSAIDs are not powerful in controlling signs and symptoms, corticosteroids are the next
drug of desire.
D. Including a two times-every day aspirin to the naproxen might also enhance the effectiveness
of the drug. - ANS-Answer: A
Rationale: Individual responses to NSAIDs can range, so the health care issuer may prescribe a
distinct NSAID. Full effectiveness of NSAIDs happens in 2 to 3 weeks. Corticosteroids are
typically reserved to be used in RA. Patients are informed to avoid aspirin when taking NSAIDs
due to the increased chance for bleeding and gastrointestinal inflammation.
Cognitive Level: Application Text Reference: p. 1697
Nursing Process: Implementation NCLEX: Physiological Integrity
4. When coaching a affected person with osteoarthritis (OA) of the left hip and decrease lumbar
vertebrae approximately management of the situation, the nurse determines that extra practise
is wanted whilst the affected person says,
a. "I can use a cane if I locate it beneficial in relieving the strain on my again and hip."
b. "A warm shower within the morning will assist relieve the stiffness I actually have after I
arise."
c. "I ought to try to live energetic throughout the day to maintain my joints from turning into stiff."
d. "I must take no extra than 1 g of acetaminophen 4 times a day to manipulate the pain." -
ANS-Answer: C
Rationale: Protection and avoidance of joint stressors are advocated for sufferers with OA, so
this affected person ought to trade intervals of relaxation with essential interest. The different
affected person statements indicate that coaching has been powerful.
Cognitive Level: Application Text Reference: pp. 1696, 1701
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance
five. A fifty eight-yr-old affected person has been identified with osteoarthritis (OA) of the hands
and feet. The affected person tells the nurse, "I am afraid that I will be hopelessly crippled in
only some years!" The quality reaction through the nurse is that
a. Progression of OA can be averted with a regimen of workout, diet, and drugs.
B. OA is an inflammatory manner with durations of exacerbation and remission.
C. Joint degeneration with pain and deformity happens with OA through age 60 to 70.
D. OA is commonplace with getting old, however typically it's far localized and does no longer
reason deformity. - ANS-Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although exercising,
weight loss plan, and capsules can assist to decrease signs and symptoms and gradual disease
progression, they may not save you progression of the sickness. OA is modern and does now
not have exacerbations and remissions, which are traditional of RA. Joint degeneration and pain
occur later in OA; joint deformity isn't always a common symptom.
Cognitive Level: Application Text Reference: pp. 1701, 1704
Nursing Process: Implementation NCLEX: Physiological Integrity
,6. A patient with hip ache is recognized with osteoarthritis (OA). The nurse might also want to
educate the patient approximately using
a. Prednisone (Deltasone).
B. Capsaicin cream (Zostrix).
C. Sulfasalazine (Azulfidine).
D. Doxycycline (Vibramycin). - ANS-Answer: B
Rationale: Capsaicin cream blocks the transmission of ache impulses and is helpful for some
sufferers in treating OA. The other medications could be used for patients with RA.
Cognitive Level: Application Text Reference: p. 1696
Nursing Process: Planning NCLEX: Physiological Integrity
7. A 71-yr-antique obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches
the patient that the maximum useful degree to protect the joints is to
a. Use a wheelchair to keep away from walking as a lot as feasible.
B. Sit down in chairs that don't cause the hips to be decrease than the knees.
C. Use a walker for ambulation to relieve the stress at the hips.
D. Devour according to a weight-discount diet to acquire a wholesome body weight. -
ANS-Answer: D
Rationale: Because the patient's principal risk thing is obesity, the nurse ought to educate the
affected person that weight loss is the exceptional way to reduce stress at the hips. Avoiding
activity through sitting in a wheelchair might possibly increase the patient's weight; slight interest
is usually recommended for patients with OA. Sitting with the hips better than the knees and the
use of a walker might be endorsed however are not as useful as weight loss for this overweight
affected person.
Cognitive Level: Application Text Reference: p. 1701
Nursing Process: Implementation NCLEX: Physiological Integrity
8. The health care company prescribes methotrexate (Rheumatrex) for a 28-12 months-antique
woman with degree II mild rheumatoid arthritis (RA). When obtaining a health history from the
patient, the most important information for the nurse to talk to the health care issuer is that the
patient has
a. A history of infectious mononucleosis as a teenager.
B. A circle of relatives records of age-associated macular degeneration of the retina.
C. Been looking to have a child before her disorder becomes greater severe.
D. Been the usage of large doses of vitamins and fitness ingredients to treat the RA. -
ANS-Answer: C
Rationale: Methotrexate is teratogenic, and the patient must be taking contraceptives all through
methotrexate therapy. The different information will now not impact the selection of methotrexate
as therapy.
Cognitive Level: Application Text Reference: p. 1699
Nursing Process: Assessment NCLEX: Physiological Integrity
9. A affected person with an acute exacerbation of rheumatoid arthritis (RA) has localized ache
and inflammation of the arms, wrists, and toes with swelling, redness, and restrained motion of
, the joints. When growing the plan of care, the nurse acknowledges that the most suitable
affected person final results at this time is to
a. Preserve a advantageous self-photo.
B. Perform activities of each day residing independently.
C. Attain fine manipulate of pain.
D. Make a successful adjustment to sickness progression. - ANS-Answer: C
Rationale: The consciousness throughout an acute exacerbation of RA is to control ache
correctly. The different results are appropriate long-time period effects.
Cognitive Level: Application Text Reference: p. 1707
Nursing Process: Planning
NCLEX: Health Promotion and Maintenance
10. A domestic fitness affected person with rheumatoid arthritis (RA) complains to the nurse
approximately having chronically dry eyes and a dry mouth. Which motion by way of the nurse is
most suitable?
A. Have the affected person withhold the each day methotrexate (Rheumatrex) until speakme
with the fitness care provider.
B. Reassure the patient that dry eyes and mouth are very not unusual with RA.
C. Teach the patient to use an antiseptic mouth wash tid.
D. Suggest that the affected person start the usage of over-the-counter (OTC) artificial tears. -
ANS-Answer: D
Rationale: The patient's dry eyes and oral mucous membranes are steady with Sjögren's
syndrome, a not unusual extraarticular manifestation of RA. Symptomatic therapy inclusive of
OTC eye drops is usually recommended. Dry eyes and mouth are not side outcomes of
methotrexate. Although dry eyes and mouth are commonplace in RA, it's miles greater
beneficial to provide an offer to relieve those signs and symptoms than to offer reassurance.
Rinsing the mouth to decrease oral dryness is appropriate, but the common use of antiseptic
mouthwashes isn't always appropriate until the affected person has oral signs and symptoms
that require this.
Cognitive Level: Application Text Reference: p. 1726
Nursing Process: Implementation NCLEX: Physiological Integrity
eleven. When teaching variety-of-movement exercises to a patient who is having an acute
exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both palms, the nurse
teaches the patient that
a. Affected joints ought to no longer be exercised while pain is present.
B. Bloodless applications before workout will lower joint ache.
C. Exercises must be executed passively by using a person apart from the affected person.
D. Regular taking walks might also replacement for variety-of-motion (ROM) exercises on a few
days. - ANS-Answer: B
Rationale: Cold software is beneficial in decreasing pain for the duration of periods of
exacerbation of RA. Because the joint ache is persistent, patients are told to exercise even
when joints are painful. ROM sporting activities are intended to strengthen joints as well as
14-16, 23-24, 41-50, 63-65)
1. A 60-yr-antique patient has osteoarthritis (OA) of the left knee. A finding that the nurse might
anticipate to be present on exam of the affected person's knee is
a. Heberden's nodules.
B. Redness and swelling of the knee joint.
C. Ache upon joint movement.
D. Stiffness that increases with movement. - ANS-Answer: C
Rationale: Initial signs and symptoms of OA consist of pain with joint movement. Heberden's
nodules arise at the arms. Redness of the joint is extra strongly associated with rheumatoid
arthritis (RA), and stiffness in OA is worse right after the affected person rests and reduces with
joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694
Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening sufferers at a network center, the nurse will plan to train methods to reduce
risk elements for osteoarthritis to a
a. 24-yr-antique guy who participates in a summer season softball team.
B. 36-12 months-old lady who is newly identified with diabetes mellitus.
C. Forty nine-yr-vintage woman who works on an car meeting line.
D. 56-yr-old guy who is a member of a construction crew. - ANS-Answer: C
Rationale: OA is much more likely to arise in women due to estrogen discount at menopause
and in people whose paintings includes repetitive actions and lifting. Moderate workout, which
include softball, reduces chance for OA. Diabetes isn't a risk issue for OA. Working on a
production group would involve nonrepetitive paintings and for this reason might now not be as
volatile.
Cognitive Level: Application Text Reference: p. 1694
Nursing Process: Planning NCLEX: Physiological Integrity
three. The fitness care provider has prescribed naproxen (Naprosyn) two times every day for a
patient with osteoarthritis (OA) of the arms. The affected person tells the nurse after three
weeks of use that the drug does now not appear to be effective in controlling the ache. The
nurse ought to teach the patient that
a. Some other kind of nonsteroidal antiinflammatory drug (NSAID) can be indicated because of
variations in individual response to the medication.
,B. It could take up to 4 to 6 weeks for NSAIDs to reach healing stages in the blood.
C. If NSAIDs are not powerful in controlling signs and symptoms, corticosteroids are the next
drug of desire.
D. Including a two times-every day aspirin to the naproxen might also enhance the effectiveness
of the drug. - ANS-Answer: A
Rationale: Individual responses to NSAIDs can range, so the health care issuer may prescribe a
distinct NSAID. Full effectiveness of NSAIDs happens in 2 to 3 weeks. Corticosteroids are
typically reserved to be used in RA. Patients are informed to avoid aspirin when taking NSAIDs
due to the increased chance for bleeding and gastrointestinal inflammation.
Cognitive Level: Application Text Reference: p. 1697
Nursing Process: Implementation NCLEX: Physiological Integrity
4. When coaching a affected person with osteoarthritis (OA) of the left hip and decrease lumbar
vertebrae approximately management of the situation, the nurse determines that extra practise
is wanted whilst the affected person says,
a. "I can use a cane if I locate it beneficial in relieving the strain on my again and hip."
b. "A warm shower within the morning will assist relieve the stiffness I actually have after I
arise."
c. "I ought to try to live energetic throughout the day to maintain my joints from turning into stiff."
d. "I must take no extra than 1 g of acetaminophen 4 times a day to manipulate the pain." -
ANS-Answer: C
Rationale: Protection and avoidance of joint stressors are advocated for sufferers with OA, so
this affected person ought to trade intervals of relaxation with essential interest. The different
affected person statements indicate that coaching has been powerful.
Cognitive Level: Application Text Reference: pp. 1696, 1701
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance
five. A fifty eight-yr-old affected person has been identified with osteoarthritis (OA) of the hands
and feet. The affected person tells the nurse, "I am afraid that I will be hopelessly crippled in
only some years!" The quality reaction through the nurse is that
a. Progression of OA can be averted with a regimen of workout, diet, and drugs.
B. OA is an inflammatory manner with durations of exacerbation and remission.
C. Joint degeneration with pain and deformity happens with OA through age 60 to 70.
D. OA is commonplace with getting old, however typically it's far localized and does no longer
reason deformity. - ANS-Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although exercising,
weight loss plan, and capsules can assist to decrease signs and symptoms and gradual disease
progression, they may not save you progression of the sickness. OA is modern and does now
not have exacerbations and remissions, which are traditional of RA. Joint degeneration and pain
occur later in OA; joint deformity isn't always a common symptom.
Cognitive Level: Application Text Reference: pp. 1701, 1704
Nursing Process: Implementation NCLEX: Physiological Integrity
,6. A patient with hip ache is recognized with osteoarthritis (OA). The nurse might also want to
educate the patient approximately using
a. Prednisone (Deltasone).
B. Capsaicin cream (Zostrix).
C. Sulfasalazine (Azulfidine).
D. Doxycycline (Vibramycin). - ANS-Answer: B
Rationale: Capsaicin cream blocks the transmission of ache impulses and is helpful for some
sufferers in treating OA. The other medications could be used for patients with RA.
Cognitive Level: Application Text Reference: p. 1696
Nursing Process: Planning NCLEX: Physiological Integrity
7. A 71-yr-antique obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches
the patient that the maximum useful degree to protect the joints is to
a. Use a wheelchair to keep away from walking as a lot as feasible.
B. Sit down in chairs that don't cause the hips to be decrease than the knees.
C. Use a walker for ambulation to relieve the stress at the hips.
D. Devour according to a weight-discount diet to acquire a wholesome body weight. -
ANS-Answer: D
Rationale: Because the patient's principal risk thing is obesity, the nurse ought to educate the
affected person that weight loss is the exceptional way to reduce stress at the hips. Avoiding
activity through sitting in a wheelchair might possibly increase the patient's weight; slight interest
is usually recommended for patients with OA. Sitting with the hips better than the knees and the
use of a walker might be endorsed however are not as useful as weight loss for this overweight
affected person.
Cognitive Level: Application Text Reference: p. 1701
Nursing Process: Implementation NCLEX: Physiological Integrity
8. The health care company prescribes methotrexate (Rheumatrex) for a 28-12 months-antique
woman with degree II mild rheumatoid arthritis (RA). When obtaining a health history from the
patient, the most important information for the nurse to talk to the health care issuer is that the
patient has
a. A history of infectious mononucleosis as a teenager.
B. A circle of relatives records of age-associated macular degeneration of the retina.
C. Been looking to have a child before her disorder becomes greater severe.
D. Been the usage of large doses of vitamins and fitness ingredients to treat the RA. -
ANS-Answer: C
Rationale: Methotrexate is teratogenic, and the patient must be taking contraceptives all through
methotrexate therapy. The different information will now not impact the selection of methotrexate
as therapy.
Cognitive Level: Application Text Reference: p. 1699
Nursing Process: Assessment NCLEX: Physiological Integrity
9. A affected person with an acute exacerbation of rheumatoid arthritis (RA) has localized ache
and inflammation of the arms, wrists, and toes with swelling, redness, and restrained motion of
, the joints. When growing the plan of care, the nurse acknowledges that the most suitable
affected person final results at this time is to
a. Preserve a advantageous self-photo.
B. Perform activities of each day residing independently.
C. Attain fine manipulate of pain.
D. Make a successful adjustment to sickness progression. - ANS-Answer: C
Rationale: The consciousness throughout an acute exacerbation of RA is to control ache
correctly. The different results are appropriate long-time period effects.
Cognitive Level: Application Text Reference: p. 1707
Nursing Process: Planning
NCLEX: Health Promotion and Maintenance
10. A domestic fitness affected person with rheumatoid arthritis (RA) complains to the nurse
approximately having chronically dry eyes and a dry mouth. Which motion by way of the nurse is
most suitable?
A. Have the affected person withhold the each day methotrexate (Rheumatrex) until speakme
with the fitness care provider.
B. Reassure the patient that dry eyes and mouth are very not unusual with RA.
C. Teach the patient to use an antiseptic mouth wash tid.
D. Suggest that the affected person start the usage of over-the-counter (OTC) artificial tears. -
ANS-Answer: D
Rationale: The patient's dry eyes and oral mucous membranes are steady with Sjögren's
syndrome, a not unusual extraarticular manifestation of RA. Symptomatic therapy inclusive of
OTC eye drops is usually recommended. Dry eyes and mouth are not side outcomes of
methotrexate. Although dry eyes and mouth are commonplace in RA, it's miles greater
beneficial to provide an offer to relieve those signs and symptoms than to offer reassurance.
Rinsing the mouth to decrease oral dryness is appropriate, but the common use of antiseptic
mouthwashes isn't always appropriate until the affected person has oral signs and symptoms
that require this.
Cognitive Level: Application Text Reference: p. 1726
Nursing Process: Implementation NCLEX: Physiological Integrity
eleven. When teaching variety-of-movement exercises to a patient who is having an acute
exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both palms, the nurse
teaches the patient that
a. Affected joints ought to no longer be exercised while pain is present.
B. Bloodless applications before workout will lower joint ache.
C. Exercises must be executed passively by using a person apart from the affected person.
D. Regular taking walks might also replacement for variety-of-motion (ROM) exercises on a few
days. - ANS-Answer: B
Rationale: Cold software is beneficial in decreasing pain for the duration of periods of
exacerbation of RA. Because the joint ache is persistent, patients are told to exercise even
when joints are painful. ROM sporting activities are intended to strengthen joints as well as
