MSK EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALE (NEWEST VERSION)

MSK EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALE (NEWEST VERSION) Which description is most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)? a. Not systemic or symmetric b. Rheumatoid factor (RF) positive c. Most commonly occurs in women d. Morning joint stiffness lasts 1 to several hours - Answer-a. Rationale: OA is not systemic or symmetric. In OA, morning joint stiffness resolves in about 30 minutes. Rheumatoid arthritis (RA) is often rheumatoid factor (RF) positive, occurs more in women than men, is systemic, and affects small joints symmetrically. In RA, morning joint stiffness lasts 60 minutes to all day. What best describes the manifestations of OA? a. Smaller joints are typically affected first. b. There is joint stiffness after periods of inactivity. c. Joint stiffness is accompanied by fatigue, anorexia, and weight loss. d. Pain and immobility may be aggravated by falling barometric pressure. - Answer-d. Rationale: Pain and immobility of OA may be aggravated by falling barometric pressure. OA primarily first affects weight-bearing joints of knees and hips. Stiffness occurs on arising but usually resolves after 30 minutes. Pain during the day is relieved with rest. Fatigue, anorexia, and weight loss are nonspecific manifestations of the onset of RA. During the physical assessment of the patient with early to moderate RA, what should the nurse expect to find? a. Hepatomegaly b. Heberden's nodes c. Spindle-shaped fingers d. Crepitus on joint movement - Answer-c. Rationale: In early disease, the fingers of the patient with moderate RA may become spindle shaped from synovial hypertrophy and thickening of the joint capsule. The patient may not have joint deformities but may have limited joint mobility, adjacent muscle atrophy, and inflammation. Splenomegaly may be found with Felty syndrome in those with severe nodule-forming RA. Heberden's nodes and crepitus on movement are associated with OA. What laboratory findings should the nurse expect to be present in the patient with RA? a. Polycythemia b. Increased immunoglobulin G (IgG) c. Decreased white blood cell (WBC) count d. Antibodies to citrullinated peptide (anti-CCP) - Answer-d. Rationale: The antibody to citrullinated peptide (anti-CCP) is more specific than RF for RA and may allow earlier and more accurate diagnosis. Other tests include C-reactive protein (CRP) that is elevated from inflammation of RA, a finding that is useful in monitoring the response to therapy. Anemia, rather than polycythemia, is common. Immunoglobulin G (IgG) levels are normal. The white blood cell (WBC) count may be increased in response to inflammation and is also elevated in synovial fluid. A 70-year-old patient is being evaluated for symptoms of RA. What should the nurse recognize as the major problem in the management of RA in the older adult? a. RA is usually more severe in older adults. b. Older patients are not as likely to comply with treatment regimens. c. Drug interactions and toxicity are more likely to occur with multidrug therapy. d. Laboratory and other diagnostic tests are not effective in identifying RA in older adults. - Answer-c. Rationale: The use of multidrug therapy in RA is particularly problematic in older adults because of the increased likelihood of adverse drug interactions and toxicity. Rheumatic disorders affect younger and older adults. Older adults are not less compliant with drug treatment but may need help with complex regimens. Interpretation of laboratory values in diagnosing RA in older adults is more difficult because of age-related serologic changes, but the disease can be diagnosed After teaching a patient with RA about the prescribed therapeutic regimen, which patient statement indicates that further instruction is needed? a. "It is important for me to perform my prescribed exercises every day." b. "I should do most of my daily chores in the morning when my energy level is highest." c. "An ice pack to a joint for 10 minutes may help relieve pain when I have an acute flare." d. "I can use assistive devices, like padded utensils and elevated toilet seats, to protect my joints." - Answer-b. Rationale: Most patients with RA have morning stiffness. Morning activities should be scheduled later in the day after the stiffness subsides. Taking a warm shower in the morning and allowing time to become more mobile before activity are advised. Ice for 10 minutes or splinting are helpful during increased disease activity. Management of RA includes daily exercises for the affected joints and protection of joints with devices and movements that prevent joint stress. Patient-Centered Care: A patient recovering from an acute exacerbation of RA tells the nurse that she is too tired to bathe. What should the nurse do for this patient? a. Give the patient a bed bath to conserve her energy. b. Allow the patient a rest period before showering with the nurse's help. c. Tell the patient that she can skip bathing if she will walk in the hall later. d. Teach the patient that it is important for her to maintain self-care activities. - Answer-b. Rationale: Pacing activities and alternating rest with activity are important in maintaining selfcare and independence of the patient with RA. These strategies also prevent deconditioning and improve patient attitude. The nurse should not complete activities for the patient but instead should support and assist the patient as necessary. A warm shower or sitting in a tub with warm water and towels over the shoulders may help relieve some stiffness After teaching a patient with RA to use heat and cold therapy to relieve symptoms, which patient statement indicates to the nurse that teaching has been effective? a. "Heat treatments should not be used if muscle spasms are present." b. "Cold applications can be applied for 25 to 30 minutes to relieve joint stiffness." c. "I should use heat applications for 25 minutes to relieve the symptoms of an acute flare." d. "When my joints are painful, using a bag of frozen corn for 10 to 15 minutes may relieve the pain." - Answer-d. Rationale: Cold therapy is indicated to relieve pain during an acute inflammation. It can be applied for 10 to 15 minutes at a time with packages of frozen vegetables. Heat in the form of heating pads, moist warm packs, paraffin baths, or warm baths or showers is indicated to relieve stiffness and muscle spasm. Heat should not be applied for more than 20 minutes at a time. A patient is seen at the outpatient clinic for a sudden onset of inflammation and severe pain in the great toe. What establishes a definitive diagnosis of gouty arthritis? a. A family history of gout b. Elevated urine uric acid levels c. Elevated serum uric acid levels d. Presence of monosodium urate crystals in synovial fluid - Answer-d. Rationale: The definitive diagnosis of gout is established by finding needle-like monosodium urate crystals in the synovial fluid of an inflamed joint or tophus. Although there is a familial predisposition to hyperuricemia, environmental and genetic factors contribute to gout. Hyperuricemia and elevated urine uric acid are not diagnostic for gout because they may be related to a variety of drugs or may exist as a totally asymptomatic abnormality in the general population.