NUR 502 MED SURG STUDY GUIDE QUESTIONS MATURING FINAL EXAM

NUR 502 MED SURG STUDY GUIDE QUESTIONS MATURING FINAL EXAM Chapter 65: Connective Tissue Diseases 1. A 60-year-old woman has pain on motion in her fingers and asks the nurse whether this is just a result of aging. The best response by the nurse should include what information? a. Joint pain with functional limitation is a normal change that affects all people to some extent. b. Joint pain that develops with age is usually related to previous trauma or infection of the joints. c. This is a symptom of a systemic arthritis that eventually affects all joints as the disease progresses. d. Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age. 2. Number in sequence from 1 to 6 the pathophysiologic processes that occur in osteoarthritis (OA). a. Erosion of articular surfaces b. Incongruity in joint surfaces c. Reduction in motion d. Joint cartilage becomes yellow and granular e. Osteophytes form at joint margins f. Cartilage becomes softer and less elastic 3. What is most likely to cause the pain experienced in the later stages of OA? a. Crepitation b. Bouchard’s nodes c. Heberden’s nodes d. Bone surfaces rubbing together 4. To preserve function and the ability to perform activities of daily living (ADLs), what should the nurse teach the patient with OA? a. Avoid exercise that involves the affected joints. b. Plan and organize task performance to be less stressful to joints. c. Maintain normal activities during an acute episode to prevent loss of function. d. Use mild analgesics to control symptoms when performing tasks that cause pain. 5. A patient with OA asks the nurse whether he could try glucosamine and chondroitin for control of his symptoms. The best response by the nurse includes what information? a. Some patients find these supplements helpful for relieving arthritis pain and improving mobility. b. Although these substances may not help, there is no evidence that they can cause any untoward effects. c. These supplements are a fad that has not been shown to reduce pain or increase joint mobility in patients with OA. d. Only dosages of these supplements available by prescription are high enough to provide any benefit in treatment of OA. 6. A patient taking ibuprofen (Motrin) for treatment of OA has good pain relief but is experiencing increased dyspepsia and nausea with the drug’s use. The nurse consults the patient’s primary care provider about doing what? a. Adding misoprostol (Cytotec) to the patient’s drug regimen b. Substituting naproxen (Naprosyn) for the ibuprofen (Motrin) c. Returning to the use of acetaminophen but at a dose of 5 g/day instead of 4 g/day d. Administering the ibuprofen with antacids to decrease the gastrointestinal (GI) irritation 7. 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 one to several hours 8. 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. 9. During the physical assessment of the patient with early to moderate RA, what should the nurse expect to find? a. Hepatomegaly c. Spindle-shaped fingers b. Heberden’s nodes d. Crepitus on joint movement 10. Laboratory findings that the nurse would expect to be present in the patient with RA include a. polycythemia. c. decreased white blood cell (WBC) count. b. increased immunoglobulin G (IgG). d. anti-citrullinated protein antibody (ACPA). 11. Which other extraarticular manifestation of RA is most likely to be seen in the patient with rheumatoid nodules? a. Lyme disease c. Sjögren’s syndrome b. Felty syndrome d. Spondyloarthropathies 12. Which drug that prevents binding of the tumor necrosis factor and inhibits the inflammatory response is used in the management of RA? a. Anakinra (Kineret) c. Leflunomide (Arava) b. Entanercept (Enbrel) d. Azathioprine (Imuran) 13. The patient has had RA for some time but has not had success with previous medications. Although there is an increased risk for tuberculosis, which monoclonal antibody is used with methotrexate to best treat symptoms? a. Parenteral gold c. Tocilizumab (Actemra) b. Certolizumab (Cimzia) d. Hydroxychloroquine (Paquenil) 14. A 70-year-old patient is being evaluated for symptoms of RA. The nurse recognizes what 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. 15. After teaching a patient with RA about the prescribed therapeutic regimen, the nurse determines that further instruction is needed when the patient says what? a. “It is important for me to perform my prescribed exercises every day.” b. “I should perform 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 to relieve pain and inflammation when I have an acute flare.” d. “I can use assistive devices such as padded utensils, electric can openers, and elevated toilet seats to protect my joints.” 16. 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. Inform the patient that it is important for her to maintain self-care activities. 17. After teaching a patient with RA to use heat and cold therapy to relieve symptoms, the nurse determines that teaching has been effective when what is said by the patient? a. “Heat treatments should not be used if muscle spasms are present.” b. “Cold applications can be applied for 15 to 20 minutes to relieve joint stiffness.” c. “I should use heat applications for 20 minutes to relieve the symptoms of an acute flare.” d. “When my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relieve the pain.” 18. The nurse teaches the patient with RA that which exercise is one of the most effective methods of aerobic exercise? a. Ballet dancing c. Aquatic exercises b. Casual walking d. Low-impact aerobic exercises 24. Which descriptions are related to reactive arthritis (select all that apply)? a. Methotrexate is a treatment of choice b. Symptoms include urethritis and conjunctivitis c. Diagnosed by finding of hypersensitive tender points d. Increased risk in persons with decreased host resistance e. Infection of a joint often caused by hematogenous route f. Self-limiting arthritis following GI (enteral) or sexually transmitted infections CHAPTER 62: 4. Which type of bone cell is responsible for the formation of bone? a. Osteocyte c. Osteoblast b. Osteoclast d. Sarcomere 5. The patient is told by the health care provider that the size of the patient’s muscle has decreased. How should the nurse document this occurrence? a. Hyaline c. Isometric b. Atrophy d. Hypertrophy 6. An older patient is describing increased rigidity in the shoulders, back, and hips. The loss of elasticity in what tissue contributes to this? a. Actin c. Myosin b. Fascia d. Cartilage 7. What is the best description of the periosteum? a. Lining of a joint capsule c. Most common type of cartilage tissue b. A characteristic of skeletal muscle d. Fibrous connective tissue covering bone 8. What is the function of a tendon? a. Attaches muscle to bone c. Connects cartilage to muscle in joints b. Connects bone to bone at the joint d. Attaches synovium to the joint capsule 9. In performing range of motion (ROM) with a patient, the nurse puts each joint through its full movement. Which joints are capable of abduction and adduction (select all that apply)? a. Hip d. Elbow b. Knee e. Thumb c. Wrist f. Shoulder 10. While having his height measured during a routine health examination, a 79-year-old man asks the nurse why he is