Medical Surgical Nursing Assessment and Management of Clinical Problems, 10th Edition by Sharon L. Lewis
Medical Surgical Nursing Assessment and Management of Clinical Problems, 10th Edition by Sharon L. Lewis
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Chapter 64: Arthritis and Connective Tissue Diseases
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
| a. | Presence of Heberden’s nodules |
| b. | Discomfort with joint movement |
| c. | Redness and swelling of the knee joint |
| d. | Stiffness that increases with movement |
ANS: B
Initial symptoms of OA include pain with joint movement. Heberden’s nodules occur on the fingers. Redness of the joint is associated with inflammatory arthritis such as rheumatoid arthritis. Stiffness in OA is worse right after the patient rests and decreases with joint movement.
DIF: Cognitive Level: Understand (comprehension) REF: 1518
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
| a. | The patient has gained 3 lb. |
| b. | The patient has dark-colored stools. |
| c. | The patient’s pain affects multiple joints. |
| d. | The patient uses capsaicin cream (Zostrix). |
ANS: B
Dark-colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. The patient’s ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
DIF: Cognitive Level: Apply (application) REF: 1521
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
| a. | “I can exercise every day to help maintain joint motion.” |
| b. | “I will take 1 g of acetaminophen (Tylenol) every 4 hours.” |
| c. | “I will take a shower in the morning to help relieve stiffness.” |
| d. | “I can use a cane to decrease the pressure and pain in my hip.” |
ANS: B
No more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily to decrease the risk for liver damage. Regular exercise, moist heat, and supportive equipment are recommended for OA management.
DIF: Cognitive Level: Apply (application) REF: 1523
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
| a. | Prednisone | c. | Capsaicin cream (Zostrix) |
| b. | Adalimumab (Humira) | d. | Sulfasalazine (Azulfidine) |
ANS: C
Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with rheumatoid arthritis.
DIF: Cognitive Level: Apply (application) REF: 1520
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
| a. | Draw blood for rheumatoid factor analysis. |
| b. | Teach the patient about injections for the nodules. |
| c. | Assess the nodules for skin breakdown or infection. |
| d. | Discuss the need for surgical removal of the nodules. |
ANS: C
Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor, and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.
DIF: Cognitive Level: Apply (application) REF: 1527
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
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