Exam 5- Adult Health- Review Questions & Answers.
Adult Health Exam 5-Musculoskeletal, Neurological, Cognitive & Perceptual, & Endocrine Disorders
Review Questions & Answers
Musculoskeletal Disorders
1. A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration
of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following
procedures will be involved?
A. Angiography
B. Myelography
C. Paracentesis
D. Arthrocentesis
Ans: D. Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with
a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken
after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis
is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through
the abdominal wall under sterile conditions.
2. A nurse is providing care for a patient who has just been diagnosed as being in the early stage
of rheumatoid arthritis. The nurse should anticipate the administration of which of the
following?
A. Hydromorphone (Dilaudid)
B. Methotrexate (Rheumatrex)
C. Allopurinol (Zyloprim)
D. Prednisone
Ans: B. In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly
documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or
sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that
treatment with the non-biologic DMARDs begin within 3 months of disease onset. Allopurinol is used to treat gout.
Opioids are not indicated in early RA. Prednisone is used in unremitting RA.
3. A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic
lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on
inspection?
A. Petechiae
B. Butterfly rash
C. Jaundice
D. Skin sloughing
Ans: B. An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks
occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with
SLE do not typically experience jaundice or skin sloughing.
4. A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout
to the patient, the nurse should describe which of the following?
A. Autoimmune processes in the joints
B. Chronic metabolic
acidosis C. Increased uric acid
levels
D. Unstable serum calcium levels
Ans: C. Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an autoimmune
disease and it does not result from metabolic acidosis or unstable serum calcium levels.
5. A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the
synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health
problem?
A. Rheumatoid arthritis (RA)
B. Systemic lupus erythematosus
,Exam 5- Adult Health- Review Questions & Answers.
C. Osteoporosis
D. Polymyositis
Ans: A. In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down
collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys
cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.
6. A nurse is performing the health history and physical assessment of a patient who has a diagnosis of
1
,Adult Health Exam 5
rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of
RA?
A. Cool joints with decreased range of motion
B. Signs of systemic infection
C. Joint stiffness, especially in the morning
D. Visible atrophy of the knee and shoulder joints
Ans: C. In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning.
Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often
warm rather than cool.
7. A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed
cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential
adverse effect?
A. Infection
B. Acute confusion
C. Sedation
D. Malignant hyperthermia
Ans: A. When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of
bone marrow suppression and infection. Confusion and sedation are atypical adverse effects. Malignant
hyperthermia is a surgical complication and not a possible adverse effect.
8. A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What
assessment finding would the nurse interpret as a risk factor?
A. The patient has a 30 pack-year smoking
history. B. The patients body mass index is 34
(obese).
C. The patient has primary hypertension.
D. The patient is 58 years old.
Ans: B. Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include
smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly
heightened risk.
9. A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks
the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the
best response by the nurse?
A. OA is a considered a noninflammatory joint disease. RA is characterized by inflamed,
swollen joints.
B. OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects
the larger, weight-bearing joints like the knees.
C. OA originates with an infection. RA is a result of your body's cells attacking one another.
D. OA is associated with impaired immune function; RA is a consequence of physical damage.
Ans: A. OA is a degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the
articular surfaces of weight-bearing joints, with spur development. RA is characterized by inflammation of synovial
membranes and surrounding structures. The diseases are not distinguished by the joints affected and neither has an
infectious etiology.
10.A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that
the patient has understood health education when the patient makes what statement?
A. Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels.
B. Ill try to be as physically active as possible between flare-ups.
C. Ill make sure to monitor my body temperature on a regular basis.
D. Ill stop taking my steroids when I get relief from my symptoms.
Ans: C. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of
ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE.
Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered
because they can suppress the function of the adrenal gland. As well, these drugs should not be independently
adjusted by the patient.
2
, Adult Health Exam 5
11.A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients
3
Adult Health Exam 5-Musculoskeletal, Neurological, Cognitive & Perceptual, & Endocrine Disorders
Review Questions & Answers
Musculoskeletal Disorders
1. A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration
of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following
procedures will be involved?
A. Angiography
B. Myelography
C. Paracentesis
D. Arthrocentesis
Ans: D. Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with
a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken
after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis
is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through
the abdominal wall under sterile conditions.
2. A nurse is providing care for a patient who has just been diagnosed as being in the early stage
of rheumatoid arthritis. The nurse should anticipate the administration of which of the
following?
A. Hydromorphone (Dilaudid)
B. Methotrexate (Rheumatrex)
C. Allopurinol (Zyloprim)
D. Prednisone
Ans: B. In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly
documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or
sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that
treatment with the non-biologic DMARDs begin within 3 months of disease onset. Allopurinol is used to treat gout.
Opioids are not indicated in early RA. Prednisone is used in unremitting RA.
3. A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic
lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on
inspection?
A. Petechiae
B. Butterfly rash
C. Jaundice
D. Skin sloughing
Ans: B. An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks
occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with
SLE do not typically experience jaundice or skin sloughing.
4. A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout
to the patient, the nurse should describe which of the following?
A. Autoimmune processes in the joints
B. Chronic metabolic
acidosis C. Increased uric acid
levels
D. Unstable serum calcium levels
Ans: C. Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an autoimmune
disease and it does not result from metabolic acidosis or unstable serum calcium levels.
5. A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the
synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health
problem?
A. Rheumatoid arthritis (RA)
B. Systemic lupus erythematosus
,Exam 5- Adult Health- Review Questions & Answers.
C. Osteoporosis
D. Polymyositis
Ans: A. In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down
collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys
cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.
6. A nurse is performing the health history and physical assessment of a patient who has a diagnosis of
1
,Adult Health Exam 5
rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of
RA?
A. Cool joints with decreased range of motion
B. Signs of systemic infection
C. Joint stiffness, especially in the morning
D. Visible atrophy of the knee and shoulder joints
Ans: C. In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning.
Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often
warm rather than cool.
7. A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed
cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential
adverse effect?
A. Infection
B. Acute confusion
C. Sedation
D. Malignant hyperthermia
Ans: A. When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of
bone marrow suppression and infection. Confusion and sedation are atypical adverse effects. Malignant
hyperthermia is a surgical complication and not a possible adverse effect.
8. A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What
assessment finding would the nurse interpret as a risk factor?
A. The patient has a 30 pack-year smoking
history. B. The patients body mass index is 34
(obese).
C. The patient has primary hypertension.
D. The patient is 58 years old.
Ans: B. Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include
smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly
heightened risk.
9. A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks
the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the
best response by the nurse?
A. OA is a considered a noninflammatory joint disease. RA is characterized by inflamed,
swollen joints.
B. OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects
the larger, weight-bearing joints like the knees.
C. OA originates with an infection. RA is a result of your body's cells attacking one another.
D. OA is associated with impaired immune function; RA is a consequence of physical damage.
Ans: A. OA is a degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the
articular surfaces of weight-bearing joints, with spur development. RA is characterized by inflammation of synovial
membranes and surrounding structures. The diseases are not distinguished by the joints affected and neither has an
infectious etiology.
10.A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that
the patient has understood health education when the patient makes what statement?
A. Ill make sure I get enough exposure to sunlight to keep up my vitamin D levels.
B. Ill try to be as physically active as possible between flare-ups.
C. Ill make sure to monitor my body temperature on a regular basis.
D. Ill stop taking my steroids when I get relief from my symptoms.
Ans: C. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of
ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE.
Patients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered
because they can suppress the function of the adrenal gland. As well, these drugs should not be independently
adjusted by the patient.
2
, Adult Health Exam 5
11.A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients
3
