Medical-Surgical B - Questions And Answers
Rank in order the sequence of events leading to joint destruction in secondary osteoarthritis
(OA) beginning with the effect of an injury to the cervical spine.
A. Exacerbation of abdominal tissue growth
B. Bony articular surfaces in joint exposed
C. Fragile, soft, dull joint cartilage develops
D. Irregular joint motion, stiffness, and pain Correct Ans:- C. Fragile, soft, dull joint cartilage
develops
A. Exacerbation of abdominal tissue growth
D. Irregular joint motion, stiffness, and pain
B. Bony articular surfaces in joint exposed
A precipitating factor, such as trauma to the spine, leads to the development of OA by
damaging the cartilage. Joint destruction begins with the development of dull, soft, less elastic,
and more fragile cartilage. Because the body is unable to repair the cartilage fast enough, the
cartilage develops fissures and erosion and, in so doing, becomes thinner, leading to the
formation of osteophytes and cartilage at the joint margins. The formation of abnormal tissue
leads to abnormal joint movement. Pain and stiffness increase as the bony surfaces of the joint
are exposed.
Ch. 65 Pre-Assessment #1
The nurse is assessing a patient who is complaining of joint pain and stiffness. Which
assessment does not differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA)?
A. Symmetry of joint effect
B. Duration of joint stiffness
C. Space between the bones
D. Erythrocyte sedimentation rate Correct Ans:- C. Space between the bones
Both OA and RA manifest with narrowed joint spaces so this is not a valid assessment to help
differentiate between the two disorders. The remaining options are patient assessments that
facilitate differentiation of OA and RA because symmetric joints are affected in RA but not in
OA; stiffness resolves in less than 30 minutes with OA but not RA; and a patient with RA, but
not OA, is likely to have elevated erythrocyte sedimentation levels indicating inflammation.
Ch. 65 Pre-Assessment #2
A 75-year-old female patient complains about morning stiffness and increasing joint pain in her
right hip. What is the best initial drug therapy for her?
,A. aspirin
B. naproxen (Aleve)
C. ibuprofen (Motrin)
D. acetaminophen (Tylenol) Correct Ans:- D. acetaminophen (Tylenol)
For patients with osteoarthritis who have mild to moderate pain, the initial drug of choice is
acetaminophen.
Ch. 65 Pre-Assessment #3
Which of the following laboratory values would probably be found in a patient with
osteoarthritis (OA)?
A. Decreased RBCs
B. Increased WBCs
C. Clear yellow synovial fluid
D. Increased C-reactive protein
E. Increased erythrocyte sedimentation rate Correct Ans:- C. Clear yellow synovial fluid
Normally there are no laboratory abnormalities or biomarkers for OA. Clear yellow fluid is
normal synovial fluid.
Ch. 65 Pre-Assessment #4
A patient who has ankylosing spondylitis (AS) asks the nurse for help in choosing suitable
activities for maintaining good posture. Which exercise should the nurse advise the patient to
avoid?
A. Do stomach crunching
B. Stand on a single leg
C. Face wall and push off
D. Stretch the lower back Correct Ans:- A. Do stomach crunching
The nurse advises a patient who has AS to avoid stomach crunches because they involve spinal
flexion, which over the long term can aggravate pulmonary complications by decreasing the
thoracic cage. The help strengthen the same muscles, the nurse encourages exercises to
strengthen the upper and lower back such as leg lifts in the prone position because in the prone
position the back is supported to prevent flexion. The remaining options can be suitable
exercises for this patient, standing on one leg promotes core strength, pushing off a wall
strengthens back muscles, and stretching the lower back helps maintain joint flexibility.
Ch. 65 Pre-Assessment #5
, The incidence of Lyme disease is very high in a Pennsylvania county, so the public health nurse
provides community education to increase the number of patients who seek health care
promptly after a tick bite. Which information should the nurse provide in community teaching
people who are at risk for a tick bite?
A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Antibiotics will prevent Lyme disease if taken for 10 days.
D. Surveillance is necessary during the summer months only. Correct Ans:- B. Check for an
enlarging reddened area with a clear center.
Following a tick bite, individuals should mark the area with a pen and watch for a reddened
lesion that enlarges within 2 to 30 days after the bite, develops a clear center, has a bright red
border, and is accompanied by flu-like symptoms and migrating joint and muscle pain. When
Lyme disease is confirmed, oral doxycycline (Vibramycin) can be effective if started within 3
days of the bite, and 2 to 3 weeks of antibiotic therapy is usually effective. Although ticks are
most prevalent during summer months, residents of high-risk areas should check for ticks
whenever they are outdoors.
Ch. 65 Pre-Assessment #6
In comparing connective tissue disorders, which disorder is most likely to result in patient
injury, affect pulmonary function, and increase the patient's risk of infection as a result of the
indicated drug therapy?
A. Polymyositis (PN)
B. Sjogren's Syndrome (SS)
C. Systemic sclerosis (scleroderma)
D. Systemic lupus erythematousus (SLE) Correct Ans:- A. Polymyositis (PN)
PN is an inflammatory disease of striated muscle, resulting in muscle weakness that increases
the patient's risk of falls and injury. In addition, most patients with PN develop interstitial lung
disease, which can impair pulmonary function. The risk of infection increases during therapy
with corticosteroids because these drugs suppress the immune response to potential
pathogens.
Ch. 65 Pre-Assessment #7
Patients who have which of this following connective disorders are least likely to experience
significant pain because of the primary pathophysiologic process of this disorder?
A. FIbromyalgia
B. Lyme disease
C. Sjogren's syndrome (SS)
Rank in order the sequence of events leading to joint destruction in secondary osteoarthritis
(OA) beginning with the effect of an injury to the cervical spine.
A. Exacerbation of abdominal tissue growth
B. Bony articular surfaces in joint exposed
C. Fragile, soft, dull joint cartilage develops
D. Irregular joint motion, stiffness, and pain Correct Ans:- C. Fragile, soft, dull joint cartilage
develops
A. Exacerbation of abdominal tissue growth
D. Irregular joint motion, stiffness, and pain
B. Bony articular surfaces in joint exposed
A precipitating factor, such as trauma to the spine, leads to the development of OA by
damaging the cartilage. Joint destruction begins with the development of dull, soft, less elastic,
and more fragile cartilage. Because the body is unable to repair the cartilage fast enough, the
cartilage develops fissures and erosion and, in so doing, becomes thinner, leading to the
formation of osteophytes and cartilage at the joint margins. The formation of abnormal tissue
leads to abnormal joint movement. Pain and stiffness increase as the bony surfaces of the joint
are exposed.
Ch. 65 Pre-Assessment #1
The nurse is assessing a patient who is complaining of joint pain and stiffness. Which
assessment does not differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA)?
A. Symmetry of joint effect
B. Duration of joint stiffness
C. Space between the bones
D. Erythrocyte sedimentation rate Correct Ans:- C. Space between the bones
Both OA and RA manifest with narrowed joint spaces so this is not a valid assessment to help
differentiate between the two disorders. The remaining options are patient assessments that
facilitate differentiation of OA and RA because symmetric joints are affected in RA but not in
OA; stiffness resolves in less than 30 minutes with OA but not RA; and a patient with RA, but
not OA, is likely to have elevated erythrocyte sedimentation levels indicating inflammation.
Ch. 65 Pre-Assessment #2
A 75-year-old female patient complains about morning stiffness and increasing joint pain in her
right hip. What is the best initial drug therapy for her?
,A. aspirin
B. naproxen (Aleve)
C. ibuprofen (Motrin)
D. acetaminophen (Tylenol) Correct Ans:- D. acetaminophen (Tylenol)
For patients with osteoarthritis who have mild to moderate pain, the initial drug of choice is
acetaminophen.
Ch. 65 Pre-Assessment #3
Which of the following laboratory values would probably be found in a patient with
osteoarthritis (OA)?
A. Decreased RBCs
B. Increased WBCs
C. Clear yellow synovial fluid
D. Increased C-reactive protein
E. Increased erythrocyte sedimentation rate Correct Ans:- C. Clear yellow synovial fluid
Normally there are no laboratory abnormalities or biomarkers for OA. Clear yellow fluid is
normal synovial fluid.
Ch. 65 Pre-Assessment #4
A patient who has ankylosing spondylitis (AS) asks the nurse for help in choosing suitable
activities for maintaining good posture. Which exercise should the nurse advise the patient to
avoid?
A. Do stomach crunching
B. Stand on a single leg
C. Face wall and push off
D. Stretch the lower back Correct Ans:- A. Do stomach crunching
The nurse advises a patient who has AS to avoid stomach crunches because they involve spinal
flexion, which over the long term can aggravate pulmonary complications by decreasing the
thoracic cage. The help strengthen the same muscles, the nurse encourages exercises to
strengthen the upper and lower back such as leg lifts in the prone position because in the prone
position the back is supported to prevent flexion. The remaining options can be suitable
exercises for this patient, standing on one leg promotes core strength, pushing off a wall
strengthens back muscles, and stretching the lower back helps maintain joint flexibility.
Ch. 65 Pre-Assessment #5
, The incidence of Lyme disease is very high in a Pennsylvania county, so the public health nurse
provides community education to increase the number of patients who seek health care
promptly after a tick bite. Which information should the nurse provide in community teaching
people who are at risk for a tick bite?
A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Antibiotics will prevent Lyme disease if taken for 10 days.
D. Surveillance is necessary during the summer months only. Correct Ans:- B. Check for an
enlarging reddened area with a clear center.
Following a tick bite, individuals should mark the area with a pen and watch for a reddened
lesion that enlarges within 2 to 30 days after the bite, develops a clear center, has a bright red
border, and is accompanied by flu-like symptoms and migrating joint and muscle pain. When
Lyme disease is confirmed, oral doxycycline (Vibramycin) can be effective if started within 3
days of the bite, and 2 to 3 weeks of antibiotic therapy is usually effective. Although ticks are
most prevalent during summer months, residents of high-risk areas should check for ticks
whenever they are outdoors.
Ch. 65 Pre-Assessment #6
In comparing connective tissue disorders, which disorder is most likely to result in patient
injury, affect pulmonary function, and increase the patient's risk of infection as a result of the
indicated drug therapy?
A. Polymyositis (PN)
B. Sjogren's Syndrome (SS)
C. Systemic sclerosis (scleroderma)
D. Systemic lupus erythematousus (SLE) Correct Ans:- A. Polymyositis (PN)
PN is an inflammatory disease of striated muscle, resulting in muscle weakness that increases
the patient's risk of falls and injury. In addition, most patients with PN develop interstitial lung
disease, which can impair pulmonary function. The risk of infection increases during therapy
with corticosteroids because these drugs suppress the immune response to potential
pathogens.
Ch. 65 Pre-Assessment #7
Patients who have which of this following connective disorders are least likely to experience
significant pain because of the primary pathophysiologic process of this disorder?
A. FIbromyalgia
B. Lyme disease
C. Sjogren's syndrome (SS)
