OA and RA - Practice Questions And
Answers, Complete Solution
Which finding will the nurse expect when assessing a 58-year-old patient who has
osteoarthritis (OA) of the knee?
a. Discomfort with joint movement
b. Heberden's and Bouchard's nodes
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement
ANS: A
Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on
the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis
(RA). Stiffness in OA is worse right after the patient rests and decreases with joint
movement.
Which assessment finding about a patient who has been using naproxen
(Naprosyn) for 6 weeks to treat osteoarthritis is most important for the nurse to
report to the health care provider?
a. The patient has gained 3 pounds.
b. The patient has dark-colored stools.
c. The patient's pain has become more severe.
d. The patient is using capsaicin cream (Zostrix).
ANS: B
Dark-colored stools may indicate that the patient is experiencing gastrointestinal
bleeding caused by the naproxen. The information about the patient's ongoing pain and
weight gain also will 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.
After the nurse has finished teaching a 68-year-old patient with osteoarthritis
(OA) of the right hip about how to manage the OA, which patient statement
indicates a need for more teaching?
a. "I can take glucosamine to help decrease my knee pain."
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 should be taken daily to avoid liver damage. The
other patient statements are correct and indicate good understanding of OA
management.
The nurse will anticipate the need to teach a 57-year-old patient who has
osteoarthritis (OA) about which medication?
a. Adalimumab (Humira)
b. Prednisone (Deltasone)
,c. Capsaicin cream (Zostrix)
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 RA.
A patient with rheumatoid arthritis being seen in the clinic has rheumatoid
nodules on the elbows. Which action will the nurse take?
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.
Which action will the nurse include in the plan of care for a 33-year-old patient
with a new diagnosis of rheumatoid arthritis?
a. Instruct the patient to purchase a soft mattress.
b. Suggest that the patient take a nap in the afternoon.
c. Teach the patient to use lukewarm water when bathing.
d. Suggest exercise with light weights several times daily.
ANS: B
Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid
arthritis. Patients are taught to avoid stressing joints, to use warm baths to relieve
stiffness, and to use a firm mattress. When stabilized, a therapeutic exercise program is
usually developed by a physical therapist to include exercises that improve the flexibility
and strength of the affected joints, and the patient's overall endurance.
A patient with rheumatoid arthritis (RA) complains to the clinic nurse about
having chronically dry eyes. Which action by the nurse is most appropriate?
a. Teach the patient about adverse effects of the RA medications.
b. Suggest that the patient use over-the-counter (OTC) artificial tears.
c. Reassure the patient that dry eyes are a common problem with RA.
d. Ask the health care provider about discontinuing methotrexate (Rheumatrex) .
ANS: B
The patient's dry eyes are consistent with Sjögren's syndrome, a common extraarticular
manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended.
Dry eyes are not a side effect of methotrexate. Although dry eyes are common in RA, it
is more helpful to offer a suggestion to relieve these symptoms than to offer
reassurance. The dry eyes are not caused by RA treatment, but by the disease itself
Which information will the nurse include when preparing teaching materials for
patients with exacerbations of rheumatoid arthritis?
a. Affected joints should not be exercised when pain is present.
b. Application of cold packs before exercise may decrease joint pain.
c. Exercises should be performed passively by someone other than the patient.
d. Walking may substitute for range-of-motion (ROM) exercises on some days.
,ANS: B
Cold application is helpful in reducing pain during periods of exacerbation of RA.
Because the joint pain is chronic, patients are instructed to exercise even when joints
are painful. ROM exercises are intended to strengthen joints and improve flexibility, so
passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a
replacement for ROM exercises.
Which laboratory result will the nurse monitor to determine whether prednisone
(Deltasone) has been effective for a 30-year-old patient with an acute
exacerbation of rheumatoid arthritis?
a. Blood glucose test
b. Liver function tests
c. C-reactive protein level
d. Serum electrolyte levels
ANS: C
C-reactive protein is a marker for inflammation, and a decrease would indicate that the
corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also
be monitored to check for side effects of prednisone. Liver function is not routinely
monitored in patients receiving corticosteroids.
The nurse teaching a support group of women with rheumatoid arthritis (RA)
about how to manage activities of daily living suggests that they
a. stand rather than sit when performing household and yard chores.
b. strengthen small hand muscles by wringing sponges or washcloths.
c. protect the knee joints by sleeping with a small pillow under the knees.
d. avoid activities that require repetitive use of the same muscles and joints.
ANS: D
Patients are advised to avoid repetitious movements. Sitting during household chores is
recommended to decrease stress on joints. Wringing water out of sponges would
increase the joint stress. Patients are encouraged to position joints in the extended
position, and sleeping with a pillow behind the knees would decrease the ability of the
knee to extend and also decrease knee range of motion (ROM).
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis
(RA) plan to start each day with
a. a warm bath followed by a short rest.
b. a short routine of isometric exercises.
c. active range-of-motion (ROM) exercises.
d. stretching exercises to relieve joint stiffness.
ANS: A
Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse
in the morning. Isometric exercises would place stress on joints and would not be
recommended. Stretching and ROM should be done later in the day, when joint stiffness
is decreased.
Anakinra (Kineret) is prescribed for a 49-year-old patient who has rheumatoid
arthritis (RA). When teaching the patient about this drug, the nurse will include
information about
a. avoiding concurrently taking aspirin.
b. symptoms of gastrointestinal (GI) bleeding.
, c. self-administration of subcutaneous injections.
d. taking the medication with at least 8 oz of fluid.
ANS: C
Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of
this medication. Because the medication is injected, instructions to take it with 8 oz of
fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or
nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued
A 37-year-old patient with 2 school-age children who has recently been
diagnosed with rheumatoid arthritis (RA) tells the nurse that home life is very
stressful. Which response by the nurse is most appropriate?
a. "Tell me more about situations that are causing you stress."
b. "You need to see a family therapist for some help with stress."
c. "Your family should understand the impact of your rheumatoid arthritis."
d. "Perhaps it would be helpful for your family to be involved in a support group."
ANS: A
The initial action by the nurse should be further assessment. The other three responses
might be appropriate based on the information the nurse obtains with further
assessment
Which information will the nurse include when teaching a 38-year-old male
patient with newly diagnosed ankylosing spondylitis (AS) about the management
of the condition?
a. Exercise by taking long walks.
b. Do daily deep-breathing exercises.
c. Sleep on the side with hips flexed.
d. Take frequent naps during the day.
ANS: B
Deep-breathing exercises are used to decrease the risk for pulmonary complications
that may occur with the reduced chest expansion that can occur with ankylosing
spondylitis (AS). Patients should sleep on the back and avoid flexed positions.
Prolonged standing and walking should be avoided. There is no need for frequent naps
A 19-year-old patient hospitalized with a fever and red, hot, and painful knees is
suspected of having septic arthritis. Information obtained during the nursing
history that indicates a risk factor for septic arthritis is that the patient
a. had several knee injuries as a teenager.
b. recently returned from South America.
c. is sexually active with multiple partners.
d. has a parent who has rheumatoid arthritis.
ANS: C
Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active
young adults. The other information does not point to any risk for septic arthritis.
The nurse notices a circular lesion with a red border and clear center on the arm
of an 18-year-old summer camp counselor who is in the camp clinic complaining
of chills and muscle aches. Which action should the nurse take next?
a. Palpate the abdomen.
b. Auscultate the heart sounds.
Answers, Complete Solution
Which finding will the nurse expect when assessing a 58-year-old patient who has
osteoarthritis (OA) of the knee?
a. Discomfort with joint movement
b. Heberden's and Bouchard's nodes
c. Redness and swelling of the knee joint
d. Stiffness that increases with movement
ANS: A
Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on
the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis
(RA). Stiffness in OA is worse right after the patient rests and decreases with joint
movement.
Which assessment finding about a patient who has been using naproxen
(Naprosyn) for 6 weeks to treat osteoarthritis is most important for the nurse to
report to the health care provider?
a. The patient has gained 3 pounds.
b. The patient has dark-colored stools.
c. The patient's pain has become more severe.
d. The patient is using capsaicin cream (Zostrix).
ANS: B
Dark-colored stools may indicate that the patient is experiencing gastrointestinal
bleeding caused by the naproxen. The information about the patient's ongoing pain and
weight gain also will 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.
After the nurse has finished teaching a 68-year-old patient with osteoarthritis
(OA) of the right hip about how to manage the OA, which patient statement
indicates a need for more teaching?
a. "I can take glucosamine to help decrease my knee pain."
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 should be taken daily to avoid liver damage. The
other patient statements are correct and indicate good understanding of OA
management.
The nurse will anticipate the need to teach a 57-year-old patient who has
osteoarthritis (OA) about which medication?
a. Adalimumab (Humira)
b. Prednisone (Deltasone)
,c. Capsaicin cream (Zostrix)
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 RA.
A patient with rheumatoid arthritis being seen in the clinic has rheumatoid
nodules on the elbows. Which action will the nurse take?
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.
Which action will the nurse include in the plan of care for a 33-year-old patient
with a new diagnosis of rheumatoid arthritis?
a. Instruct the patient to purchase a soft mattress.
b. Suggest that the patient take a nap in the afternoon.
c. Teach the patient to use lukewarm water when bathing.
d. Suggest exercise with light weights several times daily.
ANS: B
Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid
arthritis. Patients are taught to avoid stressing joints, to use warm baths to relieve
stiffness, and to use a firm mattress. When stabilized, a therapeutic exercise program is
usually developed by a physical therapist to include exercises that improve the flexibility
and strength of the affected joints, and the patient's overall endurance.
A patient with rheumatoid arthritis (RA) complains to the clinic nurse about
having chronically dry eyes. Which action by the nurse is most appropriate?
a. Teach the patient about adverse effects of the RA medications.
b. Suggest that the patient use over-the-counter (OTC) artificial tears.
c. Reassure the patient that dry eyes are a common problem with RA.
d. Ask the health care provider about discontinuing methotrexate (Rheumatrex) .
ANS: B
The patient's dry eyes are consistent with Sjögren's syndrome, a common extraarticular
manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended.
Dry eyes are not a side effect of methotrexate. Although dry eyes are common in RA, it
is more helpful to offer a suggestion to relieve these symptoms than to offer
reassurance. The dry eyes are not caused by RA treatment, but by the disease itself
Which information will the nurse include when preparing teaching materials for
patients with exacerbations of rheumatoid arthritis?
a. Affected joints should not be exercised when pain is present.
b. Application of cold packs before exercise may decrease joint pain.
c. Exercises should be performed passively by someone other than the patient.
d. Walking may substitute for range-of-motion (ROM) exercises on some days.
,ANS: B
Cold application is helpful in reducing pain during periods of exacerbation of RA.
Because the joint pain is chronic, patients are instructed to exercise even when joints
are painful. ROM exercises are intended to strengthen joints and improve flexibility, so
passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a
replacement for ROM exercises.
Which laboratory result will the nurse monitor to determine whether prednisone
(Deltasone) has been effective for a 30-year-old patient with an acute
exacerbation of rheumatoid arthritis?
a. Blood glucose test
b. Liver function tests
c. C-reactive protein level
d. Serum electrolyte levels
ANS: C
C-reactive protein is a marker for inflammation, and a decrease would indicate that the
corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also
be monitored to check for side effects of prednisone. Liver function is not routinely
monitored in patients receiving corticosteroids.
The nurse teaching a support group of women with rheumatoid arthritis (RA)
about how to manage activities of daily living suggests that they
a. stand rather than sit when performing household and yard chores.
b. strengthen small hand muscles by wringing sponges or washcloths.
c. protect the knee joints by sleeping with a small pillow under the knees.
d. avoid activities that require repetitive use of the same muscles and joints.
ANS: D
Patients are advised to avoid repetitious movements. Sitting during household chores is
recommended to decrease stress on joints. Wringing water out of sponges would
increase the joint stress. Patients are encouraged to position joints in the extended
position, and sleeping with a pillow behind the knees would decrease the ability of the
knee to extend and also decrease knee range of motion (ROM).
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis
(RA) plan to start each day with
a. a warm bath followed by a short rest.
b. a short routine of isometric exercises.
c. active range-of-motion (ROM) exercises.
d. stretching exercises to relieve joint stiffness.
ANS: A
Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse
in the morning. Isometric exercises would place stress on joints and would not be
recommended. Stretching and ROM should be done later in the day, when joint stiffness
is decreased.
Anakinra (Kineret) is prescribed for a 49-year-old patient who has rheumatoid
arthritis (RA). When teaching the patient about this drug, the nurse will include
information about
a. avoiding concurrently taking aspirin.
b. symptoms of gastrointestinal (GI) bleeding.
, c. self-administration of subcutaneous injections.
d. taking the medication with at least 8 oz of fluid.
ANS: C
Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of
this medication. Because the medication is injected, instructions to take it with 8 oz of
fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or
nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued
A 37-year-old patient with 2 school-age children who has recently been
diagnosed with rheumatoid arthritis (RA) tells the nurse that home life is very
stressful. Which response by the nurse is most appropriate?
a. "Tell me more about situations that are causing you stress."
b. "You need to see a family therapist for some help with stress."
c. "Your family should understand the impact of your rheumatoid arthritis."
d. "Perhaps it would be helpful for your family to be involved in a support group."
ANS: A
The initial action by the nurse should be further assessment. The other three responses
might be appropriate based on the information the nurse obtains with further
assessment
Which information will the nurse include when teaching a 38-year-old male
patient with newly diagnosed ankylosing spondylitis (AS) about the management
of the condition?
a. Exercise by taking long walks.
b. Do daily deep-breathing exercises.
c. Sleep on the side with hips flexed.
d. Take frequent naps during the day.
ANS: B
Deep-breathing exercises are used to decrease the risk for pulmonary complications
that may occur with the reduced chest expansion that can occur with ankylosing
spondylitis (AS). Patients should sleep on the back and avoid flexed positions.
Prolonged standing and walking should be avoided. There is no need for frequent naps
A 19-year-old patient hospitalized with a fever and red, hot, and painful knees is
suspected of having septic arthritis. Information obtained during the nursing
history that indicates a risk factor for septic arthritis is that the patient
a. had several knee injuries as a teenager.
b. recently returned from South America.
c. is sexually active with multiple partners.
d. has a parent who has rheumatoid arthritis.
ANS: C
Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active
young adults. The other information does not point to any risk for septic arthritis.
The nurse notices a circular lesion with a red border and clear center on the arm
of an 18-year-old summer camp counselor who is in the camp clinic complaining
of chills and muscle aches. Which action should the nurse take next?
a. Palpate the abdomen.
b. Auscultate the heart sounds.
