Medical-Surgical B exam with correct 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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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
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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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 |answer |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
