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Exam 4 (Medsurg): Arthritis/CT Disorders

Total questions: 130

Worksheet time: 1hrs 9mins

Name
Class
Date
1.

Osteoarthritis is a slowly progressive noninflammatory disorder of the ________ (SYNOVIAL) joints.

a)

diarthrodial

b)

cartilaginous

c)

fibrous

d)

amphiarthrodial

2.

Gradual onset of some degree of osteoarthritis is part of the normal aging process.

a)

True

b)

False

3.

At what age does cartilage destruction in osteoarthritis typically begin?

a)

20-30

b)

10-15

c)

40-50

d)

60-70

4.

Symptoms of osteoarthritis usually do not manifest until after what age?

a)

50-60

b)

20-30

c)

30-40

d)

40-50

e)

60-70

5.

After age 50, who gets osteoarthritis more commonly?

a)

Men

b)

Women

6.

Osteoarthritis is correlated with the formation of _______ at the joint margins.

a)

osteocytes

b)

osteoclasts

c)

osteoblasts

d)

osteophytes

7.

SATA: New joint tissue formed in response to destruction of cartilage in osteoarthritis becomes:

a)

Dull, yellow, and granular

b)

Softer and less elastic

c)

Less able to resist wear with heavy use

d)

Harder and more brittle

e)

Vibrantly erythatemous

8.

Inflammation in osteoarthritis is typical.

a)

True

b)

False

9.

Which of the following is NOT present in osteoarthritis (OA)?

a)

Systemic manifestations

b)

Palpable bony joint enlargement

c)

Morning stiffness lasting over 30 mins

d)

Reduced range of motion (ROM)

10.

One of the main distinctions between OA and RA (rheumatoid arthritis) is:

a)

OA has systemic symptoms

b)

RA has systemic symptoms

c)

OA has symmetrical joint involvement

d)

RA has clear synovial fluid

11.

Fill in the blank: In OA, morning stiffness typically lasts under ____ minutes.

a)

30

b)

10

c)

60

d)

5

12.

Which condition is associated with palpable bony joint enlargement?

a)

OA

b)

RA

13.

Which of the following is a physical exam finding in OA?

a)

Synovitis

b)

Joint malalignment

c)

Symmetrical joint involvement

d)

Extra-articular manifestation

14.

Systemic symptoms such as fatigue, fever, and organ involvement are present in OA.

a)

True

b)

False

15.

Which of the following is THE primary symptom of osteoarthritis?

a)

joint pain

b)

leakage of synovial fluid

c)

bone spur formation

d)

joint destruction

16.

In osteoarthritis, pain worsens with joint use. In the early stages, what relieves the pain?

a)

Exercise

b)

Rest

c)

Medication

d)

Heat

17.

In late stages of osteoarthritis, joint pain can still be relived with rest and sleep.

a)

True

b)

False

18.

Osteoarthritic pain may be referred to which of the following areas?

a)

Groin

b)

Buttock

c)

Outside of thigh or knee

d)

All of the above

19.

For patients with osteoarthritis, sitting down becomes difficult, as does getting up from a chair when their______ are lower than their______.

a)

hips, knees

b)

knees, hips

c)

sacrum, ribs

d)

ribs, sacrum

20.

Joint stiffness occurs after periods of rest or ________ position.

a)

unchanged

b)

elevated

c)

frequently changed

d)

rotated

21.

Early morning stiffness caused by osteoarthritis USUALLY resolves within how many minutes?

a)

10 mins

b)

20 mins

c)

30 mins

d)

60 mins

22.

Overactivity can lead to mild joint ________, which can temporarily increase stiffness in osteoarthritis.

a)

effusion

b)

perfusion

c)

effacement

d)

fusion

23.

Manifestations of osteoarthritis/OA, such as pain, stiffness, and crepitus, typically present in a(n) ________ fashion, which differentiates this condition from rheumatoid arthritis/RA.

a)

symmetrical

b)

asymmetrical

24.

Fill in the blank: For detecting EARLY joint changes in osteoarthritis, ________, CT scan, and MRI are used as PRIMARILY used as diagnostic tools.

a)

Bone scan

b)

Ultrasound

c)

X-ray

d)

PET scan

25.

Which imaging technique is PRIMARILY used to detect joint space narrowing, bony sclerosis, and osteophyte formation in osteoarthritis?

a)

MRI

b)

X-rays

c)

Ultrasound

d)

PET scan

26.

Fill in the blank: In osteoarthritis, there are ________ lab abnormalities.

a)

No specific

b)

Multiple

c)

Severe

d)

Consistent

e)

Marked

27.

Fill in the blank: ________ fluid analysis is a diagnostic tool for osteoarthritis.

a)

Synovial

b)

Cerebrospinal

c)

Peritoneal

d)

Pleural

28.

Fill in the blank: Nondrug interventions are ________ for OA management.

a)

the basis

b)

an adjunct

c)

an alternative

d)

the last resort

29.

Fill in the blank: Drug therapy ________ nondrug treatment in osteoarthritis care.

a)

SUPPLEMENTS

b)

REPLACES

c)

ELIMINATES

d)

CONTRADICTS

30.

Which of the following should be avoided in knee osteoarthritis?

a)

Prolonged standing

b)

Kneeling

c)

Squatting

d)

All of the above

31.

Fill in the blank: Ice is recommended for ________ inflammation in osteoarthritis.

a)

acute

b)

chronic

c)

mild

d)

long-lasting

32.

Fill in the blank: Heat is recommended for ________ in osteoarthritis.

a)

stiffness

b)

swelling

c)

pain

d)

bleeding

e)

inflammation

33.

Which of the following is considered MOST CRITICAL for osteoarthritis management?

a)

Weight reduction

b)

Dietary changes

c)

Healthy sleep habits

d)

Drug therapy

34.

SATA: Select the types of exercise recommended for osteoarthritis management.

a)

Aerobic

b)

Range of motion

c)

Quadriceps strengthening

d)

Anaerobic

e)

Calisthenics

35.

Nutritional supplements recommended for osteoarthritis include ______ and ______.

a)

Glucosamine and chondroitin sulfate

b)

Vitamin C and calcium

c)

Iron and folic acid

d)

Omega-3 and vitamin D

36.

Drug therapy for osteoarthritis is based on the severity of the patient's symptoms.

a)

True

b)

False

37.

Which medication is recommended for mild to moderate joint pain in osteoarthritis?

a)

NSAIDs

b)

Acetaminophen

c)

DMOADs

d)

Strontium ranelate

38.

Topical agents, OTC creams, and topical salicylates are used for ______ joint pain in osteoarthritis.

a)

mild to moderare

b)

moderate to severe

c)

severe to debilitating

39.

Which of the following is used for moderate to severe joint pain in osteoarthritis?

a)

NSAIDs

b)

Acetaminophen

c)

Glucosamine

d)

Tai Chi

40.

Intraarticular corticosteroid injections are recommended for ________ joint pain in osteoarthritis.

a)

mild to moderate

b)

moderate to severe

c)

severe to debilitating

41.

Hyaluronic acid injection for osteoarthritis is an older treatment method that assists with viscosupplementation. This treatment methodology is still recommended to this day.

a)

True

b)

False

42.

Are there any drugs approved to modify OA progression according to the DMOADs section?

a)

No drugs approved

b)

Corticosteroids are approved

c)

NSAIDs are approved

d)

Hyaluronic acid is approved

43.

Arthroscopic surgery is common treatment for patients with osteoarthritis, but the procedure may provide no additional benefit over treatments like physical therapy.

a)

True

b)

False

44.

SATA: Select all of the joint aspects the RN should assess for in patients with osteoarthritis.

a)

tenderness

b)

swelling

c)

limitation of movement

d)

crepitation

e)

stiffness

45.

Alteration of ______ risk factors is a major part of community education for patients at risk for osteoarthritis.

a)

modifiable

b)

static

c)

inherited

d)

autoimmune

46.

Losing weight and reducing occupational and recreational hazards are recommended for health promotion in osteoarthritis.

a)

True

b)

False

47.

What is arthroscopic surgery?

a)

minimally invasive joint modification utilizing small incisions

b)

total joint replacement

c)

surgical drainage of affected synovial fluid

d)

surgical initiation of the synovitis process

48.

What color is the synovial fluid of affected joints in osteoarthritis/OA?

a)

clear

b)

yellow

c)

brown

d)

red

49.

SATA: Select some home and work environment modifications that could be useful for osteoarthritic patients.

a)

scatter rugs

b)

extra railings

c)

night lights

d)

small yippy dogs

e)

assistive devices

50.

Assistive devices such as canes, walkers, elevated toilet seats, and grab bars are recommended for osteoarthritis management.

a)

True

b)

False

51.

What type of disease is Rheumatoid Arthritis?

a)

Infectious disease

b)

Autoimmune disease

c)

Genetic disorder

d)

Nonprogressive disease

52.

Rheumatoid Arthritis involves inflammation of which tissue in synovial/diarthroidal joints?

a)

Connective tissue

b)

Muscle tissue

c)

Epithelial tissue

d)

Nervous tissue

53.

Periods of remission and exacerbation in Rheumatoid Arthritis are known as ________.

a)

spells

b)

cycles

c)

waves

d)

phases

54.

Rheumatoid Arthritis affects ALL ethnic groups in roughly equal proportions.

a)

True

b)

False

55.

At what age does the incidence of Rheumatoid Arthritis peak?

a)

10-20

b)

20-30

c)

30-50

d)

50-70

56.

Rheumatoid Arthritis is ______ times more likely in women than men.

a)

3

b)

1

c)

2

d)

5

57.

Which of the following is NOT a proinflammatory cytokine secreted by fibroblasts in Rheumatoid Arthritis?

a)

Interleukin-1 (IL-1)

b)

Interleukin-6 (IL-6)

c)

Tumor Necrosis Factor (TNF)

d)

Intrinsic Factor (IF)

58.

Without adequate treatment, more than what percentage of Rheumatoid Arthritis cases develop marked functional impairment within 20 years?

a)

60%

b)

30%

c)

45%

d)

80%

59.

What is needed for patients in the advanced stages of Rheumatoid Arthritis?

a)

Complete joint reconstruction

b)

Intense joint exercise

c)

Mild joint adjustment

d)

Frequent opioid pain medication administration

60.

By the end stage of Rheumatoid Arthritis, patients experience loss of independence and require daily care.

a)

True

b)

False

61.

Which of the following symptoms is NOT present in stage 1 of rheumatoid arthritis?

a)

joint destruction

b)

soft tissue swelling

c)

synovitis

d)

osteoporosis

62.

Which stage of Rheumatoid Arthritis involves gradual destruction in joint cartilage?

a)

Stage 2

b)

Stage 1

c)

Stage 3

d)

Stage 4

63.

Which finding is consistent with stage 3 rheumatoid arthritis?

a)

moderate destruction of joint cartilage

b)

complete loss of joint function

c)

extensive cartilage loss and erosion of joints

d)

no visible evidence of joint destruction

64.

Stage 4 of rheumatoid arthritis is characterized by COMPLETE LOSS of joint function.

a)

True

b)

False

65.

Onset of joint symptoms in Rheumatoid Arthritis is typically _______.

a)

insidious

b)

acute

c)

rapidly

d)

suspicious

66.

List some general symptoms that may occur in Rheumatoid Arthritis.

a)

Fatigue, anorexia, weight loss, generalized stiffness

b)

Joint dislocation, bone fracture, muscle hypertrophy

c)

High fever, severe bleeding, jaundice

d)

Sudden paralysis, blurred vision, chest pain

67.

SATA: When giving their medical history, patients with Rheumatoid Arthritis may report onset of joint symptoms following what kind of precipitating events?

a)

infection

b)

extreme stress

c)

childbirth

d)

major surgery

e)

extreme exertion

68.

Symptoms of rheumatoid arthritis often occur ________.

a)

SYMMETRICALLY

b)

ASYMETRICALLY

69.

Which joints are MOST often affected in rheumatoid arthritis?

a)

Small joints

b)

Large joints

c)

Hip joints

d)

Spine joints

70.

A patient with rheumatoid arthritis that has spinal manifestations would MOST likely experience symptoms in which portion of the spine?

a)

Cervical

b)

Thoracic

c)

Lumbar

d)

Sacral

71.

Joint stiffness in Rheumatoid Arthritis usually occurs after what?

a)

Inactivity

b)

Exercise

c)

Eating

d)

Sleeping

72.

Morning stiffness in Rheumatoid Arthritis lasts how long?

a)

60+ minutes

b)

Less than 30 minutes

c)

30 to 60 minutes

d)

30 to 45 minutes

73.

SATA: Which joints of the hand are TYPICALLY swollen in Rheumatoid Arthritis? (all of these joints can be affected by RA)

a)

PIP joints

b)

DIP joints

c)

IP joints

d)

CMC joints

e)

MCP joints

74.

Fingers in Rheumatoid Arthritis may be ______ shaped.

a)

spindle

b)

cuboid

c)

circular

d)

triangular

e)

spiral

75.

Joints in Rheumatoid Arthritis are often tender, painful, and ______ to the touch.

a)

warm

b)

cold

c)

dry

d)

rough

76.

Pain in Rheumatoid Arthritis increases with ______.

a)

motion

b)

inactivity

77.

Tenosynovitis in Rheumatoid Arthritis can cause symptoms similar to which syndrome?

a)

Carpal tunnel syndrome

b)

De Quervain's syndrome

c)

Raynaud's syndrome

d)

Cubital tunnel syndrome

78.

Sjogren’s Syndrome, which is an extraarticular complication of rheumatoid arthritis, is characterized by diminished ______ and ______ secretion.

a)

lacrimal and salivary

b)

gastric and pancreatic

c)

thyroid and adrenal

d)

renal and hepatic

79.

Felty Syndrome, which is an extraarticular complication of rheumatoid arthritis, is associated with an enlarged ______ and low ______ count.

a)

spleen, WBC

b)

liver, RBC

c)

kidney, platelet

d)

pancreas, hemoglobin

80.

Which lab test is NOT used in the diagnosis of Rheumatoid Arthritis?

a)

Rheumatoid factor (RF)

b)

ESR and C-reactive protein (CRP)

c)

ASTs/ALTs (LFTs)

d)

Antinuclear antibody (ANA)

81.

What does Anti-CCP stand for in Rheumatoid Arthritis diagnostics?

a)

Antibodies to citrullinated peptide

b)

Antibodies to cyclic citric protein

c)

Antigens to collagen peptide

d)

Antibodies to calcium phosphate

82.

Which imaging techniques are PRIMARILY used to assess involved joints in Rheumatoid Arthritis?

a)

X-rays and bone scans

b)

Ultrasound and PET scan

c)

CT scan and MRI

d)

Fluoroscopy and Doppler ultrasound

83.

Patient education for Rheumatoid Arthritis includes which of the following?

a)

Drug therapy

b)

Home management strategies

c)

Physical and occupational therapy

d)

All of the above

84.

Which drug therapy is used to decrease the permanent effects of RA?

a)

DMARDs

b)

NSAIDs

c)

Corticosteroids

d)

Analgesics

e)

All of the above

85.

Patients taking methotrexate for rheumatoid arthritis require the RN to vigilantly monitor for which two adverse effects?

a)

Bone marrow suppression and hepatotoxicity

b)

Renal calculi and hypertension

c)

Hyperglycemia and pancreatitis

d)

Pulmonary embolism and deep vein thrombosis

86.

Which drugs are listed as DMARDs for RA therapy?

a)

Methotrexate, Sulfasalazine, Azulfidine, Hydroxychloroquine, Plaquenil

b)

Ibuprofen, Naproxen, Aspirin, Celecoxib, Diclofenac

c)

Prednisone, Methylprednisolone, Dexamethasone, Hydrocortisone, Triamcinolone

d)

Adalimumab, Etanercept, Infliximab, Golimumab, Certolizumab

87.

Heberden's nodes are located on which finger joint?

a)

DIP

b)

PIP

c)

MCP

d)

CMC

88.

Brouchard's nodes are located on which finger joint?

a)

DIP

b)

PIP

c)

MCP

d)

PCP

89.

One distinction in joint presentation for osteoarthritic patients when compared to rheumatoid patients is that patients with osteoarthritis do NOT have:

a)

swollen and tender joints

b)

visible joint deformity

c)

erythemateous joints

d)

significant loss of joint function

90.

SATA: The etiology of rheumatoid arthritis/RA is a combination of which factors?

a)

genetic

b)

environmental

c)

viral

d)

fungal

e)

bacterial

91.

In patients with rheumatoid arthritis, antigens trigger the formation of abnormal ____.

a)

IgA

b)

IgE

c)

IgG

d)

IgD

92.

What is rheumatoid factor?

a)

abnormal immunoglobulins

b)

autoantibodies developed against abnormal immunoglobulins

c)

bony prominences that form in the synovial joint spaces

d)

decreased crystallized deposition of uric acid in the synovium

93.

Choose the BEST answer. Rheumatoid factor combines with abnormal immunoglobulin complexes and deposits on:

a)

synovial membranes and joint cartilage

b)

synovial fluid and synovial membranes

c)

synovial fluid and bone marrow

d)

synovium and myocardium

94.

The presence of rheumatoid factor combined with abnormal immunoglobulin complexes results in the activation of the _____ system and an inflammatory response.

a)

Complement

b)

Articular

c)

Synovial

d)

Reticulocyte

95.

During the immune response of rheumatoid arthritis, neutrophils release ______ enzymes, which damage cartilage and thicken the lining of the synovium.

a)

caustic

b)

proteolytic

c)

fibrinolytic

d)

sickling

96.

SATA: T helper cells (CD4s) activate during the immune response of rheumatoid arthritis, and stimulate which cell types?

a)

synovial erythrocytes

b)

eosinophils

c)

monocytes

d)

macrophages

e)

synovial fibroblasts

97.

Stiffness in Rheumatoid Arthritis increases with ______.

a)

motion

b)

inactivity

98.

The therapeutic effects of DMARD therapy take ______ weeks to become evident.

a)

3-4

b)

4-6

c)

8-12

d)

12-16

99.

Biologic response modifiers, or BRMs, are used for rheumatoid arthritis. BRMs are also used for which type of cancer therapy?

a)

chemotherapy

b)

radiation

c)

immunotherapy

d)

biopsy

100.

Why would a patient with rheumatoid arthritis be placed on BRM medications?

a)

To avoid DMARD treatment

b)

As an initial treatment for joint manifestations

c)

To treat disease that is not responsive to DMARDs

d)

To avoid long term use of corticosteroids

101.

It is safe for rheumatoid arthritis patients to take DMARDs and BRMs simultaneously.

a)

True

b)

False

102.

SATA: Select the TNF inhibitors from the drugs listed below.

a)

etanercept

b)

infliximab

c)

adalimumab

d)

methotrexate

e)

sulfasazline

103.

TNF inhibitors bind with tumor necrosis factors and inhibit ________.

a)

wound healing

b)

inflammation

c)

synovial fluid leakage

d)

bone marrow production

104.

When a patient with rheumatoid arthritis is taking TNF inhibitors, the nurse must vigilantly monitor for _____ and avoid ______ vaccinations.

a)

infection, live

b)

cerebral edema, all

c)

neoplasms, subunit

d)

synovitis, inactivated

105.

When using corticosteroids to treat rheumatoid arthritis, they are injected into the ________ space and can eventually be transitioned to low-dose ____ forms.

a)

subarachnoid, SQ

b)

intraarticular, PO

c)

intramuscular, IVP

d)

epidural, buccal

106.

What is a synovectomy?

a)

complete removal of the joint lining

b)

repair of joint ligaments via small incisions

c)

total joint replacement

d)

surgical draining of the synovial fluid

107.

What is an arthroplasty?

a)

complete removal of joint lining

b)

total joint replacement

c)

surgical drainage of synovial fluid

d)

minimally invasive joint reconstruction

108.

SATA: Analysis of the synovial fluid of a patient with rheumatoid arthritis will show:

a)

increased ESR

b)

increased WBC count

c)

decreased ESR

d)

decreased WBC count

e)

decreased reticulocyte count

109.

SATA: Select some objective clinical manifestations of rheumatoid arthritis.

a)

histoplasmosis

b)

Raynaud's phenomenon

c)

keratoconjunctivitis

d)

lymphadenopathy

e)

splenomegaly

110.

Rheumatoid arthritis is a preventable disease.

a)

True

b)

False

111.

Ice is better at treating ______ in regard to arthritis.

a)

acute pain/inflammation

b)

stiffness

112.

Heat is better at treating ______ in regard to arthritis.

a)

acute pain/inflammation

b)

stiffness

113.

Patients with rheumatoid arthritis should be encouraged to utilize positions of _____ and avoid positions of ______.

a)

flexion, extension

b)

extension, flexion

c)

adduction, abduction

d)

abduction, adduction

114.

The RN should NOT place pillows under the knees of a patient with rheumatoid arthritis, as this can cause contracture.

a)

True

b)

False

115.

Myofascial pain is chronic ______ pain of the chest, neck, shoulders, hips, and lower back.

a)

somatic

b)

visceral

c)

musculoskeletal

d)

nociceptive

116.

Myofascial pain can cause:

a)

HBV

b)

RSV

c)

CAD

d)

TMJ

117.

Trigger point injections, topical patches, and the _____ and _____ method are all used to treat myofascial pain.

a)

rub, tug

b)

push, pull

c)

spray, stretch

d)

snap, break

118.

Fibromyalgia is a chronic central pain syndrome, characterized by widespread _______ musculoskeletal pain and fatigue.

a)

articular

b)

synovial

c)

nonarticular

d)

visceral

119.

Patients with fibromyalgia have a deficiency in the _____ which causes abnormal processing of nociceptive input.

a)

PNS

b)

CNS

c)

adrenal glands

d)

pituitary glands

120.

SATA: What are some of the physiologic abnormalities that make up fibromyalgia?

a)

increased levels of substance P in the spinal fluid

b)

low blood flow to the thalamus

c)

dysfunction of the hypothalamic-pituitary-adrenal axis

d)

low levels of serotonin and tryptophan

e)

cytokine functional abnormalities

121.

One hallmark of fibromyalgia is that the patient's description of their pain is:

a)

localized

b)

systemic

c)

unbearable

d)

vague

122.

It is difficult to establish a diagnosis of fibromyalgia, as lab results must rule out other suspected disorders.

a)

True

b)

False

123.

A low ANA titer is diagnostic of fibromyalgia on its own.

a)

True

b)

False

124.

On a muscle biopsy of a patient with fibromyalgia, the tissue would have a distinct ________ appearance.

a)

wrinkly

b)

slimy

c)

dessicated

d)

moth-eaten

125.

Fibromyalgia patients should be placed on ______ precautions.

a)

airborne

b)

droplet

c)

seizure

d)

aspiration

e)

contact

126.

Fibromyalgia requires two criteria to be met. One of which is an episode of pain experienced in at least 11 of the 18 defined fibromyalgia tender points on palpation. The second criteria is a history of widespread pain noted for AT LEAST _____ months.

a)

3

b)

4

c)

5

d)

6

127.

Systemic Exertion Intolerance Disease is a complex multisystem disease, and exertion of any kind can adversely affect:

a)

the heart

b)

the lungs

c)

the kidneys

d)

the liver

e)

multiple organs at once

128.

SATA: Diagnosis of Systemic Exertion Intolerance Disease requires the presence of 3 symptoms, which are?

a)

profound fatigue lasting at least 6 months

b)

profound fatigue lasting at least 3 months

c)

post-exertional malaise

d)

unrefreshing sleep

e)

myofascial pain

129.

SATA: What are some possible manifestations of Systemic Exertion Intolerance Disease?

a)

cognitive impairment

b)

orthostatic intolerance

c)

severe fatigue

d)

dyspnea and SOB

e)

hyporeflexia

130.

Systemic Exertion Intolerance Disease is considered a diagnosis of ______, and the disorder does not appear to be _______.

a)

exclusion, progressive

b)

inclusion, regressive

c)

exclusion, treatable

d)

inclusion, curable