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WorksheetsExam 4 (Medsurg): Arthritis/CT Disorders
Total questions: 130
Worksheet time: 1hrs 9mins
Osteoarthritis is a slowly progressive noninflammatory disorder of the ________ (SYNOVIAL) joints.
diarthrodial
cartilaginous
fibrous
amphiarthrodial
Gradual onset of some degree of osteoarthritis is part of the normal aging process.
True
False
At what age does cartilage destruction in osteoarthritis typically begin?
20-30
10-15
40-50
60-70
Symptoms of osteoarthritis usually do not manifest until after what age?
50-60
20-30
30-40
40-50
60-70
After age 50, who gets osteoarthritis more commonly?
Men
Women
Osteoarthritis is correlated with the formation of _______ at the joint margins.
osteocytes
osteoclasts
osteoblasts
osteophytes
SATA: New joint tissue formed in response to destruction of cartilage in osteoarthritis becomes:
Dull, yellow, and granular
Softer and less elastic
Less able to resist wear with heavy use
Harder and more brittle
Vibrantly erythatemous
Inflammation in osteoarthritis is typical.
True
False
Which of the following is NOT present in osteoarthritis (OA)?
Systemic manifestations
Palpable bony joint enlargement
Morning stiffness lasting over 30 mins
Reduced range of motion (ROM)
One of the main distinctions between OA and RA (rheumatoid arthritis) is:
OA has systemic symptoms
RA has systemic symptoms
OA has symmetrical joint involvement
RA has clear synovial fluid
Fill in the blank: In OA, morning stiffness typically lasts under ____ minutes.
30
10
60
5
Which condition is associated with palpable bony joint enlargement?
OA
RA
Which of the following is a physical exam finding in OA?
Synovitis
Joint malalignment
Symmetrical joint involvement
Extra-articular manifestation
Systemic symptoms such as fatigue, fever, and organ involvement are present in OA.
True
False
Which of the following is THE primary symptom of osteoarthritis?
joint pain
leakage of synovial fluid
bone spur formation
joint destruction
In osteoarthritis, pain worsens with joint use. In the early stages, what relieves the pain?
Exercise
Rest
Medication
Heat
In late stages of osteoarthritis, joint pain can still be relived with rest and sleep.
True
False
Osteoarthritic pain may be referred to which of the following areas?
Groin
Buttock
Outside of thigh or knee
All of the above
For patients with osteoarthritis, sitting down becomes difficult, as does getting up from a chair when their______ are lower than their______.
hips, knees
knees, hips
sacrum, ribs
ribs, sacrum
Joint stiffness occurs after periods of rest or ________ position.
unchanged
elevated
frequently changed
rotated
Early morning stiffness caused by osteoarthritis USUALLY resolves within how many minutes?
10 mins
20 mins
30 mins
60 mins
Overactivity can lead to mild joint ________, which can temporarily increase stiffness in osteoarthritis.
effusion
perfusion
effacement
fusion
Manifestations of osteoarthritis/OA, such as pain, stiffness, and crepitus, typically present in a(n) ________ fashion, which differentiates this condition from rheumatoid arthritis/RA.
symmetrical
asymmetrical
Fill in the blank: For detecting EARLY joint changes in osteoarthritis, ________, CT scan, and MRI are used as PRIMARILY used as diagnostic tools.
Bone scan
Ultrasound
X-ray
PET scan
Which imaging technique is PRIMARILY used to detect joint space narrowing, bony sclerosis, and osteophyte formation in osteoarthritis?
MRI
X-rays
Ultrasound
PET scan
Fill in the blank: In osteoarthritis, there are ________ lab abnormalities.
No specific
Multiple
Severe
Consistent
Marked
Fill in the blank: ________ fluid analysis is a diagnostic tool for osteoarthritis.
Synovial
Cerebrospinal
Peritoneal
Pleural
Fill in the blank: Nondrug interventions are ________ for OA management.
the basis
an adjunct
an alternative
the last resort
Fill in the blank: Drug therapy ________ nondrug treatment in osteoarthritis care.
SUPPLEMENTS
REPLACES
ELIMINATES
CONTRADICTS
Which of the following should be avoided in knee osteoarthritis?
Prolonged standing
Kneeling
Squatting
All of the above
Fill in the blank: Ice is recommended for ________ inflammation in osteoarthritis.
acute
chronic
mild
long-lasting
Fill in the blank: Heat is recommended for ________ in osteoarthritis.
stiffness
swelling
pain
bleeding
inflammation
Which of the following is considered MOST CRITICAL for osteoarthritis management?
Weight reduction
Dietary changes
Healthy sleep habits
Drug therapy
SATA: Select the types of exercise recommended for osteoarthritis management.
Aerobic
Range of motion
Quadriceps strengthening
Anaerobic
Calisthenics
Nutritional supplements recommended for osteoarthritis include ______ and ______.
Glucosamine and chondroitin sulfate
Vitamin C and calcium
Iron and folic acid
Omega-3 and vitamin D
Drug therapy for osteoarthritis is based on the severity of the patient's symptoms.
True
False
Which medication is recommended for mild to moderate joint pain in osteoarthritis?
NSAIDs
Acetaminophen
DMOADs
Strontium ranelate
Topical agents, OTC creams, and topical salicylates are used for ______ joint pain in osteoarthritis.
mild to moderare
moderate to severe
severe to debilitating
Which of the following is used for moderate to severe joint pain in osteoarthritis?
NSAIDs
Acetaminophen
Glucosamine
Tai Chi
Intraarticular corticosteroid injections are recommended for ________ joint pain in osteoarthritis.
mild to moderate
moderate to severe
severe to debilitating
Hyaluronic acid injection for osteoarthritis is an older treatment method that assists with viscosupplementation. This treatment methodology is still recommended to this day.
True
False
Are there any drugs approved to modify OA progression according to the DMOADs section?
No drugs approved
Corticosteroids are approved
NSAIDs are approved
Hyaluronic acid is approved
Arthroscopic surgery is common treatment for patients with osteoarthritis, but the procedure may provide no additional benefit over treatments like physical therapy.
True
False
SATA: Select all of the joint aspects the RN should assess for in patients with osteoarthritis.
tenderness
swelling
limitation of movement
crepitation
stiffness
Alteration of ______ risk factors is a major part of community education for patients at risk for osteoarthritis.
modifiable
static
inherited
autoimmune
Losing weight and reducing occupational and recreational hazards are recommended for health promotion in osteoarthritis.
True
False
What is arthroscopic surgery?
minimally invasive joint modification utilizing small incisions
total joint replacement
surgical drainage of affected synovial fluid
surgical initiation of the synovitis process
What color is the synovial fluid of affected joints in osteoarthritis/OA?
clear
yellow
brown
red
SATA: Select some home and work environment modifications that could be useful for osteoarthritic patients.
scatter rugs
extra railings
night lights
small yippy dogs
assistive devices
Assistive devices such as canes, walkers, elevated toilet seats, and grab bars are recommended for osteoarthritis management.
True
False
What type of disease is Rheumatoid Arthritis?
Infectious disease
Autoimmune disease
Genetic disorder
Nonprogressive disease
Rheumatoid Arthritis involves inflammation of which tissue in synovial/diarthroidal joints?
Connective tissue
Muscle tissue
Epithelial tissue
Nervous tissue
Periods of remission and exacerbation in Rheumatoid Arthritis are known as ________.
spells
cycles
waves
phases
Rheumatoid Arthritis affects ALL ethnic groups in roughly equal proportions.
True
False
At what age does the incidence of Rheumatoid Arthritis peak?
10-20
20-30
30-50
50-70
Rheumatoid Arthritis is ______ times more likely in women than men.
3
1
2
5
Which of the following is NOT a proinflammatory cytokine secreted by fibroblasts in Rheumatoid Arthritis?
Interleukin-1 (IL-1)
Interleukin-6 (IL-6)
Tumor Necrosis Factor (TNF)
Intrinsic Factor (IF)
Without adequate treatment, more than what percentage of Rheumatoid Arthritis cases develop marked functional impairment within 20 years?
60%
30%
45%
80%
What is needed for patients in the advanced stages of Rheumatoid Arthritis?
Complete joint reconstruction
Intense joint exercise
Mild joint adjustment
Frequent opioid pain medication administration
By the end stage of Rheumatoid Arthritis, patients experience loss of independence and require daily care.
True
False
Which of the following symptoms is NOT present in stage 1 of rheumatoid arthritis?
joint destruction
soft tissue swelling
synovitis
osteoporosis
Which stage of Rheumatoid Arthritis involves gradual destruction in joint cartilage?
Stage 2
Stage 1
Stage 3
Stage 4
Which finding is consistent with stage 3 rheumatoid arthritis?
moderate destruction of joint cartilage
complete loss of joint function
extensive cartilage loss and erosion of joints
no visible evidence of joint destruction
Stage 4 of rheumatoid arthritis is characterized by COMPLETE LOSS of joint function.
True
False
Onset of joint symptoms in Rheumatoid Arthritis is typically _______.
insidious
acute
rapidly
suspicious
List some general symptoms that may occur in Rheumatoid Arthritis.
Fatigue, anorexia, weight loss, generalized stiffness
Joint dislocation, bone fracture, muscle hypertrophy
High fever, severe bleeding, jaundice
Sudden paralysis, blurred vision, chest pain
SATA: When giving their medical history, patients with Rheumatoid Arthritis may report onset of joint symptoms following what kind of precipitating events?
infection
extreme stress
childbirth
major surgery
extreme exertion
Symptoms of rheumatoid arthritis often occur ________.
SYMMETRICALLY
ASYMETRICALLY
Which joints are MOST often affected in rheumatoid arthritis?
Small joints
Large joints
Hip joints
Spine joints
A patient with rheumatoid arthritis that has spinal manifestations would MOST likely experience symptoms in which portion of the spine?
Cervical
Thoracic
Lumbar
Sacral
Joint stiffness in Rheumatoid Arthritis usually occurs after what?
Inactivity
Exercise
Eating
Sleeping
Morning stiffness in Rheumatoid Arthritis lasts how long?
60+ minutes
Less than 30 minutes
30 to 60 minutes
30 to 45 minutes
SATA: Which joints of the hand are TYPICALLY swollen in Rheumatoid Arthritis? (all of these joints can be affected by RA)
PIP joints
DIP joints
IP joints
CMC joints
MCP joints
Fingers in Rheumatoid Arthritis may be ______ shaped.
spindle
cuboid
circular
triangular
spiral
Joints in Rheumatoid Arthritis are often tender, painful, and ______ to the touch.
warm
cold
dry
rough
Pain in Rheumatoid Arthritis increases with ______.
motion
inactivity
Tenosynovitis in Rheumatoid Arthritis can cause symptoms similar to which syndrome?
Carpal tunnel syndrome
De Quervain's syndrome
Raynaud's syndrome
Cubital tunnel syndrome
Sjogren’s Syndrome, which is an extraarticular complication of rheumatoid arthritis, is characterized by diminished ______ and ______ secretion.
lacrimal and salivary
gastric and pancreatic
thyroid and adrenal
renal and hepatic
Felty Syndrome, which is an extraarticular complication of rheumatoid arthritis, is associated with an enlarged ______ and low ______ count.
spleen, WBC
liver, RBC
kidney, platelet
pancreas, hemoglobin
Which lab test is NOT used in the diagnosis of Rheumatoid Arthritis?
Rheumatoid factor (RF)
ESR and C-reactive protein (CRP)
ASTs/ALTs (LFTs)
Antinuclear antibody (ANA)
What does Anti-CCP stand for in Rheumatoid Arthritis diagnostics?
Antibodies to citrullinated peptide
Antibodies to cyclic citric protein
Antigens to collagen peptide
Antibodies to calcium phosphate
Which imaging techniques are PRIMARILY used to assess involved joints in Rheumatoid Arthritis?
X-rays and bone scans
Ultrasound and PET scan
CT scan and MRI
Fluoroscopy and Doppler ultrasound
Patient education for Rheumatoid Arthritis includes which of the following?
Drug therapy
Home management strategies
Physical and occupational therapy
All of the above
Which drug therapy is used to decrease the permanent effects of RA?
DMARDs
NSAIDs
Corticosteroids
Analgesics
All of the above
Patients taking methotrexate for rheumatoid arthritis require the RN to vigilantly monitor for which two adverse effects?
Bone marrow suppression and hepatotoxicity
Renal calculi and hypertension
Hyperglycemia and pancreatitis
Pulmonary embolism and deep vein thrombosis
Which drugs are listed as DMARDs for RA therapy?
Methotrexate, Sulfasalazine, Azulfidine, Hydroxychloroquine, Plaquenil
Ibuprofen, Naproxen, Aspirin, Celecoxib, Diclofenac
Prednisone, Methylprednisolone, Dexamethasone, Hydrocortisone, Triamcinolone
Adalimumab, Etanercept, Infliximab, Golimumab, Certolizumab
Heberden's nodes are located on which finger joint?
DIP
PIP
MCP
CMC
Brouchard's nodes are located on which finger joint?
DIP
PIP
MCP
PCP
One distinction in joint presentation for osteoarthritic patients when compared to rheumatoid patients is that patients with osteoarthritis do NOT have:
swollen and tender joints
visible joint deformity
erythemateous joints
significant loss of joint function
SATA: The etiology of rheumatoid arthritis/RA is a combination of which factors?
genetic
environmental
viral
fungal
bacterial
In patients with rheumatoid arthritis, antigens trigger the formation of abnormal ____.
IgA
IgE
IgG
IgD
What is rheumatoid factor?
abnormal immunoglobulins
autoantibodies developed against abnormal immunoglobulins
bony prominences that form in the synovial joint spaces
decreased crystallized deposition of uric acid in the synovium
Choose the BEST answer. Rheumatoid factor combines with abnormal immunoglobulin complexes and deposits on:
synovial membranes and joint cartilage
synovial fluid and synovial membranes
synovial fluid and bone marrow
synovium and myocardium
The presence of rheumatoid factor combined with abnormal immunoglobulin complexes results in the activation of the _____ system and an inflammatory response.
Complement
Articular
Synovial
Reticulocyte
During the immune response of rheumatoid arthritis, neutrophils release ______ enzymes, which damage cartilage and thicken the lining of the synovium.
caustic
proteolytic
fibrinolytic
sickling
SATA: T helper cells (CD4s) activate during the immune response of rheumatoid arthritis, and stimulate which cell types?
synovial erythrocytes
eosinophils
monocytes
macrophages
synovial fibroblasts
Stiffness in Rheumatoid Arthritis increases with ______.
motion
inactivity
The therapeutic effects of DMARD therapy take ______ weeks to become evident.
3-4
4-6
8-12
12-16
Biologic response modifiers, or BRMs, are used for rheumatoid arthritis. BRMs are also used for which type of cancer therapy?
chemotherapy
radiation
immunotherapy
biopsy
Why would a patient with rheumatoid arthritis be placed on BRM medications?
To avoid DMARD treatment
As an initial treatment for joint manifestations
To treat disease that is not responsive to DMARDs
To avoid long term use of corticosteroids
It is safe for rheumatoid arthritis patients to take DMARDs and BRMs simultaneously.
True
False
SATA: Select the TNF inhibitors from the drugs listed below.
etanercept
infliximab
adalimumab
methotrexate
sulfasazline
TNF inhibitors bind with tumor necrosis factors and inhibit ________.
wound healing
inflammation
synovial fluid leakage
bone marrow production
When a patient with rheumatoid arthritis is taking TNF inhibitors, the nurse must vigilantly monitor for _____ and avoid ______ vaccinations.
infection, live
cerebral edema, all
neoplasms, subunit
synovitis, inactivated
When using corticosteroids to treat rheumatoid arthritis, they are injected into the ________ space and can eventually be transitioned to low-dose ____ forms.
subarachnoid, SQ
intraarticular, PO
intramuscular, IVP
epidural, buccal
What is a synovectomy?
complete removal of the joint lining
repair of joint ligaments via small incisions
total joint replacement
surgical draining of the synovial fluid
What is an arthroplasty?
complete removal of joint lining
total joint replacement
surgical drainage of synovial fluid
minimally invasive joint reconstruction
SATA: Analysis of the synovial fluid of a patient with rheumatoid arthritis will show:
increased ESR
increased WBC count
decreased ESR
decreased WBC count
decreased reticulocyte count
SATA: Select some objective clinical manifestations of rheumatoid arthritis.
histoplasmosis
Raynaud's phenomenon
keratoconjunctivitis
lymphadenopathy
splenomegaly
Rheumatoid arthritis is a preventable disease.
True
False
Ice is better at treating ______ in regard to arthritis.
acute pain/inflammation
stiffness
Heat is better at treating ______ in regard to arthritis.
acute pain/inflammation
stiffness
Patients with rheumatoid arthritis should be encouraged to utilize positions of _____ and avoid positions of ______.
flexion, extension
extension, flexion
adduction, abduction
abduction, adduction
The RN should NOT place pillows under the knees of a patient with rheumatoid arthritis, as this can cause contracture.
True
False
Myofascial pain is chronic ______ pain of the chest, neck, shoulders, hips, and lower back.
somatic
visceral
musculoskeletal
nociceptive
Myofascial pain can cause:
HBV
RSV
CAD
TMJ
Trigger point injections, topical patches, and the _____ and _____ method are all used to treat myofascial pain.
rub, tug
push, pull
spray, stretch
snap, break
Fibromyalgia is a chronic central pain syndrome, characterized by widespread _______ musculoskeletal pain and fatigue.
articular
synovial
nonarticular
visceral
Patients with fibromyalgia have a deficiency in the _____ which causes abnormal processing of nociceptive input.
PNS
CNS
adrenal glands
pituitary glands
SATA: What are some of the physiologic abnormalities that make up fibromyalgia?
increased levels of substance P in the spinal fluid
low blood flow to the thalamus
dysfunction of the hypothalamic-pituitary-adrenal axis
low levels of serotonin and tryptophan
cytokine functional abnormalities
One hallmark of fibromyalgia is that the patient's description of their pain is:
localized
systemic
unbearable
vague
It is difficult to establish a diagnosis of fibromyalgia, as lab results must rule out other suspected disorders.
True
False
A low ANA titer is diagnostic of fibromyalgia on its own.
True
False
On a muscle biopsy of a patient with fibromyalgia, the tissue would have a distinct ________ appearance.
wrinkly
slimy
dessicated
moth-eaten
Fibromyalgia patients should be placed on ______ precautions.
airborne
droplet
seizure
aspiration
contact
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.
3
4
5
6
Systemic Exertion Intolerance Disease is a complex multisystem disease, and exertion of any kind can adversely affect:
the heart
the lungs
the kidneys
the liver
multiple organs at once
SATA: Diagnosis of Systemic Exertion Intolerance Disease requires the presence of 3 symptoms, which are?
profound fatigue lasting at least 6 months
profound fatigue lasting at least 3 months
post-exertional malaise
unrefreshing sleep
myofascial pain
SATA: What are some possible manifestations of Systemic Exertion Intolerance Disease?
cognitive impairment
orthostatic intolerance
severe fatigue
dyspnea and SOB
hyporeflexia
Systemic Exertion Intolerance Disease is considered a diagnosis of ______, and the disorder does not appear to be _______.
exclusion, progressive
inclusion, regressive
exclusion, treatable
inclusion, curable
