MS System I
A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for osteoporosis?
A) Having a body mass index (BMI) that indicates obesity
B) Using glucocorticoids for 10 years because of a chronic lung disorder
C) Eating three to five servings of shrimp and liver per week
D) Drinking three glasses of skim milk daily
Answer: B
Explanation: Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout.
True or False:
Early treatment of RA helps delay or prevent joint destruction?
True
Current guidelines recommend starting a DMARD (methotrexate) early—within 3 months of RA diagnosis for most patients. By instituting DMARD therapy early, it is possible to delay or even prevent serious joint injury.
True or False?
When taking Enbrel, a DMRAD, for RA it is important to get only receive live vaccines.
False: no live virus vaccines during treatment because it suppresses the immune system due to Inactivation of tumor necrosis factor (TNF)
On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for:
A. Limited motion of joints.
B. Deformed joints of the hands.
C. Early morning stiffness.
D. Rheumatoid nodules.
Answer: C
Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.
Which is the first line treatment for RA?
A) NSAIDS
B) Prednisone
C) Plaquenil
D) Methotrexate
D) Methotrexate
A) You must use contraception when taking methotrexate.
B) This is safe to take while breast-feeding
C) There are no associated fertility risks with this medication
D) It is ok to continue to drink socially
A) You must use contraception when taking methotrexate.
Rationale: Teratogenic
How is bone mass density measured?
A) DEXA scan
B) CT scan
C) US
D) MRI
A) DEXA scan
The standard technique for measuring BMD is dual-energy x-ray absorptiometry (DEXA). DEXA scans take only a few minutes, and exposure to radiation is minimal—about one-tenth that of a standard chest x-ray.
When treating RA, which other specialists might you involve? Choose all that apply.
A) Physical therapist
B) Cardiologist
C) Rheumatologist
D) Orthopedic
A, C, D
Taking over-the-counter calcium supplementations such as TUMS is safe.
False:
When calcium is taken chronically in high doses (3 to 4 gm/day), hypercalcemia can result.
Which one is not used to treat osteoporosis?
A. Selective Estrogen Receptor Modulators (SERMs)
B. Bisphosphates
C. Calcitonin
D. Vitamin D Supplements
D. Vitamin D Supplements
When taking Alendronate (Fosamax) it is important to teach the client to:
A) Take with food
B) Only take with water
C) Take at bedtime and go to sleep after to minimize side effects
D) Take with your other medications
B) Only take with water
Take with at least 6-8oz of water; sit up right for 30 minutes post administration to avoid esophagitis
Which is not a sign and symptoms of hypercalcemia?
A) Nausea and vomiting
B) Lethargy
C) Constipation
D) Diarrhea
D) Diarrhea
Rationale: Signs and symptoms include GI disturbances (nausea, vomiting, constipation), renal dysfunction (polyuria, nephrolithiasis), and CNS effects (lethargy, depression)
True or False:
It is important to have sufficient amounts of calcium or vitamin D when treating osteoporosis.
True
Selective Estrogen Receptor Modulators (SERMs) can cause:
A) Pulmonary embolism
B) Renal calculi
C) Breast Cancer
D) Heart attack
A) Pulmonary embolism
Treatment for RA is directed at (choose all that apply):
A) relieving symptoms (pain, inflammation, and stiffness)
B. maintaining joint function and range of motion
C. minimizing systemic involvement
D. delaying disease progression
ALL!