Test Bank - Lewis's Medical Surgical Nursing MED-
SURG FINAL (Chapters 14-16, 23-24, 41-50, 63-65)
1. A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would
expect to be present on examination of the patient's knee is
a. Heberden's nodules.
b. redness and swelling of the knee joint.
c. pain upon joint movement.
d. stiffness that increases with movement. - CORRECT ANSWER-Answer: C
Rationale: 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),
and stiffness in OA is worse right after the patient rests and decreases with joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694
Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening patients at a community center, the nurse will plan to teach ways to reduce
risk factors for osteoarthritis to a
a. 24-year-old man who participates in a summer softball team.
b. 36-year-old woman who is newly diagnosed with diabetes mellitus.
c. 49-year-old woman who works on an automotive assembly line.
d. 56-year-old man who is a member of a construction crew. - CORRECT ANSWER-Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause
and in individuals whose work involves repetitive movements and lifting. Moderate exercise,
such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a
construction crew would involve nonrepetitive work and thus would not be as risky.
Cognitive Level: Application Text Reference: p. 1694
Nursing Process: Planning NCLEX: Physiological Integrity
,3. The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient with
osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use that the drug
does not seem to be effective in controlling the pain. The nurse should teach the patient that
a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of
variations in individual response to the drugs.
b. it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood.
c. if NSAIDs are not effective in controlling symptoms, corticosteroids are the next drug of
choice.
d. adding a twice-daily aspirin to the naproxen may improve the effectiveness of the drug. -
CORRECT ANSWER-Answer: A
Rationale: Individual responses to NSAIDs can vary, so the health care provider may prescribe a
different NSAID. Full effectiveness of NSAIDs occurs in 2 to 3 weeks. Corticosteroids are
usually reserved for use in RA. Patients are instructed to avoid aspirin when taking NSAIDs
because of the increased risk for bleeding and gastrointestinal irritation.
Cognitive Level: Application Text Reference: p. 1697
Nursing Process: Implementation NCLEX: Physiological Integrity
4. When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae
about management of the condition, the nurse determines that additional instruction is needed
when the patient says,
a. "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
b. "A warm shower in the morning will help relieve the stiffness I have when I get up."
c. "I should try to stay active throughout the day to keep my joints from becoming stiff."
d. "I should take no more than 1 g of acetaminophen four times a day to control the pain." -
CORRECT ANSWER-Answer: C
Rationale: Protection and avoidance of joint stressors are recommended for patients with OA, so
this patient should alternate periods of rest with necessary activity. The other patient statements
indicate that teaching has been effective.
,Cognitive Level: Application Text Reference: pp. 1696, 1701
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance
5. A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The
patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The
best response by the nurse is that
a. progression of OA can be prevented with a regimen of exercise, diet, and drugs.
b. OA is an inflammatory process with periods of exacerbation and remission.
c. joint degeneration with pain and deformity occurs with OA by age 60 to 70.
d. OA is common with aging, but usually it is localized and does not cause deformity. -
CORRECT ANSWER-Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although exercise,
diet, and drugs can help to decrease symptoms and slow disease progression, they will not
prevent progression of the disease. OA is progressive and does not have exacerbations and
remissions, which are typical of RA. Joint degeneration and pain occur later in OA; joint
deformity is not a common symptom.
Cognitive Level: Application Text Reference: pp. 1701, 1704
Nursing Process: Implementation NCLEX: Physiological Integrity
6. A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to teach the
patient about the use of
a. prednisone (Deltasone).
b. capsaicin cream (Zostrix).
c. sulfasalazine (Azulfidine).
d. doxycycline (Vibramycin). - CORRECT ANSWER-Answer: B
Rationale: 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.
, Cognitive Level: Application Text Reference: p. 1696
Nursing Process: Planning NCLEX: Physiological Integrity
7. A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches the
patient that the most beneficial measure to protect the joints is to
a. use a wheelchair to avoid walking as much as possible.
b. sit in chairs that do not cause the hips to be lower than the knees.
c. use a walker for ambulation to relieve the pressure on the hips.
d. eat according to a weight-reduction diet to obtain a healthy body weight. - CORRECT
ANSWER-Answer: D
Rationale: Because the patient's major risk factor is obesity, the nurse should teach the patient
that weight loss is the best way to reduce stress on the hips. Avoiding activity by sitting in a
wheelchair would likely increase the patient's weight; moderate activity is recommended for
patients with OA. Sitting with the hips higher than the knees and using a walker would be
recommended but are not as helpful as weight loss for this obese patient.
Cognitive Level: Application Text Reference: p. 1701
Nursing Process: Implementation NCLEX: Physiological Integrity
8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with
stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient,
the most important information for the nurse to communicate to the health care provider is that
the patient has
a. a history of infectious mononucleosis as a teenager.
b. a family history of age-related macular degeneration of the retina.
c. been trying to have a baby before her disease becomes more severe.
d. been using large doses of vitamins and health foods to treat the RA. - CORRECT ANSWER-
Answer: C
SURG FINAL (Chapters 14-16, 23-24, 41-50, 63-65)
1. A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would
expect to be present on examination of the patient's knee is
a. Heberden's nodules.
b. redness and swelling of the knee joint.
c. pain upon joint movement.
d. stiffness that increases with movement. - CORRECT ANSWER-Answer: C
Rationale: 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),
and stiffness in OA is worse right after the patient rests and decreases with joint movement.
Cognitive Level: Comprehension Text Reference: p. 1694
Nursing Process: Assessment NCLEX: Physiological Integrity
2. When screening patients at a community center, the nurse will plan to teach ways to reduce
risk factors for osteoarthritis to a
a. 24-year-old man who participates in a summer softball team.
b. 36-year-old woman who is newly diagnosed with diabetes mellitus.
c. 49-year-old woman who works on an automotive assembly line.
d. 56-year-old man who is a member of a construction crew. - CORRECT ANSWER-Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause
and in individuals whose work involves repetitive movements and lifting. Moderate exercise,
such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a
construction crew would involve nonrepetitive work and thus would not be as risky.
Cognitive Level: Application Text Reference: p. 1694
Nursing Process: Planning NCLEX: Physiological Integrity
,3. The health care provider has prescribed naproxen (Naprosyn) twice daily for a patient with
osteoarthritis (OA) of the hands. The patient tells the nurse after 3 weeks of use that the drug
does not seem to be effective in controlling the pain. The nurse should teach the patient that
a. another type of nonsteroidal antiinflammatory drug (NSAID) may be indicated because of
variations in individual response to the drugs.
b. it may take up to 4 to 6 weeks for NSAIDs to reach therapeutic levels in the blood.
c. if NSAIDs are not effective in controlling symptoms, corticosteroids are the next drug of
choice.
d. adding a twice-daily aspirin to the naproxen may improve the effectiveness of the drug. -
CORRECT ANSWER-Answer: A
Rationale: Individual responses to NSAIDs can vary, so the health care provider may prescribe a
different NSAID. Full effectiveness of NSAIDs occurs in 2 to 3 weeks. Corticosteroids are
usually reserved for use in RA. Patients are instructed to avoid aspirin when taking NSAIDs
because of the increased risk for bleeding and gastrointestinal irritation.
Cognitive Level: Application Text Reference: p. 1697
Nursing Process: Implementation NCLEX: Physiological Integrity
4. When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae
about management of the condition, the nurse determines that additional instruction is needed
when the patient says,
a. "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
b. "A warm shower in the morning will help relieve the stiffness I have when I get up."
c. "I should try to stay active throughout the day to keep my joints from becoming stiff."
d. "I should take no more than 1 g of acetaminophen four times a day to control the pain." -
CORRECT ANSWER-Answer: C
Rationale: Protection and avoidance of joint stressors are recommended for patients with OA, so
this patient should alternate periods of rest with necessary activity. The other patient statements
indicate that teaching has been effective.
,Cognitive Level: Application Text Reference: pp. 1696, 1701
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance
5. A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The
patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The
best response by the nurse is that
a. progression of OA can be prevented with a regimen of exercise, diet, and drugs.
b. OA is an inflammatory process with periods of exacerbation and remission.
c. joint degeneration with pain and deformity occurs with OA by age 60 to 70.
d. OA is common with aging, but usually it is localized and does not cause deformity. -
CORRECT ANSWER-Answer: D
Rationale: OA is localized to joints that have been injured or have high use. Although exercise,
diet, and drugs can help to decrease symptoms and slow disease progression, they will not
prevent progression of the disease. OA is progressive and does not have exacerbations and
remissions, which are typical of RA. Joint degeneration and pain occur later in OA; joint
deformity is not a common symptom.
Cognitive Level: Application Text Reference: pp. 1701, 1704
Nursing Process: Implementation NCLEX: Physiological Integrity
6. A patient with hip pain is diagnosed with osteoarthritis (OA). The nurse may need to teach the
patient about the use of
a. prednisone (Deltasone).
b. capsaicin cream (Zostrix).
c. sulfasalazine (Azulfidine).
d. doxycycline (Vibramycin). - CORRECT ANSWER-Answer: B
Rationale: 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.
, Cognitive Level: Application Text Reference: p. 1696
Nursing Process: Planning NCLEX: Physiological Integrity
7. A 71-year-old obese patient has bilateral osteoarthritis (OA) of the hips. The nurse teaches the
patient that the most beneficial measure to protect the joints is to
a. use a wheelchair to avoid walking as much as possible.
b. sit in chairs that do not cause the hips to be lower than the knees.
c. use a walker for ambulation to relieve the pressure on the hips.
d. eat according to a weight-reduction diet to obtain a healthy body weight. - CORRECT
ANSWER-Answer: D
Rationale: Because the patient's major risk factor is obesity, the nurse should teach the patient
that weight loss is the best way to reduce stress on the hips. Avoiding activity by sitting in a
wheelchair would likely increase the patient's weight; moderate activity is recommended for
patients with OA. Sitting with the hips higher than the knees and using a walker would be
recommended but are not as helpful as weight loss for this obese patient.
Cognitive Level: Application Text Reference: p. 1701
Nursing Process: Implementation NCLEX: Physiological Integrity
8. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with
stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient,
the most important information for the nurse to communicate to the health care provider is that
the patient has
a. a history of infectious mononucleosis as a teenager.
b. a family history of age-related macular degeneration of the retina.
c. been trying to have a baby before her disease becomes more severe.
d. been using large doses of vitamins and health foods to treat the RA. - CORRECT ANSWER-
Answer: C
