1.

Osteoarthritis develops due to the deterioration of the synovium within the

joint that can lead to complete bone fusion.

 True 
 False
The answer is FALSE: Osteoarthritis is the most common type of arthritis that develops
due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone. This
can lead to bone break down, sclerosis of the bone, and osteophytes formation (bone
spurs).

2. Which patients below are at risk for developing osteoarthritis? Select-all-that-

apply:

 A. A 65 year old male with a BMI of 35. 

 B. A 59 year old female with a history of taking long term doses of
corticosteroids.
 C. A 55 year old male with a history of repeated right knee

injuries. 

 D. A 60 year old female with high uric acid levels. 

The answers are A and C. The risk factors for developing OA include: older age, being
overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B
is at risk for osteoporosis, and option D is at risk for gout.

3. During a head-to-toe assessment of a patient with osteoarthritis, you note bony

outgrowths on the distal interphalangeal joints. You document these findings as:

 A. Bouchard's Nodes 
 B. Heberden's Nodes
 C. Neurofibromatosis
 D. Dermatofibromas
The answer is B. Bony outgrowths found on the DISTAL interphalangeal joint (closest to
the fingernail and furthest away from the body) is called Heberden's Node. If the bony
outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the
finger…closest to the body) it is called Bouchard's Node.
4. A patient with osteoarthritis is describing their signs and symptoms. Which
signs and symptoms below are NOT associated with osteoarthritis? Select-all-
that-apply:

 A. Morning stiffness greater than 30 minutes 

 B. Experiencing grating during joint movement

 C. Fever and Anemia 

 D. Symmetrical joint involvement 

 E. Pain and stiffness tends to be worst at the end of the day
The answers are: A, C, D. These options are signs and symptoms found with
rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30
minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is
asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at
the end of the day compared to the beginning due to overuse of the joints. 

5. A patient with osteoarthritis has finished their first physical therapy session.
As the nurse you want to evaluate the patient's understanding of the type of
exercises they should be performing regularly at home as self-management.
Select all the appropriate types of exercise stated by the patient:

 A. Jogging 

 B. Water aerobics 

 C. Weight Lifting 
 D. Tennis

 E. Walking 
The answers are B, C, E. The patient wants to perform exercises that are low impact
like: walking, water aerobics, stationary bike riding along with strengthen training (lifting
weights: helps strengthen muscles around the joint), ROM: improves the mobility of the
joint and decreases stiffness. It is important patients with OA avoid high impact
exercises that will increase stress on weight bearing joints such as running/jogging,
jump rope, tennis, or any type of exercise with both feet off the ground.
6. A 63 year old patient has severe osteoarthritis in the right knee. The patient is
scheduled for a knee osteotomy. You are providing pre-op teaching about this
procedure to the patient. Which statement made by the patient is correct about
this procedure?

 A. "This procedure will realign the knee and help decrease the amount
of weight experienced on my right knee."

 B. "A knee osteotomy is also called a total knee replacement." 

 C. "A knee osteotomy is commonly performed for patients who have
osteoarthritis in both knees."
 D. "This procedure will realign the unaffected knee and help alleviate the
amount of weight experienced on the right knee."
The answer is A. A knee osteotomy is NOT known as a total knee replacement. A knee
osteotomy can be used as an alternative for a total knee replacement but is not the
same thing. In addition, a knee osteotomy is performed when there is OA on only one
side of the knee.

7. A patient newly diagnosed with osteoarthritis asks about the medication

treatments for their condition. Which medication is NOT typically prescribed for
OA?

 A. NSAIDs

 B. Topical Creams 
 C. Oral corticosteroids
 D. Acetaminophen (Tylenol)
The answer is C. Intra-articular corticosteroids (an injection in the joint) are commonly
prescribed rather than oral corticosteroids. Remember OA in within the joint...not
systemic so oral corticosteroids are not as effective. All the other medications listed are
prescribed in OA.

8. You receive your patient back from radiology. The patient had an x-ray of the
hips and knees for the evaluation of possible osteoarthritis. What findings would
appear on the x-ray if osteoarthritis was present? Select-all-that-apply:

 A. Increased joint space 

  B. Osteophytes 

 C. Sclerosis of the bone 

 D. Abnormal sites of hyaline cartilage
The answers are B and C. The joint space would be DECREASED not increased in OA.
In addition, an x-ray cannot show hyaline cartilage…therefore, the cartilage cannot be
assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs),
sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

1. During a routine health check-up visit a patient states, "I've been experiencing
severe pain and stiffness in my joints lately." As the nurse, you will ask the
patient what questions to assess for other possible signs and symptoms of
rheumatoid arthritis? Select-all-that-apply:

 A. "Does the pain and stiffness tend to be the worst before bedtime?" 

 B. "Are you experiencing fatigue and fever as well?" 

 C. "Is your pain and stiffness symmetrical on the body?" 

 D. "Is your pain and stiffness aggravated by extreme temperature
changes?"
The answers are B and C. Patients with RA will experience pain and stiffness in the
morning (for more than 30 minutes) not bedtime. It is common for patients to have a
fever and be fatigued...remember RA affects the whole body not just the joints. It will
also affect the same joints on the opposite side of the body. Therefore, if the right wrist
is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by
extreme temperatures. This is found in osteoarthritis.

2. True or False: Rheumatoid arthritis tends to affect women more than men and
people who are over the age of 60.

 True

 False 
False: Yes, RA tends to affect women more than men BUT it can affect all ages...most
commonly 20-60 years old.
3. Identify the correct sequence in how rheumatoid arthritis develops:

 A. Development of pannus, synovitis, ankylosis

 B. Anklyosis, development of pannus, synovitis

 C. Synovitis, development of pannus, anklyosis 

 D. Synovitis, anklyosis, development of pannus
The answer is C. The body attacks (specifically the WBCs) the synovium of the joint.
The synovium becomes inflamed and this process is called synovitis. The inflammation
of the synovium leads to thickening and the formation of a pannus, which is a layer of
vascular fibrous tissue. The pannus will grow so large it will damage the bone and
cartilage within the joint. The space in between the joints will disappear and anklyosis
will develop, which is the fusion of the bone.

4. A patient with severe rheumatoid arthritis is scheduled for a procedure called

an arthrodesis. The nursing student you are precepting asks what type of
procedure this is. Your response is:
 A. "It is a procedure where the affected joint is removed and each end

of the bones found within that joint are fused together." 

 B. "It is a procedure that involves replacing the joint with an artificial one."
 C. "It is a procedure where the surgeon goes in with a scope and cleans out
the affected joint."
 D. "It is a procedure where the synovium is completely removed within the
joint, which helps decrease inflammation of the joint.
The answer is A. An arthrodesis (also called joint fusion) is where the affected joint is
removed and the bones within it are fused together. Option B describes a joint
replacement. Option C is known as a surgical cleaning. Option D is known as a
synovectomy.

5. A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While

assisting the patient with her morning routine, the patient verbalizes a pain rating
of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note
the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing
interventions can you provide to this patient to help alleviate pain and stiffness?
Select-all-that-apply:

 A. Exercise the affected joints

  B. Assist the patient with a warm shower or bath 
 C. Perform deep massage therapy to the wrist joints

 D. Assist the patient with applying wrist splints 

The answers are B and D. During flare-ups of RA the joint should be rested (not
exercised) and should not be deep massaged because this can further damage the joint
(in addition cause the patient more pain). Heat therapy, like a warm shower or bath, will
help alleviate the stiffness. Furthermore, cold therapy can be used to reduce the
inflammation along with splinting the affected joints to protect and rest them.

6. You are providing education to a patient, who was recently diagnosed with
rheumatoid arthritis, about physical exercise. Which statement made by the
patient is correct?

 A. "It is best I try to incorporate a moderate level of high impact exercises

weekly into my routine, such as running and aerobics."
 B. "I will be sure to rest joints that are experiencing a flare-up, but I
will try to maintain a weekly regime of range of motion exercises

along with walking and riding a stationary bike." 

 C. "It is important I perform range of motion exercises during joint flare-ups
and incorporate low-impact exercises into my daily routine."
 D. "Physical exercise should be limited to only range of motion exercises to
prevent further joint damage."
The answer is B. During flare-ups of RA the patient should rest the joint. However, it is
important the patient performs range of motion exercises along with LOW-IMPACT
exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will
help with increasing the patient's energy level along with muscle strength and maintain
joint health.

7. Disease-modifying antirheumatic drugs (DMARDS) are used to treat

rheumatoid arthritis. Select-all-the drugs below that are DMARDS:

 A. Dexamethasone (Decadron)

 B. Hydroxychloroquine (Plaquenil) 
 C. Teriparatide (Forteo)
  D. Calcitonin 

 E. Leflunomide (Arava) 

 F. Methotrexate (Trexall) 
The answers are B, E, and F. These are DMARDs that can be prescribed for RA.
Option A is a corticosteroid. Option C and D are sometimes prescribed in osteoporosis.

8. A patient with rheumatoid arthritis is experiencing sudden vision changes.

Which medication found in the patient's medication list can cause retinal
damage?

 A. Hydroxychloroquine (Plaquenil) 
 B. Lefluomide (Arava)
 C. Sulfasalazine (Azulfidine)
 D. Methylprednisolone (Medrol)
The answer is A. This medication is a DMARD and can cause retinal damage.
Therefore, the patient should be monitored for vision changes.

9. You're providing care to a patient with severe rheumatoid arthritis. While

performing the head-to-toe nursing assessment, you note the patient's overall
skin color to be pale and the patient looks exhausted. You ask the patient how
she is feeling, and she says "I'm so tired. I can't even get out of this bed without
getting short of breath." Which finding on the patient's morning lab work may
confirm a complication that can be experienced with rheumatoid arthritis?

 A. Potassium 3.2 mEq/L

 B. Hemoglobin 7 g/dL 
 C. Sodium 135 mEq/L
 D. WBC count 6,500
The answer is B. Patients with RA can experience anemia. A hemoglobin level can be
helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient’s
signs and symptoms above are classic findings in anemia.
10. A physician suspects a patient may have rheumatoid arthritis due to the
patient's presenting symptoms. What diagnostic testing can be ordered to help a
physician diagnose rheumatoid arthritis? Select all that apply:

 A. Rheumatoid factor 
 B. Uric acid level

 C. Erythrocyte sedimentation 
 D. Dexa-Scan

 E. X-ray imaging 
The answers are A, C, and E. These are diagnostic tests to help diagnose RA. Option B
is used in gout, and option D is used with osteoporosis