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Pathophysiology Introductory Concepts 1st Edition Capriotti Frizzell Test Bank

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Pathophysiology Introductory Concepts 1st Edition Capriotti Frizzell Test Bank

ISBN-13: 978-0803615717

ISBN-10: 080361571X

 

 

Description

Pathophysiology Introductory Concepts 1st Edition Capriotti Frizzell Test Bank

ISBN-13: 978-0803615717

ISBN-10: 080361571X

 

 

 

 

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Free Nursing Test Questions:

Chapter 39: Infection and Inflammatory Disorders of the Musculoskeletal System

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   The laboratory report of a client with a bone infection shows an abscess below the bone surface. Which stage of bone infection does the nurse suspect in the client?

1. 1
2. 2
3. 3
4. 4

 

 

____     2.   A registered nurse is teaching a group of student nurses about synovial fluid. Which statement made by a student nurse indicates the need for further teaching?

1. “Synovial fluid provides stabilizing effects.”
2. “The volume of synovial fluid increases in the presence of a joint disease.”
3. “There is a wide exchange between the bloodstream and the synovial joint.”
4. “In the synovium, all the essential nutrients are delivered and metabolic byproducts are cleared by the bloodstream.”

 

 

____     3.   Which disease can cause iritis and pulmonary fibrosis?

1. Polymyositis
2. Psoriatic arthritis
3. Ankylosing spondylitis
4. Polymyalgia rheumatica

 

 

____     4.   A client is found to have both osteomyelitis and arthritis. Which condition does the nurse suspect in the client?

1. Tophi
2. Podagra
3. Pott’s disease
4. Lyme disease

 

 

____     5.   A registered nurse is teaching a group of student nurses about gout. Which statement made by a student nurse indicates effective learning?

1. “Thiazides are used to treat gout.”
2. “Primary gout is attributed to obesity.”
3. “Pott’s disease is associated with gout.”
4. “Estrogen protects against hyperuricemia.”

 

 

____     6.   Which statement made by a client with musculoskeletal inflammation makes the nurse suspect polymyalgia rheumatica?

1. “I feel pain and stiffness in my back.”
2. “My nails are separating from my nail beds.”
3. “I feel stiffness in my shoulders and upper arms during the morning hours.”
4. Both A and B

 

 

____     7.   Which laboratory test is used to identify Lyme disease?

1. Western blot test
2. Immunofluorescent assay (IFA)
3. Ultrasonography
4. Both A and B

 

 

____     8.   Which treatment would a nurse expect to be beneficial in a client diagnosed with Lyme disease?

1. A local corticosteroid injection
2. A 10- to 21-day course of doxycycline
3. A high starting dose of nonsteroidal antiinflammatory drugs (NSAIDs)
4. Both A and B

 

 

____     9.   The laboratory report of a client shows elevated levels of interleukin-2 (IL-2) and interleukin-6 (IL-6). Which musculoskeletal disorder does the nurse suspect in the client?

1. Gout
2. Psoriatic arthritis
3. Ankylosing spondylitis
4. Polymyalgia rheumatica

 

 

____   10.   Which test is most important in diagnosing ankylosing spondylitis?

1. X-ray
2. Bone biopsy
3. Electromyography
4. Radionuclide bone scan

 

 

____   11.   The radiographic reports of a client reveal inflammation of the metatarsophalangeal joint of the great toe. Which disorder should the nurse suspect in the client?

1. Gout
2. Lyme disease
3. Septic arthritis
4. Polymyalgia rheumatica

 

 

____   12.   A nurse is caring for a client with hyperuricemia. Which part(s) of the client’s body does the nurse assess for the presence of tophi?

1. Achilles tendon
2. Pinnae of the ears
3. Joints of the hands
4. All of the above

 

 

____   13.   A nurse is caring for a client with gout. Which medication in the client’s prescription does the nurse suspect to decrease uric acid synthesis?

1. Probenecid
2. Colchicine
3. Allopurinol
4. Both A and B

 

 

____   14.   While reviewing an x-ray of the fingers of a client, the nurse observes that the end of the bone was whittled down to a sharp point. Which musculoskeletal disorder does the nurse suspect in the client?”

1. Lyme disease
2. Psoriatic arthritis
3. Ankylosing spondylitis
4. Pott’s disease

 

 

____   15.   A nurse is teaching a client nonpharmacological therapy to treat gout. Which statement by the client indicates the need for further teaching?

1. “I should avoid rapid weight loss.”
2. “I should increase the intake of dietary meats.”
3. “I should avoid binge drinking.”
4. “I should drink 2 to 3 liters of fluid per day.”

 

 

____   16.   A client complains of pitting, ridging, and separation of nails from the nail bed. Which musculoskeletal disorder does the nurse suspect in the client?

1. Septic arthritis
2. Psoriatic arthritis
3. Ankylosing spondylitis
4. Polymyalgia rheumatic

 

 

____   17.   Which pathogen may cause ankylosing spondylitis?

1. Escherichia coli (E. coli)
2. Borrelia burgdorferi
3. Klebsiella pneumoniae
4. Staphylococcus aureus

 

 

____   18.   Which is the most definitive diagnostic test for polymyositis and dermatomyositis?

1. Muscle biopsy
2. Western blot test
3. Immunofluorescent assay
4. Dual-energy x-ray absorptiometry (DEXA) scan

 

 

____   19.   A client is having a skin rash presented as an oval-shaped and red-colored lesion. On assessment, the nurse finds enlargement of lymph nodes in this client. Which condition should the nurse suspect in the client?

1. Sacroilitis
2. Dactylitis
3. Lyme disease
4. Psoriatic arthritis

 

 

____   20.   Which statement made by a student nurse indicates the need for further teaching about treatment of various musculoskeletal disorders?

1. “Doxycycline is the first-line treatment for Lyme disease.”
2. “Immunosuppressive agents are first-line agents for psoriatic arthritis.”
3. “Oral corticosteroids are the first-line treatment for polymyalgia rheumatica.”
4. “Nonsteroidal antiinflammatory drugs (NSAIDs) are the first-line agents for gout.”

 

 

____   21.   Which condition is related to ankylosing spondylitis?

1. Formation of abscesses in the bone
2. Inflammation at the joint of the great toe
3. Formation of abscesses in the paravertebral muscles
4. Inflammation at the point where tendons and ligaments join the bone around a joint

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____   22.   A nurse is caring for a client with Lyme disease. Which symptoms in the client lead the nurse to suspect early localized disease? Select all that apply.

1. Arthralgia
2. Cranial neuritis
3. Bull’s-eye rash
4. Lymphadenopathy
5. Subacute encephalopathy

 

 

____   23.   A client is diagnosed with ankylosing spondylitis. Which complications should the nurse expect to be present in the client? Select all that apply.

1. Neural inflammation
2. Paralysis of facial nerves
3. Inflammation of the eyes
4. Scarring throughout the lungs
5. Inflammation of joints in extremities

 

 

____   24.   Which are the forms of psoriatic arthritis? Select all that apply.

1. Spondylitis
2. Septic arthritis
3. Dermatomyositis
4. Arthritis mutilans
5. Distal interphalangeal (DIP) predominant

 

 

____   25.   What are the causes of secondary gout? Select all that apply.

1. Psoriasis
2. Scleroderma
3. Rheumatoid arthritis
4. Neoplastic disease
5. Glycogen storage disease

 

Chapter 39: Infection and Inflammatory Disorders of the Musculoskeletal System

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 925

Objective: N/A

Difficulty: Moderate

Heading: Bone Infection and Inflammation

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Application [Applying]

Concept: Critical Thinking

 

  Feedback
1 Stage 1 of bone infection is inflammation, which shows initial inflammation with vascular congestion and increased pressure within the interior bone.
2 Suppuration is the stage 2 of bone infection. In this stage, the infectious material forces through the haversian system and forms an abscess below the surface of the bone. Therefore, the nurse suspects stage 2 of bone infection in the client.
3 Stage 3 of bone infection involves bone necrosis due to increased pressure, vascular obstruction, and thrombi.
4 Involucrum is stage 4 of bone infection, where new bone formation from the stripped surface of periosteum takes place.

 

 

PTS:   1                    CON:  Critical Thinking

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 930

Objective: N/A

Difficulty: Difficult

Heading: Synovial Fluid

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Analysis [Analyzing]

Concept: Nursing Roles

 

  Feedback
1 Synovial fluid provides stabilizing effects by acting as a seal that freely permits sliding motion between cartilaginous surfaces. Therefore, this statement by the student nurse does not indicate the need for further teaching.
2 When there is a joint disease, the volume of synovial fluid increases, which creates edema of the joint. Therefore, this statement of the student nurse does not indicate the need for further teaching.
3 Though the bloodstream delivers all the essential nutrients and clears metabolic products in the synovium, there is a limited exchange between the bloodstream and the synovial joint. Therefore, this statement of the student nurse indicates the need for further teaching.
4 In the synovium, the bloodstream delivers essential nutrients and clears all the metabolic products. Therefore, this statement of the student nurse does not indicate the need for further teaching.

 

 

PTS:   1                    CON:  Nursing Roles

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 944

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1 Polymyositis is a chronic inflammation of skeletal muscles in the body.
2 Psoriatic arthritis is commonly seen in clients with skin psoriasis. It affects the joints and connective tissues.
3 Ankylosing spondylitis is a chronic inflammation of the spine and sacroiliac joints, which affects multiple tissues of the body such as the heart, lungs, eyes, and kidneys. Therefore, it can cause iritis and pulmonary fibrosis.
4 Polymyalgia rheumatica is an inflammatory condition that majorly affects the neck, shoulders, upper arms, and pelvic girdle.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 942

Objective: N/A

Difficulty: Easy

Heading: Pathophysiology of Selected Infectious Musculoskeletal Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Assessment

 

  Feedback
1 Tophi are the small, white nodules of uric acid crystals seen in clients with gout. Therefore, the nurse does not suspect tophi in the client.
2 An acute inflammation of the metatarsophalangeal joint of the great toe is called podagra. Therefore, the nurse does not suspect podagra in the client.
3 Vertebral tuberculosis is known as Pott’s disease. It is the combination of osteomyelitis and arthritis, which involves more than one vertebra. Therefore, the nurse suspects Pott’s disease in the client.
4 Lyme disease is an infectious condition caused by Borrelia burgdorferi. It is not characterized by osteomyelitis and arthritis. Therefore, the nurse does not suspect Lyme disease in the client.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  4

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 934

Objective: N/A

Difficulty: Difficult

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Analysis [Analyzing]

Concept: Nursing Roles

 

  Feedback
1 Diuretics such as thiazides reduce renal excretion, thereby causing hyperuricemia and increasing the risk of gout. Therefore, this statement of the student nurse does not indicate effective learning.
2 Secondary gout is associated with obesity, not primary gout. Therefore, this statement of the student nurse does not indicate effective learning.
3 Pott’s disease is caused by mycobacterium tuberculosis. It is not associated with gout. Therefore, this statement of the student nurse does not indicate effective learning.
4 Estrogen is protective against hyperuricemia. Therefore, gout is rarely seen in women until menopause.

 

 

PTS:   1                    CON:  Nursing Roles

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 940

Objective: N/A

Difficulty: Difficult

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Analysis [Analyzing]

Concept: Critical Thinking

 

  Feedback
1 Chronic inflammation of the spine and sacroiliac joints is seen in ankylosing spondylitis. Therefore, clients with ankylosing spondylitis report stiffness and pain in the spine.
2 Painless separation of nails from the nail bed is onycholysis. It is observed in clients with psoriatic arthritis.
3 Polymyalgia rheumatica is a disorder characterized by pain and stiffness mostly in the neck, upper arms, and shoulders. Therefore, this statement made by the client made the nurse suspect for polymyalgia rheumatica.
4 Stiffness in the back is the symptom of ankylosing spondylitis. Nails getting separated from the nail bed is one of the symptoms of psoriatic arthritis.

 

 

PTS:   1                    CON:  Critical Thinking

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 943

Objective: N/A

Difficulty: Easy

Heading: Pathophysiology of Selected Infectious Musculoskeletal Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1 The Western blot test is a secondary recommended test to identify the presence of Lyme disease.
2 Immunofluorescent assay (IFA) or enzyme-linked immunosorbent assay (ELISA) is the initial test recommended for the identification of Lyme disease.
3 Ultrasonography is used to confirm the presence of an effusion in septic arthritis.
4 The initial recommended test for identifying Lyme disease is immunofluorescent assay. The second recommended test for identifying Lyme disease is the Western blot.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 942

Objective: N/A

Difficulty: Easy

Heading: Pathophysiology of Selected Infectious Musculoskeletal Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level: Comprehension [Understanding]

Concept: Medication

 

  Feedback
1 Local corticosteroid injections are the first-line treatment choice to decrease the inflammation, joint pain, and stiffness in a client with psoriatic arthritis.
2 Lyme disease is commonly treated with antibiotics. Doxycycline is an antibiotic belonging to the tetracycline class. A 10- to 21-day course of doxycycline is beneficial in a client with Lyme disease.
3 A high starting dose of NSAIDs is the first-line treatment for gout.
4 A 10- to 21-day course of doxycycline is useful to treat Lyme disease.

 

 

PTS:   1                    CON:  Medication

 

  1. ANS:  4

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 940

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Assessment

 

  Feedback
1 Gout is an inflammatory disorder caused by an elevation of uric acid in the blood and synovial fluid.
2 Psoriatic arthritis is an autoimmune disorder that is associated with skin and nail changes. An x-ray may reveal “pencil and cup” phenomenon.
3 The presence of specific human leukocyte antigen HLA-B27 on the cell surfaces is associated with ankylosing spondylitis.
4 The presence of elevated levels of IL-2 and IL-6 in the blood indicates polymyalgia rheumatica.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  1

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 939

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1 Ankylosing spondylitis is the inflammation of the spine and sacroiliac joints. An x-ray is the single most important diagnostic test. It can detect the loss of joint space.
2 A bone biopsy is needed for a culture of infection in osteomyelitis.
3 Electromyography is used in clients with polymyositis and dermatomyositis.
4 A radionuclide bone scan is used in osteomyelitis for determining the area of infection.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  1

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 941

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1 Gout is an inflammatory disorder characterized by hyperuricemia. The most common presentation of this condition is inflammation in the metatarsophalangeal joint of the great toe. Therefore, the nurse suspects gout in the client.
2 Lyme disease is characterized by a localized rash at the site of the tick bite. There is no inflammation of the metatarsophalangeal joint of the great toe in Lyme disease.
3 Direct invasion of pathogens in the spaces of joints results in septic arthritis. It is characterized by inflammation of the synovium.
4 Polymyalgia rheumatica is an inflammatory condition that is characterized by stiffness in the neck, upper arms, shoulders, and pelvic girdle. There is no inflammation of the metatarsophalangeal joint of the great toe in polymyalgia rheumatica.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  4

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 934

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Comprehension [Understanding]

Concept: Assessment

 

  Feedback
1 Hyperuricemia is the excess production of uric acid. It is seen in clients with gout. Uric acid in the body gets deposited in the subcutaneous tissue over time and results in small, white nodules. These are referred to as tophi. Tophi are found in the Achilles tendon.
2 Pinnae of the ears show the presence of tophi in clients with hyperuricemia.
3 Tophi are found in the joints of the hands in clients with hyperuricemia.
4 Tophi are present in the Achilles tendon, pinnae of the ears, and joints of the hands in clients with hyperuricemia.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 943

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1 Probenecid is a uricosuric agent. It is used to increase the renal excretion of uric acid in a client.
2 Colchicine is used in the treatment of gout. It blocks the inflammation caused by uric acid crystals.
3 Allopurinol is a xanthine oxidase inhibitor used to treat hyperuricemia. It acts by decreasing uric acid synthesis. Therefore, the nurse suspects the client is taking allopurinol for this condition.
4 Probenecid is used to increase the renal excretion of uric acid. Colchicine blocks the inflammation caused by the crystals of uric acid. Therefore, the nurse does not suspect probenecid and colchicine to decrease the uric acid synthesis.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 937

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1 Lyme disease is usually caused by a tick spirochete. The diagnosis of Lyme disease is done by both the enzyme-linked immunosorbent assay (ELISA) and the Western blot test. An x-ray is not used to diagnose Lyme disease.
2 Psoriatic arthritis is an inflammatory disorder of joints and connective tissues. The x-ray examination of fingers of a client with this disease reveals “pencil and cup” phenomenon because the end of the bone gets whittled down to a sharp point. Therefore, the nurse suspects psoriatic arthritis in the client.
3 Ankylosing spondylitis is characterized by inflammation and pain in the spine and sacroiliac joints. An x-ray of a client with ankylosing spondylitis gives the appearance of “bamboo spine.” Therefore, the nurse does not suspect ankylosing spondylitis in the client.
4 In Pott’s disease, an x-ray of the affected vertebral bone shows soft tissue swelling and joint space narrowing.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 936

Objective: N/A

Difficulty: Difficult

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Analysis [Analyzing]

Concept: Nursing Roles

 

  Feedback
1 Rapid weight loss can cause excess lactic acid buildup in the body, which prevents uric acid excretion by the kidneys. Therefore, this statement of the client does not indicate the need for further teaching.
2 Dietary meats contain purine compounds, which can raise the levels of uric acid. The client should limit the intake of meats. Therefore, this statement of the client indicates the need for further teaching.
3 Binge drinking is heavy episodic drinking of alcoholic beverages. Alcohol contains purines, which can elevate uric acid levels in the body. Clients with gout should avoid binge drinking. Therefore, this statement of the client does not indicate the need for further teaching.
4 Clients with gout should drink plenty of fluids to maintain a low concentration of uric acid in the blood. Therefore, this statement of the client does not indicate the need for further teaching.

 

 

PTS:   1                    CON:  Nursing Roles

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 937

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1 Clients with septic arthritis may have fever, malaise, edematous, and erythematous joint. Onycholysis, which is the separation of nails from nail beds, is not seen in these clients.
2 Psoriatic arthritis is an inflammatory disorder of the joints and connective tissues. Nail changes are seen in a majority of clients. Pitting, ridging, and onycholysis are observed in this condition. Therefore, the nurse suspects psoriatic arthritis in the client.
3 Ankylosing spondylitis is characterized by inflammation and pain in the spine and sacroiliac joints. Nail changes are not associated with ankylosing spondylitis.
4 Polymyalgia rheumatic is an inflammatory disorder that causes stiffness and pain in the neck, upper arms, shoulders, and pelvic girdle. It is not associated with onycholysis.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 939

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1 E. coli causes septic arthritis in infants.
2 Lyme disease is caused by Borrelia burgdorferi, which is transferred to humans through tick bites.
3 Ankylosing spondylitis can be caused by Klebsiella pneumoniae.
4 Staphylococcus aureus is most commonly associated with septic arthritis and osteomyelitis.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  1

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 937

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Reduction of Risk Potential

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1 A muscle biopsy is used to study the stages of inflammation in polymyositis and dermatomyositis. It is the most definitive diagnostic test for polymyositis and dermatomyositis.
2 The Western blot test is used to diagnose Lyme disease.
3 Immunofluorescent assay is used to diagnose Lyme disease.
4 A DEXA scan is used in clients with osteomyelitis to investigate bone density.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  3

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 929

Objective: N/A

Difficulty: Difficult

Heading: Pathophysiology of Selected Infectious Musculoskeletal Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level:  Application [Applying]

Concept: Critical Thinking

 

  Feedback
1 Sacroilitis is inflammation along the sacroiliac joints. It is not characterized by a rash.
2 Dactylitis is inflammation of all the finger joints seen in clients with psoriatic arthritis.
3 A skin rash with an oval-shaped, red-colored lesion is a characteristic feature of erythema migrans caused by the organism Borrelia burgdorferi in Lyme disease. It is observed in the area of the tick bite. Therefore, the nurse suspects Lyme disease in the client.
4 Psoriatic arthritis is a disorder characterized by inflammation of the joints and connective tissues. Clients may have plaque psoriasis of the skin, and psoriatic nail changes.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  2

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 936

Objective: N/A

Difficulty: Difficult

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level: Analysis [Analyzing]

Concept: Nursing Roles

 

  Feedback
1 Doxycycline is in the tetracycline class of antibiotic, which is used as the first-line agent in clients with Lyme disease. Therefore, this statement made by the student nurse does not indicate the need for further teaching.
2 Immunosuppressive agents are the first-line treatment for polymyositis and dermatomyositis. NSAIDs and local corticosteroid injections are the first treatment in psoriatic arthritis. Therefore, this statement made by the student nurse indicates the need for further teaching.
3 In polymyalgia rheumatica, oral corticosteroids are the first-line treatment agents. Therefore, this statement made by the student nurse does not indicate the need for further teaching.
4 NSAIDs are the first-line agents for the treatment of gout. Therefore, this statement made by the student nurse does not indicate the need for further teaching.

 

 

PTS:   1                    CON:  Nursing Roles

 

  1. ANS:  4

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 938

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Assessment

 

  Feedback
1 In osteomyelitis, the bacteria present in the bloodstream invade the bone and settle, which results in the formation of an abscess.
2 Inflammation of the joint of the great toe is seen in clients with gout due to excess secretion of uric acid.
3 Pott’s disease is associated with thoracic vertebrae and intervertebral discs. The infection of vertebral bone results in the abscess formation in the paravertebral muscles.
4 Ankylosing spondylitis is the inflammation of the spine and sacroiliac joints. In this condition, the primary site of inflammation is the point where tendons and ligaments join the bone around the joint.

 

 

PTS:   1                    CON:  Assessment

 

MULTIPLE RESPONSE

 

  1. ANS:  1, 3, 4

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 932

Objective: N/A

Difficulty: Easy

Heading: Pathophysiology of Selected Infectious Musculoskeletal Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1. This is correct. Arthralgia refers to joint pain. Early localized disease is characterized by flu-like symptoms, which includes arthralgia.
2. This is incorrect. Cranial neuritis is the paralysis of facial nerves. It is observed in the early disseminated disease stage.
3. This is correct. In early localized Lyme disease, the rash at the site of the tick bite enlarges over several days, resulting in the formation of a round lesion in the middle of the ring. This is called a bull’s-eye rash.
4. This is correct. Regional enlargement of lymph nodes is called lymphadenopathy. It may be observed in the early localized disease stage.
5. This is incorrect. Subacute encephalopathy is observed in late disseminated Lyme disease.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  3, 4, 5

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 939

Objective: N/A

Difficulty: Moderate

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Assessment

 

  Feedback
1. This is incorrect. Neural inflammation is observed in Lyme disease if spinal nerves are involved. It is not accompanied with ankylosing spondylitis.
2. This is incorrect. Paralysis of facial nerves occurs due to cranial neuritis. It is observed in early disseminated Lyme disease.
3. This is correct. Ankylosing spondylitis is the inflammation of the spine and sacroiliac joints. It is accompanied by iritis, which is inflammation of the eyes.
4. This is correct. Scarring throughout the lungs is termed pulmonary fibrosis, which may be seen in clients with ankylosing spondylitis.
5. This is correct. Inflammation of joints in the extremities is arthritis. It is found in ankylosing spondylitis.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  1, 4, 5

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 938

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1. This is correct. Spondylitis is a form of psoriatic arthritis that is characterized by inflammation of the spine.
2. This is incorrect. Septic arthritis occurs with the direct invasion of the joint spaces with bacteria, viruses, and fungi. It is not a form of psoriatic arthritis.
3. This is incorrect. Dermatomyositis is the inflammation of muscles and skin. It is not a form of psoriatic arthritis.
4. This is correct. Arthritis mutilans is a severe destructive arthritis. It is a form of psoriatic arthritis.
5. This is correct. The classic form of psoriatic arthritis is DIP predominant.

 

 

PTS:   1                    CON:  Assessment

 

  1. ANS:  1, 4, 5

Chapter: Chapter 39, Infection and Inflammatory Disorders of the Musculoskeletal System

Page: 938

Objective: N/A

Difficulty: Easy

Heading: Common Musculoskeletal Inflammatory Disorders

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Knowledge [Remembering]

Concept: Assessment

 

  Feedback
1. This is correct. Secondary gout is caused by underlying medical conditions. Psoriasis can cause secondary gout.
2. This is incorrect. Both polymyositis and dermatomyositis are linked to autoimmune disorders such as scleroderma.
3. This is incorrect. Rheumatoid arthritis is an autoimmune disease, which is a risk factor for polymyositis and dermatomyositis.
4. This is correct. Neoplastic disease increases the risk for secondary gout in clients.
5. This is correct. Glycogen storage disease can result in secondary gout.

 

 

PTS:   1                    CON:  Assessment

 

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