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Osteoarthritis (OA) Practice Exams
w/Rationales 2024 - 2025
The nurse is teaching a class about the joints commonly affected by OA. Which joints should the nurse include?
A) Hands, knees, hips
B) Neck, shoulders, ankles
C) Ankles, feet, spine
D) Knees, feet, spine - ANS-A) Hands, knees, hips
Rationale:
Hands, knees and hips are the most commonly affected joints of OA. Feet, spine, neck, shoulders, and ankles are not the most common locations.
After performing a physical assessment, the nurse suspects that a client is experiencing manifestations of OA. Which finding supports the nurse's suspicion? SATA
A) Joint tenderness
B) Crepitation
C) Joint stiffness
D) Leg tremors
E) Reduced joint flexibility - ANS-A, B, C, E
Rationale:
Manifestations of OA include crackling sounds, or crepitation, with joint movement; joint stiffness and tenderness; and reduced joint flexibility. Leg tremors can be associated with multiple sclerosis or Parkinson disease.
Which is a common risk factor for OA? SATA
A) Overuse of joints from sports or strenuous activities
B) Autoimmune disorder
C) Activities affecting weight-bearing joints
D) Obesity
E) Ingestion of large amounts of purine - ANS-A, C, D
Rationale:
Common risk factors for OA include obesity, overuse of joints from sports injuries or strenuous activities, and activities affecting weight-bearing joints. Rheumatoid arthritis is thought to be an autoimmune disorder. Ingestion of large amounts of purines is a risk factor for gout.
Which clinical manifestation of OA should the nurse include when teaching about OA? SATA
A) Abrupt onset
B) Mild fever
C) Pain and stiffness at night
D) Crepitus with movement of joint
E) Joint pain with activity - ANS-C, D, E
Rationale:
Joint pain with activity, grating or crepitus noted with movement, and pain and stiffness with prolonged inactivity are general manifestations of OA. Mild fever is associated with rheumatoid arthritis, not OA. Osteoarthritis is a degenerative disease that develops over time, although symptoms may appear suddenly.
A client diagnosed with localized idiopathic osteoarthritis asks the nurse what this means. Which response by the nurse provides the most accurate information?
A client diagnosed with OA asks the nurse, "If I am losing the cartilage in my knees, why do my knees look larger?" Which response should the nurse give?
A) "Sometimes inflammation increases the size of your knees or fluid buildup occurs."
B) "The muscle mass is increasing as a result of the exercises you must do."
C) "Although the cartilage is destroyed, you may be building up more bone in the knee."
D) "Your knees have developed contractures, increasing the size of the knees." - ANS-A) "Sometimes inflammation increases the size of your knees or fluid buildup occurs."
Rationale:
Inflammation causes swelling of the knee joint, which makes the joint appear larger. Joint effusion or fluid buildup may also occur. An increase in bone or muscle tissue does not occur in osteoarthritis. Flexion contractures may develop with osteoarthritis of the knee joint, but this will not result in an increase in the size of the joint.
The nurse is counseling a newly pregnant client with OA. Which information should the nurse include?
A) "Your pain from the OA may increase due to the weight gain of pregnancy."
B) "Pregnancy has no impact on OA if you keep your weight gain within the recommended limits."
C) "You may continue to take your prescription NSAID drug without any risk of harm to the fetus."
D) "You need to restrict your participation in low-impact aerobic exercises." - ANS-A) "Your pain from the OA may increase due to the weight gain of pregnancy."
Rationale:
Weight gain of pregnancy may increase the pain resulting from OA due to the increased stress on the joints; this would be important information to include. The impact of nonsteroidal anti-inflammatory drugs, such as celecoxib (Celebrex), on the fetus is unknown; the nurse would not tell the client that it is safe to use. Low-impact aerobic exercises are recommended for clients with OA. The recommended weight gain for pregnancy would not be changed due to the OA, nor is it valid to indicate that pregnancy will have no impact on the OA.
The parents of a child newly diagnosed with juvenile OA are concerned about their child's future ability to be disability free and remain independent. Which information should the nurse give the parents? SATA
A) "OA in children is usually idiopathic, making it difficult to determine how it will affect them as adults."
B) "OA in children is generalized, thus impacting all joints and increasing possible impairment."
C) "Children may outgrow OA as they age."
D) "The amount of disability will depend on how well the OA is managed as a child."
E) "Children with OA are less likely to become disabled." - ANS-C, E
Rationale:
Children with OA are less likely to become disabled as adults and may outgrow the OA as they age. It's not likely that children with OA will be disabled as adults.
The nurse is teaching an older adult recently diagnosed with OA about interventions to help maintain mobility of the joints. Which should the nurse include?
A) Physical therapy
B) Routine NSAID use
C) Glucosamine and chondroitin supplements
D) Jogging three times a week - ANS-A) Physical therapy
Rationale:
Physical therapy is particularly important for older adults with OA to help them maintain or improve joint mobility. NSAIDs should generally not be used by older adults due to the risks associated with their use. Older adults should use acetaminophen as a first-line drug and narcotics as a second-line choice. Jogging is a high-impact activity that could place more stress on the joints and would not be recommended. The utility of supplements has not been supported as effective; additionally, the use of glucosamine and chondroitin may increase the risk of bleeding.
A 32 year old client who has limited hip joint damage from OA asks the nurse why an osteotomy is being performed rather than other procedures. Which response by the nurse provides the most accurate information?
A) "This procedure can be done since you are young and healthy and your hip damage is limited."
B) "This procedure prepares you for joint resurfacing and a total hip replacement later in life."
C) "An osteotomy is much less invasive than all of the other procedures."
D) "This procedure is usually tried first; arthroplasty will be done later if this doesn't work." - ANS-A) "This procedure can be done since you are young and healthy and your hip damage is limited."
Rationale:
An osteotomy is performed to realign the joint or to shift the joint load toward areas of less cartilage damage. It is used instead of joint replacement surgery if the client is young, healthy, and damage is limited to only one side of the joint. This would provide the most accurate explanation to the client. It is not indicated as a surgery to necessarily be done first before an arthroplasty, nor to prepare the client for joint resurfacing surgery.
A client with possible OA is scheduled for synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for which reason?
A) To rule out inflammatory arthritis and gout
B) To determine the extent of joint damage
C) To evaluate for increased density of subchondral bone
D) To identify irregular joint space narrowing - ANS-A) To rule out inflammatory arthritis and gout
Rationale:
Joint fluid analysis is used to detect inflammation, bacteria, and uric acid crystals to rule out inflammatory arthritis and gout. This test will not provide information on the extent of the joint damage. This test cannot identify the amount of joint space that has narrowed. This test cannot evaluate bone density.
The nurse is providing teaching about home care for a client with OA of the knees. Which information should the nurse include? SATA
A) Encouraging heavy lifting to maintain muscle strength
B) Using assistive devices to minimize stress placed on affected joint
C) Continuing activity with repetitive movement
D) Taking pain medications as ordered
E) Installing handrails in the bathroom - ANS-B, D, E
Rationale:
Taking pain medications as ordered will assist with pain management and allow the client to participate in daily activities. Installing handrails in the bathroom is information that the nurse should include when educating a client to keep the client safer during activities of daily living at home. The nurse should educate the client on the importance of using assistive devices to minimize joint stress. The nurse should instruct the client to avoid repetitive movement and to avoid heavy lifting, because these actions will increase pain and joint degeneration and will not improve physical mobility.
The nurse is planning care for a client with OA. Which nursing diagnosis is a priority for the nurse to address?
A) Skin Integrity, Impaired
B) Lifestyle, Sedentary
C) Pain, Chronic
D) Family Processes, Interrupted - ANS-C) Pain, Chronic
Rationale:
Chronic pain is the priority problem for the nurse to address when planning care for a client diagnosed with osteoarthritis. Sedentary lifestyle would be a concern because exercise can help to address OA but would not be a priority nursing diagnosis. Skin integrity and impaired family processes are not expected problems for the nurse to address when planning care for a client diagnosed with OA.
A) Using compression cold packs to provide a deeper cold to the wrist joint
B) Encouraging use of assistive devices during daily activities to decrease stress on the joint
C) Increasing ROM exercises for the joint to 3X/day
D) Applying a warm towel to the wrist joint 3X/day for 20 minutes at a time. - ANS-A) Using compression cold packs to provide a deeper cold to the wrist joint
Rationale:
The use of deep cold can best help to address swelling. Increasing ROM exercises to 3 times a day is not the best approach to decrease swelling; ROM helps to maintain flexibility of the joint. Heat decreases pain and increases flexibility; it does not address swelling. Assistive device use can decrease stress on the joint to possibly prevent swelling, but it would not be the best approach to address swelling once it has occurred.
The nurse is assessing an older adult who has OA. Which finding indicates the impact of OA?
A) Requesting a dose of acetaminophen to address joint pain
B) Sitting in a soft chair and not getting up to greet the nurse
C) Leaning on furniture while walking
D) Asking the nurse to retrieve items from across the room - ANS-C) Leaning on furniture while walking
Rationale:
When assessing the client with OA, the nurse should observe how the client moves and ambulates. Noting that the client leans on furniture while walking indicates possible issues related to the OA. Asking the nurse to retrieve items from across the room, requesting a dose of acetaminophen, and not getting up when the nurse arrives do not provide any direct observable data to indicate the possible impact of OA on the client.
The nurse is providing teaching to the client recently diagnosed with OA. Which statement by the nurse is correct?
A) "Osteoarthritis is most commonly seen in thin, small-built female clients."
B) "Osteoarthritis is a result of joint inflammation."
C) "Osteoarthritis occurs due to erosion of cartilage in the joints."
D) "Osteoarthritis is a metabolic bone disease." - ANS-C) "Osteoarthritis occurs due to erosion of cartilage joints."
Rationale:
Osteoarthritis is characterized by progressive erosion of the cartilage within joints. It is not a metabolic bone disease; examples of such diseases include osteoporosis, osteomalacia, and Paget disease. Thin, small-built female clients are at increased risk for osteoporosis, not osteoarthritis. In fact, osteoarthritis is more commonly associated with obesity than with slight build. Finally, joint inflammation is a characteristic of rheumatoid arthritis, not osteoarthritis.
The nurse is caring for client with OA. Which factor in the client's history and physial assessment would the nurse recognize as a risk factor for developing this condition?
A) BMI of 36.
B) History of esophageal reflux disease
C) Client plays tennis three times/week
D) BP of 136/78 mmHg - ANS-A) BMI of 36.
Rationale:
Obesity increases the risk of developing osteoarthritis (OA), because the added weight increases stress on weight-bearing joints, causing the joints to wear down more quickly. This client has a body mass index of 36.5, which is considered obese. Moderate recreational exercise (such as tennis three times per week) has been shown to decrease the chance of developing OA and slow the progression of manifestations when OA is present. Esophageal reflux is not associated with OA. Blood pressure is not a known risk factor for the development of OA.
An older adult client with bilateral OA of the knees tells the nurse, "I know I need to lose weight, but exercising makes my knees ache." What instruction should the nurse provide to this client?
A) "You should discuss knee replacement surgery with your physician."
B) Instruct the client on the importance of strict bedrest
C) Provide NSAIDs when pain becomes severe
D) Provide opioid pain medication as prescribed - ANS-A) Provide moist heat packs to the affected joint 3 times/day
Rationale:
Interventions appropriate for a client with osteoarthritis (OA) include NSAIDs, moist heat, active range- of-motion exercises, proper posture and body mechanics, and assistive devices to safely maintain independence with activities of daily living. Opioid medication is not typically prescribed for the treatment of OA. NSAIDs are most effective if taken before the pain is severe. The client should be encouraged to be mobile, not on strict bedrest.
The nurse is evaluating care provided to a client with OA. Which client statement indicates to the nurse that interventions for OA have been successful?
A) "I had to take early retirement and now stay at home all day and rest my legs."
B) "I am sleeping throughout the night and have not missed any work because of my knee pain."
C) "I am moving from my two-story house into the first floor of my daughter's home so I won't have to walk steps anymore."
D) "I changed my work hours so now I work part-time and have a nursing assistant who helps me bathe twice a week at home." - ANS-B) "I am sleeping throughout the night and have not missed any work because of my knee pain."
Rationale: Expected outcomes for the care of a client with OA include independence with activities of daily living, minimal lifestyle impact because of OA, and controlled pain that allows for rest and sleep. Of the client statements provided, only the one about improved sleep and pain not interfering with work indicates achievement of these outcomes. A client who changes work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. A client who is moving in with a daughter is experiencing significant lifestyle impact. A client who retires early and stays at home all day is also experiencing a significant impact in lifestyle.
A client with OA tells the nurse she has difficulty walking to the bathroom first thing in the morning. Which nursing action would assist this client?
A) Suggesting a family member provide the client with a bedpan
B) Discussing the option of residing in an assisted-living facility
C) Consulting w/physical therapy for an assistive walking device such as a walker or cane
D) Suggesting the client use a bedside commode - ANS-C) Consulting w/physical therapy for an assistive walking device such as a walker or cane
Rationale:
Assistive devices are items used to maintain, increase, or improve function. The client describes difficulty walking to the bathroom in the morning. The best intervention to help this client would be to consult with physical therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom, but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.
A client with chronic hip pain is diagnosed with OA. Which instruction regarding home safety is most appropriate for the nurse to provide to this client?
A) Walk up and down the steps at home as much as possible
B) Rest in a recliner
C) Place scatter rugs in high-traffic areas
D) Install grab bars in the bathroom near the commode and in the shower. - ANS-D) Install grab bars in the bathroom near the commode and in the shower
Rationale:
The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should also be instructed to sit in a straight-back chair, avoid slumping, and avoid use of a recliner.
A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20-40lb boxes. Based on the client's history, the nurse should anticipate which initial recommendation from the multidisciplinary healthcare team?
A) Reinforce the correct use of hot packs
B) Suggest the client replace running with a lower impact exercise
C) Explain the risk of injury associated with use of cold packs
D) Advise the client to continue weight loss
E) Congratulate the client on starting water aerobics - ANS-A, B, C, E
Rationale:
The nurse should congratulate the client on starting water aerobics because it is a low-impact exercise mode. The nurse should also congratulate the client on the weight loss. Note, however, that a BMI of 22 is ideal, so continued weight loss should not be encouraged. The client should be informed that using cold packs for more than 30 minutes may cause skin injury. The nurse should also reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Finally, the nurse should suggest that the client replace the high impact exercise of running with a lower impact exercise such as walking or biking.
A nurse is teaching the parents of a client who was recently diagnosed with osteoarthritis about their child's condition. Which statement by the parents indicates the need for further instruction?
A) "Our daughters OA is likely related to a joint injury sh sustained last year."
B) "Most kids with OA usually have only one or two affected joints."
C) "Because our daughter developed OA as a child, she is more likely to become disabled as a result of this condition."
D) "Our daughter may outgrow her OA as she ages." - ANS-C) "Because our daughter developed OA as a child, she is more likely to become disabled as a result of this condition."
Rationale:
Juvenile OA is usually secondary to a congenital abnormality, genetic condition, or joint injury. It typically occurs only in the one or two joints affected by the abnormality or injury. Children with OA are less likely to become disabled and may outgrow the condition as they age. Thus, the parents' statement about an increased likelihood of disability indicates the need for further instruction
Which of the following treatment options would least likely be considered for a 71 year old client with OA?
A) Physical therapy
B) Administration of NSAIDs
C) Weekly tai chi sessions
D) Administration of narcotics - ANS-B) Administration of NSAIDs
Rationale:
Acetaminophen is a first-line medication for older adults due to its efficacy and safety. Narcotics are a second-line choice, because they are safer than NSAIDs for older adults. Mindfulness exercises and complementary health approaches such as yoga or tai chi may assist older adults in increasing mobility and reducing pain levels. Physical therapy is especially important in older adults to maintain or improve mobility of joint(s).
Which of the following procedures used in the treatment of OA involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the knee?
A) Osteotomy
B) Arthroplasty
C) Arthroscopy
D) Joint resurfacing - ANS-D) Joint resurfacing
Rationale:
In joint resurfacing, a small amount of bone is removed at the articulating surface of the joint and a metal replacement is fitted over the end of the bone. Osteotomy involves surgical removal of a wedge of bone above or below the joint to realign the joint and shift the weight away from the damaged portion of the joint. Arthroscopy entails insertion of a small fiber optic light source, magnifying lens, and camera into the joint to visualize the joint structures. Arthroplasty is total joint replacement, in which a surgeon removes the damaged joint surfaces and replaces them with plastic, metal, or ceramic prostheses.
Which of the following terms is used to describe OA that is caused by an underlying condition, such as injury, congenital malformation, or metabolic disease?
A) Idiopathic
B) Secondary
C) Localized
Because frequent use of corticosteroids can cause joint damage, clients should receive cortisone injections in affected weight-bearing joints no more than three or four times per year. Avoiding movement of affected joints does not reduce the risk of joint damage; rather, it worsens the effects of OA. Applying topical analgesics and taking acetaminophen and NSAIDs reduces the pain of OA but does not reduce the risk of further joint damage.
