A nurse is completing discharge teaching with a client diagnosed with osteoarthritis (OA). Which of the following statements by the client indicates an understanding of the disease process? Select all that apply.

Over time you will lose height and possibly develop an abnormal curvature to your spine known as kyphosis.

It is due to loss of calcium in the bones leading to fractures and increased injury.

It occurs during the aging process and results in the disintegration of cartilage in the joint.

OA is also known as the wear and tear disease, usually a result from the overuse of joints.

It is caused by inflammation that affects both joints and other body tissues.

Answer and Explanation

Correct Answer : C,D

Choice A rationale

The loss of height and development of kyphosis are classic indicators of osteoporosis rather than osteoarthritis. Osteoporosis involves a systemic reduction in bone mineral density, leading to vertebral compression fractures that alter spinal curvature. In contrast, osteoarthritis is a localized degenerative joint disease focusing on articular cartilage. Therefore, expecting these specific skeletal changes would indicate a misunderstanding of the primary pathophysiology of osteoarthritis which affects joint spaces instead of bone density.

Choice B rationale

Bone fractures resulting from calcium loss are the hallmark of osteoporosis, not osteoarthritis. Osteoarthritis involves the mechanical breakdown of the joint surface and the development of osteophytes, but it does not inherently involve systemic bone demineralization or pathological fragility from calcium deficiency. Calcium levels in the blood typically remain within the normal range of 9.0 to 10.5 mg/dL. Attributing the disease to calcium loss ignores the actual mechanical and enzymatic destruction of cartilage.

Choice C rationale

Osteoarthritis is characterized by the progressive disintegration of articular cartilage within the synovial joints. As people age, the repetitive mechanical stress and metabolic changes lead to the thinning of this protective layer. This results in bone rubbing against bone, causing pain and stiffness. This statement correctly identifies the central pathological process of cartilage loss that defines the disease, acknowledging that age is a primary risk factor for the degradation of joint integrity.

Choice D rationale

Labeling osteoarthritis as a wear and tear disease is scientifically accurate as it often results from long term overuse or repetitive stress on specific joints. Excessive loading leads to chondrocyte injury and the eventual failure of the cartilage matrix. Unlike systemic inflammatory conditions, this disease process is frequently localized to the joints that have been subjected to the most mechanical pressure over time, such as the knees, hips, and the small joints of the hands.

Choice E rationale

Describing the disease as an inflammatory process affecting both joints and other body tissues characterizes rheumatoid arthritis rather than osteoarthritis. While low grade inflammation can occur in osteoarthritis, it is not a systemic autoimmune disease. Rheumatoid arthritis involves a widespread immune response that can damage organs and multiple symmetric joints. Osteoarthritis is primarily a non systemic, degenerative condition focused on the physical breakdown of the joint structures without significant systemic tissue involvement.

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Correct Answer is A

Explanation

Choice A rationale

Age-related macular degeneration is characterized by the accumulation of drusen, which are small yellow or white extracellular deposits located between the retinal pigment epithelium and the Bruch membrane. These deposits interfere with the metabolic support of the photoreceptors in the macula, leading to central vision loss. Drusen are considered the hallmark early clinical sign of the dry form of the disease. Normal visual acuity is 20/20, but the presence of drusen progressively degrades the clarity of the central visual field.

Choice B rationale

Increased intraocular pressure is the primary pathophysiological mechanism associated with glaucoma, not macular degeneration. In glaucoma, the elevated pressure damages the optic nerve, typically resulting in the loss of peripheral vision rather than central vision. Normal intraocular pressure is between 10 and 21 mmHg. Macular degeneration specifically affects the macula, the area responsible for sharp, detailed central vision, and is usually unrelated to the drainage of aqueous humor or the internal pressure levels of the eyeball.

Choice C rationale

A tendency for the retina to tear or pull away from the underlying tissue describes a retinal detachment. This condition often presents with symptoms like sudden flashes of light, floaters, or a curtain-like shadow over the visual field. While both involve the retina, macular degeneration is a chronic, progressive deterioration of the central macular area, whereas a retinal tear is an acute structural failure. The underlying causes of macular degeneration are typically oxidative stress, inflammation, and genetic factors rather than mechanical traction.

Choice D rationale

Blurred vision at any distance is a general symptom that can be associated with refractive errors like astigmatism, myopia, or hyperopia. Macular degeneration specifically targets central vision, leaving peripheral vision relatively intact. Patients with macular degeneration struggle with tasks requiring fine detail, such as reading or recognizing faces, but they can usually navigate their environment using their side vision. Describing the condition as general blurring fails to capture the specific loss of the central visual field caused by macular pigmentary changes.

A. Do you regularly lift heavy objects? B. Do you take steroids? C. Have you had any trauma to the eye? D. Do you wear sunglasses when in direct sunlight? E. How much sodium is in your diet?

Correct Answer is ["A","C"]

Explanation

Choice A rationale

Regular heavy lifting or activities that involve significant straining can increase intraocular pressure and may contribute to the progression or occurrence of a retinal tear or detachment in predisposed individuals. Asking about physical exertion helps identify lifestyle factors that may have precipitated the detachment. In clinical practice, patients at risk for retinal issues are often advised to avoid the Valsalva maneuver and heavy lifting to prevent further vitreoretinal traction and ocular complications.

Choice B rationale

While long-term steroid use is significantly associated with the development of glaucoma and cataracts, it is not a direct or primary risk factor for rhegmatogenous retinal detachment. Steroids can affect intraocular pressure and lens clarity, but they do not typically cause the vitreous changes or retinal breaks that lead to detachment. Therefore, while important for a general eye history, it is not a specific priority question when investigating the immediate history of a suspected retinal detachment.

Choice C rationale

Physical trauma to the head or directly to the eye is a very common cause of retinal detachment. Blunt or penetrating injuries can cause mechanical shifts in the vitreous humor that pull the retina away from the underlying choroid layer. Establishing a timeline of any recent accidents or hits to the face is crucial for diagnosing traumatic detachment. This question is a high priority during the assessment because it directly links an event to the pathology.

Choice D rationale

Wearing sunglasses is a healthy practice for protecting the eyes from ultraviolet radiation, which helps prevent cataracts and macular degeneration. However, exposure to sunlight or the failure to wear sunglasses is not linked to the mechanical separation of the retina. This question is irrelevant to the pathophysiology of retinal detachment, which involves the structural integrity of the vitreous and retinal layers rather than damage caused by light exposure or environmental UV radiation.

Choice E rationale

Dietary sodium intake is primarily monitored in conditions related to fluid retention, such as systemic hypertension or certain types of macular edema. It does not play a role in the structural failure or tearing of the retina that results in detachment. High salt intake does not increase the risk of vitreous shrinkage or retinal holes. Therefore, asking about sodium levels would not provide useful diagnostic or historical information regarding the physical detachment of the retinal layers.

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A nurse is completing discharge teaching with a client diagnosed with osteoarthritis (OA). Which of the following statements by the client indicates an understanding of the disease process? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An ophthalmologist tells a client that he has macular degeneration. The nurse explains to the client that this means there is:

Correct Answer is A

Explanation

A nurse is admitting a client who has suspected retinal detachment. Which of the following Questions should the nurse include when gathering a client history? Select all that apply.

Correct Answer is ["A","C"]

Explanation

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A nurse is completing discharge teaching with a client diagnosed with osteoarthritis (OA). Which of the following statements by the client indicates an understanding of the disease process? Select all that apply.