Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So if you're ready, let's jump right in.
Which of the following is most often noted in a 65-year-old woman with osteoarthritis?
A. Anemia of chronic disease is often noted.
B. Usually presents as a systemic polyarthritis.
C. Constitutional signs and symptoms, including fatigue and unintended weight loss is reported.
D. Typically impacts weight-bearing joints, particularly in early disease.
Where do you start?
First, let's determine what kind of question this is. This is a helpful example of an assessment question — where you're being cued to gather information that will support the OA diagnosis.
Of course, we're told the patient has osteoarthritis already, but at the same time, ongoing information gathering is one of the key components of safe practice. And, as you know, the boards are a test to determine if the NP has and can apply the knowledge base and the clinical decision-making to practice as a safe entry-level clinician.
In other words, if your patient has an OA diagnosis, you would expect to hear and/or see the subjective and objective information consistent with the diagnosis, and subjective and objective information gathering. These are, of course, the key components of assessment.
Let's take a look at the options for answers we've been given; but, at the same time, we want to keep in mind the disease's pathophysiology will direct its clinical findings. OA is classified as a degenerative disease, largely limited to select joints.
We have been advised that this woman is in her sixties and has osteoarthritis. That's one of the more common age groups to find osteoarthritis in.
Option A: Anemia of chronic disease is often noted.
Given the disease's pathology and where findings are largely limited to the affected joint, anemia of chronic disease is not often noted in OA; however, anemia of chronic disease, a.k.a. A.C.D., is commonly seen in arthritis forms that have a more systemic inflammatory component, such as rheumatoid arthritis.
Option B: Usually presents with a systemic polyarthritis.
That answer implies that many joints would be involved. OA is more likely to develop in select joints where there is a history of "wear and tear" and frequent overuse, such as in the knee or in the hands, and often with asymmetric findings. Rheumatoid arthritis is more likely to present with symmetric findings and in smaller joints, such as the wrists and the ankles.
Option C: Constitutional signs and symptoms, including unexplained fatigue and unintended weight loss, are reported.
Again, these are more likely to be found in the systemic arthritis forms like rheumatoid arthritis and lupus. As a matter of fact, when you delve into the literature with both R.A. and lupus, particularly with lupus, it is not at all uncommon to find that the patient has had these symptoms of unexplained fatigue and unintended weight loss for many months prior to getting the diagnosis.
Option D: Typically impacts weight-bearing joints, particularly in early disease.
D is of course, the correct answer. While in later OA multiple joints could be impacted, in earlier disease weight-bearing joints such as the knees and the hips are most commonly noted.
Key takeaway: In order to answer a question on assessment, a critical part of safe and effective clinical practice, you need to know the typical clinical findings in commonly encountered clinical conditions.
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