A nurse is caring for a 57-year-old female client in the emergency department who presents with joint pain and stiffness in her hands. The client has a history of hypertension and type 2 diabetes.
Exhibits
Nurses’ Notes (0700hrs):
- The client reports experiencing joint pain and stiffness in her hands for the past few months.
- The pain is described as aching and is worse in the morning, lasting for about an hour before improving.
- The client mentions difficulty in performing daily tasks such as buttoning clothes and opening jars.
- There is visible swelling in the small joints of both hands.
- The client denies any recent trauma or injury to the hands.
- The client reports feeling fatigued and has had occasional low-grade fevers.
- The client is currently taking medication for hypertension and diabetes.
Medical History:
- Hypertension for 10 years, managed with medication.
- Type 2 diabetes for 5 years, managed with oral hypoglycemic agents.
- No known allergies.
- Family history of autoimmune diseases.
Vital Signs (0700hrs):
- Temperature: 37.8°C (100°F)
- Blood Pressure: 140/90 mmHg
- Heart Rate: 82 bpm
- Respiratory Rate: 18 breaths per minute
- Oxygen Saturation: 98% on room air
Physical Examination Results (0700hrs):
- Swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints of both hands.
- Limited range of motion in the affected joints.
- No deformities observed.
- Skin over the joints appears slightly erythematous.
- No signs of infection or injury.
Diagnostic Results (0700hrs):
- Complete Blood Count (CBC): WBC 8,000/mm³ (4,000-11,000/mm³), Hemoglobin 13.5 g/dL (12-16 g/dL), Platelets 250,000/mm³ (150,000-450,000/mm³)
- Erythrocyte Sedimentation Rate (ESR): 40 mm/hr (0-20 mm/hr)
- C-Reactive Protein (CRP): 15 mg/L (0-10 mg/L)
- Rheumatoid Factor (RF): Positive
A nurse is analyzing the assessment findings. Which findings are indicative of rheumatoid arthritis? Select all that apply.
Small joints of the hand
Joint swelling
Symmetrical involvement
Pain increases with motion
Heberden nodes
Fatigue and fever
Morning stiffness quickly resolves
Correct Answer : A,B,C,F,G
Choice A rationale: Small joints of the hand are commonly affected in rheumatoid arthritis (RA). RA typically involves the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, leading to pain, swelling, and stiffness in these areas.
Choice B rationale: Joint swelling is a hallmark of RA. The inflammation in RA causes synovial membrane thickening and fluid accumulation, leading to visible swelling in the affected joints.
Choice C rationale: Symmetrical involvement is characteristic of RA. The disease often affects the same joints on both sides of the body, which helps differentiate it from other types of arthritis.
Choice D rationale: Pain increases with motion is not specific to RA. While joint pain can worsen with movement in many types of arthritis, it is not a distinguishing feature of RA.
Choice E rationale: Heberden nodes are associated with osteoarthritis, not RA. These bony enlargements occur at the distal interphalangeal (DIP) joints and are not typically seen in RA.
Choice F rationale: Fatigue and fever are common systemic symptoms of RA. The chronic inflammation associated with RA can lead to generalized fatigue and occasional low-grade fevers.
Choice G rationale: Morning stiffness quickly resolves is not indicative of RA. In RA, morning stiffness typically lasts for more than an hour, whereas in other types of arthritis, it may resolve more quickly
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View Related questions
Correct Answer is A
Explanation
Choice A rationale
Vesicular breath sounds are normal breath sounds heard over the peripheral lung fields. Hearing vesicular sounds in the bases of both lungs posteriorly indicates normal air movement in the lungs. Therefore, the nurse should continue with the remainder of the client’s physical assessment.
Choice B rationale
Reporting the client’s lung sounds to the healthcare provider is unnecessary because vesicular breath sounds are normal and do not indicate any abnormality.
Choice C rationale
Asking the client to cough and then auscultate at the site again is not required since vesicular breath sounds are normal and do not indicate any need for further immediate assessment.
Choice D rationale
Measuring the client’s oxygen saturation with a pulse oximeter is not necessary in this context because the vesicular breath sounds indicate normal lung function.
Correct Answer is D
Explanation
Choice A rationale
A BMI of 32 kg/m² is not considered an appropriate weight for height. According to the American Heart Association, a BMI between 18.5 and 24.9 kg/m² is considered normal weight. A BMI of 32 kg/m² falls into the obese category, which indicates excess body fat and potential health risks.
Choice B rationale
While a BMI of 32 kg/m² is classified as obese, it is not categorized as extreme obesity. Extreme obesity is typically defined as a BMI of 40 kg/m² or higher. Therefore, this choice is incorrect.
Choice C rationale
A BMI of 32 kg/m² does not indicate undernutrition or malnutrition. Undernutrition is associated with a BMI of less than 18.5 kg/m². This choice is incorrect as the BMI in question indicates obesity, not undernutrition.
Choice D rationale
A BMI of 32 kg/m² is classified as obese. Obesity is a serious threat to well-being as it increases the risk of various health conditions, including heart disease, diabetes, hypertension, and certain cancers. Therefore, this choice is correct.