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
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is C
Explanation
Choice A rationale: Administering the prescribed morphine sulfate is important for managing the client’s severe pain. However, the priority action is to assess the neurovascular status of the affected limb to ensure there is no compromise
in circulation or nerve function.
Choice B rationale: Preparing the cast cart for immobilization is necessary to stabilize the fracture. However, before immobilization, it is crucial to perform a neurovascular assessment to identify any potential complications that may need
immediate attention.
Choice C rationale: Performing a neurovascular assessment of the right hand is the priority action. The client’s capillary refill time is prolonged (4 seconds), indicating potential compromised circulation. Assessing the neurovascular status will help determine if there is an urgent need for intervention to prevent further complications such as compartment
syndrome.
Choice D rationale: Initiating the IV infusion of 0.9% sodium chloride is important for maintaining hydration and ensuring venous access. However, the immediate priority is to assess the neurovascular status of the affected limb to identify any urgent issues that need to be addressed.
Correct Answer is B
Explanation
Choice A rationale
Placing a mark where the DP pulse is auscultated can help in future assessments but does not address the immediate need to locate the pulse.
Choice B rationale
Using a Doppler to assess an audible DP pulse is the correct answer. A Doppler ultrasound device is helpful when it is impossible or difficult to assess a pulse or when pulses are not palpable.
Choice C rationale
Assessing capillary refill distal to the DP pulse is important but should be done after attempting to locate the pulse with a Doppler.
Choice D rationale
Reviewing the client’s history for vascular disease is essential for understanding the underlying cause but does not address the immediate need to locate the pulse.