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While obtaining a client’s health history related to smoking cigarettes, the nurse plans to determine the client’s smoking pack years. What information should the nurse obtain for this calculation? Select all that apply.

The nurse is obtaining a health history for a client prior to a scheduled cholecystectomy. While interviewing the client, which assessment technique should the nurse use when asking about the client’s use of illegal drugs and alcohol?

The nurse examines a client’s right great toe.The joint is red, edematous, and very painful with limited range of motion. The client’s serum uric acid levels are elevated. Which action should the nurse tell the client to make?

The nurse is examining a female client who states she has no complaints, so has not had a physical examination for over 5 years.The nurse palpates enlarged lymph nodes in the axilla. Which finding is most important for the nurse to describe when reporting to the healthcare provider?

While completing an admission assessment for a client with gastrointestinal bleeding, the nurse inspects the perianal area and anus. Which findings indicate a normal appearance of the anus?

Which assessment finding supports the client statement, “My feet swell all the time?”

An adult client exhibits an allergic reaction to an insect bite. The nurse should observe the client’s skin for which finding?

While performing a physical assessment, the nurse is unable to palpate the client’s pedal pulses. Which action should the nurse take?

The nurse assesses a client who comes to the clinic with neck stiffness and discomfort. Which finding of the cervical spine should the nurse inquire further about lifestyle habits?

While auscultating a client’s breath sounds, the nurse hears vesicular sounds in the bases of both lungs posteriorly. Which action should the nurse take in response to this finding?

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.