Choice A rationale

Decreased hemoglobin is typically associated with chronic inflammation in rheumatoid arthritis, but it is not considered an early manifestation. Anemia of chronic disease develops over time due to the effects of inflammatory cytokines on iron metabolism and erythropoiesis. Normal hemoglobin ranges for females are 12 to 15.5 g/dL and for males are 13.5 to 17.5 g/dL.

Choice B rationale

Temporomandibular joint pain can occur in rheumatoid arthritis, but it is not a specific or consistent early manifestation. While RA can affect various joints, the small joints of the hands and feet are more commonly involved in the early stages. Pain in the TMJ can also be related to other conditions.

Choice C rationale

Fatigue is a common systemic symptom in rheumatoid arthritis and can occur early in the disease process. However, fatigue is also a nonspecific symptom that can be present in many other conditions, making it less definitive as an early diagnostic indicator compared to joint involvement.

Choice D rationale

Symmetric joint swelling of the fingers, particularly the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, is a hallmark early manifestation of rheumatoid arthritis. The inflammation causes synovial thickening and effusion, leading to palpable swelling that affects the same joints on both sides of the body.

Choice A rationale

Dry, scaly patches on the elbows are more characteristic of psoriasis, a chronic autoimmune skin disorder. Psoriasis typically presents with well-defined, erythematous plaques covered with silvery scales, commonly found on extensor surfaces like elbows and knees.

Choice B rationale

Different pigmented patches in the genital area could suggest various dermatological conditions, such as tinea cruris or post-inflammatory hyperpigmentation, but are not typical findings associated with herpes zoster. Herpes zoster lesions follow a dermatomal distribution.

Choice C rationale

Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus. It characteristically presents with a painful, vesicular rash that follows the distribution of a sensory nerve pathway or dermatome. The pain often precedes the appearance of the rash.

Choice D rationale

Excessive hair growth, or hirsutism, is not a typical finding associated with herpes zoster. Hirsutism is usually related to hormonal imbalances or certain medications affecting androgen levels.

Choice A rationale

Echinacea is an herb often used to support the immune system, particularly for colds and flu. There is no strong scientific evidence to support its effectiveness in managing the joint pain associated with osteoarthritis, which is a degenerative joint disease.

Choice B rationale

Applying ice to a joint before exercising can decrease pain and inflammation, but it can also stiffen the joint and potentially limit range of motion during activity. Heat application is generally recommended before exercise in osteoarthritis to warm up the muscles and tissues.

Choice C rationale

Purines are compounds that break down into uric acid. Reducing purine intake is important for managing gout, a type of inflammatory arthritis caused by the deposition of uric acid crystals in the joints, not osteoarthritis, which is characterized by cartilage breakdown.

Choice D rationale

Maintaining a recommended body weight is crucial for managing osteoarthritis. Excess weight puts additional stress on weight-bearing joints like the hips and knees, accelerating cartilage breakdown and increasing pain. Weight loss can significantly reduce these stresses and alleviate symptoms.

Choice A rationale

Decreasing fluid intake can lead to dehydration and constipation, which would further impede peristalsis rather than promote it. Adequate hydration is essential for maintaining bowel regularity and facilitating the movement of intestinal contents.

Choice B rationale

Offering the bedpan every 2 hours does not directly stimulate peristalsis. While it provides an opportunity for bowel elimination, it does not address the underlying issue of decreased intestinal motility associated with paralytic ileus.

Choice C rationale

Increasing protein intake does not directly promote peristalsis. While protein is important for overall healing, it does not have a significant impact on stimulating bowel motility. Fiber intake is more directly related to promoting bowel function.

Choice D rationale

Increased ambulation stimulates peristalsis by promoting intestinal motility. Physical activity helps to move gas and fluids through the intestines, reducing the risk of paralytic ileus, which is a functional obstruction of the bowel often occurring after surgery.

Choice A rationale

Decreased right knee range of motion is a common finding in older adults due to age-related degenerative changes like osteoarthritis. While it warrants assessment, it does not necessarily indicate an acute issue requiring immediate intervention unless accompanied by pain, swelling, or functional limitations.

Choice B rationale

Report of left hip aching when jogging could be related to musculoskeletal issues like arthritis or muscle strain, which are not uncommon in older adults. Further assessment is needed to determine the cause and appropriate management, but it does not immediately signal a critical issue requiring urgent intervention.

Choice C rationale

A history of recent loss of balance and a fall in a 77-year-old patient is a significant finding that requires further nursing assessment and intervention. Falls in older adults can lead to serious injuries such as fractures, and a recent history suggests an underlying issue affecting stability and safety. This necessitates investigation into potential causes and implementation of fall prevention strategies.

Choice D rationale

Occasional mild constipation is a common complaint among older adults due to factors like decreased physical activity, dietary changes, and medication side effects. While it should be addressed with appropriate interventions like increased fiber and fluids, it does not typically require immediate or urgent nursing intervention unless it is severe or accompanied by other concerning symptoms. .

Choice A rationale

While the partner's intention may be good, allowing someone other than the client to administer PCA medication bypasses the safety mechanisms built into the pump and disregards the client's ability to self-titrate based on their pain level. This could lead to over-sedation and respiratory depression.

Choice B rationale

Patient-controlled analgesia is designed to allow clients to manage their own pain by self-administering medication within prescribed limits. The client is the best judge of their pain intensity and medication needs. Allowing the partner to push the button undermines this principle of patient autonomy and safety.

Choice C rationale

The nurse should not administer PCA medication based on a third party's assessment of the client's needs. This still circumvents the client's control and the safety features of the pump. The nurse's role is to assess the client directly and educate the client and family on proper PCA use.

Choice D rationale

While it's important to understand the partner's reasoning, the immediate concern is the inappropriate administration of medication. Addressing the partner's actions directly and educating them on the proper use of the PCA pump is the priority.

Choice A rationale

Eye drops for glaucoma primarily work to lower intraocular pressure and slow the progression of the disease. They do not reverse existing vision loss or improve vision over time. Glaucoma-related vision loss is typically permanent due to damage to the optic nerve.

Choice B rationale

Glaucoma is usually characterized by an increase in intraocular pressure due to a blockage of the outflow of aqueous humor or overproduction of aqueous humor, not inadequate production. This elevated pressure damages the optic nerve over time, leading to vision loss.

Choice C rationale

Double vision, or diplopia, is not a typical symptom of glaucoma. Common symptoms of glaucoma include gradual peripheral vision loss, blurred vision, halos around lights, and eye pain (especially in acute angle-closure glaucoma).

Choice D rationale

Glaucoma is a progressive eye disease that damages the optic nerve. If left untreated, the increased intraocular pressure can lead to significant and irreversible vision loss, eventually resulting in blindness. Early detection and consistent treatment are crucial to prevent this outcome.

Choice A rationale

A 24-hour urinary output of 380 mL falls below the generally accepted threshold for oliguria in adults. This reduced output could indicate kidney dysfunction or decreased renal perfusion following surgery.

Choice B rationale

A 24-hour urinary output of 600 mL is within the low end of the normal range for adult urinary output, which is generally considered to be 800 mL to 2000 mL per 24 hours.

Choice C rationale

A 24-hour urinary output of 550 mL is also within the low end of the normal range for adult urinary output. While lower than average, it does not meet the criteria for oliguria.

Choice D rationale

A 24-hour urinary output of 720 mL is within the normal range for adult urinary output and does not indicate oliguria.

Choice A rationale

Glaucoma is characterized by damage to the optic nerve, often due to increased intraocular pressure. Without proper management to lower this pressure, the damage to the optic nerve progresses, leading to irreversible vision loss and eventually blindness.

Choice B rationale

The primary goal of glaucoma treatment with eye drops is to lower intraocular pressure and prevent further damage to the optic nerve, thereby preserving existing vision. Eye drops do not typically improve vision that has already been lost due to glaucoma.

Choice C rationale

Glaucoma is usually associated with impaired drainage or overproduction of aqueous humor, leading to increased intraocular pressure, not inadequate production of fluid. This elevated pressure is the primary risk factor for optic nerve damage.

Choice D rationale

Double vision (diplopia) is not a common or characteristic symptom of glaucoma. While various eye conditions can cause double vision, glaucoma primarily affects peripheral vision and visual acuity without causing diplopia. .

Choice A rationale

While laboratory testing may eventually be necessary to identify the cause of diarrhea, the immediate priority is to gather more information about the patient's condition. Jumping directly to testing without understanding the symptoms could delay appropriate initial interventions and fail to address immediate needs.

Choice B rationale

Assessing the characteristics of the stools, such as frequency, consistency, color, and any associated symptoms like abdominal pain, nausea, vomiting, or fever, is crucial for determining the potential cause and severity of the diarrhea. This information guides subsequent interventions and helps differentiate between self-limiting conditions and those requiring further investigation.

Choice C rationale

Advising the use of loperamide without a proper assessment could mask underlying issues, potentially delaying appropriate treatment if the diarrhea is due to an infection or other serious condition. Antidiarrheal medications are not always indicated and should be used cautiously.

Choice D rationale

While maintaining hydration and electrolyte balance is important, especially with diarrhea, it is not the first action a nurse should take before understanding the nature of the patient's symptoms. The initial step should be to gather more information to guide appropriate advice and interventions.