A 36-year-old woman presents with pain, aching, stiffness, and swelling in her hands for 6 months. She reports a family history of rheumatoid arthritis (RA). Which of the following most closely describes the pathophysiology of RA?
RA is a connective tissue disease caused by a bacterial infection.
RA is an autoimmune disorder that results in joint inflammation caused by infection of the Epstein-Barr virus.
RA is an autoimmune disorder in which inflammation of the synovium leads to joint destruction and deformity.
RA is a progressive disease that damages or destroys synovial joint structure and articular cartilage of the joints.
The Correct Answer is C
Choice A reason: RA is not caused by bacterial infection. It is an autoimmune disease where the immune system mistakenly attacks the synovial lining of joints, leading to chronic inflammation and joint damage.
Choice B reason: Although Epstein-Barr virus has been studied as a potential environmental trigger, it is not the direct cause of RA. The disease is primarily autoimmune in nature, with genetic and environmental factors contributing to its development.
Choice C reason: RA involves autoimmune-mediated inflammation of the synovium, which leads to pannus formation, erosion of cartilage and bone, and ultimately joint deformity. This accurately describes the core pathophysiology of RA.
Choice D reason: While RA is progressive and does damage joint structures, this answer lacks specificity. It does not highlight the autoimmune mechanism or the central role of synovial inflammation.
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Correct Answer is B
Explanation
Choice A reason: NSAIDs are commonly used to relieve pain and inflammation in RA, but they do not alter the disease course or prevent joint damage. They are considered adjunctive therapy rather than first-line disease-modifying treatment.
Choice B reason: Methotrexate is the cornerstone and first-line disease-modifying antirheumatic drug (DMARD) for RA. It reduces inflammation, slows disease progression, and prevents joint damage. It has a well-established efficacy and safety profile and is recommended by major rheumatology guidelines as the initial treatment for most patients with RA.
Choice C reason: Corticosteroid injections may be used for localized joint inflammation or as a bridge therapy while waiting for DMARDs to take effect. However, they are not considered first-line long-term treatment due to potential systemic side effects and lack of disease-modifying properties.
Choice D reason: Opioids are not recommended for RA management due to their risk of dependence and lack of anti-inflammatory or disease-modifying effects. They may be used in exceptional cases for severe pain but are not part of standard RA treatment protocols.
Correct Answer is B
Explanation
Choice A reason: While schizophrenia often begins in late adolescence or early adulthood, this age range is more typical for males. Women tend to have a slightly later onset, often in their late twenties to early thirties.
Choice B reason: The typical age of onset for schizophrenia in women is between 25 and 35 years. This later onset compared to men may be influenced by hormonal factors such as estrogen, which has neuroprotective effects and may delay symptom emergence.
Choice C reason: The 16–20 age range is more characteristic of early-onset schizophrenia, which is rare and more frequently observed in males. It is not the typical age range for women.
Choice D reason: Onset between 40–50 years is considered late-onset schizophrenia, which is uncommon and more frequently seen in women, but it is not typical. Most cases in women begin earlier.
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