A 45-year-old patient with a new diagnosis of rheumatoid arthritis is being assessed for early signs of systemic involvement. During the assessment, the nurse notes the presence of dry eyes and dry mouth. Which condition should the nurse suspect as a potential complication associated with rheumatoid arthritis?

Rationale:

A. Fasting before an MRI is generally not required unless contrast dye is planned. While fasting may prevent nausea, it does not address the critical safety concern related to the Linx device.

B. Administering antacids may help control GERD symptoms but does not impact MRI safety. The primary risk involves the magnetic properties of the Linx device, not reflux.

C. Requesting a CT scan instead of an MRI is not necessary if the Linx device is confirmed to be MRI-compatible. Substituting imaging modalities without verifying safety may delay needed diagnostic evaluation.

D. Informing the radiologist about the Linx device and confirming MRI compatibility is the most appropriate action. The Linx device, which is a magnetic ring placed around the lower esophageal sphincter, contains metal and magnets, which can interact with MRI machines. Some newer Linx devices are conditional for MRI under specific parameters, so verification with the radiology team ensures patient safety, prevents device displacement, and avoids injury or malfunction during imaging.

Rationale:

A. Instructing the patient to perform diaphragmatic breathing exercises regularly is the priority intervention. Ankylosing spondylitis can cause rigidity of the thoracic spine and costovertebral joints, limiting chest expansion and reducing lung capacity. Diaphragmatic breathing encourages full lung inflation, improves oxygenation, and prevents respiratory complications such as atelectasis or pneumonia. Regular practice helps maintain chest mobility and respiratory function despite musculoskeletal limitations.

B. Advising the patient to avoid physical activity is contraindicated. While activity should be paced to prevent overexertion, complete inactivity can lead to decreased mobility, joint stiffness, and further respiratory compromise. Gentle exercises, including breathing techniques, are essential for maintaining function.

C. Using a lumbar support pillow may improve posture and comfort while sitting but does not directly enhance thoracic expansion or respiratory function. It is supportive but secondary to interventions targeting lung capacity.

D. Increasing fluid intake is generally beneficial for overall health and mucosal hydration, but it does not address impaired chest expansion or lung ventilation. It is not the priority intervention for improving respiratory function in ankylosing spondylitis.