A 45-year-old patient with ankylosing spondylitis presents with increased thoracic pain and limited chest expansion. Which nursing intervention should be prioritized to improve the patient's respiratory function?

Rationale:

A. Weight fluctuations are not a common side effect of hydroxychloroquine. While chronic disease activity, dietary changes, or concurrent medications may influence a client’s weight, hydroxychloroquine itself is not known to cause significant weight gain or loss. Monitoring weight may still be part of overall health assessment in rheumatoid arthritis, but it is not a primary concern related to this medication.

B. High cholesterol is not directly associated with hydroxychloroquine use. Some disease-modifying anti-rheumatic drugs (DMARDs) or long-term corticosteroid therapy may affect lipid metabolism, but hydroxychloroquine generally does not alter cholesterol or lipid profiles. Cardiovascular risk assessment is important in rheumatoid arthritis, but hyperlipidemia is not a direct medication effect.

C. Eye problems are a well-recognized potential complication of hydroxychloroquine therapy. The drug can cause retinopathy, blurred vision, difficulty distinguishing colors, or changes in night vision, particularly with long-term use or higher cumulative doses. Retinal toxicity is irreversible if not detected early, so clients should undergo a baseline ophthalmologic examination before starting therapy and periodic follow-up exams (usually annually after 5 years of use, or sooner if risk factors are present). Nurses should educate clients to report any visual changes immediately, including blurred vision, difficulty reading, or changes in peripheral vision.

D. Development of ulcers is not a typical side effect of hydroxychloroquine. Gastrointestinal upset such as nausea, abdominal discomfort, or diarrhea may occur, but these are generally mild and manageable. Peptic or gastric ulcers are not directly related to hydroxychloroquine therapy.

Rationale:

A. Dyspepsia, or indigestion, is a common symptom in peptic ulcer disease (PUD), often described as burning, gnawing, or aching pain in the epigastric region. While it can significantly affect quality of life and may indicate ulcer activity, it is generally non-emergent and can be managed with medications such as proton pump inhibitors, H2 blockers, or antacids, along with lifestyle modifications. Dyspepsia does not pose an immediate threat to life.

B. Epigastric discomfort is a hallmark symptom of PUD and includes sensations such as fullness, bloating, or mild pain after meals. Like dyspepsia, it is important for monitoring disease progression and evaluating treatment effectiveness, but it is not an acute, life-threatening finding.

C. Hematemesis (vomiting blood) is the highest-priority finding in a client with PUD because it indicates active upper gastrointestinal bleeding, which is a medical emergency. Bleeding can be caused by erosion of the ulcer into a blood vessel, leading to rapid blood loss. Consequences include hypovolemic shock, anemia, and hemodynamic instability, which may necessitate IV fluid resuscitation, blood transfusion, and urgent surgical or endoscopic intervention. Immediate nursing actions include assessing vital signs, initiating two large-bore IV lines, monitoring intake and output, preparing for laboratory testing, and notifying the healthcare provider promptly.

D. Constipation may result from dietary factors, reduced activity, or certain medications but is not an urgent or life-threatening complication of PUD. It is a lower-priority concern compared to active bleeding.