A client with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers and feet, swelling, redness, restricted joint motion, and reports feeling fatigued. Which nursing problem has the highest priority for this client?

Fatigue related to disease exacerbation.

Pain related to joint inflammation

Impaired physical mobility related to joint pain.

Self-care deficit related to disease progression.

Answer and Explanation

The Correct Answer is B

A.   This is a valid nursing problem and directly related to the client's condition. However, while fatigue is a significant concern, it is often a symptom of other underlying issues.

B.   This is the highest priority nursing problem. Pain is a primary symptom of acute RA exacerbation and significantly impacts the client's quality of life, mobility, and overall well-being. Addressing pain is crucial for immediate comfort and to facilitate other interventions.
C.   This is also a valid nursing problem, directly linked to the client's symptoms. However, it is a consequence of the pain, not the primary issue. Addressing the pain will improve mobility.
D.   This is a potential long-term concern but not the highest priority at this acute stage. The client's immediate needs related to pain and mobility are more pressing.

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Correct Answer is A

Explanation

A. This instruction is particularly relevant for a client with gouty arthritis. Gout is a type of arthritis caused by elevated levels of uric acid in the blood, which can form crystals in the joints and cause severe pain and inflammation. Red meat and certain seafood are high in purines, which can increase uric acid levels and exacerbate gout symptoms.
B. This instruction might not be suitable for someone with hypertension, as many salt substitutes contain potassium. For a person with high blood pressure, excessive potassium can be harmful, especially if they are on certain medications or have kidney issues.
C. This advice may not be appropriate given the client's current inability to bear weight due to severe ankle pain. Limiting mobility equipment could lead to further physical complications. The focus should be on managing pain and inflammation to improve mobility rather than restricting the use of equipment.
D. While wrapping joints with an elastic bandage can help reduce swelling, it should be done with caution. Over-wrapping can lead to decreased circulation or additional pain. In cases of severe pain and swelling, other treatments such as rest, elevation, and ice may be more appropriate.

A. Initiate a referral for ophthalmic evaluation as soon as possible. B. Advise the client to maintain normal activities, but avoid contact sports until the spots resolve C. Instruct the client to rest, and report to the emergency department if eye pain develops. D. Tell the client to apply warm, moist compresses and notify the healthcare provider if there is no improvement.

Correct Answer is A

Explanation

A. The sudden onset of flashing lights and floaters can be a symptom of a detached retina, a serious eye condition that requires immediate medical attention.
B. This is incorrect. The client should not engage in any activities until the condition is evaluated by a healthcare professional.
C. While rest might seem appropriate, the client should seek immediate medical attention due to the potential seriousness of the symptoms.
D. Warm compresses are not indicated for this condition, and the client should seek immediate medical attention.

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A client with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers and feet, swelling, redness, restricted joint motion, and reports feeling fatigued. Which nursing problem has the highest priority for this client?

Nursing Test Bank

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Correct Answer is A

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