A female client with rheumatoid arthritis (RA) comes to the clinic with swelling of her wrists after she braced herself against a fall in the bathroom. Which pathophysiological mechanism should the nurse explain to the client regarding RA?
Bone reabsorption exceeds bone formation which leads to an increase in bone fragility.
Repetitive stress initiates a cascade leading to protease destruction of joints’ cartilage surfaces.
T-cells generate cytokine production and antigen-antibody reactions that trigger inflammatory responses.
Imbalance of uric acid metabolism deposits urate crystals in joint tissues which leads to inflammation.
The Correct Answer is C
Choice A reason: Bone reabsorption exceeding formation describes osteoporosis, not rheumatoid arthritis. RA involves autoimmune inflammation of synovial joints, driven by cytokines and T-cells, not primary bone fragility. This choice is incorrect, as it misrepresents RA’s immune-mediated synovial pathology with a bone density disorder.
Choice B reason: Repetitive stress may cause osteoarthritis, not RA. RA is an autoimmune condition where T-cells and cytokines attack synovium, causing inflammation and cartilage damage. Stress may exacerbate symptoms, but it is not the primary mechanism, making this incorrect for RA’s pathophysiological explanation.
Choice C reason: RA’s pathophysiology involves T-cells producing cytokines (e.g., TNF-α) and antigen-antibody reactions, triggering synovial inflammation. This autoimmune process causes wrist swelling and joint damage, as seen in the client. This mechanism accurately explains RA’s inflammatory nature, per rheumatology evidence, and is appropriate for client education.
Choice D reason: Uric acid imbalance and urate crystal deposition cause gout, not RA. RA is driven by autoimmune T-cell and cytokine activity, not crystal-induced inflammation. This choice is incorrect, as it describes a different arthritic condition unrelated to the client’s autoimmune rheumatoid arthritis pathology.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Acute lymphoblastic leukemia (ALL) is an aggressive malignancy of lymphoid cells, often achieving complete remission with intensive chemotherapy, especially in children. Suppression without remission is not typical, as ALL responds well to treatment, targeting rapidly dividing blast cells. CLL, a slower-progressing disease, better fits the description of suppression without complete cure.
Choice B reason: Chronic lymphocytic leukemia (CLL) is a low-grade malignancy of mature B-lymphocytes, often managed with chemotherapy to suppress disease progression rather than achieve complete remission. CLL’s indolent nature means it can be controlled, but residual disease persists due to slow cell turnover, aligning with the question’s description of suppression.
Choice C reason: Acute myelogenous leukemia (AML) is an aggressive malignancy of myeloid cells, requiring intensive chemotherapy or stem cell transplant for potential remission. Suppression without remission is less common, as AML treatment aims for complete response. CLL’s chronic nature makes it more likely to result in disease control rather than cure.
Choice D reason: Hairy-cell leukemia is a rare, indolent B-cell malignancy highly responsive to purine analogs, often achieving long-term remission or near-cure. Suppression without remission is not characteristic, as treatment typically yields durable responses. CLL’s partial response to chemotherapy better matches the scenario of ongoing disease suppression.
Correct Answer is A
Explanation
Choice A reason: The epigastric region, located midline above the umbilicus, encompasses the stomach, where the orange-sized mass was identified on imaging and palpation. GI bleeding and a stomach mass align with this location, making it the correct area for documentation, per standard anatomical landmarks used in clinical assessment.
Choice B reason: The hypochondriac regions are lateral to the epigastrium, covering parts of the liver and spleen, not the stomach. A stomach mass causing GI bleeding is located in the epigastric region. This choice is incorrect, as it does not correspond to the anatomical location of the stomach.
Choice C reason: The periumbilical area surrounds the umbilicus, covering small intestines, not the stomach. A stomach mass is in the epigastric region, as confirmed by imaging and palpation. This area is incorrect for documenting a stomach-related finding associated with GI bleeding, per anatomical standards.
Choice D reason: The costovertebral angle is posterior, near the kidneys, unrelated to the stomach. A stomach mass causing GI bleeding is in the epigastric region. This choice is incorrect, as it does not align with the stomach’s anatomical location or the clinical findings of a palpable mass.
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