A nurse in a provider's office is assessing a patient who has rheumatoid arthritis (RA). Which of the following findings is a late manifestation of this condition?

Choice A rationale

While the partner's intention may be good, allowing someone other than the client to administer PCA medication bypasses the safety mechanisms built into the pump and disregards the client's ability to self-titrate based on their pain level. This could lead to over-sedation and respiratory depression.

Choice B rationale

Patient-controlled analgesia is designed to allow clients to manage their own pain by self-administering medication within prescribed limits. The client is the best judge of their pain intensity and medication needs. Allowing the partner to push the button undermines this principle of patient autonomy and safety.

Choice C rationale

The nurse should not administer PCA medication based on a third party's assessment of the client's needs. This still circumvents the client's control and the safety features of the pump. The nurse's role is to assess the client directly and educate the client and family on proper PCA use.

Choice D rationale

While it's important to understand the partner's reasoning, the immediate concern is the inappropriate administration of medication. Addressing the partner's actions directly and educating them on the proper use of the PCA pump is the priority.

Choice A rationale

Basal cell carcinoma typically presents as a pearly or waxy bump, often with telangiectasia (small blood vessels) and a rolled border. While it can grow, it is less likely to exhibit irregular shape and significant color variation.

Choice B rationale

Malignant melanoma is characterized by the "ABCDE" criteria: asymmetry (irregular shape), border irregularity (notched, scalloped, or blurred), color variation (multiple shades of brown, black, red, white, or blue), diameter (usually larger than 6 mm), and evolving (change in size, shape, color, or elevation). The patient's report of an increased size and an irregularly shaped lesion with varying colors strongly suggests malignant melanoma, a serious form of skin cancer arising from melanocytes.

Choice C rationale

Squamous cell carcinoma often appears as a firm, red nodule or a scaly, crusty patch. While it can be irregular in shape and may grow, the description of varied colors is less typical of squamous cell carcinoma compared to melanoma.

Choice D rationale

Kaposi's sarcoma presents as red, purple, or brown blotches or nodules on the skin. It is associated with human herpesvirus 8 (HHV-8) and is more common in individuals with weakened immune systems. The description of an increasing, irregularly shaped, and multicolored lesion is not typical of Kaposi's sarcoma.