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?
Weight loss
Knuckle deformity
Low-grade fever
Anorexia
The Correct Answer is B
Choice A rationale
Weight loss can occur at various stages of rheumatoid arthritis due to chronic inflammation and increased metabolic demands. While it can be present later in the disease, it is not specifically identified as a late manifestation. Systemic inflammation leads to the release of pro-inflammatory cytokines, which can affect appetite and metabolism, contributing to weight changes throughout the course of the disease.
Choice B rationale
Knuckle deformities, such as swan neck and boutonniere deformities, are characteristic late manifestations of rheumatoid arthritis. These deformities result from chronic inflammation and synovial proliferation leading to damage of the tendons, ligaments, and joint capsule around the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Over time, this causes the characteristic changes in finger alignment.
Choice C rationale
Low-grade fever can be a systemic manifestation of the inflammatory process in rheumatoid arthritis, but it is more commonly seen during active flares and is not specifically classified as a late manifestation. The fever is a result of the release of pyrogens, such as interleukin-1 and tumor necrosis factor-alpha, during periods of heightened immune activity. Normal body temperature ranges from 97.8°F to 99.1°F (36.5°C to 37.3°C).
Choice D rationale
Anorexia, or loss of appetite, can be associated with the chronic pain and systemic inflammation of rheumatoid arthritis at any stage. Inflammatory cytokines can affect appetite regulation in the hypothalamus. While it might persist in later stages, it is not a definitive late manifestation compared to structural joint changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Increasing protein intake is important for tissue repair and overall healing in patients with osteomyelitis. However, addressing the acute bacterial infection is the immediate priority to prevent further bone destruction and systemic spread of the infection.
Choice B rationale
Teaching relaxation breathing can help manage the pain associated with osteomyelitis. While pain management is crucial for patient comfort, it does not address the underlying bacterial infection that is causing the acute illness and bone damage.
Choice C rationale
Antipyretic therapy, such as acetaminophen or ibuprofen, can help reduce fever, which is a common systemic manifestation of acute osteomyelitis. However, lowering the fever does not treat the underlying infection and its potential complications.
Choice D rationale
Acute osteomyelitis is a bone infection, and the priority intervention is the prompt administration of antibiotics. Antibiotics target and eradicate the causative bacteria, preventing further bone destruction, reducing the risk of sepsis, and promoting healing. Delaying antibiotic administration can lead to severe and potentially life-threatening complications.
Correct Answer is C
Explanation
Choice A rationale
Decreased right knee range of motion is a common finding in older adults due to age-related degenerative changes like osteoarthritis. While it warrants assessment, it does not necessarily indicate an acute issue requiring immediate intervention unless accompanied by pain, swelling, or functional limitations.
Choice B rationale
Report of left hip aching when jogging could be related to musculoskeletal issues like arthritis or muscle strain, which are not uncommon in older adults. Further assessment is needed to determine the cause and appropriate management, but it does not immediately signal a critical issue requiring urgent intervention.
Choice C rationale
A history of recent loss of balance and a fall in a 77-year-old patient is a significant finding that requires further nursing assessment and intervention. Falls in older adults can lead to serious injuries such as fractures, and a recent history suggests an underlying issue affecting stability and safety. This necessitates investigation into potential causes and implementation of fall prevention strategies.
Choice D rationale
Occasional mild constipation is a common complaint among older adults due to factors like decreased physical activity, dietary changes, and medication side effects. While it should be addressed with appropriate interventions like increased fiber and fluids, it does not typically require immediate or urgent nursing intervention unless it is severe or accompanied by other concerning symptoms. .
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