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.
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Correct Answer is D
Explanation
Choice A rationale
Echinacea is an herb often used to support the immune system, particularly for colds and flu. There is no strong scientific evidence to support its effectiveness in managing the joint pain associated with osteoarthritis, which is a degenerative joint disease.
Choice B rationale
Applying ice to a joint before exercising can decrease pain and inflammation, but it can also stiffen the joint and potentially limit range of motion during activity. Heat application is generally recommended before exercise in osteoarthritis to warm up the muscles and tissues.
Choice C rationale
Purines are compounds that break down into uric acid. Reducing purine intake is important for managing gout, a type of inflammatory arthritis caused by the deposition of uric acid crystals in the joints, not osteoarthritis, which is characterized by cartilage breakdown.
Choice D rationale
Maintaining a recommended body weight is crucial for managing osteoarthritis. Excess weight puts additional stress on weight-bearing joints like the hips and knees, accelerating cartilage breakdown and increasing pain. Weight loss can significantly reduce these stresses and alleviate symptoms.
Correct Answer is B
Explanation
Choice A rationale
Intestinal parasites can cause anemia through various mechanisms, such as blood loss, nutrient malabsorption, and inflammation. However, this is not a direct manifestation of ulcerative colitis itself but rather a separate potential cause of anemia in any individual. Ulcerative colitis primarily affects the colon and rectum.
Choice B rationale
Chronic blood loss is a significant contributing factor to anemia in patients with ulcerative colitis. The inflammation and ulceration of the colonic mucosa lead to bleeding into the intestinal lumen. Over time, this persistent blood loss can result in iron deficiency anemia, characterized by low hemoglobin and hematocrit levels. Normal hemoglobin ranges are typically 13.5 to 17.5 g/dL for men and 12.0 to 15.5 g/dL for women.
Choice C rationale
Intestinal malabsorption syndrome can lead to anemia by impairing the absorption of essential nutrients like iron, vitamin B12, and folate, which are crucial for red blood cell production. While malabsorption can occur in inflammatory bowel diseases, it is more commonly associated with Crohn's disease, which affects the entire gastrointestinal tract, rather than primarily ulcerative colitis.
Choice D rationale
Dietary iron restrictions would limit the intake of a necessary component for hemoglobin synthesis, potentially leading to or exacerbating anemia. However, this is an external factor and not a manifestation of ulcerative colitis itself. In fact, patients with ulcerative colitis are often encouraged to maintain a diet rich in iron-containing foods to compensate for blood loss.
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