A nurse is assessing a client diagnosed with rheumatoid arthritis who reports morning stiffness lasting for more than an hour. Which characteristic best distinguishes rheumatoid arthritis from osteoarthritis?
Joint swelling and redness are localized to specific areas.
Joint stiffness improves with activity throughout the day.
Pain occurs at rest and during inactivity,
The disease doesn't cause deformities in the hands and feet.
The Correct Answer is B
Rationale:
A. While both rheumatoid arthritis (RA) and osteoarthritis (OA) can cause joint swelling, RA typically involves symmetric joint inflammation affecting multiple joints, particularly the small joints of the hands and feet, whereas OA is more localized and asymmetric. Thus, localized swelling alone does not distinguish RA from OA.
B. A hallmark of RA is prolonged morning stiffness lasting more than 30–60 minutes, which eases with movement and activity. In contrast, OA typically causes brief morning stiffness (<30 minutes) that may worsen with activity. The duration of morning stiffness and its improvement with activity is a key distinguishing characteristic of RA.
C. While RA can cause pain at rest due to inflammation, this feature alone is not specific enough to distinguish RA from OA. OA pain is often activity-related but can also occur at rest in advanced stages.
D. RA frequently leads to joint deformities, such as ulnar deviation, swan-neck, and boutonniere deformities, especially in the small joints. OA can also cause deformities, but these are usually due to bony overgrowths (Heberden’s and Bouchard’s nodes). Therefore, stating no deformities occur is inaccurate for RA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Levothyroxine is usually a lifelong therapy for primary hypothyroidism. Stopping the medication once thyroid hormone levels normalize can lead to a return of hypothyroid symptoms and potential complications such as fatigue, bradycardia, and weight gain. Patients must understand that normalization of lab values does not mean the underlying thyroid deficiency is cured.
B. Regular monitoring of TSH and free T4 is essential to ensure the dose is appropriate and to prevent over- or under-replacement. Lab checks are typically done 6–8 weeks after starting or adjusting therapy and periodically thereafter.
C. Consistent daily use is critical because missing doses can lead to fluctuating thyroid hormone levels and recurrence of hypothyroid symptoms.
D. Levothyroxine absorption is maximized on an empty stomach, typically 30–60 minutes before breakfast, and should be taken separately from medications or supplements (like calcium or iron) that can impair absorption.
Correct Answer is A
Explanation
Rationale:
A. Hyperparathyroidism causes elevated parathyroid hormone (PTH) levels, which lead to hypercalcemia. High calcium levels can slow smooth muscle activity in the gastrointestinal tract, resulting in constipation. Other gastrointestinal symptoms may include nausea, vomiting, and abdominal pain, all related to calcium imbalance.
B. While hypercalcemia can cause nonspecific symptoms like fatigue or mild cognitive changes, severe headaches are not a primary manifestation of hyperparathyroidism. Headaches may occur due to other causes but are not diagnostic for this condition.
C. Hyperparathyroidism typically slows GI motility rather than increasing it. Diarrhea is not associated with hypercalcemia; in fact, constipation is more common.
D. Hyperparathyroidism does not directly cause weight gain. Some patients may experience loss of appetite or fatigue due to hypercalcemia, but weight gain is not a characteristic symptom.
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