A nurse is assessing a patient for early manifestations of rheumatoid arthritis (RA). Which of the following changes is an early manifestation of RA?

Decreased hemoglobin.

L Temporomandibular joint pain.

Fatigue.

Symmetric joint swelling of fingers.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Decreased hemoglobin is typically associated with chronic inflammation in rheumatoid arthritis, but it is not considered an early manifestation. Anemia of chronic disease develops over time due to the effects of inflammatory cytokines on iron metabolism and erythropoiesis. Normal hemoglobin ranges for females are 12 to 15.5 g/dL and for males are 13.5 to 17.5 g/dL.

Choice B rationale

Temporomandibular joint pain can occur in rheumatoid arthritis, but it is not a specific or consistent early manifestation. While RA can affect various joints, the small joints of the hands and feet are more commonly involved in the early stages. Pain in the TMJ can also be related to other conditions.

Choice C rationale

Fatigue is a common systemic symptom in rheumatoid arthritis and can occur early in the disease process. However, fatigue is also a nonspecific symptom that can be present in many other conditions, making it less definitive as an early diagnostic indicator compared to joint involvement.

Choice D rationale

Symmetric joint swelling of the fingers, particularly the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, is a hallmark early manifestation of rheumatoid arthritis. The inflammation causes synovial thickening and effusion, leading to palpable swelling that affects the same joints on both sides of the body.

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Correct Answer is C

Explanation

Choice A rationale

Dry, scaly patches on the elbows are more characteristic of psoriasis, a chronic autoimmune skin disorder. Psoriasis typically presents with well-defined, erythematous plaques covered with silvery scales, commonly found on extensor surfaces like elbows and knees.

Choice B rationale

Different pigmented patches in the genital area could suggest various dermatological conditions, such as tinea cruris or post-inflammatory hyperpigmentation, but are not typical findings associated with herpes zoster. Herpes zoster lesions follow a dermatomal distribution.

Choice C rationale

Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus. It characteristically presents with a painful, vesicular rash that follows the distribution of a sensory nerve pathway or dermatome. The pain often precedes the appearance of the rash.

Choice D rationale

Excessive hair growth, or hirsutism, is not a typical finding associated with herpes zoster. Hirsutism is usually related to hormonal imbalances or certain medications affecting androgen levels.

A. Elevate the affected leg on two pillows. B. Apply fresh ice packs every 4 hours. C. Enforce strict bedrest for 3 days. D. Apply antibiotic ointment to the wound with dressing changes.

Correct Answer is A

Explanation

Choice A rationale

Elevating the affected leg promotes venous return and lymphatic drainage, which helps to reduce swelling and inflammation associated with cellulitis. Gravity assists in the removal of excess fluid from the interstitial spaces, thereby alleviating pressure and promoting healing.

Choice B rationale

Applying fresh ice packs every 4 hours can provide some pain relief and vasoconstriction, potentially reducing inflammation in the initial stages of cellulitis. However, heat is generally preferred after the acute inflammatory phase to promote circulation and healing. Frequent, prolonged ice application might impede blood flow.

Choice C rationale

While rest is important for healing, enforcing strict bedrest for 3 days might not be necessary and could increase the risk of complications such as deep vein thrombosis. Moderate activity with elevation is usually recommended to promote circulation without exacerbating the infection.

Choice D rationale

Cellulitis is a deep infection of the skin and subcutaneous tissues, typically caused by bacteria entering through a break in the skin. Applying topical antibiotic ointment is unlikely to reach the deeper infected tissues and is not the primary treatment. Systemic antibiotics are required to treat cellulitis effectively.

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A nurse is assessing a patient for early manifestations of rheumatoid arthritis (RA). Which of the following changes is an early manifestation of RA?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has herpes zoster.Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse is developing a plan of care for a client who has cellulitis of the leg.Which of the following interventions should the nurse include in the plan?

Correct Answer is A

Explanation

Which finding for a 77-year-old patient seen in the outpatient clinic requires further nursing assessment and intervention?

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