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

Choice A rationale

Baker's cysts are fluid-filled sacs that develop behind the knee and are a later complication of rheumatoid arthritis due to chronic inflammation and joint damage, not an early manifestation.

Choice B rationale

Fatigue is a common and often debilitating early symptom of rheumatoid arthritis. It is thought to be related to the inflammatory process and the body's immune response, often preceding joint pain and stiffness.

Choice C rationale

Temporomandibular joint (TMJ) pain can occur in rheumatoid arthritis, but it is not typically considered one of the earliest or most characteristic manifestations. Small joints of the hands and feet are more commonly affected initially.

Choice D rationale

Decreased hemoglobin, leading to anemia, can occur in chronic inflammatory conditions like rheumatoid arthritis, but it is usually a later finding related to chronic inflammation affecting red blood cell production or increased destruction, not an early manifestation. Normal hemoglobin ranges for women are 12-16 g/dL and for men are 14-18 g/dL.

Choice A rationale

A rigid abdomen is a classic finding in peritonitis, an inflammation of the peritoneum. The inflammation causes the abdominal muscles to become tense and board-like as a protective mechanism. This rigidity is often accompanied by severe abdominal pain that is exacerbated by movement or palpation.

Choice B rationale

Increased urinary output is not a typical finding in peritonitis. In fact, due to fluid shifts and potential dehydration from the inflammatory process and decreased oral intake, urinary output may be decreased. Normal adult urinary output is generally considered to be at least 0.5 mL/kg/hour.

Choice C rationale

Frequent bowel movements are not characteristic of peritonitis. Peritonitis often leads to decreased bowel motility and potentially ileus due to the inflammation affecting the gastrointestinal tract. Bowel sounds may be diminished or absent rather than frequent.

Choice D rationale

Hyperactive bowel sounds are not typically associated with peritonitis. Initially, bowel sounds might be present, but as the inflammation progresses and ileus develops, bowel sounds usually become hypoactive or absent. Hyperactive bowel sounds are more commonly associated with early bowel obstruction or gastroenteritis.