A nurse is assessing a patient with Ankylosing Spondylitis.
Which of the following clinical manifestations should the nurse expect? (Select all that apply).
Limited range of motion in the spine.
Pain and stiffness in the back and pelvis.
Swelling and redness in the fingers and toes.
Fatigue and muscle weakness.
Skin rashes and lesions.
Correct Answer : A,B,D
Choice A rationale:
"Limited range of motion in the spine." Rationale: Limited range of motion in the spine is a common clinical manifestation of Ankylosing Spondylitis (AS).
The inflammation and eventual fusion of the spinal vertebrae can lead to stiffness and reduced flexibility in the spine.
Choice B rationale:
"Pain and stiffness in the back and pelvis." Rationale: Pain and stiffness in the back and pelvis are hallmark symptoms of Ankylosing Spondylitis.
These symptoms are typically worse in the morning and improve with physical activity.
Choice C rationale:
"Swelling and redness in the fingers and toes." Rationale: Swelling and redness in the fingers and toes are not typical clinical manifestations of Ankylosing Spondylitis.
These symptoms are more characteristic of other rheumatic conditions, such as rheumatoid arthritis.
Choice D rationale:
"Fatigue and muscle weakness." Rationale: Fatigue and muscle weakness can be associated with Ankylosing Spondylitis, especially when the disease is active.
Chronic inflammation and pain can lead to fatigue, and muscle weakness may occur as a result of reduced physical activity.
Choice E rationale:
"Skin rashes and lesions." Rationale: Skin rashes and lesions are not common clinical manifestations of Ankylosing Spondylitis.
These symptoms are more commonly associated with other autoimmune or dermatological conditions.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Encouraging the client to avoid physical activity is not an appropriate intervention.
Physical activity and exercise, including range of motion exercises, are essential in managing Ankylosing Spondylitis.
Inactivity can worsen symptoms and lead to further stiffness.
Choice B rationale:
Recommending surgery to correct the spine's limited range of motion is not typically the first step in managing Ankylosing Spondylitis.
Surgery may be considered in severe cases with spinal deformities, but it is not the initial intervention.
Choice C rationale:
Assisting the client in performing range of motion exercises and physical therapy is an appropriate nursing intervention.
These exercises help maintain and improve flexibility, reduce pain, and slow the progression of the disease.
Physical therapy is a key component of Ankylosing Spondylitis management.
Choice D rationale:
Administering nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed can help manage pain and inflammation in Ankylosing Spondylitis, but it is not a nursing intervention related to improving range of motion.
It is essential to combine NSAID therapy with exercise and physical therapy for optimal management of the condition.
Questions
Correct Answer is C
Explanation
Choice A rationale:
"The inflammation in Ankylosing Spondylitis primarily occurs in the peripheral joints." Rationale: This statement is incorrect.
Ankylosing Spondylitis primarily affects the axial skeleton, including the spine and sacroiliac joints.
Peripheral joint involvement is less common and usually occurs in the later stages of the disease.
Choice B rationale:
"Immune cells infiltrate muscles, leading to muscle wasting in Ankylosing Spondylitis." Rationale: This statement is not accurate.
Ankylosing Spondylitis primarily involves inflammation of the spine and sacroiliac joints, rather than muscle tissue.
Muscle wasting is not a characteristic feature of AS.
Choice C rationale:
"Pro-inflammatory cytokines like TNF-α and IL-17 contribute to inflammation in Ankylosing Spondylitis." Rationale: This statement is correct.
Ankylosing Spondylitis is associated with increased levels of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17).
These cytokines play a key role in the inflammation and tissue damage seen in AS.
Choice D rationale:
"The chronic inflammation in Ankylosing Spondylitis causes cartilage regeneration." Rationale: This statement is not accurate.
Chronic inflammation in AS can lead to structural damage and fusion of the spinal vertebrae (ankylosis), but it does not promote cartilage regeneration.
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