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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
Choice A rationale:
"Administering opioid pain medications as needed." Administering opioid pain medications as needed is not typically a first-line treatment for Ankylosing Spondylitis (AS).
Opioids may be reserved for severe cases or when other pain management strategies have failed.
It is not a primary nursing intervention and can have side effects and risks associated with its use.
Choice B rationale:
"Encouraging regular exercise and physical therapy." Encouraging regular exercise and physical therapy is a crucial nursing intervention for patients with AS.
Exercise and physical therapy help improve mobility, maintain joint function, and reduce pain.
Therefore, this intervention is appropriate and should be included in the care plan.
Choice C rationale:
"Providing emotional support and counseling for anxiety." Emotional support and counseling for anxiety are essential for patients with AS.
Chronic conditions like AS can have a significant emotional impact, and addressing the patient's mental health is an important nursing intervention.
Choice D rationale:
"Recommending smoking cessation as a preventive measure." Smoking cessation is a relevant nursing intervention for AS patients.
Smoking has been associated with worse outcomes in AS, and quitting smoking can be beneficial for overall health and symptom management.
Choice E rationale:
"Monitoring the patient's lung capacity and spinal curvature." Monitoring lung capacity and spinal curvature is important in the assessment and management of AS.
AS can affect the spine and lungs, and regular monitoring helps identify any complications or disease progression.
This nursing intervention is appropriate and necessary.
Correct Answer is A
Explanation
Choice A rationale:
Environmental factors, such as bacterial infections, are the primary cause of Ankylosing Spondylitis.
Rationale: Ankylosing Spondylitis (AS) is believed to have a multifactorial etiology, and while genetics play a significant role (particularly the HLA-B27 gene), environmental factors, such as bacterial infections, have been implicated in triggering the condition.
Certain bacteria, such as Klebsiella pneumoniae, have been associated with AS, and their presence may exacerbate inflammation in genetically predisposed individuals.
This statement accurately reflects the current understanding of AS's etiology.
Choice B rationale:
"Ankylosing Spondylitis predominantly affects females." Rationale: This statement is incorrect.
Ankylosing Spondylitis is more common in males than in females.
It has a male-to-female ratio of approximately 3:1.
Therefore, it predominantly affects males, not females.
Choice C rationale:
"The HLA-B27 gene is not associated with an increased risk of Ankylosing Spondylitis." Rationale: This statement is incorrect.
The HLA-B27 gene is strongly associated with an increased risk of Ankylosing Spondylitis.
In fact, it is one of the most significant genetic risk factors for the development of AS.
Over 90% of individuals with AS are HLA-B27 positive.
Choice D rationale:
"Symptoms of Ankylosing Spondylitis typically manifest in childhood." Rationale: This statement is incorrect.
Ankylosing Spondylitis symptoms typically do not manifest in childhood.
The onset of AS symptoms usually occurs in late adolescence or early adulthood, typically between the ages of 17 and 45.
It is rare for AS symptoms to appear in childhood.
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