A nurse is caring for a client in a provider's office.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

The client presents with symmetric joint pain, morning stiffness lasting over one hour, swelling in the metacarpophalangeal and proximal interphalangeal joints, and systemic symptoms such as fatigue and low-grade fever. Elevated inflammatory markers (ESR and CRP) and positive ANA further support an autoimmune inflammatory process. RA is a chronic systemic autoimmune disease characterized by synovial inflammation, joint destruction, and progressive disability if not managed early.

Rationale for correct choices:

• Rheumatoid arthritis: The client’s presentation of bilateral symmetric joint swelling, prolonged morning stiffness, and involvement of small joints (MCP and PIP) is classic for rheumatoid arthritis. Elevated ESR and CRP indicate active systemic inflammation, while a positive ANA supports an autoimmune process. RA commonly presents with fatigue and low-grade fever due to chronic inflammatory activity. These findings differentiate it from degenerative or metabolic joint diseases.

• Assess joints for warmth and redness: Warmth and redness are key indicators of active synovial inflammation in rheumatoid arthritis. Assessing these signs helps determine disease activity and progression of joint inflammation. Early identification of increased inflammation allows for timely intervention to prevent joint damage. This is a priority assessment in inflammatory arthritis management.

• Assess for paresthesia: RA can lead to nerve compression syndromes such as carpal tunnel syndrome due to synovial swelling and joint deformity. Paresthesia (numbness or tingling) may indicate nerve involvement or compression. Early detection helps prevent permanent nerve damage and functional impairment. This assessment supports monitoring disease complications.

• Weight-bearing joints: Although RA primarily affects small joints, progression can involve larger and weight-bearing joints over time. Monitoring these joints helps assess disease progression and functional impact on mobility. Joint involvement can lead to disability if not managed appropriately. Tracking changes in weight-bearing joints helps evaluate treatment effectiveness.

• Decreased immunity: RA is associated with immune dysregulation and increased susceptibility to infections, especially if immunosuppressive therapy is initiated. Monitoring for decreased immunity is important because both the disease and its treatments can impair immune function. Clients are at risk for opportunistic infections and delayed healing.

Rationale for incorrect Choices

• Assess for crepitus in weight-bearing joints: Crepitus is more commonly associated with osteoarthritis, where cartilage degeneration leads to bone-on-bone friction. This client’s findings are inflammatory and autoimmune in nature rather than degenerative. RA typically presents with soft tissue swelling rather than crepitus.

• Recommend the client spend at least 5 min outside in the sun daily: Sun exposure and vitamin D supplementation are more relevant to bone metabolism disorders such as osteoporosis. The client’s vitamin D and calcium levels are normal, and the condition is not related to bone density loss. RA management focuses on inflammation control rather than calcium or vitamin D intake.

• Collect a 24-hr urine sample: A 24-hour urine collection is typically used for metabolic or renal evaluations, such as calcium excretion disorders or gout assessment. The client’s uric acid level is normal, and there is no indication of renal or metabolic imbalance requiring urine collection. RA diagnosis is based on clinical and inflammatory markers rather than urine studies.

• Osteoporosis: Osteoporosis is characterized by decreased bone density and increased fracture risk rather than inflammatory joint disease. It presents as silent bone loss without joint swelling, warmth, or prolonged morning stiffness. Diagnostic findings would show low calcium or vitamin D imbalance and possible fractures rather than elevated ESR or CRP. This client’s bilateral small joint inflammation and systemic symptoms strongly point away from a bone density disorder.

• Osteoarthritis: Osteoarthritis is a degenerative joint disease caused by cartilage wear and tear, commonly affecting weight-bearing joints asymmetrically. It presents with pain that worsens with activity and improves with rest, and morning stiffness is usually brief (less than 30 minutes). It does not typically involve systemic symptoms such as fever or elevated inflammatory markers.

• Gout: Gout is a metabolic disorder caused by uric acid crystal deposition, typically presenting as sudden, severe pain in a single joint—most commonly the big toe. It is usually episodic and asymmetric rather than chronic bilateral involvement of small hand joints. This client’s uric acid level is normal, and there is no acute monoarticular inflammation. The pattern of symmetric joint involvement and systemic inflammation does not align with gout.

• Joint inflammation in the big toe: This finding is most commonly associated with gout, not rheumatoid arthritis. RA typically affects small joints of the hands, wrists, and sometimes larger joints symmetrically, but not isolated acute inflammation of the big toe. The client’s uric acid levels are normal, further reducing the likelihood of gout-related monitoring needs.

• Calcium and vitamin D levels: Calcium and vitamin D levels are primarily relevant in conditions affecting bone density such as osteoporosis. This client’s laboratory values for both are already within normal ranges and do not contribute to the current inflammatory joint disease. RA is driven by autoimmune synovial inflammation rather than bone metabolism abnormalities.

• Cervical neck pain: While cervical spine involvement can occur in advanced rheumatoid arthritis, it is not an early or primary monitoring parameter in initial disease stages. The client currently presents with peripheral joint involvement without spinal symptoms. Cervical pain would only be relevant in later disease progression when atlantoaxial instability or cervical spine inflammation develops. At this stage, it is not a priority parameter for monitoring.

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Correct Answer is B

Explanation

Methicillin-resistant Staphylococcus aureus (MRSA) infection requires strict adherence to contact precautions to prevent transmission between clients, staff, and the environment. MRSA is spread primarily through direct contact with infected wounds or contaminated surfaces. Proper infection control measures include the use of gloves, gowns, and appropriate hand hygiene. Understanding standard and transmission-based precautions is essential for safe nursing practice.

A. Wearing an N95 mask is not required for MRSA because it is not transmitted through airborne particles. N95 respirators are used for airborne precautions such as tuberculosis or measles. MRSA requires contact precautions, so this level of respiratory protection is unnecessary.

B. Wearing clean gloves when caring for the client demonstrates correct infection control practice under contact precautions. Gloves must be worn when touching the client or potentially contaminated surfaces to prevent transmission of MRSA. Hand hygiene before and after glove use is also essential to reduce cross-contamination.

C. Remaining 3 feet away from the client is not part of MRSA precautions because the organism is not spread via droplet or airborne routes. Contact precautions require physical barrier protection rather than maintaining a specific distance. This action does not reflect correct infection control practice.

D. Disposing of the isolation gown outside of the client’s room is incorrect and increases the risk of contamination. PPE such as gowns should be removed and discarded inside the client’s room before exiting to prevent spreading MRSA to other areas. Proper removal technique is a key component of contact precautions.

A. Perform range-of-motion exercises to the client's knee. B. Place pillows under the client's knee. C. Apply an ice pack to the client's knee. D. Gently massage the area around the client's incision.

Correct Answer is C

Explanation

Postoperative care following a total knee arthroplasty focuses on pain control, inflammation reduction, prevention of complications, and early mobilization. Pain at moderate levels (e.g., 6/10) is expected but requires prompt intervention to promote comfort and participation in recovery activities. Nonpharmacological measures such as cryotherapy are commonly used alongside prescribed analgesics. Proper interventions help reduce swelling and improve joint function.

A. Performing range-of-motion exercises at a pain level of 6/10 is not appropriate as it may exacerbate pain and inflammation in the immediate postoperative period. While early mobilization is important, it should be done gradually and typically after adequate pain control has been achieved. Forcing movement at this stage may increase tissue trauma and delay healing.

B. Placing pillows under the client’s knee is contraindicated after total knee arthroplasty because it promotes knee flexion contractures. Maintaining knee extension is essential to ensure proper joint alignment and optimal functional recovery. Instead, pillows should be placed under the heel to support extension without compromising joint positioning.

C. Applying an ice pack to the client’s knee is appropriate because cryotherapy reduces inflammation, swelling, and pain by causing vasoconstriction and slowing nerve conduction. This helps improve comfort and supports early rehabilitation efforts. It is a standard nonpharmacological intervention following orthopedic surgery.

D. Gently massaging the area around the incision is contraindicated in the immediate postoperative period. Massage may disrupt the surgical site, increase the risk of infection, and cause tissue damage or bleeding. The incision area should be protected and only handled using sterile technique when necessary for wound care.

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Naxlex Comprehensive Predictor Exams

A charge nurse is observing a newly licensed nurse care for a client who has a methicillin-resistant Staphylococcus aureus (MRSA). Which of the foll owing observations of the newly licensed nurse indicates an understanding of infection control precautions?

Correct Answer is B

Explanation

A nurse is caring for a client following a total knee arthroplasty. The client reports a pain level of 6 on a pain scale of 0 to 10. Which of the following interventions should the nurse take?

Correct Answer is C

Explanation

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