A nurse is caring for a client in an outpatient clinic.
Complete the following sentence by using the lists of options.
The client is at highest risk for developing
The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}
The client presents with bilateral symmetrical joint stiffness affecting the wrists and shoulders, prolonged morning stiffness, fatigue, and anorexia, which are classic early manifestations of rheumatoid arthritis. Laboratory findings show a persistently elevated ESR and positive ANA, indicating ongoing systemic inflammation and autoimmune activity. These findings suggest a chronic inflammatory arthropathy rather than degenerative or metabolic joint disease, making rheumatoid arthritis the most likely developing condition.
Rationale for correct choices:
• Rheumatoid arthritis: Rheumatoid arthritis is a chronic autoimmune disorder characterized by symmetric polyarthritis, commonly affecting small joints such as the wrists. The client’s symptoms of bilateral joint stiffness lasting hours in the morning, fatigue, and loss of appetite strongly align with inflammatory arthritis rather than mechanical joint disease. The progression over six months and worsening systemic symptoms further support an autoimmune etiology. Positive ANA and elevated inflammatory markers reinforce the likelihood of rheumatoid arthritis development.
• ESR level: The erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and is elevated in autoimmune and inflammatory conditions such as rheumatoid arthritis. The client’s persistently elevated ESR over time reflects ongoing systemic inflammatory activity. Although mildly elevated, the upward trend in ESR combined with clinical symptoms suggests chronic inflammation rather than transient infection or injury. This laboratory finding supports the presence of an evolving autoimmune process.
Rationale for incorrect choices:
• Fibromyalgia: Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive symptoms without objective inflammatory or autoimmune markers. This client demonstrates laboratory evidence of inflammation, including elevated ESR and positive ANA, which are not consistent with fibromyalgia. Additionally, fibromyalgia does not cause joint swelling or prolonged morning stiffness.
• Gout: Gout is a metabolic disorder caused by uric acid crystal deposition, typically presenting as acute, episodic monoarticular joint pain, often in the great toe. This client has symmetric involvement of wrists and shoulders rather than isolated joint attacks. Uric acid levels are within normal limits and do not indicate hyperuricemia. The chronic progressive pattern and autoimmune markers further exclude gout as the most likely condition.
• Osteoarthritis: Osteoarthritis is a degenerative joint disease characterized by cartilage wear and typically worsens with activity rather than prolonged morning stiffness. It commonly affects weight-bearing joints and distal interphalangeal joints, not typically symmetrical small joint involvement with systemic symptoms. The presence of fatigue, elevated ESR, and positive ANA is inconsistent with a purely degenerative process.
• Diuretic medication: While diuretics can contribute to gout by increasing uric acid levels, the client’s uric acid is within normal range and does not support a metabolic cause of joint disease. There is no clinical evidence linking diuretic use to the symmetric inflammatory arthritis pattern observed here. The progression of symptoms and autoimmune lab markers point toward rheumatoid arthritis rather than medication-induced joint issues.
• Family history: A family history of hypertension, hypercholesterolemia, stroke, and stomach cancer does not specifically increase risk for rheumatoid arthritis. While genetics may play a role in autoimmune conditions, no direct familial pattern of rheumatoid disease is provided here. The more relevant indicator is the presence of inflammatory markers and positive ANA. Therefore, family history is not the strongest predictor in this scenario.
• Uric acid level: The client’s serum uric acid levels are 6.1 mg/dL and 6.3 mg/dL, which sit perfectly within the normal reference range of 2.7 to 7.3 mg/dL. Normal uric acid levels effectively rule out hyperuricemia and the metabolic conditions associated with it, meaning this laboratory parameter provides absolutely no objective evidence of an active arthropathy. Uric acid levels are entirely unrelated to the systemic inflammation, anemia of chronic disease, or positive autoantibody titers observed in this client's medical record.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Receiving and transcribing a telephone prescription requires strict adherence to medication safety and communication protocols to prevent errors. A telephone order is considered a high-alert communication process that requires verification steps to ensure accuracy of the prescribed medication, dose, and route. The nurse acts as a critical safety checkpoint by using read-back verification and proper documentation. These measures are essential to reduce medication errors and maintain patient safety.
Rationale:
A. Asking the provider to spell out the name of the medication is essential to prevent misinterpretation of sound-alike or unclear drug names during verbal communication. This reduces the risk of medication errors caused by mishearing or pronunciation differences. It is a standard safety practice during telephone prescriptions.
B. Withholding the medication until the provider signs the prescription is not appropriate because telephone prescriptions are considered valid orders once properly received, read back, and documented. While providers must sign the order within the facility’s policy timeframe, immediate withholding is not required if the order has been correctly verified. Delaying administration could compromise patient care.
C. Requesting that the provider confirm the read-back of the prescription is a critical safety step in medication verification. The nurse repeats the order back to the provider to ensure accuracy, and the provider must confirm correctness. This closed-loop communication reduces transcription and interpretation errors in high-risk verbal orders.
D. Recording the date and time of the telephone prescription is required for legal and clinical documentation purposes. It ensures traceability and accountability of the order and helps maintain an accurate medical record. Proper documentation is essential for continuity of care and regulatory compliance.
E. Having another nurse record the prescription in the medical record is not appropriate because the nurse receiving the order is responsible for documenting it. Delegating transcription to another nurse increases the risk of communication errors and breaks accountability in the medication ordering process. The receiving nurse must ensure accurate documentation and verification.
Correct Answer is A
Explanation
Advance directives are legal and ethical documents that allow clients to communicate their preferences for medical care in the event they become unable to make decisions. They support patient autonomy by outlining treatment wishes and designating a health care proxy or surrogate decision-maker. These directives are used across all health care settings, not only at end of life or in emergencies. Nurses play a key role in clarifying misconceptions and reinforcing the purpose of advance care planning.
Rationale:
A. Advance directives protect a client’s right to self-determination by ensuring their health care preferences are respected even if they lose decision-making capacity. They guide providers and designated decision-makers in aligning care with the client’s values and wishes. In situations requiring critical decision-making, such as perioperative care, they help maintain autonomy and informed choice.
B. Advance directives are not the same as a consent form. A consent form is specific to a particular procedure and requires informed agreement at the time of treatment, whereas advance directives provide broader guidance for future care decisions. They serve different legal and clinical purposes.
C. Advance directives are not limited to clients with life-threatening conditions. Any competent adult can complete them as part of routine health planning. They become especially important in unpredictable situations such as surgery, trauma, or sudden illness.
D. Advance directives do not require approval by a lawyer to be valid in most jurisdictions. While legal advice may be helpful, requirements typically include the client’s signature and sometimes witnesses, depending on local regulations. Their validity is based on legal standards, not mandatory attorney involvement.
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