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A nurse is caring for a client in an outpatient clinic.

Exhibits

Complete the following sentence by using the lists of options. The client is at highest risk for developing

evidenced by the client's
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

  • Rheumatoid arthritis is the most likely condition given the client’s bilateral wrist and shoulder stiffness lasting for several hours in the morning, fatigue, and loss of appetite. The elevated ESR and anemia further support chronic inflammation. Positive ANA, while not specific, can be present in RA and other autoimmune disorders.
  • Osteoarthritis is incorrect because it typically presents with stiffness that improves within 30 minutes of activity, not lasting for several hours. It is also a non-inflammatory condition, whereas the client has elevated ESR and anemia, suggesting an inflammatory process.
  • Gout is unlikely as it usually causes acute, severe joint pain with redness and swelling, often affecting the big toe. The client’s uric acid level is within normal range, making gout less probable.
  • Carpal tunnel syndrome primarily causes numbness, tingling, and weakness in the hands due to median nerve compression. It does not typically cause prolonged morning stiffness, fatigue, or systemic inflammation.
  • Positive ANA is not the best choice because while it is seen in rheumatoid arthritis, it is also present in other autoimmune diseases such as lupus. It does not specifically confirm RA.
  • Normal WBC count does not support an inflammatory condition, as RA can lead to mild leukopenia, which is seen in the follow-up labs.
  • Low blood pressure is not a defining feature of RA and does not correlate with the client’s symptoms or disease progression


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Related Questions

Correct Answer is []

Explanation

Potential Condition:

Kawasaki disease: The child presents with prolonged fever, mucocutaneous changes (cracked lips, red tongue), extremity changes (edema, peeling skin), cervical lymphadenopathy, and elevated inflammatory markers (WBC, ESR, CRP, and platelets), all of which are consistent with Kawasaki disease.

Actions to Take

Administer IVIG: IVIG is the primary treatment to reduce inflammation and prevent coronary artery aneurysms.

Administer high-dose aspirin: Used in the acute phase to reduce inflammation and fever and in the subacute phase to prevent clot formation.

Parameters to Monitor

Heart rhythm: Kawasaki disease can cause myocarditis and coronary artery aneurysms, leading to arrhythmias.

Chest discomfort: A sign of coronary artery complications, including aneurysms or ischemia.

Rationale for Incorrect Diagnoses:

Bacterial endocarditis: Does not cause peeling skin or bright red tongue. Fever would be accompanied by murmurs and a history of heart defects.

Nephrotic syndrome: Characterized by severe proteinuria, edema, and hypoalbuminemia, which are absent here.

Acute post-streptococcal glomerulonephritis: Would present with recent strep infection, hematuria, hypertension, and periorbital edema, which are not mentioned.

Correct Answer is A

Explanation

A. Positive Chvostek's sign. Hypocalcemia increases neuromuscular excitability, leading to involuntary twitching of facial muscles when the facial nerve is tapped. This sign is a well-known indicator of calcium deficiency and reflects heightened nerve sensitivity.
B. Hypotension. While severe hypocalcemia can affect cardiovascular function, hypotension is not a primary or consistent finding. More commonly, calcium imbalances affect muscle contractions rather than directly causing low blood pressure.
C. Confusion. Hypocalcemia can cause neurological symptoms, but confusion is more common in severe or prolonged cases. Early manifestations are usually neuromuscular, such as tetany or muscle cramps, rather than cognitive impairment.
D. Positive Babinski reflex. This reflex is associated with upper motor neuron dysfunction and neurological disorders rather than electrolyte imbalances like hypocalcemia. Calcium deficiency primarily affects peripheral nerves and muscle excitability.

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