A nurse is caring for a patient with a new diagnosis of rheumatoid arthritis.
What assessment findings will the nurse recognize as early signs of the disease? (Select all that apply.)

Patient reporting pain of 5/10 to right and left finger joints.

Persistent temperature of 100.1 - 100.4 degrees Fahrenheit.

Development of subcutaneous nodules over bony prominences.

Elevated erythrocyte sedimentation rate (ESR).

Generalized fatigue and weight loss.

Answer and Explanation

Correct Answer : A,B,E

Choice A rationale

Reporting pain in the finger joints is a hallmark early sign of rheumatoid arthritis, which typically presents as a symmetrical inflammatory polyarthritis. In the early stages, the small joints of the hands and feet are most frequently affected. This pain is caused by synovitis, or inflammation of the synovial membrane, which leads to joint swelling and tenderness. The symmetrical nature of the pain is a key diagnostic clue that helps differentiate rheumatoid arthritis from osteoarthritis.

Choice B rationale

A persistent low-grade temperature ranging from 100.1 to 100.4 degrees Fahrenheit is a common systemic manifestation of early rheumatoid arthritis. Because the disease is a systemic autoimmune inflammatory process, it often produces constitutional symptoms before significant joint destruction occurs. This low-grade fever reflects the body's inflammatory response as immune complexes circulate and trigger the release of cytokines. Monitoring for these non-specific systemic signs is crucial for early detection and intervention in RA patients.

Choice C rationale

The development of subcutaneous nodules over bony prominences is generally considered a later manifestation of rheumatoid arthritis rather than an early sign. These nodules are firm, non-tender masses that typically appear in patients with more advanced disease and high levels of rheumatoid factor. They indicate a more severe disease course and persistent inflammation. Because they take time to develop following chronic synovial irritation, they are not usually found during the initial presentation of the illness.

Choice D rationale

While an elevated erythrocyte sedimentation rate (ESR) is a marker of inflammation often seen in rheumatoid arthritis, it is a non-specific laboratory finding rather than a clinical assessment finding observed directly on the patient. The ESR measures the rate at which red blood cells settle in a tube; a normal range for adults is typically 0 to 22 mm/hr for men and 0 to 29 mm/hr for women. It supports the diagnosis but is not a physical sign.

Choice E rationale

Generalized fatigue and weight loss are prominent early systemic signs of rheumatoid arthritis. These symptoms occur because the inflammatory cytokines, such as tumor necrosis factor and interleukins, affect the entire body and increase the metabolic rate. Patients often experience profound exhaustion that is not relieved by rest, alongside a decreased appetite leading to weight loss. These constitutional symptoms frequently precede or accompany the onset of joint-related symptoms in the early phase of the disease.

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Correct Answer is ["B","C","E"]

Explanation

Choice A rationale

Avoiding rest periods is inappropriate for a client with Parkinson's disease. The condition is characterized by motor symptoms such as tremors and bradykinesia, which are physically exhausting. Clients also frequently experience non-motor symptoms like fatigue and sleep disturbances. Encouraging rest periods throughout the day is essential to conserve energy, manage fatigue, and improve the client's ability to participate in daily activities and exercise, thereby enhancing their overall quality of life.

Choice B rationale

Encouraging independence is a core principle of rehabilitative care for Parkinson's disease. While the progressive nature of the disease makes daily tasks more difficult, performing activities of daily living for as long as possible helps maintain motor function and muscle strength. It also fosters a sense of autonomy and self-worth. Nurses should teach clients to use assistive devices and allow extra time for tasks to promote success while minimizing frustration during the performance of activities.

Choice C rationale

Reducing the risk for injury is critical because Parkinson's disease significantly impairs balance and gait, leading to a high risk of falls. Teaching the client to remove throw rugs, install grab bars in the bathroom, and ensure adequate lighting can prevent fractures and head injuries. Clients should also be taught about "freezing" episodes and how to safely navigate them. Maintaining a safe home environment is fundamental to preserving the client's independence and safety.

Choice D rationale

Limiting fluids is generally incorrect for clients with Parkinson's disease unless they have a specific comorbid condition like heart failure. Many clients suffer from constipation due to slowed gastrointestinal motility and the side effects of medications like anticholinergics. Maintaining an intake of at least 2,000 mL of fluid per day, along with a high-fiber diet, is necessary to promote regular bowel movements and prevent the discomfort and potential complications associated with severe constipation.

Choice E rationale

Planning a daily exercise routine involving active range of motion is vital to combat the muscle rigidity and joint stiffness characteristic of the disease. Regular movement helps maintain flexibility, improves posture, and can even help slow the progression of motor symptoms. Exercise routines should be tailored to the client's current abilities and may include walking, stretching, or specialized programs like Tai Chi, which have been shown to improve balance and coordination in Parkinson's patients.

A. Screening determines if the client is a candidate for rubella immunization during pregnancy. B. Screening will determine the risk of teratogenic effects to the fetus from prior vaccination. C. Screening will determine if the client is a carrier of the rubella virus from previous exposure. D. Screening determines adequate immunity to protect the client and fetus from the virus.

Correct Answer is D

Explanation

Choice A rationale

While it is true that screening identifies non-immune clients, the rubella vaccine is a live attenuated virus and is strictly contraindicated during pregnancy due to the theoretical risk of congenital rubella syndrome. Immunization can only be administered in the immediate postpartum period, and the client must be advised to avoid pregnancy for at least 28 days following the injection. Therefore, screening does not determine candidacy for immunization during the current pregnancy but for future protection.

Choice B rationale

The rubella screening, or rubella titer, measures the level of IgG antibodies in the maternal serum. It is used to determine current immunity levels rather than assessing the risk of teratogenic effects from a vaccination that occurred in the past. Previous vaccination is intended to provide long-term protection, and the test simply verifies if those antibodies are still present at a functional level of 1: or greater to protect the developing fetus from future exposure.

Choice C rationale

Rubella is not characterized by a carrier state in the way that some other viral or bacterial infections are. A person is either susceptible, acutely infected, or immune. The screening is designed to detect the presence of protective antibodies, not to identify the client as a chronic carrier of the virus. Understanding this distinction is important for accurate clinical interpretation of the lab results and for providing the client with correct information about their health status.

Choice D rationale

The rubella titer is performed to confirm that the client has a sufficient level of antibodies to prevent an active infection if exposed to the virus during pregnancy. Maternal rubella infection, especially during the first trimester, carries a high risk of causing congenital rubella syndrome, which can lead to deafness, cataracts, and cardiac defects in the newborn. A titer of 1: or higher indicates immunity, while a lower titer suggests the client is non-immune and vulnerable.

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A nurse is caring for a patient with a new diagnosis of rheumatoid arthritis. What assessment findings will the nurse recognize as early signs of the disease? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is planning discharge teaching for a client newly diagnosed with Parkinson's disease. Which action(s) will be included in discharge teaching? (Select all that apply).

Correct Answer is ["B","C","E"]

Explanation

The nurse is caring for a pregnant client during the first prenatal visit. Prior to obtaining prenatal lab work the client asks the nurse, "Why do I need a rubella screening? I was already vaccinated.”. What explanation by the nurse is most accurate?

Correct Answer is D

Explanation

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A nurse is caring for a patient with a new diagnosis of rheumatoid arthritis.
What assessment findings will the nurse recognize as early signs of the disease? (Select all that apply.)