A nurse is providing care to a client who has rheumatoid arthritis and reports experiencing pain and swelling of joints in both feet. Which of the following interventions should the nurse suggest the client use to assist with comfort?

Rationale:

A. Weight fluctuations are not a common side effect of hydroxychloroquine. While chronic disease activity, dietary changes, or concurrent medications may influence a client’s weight, hydroxychloroquine itself is not known to cause significant weight gain or loss. Monitoring weight may still be part of overall health assessment in rheumatoid arthritis, but it is not a primary concern related to this medication.

B. High cholesterol is not directly associated with hydroxychloroquine use. Some disease-modifying anti-rheumatic drugs (DMARDs) or long-term corticosteroid therapy may affect lipid metabolism, but hydroxychloroquine generally does not alter cholesterol or lipid profiles. Cardiovascular risk assessment is important in rheumatoid arthritis, but hyperlipidemia is not a direct medication effect.

C. Eye problems are a well-recognized potential complication of hydroxychloroquine therapy. The drug can cause retinopathy, blurred vision, difficulty distinguishing colors, or changes in night vision, particularly with long-term use or higher cumulative doses. Retinal toxicity is irreversible if not detected early, so clients should undergo a baseline ophthalmologic examination before starting therapy and periodic follow-up exams (usually annually after 5 years of use, or sooner if risk factors are present). Nurses should educate clients to report any visual changes immediately, including blurred vision, difficulty reading, or changes in peripheral vision.

D. Development of ulcers is not a typical side effect of hydroxychloroquine. Gastrointestinal upset such as nausea, abdominal discomfort, or diarrhea may occur, but these are generally mild and manageable. Peptic or gastric ulcers are not directly related to hydroxychloroquine therapy.

Rationale:

A. Administering analgesics may help relieve pain, but it does not address the life-threatening concern of post-operative bleeding. Giving analgesics before stabilizing the patient could mask worsening symptoms and delay critical interventions.

B. Preparing the patient for an emergency endoscopic procedure may eventually be necessary, but the first priority is stabilizing hemodynamics. Endoscopy cannot safely be performed if the patient is unstable due to ongoing bleeding.

C. Initiating a large-bore IV for fluid resuscitation and notifying the surgical team is the priority intervention. Hypotension, tachycardia, and abdominal distention following surgery are classic signs of postoperative hemorrhage or internal bleeding. Rapid vascular access allows for fluid and blood product administration, which is essential to restore circulating volume and maintain perfusion. Early notification of the surgical team ensures prompt evaluation and intervention, potentially preventing shock or organ failure.

D. Encouraging ambulation is inappropriate in a patient showing signs of hemodynamic instability. Ambulation could worsen hypotension, increase bleeding, and delay urgent resuscitative measures.