A patient has complaints of a sharp pain along the costovertebral angle. Which condition is this symptom related to?

A. Asymmetrical joint involvement: Osteoarthritis commonly affects weight-bearing joints such as the knees and hips in an asymmetrical pattern. This is a key feature that helps distinguish it from rheumatoid arthritis, which usually presents with symmetrical involvement.

B. Affected joints may have heat, redness, and swelling: Heat and redness are more typical of inflammatory conditions like rheumatoid arthritis or gout. In osteoarthritis, swelling may occur but is usually due to bony changes rather than acute inflammation.

C. Pain with motion of affected joints: Joint pain that worsens with activity and improves with rest is a hallmark of osteoarthritis. The pain arises from cartilage degeneration, which causes friction and stress on the affected joint.

D. Affected joints are swollen with hard, bony protuberances: Bony enlargements such as Heberden’s nodes or Bouchard’s nodes develop in osteoarthritis due to cartilage loss and bone remodeling. These hard protuberances are a classic finding in this condition.

E. Symmetrical joint movement: Symmetrical involvement is more consistent with rheumatoid arthritis. Osteoarthritis does not typically affect joints in a symmetrical distribution, making this feature less characteristic of the disease.

A. Having the patient swallow: Swallowing assesses part of cranial nerve function, but evaluating the glossopharyngeal (IX) and vagus (X) nerves fully also requires testing the gag reflex. Swallowing alone provides an incomplete assessment.

B. Testing the gag reflex and having the patient swallow: Both the gag reflex and swallowing involve the glossopharyngeal and vagus nerves. Testing these functions allows the nurse to assess motor and sensory components of these cranial nerves, ensuring a comprehensive evaluation.

C. Touching the patient's face with dull and sharp objects: This action assesses the trigeminal nerve (cranial nerve V), not the glossopharyngeal or vagus nerves. It evaluates sensory perception in the face rather than swallowing or gag reflex.

D. Testing the gag reflex: While testing the gag reflex evaluates part of cranial nerves IX and X, performing the swallow test in addition provides a more complete assessment of their function. Relying solely on the gag reflex may miss subtle deficits in swallowing ability.