Assessment findings that the nurse would expect in a patient with rheumatoid arthritis who has articular involvement include

Choice A reason: Applying pediculicide lotion is inappropriate for tick removal, as it targets lice, not ticks. This could irritate the skin or prompt the tick to regurgitate, increasing the risk of pathogen transmission, such as Borrelia burgdorferi causing Lyme disease. Proper removal uses mechanical extraction to minimize infection, ensuring safe and effective tick removal without chemical interference.

Choice B reason: Using a hot ember to remove a tick is hazardous and ineffective. Heat may cause the tick to release pathogens into the bite site, heightening infection risk, and can burn the skin. Safe removal involves tweezers grasping the tick near the skin for intact extraction, reducing complications like Lyme disease or Rocky Mountain spotted fever transmission.

Choice C reason: Grasping the tick close to the skin with fine-tipped tweezers is the standard method. This ensures complete removal, including mouthparts, minimizing infection risk from pathogens like Borrelia burgdorferi, which causes Lyme disease. The technique prevents tissue damage and pathogen spread, promoting safe extraction and reducing complications from tick-borne illnesses.

Choice D reason: Using a twisting motion risks breaking the tick’s mouthparts, leaving them embedded, which increases infection risk and complicates removal. A steady, upward pull without twisting is recommended to extract the tick fully, preventing transmission of diseases like Lyme disease or babesiosis, ensuring effective and safe tick removal.

Choice A reason: Hepatomegaly is not a typical finding in early to moderate rheumatoid arthritis (RA). It may occur in advanced RA with systemic complications like Felty’s syndrome, but early RA focuses on joint inflammation. Expecting hepatomegaly misguides assessment, potentially overlooking RA’s articular signs critical for early diagnosis and DMARD therapy to prevent joint damage.

Choice B reason: Heberden’s nodes, bony growths at distal interphalangeal joints, are characteristic of osteoarthritis, not RA. RA involves synovial inflammation, causing soft tissue swelling, not bony nodes. Assuming nodes risks misdiagnosis, delaying RA-specific treatments like methotrexate, which target inflammation to prevent progressive joint erosion and deformity.

Choice C reason: Crepitus, a grating sound from joint movement, is more typical in osteoarthritis due to cartilage loss, not early RA, where synovial inflammation dominates. Expecting crepitus misaligns assessment, potentially missing RA’s soft tissue swelling and stiffness, delaying interventions like biologics critical for controlling inflammation and joint destruction.

Choice D reason: Spindle-shaped fingers, from synovial inflammation and swelling in proximal interphalangeal joints, are a classic early to moderate RA finding. This soft tissue swelling reflects autoimmune synovitis, aiding diagnosis. Recognizing this guides timely DMARD or corticosteroid use, reducing inflammation, preventing joint damage, and improving function in RA patients.