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

Morning stiffness lasting 60 minutes or more.

Bamboo-shaped fingers.

Asymmetric involvement of small joints.

Noninflammatory pain in large joints.

Answer and Explanation

The Correct Answer is A

Choice A reason: Morning stiffness lasting 60 minutes or more is a hallmark of rheumatoid arthritis (RA) due to synovial inflammation in affected joints. This prolonged stiffness, worse after inactivity, reflects autoimmune-mediated synovitis, distinguishing RA from osteoarthritis. Recognizing this guides diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) to reduce joint damage.

Choice B reason: Bamboo-shaped fingers are characteristic of psoriatic arthritis, not RA. RA causes joint deformities like swan-neck or boutonnière due to synovial destruction, not a bamboo appearance. Expecting this finding risks misdiagnosis, delaying RA-specific therapies like methotrexate, which target inflammation and prevent progressive joint erosion.

Choice C reason: Asymmetric small joint involvement is typical of osteoarthritis or psoriatic arthritis, not RA. RA features symmetric involvement of small joints, like metacarpophalangeal joints, due to systemic autoimmune inflammation. Assuming asymmetry misguides assessment, potentially overlooking RA’s bilateral pattern critical for early diagnosis and effective immunosuppressive treatment.

Choice D reason: Noninflammatory pain in large joints is not typical of RA, which involves inflammatory pain in small joints due to synovitis. Large joint pain may occur in osteoarthritis or gout. Expecting noninflammatory pain misdirects RA diagnosis, delaying interventions like corticosteroids or biologics to manage inflammation and joint destruction.

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Correct Answer is B

Explanation

Choice A reason: Interleukin 1 is a pro-inflammatory cytokine involved in gout’s acute inflammatory response, not directly targeted by allopurinol. Allopurinol reduces uric acid production, preventing crystal formation, not cytokine levels. This choice is incorrect, as it misaligns with the medication’s mechanism of action in chronic gout management.

Choice B reason: Allopurinol inhibits xanthine oxidase, reducing uric acid production, which is elevated in chronic tophaceous gout. Lowering uric acid levels prevents urate crystal formation in joints, reducing tophi and gout attacks. This is the correct explanation, as allopurinol directly targets hyperuricemia, the root cause of gout pathology.

Choice C reason: Potassium levels are unrelated to gout or allopurinol’s action. Allopurinol does not affect electrolyte balance but focuses on purine metabolism to lower uric acid. This choice is incorrect, as potassium is not involved in gout’s pathophysiology or the therapeutic effect of allopurinol.

Choice D reason: Chloride is an electrolyte not associated with gout or allopurinol’s mechanism. Allopurinol’s role is specific to uric acid reduction, not chloride homeostasis. This choice is irrelevant, as chloride levels do not contribute to gout or require modification in chronic tophaceous gout management.

A. Alcohol B. Orange juice C. Milk D. Coffee

Correct Answer is A

Explanation

Choice A reason: Alcohol, particularly beer and liquor, triggers gout attacks by increasing uric acid production and reducing renal excretion. Ethanol metabolism raises purine breakdown, elevating serum urate levels, while dehydration from alcohol exacerbates crystal formation in joints. Avoiding alcohol is a key dietary recommendation to prevent acute gout flares.

Choice B reason: Orange juice, rich in vitamin C, may lower uric acid levels by enhancing renal excretion. It is not a trigger for gout attacks and is generally safe. Fructose in some juices can increase uric acid, but orange juice’s effect is minimal, making this an incorrect choice.

Choice C reason: Milk and dairy products are low in purines and may reduce gout risk by promoting uric acid excretion. Calcium and casein in milk have uricosuric effects, making it a beneficial beverage. Milk does not trigger attacks, so this choice is incorrect for gout management.

Choice D reason: Coffee, containing caffeine and polyphenols, may lower uric acid levels and gout risk through antioxidant effects and increased urate excretion. It is not a trigger for attacks and is generally safe for gout patients, making this an incorrect choice for dietary restrictions.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has chronic tophaceous gout about his new prescription for allopurinol. The nurse should explain that the purpose of this medication is to reduce blood levels of which of the following substances?

Correct Answer is B

Explanation

A nurse is teaching a client who has gout about dietary recommendations. The nurse should teach the client that which of the following beverages can trigger an attack?

Correct Answer is A

Explanation

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

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