During a physical assessment of a patient with rheumatoid arthritis, the nurse notes the presence of multiple rheumatoid nodules on the patient's elbows and forearms. What potential complication should the nurse prioritize in her assessment and management plan?
Hypertension due to systemic inflammation
Hypoglycemia due to medication interaction
increased joint mobility due to nodule presence
Skin ulceration due to friction and pressure
The Correct Answer is D
Rationale:
A. Hypertension is not a direct complication of rheumatoid nodules. While rheumatoid arthritis is a systemic inflammatory disease that can increase cardiovascular risk over time, the presence of nodules themselves does not directly cause hypertension and is not the priority concern related to elbow and forearm nodules.
B. Hypoglycemia is not associated with rheumatoid nodules. Although some medications used to treat rheumatoid arthritis (such as corticosteroids) can affect blood glucose levels, they are more commonly linked to hyperglycemia, not hypoglycemia, and this complication is unrelated to nodule formation.
C. Rheumatoid nodules do not increase joint mobility. In fact, rheumatoid arthritis typically causes joint stiffness, deformity, and decreased range of motion. Nodules are firm, non-tender subcutaneous masses that occur over pressure points and do not enhance movement.
D. Rheumatoid nodules commonly develop over pressure points, such as the elbows and forearms. Repeated friction and pressure can lead to skin breakdown, ulceration, and secondary infection, especially in patients with limited mobility or prolonged pressure on affected areas. Preventing skin injury, monitoring for signs of breakdown, and implementing protective measures are key nursing priorities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Sleeping on the back with the head flat does not reduce reflux. In this position, gastric contents can more easily move into the esophagus, worsening symptoms during sleep.
B. Sleeping on the left side is recommended for clients with GERD. The anatomical position of the stomach and esophagus allows gravity to keep stomach contents lower in the stomach, reducing acid reflux into the esophagus and improving comfort during sleep. This position has been shown to decrease nocturnal symptoms effectively.
C. Sleeping on the stomach with the head flat can increase intra-abdominal pressure, promoting reflux. This position is not recommended for GERD management.
D. Sleeping on the right side can worsen reflux because the stomach is positioned higher than the esophagus in this orientation, making it easier for acid to flow upward during sleep.
Correct Answer is A
Explanation
Rationale:
A. Administering prescribed antiemetic medication is the priority intervention. Chemotherapy-induced nausea and vomiting (CINV) can lead to dehydration, electrolyte imbalance, malnutrition, and decreased quality of life. Antiemetics, such as ondansetron or metoclopramide, work directly to control nausea and vomiting, preventing complications and allowing the patient to tolerate oral intake and treatment.
B. Increasing fluid intake is important to prevent dehydration, but if the patient is actively vomiting, oral intake may be ineffective, making antiemetic administration the higher priority to stop ongoing losses first.
C. Encouraging small, frequent meals is a helpful supportive measure, but it will be ineffective if nausea and vomiting are not controlled. Adequate symptom management is required before dietary strategies can be successful.
D. Advising the patient to avoid strong odors may reduce nausea triggers, but it is a non-pharmacologic and secondary measure. It cannot replace prompt administration of prescribed antiemetics, which directly addresses the underlying problem.
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