Patient Data

Exhibits

Click to indicate which findings are indicative of rheumatoid arthritis or are not applicable to that disease. Each row must have only one response option selected.

Joint swelling

Pain increases with motion

Morning stiffness quickly resolves

Fatigue and fever

Small joints of the hand

Symmetrical involvement

Heberden nodes

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"},"G":{"answers":"B"}}

Rationale:

• Joint swelling: In rheumatoid arthritis (RA), joint swelling results from synovial membrane inflammation, leading to increased fluid and thickening within the joint capsule. Swollen joints are tender and may feel warm to the touch. Swelling is a key clinical sign of active disease and contributes to joint deformity over time if untreated.

• Pain increases with motion: Pain with movement is a typical feature of RA because inflamed joints are sensitive to mechanical stress. As the joint capsule becomes swollen and irritated, using the joint increases the discomfort. This distinguishes RA from other conditions where pain might be more pronounced at rest.

• Morning stiffness quickly resolves: In RA, morning stiffness usually lasts longer than 30 minutes and often persists for several hours. If stiffness resolves quickly (within minutes), it is more typical of osteoarthritis or mechanical joint issues rather than inflammatory arthritis like RA. Thus, quick resolution is not applicable to RA.

• Fatigue and fever: RA is a systemic inflammatory disease, meaning it can affect the whole body, not just the joints. Cytokine release during active disease often causes generalized symptoms such as fatigue, low-grade fever, malaise, and weight loss, highlighting the autoimmune nature of the condition.

• Small joints of the hand: RA typically affects the small joints first — especially the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. This early involvement of the fingers and hands helps differentiate RA from osteoarthritis, which often targets larger, weight-bearing joints initially.

• Symmetrical involvement: A hallmark of RA is symmetrical joint involvement, meaning that the same joints on both sides of the body are affected. Symmetry helps distinguish RA from other types of arthritis such as gout or septic arthritis, which tend to be asymmetrical and localized.

• Heberden nodes: Heberden nodes are bony swellings at the distal interphalangeal (DIP) joints, characteristic of osteoarthritis, not RA. RA rarely affects DIP joints and does not form hard bony nodules at the joint surface. Therefore, Heberden nodes are considered not applicable to RA findings.

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Correct Answer is D

Explanation

Rationale:
A. Hematocrit: Hematocrit measures the proportion of red blood cells in the blood and helps assess for anemia or dehydration, but it does not directly reflect short-term changes in nutritional status or protein stores.

B. Serum calcium: Serum calcium levels assess electrolyte balance and bone health but are not specific indicators of overall nutritional status. Calcium levels can be maintained even when nutritional intake is poor.

C. Hemoglobin: Hemoglobin evaluates oxygen-carrying capacity and can suggest anemia, which may indirectly reflect poor nutrition, but it is not as sensitive a marker for acute or current nutritional status as prealbumin.

D. Serum prealbumin: Serum prealbumin is a sensitive marker of recent nutritional intake and protein status, reflecting short-term changes in nutrition. It is the most important laboratory value to assess when evaluating a client for malnutrition, especially in the setting of appetite loss and generalized malaise.

A. Palpate the area for warmth and swelling. B. Measure the degree of skin elasticity. C. Determine the client's oxygen saturation. D. Observe the appearance of the nailbeds.

Correct Answer is A

Explanation

Rationale:
A. Palpate the area for warmth and swelling: Erythema, or redness of the skin, can indicate inflammation, infection, or irritation. Palpating the area for warmth and swelling helps assess for signs of underlying infection, cellulitis, or inflammatory response, providing critical information to guide further management.

B. Measure the degree of skin elasticity: Skin elasticity assessment, such as testing for turgor, is useful for evaluating hydration status. However, it is unrelated to erythema and does not help determine the underlying cause or severity of the redness observed.

C. Determine the client's oxygen saturation: Oxygen saturation is important for assessing respiratory and circulatory function but does not directly relate to localized erythema. Erythema usually results from localized skin or tissue changes, not systemic hypoxemia.

D. Observe the appearance of the nailbeds: Observing nailbeds can help assess systemic perfusion and oxygenation issues like cyanosis, but it does not provide specific information about localized redness or inflammation in an area like the arm where erythema is present.

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Patient Data Exhibits Click to indicate which findings are indicative of rheumatoid arthritis or are not applicable to that disease. Each row must have only one response option selected.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older adult client is admitted to the medical unit because of a loss of appetite and generalized malaise. To analyze the client's general nutritional status, which laboratory value is most important for the nurse to review?

Correct Answer is D

Explanation

When inspecting a client's skin, the nurse observes an area of erythema on the arm. Which follow up assessment should the nurse complete?

Correct Answer is A

Explanation

Patient Data Exhibits Click to indicate which findings are indicative of rheumatoid arthritis or are not applicable to that disease. Each row must have only one response option selected.

A male client reports the onset of a burning sensation in his hands and legs. How should the nurse document this finding in the electronic medical record (EMR)?

Which is the best approach for the nurse to use when interviewing a client about alcohol and substance use?

The nurse completes percussion of the abdomen on an adult client. Which finding is considered normal?

The nurse assesses a client's fingernails as seen in the photo. How should the nurse document the findings?

While performing a mental status examination, which question should the nurse ask when attempting to evaluate a client's judgment?

An older adult client with a history of heart failure (HF) comes to the clinic troubled by awakening during the night in a cold sweat, accompanied by difficulty breathing, and a racing heart beat. Which assessment should the nurse complete first?

In completing a physical assessment of a young adult, the clinic nurse observes muscular atrophy of the right thigh and calf. To gather additional data related to this finding, which action should the nurse take?

Patient Data

Exhibits

Click to indicate which findings are indicative of rheumatoid arthritis or are not applicable to that disease. Each row must have only one response option selected.