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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Free Nursing Study Resources

Correct Answer is ["A","D","E"]

Explanation

Rationale:
A. Contracture: Contractures, which are the permanent tightening of muscles, tendons, or ligaments, can be identified visually through inspection. The nurse may notice abnormal positioning of joints or decreased range of motion, indicating underlying musculoskeletal abnormalities.

B. Crepitus: Crepitus refers to a crackling or grating sound felt or heard during joint movement and is best assessed through palpation or auscultation, not inspection. The nurse must touch or listen to the joint to detect crepitus, making it unsuitable for assessment by inspection alone.

C. Osteopenia: Osteopenia is a reduction in bone mineral density that is diagnosed through specialized imaging tests like dual-energy X-ray absorptiometry (DEXA) scans. It is not visible during physical inspection, as bone density changes do not produce obvious external signs without significant fractures.

D. Atrophy: Muscle atrophy, which is the wasting or loss of muscle mass, can be visually identified through inspection. The nurse may observe a noticeable decrease in muscle bulk compared to the opposite side or to expected norms, indicating disuse or neurologic impairment.

E. Kyphosis: Kyphosis, an exaggerated outward curvature of the thoracic spine, can be detected through inspection by observing the client’s posture and spinal alignment. Visual clues such as a hunchback appearance or forward stooping posture are hallmark signs noted during inspection.

A. Numeric pain intensity scale. B. Apical-radial pulse deficit. C. Anteroposterior (AP) chest diameter. D. Body temperature.

Correct Answer is A

Explanation

Rationale:
A. Numeric pain intensity scale: Splinting the chest with a pillow is a common behavioral sign of chest pain or discomfort, often due to surgical incisions, musculoskeletal strain, or cardiac issues. Assessing the client's pain using a numeric scale provides crucial information for guiding pain management and further diagnostic evaluation.

B. Apical-radial pulse deficit: An apical-radial pulse deficit is useful for detecting cardiac arrhythmias, but it is not the immediate priority based on the client's behavior. Addressing the possible cause of splinting, likely pain, should come first before assessing for pulse discrepancies.

C. Anteroposterior (AP) chest diameter: Measuring AP chest diameter helps assess chronic lung conditions such as barrel chest in emphysema. However, this measurement does not address acute signs of pain or discomfort indicated by chest splinting.

D. Body temperature: Checking temperature can help detect infection or fever but is not the most relevant initial assessment when a client is demonstrating behaviors specifically suggestive of chest pain. Pain assessment should take precedence in this context.

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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

The nurse begins a client's musculoskeletal assessment. While using the technique of inspection, the nurse assesses for which possible finding(s)? Select all that apply.

Correct Answer is ["A","D","E"]

Explanation

When entering a male client's room, the nurse observes that he is splinting his chest with a pillow. Which follow up assessment should the nurse complete?

Correct Answer is A

Explanation

The nurse determines that a male client has smoked 2 packs of cigarettes daily for the past 20 years. In calculating his smoking history, how many pack-years should be documented for this client? (Enter numeric value only.)

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The nurse is assessing a client's skeletal muscle movements and strength. Which action should the nurse instruct the client to perform to evaluate prime-mover muscle groups?

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The nurse is assessing the perianal area of a female client who reports she has chronic constipation and has bright red blood on the toilet paper after having a bowel movement. Which finding should the nurse report to the healthcare provider (HCP) that is most consistent with the client's report?

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

To assess for the presence of kyphosis, 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.