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. Rapid strep test: A rapid strep test screens for streptococcal throat infections and is unrelated to urinary symptoms. It would not help identify the cause of painful urination in a client with diabetes mellitus.

B. Nitazine pH strip: Nitazine pH testing is primarily used to assess amniotic fluid leakage in pregnant women, not for urinary tract infections (UTIs). It would not provide helpful information for evaluating dysuria in this situation.

C. Finger stick glucose: While important for monitoring diabetes management, finger stick glucose does not directly address the acute complaint of painful urination. It would not diagnose a urinary tract infection, which is the immediate concern.

D. Urine dipstick test: A urine dipstick test screens for leukocytes, nitrites, blood, and glucose in the urine and is the appropriate first screening for suspected UTI. Clients with uncontrolled diabetes are at higher risk for UTIs, and the dipstick can quickly detect infection-related changes.

A. Glucose. B. White blood cell count (WBC). C. Blood urea nitrogen (BUN). D. Hematocrit.

Correct Answer is D

Explanation

Rationale:
A. Glucose: Monitoring glucose levels is important for clients with diabetes or metabolic concerns, but it does not provide direct information about blood loss. Melena indicates gastrointestinal bleeding, and glucose measurements would not help evaluate the severity of this blood loss.

B. White blood cell count (WBC): A WBC count can detect infection or inflammation but is not the primary concern in a client with melena. Since melena suggests gastrointestinal bleeding, monitoring for anemia or hypovolemia is far more critical than assessing for infection at this point.

C. Blood urea nitrogen (BUN): BUN levels may rise with upper gastrointestinal bleeding due to the digestion of blood proteins. However, while helpful in some cases, BUN is less directly reflective of the immediate clinical impact of blood loss compared to hematocrit, which assesses the blood’s oxygen-carrying capacity.

D. Hematocrit: Hematocrit measures the proportion of red blood cells in the blood and is a critical indicator of anemia and blood loss severity. In clients with melena, monitoring hematocrit helps evaluate the extent of bleeding and the need for interventions like fluid replacement or transfusion.

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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 is completing an assessment for a client with uncontrolled diabetes mellitus (DM) who came to the clinic reporting frequent, painful urination. Which screening test should the nurse perform first?

Correct Answer is D

Explanation

The nurse observes that a client is experiencing melena. Which serum laboratory test should the nurse monitor in response to this finding?

Correct Answer is D

Explanation

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Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

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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.