Patient Data

Exhibits

Nurse analyzes the assessment findings.

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.

Morning stiffness quickly resolves

Small joints of the hand

Fatigue and fever

Joint swelling

Heberden nodes

Symmetrical involvement

Pain increases with motion

Answer and Explanation

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

Morning stiffness quickly resolves:

Rheumatoid Arthritis: Morning stiffness is a hallmark of rheumatoid arthritis, although it typically lasts more than just a brief period.

Small joints of the hand:

Rheumatoid Arthritis: Rheumatoid arthritis commonly affects the small joints of the hands and wrists, leading to pain, stiffness, and swelling.

Fatigue and fever:

Rheumatoid Arthritis: Systemic symptoms like fatigue and low-grade fever are often associated with rheumatoid arthritis due to its inflammatory nature.

Joint swelling:

Rheumatoid Arthritis: Swelling of the joints is a key symptom of rheumatoid arthritis, typically due to inflammation and fluid accumulation within the joint.

Heberden nodes:

Not Applicable: Heberden nodes are associated with osteoarthritis, not rheumatoid arthritis. These nodes occur at the distal interphalangeal joints.

Symmetrical involvement:

Rheumatoid Arthritis: One of the classic features of rheumatoid arthritis is symmetrical involvement of joints, particularly in the hands and wrists.

Pain increases with motion:

Rheumatoid Arthritis: Joint pain that increases with motion is a common symptom of rheumatoid arthritis, reflecting active inflammation in the joints.

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Correct Answer is D

Explanation

A. Absent deep tendon reflexes are not typically associated with nailbed clubbing. While reflexes may be diminished in some conditions, they are not commonly related to the pathophysiology behind clubbing.
B. A capillary refill time of less than 3 seconds is a normal finding and does not align with clubbing, which often indicates chronic hypoxia or systemic conditions such as heart or lung disease.
C. Peripheral dependent edema refers to swelling in the lower extremities, which can be associated with circulatory problems, but it is not directly linked to nailbed clubbing. Edema is more common in conditions like heart failure or kidney disease.
D. A low oxygen saturation of 85% is consistent with conditions that cause chronic hypoxia, such as chronic lung disease or congenital heart disease. Chronic low oxygen levels can lead to nailbed clubbing as a compensatory response to inadequate oxygenation.

A. Blowing, hollow sounds above sternum. B. Slight crackling throughout lung fields. C. Faint whistling over both lung bases. D. Right breath sounds louder than left.

Correct Answer is D

Explanation

A. Blowing or hollow sounds above the sternum are abnormal and may suggest a condition like aortic or pulmonary disease. Such sounds are not typical during routine chest auscultation and may indicate pathology like bronchial obstruction or an abnormal vascular sound.
B. Slight crackling sounds, also known as "rales" or "crackles," may be indicative of fluid accumulation in the lungs, often seen in conditions like pneumonia or congestive heart failure. These are not considered normal findings and warrant further evaluation.
C. Faint whistling sounds may be indicative of wheezing, which is often a sign of airway narrowing or obstruction, as seen in asthma or chronic obstructive pulmonary disease (COPD). Wheezing is not typically considered normal and should be investigated further.
D. Right-sided breath sounds being louder than the left could be a normal finding in certain individuals, depending on factors like body position or anatomical variations. In a healthy individual, this difference may not indicate pathology unless associated with other symptoms such as asymmetry in lung sounds or dyspnea.

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Patient Data Exhibits Nurse analyzes the assessment findings. 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 assesses that a client has nailbed clubbing. Which additional information is consistent with this finding?

Correct Answer is D

Explanation

Which assessment finding, obtained during chest auscultation, should the nurse consider a normal finding?

Correct Answer is D

Explanation

The nurse is performing a head-to-toe physical examination on a known victim of intimate partner violence. The visual exam reveals several round, flat, pinpoint, red spots. How should the nurse document this finding?

While conducting a physical assessment, the nurse shines a pen light into a client's right eye and moves the light source to check the client's left eye. Which finding indicates the need for further evaluation?

During a health assessment, the client reports being treated for osteoarthritis. The nurse examines a client's hands and finds Heberden's nodes. Which finding should the nurse document in the client's medical record?

Which question by the nurse is likely to elicit the most information regarding a client's use of medications to treat a chronic cough?

Which finding, obtained during a skin assessment, should the school nurse report to the healthcare provider?

The nurse learns in report that a client is stuporous. Which assessment should the nurse perform to confirm this report?

In assessing an adult client, the nurse calculates the body mass index (BMI) as 14 kg/m2. Which nursing problem should be included in this client's plan of care? Reference Range: Body mass index (BMI) [normal 18.0 to 24.9 kg/m2]

The school nurse is interviewing a 13-year-old girl who wants to go home from school because of "back pain." Which question should the nurse ask the adolescent first?

Patient Data

Exhibits

Nurse analyzes the assessment findings.

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.