The nurse is caring for a client who reports taking methotrexate, a disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis. What finding, if experienced by the client, would the nurse suspect is a complication of the medication?

Choice A reason: Morning stiffness lasting 25 minutes suggests mild joint inflammation but is not specific to rheumatoid arthritis (RA). RA typically involves stiffness exceeding 30-60 minutes and multiple joints bilaterally. This symptom alone is less indicative than red, spongy joints, making this choice less likely for RA.

Choice B reason: Crepitus in the right knee indicates cartilage wear, more characteristic of osteoarthritis than RA. RA causes synovial inflammation, not primarily crepitus. This 45-year-old male’s symptom suggests mechanical joint issues, not the inflammatory, systemic features of RA, making this choice incorrect.

Choice C reason: Red, soft, spongy joints in both knees indicate synovial inflammation and effusion, hallmark signs of RA. This autoimmune disease causes bilateral joint swelling, warmth, and tenderness due to synovitis. This 30-year-old female’s symptoms align with RA’s clinical presentation, making this the most likely manifestation.

Choice D reason: Osteophyte formation and decreased joint space are typical of osteoarthritis, not RA. RA involves synovial inflammation and cartilage erosion without osteophytes early on. This 40-year-old male’s findings suggest degenerative joint disease, not the inflammatory changes of RA, making this choice incorrect.

Choice A reason: Achieving euthyroid state before hyperthyroidism procedures, like thyroidectomy, aims to normalize thyroid hormone levels, not prevent hypothyroidism. Post-procedure hypothyroidism is a separate concern managed with hormone replacement. This statement is inaccurate, as the primary goal is to stabilize metabolism, not prevent low thyroid function.

Choice B reason: Medications like methimazole or propylthiouracil are used pre-procedure to achieve euthyroid state, reducing thyroid hormone levels to prevent thyroid storm—a life-threatening hypermetabolic crisis triggered by surgery or stress. This statement is accurate, as stabilizing thyroid function minimizes perioperative complications like tachycardia or hyperthermia.

Choice C reason: Euthyroid state does not directly enhance the efficacy of anti-thyroid medications but rather prepares the patient for surgery by reducing hyperthyroid symptoms. Medications are effective independently, and this statement is inaccurate, as the rationale focuses on patient safety, not drug potentiation.

Choice D reason: While euthyroid state reduces metabolic stress, it does not primarily minimize bleeding risk. Bleeding is managed through surgical techniques and coagulation status, not thyroid hormone levels. This statement is inaccurate, as bleeding risk is not the primary concern addressed by achieving euthyroid state pre-procedure.