The nurse is performing a health history and physical assessment on a patient with chronic rheumatoid arthritis (RA). Which symptom(s) should the nurse anticipate?

Non-tender osteophytes of the finger joints

Deterioration of articular cartilage surfaces

Joint pain that is worse later in the day

Bilateral swelling and tenderness of joints

Strong ability to reposition independently

Answer and Explanation

The Correct Answer is D

A. Non-tender osteophytes of the finger joints: Osteophytes are bony spurs characteristic of degenerative joint disease, not the inflammatory erosion seen in RA. RA is characterized by synovial thickening and bone destruction rather than new bone growth. These spurs are hallmarks of osteoarthritis.

B. Deterioration of articular cartilage surfaces: While RA eventually destroys cartilage, this is the primary pathological mechanism of osteoarthritis (OA). In RA, the initial insult is an autoimmune attack on the synovium. The disease process is inflammatory and systemic rather than purely mechanical wear.

C. Joint pain that is worse later in the day: Pain that worsens with activity and later in the day is typical of osteoarthritis. RA patients characteristically experience significant morning stiffness that lasts longer than 60 minutes. RA pain typically improves with movement and throughout the day.

D. Bilateral swelling and tenderness of joints: Rheumatoid arthritis is a systemic autoimmune disease that typically presents with a symmetrical, bilateral pattern of joint involvement. Swelling, warmth, and tenderness result from chronic synovitis within the affected joints. This symmetry distinguishes it from the asymmetrical nature of OA.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

A. 0/5
This indicates no muscle contraction at all. It would apply if the patient had complete paralysis and could not initiate any movement. Since Marcus can elevate his shoulders, this is not correct.

B. 1/5
This means a trace contraction is palpable or visible, but no movement occurs. Again, Marcus is able to move his shoulders against gravity, so this does not fit.

C. 2/5
This score is given when the patient can move the joint only if gravity is eliminated, but cannot overcome gravity. Marcus can elevate his shoulders against gravity, so this is not accurate.

D. 3/5
This represents full range of motion against gravity but not against resistance. Marcus can elevate his shoulders, but when the nurse applies resistance, he cannot maintain the movement. This matches his presentation.

E. 4/5
This indicates full range of motion against gravity and some resistance, but less than normal strength. If Marcus had been able to elevate his shoulders and withstand the nurse’s pressure partially, this would apply. However, he was unable to resist at all, so 4/5 is not correct.

F. 5/5
This is normal strength, meaning full range of motion against gravity and full resistance. Since Marcus cannot resist the nurse’s pressure, this is not appropriate.

A. Document the oral temperature in the health care record B. Offer a blanket to prevent patient shivering C. Inspect the surgical incision for redness, swelling, heat, & pain D. Administer acetaminophen as ordered pm to reduce fever E. Notify the Health Care Provider (HCP)

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

Explanation

A. Document the oral temperature in the health care record: Accurate documentation of vital signs is a legal and clinical necessity for tracking the patient's postoperative trajectory. A temperature of 38°C represents a low-grade pyrexia that must be recorded to establish a trend. This data is essential for subsequent clinical decision-making and interdisciplinary communication.

B. Offer a blanket to prevent patient shivering: While blankets provide comfort, they can further insulate a febrile patient and cause a paradoxical rise in core body temperature. Shivering is a physiological mechanism to generate heat, but external warming during a fever is generally contraindicated unless the patient is in the chill phase. Nursing interventions should focus on heat dissipation.

C. Inspect the surgical incision for redness, swelling, heat, & pain: Assessment of the operative site is critical to differentiate between physiological postoperative inflammation and early surgical site infection. The nurse must evaluate for localized rubor, tumor, calor, and dolor as part of a comprehensive febrile workup. This helps identify the potential source of the elevated temperature.

D. Administer acetaminophen as ordered pm to reduce fever: Acetaminophen acts on the hypothalamic heat-regulating center to reduce fever and provide postoperative analgesia. Administration is appropriate when the temperature meets the threshold defined in the standing PRN orders. This intervention improves patient comfort and reduces the metabolic demands associated with pyrexia.

E. Notify the Health Care Provider (HCP): While low-grade fevers are common within 24 hours of surgery due to atelectasis or inflammatory stress, the HCP must be informed of any deviations from baseline. This ensures that the surgical team can order diagnostic tests, such as a chest X-ray or urinalysis, if indicated. Timely notification is a key component of postoperative surveillance.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is performing a health history and physical assessment on a patient with chronic rheumatoid arthritis (RA). Which symptom(s) should the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The patient is able to elevate his shoulders bilaterally until the nurse presses down on his shoulders. How should the nurse document his muscle strength?

Correct Answer is D

Explanation

The nurse cares for a patient who is one day post-op surgery. The nurse checks the patient's oral temperature and notes that it is 38° Celsius. Which action by the nurse is appropriate? Select all that apply.

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

Explanation

The nurse assesses a patient's neurologic function. Which sign could indicate injury to the cerebellum? Select all that apply.

The nurse notes that the patient has been diagnosed with arterial insufficiency. The patient has a dark-skinned complexion. Which assessment finding would support this diagnosis?

A 16-year-old patient who is six months post wrist fracture is in for a follow up visit. The nurse assesses the range of motion (ROM) of the affected arm and notes which bones are involved in pronation and supination of the forearm?

The nurse is assessing the abdomen of a woman who is eight months pregnant. Which characteristic is the nurse likely to observe? Select all that apply.

The patient has a high fever and states, "There is a monster in the corner of the room." This is an example of which type of mental disorder? Select all that apply.

Which is a function of the musculoskeletal system? Select all that apply.

A patient reports severe abdominal pain around the umbilicus and right lower quadrant (RLQ) as well as nausea and vomiting for 2 days. Place these nursing assessment steps in the correct order.