What would the nurse check when assessing the patient with early to moderate rheumatoid arthritis?

Choice A reason: An open fracture involves bone piercing the skin, exposing it to the environment, often from high-impact trauma. Osteoporosis causes weakened bones, but a spontaneous hip fracture typically occurs without external trauma or skin breach. This term does not apply, as the fracture results from underlying bone pathology, not an open wound.

Choice B reason: A pathologic fracture occurs in diseased bone, such as in osteoporosis, where reduced bone density causes fragility. A spontaneous hip fracture in this context results from minimal or no trauma, reflecting the weakened bone structure. This documentation accurately describes the fracture’s etiology, linking it to the underlying condition of osteoporosis.

Choice C reason: An oblique fracture describes a diagonal break across the bone, typically from twisting forces. While possible in osteoporosis, the term does not address the spontaneous nature or underlying bone weakness. Pathologic fracture is more specific, as it indicates the fracture’s cause, not just its physical pattern.

Choice D reason: A greenstick fracture is an incomplete break, common in children due to flexible bones, where the bone bends and partially fractures. Osteoporotic hip fractures in adults are typically complete due to brittle bones. This term is inappropriate, as it does not reflect the pathology or spontaneous nature of the injury.

Choice A reason: Tennis involves high-impact movements, twisting, and sudden directional changes, which stress the lumbar spine and exacerbate low back pain. These actions increase pressure on intervertebral discs and strain paraspinal muscles, risking further injury. For clients with back pain, low-impact exercises are preferred to avoid aggravating the condition.

Choice B reason: Swimming is a low-impact aerobic exercise that strengthens core and back muscles without stressing the spine. Buoyancy in water reduces gravitational load on vertebrae, minimizing disc compression. Freestyle or backstroke promotes spinal alignment and flexibility, making it an ideal recommendation for managing low back pain safely and effectively.

Choice C reason: Rowing involves repetitive forward flexion and rotation, which can strain lumbar muscles and compress spinal discs, worsening low back pain. The seated position and pulling motion increase intradiscal pressure, risking injury. This high-intensity activity is not suitable for clients seeking back pain relief through exercise.

Choice D reason: Canoeing requires prolonged sitting and repetitive twisting, which stress the lower back. The forward paddling motion increases lumbar flexion, straining muscles and discs. This activity is not recommended, as it can exacerbate pain and lacks the supportive, low-impact qualities needed for safe back pain management.