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

Choice A reason: Checking capillary refill is the priority to assess neurovascular status in a client with a casted tibia fracture. Impaired circulation, indicated by delayed refill (>2 seconds), suggests complications like compartment syndrome or vascular compromise. Early detection prevents tissue ischemia, nerve damage, or limb loss, as casts can compress vessels, especially in the initial post-casting period. This assessment ensures adequate blood flow, critical for healing and preventing irreversible damage.

Choice B reason: Discussing cast care, such as keeping it dry or avoiding weight-bearing, is important for long-term management but not the first priority. Education prevents complications like infection or cast breakdown but does not address immediate risks like vascular compromise. Neurovascular assessment takes precedence to ensure limb viability before focusing on patient education about cast maintenance and care.

Choice C reason: Performing range of motion exercises helps maintain joint mobility and prevent stiffness but is not the initial priority. Moving a casted limb prematurely may exacerbate swelling or disrupt fracture alignment. Neurovascular status must be confirmed first to ensure circulation is intact, as compromised blood flow could worsen with movement, risking further tissue damage.

Choice D reason: Managing pain is important, as pain may indicate complications like swelling or pressure within the cast. However, pain assessment is secondary to checking capillary refill, which directly evaluates circulation. Unaddressed vascular compromise could lead to ischemia, making neurovascular assessment the priority to rule out life-threatening conditions before addressing pain with medication or other interventions.

Choice A reason: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder. Males (XY) pass their Y chromosome to sons and X to daughters, not the DMD gene. Females (XX) can pass the mutated X to offspring. This statement is incorrect, as males cannot pass the DMD gene to their children.

Choice B reason: DMD primarily affects males, as it is X-linked recessive, and males lack a second X chromosome to mask the mutation. Females are rarely affected, typically as carriers or in rare cases with skewed X-inactivation. This statement is incorrect, as patients are predominantly male, not female.

Choice C reason: Genetic testing identifies DMD gene mutations, confirming diagnosis and guiding treatment, such as corticosteroids to slow muscle degeneration or emerging gene therapies. It informs prognosis, carrier status, and family planning, making it critical for tailoring interventions and counseling families about the disease’s progression and management.

Choice D reason: Not all daughters of a carrier female will be carriers. A carrier mother has a 50% chance of passing the mutated X chromosome to each daughter, making half likely carriers. This statement is incorrect, as it overstates the genetic transmission probability for female offspring.