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

Hepatomegaly.

Heberden’s nodes.

Crepitus on joint movement.

Spindle-shaped fingers.

Answer and Explanation

The Correct Answer is D

Choice A reason: Hepatomegaly is not a typical finding in early to moderate rheumatoid arthritis (RA). It may occur in advanced RA with systemic complications like Felty’s syndrome, but early RA focuses on joint inflammation. Expecting hepatomegaly misguides assessment, potentially overlooking RA’s articular signs critical for early diagnosis and DMARD therapy to prevent joint damage.

Choice B reason: Heberden’s nodes, bony growths at distal interphalangeal joints, are characteristic of osteoarthritis, not RA. RA involves synovial inflammation, causing soft tissue swelling, not bony nodes. Assuming nodes risks misdiagnosis, delaying RA-specific treatments like methotrexate, which target inflammation to prevent progressive joint erosion and deformity.

Choice C reason: Crepitus, a grating sound from joint movement, is more typical in osteoarthritis due to cartilage loss, not early RA, where synovial inflammation dominates. Expecting crepitus misaligns assessment, potentially missing RA’s soft tissue swelling and stiffness, delaying interventions like biologics critical for controlling inflammation and joint destruction.

Choice D reason: Spindle-shaped fingers, from synovial inflammation and swelling in proximal interphalangeal joints, are a classic early to moderate RA finding. This soft tissue swelling reflects autoimmune synovitis, aiding diagnosis. Recognizing this guides timely DMARD or corticosteroid use, reducing inflammation, preventing joint damage, and improving function in RA patients.

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Correct Answer is C

Explanation

Choice A reason: Applying pediculicide lotion is inappropriate for tick removal, as it targets lice, not ticks. This could irritate the skin or prompt the tick to regurgitate, increasing the risk of pathogen transmission, such as Borrelia burgdorferi causing Lyme disease. Proper removal uses mechanical extraction to minimize infection, ensuring safe and effective tick removal without chemical interference.

Choice B reason: Using a hot ember to remove a tick is hazardous and ineffective. Heat may cause the tick to release pathogens into the bite site, heightening infection risk, and can burn the skin. Safe removal involves tweezers grasping the tick near the skin for intact extraction, reducing complications like Lyme disease or Rocky Mountain spotted fever transmission.

Choice C reason: Grasping the tick close to the skin with fine-tipped tweezers is the standard method. This ensures complete removal, including mouthparts, minimizing infection risk from pathogens like Borrelia burgdorferi, which causes Lyme disease. The technique prevents tissue damage and pathogen spread, promoting safe extraction and reducing complications from tick-borne illnesses.

Choice D reason: Using a twisting motion risks breaking the tick’s mouthparts, leaving them embedded, which increases infection risk and complicates removal. A steady, upward pull without twisting is recommended to extract the tick fully, preventing transmission of diseases like Lyme disease or babesiosis, ensuring effective and safe tick removal.

A. Interleukin 1 B. Uric acid C. Potassium D. Chloride

Correct Answer is B

Explanation

Choice A reason: Interleukin 1 is a pro-inflammatory cytokine involved in gout’s acute inflammatory response, not directly targeted by allopurinol. Allopurinol reduces uric acid production, preventing crystal formation, not cytokine levels. This choice is incorrect, as it misaligns with the medication’s mechanism of action in chronic gout management.

Choice B reason: Allopurinol inhibits xanthine oxidase, reducing uric acid production, which is elevated in chronic tophaceous gout. Lowering uric acid levels prevents urate crystal formation in joints, reducing tophi and gout attacks. This is the correct explanation, as allopurinol directly targets hyperuricemia, the root cause of gout pathology.

Choice C reason: Potassium levels are unrelated to gout or allopurinol’s action. Allopurinol does not affect electrolyte balance but focuses on purine metabolism to lower uric acid. This choice is incorrect, as potassium is not involved in gout’s pathophysiology or the therapeutic effect of allopurinol.

Choice D reason: Chloride is an electrolyte not associated with gout or allopurinol’s mechanism. Allopurinol’s role is specific to uric acid reduction, not chloride homeostasis. This choice is irrelevant, as chloride levels do not contribute to gout or require modification in chronic tophaceous gout management.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a group of clients about tick-borne illnesses. Which of the following information should the nurse include in the teaching regarding ticks?

Correct Answer is C

Explanation

A nurse is teaching a client who has chronic tophaceous gout about his new prescription for allopurinol. The nurse should explain that the purpose of this medication is to reduce blood levels of which of the following substances?

Correct Answer is B

Explanation

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

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