Which client presenting in the clinic most likely reveals manifestation(s) of rheumatoid arthritis?

A 35-year-old female with morning stiffness for 25 minutes in the knee

A 45-year-old male with crepitus in the right knee

A 30-year-old female with red, soft, spongy joints in both knees

A 40-year-old male with osteophyte formation and decreased joint space in the left knee

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is B

Explanation

Choice A reason: Hard, formed stool is typical of descending or sigmoid colostomies, where the colon reabsorbs water. A transverse colostomy, located higher in the colon, has less water absorption, producing liquid stool. This statement is inaccurate, as transverse colostomy stool is not hard or formed.

Choice B reason: A transverse colostomy, located in the mid-colon, produces mostly liquid feces with mucus due to limited water reabsorption before the stoma. The proximal colon’s contents are less formed, and mucus from inflammation (common in IBD) is present, making this statement accurate for stool consistency.

Choice C reason: Soft, semi-formed stool is more typical of descending colostomies, where water absorption occurs longer. Transverse colostomies, higher in the colon, produce more liquid output due to shorter transit time. This statement is inaccurate, as it does not reflect transverse colostomy stool consistency.

Choice D reason: Dry, pellet-like stool is characteristic of constipation or distal colon output, not a transverse colostomy. The transverse colon’s contents are liquid due to minimal water reabsorption, especially in IBD with inflammation. This statement is inaccurate, as it misrepresents the expected stool consistency.

A. The client’s core body temperature reached the new thermoregulatory set point and the body is trying to prevent overheating B. An exogenous pyrogen is directly resetting the client’s thermoregulatory set point in the anterior pituitary C. The client is experiencing hyperthermia and the body’s mechanisms to control heat are no longer working effectively D. An endogenous pyrogen is stimulating the production of leukotrienes to increase the thermoregulatory set point of the hypothalamus

Correct Answer is A

Explanation

Choice A reason: In fever, pyrogens reset the hypothalamic thermoregulatory set point, causing the body to raise core temperature via shivering and vasoconstriction. Once reached, diaphoresis and flushing occur to dissipate heat, preventing overheating. This statement accurately describes the body’s response to achieving the fever’s set point in pneumonia.

Choice B reason: Exogenous pyrogens (e.g., bacterial toxins) act via endogenous pyrogens (cytokines) to reset the hypothalamic, not anterior pituitary, set point. The pituitary regulates hormones, not thermoregulation. This statement is inaccurate, as it misidentifies the anatomical site and mechanism of fever induction.

Choice C reason: Hyperthermia involves uncontrolled heat gain (e.g., heat stroke), not a regulated fever like in pneumonia. The client’s diaphoresis and flushing indicate intact heat loss mechanisms, not failure. This statement is inaccurate, as fever, not hyperthermia, drives the observed symptoms in this scenario.

Choice D reason: Endogenous pyrogens (e.g., IL-1, IL-6) stimulate prostaglandins, not leukotrienes, to reset the hypothalamic set point in fever. Leukotrienes are involved in allergic responses, not thermoregulation. This statement is inaccurate, as it misattributes the biochemical mediator of fever in pneumonia.

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Which client presenting in the clinic most likely reveals manifestation(s) of rheumatoid arthritis?

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Explanation

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