Question

A nurse is caring for a client who has been recently diagnosed with rheumatoid arthritis (RA). Which assessment finding does the nurse expect to assess?.

Answer 1

Correct Answers:

Symmetrical joint pain.

Rationale :

🔸Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the synovial joints, resulting in symmetrical joint inflammation.

🔸It commonly begins in the small joints of the hands, wrists, and feet, and affects both sides of the body equally.

🔸Unlike osteoarthritis, RA pain typically worsens with rest and improves with movement.

🔸 Bouchard’s nodes are more characteristic of osteoarthritis, and unilateral pain is not consistent with RA's systemic nature.

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Answer 2

Correct Answers:

Swollen joints.

Rationale :

🔹Joint swelling is a classic manifestation of RA due to synovial membrane inflammation and fluid accumulation.

🔹This contributes to stiffness, warmth, and limited mobility.

🔹 RA is systemic, so fatigue, low-grade fever, and appetite loss can occur, but joint swelling is a more consistent and specific clinical finding early in the disease course.

🔹Deformities like knuckle changes typically occur later in progression.

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Answer 3

Correct Answers:

Assist the client to the bathroom.

Rationale :

Tasks that involve basic client care and routine activities of daily living (ADLs) can be safely delegated to unlicensed assistive personnel (UAPs).
Helping a stable post-op client to the bathroom falls within this scope. It does not require nursing judgment, nor does it involve assessment or medication administration.
In contrast, reassessing a surgical site, titrating IV fluids, or administering pain medication are considered nursing responsibilities that require clinical knowledge and licensure.
The nurse retains full accountability for the client's outcomes and must ensure that delegated tasks are appropriate and supervised when necessary.

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Answer 4

Correct Answers:

"I will carry my laundry basket with the tip of my fingers.".

Rationale :

✍️Clients with RA must be taught joint protection strategies to minimize further joint damage and deformity.

✍️Carrying objects with the tips of the fingers places excessive stress on the small joints of the hands, which are already vulnerable to inflammation and deformity in RA.

✍️ Instead, they should use larger, stronger muscles (like the arms and thighs) and hold items close to the body to reduce joint strain.

✍️This statement reflects a misunderstanding of proper technique and indicates the need for further teaching.

✍️ Client education should emphasize ergonomics and body mechanics to preserve joint function.

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Answer 5

Correct Answers:

Report of bloody stools.

Rationale :

👉Aspirin, a commonly used NSAID, is known to cause gastrointestinal mucosal irritation, which can lead to gastritis, ulcers, or GI bleeding.

👉A report of bloody stools could indicate a serious complication such as GI hemorrhage, which can be life-threatening and must be addressed immediately.

👉While joint inflammation and headaches are frequent in RA, they are not urgent.

👉Aspirin can exacerbate existing GI conditions, especially in older adults or those on long-term NSAID therapy.

👉This makes GI bleeding the most critical contraindication among the choices provided.

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Answer 6

Correct Answers:

"Drink 2 liters of fluid each day while taking the medication."

Rationale :

Allopurinol is a xanthine oxidase inhibitor used in chronic gout management to reduce uric acid production.
Increased fluid intake (at least 2–3 liters daily) is crucial because it dilutes the urine and helps prevent the formation of uric acid kidney stones, which are a common complication of gout and allopurinol use.
Clients should avoid aspirin, which can antagonize the uricosuric effect.
Taking it on an empty stomach is not advised due to potential GI irritation.
Crushing is unnecessary unless prescribed for a patient with swallowing difficulties.
The emphasis should be on hydration and monitoring for adverse effects like rash or hypersensitivity.

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Answer 7

Correct Answers:

Butterfly rash on the face.
Raynaud’s phenomenon.
Photosensitive skin.

Rationale :

🔸Butterfly rash on the face:

This is a classic manifestation of systemic lupus erythematosus (SLE), appearing as a red or purplish rash across the cheeks and bridge of the nose.
It often flares with sun exposure or during disease exacerbations.

🔸Raynaud’s phenomenon:

Many clients with lupus experience this condition, where fingers and toes turn white, blue, and then red due to cold-induced vasospasm.
It’s linked to vascular inflammation and immune complex deposition in SLE.

🔸Photosensitive skin:

Clients with SLE often have exaggerated responses to sunlight, resulting in skin rashes and worsening of systemic symptoms.
This photosensitivity is a hallmark of the disease and can trigger flares.

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Answer 8

Correct Answers:

Blurry vision

Rationale :

Hydroxychloroquine, an antimalarial used to treat SLE, can cause retinal toxicity, especially with long-term use.
Clients must be educated to report visual disturbances such as blurry vision, halos, or difficulty focusing, which may indicate early retinal damage.
This side effect can become irreversible if not caught early, so regular ophthalmologic evaluations (baseline and every 6–12 months) are recommended.
Other side effects like GI upset and pruritus are more common but less severe and manageable without altering the therapeutic plan.

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Answer 9

Correct Answers:

Female.
Obesity.
Estrogen therapy.

Rationale :

🔹Female:

Women are more prone to cholelithiasis due to hormonal influences, especially estrogen, which promotes bile stasis and cholesterol saturation.

🔹Obesity:

Excess body fat increases the risk of cholesterol supersaturation in bile, leading to gallstone formation.
Obesity also reduces gallbladder motility, increasing stone retention.

🔹Estrogen therapy:

Use of hormone replacement therapy or oral contraceptives raises estrogen levels, which impair bile flow and increase cholesterol levels, contributing to stone formation.

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Answer 10

Correct Answers:

"I can use either heat or ice to help relieve the discomfort:

Rationale :

🔹Clients with osteoarthritis (OA) often benefit from nonpharmacological interventions, including heat and cold therapy, to manage joint pain and stiffness.

Heat helps improve blood flow, increases flexibility, and eases muscle tension.
Cold reduces inflammation, swelling, and numbs pain in acutely inflamed joints.

🔹Clients should be taught how to use these therapies safely and effectively.

🔹 Elevating the knees with pillows can cause joint contractures, and complete activity limitation is not advised.

🔹Moderate exercise strengthens muscles, maintains joint mobility, and is a core recommendation in OA management.

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RN MS II Fall~2023 Quiz

No.

1 : A nurse is caring for a client who has been recently diagnosed with rheumatoid arthritis (RA). Which assessment finding does the nurse expect to assess?.

2 : A nurse in a provider's office is assessing a client who has been diagnosed with rheumatoid arthritis (RA). Which assessment finding does the nurse expect as a manifestation of this condition?

3 : The nurse is caring for a client who is post-op day 1 from a laparoscopic cholecystectomy. Which task should the nurse delegate to the unlicensed assistive personnel?

4 : The nurse is preparing discharge teaching for a client who has been recently diagnosed with Rheumatoid arthritis. Which of the statements made by the client would indicate the need for further teaching?

5 : A nurse is caring for a female client with rheumatoid arthritis, the client asks the nurse if it is safe to take aspirin. The nurse should recognize which of the following contraindications is of most concern?

6 : A nurse is teaching a client who has a new prescription of allopurinol for the treatment of Gout. Which of the following is most important to include in the client teaching?

7 : A client with Systemic lupus erythematosus (SLE) has been admitted into the Med-surgical unit. The nurse should recognize which of the following manifestations associated with lupus? (Select All that Apply.).

8 : A client with systemic lupus has been ordered hydroxychloroquine. Which of the following adverse effects is of most concern?

9 : A nurse working in the Med-surgical unit is caring for a client with choliathiasis. Which of the following risk factors are most associated with choliathiasis? (Select All that Apply.)

10 : A nurse in a medical clinic is providing teaching to an older adult client who has osteoarthritis that is affecting her knees. Which of the following client statements indicates an understanding of the teaching?

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