A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

Choice A reason: An elevated serum rheumatoid factor is most commonly associated with rheumatoid arthritis, an autoimmune disease. This finding supports the diagnosis and indicates the presence of autoantibodies that attack the body's own tissues. The rheumatoid factor is used as one of the diagnostic criteria for rheumatoid arthritis and confirms the autoimmune nature of the disease. It does not indicate disease severity or progression but rather the presence of the disease.

Choice B reason: An elevated serum rheumatoid factor is not necessarily representative of a decline in the client's condition. While high levels of rheumatoid factor can be present in individuals with active disease, they do not directly correlate with disease activity or progression. The presence of rheumatoid factor alone does not provide information about the current state or severity of the client's condition.

Choice C reason: An elevated serum rheumatoid factor does not indicate the onset of joint degeneration. Rheumatoid factor is an antibody that indicates the presence of an autoimmune response but does not directly cause joint damage. Joint degeneration in rheumatoid arthritis results from the chronic inflammation and immune response within the joints, leading to tissue damage over time. Rheumatoid factor is a marker of the disease but not a direct indicator of joint damage.

Choice D reason: An elevated serum rheumatoid factor is not evidence of the spread of the disease to the kidneys. Rheumatoid arthritis primarily affects the joints and can also have systemic manifestations, but the presence of rheumatoid factor is not indicative of kidney involvement. Kidney involvement in rheumatoid arthritis is relatively rare and would typically require additional diagnostic tests and clinical evaluation to determine.

Choice A reason: Administering PRN pain medication can help manage the client's discomfort, but it does not address the underlying cause of the pain. It is essential to assess and identify the source of the pain before administering pain relief. Providing pain medication without a thorough assessment may mask symptoms of a serious underlying issue.

Choice B reason: Observing the leg for swelling is important, as swelling can indicate complications such as compartment syndrome or infection. However, it is not the first action the nurse should take. While swelling is a significant sign, assessing blood flow to the extremity is more critical and should be prioritized.

Choice C reason: Assessing peripheral pulses is the correct first intervention. The presence of foot pain in a client with an external fixation device for a fractured femur could indicate compromised blood flow to the lower extremity. Assessing the peripheral pulses will help determine if there is adequate circulation. If pulses are weak or absent, it may suggest a serious vascular issue that requires immediate intervention to prevent further complications such as tissue ischemia or necrosis.

Choice D reason: Auscultating blood pressure is a routine assessment but does not directly address the immediate concern of left foot pain in this scenario. Blood pressure assessment is important for overall health monitoring but is not the priority when dealing with a possible vascular complication in the affected limb. Ensuring adequate blood flow to the extremity takes precedence.