A client with emphysema is reporting difficulty breathing and exhibiting audible wheezing. The nurse administers albuterol as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse?

Choice A reason: A foreign body in the eye may cause irritation or damage but is not a contraindication for ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. The nurse would ensure removal of the foreign body first, but ketorolac can be used post-removal if indicated.

Choice B reason: Radiation exposure, such as from UV light, may cause photokeratitis but is not a specific contraindication for ophthalmic ketorolac. The medication reduces inflammation and pain, which may be beneficial in such cases. The nurse should assess for other ocular conditions, but radiation exposure alone does not preclude its use.

Choice C reason: Chemical burns require immediate irrigation and specific treatments based on the chemical involved. Ketorolac may reduce pain and inflammation post-irrigation, but it is not contraindicated. The nurse should prioritize burn management, but chemical burns do not inherently prohibit ketorolac use compared to corneal abrasions.

Choice D reason: Corneal abrasions are a contraindication for ophthalmic ketorolac, as NSAIDs can delay corneal healing and increase the risk of complications like corneal ulceration. The nurse must review the medical record to confirm the absence of abrasions, as ketorolac is typically used for postoperative pain, not traumatic corneal injuries.

Choice A reason: Palpating for joint warmth and swelling is the best technique for early rheumatoid arthritis, as it detects synovitis, a hallmark of the disease. Inflamed joints are warm, swollen, and tender due to autoimmune-driven synovial proliferation, enabling early identification and intervention to prevent joint damage.

Choice B reason: Measuring range of motion assesses joint function but is less specific for early rheumatoid arthritis. Reduced motion occurs later, after significant synovial inflammation or damage. Palpating for warmth and swelling directly identifies active synovitis, making it more effective for early detection.

Choice C reason: Assessing grip strength evaluates muscle and joint function but is nonspecific for early rheumatoid arthritis. Weakness may result from pain or later joint damage. Palpating for warmth and swelling targets synovial inflammation, the earliest sign, making it the preferred technique for early diagnosis.

Choice D reason: Observing gait and posture detects functional limitations but is not specific for early rheumatoid arthritis. Gait changes occur with advanced disease or other conditions. Palpating for joint warmth and swelling directly identifies synovial inflammation, the primary early feature, making it more diagnostic.