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A nurse is caring for a 57-year-old female client in the emergency department who presents with joint pain and stiffness in her hands. The client has a history of hypertension and type 2 diabetes.

Exhibits

A nurse is analyzing the assessment findings. Which findings are indicative of rheumatoid arthritis? Select all that apply.

Small joints of the hand

Joint swelling

Symmetrical involvement

Pain increases with motion

Heberden nodes

Fatigue and fever

Morning stiffness quickly resolves

Answer and Explanation

Correct Answer : A,B,C,F,G

Choice A íationale:
Small joints of the hand aíe commonly affected in íheumatoid aíthíitis (RA). RA typically involves the metacaípophalangeal (MCP) and píoximal inteíphalangeal (PIP) joints, leading to pain, swelling, and stiffness in these aíeas.
Choice B íationale:
Joint swelling is a hallmaík of RA. ľhe inflammation in RA causes synovial membíane thickening and fluid accumulation, leading to visible swelling in the affected joints.
Choice C íationale:
Symmetíical involvement is chaíacteíistic of RA. ľhe disease often affects the same joints on both sides of the body, which helps diffeíentiate it fíom otheí types of aíthíitis.
Choice D íationale:
Pain incíeases with motion is not specific to RA. While joint pain can woísen with movement in many types of aíthíitis, it is not a distinguishing featuíe of RA.
Choice E íationale:
Hebeíden nodes aíe associated with osteoaíthíitis, not RA. ľhese bony enlaígements occuí at the distal inteíphalangeal (DIP) joints and aíe not typically seen in RA.
Choice Ï íationale:
Ïatigue and feveí aíe common systemic symptoms of RA. ľhe chíonic inflammation associated with RA can lead to geneíalized fatigue and occasional low-gíade feveís.
Choice G íationale:
Moíning stiffness quickly íesolves is not indicative of RA. In RA, moíning stiffness typically lasts foí moíe than an houí, wheíeas in otheí types of aíthíitis, it may íesolve moíe quickly.

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Correct Answer is A

Explanation

Choice A rationale
Generalized lumpiness of both breasts with no discrete masses and no nipple discharge is a common finding, especially before menstrual periods. Assuring the client that her breasts are normal and advising annual evaluations is appropriate.
Choice B rationale
Requesting a return visit after her menstrual period for a breast exam re-check is unnecessary if the findings are consistent with normal premenstrual changes.
Choice C rationale
Explaining to the client that an ultrasound of the breast will likely be necessary is not warranted based on the current findings.
Choice D rationale
Suggesting that the client schedule a mammogram after her next menstrual period is not necessary for a young adolescent with normal premenstrual breast changes.

A. Continue with the remainder of the client’s physical assessment. B. Report the client’s abnormal lung sounds to the healthcare provider. C. Ask the client to cough and then auscultate at the site again. D. Measure the client’s oxygen saturation with a pulse oximeter.

Correct Answer is A

Explanation

Choice A rationale
Vesicular breath sounds are normal breath sounds heard over the peripheral lung fields. Hearing vesicular sounds in the bases of both lungs posteriorly indicates normal air movement in the lungs. Therefore, the nurse should continue with the remainder of the client’s physical assessment.
Choice B rationale
Reporting the client’s lung sounds to the healthcare provider is unnecessary because vesicular breath sounds are normal and do not indicate any abnormality.
Choice C rationale
Asking the client to cough and then auscultate at the site again is not required since vesicular breath sounds are normal and do not indicate any need for further immediate assessment.
Choice D rationale
Measuring the client’s oxygen saturation with a pulse oximeter is not necessary in this context because the vesicular breath sounds indicate normal lung function.

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Naxlex Comprehensive Predictor Exams

An adolescent female client comes to the clinic troubled by breast tenderness before her menstrual periods. On examination, the nurse notes generalized lumpiness of both breasts with no discrete masses and no nipple discharge. Which action should the nurse take?

Correct Answer is A

Explanation

While auscultating a client’s breath sounds, the nurse hears vesicular sounds in the bases of both lungs posteriorly. Which action should the nurse take in response to this finding?

Correct Answer is A

Explanation

The nurse observes the presence of brittle, concave curves to the nails of a client on assessment. Which information should the nurse obtain from the client that may explain the appearance of the nails?

In assessing tactile fremitus in the client with suspected pneumonia, the nurse should perform which action?

The nurse completes palpation of the thoracic region on an adult client. Which finding is considered normal for this client?

A client presents with itching and pain in the left ear that started several days after beginning swim lessons. The nurse observes a discharge coming from the ear with a musty odor. How should the nurse expect the ear to appear when performing an otoscopic examination?

The nurse examines a client’s right great toe. The joint is red, edematous, and very painful with limited range of motion. The client’s serum uric acid levels are elevated. Which action should the nurse tell the client to make?

The nurse asks a female client about the proverb “Glass Houses,” and she replies, “It will break the windows.”. Which conclusion should be documented about this client’s response?

In assessing a client’s neck, the nurse hears a blowing swish when auscultating the area over the left carotid artery, but hears no sound over the right carotid artery. How should the nurse document this finding?