A 40-year-old client presents with a complaint of morning stiffness in her hands, and painful joints of about 3 months duration. On physical examination, you note deviation of the fingers of both hands toward the ulnar side, and swelling and thickening of the proximal interphalangeal joints. You refer the client to a physician for diagnosis and treatment of what you expect to be

Correct Answer: C

Rationale: The correct answer is C) rheumatoid arthritis. In this case, the client's presentation of morning stiffness, ulnar deviation of fingers, swelling, and thickening of proximal interphalangeal joints are classic signs of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that primarily affects the joints, causing inflammation, pain, and deformity if left untreated. Option A) osteoarthritis is a degenerative joint disease primarily caused by wear and tear on the joints, typically affecting older adults. It does not typically present with the same pattern of joint involvement as described in the case. Option B) degenerative joint disease is a general term for conditions like osteoarthritis, which involve the breakdown of joint cartilage over time. However, the specific symptoms and joint deformities described in the case are more indicative of rheumatoid arthritis. Option D) gouty arthritis is a type of arthritis caused by the buildup of uric acid crystals in the joints, often affecting the big toe. The symptoms and joint deformities described in the case do not align with those typically seen in gouty arthritis. Educationally, understanding the distinct clinical presentations of different types of arthritis is crucial for healthcare providers to accurately diagnose and manage patients. Recognizing the specific signs and symptoms of rheumatoid arthritis can lead to timely referral for appropriate treatment, which can help improve outcomes and quality of life for patients with this chronic condition.

Correct Answer: D

Rationale: The correct answer is D) Antinuclear antibody (ANA) in confirming the diagnosis for Mrs. Post. ANA is a crucial test in diagnosing autoimmune disorders such as systemic lupus erythematosus (SLE), which can present with neurological symptoms. ANA detects autoantibodies that target the cell nucleus, indicating an autoimmune response affecting multiple organs, including the nervous system. Option A) Sedimentation rate is a nonspecific marker of inflammation and does not provide information specific to neurological disorders. Option B) Rheumatoid factor is associated with rheumatoid arthritis, primarily affecting the joints, not commonly linked to neurological issues. Option C) LE cells are specific to lupus erythematosus, but not necessarily to neurological involvement. In an educational context, understanding the significance of specific laboratory tests in diagnosing neurological conditions is crucial for healthcare professionals. This question emphasizes the importance of ANA testing in the workup of patients with suspected autoimmune neurological disorders, guiding appropriate treatment and management strategies based on accurate diagnoses.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Inability to take oral medications because of vomiting. This is the most critical symptom that requires immediate medical attention in a patient with systemic lupus erythematosus (SLE) who is being discharged on prednisone and aspirin. Patients with SLE are often on immunosuppressive medications like prednisone to manage their condition. Vomiting can prevent proper absorption of these medications, leading to inadequate treatment and potential disease exacerbation. Therefore, the patient must contact their physician promptly to address this issue and ensure appropriate management. Now, let's discuss why the other options are incorrect: A) Missed menstrual period: While changes in menstrual periods can occur in patients with SLE, it is not an urgent symptom that necessitates immediate medical attention. C) Temperature elevated to 99.6°F: A mild elevation in temperature is not uncommon and may not be alarming, especially in the context of autoimmune diseases. It is not a critical symptom that requires immediate action. D) Ankle edema: Ankle edema can be a symptom of SLE, but it is not as urgent as the inability to take medications due to vomiting. It can be addressed at the next scheduled appointment or sooner if it worsens significantly. Educationally, this question highlights the importance of recognizing critical symptoms in patients with SLE and understanding the significance of adherence to medication regimens. It emphasizes the need for patients to communicate effectively with their healthcare providers to ensure optimal management of their condition and prevent potential complications.

Correct Answer: B

Rationale: In the case of a patient who has just undergone open carpal tunnel release surgery, keeping the hand and arm elevated above the level of the heart is crucial for reducing postoperative swelling. By elevating the extremity, gravity helps to facilitate venous return and prevent the accumulation of excess fluid in the surgical site, which can lead to edema and delayed healing. Option A, reducing lymphatic drainage, is incorrect because elevating the arm actually helps to improve lymphatic drainage by aiding in the movement of lymphatic fluid back towards the central circulation. Option C, restricting hand movements, is not the primary purpose of keeping the hand elevated postoperatively. While some restrictions on hand movements may be necessary to protect the surgical site, the main goal of elevation is to reduce swelling. Option D, decreasing the possibility of nosocomial infection, is not directly related to the rationale for keeping the hand elevated postoperatively. Infection prevention involves other strategies such as maintaining proper hand hygiene and aseptic techniques during wound care. Educationally, it is important for healthcare providers to understand the rationale behind postoperative care instructions to ensure optimal patient outcomes. By grasping the reasons for specific interventions like elevation, healthcare professionals can provide better care and help patients recover more effectively.

Correct Answer: C

Rationale: The correct answer is C) Carpal tunnel syndrome. Patients who work in settings that require repetitive hand movements over a long period are at an increased risk for developing carpal tunnel syndrome. This is because repetitive motions can cause swelling or inflammation in the carpal tunnel, a narrow passageway in the wrist where the median nerve and tendons pass through. This can lead to compression of the median nerve, resulting in symptoms such as pain, numbness, tingling, and weakness in the hand and wrist. Option A) Osteomyelitis is incorrect because it is a bone infection typically caused by bacteria, not related to repetitive hand movements. Option B) Osteoporosis is incorrect as it is a condition characterized by weakened bones, usually due to loss of bone density, and is not directly related to repetitive hand movements. Option D) Fracture of the overused area is incorrect because while repetitive stress can lead to overuse injuries like stress fractures, carpal tunnel syndrome is a more common and specific risk associated with repetitive hand movements. Educationally, understanding the risk factors associated with repetitive hand movements and the development of carpal tunnel syndrome is crucial for healthcare professionals, especially those working with patients in occupational therapy, physical therapy, or ergonomics. By recognizing these risks, professionals can provide preventive education, ergonomic interventions, and early interventions to mitigate the impact of repetitive motion injuries on individuals working in high-risk settings.