The nurse is performing a musculoskeletal assessment and notes that the patient has a tender, swollen joint with decreased range of motion. What is the most likely diagnosis?

Correct Answer: B

Rationale: The correct answer is B: Rheumatoid arthritis. This diagnosis is supported by the presence of tender, swollen joint with decreased range of motion which are typical symptoms of rheumatoid arthritis. In this condition, the body's immune system attacks the joints, causing inflammation, pain, and limited movement. Osteoarthritis (A) typically presents with joint pain and stiffness, but not usually with significant swelling. Gout (C) is characterized by sudden and severe pain, redness, and swelling in joints, often affecting the big toe. Bursitis (D) is inflammation of the bursae sacs, causing pain and swelling around joints, but typically without significant limitation in range of motion.

Correct Answer: A

Rationale: Pain stimulates the sympathetic nervous system, often increasing pulse rate as the body responds to stress, a common finding in acute abdominal pain. A decrease in body temperature isnt typical, as pain may elevate temperature if inflammation is present. A decrease in blood pressure could occur in shock but isnt a primary pain response; pain often increases blood pressure initially. An increase in respiratory depth (D replaced with E) and rate (E) may occur, but the correct answer focuses on A. Pain typically accelerates pulse and respiratory rate while potentially decreasing depth, not increasing it. Choice A is correct as it consistently aligns with physiological responses to severe pain, supported by clinical observations of tachycardia in painful conditions like appendicitis or perforation.

Correct Answer: D

Rationale: Arrhythmias disrupt peripheral pulse reliability, requiring a central site. Brachial and radial are peripheral, potentially missing beats. Dorsalis pedis is distal, less accurate for arrhythmias. Apical at the heart apex directly counts beats, unaffected by peripheral irregularities, making it correct. Choice D is standard for arrhythmia patients, ensuring accurate rate and rhythm assessment per cardiovascular nursing protocols.

Correct Answer: B

Rationale: Pulse pressure is systolic minus diastolic: 140 - 60 = 80 . 60 is diastolic. 140 is systolic. 200 is unrelated. Choice B is correct, reflecting arterial pressure dynamics, a key nursing calculation.

Correct Answer: B

Rationale: Hypothermia is a core temperature below 95°F (35°C), but 96.8°F (36°C) is a practical threshold for early detection . An increase over 96.8°F suggests normothermia or fever. Cyanosis is a symptom, not hypothermia. ‘None' is incorrect. Choice B is correct, aligning with nursing definitions (e.g., CDC) where subnormal temperature signals risk, guiding interventions like warming to prevent complications.