Choice A rationale:
Symmetrical joint pain that is relieved with rest. Rheumatoid arthritis (RA) is characterized by symmetrical joint pain, but the pain is not typically relieved with rest.
Choice B rationale:
Symmetrical joint pain. This is a common symptom of RA, as the disease often affects the same joints on both sides of the body.
Choice C rationale:
Bouchard’s nodes in the middle joints. Bouchard’s nodes are more commonly associated with osteoarthritis, not RA123.
Choice D rationale:
Unilateral pain in the weight-bearing joints. RA typically causes symmetrical joint pain, not unilateral.

Choice A rationale:
Swollen joints. Swelling is a common symptom of RA due to inflammation in the joints.
Choice B rationale:
Fatigue and loss of appetite. These are systemic symptoms that can occur with RA123.
Choice C rationale:
Low-grade fever. This can occur in RA due to the body’s immune response.
Choice D rationale:
Knuckle deformity. Over time, RA can cause deformities in the joints, including the knuckles.

Choice A rationale:
Reassess the incision site for bleeding. This task requires clinical judgment and should be performed by the nurse.
Choice B rationale:
Increase the client’s IV fluids. This task involves medication administration and should be performed by the nurse.
Choice C rationale:
Administer p.o. pain medication. This task involves medication administration and should be performed by the nurse.
Choice D rationale:
Assist the client to the bathroom. This is a task that can be safely delegated to unlicensed assistive personnel.

Choice A rationale:
Holding an object close to the body can help distribute the weight evenly and reduce strain on the joints, which is beneficial for someone with Rheumatoid arthritis.
Choice B rationale:
Using larger muscle groups like the arms and legs can help reduce the strain on smaller, more sensitive joints.
Choice C rationale:
Carrying a laundry basket with the tips of the fingers can put unnecessary strain on the finger joints, which can exacerbate symptoms of Rheumatoid arthritis.
Choice D rationale:
Bending at the knees, rather than the waist, can help protect the back and maintain balance when picking up an item from the floor.

Choice A rationale:
While inflammation in the joints is a symptom of rheumatoid arthritis, it is not a contraindication for taking aspirin.
Choice B rationale:
Joint pain that is not relieved with rest is a common symptom of rheumatoid arthritis, but it is not a contraindication for taking aspirin.
Choice C rationale:
A recent headache is not a contraindication for taking aspirin. In fact, aspirin is often used to relieve headaches.
Choice D rationale:
Bloody stools can be a sign of gastrointestinal bleeding, which can be exacerbated by aspirin use due to its blood-thinning properties.

Choice A rationale:
While it’s generally recommended to take medication with food to prevent stomach upset, allopurinol does not need to be taken on an empty stomach.
Choice B rationale:
Aspirin can increase the risk of bleeding, and since allopurinol can occasionally cause blood disorders, it’s not recommended to take these two medications together without medical advice.
Choice C rationale:
Allopurinol tablets should not be crushed. They should be swallowed whole with a glass of water.
Choice D rationale:
Drinking plenty of fluids while taking allopurinol can help prevent the formation of kidney stones, a potential side effect of the medication.

Choice A rationale:
Tophi presentation on the joints is associated with gout, not SLE1.
Choice B rationale:
Heberden’s nodes are associated with osteoarthritis, not SLE1.
Choice C rationale:
A butterfly rash on the face is a common manifestation of SLE1.
Choice D rationale:
Raynaud’s phenomenon can occur in SLE1.
Choice E rationale:
Photosensitive skin is a common symptom of SLE1.

Choice A rationale:
Extreme nausea is a common side effect of hydroxychloroquine, but it’s not the most concerning.
Choice B rationale:
Pruritus is a possible side effect of hydroxychloroquine, but it’s not the most concerning.
Choice C rationale:
Diarrhea is a common side effect of hydroxychloroquine, but it’s not the most concerning.
Choice D rationale:
Blurry vision is a serious side effect of hydroxychloroquine and can indicate retinal damage.

Choice A rationale:
An active lifestyle is generally not associated with an increased risk of cholelithiasis.
Choice B rationale:
Being female is a risk factor for cholelithiasis.
Choice C rationale:
Obesity is a well-known risk factor for cholelithiasis.
Choice D rationale:
A low-fat diet is generally not associated with an increased risk of cholelithiasis.
Choice E rationale:
Estrogen therapy can increase the risk of cholelithiasis.

Choice A rationale:
Elevating the legs can help reduce swelling, but placing pillows under the knees can potentially increase knee stiffness, which is not beneficial for osteoarthritis.
Choice B rationale:
While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help reduce pain and inflammation in osteoarthritis, it is not necessarily the first step in medication therapy. This can vary based on the individual’s condition and doctor’s recommendation.
Choice C rationale:
Physical activity is actually beneficial for osteoarthritis as it strengthens the muscles around the joints and improves joint flexibility. Limiting physical activity may lead to joint stiffness.
Choice D rationale:
Using heat or ice can help relieve discomfort caused by osteoarthritis. Heat can relax muscles and help lubricate the joint, and ice can help reduce joint swelling.

Choice A rationale:
Swan neck deformity is more commonly associated with rheumatoid arthritis, not osteoarthritis.
Choice B rationale:
Heberden and Bouchard nodes, which are hard, bony enlargements, are common clinical manifestations of osteoarthritis.
Choice C rationale:
Boutonniere deformity is also more commonly associated with rheumatoid arthritis. Joint swelling can occur in osteoarthritis, but it’s not as common as other symptoms.
Choice D rationale:
Pain at rest and crepitus (a grating or crackling sound or sensation) can occur in osteoarthritis.

Choice A rationale:
Avoiding stressful situations can help manage fibromyalgia symptoms as stress can exacerbate the condition.
Choice B rationale:
Increasing caffeine intake is not recommended as it can interfere with sleep, which is crucial for managing fibromyalgia.
Choice C rationale:
Steroids are not a standard treatment for fibromyalgia and they do not provide a cure.
Choice D rationale:
Duloxetine is an antidepressant used to treat fibromyalgia symptoms. It should not be stopped abruptly without consulting a healthcare provider.

Choice A rationale:
A dry, raised rash on the face is a common symptom of SLE, but it’s not the highest priority.
Choice B rationale:
Pitting edema in the ankles and feet could indicate kidney involvement, a serious complication of SLE that requires immediate medical attention.
Choice C rationale:
Joint pain is a common symptom of SLE, but it’s not the highest priority.
Choice D rationale:
Feelings of depression should be addressed, but they are not the highest priority in this context.

Choice A rationale:
The Sims position is not specifically recommended for easing discomfort after cholecystectomy.
Choice B rationale:
The right lateral position is not specifically recommended for easing discomfort after cholecystectomy.
Choice C rationale:
Deep breathing and coughing can help alleviate discomfort due to CO2 used during surgery by promoting the absorption and excretion of the gas.
Choice D rationale:
Placing the client in the prone position with the head of bed elevated is not specifically recommended for easing discomfort after cholecystectomy.

Choice A rationale:
Sleeping too many hours can indeed cause fatigue. However, this is not the most likely cause in this case as the patient has fibromyalgia, which is often associated with sleep disturbances.
Choice B rationale:
While a new mattress might improve sleep quality, there’s no information suggesting that the patient’s mattress is a problem.
Choice C rationale:
Using electronics at bedtime can interfere with sleep, but again, there’s no information suggesting that this is the case here.
Choice D rationale:
Fibromyalgia is often associated with sleep disturbances such as insomnia. This is the most likely cause of the patient’s fatigue.
Choice E rationale:
Worrying can indeed cause fatigue, but there’s no information suggesting that the patient has been worried about anything in particular.

Step 1 is to convert the time from minutes to hours: 15 min ÷ 60 min/hr = 0.25 hr.

Step 2 is to calculate the rate: 250 ml ÷ 0.25 hr = 1000 ml/hr.

Choice A rationale:
Liver and bacon are high in purines, which can exacerbate gout. Therefore, they should be avoided.
Choice B rationale:
Vegetables and bananas are low in purines and are therefore good choices for a patient with gout.
Choice C rationale:
Fruits are generally low in purines, but bacon is high in purines and should be avoided.
Choice D rationale:
Nuts are a good choice as they are low in purines, but fish can be high in purines and should be eaten in moderation.

Choice A rationale:
A high sugar and low fat diet is not recommended for cholecystitis. High sugar diets can lead to obesity, which is a risk factor for gallstones. Low fat is correct, as fat can stimulate the gallbladder to contract, potentially causing pain.
Choice B rationale:
A low protein and high fat diet is not recommended. Protein is needed for healing and high fat can exacerbate symptoms.
Choice C rationale:
A high protein and low fat diet is generally recommended. Protein is needed for healing and low fat is recommended to prevent gallbladder contraction.
Choice D rationale:
A high carbohydrate diet is not specifically beneficial or harmful for cholecystitis. It’s the type of carbohydrate that matters - whole grains are beneficial, while refined carbs are not.

Choice A rationale:
High veal diet should be avoided as it is high in purines which can exacerbate gout.
Choice B rationale:
High bacon diet should be avoided as it is high in purines and sodium which can exacerbate gout.
Choice C rationale:
Increasing alcohol intake is not recommended as it can increase uric acid production, worsening gout.
Choice D rationale:
High fish diet should be avoided as it is high in purines which can exacerbate gout.
Choice E rationale:
Starvation diet is not recommended as rapid weight loss can increase uric acid levels, triggering a gout attack.

Choice A rationale:
This patient is unstable (low BP) and should be assigned to a more experienced nurse.
Choice B rationale:
This patient is stable and requires teaching, which is appropriate for a new graduate.
Choice C rationale:
This patient is unstable (confused, DKA) and should be assigned to a more experienced nurse.
Choice D rationale:
This patient is unstable (chest pain) and should be assigned to a more experienced nurse.

Choice A rationale:
Ibuprofen is not the first step in medication therapy for OA. It can be used for pain relief but is not recommended during pregnancy.
Choice B rationale:
Restricting all physical activity is not recommended. Moderate exercise can help maintain joint flexibility and strength.
Choice C rationale:
Pregnancy can impact OA due to weight gain and hormonal changes. However, keeping weight gain within recommended limits can help manage symptoms.
Choice D rationale:
Pain from OA may increase due to pregnancy weight gain. This is an important point to include in teaching.

Choice A rationale:
Hypoglycemia is a condition characterized by low blood sugar levels. However, the client is on Prednisone and NSAIDs, which do not typically cause hypoglycemia. Therefore, it’s unlikely that the client would develop this condition as a side effect of these medications.
Choice B rationale:
Weight loss could occur in some individuals taking Prednisone due to potential side effects like loss of appetite or stomach upset. However, it’s more common for individuals on Prednisone to experience weight gain due to increased appetite.
Choice C rationale:
Weight gain is a common side effect of Prednisone. This medication can cause increased appetite leading to weight gain. It can also cause fluid retention and redistribution of fat, particularly in the face, back of the neck, and abdomen.
Choice D rationale:
Hyperglycemia, or high blood sugar, is a potential side effect of Prednisone. This medication can cause an increase in blood sugar levels, which if persistently high, can lead to diabetes. Regular monitoring of blood glucose levels is recommended for clients on this medication.

Choice A rationale:

A clear liquids diet is often recommended for patients with gastrointestinal issues as it allows the digestive system to rest. However, this diet lacks adequate nutrition for long-term use.

Choice B rationale:

A regular diet may exacerbate the patient’s abdominal discomfort, especially since her pain worsens after meals.

Choice C rationale:

Maintaining the patient NPO (nothing by mouth) is typically done before procedures that require anesthesia, such as a HIDA scan, to reduce the risk of aspiration.

So, the correct answer is Choice C: Maintain patient NPO. This is because the patient is scheduled for a HIDA scan, and it’s standard practice to keep patients NPO prior to such procedures.