A patient with rheumatoid arthritis may reveal which of the following assessment data?

Appeared in: HPSSC - 2015

Explanation

Swan neck deformity is a hallmark sign of advanced rheumatoid arthritis (RA), clearly visible in the provided image.
This deformity is caused by chronic inflammation that damages the ligaments and tendons of the finger.
It is characterized by hyperextension of the proximal interphalangeal (PIP) joint and compensatory flexion of the distal interphalangeal (DIP) joint.

Option A: This describes the morning stiffness associated with Osteoarthritis (OA). Rheumatoid arthritis is characterized by prolonged morning stiffness that typically lasts for more than 60 minutes.
Option B: Heberden's nodes are bony enlargements of the distal interphalangeal (DIP) joints. They are a classic sign of Osteoarthritis, not Rheumatoid Arthritis.
Option D: Rheumatoid arthritis is a systemic disease that typically presents with symmetric joint involvement, meaning it affects the same joints on both sides of the body.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of Rheumatoid Arthritis to guide bedside assessment, documentation, and the next nursing action.
Accurately differentiating RA from OA is critical because their treatments are vastly different. RA requires immunosuppressive drugs (DMARDs) to slow disease progression, while OA management focuses on pain relief and preserving function.
Nurses must assess for these specific deformities, as they indicate advanced disease and can severely impact a patient's ability to perform activities of daily living (ADLs).
Patient education is a key nursing role, focusing on joint protection strategies, energy conservation, and the importance of adherence to medication regimens to prevent further joint damage.

How to Approach the Question

First, identify the core condition in the question stem: 'rheumatoid arthritis'.
Carefully examine the provided image. Recognize the finger postures as classic deformities (swan neck and boutonnière).
Recall the defining characteristics of rheumatoid arthritis: it is a systemic, inflammatory, autoimmune disease causing symmetric joint swelling and prolonged morning stiffness (greater than 60 minutes).
Evaluate each option against this knowledge. 'Swan neck deformities' is a known, classic sign of RA and matches the visual evidence.
Systematically eliminate the incorrect options by identifying them as hallmark signs of Osteoarthritis (OA): morning stiffness less than 30 minutes, Heberden nodes, and asymmetric joint involvement.

Concept Tested & Keywords

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E6 Medicine Macleod Clinical Examination 15e p. 307-309

E6 Medicine Harrison 22e Part 2 p. 847-849

Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.