DHS 2018 shift 1st
Medical & Surgical Nursing
Medium
To prevent deformities of the knee joints in a client with an exacerbation of rheumatoid arthritis, the nurse should?
Appeared in: DHS 2018 shift 1st
Explanation
- During a rheumatoid arthritis (RA) exacerbation, inflammation causes pain, but complete immobility leads to permanent joint stiffness (contractures) and muscle weakness.
- Encouraging gentle movement within the client's pain tolerance is the best therapeutic approach to balance rest and activity.
- This strategy maintains joint function, prevents the joint from 'freezing' in a bent position, and preserves surrounding muscle strength.
- Exercises should be performed slowly and smoothly, stopping at the point of resistance or significant pain, to avoid worsening the inflammation.
Why Other Options Were Wrong
- Option A: Prolonged bed rest is contraindicated as it promotes joint stiffness, muscle atrophy, and the development of flexion contractures, which are permanent deformities.
- Option B: Passive range-of-motion (PROM) is a crucial intervention if the client cannot actively move their joints due to pain or weakness. It helps maintain mobility without requiring muscle effort from the client.
- Option D: Prolonged immobilization for several weeks is highly dangerous and can lead to permanent joint fusion (ankylosis) and severe, irreversible muscle atrophy.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Nursing management of rheumatoid arthritis and prevention of joint deformities to guide bedside assessment, documentation, and the next nursing action.
- Nurses play a vital role in educating clients with RA on self-management, emphasizing the critical balance between rest and activity to preserve long-term joint function and independence.
- A common client misconception is that complete rest is best during a flare-up; nurses must correct this and teach safe, gentle exercise techniques.
- What if... the client's pain is severe and they refuse to move the joint at all? The nurse should first ensure pain is adequately managed with prescribed analgesics and consider applying cold packs to reduce acute inflammation. Then, the nurse can attempt very gentle passive ROM, explaining the rationale, and collaborate with a physical therapist for a specialized plan.
How to Approach the Question
- First, identify the core of the question: it asks for a nursing intervention to prevent deformities in a client with an exacerbation of rheumatoid arthritis.
- Recall the pathophysiology of RA. It is an inflammatory disease where inflammation can lead to pain and swelling, but lack of movement leads to permanent damage like joint stiffness and contractures.
- Analyze the options based on the principle of balancing rest and activity. Options promoting complete immobility (bed rest, immobilization) are likely incorrect because they lead to contractures.
- Evaluate the options promoting movement. Discouraging passive ROM is counterintuitive, as it's a way to maintain mobility. Encouraging motion within pain limits respects the client's symptoms while still achieving the therapeutic goal.
- Conclude that the best strategy must involve some form of controlled movement to prevent stiffness. Therefore, encouraging motion within pain limits is the most logical and evidence-based answer.
Concept Tested & Keywords
- Concept Tested: Nursing management of rheumatoid arthritis and prevention of joint deformities.
- Stem keywords: prevent deformities, knee joints, rheumatoid arthritis, exacerbation
- Lead-in keywords: nurse should
- Negative lead-in flag: false
Question ID
QruSogV45F68UpU2RDhjJq
Reference Book
E6 Medicine Davidson Principles Practice 24e p. 1021-1023
E6 Nursing Fundamentals Taylor p. 336-338
Practise the full DHS 2018 shift 1st
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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