Examl 4:l NSGl 320/l NSG320l (NEWl 2025/l
2026l Update)l Adultl Healthl Nursingl Il
Completel Guide|l Questionsl &l Answers|l
Gradel A|l 100%l Correctl (Verifiedl
Solutions)-l GCU
QUESTION
rheumatoidl arthritis
Answer:
chronic,l systemicl autoimmunel disorderl characterizedl byl inflammationl ofl thel CTl inl
synoviall joints
-periodsl orl remissionl andl exacerbationl
-causesl symptomsl outsidel ofl thel jointsl andl alll aroundl thel bodyl (extraarticular)l
MANIFESTATIONS
-subtle:l fatigue,l anorexia,l weightl loss,l stiffness
-specificl jointl involvement:l pain,l warmth,l inflammation,l limitedl movement
-stiffnessl afterl inactivity,l morningl stiffnessl lastsl 60l minsl tol hrs
-symmetrical
-oftenl involvesl smalll joint:l PIP,l MTP,l MCP
-largerl jointsl andl cervicall vertebrael mayl bel involvedl
EXTRAARTICULARl MANIFESTATIONS
1.l atherosclerosis:
-chronicl inflammation->damagel tol BV
-increasedl Cll plaques,l whenl theyl dislodgel theyl canl causel heartl attackl orl stroke
2.l rheumatoidl nodules:
-firm,l nonl tender,l onl bonyl prominencesl exposedl tol pressure
-fingersl andl elbows
-mayl forml inl thel lungs,l watchl forl skinl damagel
3.l Sjogren'sl syndrome:l
-damagel tol lacrimall glands
-dry,l gritty,l photosensitivel eyes
4.l feltyl syndrome:
-largel spleen,l lowl WBC->infection,l lymphomal
5.l flexionl contracturel andl handl deformity:
-leadl tol decreasedl gripl strength
6.l depression:
,-causedl byl pain
-increasedl cl reactivel proteinl froml inflammationl linkedl tol depression
QUESTION
RAl cont.
Answer:
DIAGNOSE
-atl leastl onel jointl wl synovitis
-RFl levels
-symptoms
-synoviall fluidl analysisl
DRUGl THERAPY
*cornerstonel tol treatmentl
1.l DMARDS
-diseasel modifyingl antirheumaticl drugs
-irreversiblel changesl inl thel firstl yearl sol HCPl aggressivelyl prescribedl thesel tol slowl
progressionl andl decreasel riskl ofl deformityl andl erosion
-hydroxychloroquine,l methotrexate,l leflunomide,l sulfasalazine
2.l biologicall responsel modifiers
-immunotherapy
-slowl progression,l inhibl inflaml response
-usedl alonel orl wl DMARDS
-forl modl tol severel RAl notl responsivel tol DMARDl
*alert:l xl rayl andl tuberculinl testl before,l livel vaccinesl takenl 4l weeksl beforel startingl
this,l monitorl forl infectionl
OTHER
-nsaids
-intraarticularl orl systemicl corticosteroidl injections
-TNFl inhib:l endl inl -mab
QUESTION
RAl management
Answer:
DRUGl THERAPY
REST
-alternatel periodsl ofl restl andl activity
-avoidl bedl rest
-8l tol 10l hoursl ofl sleepl plusl daytimel rest
,-sleepl wl properl alignment:l firml mattress,l extensionl ratherl thanl flexion,l nol pillowl underl
knees,l smalll flatl pillowl underl head
COLDl THERAPY
-duringl exacerbation
-nol morel thanl 10-15l minsl atl al time,l dol multl timesl al day
-icel packsl orl frozenl veggies
HEATl THERAPY
-moistl heat:l paraffinl baths,l headl pad,l moistl hotl packs,l warml bathl orl shower
EXERCISE
-forl strength,l endurance,l andl flexibility
-aquaticl exercisel inl warml pool
-dailyl gentlel ROM
JOINTl PROTECTION
-assistivel devices
-modifyl activitiesl tol decreasel stressl onl joint
-inl reachl storage
NUTRITION
-wl loss:l bcl ofl pain,l depression,l decreasedl mobilityl tol gol shop
-wl gain:l corticosteroids,l decreasel mobility
PSYCHOl SUPPORT
QUESTION
gout
Answer:
typel ofl arthritisl characterizedl byl highl uricl acidl levels,l andl uricl acidl depositsl inl 1+l
joints
CAUSESl OFl HIGHl URICl ACID
-cancer,l chemo
-alc:l beerl andl wine
-obesity
-HTN
-diabetes
-metabolicl syndromel
-renall problems
-acidosis
MANIFESTATIONS
-affectl onel orl morel joints,l typicallyl greatl toel butl canl occurl inl wrist,l knee,l ankle,l andl
midfoot
-affectedl joint:l cyanotic/dusky,l tender
-attackl canl bel triggeredl byl infection,l trauma,l surgery,l orl alc
, >lastsl 2-10l days
>suddenl swellingl andl severel painl onsetl atl nightl andl peaksl inl al fewl hoursl
-chronic:l multiplel jointl involvement,l tophil (hardl whitel nodules)
DIAGNOSE
-normall uricl acidl levels:l 2.7-8.5
>higherl thel numberl thel greaterl riskl ofl depositl andl attack
-goldl standard:l synoviall fluidl aspiration
-xl rayl ofl affectedl jointl
-24l hrl urinel uricl acid:l determinel causel
DRUG
1.l acutel attack:
-orall colchicine:l decreasel inflammationl
-nsaidsl forl pain
-corticosteroids
2.l preventl futurel attacks:
-xanthinel oxidasel inhibitors:l decreasel uricl acidl production
>allopurinol
>febuxostatl
MANAGE
-monitorl uricl acidl levels
-dietl therapy:
>nol alcl andl purinel foods
>weightl reduction
-mayl needl bedl rest
-supportivel carel forl affectedl joint
QUESTION
systemicl lupusl erythematosus
Answer:
autoimmune,l inflammatoryl diseasel thatl affectsl multiplel bodyl systems
INTEGUMENT
-skinl lesions:l typicallyl inl sunl exposedl areasl
>chronicl cutaneousl lupusl erythematosusl (CCLE):l discoidl lesionsl onl scalpl andl face
>subacutel cutaneousl lupusl erythematosusl (SCLE):l red,l ringl shapedl lesionsl onl nosel andl
cheeksl
-alopecia
-orall ulcers
MUSCULOSKELETAL
-polyarthralgial (inflaml ofl multl joints)l wl morningl stiffness
-deformity:l swanl neckl fingers,l ulnarl deviation
2026l Update)l Adultl Healthl Nursingl Il
Completel Guide|l Questionsl &l Answers|l
Gradel A|l 100%l Correctl (Verifiedl
Solutions)-l GCU
QUESTION
rheumatoidl arthritis
Answer:
chronic,l systemicl autoimmunel disorderl characterizedl byl inflammationl ofl thel CTl inl
synoviall joints
-periodsl orl remissionl andl exacerbationl
-causesl symptomsl outsidel ofl thel jointsl andl alll aroundl thel bodyl (extraarticular)l
MANIFESTATIONS
-subtle:l fatigue,l anorexia,l weightl loss,l stiffness
-specificl jointl involvement:l pain,l warmth,l inflammation,l limitedl movement
-stiffnessl afterl inactivity,l morningl stiffnessl lastsl 60l minsl tol hrs
-symmetrical
-oftenl involvesl smalll joint:l PIP,l MTP,l MCP
-largerl jointsl andl cervicall vertebrael mayl bel involvedl
EXTRAARTICULARl MANIFESTATIONS
1.l atherosclerosis:
-chronicl inflammation->damagel tol BV
-increasedl Cll plaques,l whenl theyl dislodgel theyl canl causel heartl attackl orl stroke
2.l rheumatoidl nodules:
-firm,l nonl tender,l onl bonyl prominencesl exposedl tol pressure
-fingersl andl elbows
-mayl forml inl thel lungs,l watchl forl skinl damagel
3.l Sjogren'sl syndrome:l
-damagel tol lacrimall glands
-dry,l gritty,l photosensitivel eyes
4.l feltyl syndrome:
-largel spleen,l lowl WBC->infection,l lymphomal
5.l flexionl contracturel andl handl deformity:
-leadl tol decreasedl gripl strength
6.l depression:
,-causedl byl pain
-increasedl cl reactivel proteinl froml inflammationl linkedl tol depression
QUESTION
RAl cont.
Answer:
DIAGNOSE
-atl leastl onel jointl wl synovitis
-RFl levels
-symptoms
-synoviall fluidl analysisl
DRUGl THERAPY
*cornerstonel tol treatmentl
1.l DMARDS
-diseasel modifyingl antirheumaticl drugs
-irreversiblel changesl inl thel firstl yearl sol HCPl aggressivelyl prescribedl thesel tol slowl
progressionl andl decreasel riskl ofl deformityl andl erosion
-hydroxychloroquine,l methotrexate,l leflunomide,l sulfasalazine
2.l biologicall responsel modifiers
-immunotherapy
-slowl progression,l inhibl inflaml response
-usedl alonel orl wl DMARDS
-forl modl tol severel RAl notl responsivel tol DMARDl
*alert:l xl rayl andl tuberculinl testl before,l livel vaccinesl takenl 4l weeksl beforel startingl
this,l monitorl forl infectionl
OTHER
-nsaids
-intraarticularl orl systemicl corticosteroidl injections
-TNFl inhib:l endl inl -mab
QUESTION
RAl management
Answer:
DRUGl THERAPY
REST
-alternatel periodsl ofl restl andl activity
-avoidl bedl rest
-8l tol 10l hoursl ofl sleepl plusl daytimel rest
,-sleepl wl properl alignment:l firml mattress,l extensionl ratherl thanl flexion,l nol pillowl underl
knees,l smalll flatl pillowl underl head
COLDl THERAPY
-duringl exacerbation
-nol morel thanl 10-15l minsl atl al time,l dol multl timesl al day
-icel packsl orl frozenl veggies
HEATl THERAPY
-moistl heat:l paraffinl baths,l headl pad,l moistl hotl packs,l warml bathl orl shower
EXERCISE
-forl strength,l endurance,l andl flexibility
-aquaticl exercisel inl warml pool
-dailyl gentlel ROM
JOINTl PROTECTION
-assistivel devices
-modifyl activitiesl tol decreasel stressl onl joint
-inl reachl storage
NUTRITION
-wl loss:l bcl ofl pain,l depression,l decreasedl mobilityl tol gol shop
-wl gain:l corticosteroids,l decreasel mobility
PSYCHOl SUPPORT
QUESTION
gout
Answer:
typel ofl arthritisl characterizedl byl highl uricl acidl levels,l andl uricl acidl depositsl inl 1+l
joints
CAUSESl OFl HIGHl URICl ACID
-cancer,l chemo
-alc:l beerl andl wine
-obesity
-HTN
-diabetes
-metabolicl syndromel
-renall problems
-acidosis
MANIFESTATIONS
-affectl onel orl morel joints,l typicallyl greatl toel butl canl occurl inl wrist,l knee,l ankle,l andl
midfoot
-affectedl joint:l cyanotic/dusky,l tender
-attackl canl bel triggeredl byl infection,l trauma,l surgery,l orl alc
, >lastsl 2-10l days
>suddenl swellingl andl severel painl onsetl atl nightl andl peaksl inl al fewl hoursl
-chronic:l multiplel jointl involvement,l tophil (hardl whitel nodules)
DIAGNOSE
-normall uricl acidl levels:l 2.7-8.5
>higherl thel numberl thel greaterl riskl ofl depositl andl attack
-goldl standard:l synoviall fluidl aspiration
-xl rayl ofl affectedl jointl
-24l hrl urinel uricl acid:l determinel causel
DRUG
1.l acutel attack:
-orall colchicine:l decreasel inflammationl
-nsaidsl forl pain
-corticosteroids
2.l preventl futurel attacks:
-xanthinel oxidasel inhibitors:l decreasel uricl acidl production
>allopurinol
>febuxostatl
MANAGE
-monitorl uricl acidl levels
-dietl therapy:
>nol alcl andl purinel foods
>weightl reduction
-mayl needl bedl rest
-supportivel carel forl affectedl joint
QUESTION
systemicl lupusl erythematosus
Answer:
autoimmune,l inflammatoryl diseasel thatl affectsl multiplel bodyl systems
INTEGUMENT
-skinl lesions:l typicallyl inl sunl exposedl areasl
>chronicl cutaneousl lupusl erythematosusl (CCLE):l discoidl lesionsl onl scalpl andl face
>subacutel cutaneousl lupusl erythematosusl (SCLE):l red,l ringl shapedl lesionsl onl nosel andl
cheeksl
-alopecia
-orall ulcers
MUSCULOSKELETAL
-polyarthralgial (inflaml ofl multl joints)l wl morningl stiffness
-deformity:l swanl neckl fingers,l ulnarl deviation
