RHEUMATOID ATHRITIS Diagnostic Evaluation 2026/2027
Diagnostic Evaluation
Terry is scheduled for a CBC (complete blood count), RF (rheumatoid factor), ESR (erythrocyte
sedimentation rate), joint x-rays, and a bone scan. Additional diagnostic tests, which may be
performed to help diagnose rheumatoid arthritis, include MRI and synovial fluid analysis, or
synovial biopsy.
1.
Which nursing intervention related to the scheduled bone scan is most important to implement?
A) Ask the client if she has any internal metal devices.
INCORRECT
This is an important measure prior to an MRI, because the magnetic force may cause movement
of internal metal devices.
B) Assess the joint puncture site for signs of inflammation.
INCORRECT
This is an important intervention after synovial joint fluid analysis. Joint fluid for analysis is
obtained using sterile procedure, but the client should be monitored carefully after the procedure
for any signs of bleeding or infection at the site of the needle insertion.
C) Advise the client that the test requires lying still in an enclosed cylinder.
INCORRECT
This is an important intervention prior to an enclosed MRI, since clients with claustrophobia may
have difficulty in an enclosed space.
D) Instruct Terry to increase fluid intake after the test.
CORRECT
Increasing fluid intake after a bone scan will help with elimination of the injected radioisotope.
Terry should also be instructed that because the dose of radioisotope is minimal, no special
precautions are necessary.
Points Earned: 0.0/1.0
Correct Answer(s): D
Etiology/Risk Factors
Terry's test results confirm the diagnosis of rheumatoid arthritis. Her CBC shows normochromic
anemia, her RF is positive, and her ESR is elevated. The x-rays and bone scan show evidence of
rheumatoid arthritis.
Terry is told of her diagnosis of rheumatoid arthritis (RA). She expresses confusion, and states,
"How did I get this? What is it? How long will I be like this?"
,RHEUMATOID ATHRITIS Diagnostic Evaluation 2026/2027
The nurse provides the following explanation:
Rheumatoid arthritis is an autoimmune disease affecting not only joints, but organ systems as
well. The symptoms of this inflammatory disease can often be controlled, but the disease itself
cannot be cured. It is a chronic, progressive disease that seems to affect women more often than
men.
2.
Which etiologic factor is related to the onseT of rheumatoid arthritis?
A) Increasing age.
INCORRECT
The onset of rheumatoid arthritis (RA) occurs primarily between the ages of 35-45, although it
can occur at any age.
B) Genetic predisposition.
CORRECT
Because the incidence of RA in persons with a positive family history is significantly greater than
for the general population, genetic predisposition is probably a significant etiologic factor. In
addition, increased stress has been linked to RA, and viral infections are believed to be a trigger
for the onset of this autoimmune disease.
C) Environmental exposure to carcinogens.
INCORRECT
Although environmental factors may be involved, there is no clear evidence to link specific
exposure to carcinogens to the onset of RA.
D) History of osteoarthritis.
INCORRECT
Osteoarthritis is a degenerative joint disease, and although it is not related to RA as an etiologic
factor, persons with RA may develop secondary degenerative joint disease.
Points Earned: 0.0/1.0
Correct Answer(s): B
Clinical Manifestations
The nurse completes an assessment of Terry.
3.
In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional
manifestation of RA is Terry likely to exhibit?
, RHEUMATOID ATHRITIS Diagnostic Evaluation 2026/2027
A) Finger tophi.
INCORRECT
Finger tophi are typically seen in the client with gout, although joint deformities and
subcutaneous nodules are common in advanced RA.
B) Drooling.
INCORRECT
In fact, the client with RA is likely to experience dry mouth, which, along with dry eyes, are the
hallmark symptoms. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness.
Of the several syndromes associated with advanced RA, Sjogren's syndrome is the most common.
C) Butterfly rash.
INCORRECT
A butterfly rash on the face is a classic manifestation of systemic lupus erythematosus (SLE)
rather than RA.
D) Fever.
CORRECT
A persistent low-grade fever is a common early manifestation of this inflammatory disease.
Remember, RA is both a local and systemic inflammatory disease with many generalized
symptoms such as fever, fatigue, and weakness, along with multiple lung, cardiac, and renal
manifestations.
Points Earned: 0.0/1.0
Correct Answer(s): D
Pharmacologic Therapy
The nurse's assessment findings for Terry include stiffness and swelling of her wrists and elbows,
with a decreased range of motion in these joints. On palpation of the joints, the nurse notes that
the joints feel somewhat soft. Terry indicates that she has experienced a slight fever, run-down
feeling, and a loss of appetite that has resulted in her five-pound weight loss.
Terry's healthcare provider prescribes the following medications:
• Buffered aspirin 500 mg PO daily.
• Auranofin (Ridaura) 6 mg PO daily.
• Methotrexate (Mexate) 2.5 mg PO q12h for 3 doses, then 7.5 mg weekly.
Ridaura is a gold compound used in RA for its antiinflammatory, antiarthritis, and immune-
modifying effects. In addition to these medications, corticosteroids such as prednisone may be
prescribed in the treatment of rheumatoid arthritis.
The nurse is aware that aspirin is a salicylate with excellent antiinflammatory, antipyretic, and
analgesic properties. However, it does have the potential for causing significant side effects and
toxicity, especially in the high doses needed to manage the symptoms of rheumatoid arthritis.
Diagnostic Evaluation
Terry is scheduled for a CBC (complete blood count), RF (rheumatoid factor), ESR (erythrocyte
sedimentation rate), joint x-rays, and a bone scan. Additional diagnostic tests, which may be
performed to help diagnose rheumatoid arthritis, include MRI and synovial fluid analysis, or
synovial biopsy.
1.
Which nursing intervention related to the scheduled bone scan is most important to implement?
A) Ask the client if she has any internal metal devices.
INCORRECT
This is an important measure prior to an MRI, because the magnetic force may cause movement
of internal metal devices.
B) Assess the joint puncture site for signs of inflammation.
INCORRECT
This is an important intervention after synovial joint fluid analysis. Joint fluid for analysis is
obtained using sterile procedure, but the client should be monitored carefully after the procedure
for any signs of bleeding or infection at the site of the needle insertion.
C) Advise the client that the test requires lying still in an enclosed cylinder.
INCORRECT
This is an important intervention prior to an enclosed MRI, since clients with claustrophobia may
have difficulty in an enclosed space.
D) Instruct Terry to increase fluid intake after the test.
CORRECT
Increasing fluid intake after a bone scan will help with elimination of the injected radioisotope.
Terry should also be instructed that because the dose of radioisotope is minimal, no special
precautions are necessary.
Points Earned: 0.0/1.0
Correct Answer(s): D
Etiology/Risk Factors
Terry's test results confirm the diagnosis of rheumatoid arthritis. Her CBC shows normochromic
anemia, her RF is positive, and her ESR is elevated. The x-rays and bone scan show evidence of
rheumatoid arthritis.
Terry is told of her diagnosis of rheumatoid arthritis (RA). She expresses confusion, and states,
"How did I get this? What is it? How long will I be like this?"
,RHEUMATOID ATHRITIS Diagnostic Evaluation 2026/2027
The nurse provides the following explanation:
Rheumatoid arthritis is an autoimmune disease affecting not only joints, but organ systems as
well. The symptoms of this inflammatory disease can often be controlled, but the disease itself
cannot be cured. It is a chronic, progressive disease that seems to affect women more often than
men.
2.
Which etiologic factor is related to the onseT of rheumatoid arthritis?
A) Increasing age.
INCORRECT
The onset of rheumatoid arthritis (RA) occurs primarily between the ages of 35-45, although it
can occur at any age.
B) Genetic predisposition.
CORRECT
Because the incidence of RA in persons with a positive family history is significantly greater than
for the general population, genetic predisposition is probably a significant etiologic factor. In
addition, increased stress has been linked to RA, and viral infections are believed to be a trigger
for the onset of this autoimmune disease.
C) Environmental exposure to carcinogens.
INCORRECT
Although environmental factors may be involved, there is no clear evidence to link specific
exposure to carcinogens to the onset of RA.
D) History of osteoarthritis.
INCORRECT
Osteoarthritis is a degenerative joint disease, and although it is not related to RA as an etiologic
factor, persons with RA may develop secondary degenerative joint disease.
Points Earned: 0.0/1.0
Correct Answer(s): B
Clinical Manifestations
The nurse completes an assessment of Terry.
3.
In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional
manifestation of RA is Terry likely to exhibit?
, RHEUMATOID ATHRITIS Diagnostic Evaluation 2026/2027
A) Finger tophi.
INCORRECT
Finger tophi are typically seen in the client with gout, although joint deformities and
subcutaneous nodules are common in advanced RA.
B) Drooling.
INCORRECT
In fact, the client with RA is likely to experience dry mouth, which, along with dry eyes, are the
hallmark symptoms. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness.
Of the several syndromes associated with advanced RA, Sjogren's syndrome is the most common.
C) Butterfly rash.
INCORRECT
A butterfly rash on the face is a classic manifestation of systemic lupus erythematosus (SLE)
rather than RA.
D) Fever.
CORRECT
A persistent low-grade fever is a common early manifestation of this inflammatory disease.
Remember, RA is both a local and systemic inflammatory disease with many generalized
symptoms such as fever, fatigue, and weakness, along with multiple lung, cardiac, and renal
manifestations.
Points Earned: 0.0/1.0
Correct Answer(s): D
Pharmacologic Therapy
The nurse's assessment findings for Terry include stiffness and swelling of her wrists and elbows,
with a decreased range of motion in these joints. On palpation of the joints, the nurse notes that
the joints feel somewhat soft. Terry indicates that she has experienced a slight fever, run-down
feeling, and a loss of appetite that has resulted in her five-pound weight loss.
Terry's healthcare provider prescribes the following medications:
• Buffered aspirin 500 mg PO daily.
• Auranofin (Ridaura) 6 mg PO daily.
• Methotrexate (Mexate) 2.5 mg PO q12h for 3 doses, then 7.5 mg weekly.
Ridaura is a gold compound used in RA for its antiinflammatory, antiarthritis, and immune-
modifying effects. In addition to these medications, corticosteroids such as prednisone may be
prescribed in the treatment of rheumatoid arthritis.
The nurse is aware that aspirin is a salicylate with excellent antiinflammatory, antipyretic, and
analgesic properties. However, it does have the potential for causing significant side effects and
toxicity, especially in the high doses needed to manage the symptoms of rheumatoid arthritis.
