COMPLETE NEW UPDATED DOCUMENT FOR
HESI CB CASE STUDY
Meet the Client: Terry BarnesTerry Barnes, a 35-year-old mother of three young children, visits
the healthcare clinic. She reports experiencing increasing bilateral joint pain, especially in her
hands, wrists, and knees. She also reports increasing fatigue and a weight loss of 5 pounds
over the last 2 months. She states she has been taking a couple of aspirins a day, but the joint
pain is increasing, and she is hesitant to take more medication without a medical evaluation.
She appears tense and anxious, and states that she is upset because it is becoming
increasingly more difficult to do all the little things necessary to care for her three children. She
states, "I'm too young to have arthritis. That's something you get when you're old." Terry's initial
medical diagnosis is rheumatoid arthritis, and she is scheduled for diagnostic evaluation.
Terry is scheduled for a Complete Blood Count (CBC), rheumatoid factor (RF), erythrocyte
sedimentation rate (ESR), 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.
Which nursing intervention related to the scheduled bone scan is most important to implement?
- CORRECT ANSWER Inform Terry that radioisotope will be administered 2 hours before the
procedure.
Radiosotope is given 2 hours before the bone scan. Terry should also be instructed that
because the dose of radioisotope is minimal, no special precautions are necessary.
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?" The nurse
explains, "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."
Which etiologic factor is related to the onset of rheumatoid arthritis? - CORRECT ANSWER
Genetic predisposition.
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.
, The nurse completes an assessment of Terry. In addition to the bilateral swollen tender joints,
weight loss, and fatigue, what additional manifestations of RA might Terry exhibit? - CORRECT
ANSWER Joints tender, painful, and warm to the touch.
In RA, joints are tender, painful, and warm to the touch.
Fever.
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.
Swan neck deformity of fingers.
Swan neck deformity of the fingers is a manifestation of RA.
Bilateral symmetric joint involvement.
The symptoms usually include bilateral, symmetric joint involvement.
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 5 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 every 12 hours 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.
Which assessment findings may indicate aspirin toxicity? - CORRECT ANSWER Headache and
confusion.
Symptoms of aspirin toxicity include tinnitus, headache, confusion, weakness, GI bleeding, and
diarrhea.
Hyperventilation and agitation.
Symptoms of aspirin toxicity include headache, hyperventilation, and agitation.
HESI CB CASE STUDY
Meet the Client: Terry BarnesTerry Barnes, a 35-year-old mother of three young children, visits
the healthcare clinic. She reports experiencing increasing bilateral joint pain, especially in her
hands, wrists, and knees. She also reports increasing fatigue and a weight loss of 5 pounds
over the last 2 months. She states she has been taking a couple of aspirins a day, but the joint
pain is increasing, and she is hesitant to take more medication without a medical evaluation.
She appears tense and anxious, and states that she is upset because it is becoming
increasingly more difficult to do all the little things necessary to care for her three children. She
states, "I'm too young to have arthritis. That's something you get when you're old." Terry's initial
medical diagnosis is rheumatoid arthritis, and she is scheduled for diagnostic evaluation.
Terry is scheduled for a Complete Blood Count (CBC), rheumatoid factor (RF), erythrocyte
sedimentation rate (ESR), 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.
Which nursing intervention related to the scheduled bone scan is most important to implement?
- CORRECT ANSWER Inform Terry that radioisotope will be administered 2 hours before the
procedure.
Radiosotope is given 2 hours before the bone scan. Terry should also be instructed that
because the dose of radioisotope is minimal, no special precautions are necessary.
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?" The nurse
explains, "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."
Which etiologic factor is related to the onset of rheumatoid arthritis? - CORRECT ANSWER
Genetic predisposition.
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.
, The nurse completes an assessment of Terry. In addition to the bilateral swollen tender joints,
weight loss, and fatigue, what additional manifestations of RA might Terry exhibit? - CORRECT
ANSWER Joints tender, painful, and warm to the touch.
In RA, joints are tender, painful, and warm to the touch.
Fever.
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.
Swan neck deformity of fingers.
Swan neck deformity of the fingers is a manifestation of RA.
Bilateral symmetric joint involvement.
The symptoms usually include bilateral, symmetric joint involvement.
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 5 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 every 12 hours 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.
Which assessment findings may indicate aspirin toxicity? - CORRECT ANSWER Headache and
confusion.
Symptoms of aspirin toxicity include tinnitus, headache, confusion, weakness, GI bleeding, and
diarrhea.
Hyperventilation and agitation.
Symptoms of aspirin toxicity include headache, hyperventilation, and agitation.
