# A nurse is assessing a 45-year-old client with a 3-year history of rheumatoid arthritis. Which assessment finding would be most characteristic of this condition?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541068  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 45-year-old client with a 3-year history of rheumatoid arthritis. Which assessment finding would be most characteristic of this condition?

## 보기

1. Bilateral symmetrical joint swelling and stiffness, particularly in the hands and wrists, that is worse in the morning and lasts over an hour. **✔ 정답**
2. Unilateral joint pain that primarily affects weight-bearing joints such as the hips and knees, worse with activity and improves with rest.
3. Joint stiffness that occurs after periods of inactivity but resolves within 15-30 minutes of movement, typical of osteoarthritis.
4. Asymmetrical joint involvement with characteristic skin changes including butterfly rash across the cheeks, suggestive of systemic lupus erythematosus.

**정답: 1**

## 해설

Bilateral symmetrical joint swelling and stiffness in small joints like hands/wrists with morning stiffness >1 hour is characteristic of RA. Other options describe features of osteoarthritis, lupus, or mechanical pain.

## 심화 해설

Clinical Judgment
This question evaluates your ability to identify the most characteristic clinical presentation of Rheumatoid Arthritis (RA). The key points are bilateral symmetry and involvement of small joints. RA is a systemic autoimmune disease where the immune system attacks the synovial membrane of its own joints, causing chronic inflammation. This inflammatory process tends to affect the same joints on both sides of the body (e.g., the metacarpophalangeal joints and wrists of both hands) simultaneously, resulting in symmetrical symptoms. Additionally, morning stiffness lasting more than 1 hour is a crucial clue that distinguishes RA from degenerative arthritis (osteoarthritis).

Memory Tip:
**R**heumatoid **A**rthritis = **R**eally **A**lways Symmetrical. Or **S**mall, **S**ymmetric, **S**tiffness > 1 hour.

KR vs US
While the basic diagnostic criteria and treatment principles for RA are the same in Korea, the NCLEX heavily emphasizes 'bilateral symmetry' and the 'duration of morning stiffness' as key assessment points to differentiate it from other types of arthritis. Korean nurses may be more familiar with the overall concept of 'chronic inflammatory arthritis' rather than 'symmetry,' so be sure to clearly remember these two specific characteristics.

## 임상 시나리오

Clinical Practice Guide
When assessing an RA patient, systematically evaluate the following: 1) joint pain, swelling, tenderness, range of motion, and warmth, 2) onset time and duration of morning stiffness, 3) ability to perform activities of daily living (ADLs), 4) systemic symptoms such as fatigue, low-grade fever, and loss of appetite.
Caution
In SATA (Select All That Apply) questions asking about the characteristics of RA, "bilateral joint involvement," "small joint involvement (hands, wrists)," and "morning stiffness lasting more than 1 hour" are correct answers. Be cautious, as "pain that worsens with activity" or "asymmetric involvement" are characteristics of degenerative arthritis or other conditions.

## 핵심 개념

- **Rheumatoid Arthritis** — A chronic systemic autoimmune inflammatory disease that primarily affects synovial joints, causing bilateral symmetric arthritis, morning stiffness, and joint destruction.
- **Synovitis** — Inflammation of the joint synovium. This is the main pathological process of RA, causing joint swelling, pain, and warmth.
- **Morning Stiffness** — Joint stiffness that occurs after periods of rest or inactivity. In RA, stiffness lasting more than 1 hour is one of the diagnostic criteria.
- **Bilateral Symmetrical Involvement** — Symmetrical involvement of the same joints on both sides of the body. This is the most characteristic clinical finding of RA.
- **Osteoarthritis** — Degenerative arthritis. It is characterized by gradual damage and destruction of cartilage, mainly affecting weight-bearing joints and may be asymmetric. It must be distinguished from RA.

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