# A nurse is assessing a 65-year-old client with osteoarthritis of the knees. Which assessment finding would be most characteristic of this condition?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541072  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 65-year-old client with osteoarthritis of the knees. Which assessment finding would be most characteristic of this condition?

## 보기

1. Sharp, stabbing pain that occurs primarily at rest
2. Symmetrical joint swelling with morning stiffness lasting over 2 hours
3. Joint pain that worsens with activity and improves with rest **✔ 정답**
4. Fever and systemic symptoms accompanying joint pain

**정답: 3**

## 해설

Joint pain worsening with activity and improving with rest is the hallmark of osteoarthritis, due to mechanical cartilage wear, distinguishing it from inflammatory arthritis.

## 심화 해설

Understanding the Clinical Presentation of Knee Osteoarthritis

The most characteristic assessment finding for a client with knee osteoarthritis (OA) is joint pain that worsens with activity and improves with rest. This pattern is a hallmark of the mechanical pathophysiology underlying OA. In this degenerative joint disease, the protective articular cartilage that cushions the ends of bones wears down over time. As a result, during weight-bearing activities such as walking or climbing stairs, the increased mechanical stress and friction on the subchondral bone lead to pain. When the joint is at rest, this mechanical stress is removed, providing relief. This is clinically described as a "mechanical" pain pattern, which is distinct from the "inflammatory" pain pattern seen in conditions like rheumatoid arthritis.

To further clarify this distinction for the NCLEX-RN, consider the other options. Sharp, stabbing pain at rest is not typical for OA and may suggest an acute injury, such as a meniscal tear, or a neuropathic component. Symmetrical joint swelling with prolonged morning stiffness lasting over an hour is a classic feature of rheumatoid arthritis, a systemic autoimmune condition, rather than the asymmetrical, localized degeneration of OA. Similarly, fever and systemic symptoms are red flags for an infectious or inflammatory arthritis, such as septic arthritis, and are not associated with the localized, non-inflammatory nature of OA.

The global burden of this condition is immense, with knee OA constituting 83% of the overall OA disease burden [2]. This high prevalence makes it a critical topic for nursing assessment. Your physical examination should focus on identifying findings consistent with this mechanical wear-and-tear process, including crepitus (a grating sensation or sound during joint movement), bony enlargement, and pain localized to the medial or lateral joint line that is reliably reproduced with active or passive range of motion. The Kellgren-Lawrence classification system is often used to grade the radiographic severity of these changes, from doubtful joint space narrowing to large osteophyte formation and severe sclerosis [2]. Recognizing the activity-dependent nature of the pain is the cornerstone of differentiating OA from other joint disorders and guiding appropriate nursing interventions, such as balancing rest with prescribed exercise and weight management strategies.References (research sources)

- [2]Classifications in Brief: Kellgren-Lawrence Classification of OsteoarthritisResearch articleMark D. Kohn, Adam Sassoon, Navin Fernando (2016) · DOI: 10.1007/s11999-016-4732-4

## 임상 시나리오

Mechanical vs. Inflammatory Pain AssessmentDifferentiating Osteoarthritis from Inflammatory Arthritis
The hallmark of osteoarthritis (OA) is a mechanical pain pattern: pain worsens with activity (e.g., walking, climbing stairs) and improves with rest. This occurs as worn cartilage increases friction on the subchondral bone during weight-bearing.

In contrast, rheumatoid arthritis (RA) presents with an inflammatory pain pattern. Key features include symmetrical joint swelling and morning stiffness lasting longer than 1 hour, which improves with activity.

CautionDo not confuse OA with systemic conditions. The presence of fever, systemic symptoms, or pain at rest should prompt evaluation for septic arthritis or an acute injury, not OA.

## 핵심 개념

- **Mechanical Pain** — Pain caused by stress or friction on a joint during movement or weight-bearing, typically relieved by rest; characteristic of osteoarthritis.
- **Osteoarthritis (OA)** — A degenerative joint disease characterized by the progressive loss of articular cartilage, leading to pain, stiffness, and reduced function.
- **Rheumatoid Arthritis (RA)** — A systemic autoimmune disease causing symmetrical joint inflammation, prolonged morning stiffness, and potential systemic symptoms.
- **Subchondral Bone** — The layer of bone just below the cartilage in a joint; exposed in advanced OA, contributing to pain during weight-bearing.

## 같은 주제 문제

- [A 68-year-old client with osteoarthritis of the knees is being assessed by the nurse durin…](https://mymerci.kr/pages/nclex_q.php?qn_id=541073)
- [A 65-year-old male client with osteoarthritis is being assessed by the nurse. Which assess…](https://mymerci.kr/pages/nclex_q.php?qn_id=541074)
- [A nurse is caring for a 68-year-old client with osteoarthritis of the knees. Which nursing…](https://mymerci.kr/pages/nclex_q.php?qn_id=541075)
- [A nurse is caring for a 65-year-old client with osteoarthritis of the hands. Which nursing…](https://mymerci.kr/pages/nclex_q.php?qn_id=541076)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._