Question

elizabeth is a 34 y/o female who comes to the clinic with a chief complaint of bilateral pain, swelling and warmth in her hand, knees and feet. some of her systemic complaints are: fatigue, malaise, anorexia, weight loss, and fever.
in light of elizabeths current diagnosis the np knows that in the later stages of her disease she may well develop:
boutonniere deformities
swan neck deformities
ulnar deviation of the metacarpophalangeal joints
all the above

Explanation:

Elizabeth's symptoms (bilateral joint pain, swelling, warmth along with systemic symptoms like fatigue, malaise, anorexia, weight loss, fever) are highly suggestive of rheumatoid arthritis. In the later stages of rheumatoid arthritis, several hand deformities can occur. Boutonniere deformities involve hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint. Swan - neck deformities are characterized by flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. Ulnar deviation of the metacarpophalangeal joints is also a common deformity in advanced rheumatoid arthritis as the disease affects the joint architecture and the balance of the tendons around the joints.

Answer:

D. All the Above