A nurse is assessing a client who has a long history of rheumatoid arthritis. The nurse should expect to find which of the following?

Choice A rationale Heberden's nodes are bony enlargements located at the distal interphalangeal joints, which are the joints closest to the fingertips. These are classic markers of osteoarthritis, not rheumatoid arthritis. Osteoarthritis involves the mechanical wear and tear of articular cartilage rather than the systemic inflammatory process seen in rheumatoid arthritis. Therefore, observing these specific nodules would lead the clinician toward a degenerative joint disease diagnosis rather than an autoimmune inflammatory condition like rheumatoid arthritis. Choice B rationale Ulnar deviation is a characteristic finding in chronic rheumatoid arthritis where the fingers drift toward the ulnar bone due to the inflammatory destruction of the metacarpophalangeal joints. This systemic autoimmune disease causes synovial hypertrophy and ligamentous laxity, resulting in the classic joint deformities and malalignments observed in long-term cases. Unlike osteoarthritis, which is localized, rheumatoid arthritis involves symmetrical joint involvement and systemic symptoms, making ulnar deviation a hallmark sign of advanced disease progression. Choice C rationale Tophi are deposits of monosodium urate crystals that appear as hard, yellow or white nodules under the skin, typically around joints or the outer ear. These are the pathognomonic feature of chronic tophaceous gout, which results from long-standing hyperuricemia. While gout is an inflammatory arthritis, the pathophysiology involves crystal deposition rather than the autoimmune synovial invasion seen in rheumatoid arthritis. Thus, the presence of tophi indicates a metabolic disorder rather than a systemic autoimmune condition. Choice D rationale Bouchard's nodes are bony growths found at the proximal interphalangeal joints, which are the middle joints of the fingers. Much like Heberden's nodes, these are indicative of osteoarthritis and represent the formation of new bone, or osteophytes, in response to cartilage degradation. While rheumatoid arthritis also affects the proximal interphalangeal joints, it typically causes soft tissue swelling and spindling rather than the hard, bony outgrowths characterized by Bouchard's nodes in degenerative joint diseases.