The nurse is caring for a client who has severe osteoarthritis. What primary joint problems will the nurse expect the client to report?

Choice C rationale Pain is the primary joint problem reported in severe osteoarthritis (OA). It results from the erosion and loss of articular cartilage, which removes the joint's shock absorber. This leads to bone-on-bone friction, inflammation of the synovium, and irritation of underlying bone nerve endings, causing chronic, deep, aching joint pain that is typically exacerbated by weight-bearing and activity and relieved by rest. Choice A rationale Crepitus, a grating or crunching sound or sensation, is caused by the roughened articular surfaces rubbing against each other and is a sign of advanced OA. While present, it is an objective clinical finding or associated symptom rather than the primary problem reported by the client, which is the subjective, debilitating experience of pain. Choice B rationale Joint effusions, or excess synovial fluid accumulation, occur in OA when the joint capsule and synovium become inflamed due to the cartilage breakdown products, causing swelling. Although common, effusions are a secondary manifestation of the disease process and inflammation, whereas the client's overriding subjective complaint is the chronic, activity-related joint pain. Choice D rationale Joint deformities, such as Heberden's or Bouchard's nodes, or malalignment, represent the late-stage, irreversible structural changes and bone remodeling that occur in severe OA. These are a long-term consequence or sign of the disease, not the primary, acute problem reported by the client, which is the functional limitation and suffering caused by the pain.