I would like to advise Jill to draft a living will. The correct answer to this question is B.
What is a living will?A living will can be defined as a written, legal contract that specifies the medical procedures that someone would and would not want used to keep them alive, as well as their choices for other medical decisions like pain control or donating organs.
This document also can be defined as a sort of advance care planning in which a person specifies the particular types of medical treatment that they prefer to receive if they are unable to make medical decisions due to a terminal disease or by being permanently unconscious.
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FILL IN THE BLANK. A stereotype based on appearance that is largely accurate is that, in contrast to less attractive people, more attractive people tend to ______.
A stereotype is an assumption that links a group of individuals to particular features or qualities. An assumption about a person based on the a group to which they may belong is called a stereotype. Stereotypical concepts or pictures are frequently unchanging and too simplistic. As per a report release out from University of Southern California, patients who feel evaluated by healthcare professionals are more like to mistrust the doctors as well as other healthcare providers and to follow medical instructions less closely.
How can we prevent stereotypes in healthcare and its uses?1. Take various viewpoints into account. From another perspective, how do things appear or feel.
2. Be patient. Avoid rushing an interaction and resist the need to react automatically to spot prejudices.
3. Learn about the person. To avoid stereotyping, learn more about the other person specifically.
According to Simply Psychology, stereotypes help us make sense of the social world and minimize the amount of processing (i.e. thinking) required when meeting a new person by classifying them under a "preconceived marker" of comparable characteristics.
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the nurse asks the client about sexual orientation. the client replies that they are still exploring sexual orientation. what is the appropriate term to document for this response?
The body gradually resumes its regular level of sexual orientation. functioning throughout resolution, and swollen and erect bodily components shrink back to their original size and color. An overall feeling of well-being, increased intimacy, and frequently weariness characterize this phase.
An evaluation of behavior is what?The Behavior Self-Assessment is intended to assist you in identifying life themes that influence your undesirable choices. These activities, such as the use of infidelity, purchasing, chance encounters, etc., are not random.
The function questionnaire is what?Female function is assessed through self-report using the Function Questionnaire (SFQ). A new arousal-cognitive domain and 28 items (SFQ28) have been added as a result of recent revisions.
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a client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. which is the most appropriate response by the nurse?
Yes, Milk thistle is one the most popular liver supplements for treating and repairing the liver thanks to its amazing seeds, which contain a flavonoid called silymarin. Silymarin is an important antioxidant and protects the liver by optimizing liver function and detoxification.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue form, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
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which nursing action would the nurse take when caring for a patient during the acute phase of diabetic ketoacidosis?
Intravenous insulin, regular monitoring, and replenishment of electrolytes, namely potassium and sodium, can all be used to treat diabetic ketoacidosis.
What should a patient with DKA have monitored?Patients need to be checked on frequently and closely. Until the patient is stable, blood sugar levels should be checked every one to two hours. Depending on the severity of the DKA, blood urea nitrogen, serum creatinine, sodium, potassium, and bicarbonate levels should also be checked every two to six hours.
When a customer has diabetic ketoacidosis Which kind of insulin will be administered by the nurse?In DKA, only short-acting insulin is utilized to treat hyperglycemia. 100 mg/dL/h is the ideal rate for glucose decrease.
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a client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. what complication should the nurse interpret as the findings?
The complication that the nurse should interpret based on the findings in the question above is Osteomyelitis.
Osteomyelitis is an inflammation that occurs in the bone. It is caused by infection and generally happens in the arm, legs, or spine. The infection travels to the inside of the bone by the bloodstream, spreading from nearby tissue, or by an injury that exposes the bone to germs.
Osteomyelitis symptoms include:
SwellingWarmth and redness over the infected areaPain in the infected areaFeverFatigueSince the patient in question presents to the emergency department with a fractured jaw, it is possible that the infection may be caused by exposure.
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the client has a history of migraine headaches and has tried various drug therapies without success. the healthcare provider has decided to start the client on ergotamine tartrate. which information should the nurse teach the client about ergotamine tartrate? select all that apply.
"Numbness or trembling in the fingers or toes should be reported."
"As soon as you see a migraine coming on, take medicine."
"Ensure that your blood is checked frequently."
What does the term "nurse" actually mean?
a person who looks after the ill or disabled. Specifically: a qualified health-care worker with expertise in promoting and keeping health who works independently or under the supervision of a doctor, surgeon, or dentist. Compare efficient solution nurse, registered nurse.
What does a nurse do?
From the time of birth until the end of life, nurses are present in every community, big and small. Direct patient care, case management, devising quality control methods, and setting nursing practice standards are all responsibilities that nurses can play.
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of the following individuals, who is most likely to benefit from therapeutic drugs that block receptor sites for dopamine?matthew, who feels hopeless and lethargic after losing his jobamir, who complains about feeling tense and fearful most of the time but doesn't know whymarcella, who is so obsessed with fear of a heart attack that she frequently counts her heartbeats aloudbesty, who hears imaginary voices telling her she will soon be killed
The individual that is most likely to benefit from therapeutic drugs that block receptor sites for dopamine is Betsy, who hears imaginary voices telling her she will soon be killed. Thus, the correct answer is D.
Dopamine is categorized as a neurotransmitter, meaning it transports signals throughout the brain. Most antipsychotic medications are known to inhibit certain dopamine receptors in the brain. This lowers the flow of these messages, which may aid in the reduction of any psychotic symptoms.
Some disorders, such as schizophrenia, nausea, mood disorder (bipolar disorder), and vomiting, are treated using dopamine receptor antagonists. The correct answer is D since Betsy's condition is associated to schizophrenia.
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the nurse, along with a nursing student, is caring for mrs. roper, who was admitted with dehydration. the student asks the nurse where most of the body fluid is located. the nurse should answer with which fluid compartment?
Roper, who had dehydration when he was hospitalized. Where is the majority of the bodily fluid, the pupil queries the nurse. About 70% of the water in the body is intracellular, or the fluid inside cells.
Osmoreceptors, which are specialized cells in the brain, detect this drop in cell water and activate the dehydration thirst mechanism, which includes the process of seeking out and consuming water as well as the release of fluid antidiuretic hormone into the blood. Dehydration symptoms include increased thirst, a dry mouth, dizziness, fatigue, impaired mental clarity, low urine output fluid , dry skin, the inability to cry, and sunken eyes.
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the nurse assesses a patient who experienced a reaction to a bee sting. the patient's clinical findings indicate a pre-shock condition, which is evidenced by:
Restlessness, agitation, and anxiety, which are among the first indications of hypoxia, are signs and symptoms of compensated pre-shock condition.
Which one of the following describes the clinical features of neurogenic shock?
The hallmark symptoms of neurogenic shock are bradyarrhythmia, hypotension, and flushed, heated skin.
Which step is the compensatory?In the compensatory stage, the body uses neurological, hormonal, and biochemical systems in an effort to reverse the lactic acidosis. The Cushing reflex will be triggered by the rise in acidity, leading to the development of the typical shock symptoms. A sluggish heart rhythm is a symptom of neurogenic shock. A rapid heartbeat is a sign of hypovolemic shock.
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a nurse cares for a client who is sccheduled for a total laryngectomy. which action would the nurse take prior to surgery
After surgery, the patient won't be able to speak. The nurse should help the patient select a form of communication they'd like to employ following surgery.
Which is more important in the first few days following a laryngectomy?Learning how to take care of their new airway should be a top priority for people who have undergone total laryngectomy surgery. Patients need to pay close attention to their only source of breathing because the lower airway is no longer connected to the upper airway.
Which treatment would the nurse administer to a patient who has a partial laryngectomy to prevent aspiration?The supraglottic swallow maneuver was first designed to be used with patients who have supraglottic laryngectomy to enhance their capacity to protect the airway and prevent aspiration during the swallow.
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a client has developed a type 1 hypersensitivity reaction. when should the nurse assess for a possible progressing response to the secondary or late-phase?
Just after primary or initial-phase response, it may happen 2 to 8 hours later and extend for several days.About 2 to 8 hours following your primary or initial-phase response, a secondary and late-phase response sets in and lasts for several days.Within 5 to 30 minutes after antigen exposure, the initial or immediate-phase reaction typically manifests and diminishes within 60 minutes.
Why do type 1 hypersensitivity reactions occur?Within minutes after antigen exposure, type I hypersensitivity develops.Antigen-associated IgE on mast cells binds to it to cause it.There may be anaphylactic reactions as a result of the production of vasoactive amines.Some skin reactions following helminth infections appear to be brought on by this Category I hypersensitivity.
What features define type 1 hypersensitivity?hypersensitive type 1 response.After being exposed to an antigen, a person develops type 1 hypersensitivity, which results in an instant reaction.In this kind of reaction, the body produces an IgE specific form of antibody in response to an antigen.
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NSAIDs are effective in treating rheumatoid arthritis because these drugs inhibit the _____ enzyme that initiates _____ synthesis
Because these medications are used to treat rheumatoid arthritis by inhibiting the Cyclooxygenase enzyme, which starts the creation of steroids.
Why is it termed a drug?Etymology. The word "drug" is believed to have come from the Old French word "drogue," which may have been derived from the Middle Dutch word "droge (vate)," which meant "dry.
Who developed medicines?Over the following 150 years, scientists discovered more about biology and chemistry. Friedrich Sertürner, a German scientist, created the first pharmacological medication in 1804. In his laboratory, he isolated the primary chemical constituent of opium, giving it the name "morphine," after the Greek sleep deity.
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the nurse administers lubiprostone to the client with irritable bowel syndrome and anticipates what therapeutic action from the drug?
The nurse anticipates secretion of chloride-rich intestinal fluid leading to increased motility.
What is lubiprostone?
Lubiprostone is a medication most often used in management of chronic idiopathic constipation, mostly opioid-induced constipation and irritable bowel syndrome-associated constipation in women. Increasing intestinal fluid will lead to increased motility. It does not irritate the inner lining, add bulk, or innervate the bowel.
Lubiprostone is also used to relieve stomach pain, straining, bloating, and produce softer and more frequent bowel movements for people with chronic idiopathic constipation. It increases the amount of fluid that flows in the bowel, thereby allowing the stool to pass more easily.
Therefore, the nurse anticipates secretion of chloride-rich intestinal fluid leading to increased motility.
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1. the nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. which sound should the nurse expect to hear?
The right upper quadrant of the body contains the liver, which would produce a dull percussion noise. The nurse is most likely to hear this noise.
What is the midclavicular line ?The liver is an abdominal organ that performs a variety of tasks, such as filtering blood from the GI system, secreting bile into the GI tract, metabolizing medications, and synthesising proteins (eg, clotting factors). The term "hepatomegaly," which is used to describe an enlargement of the liver beyond its usual size, refers to a variety of disorders that might affect the liver's vascularity, location, and functions. Based on the results of a physical examination or imaging, hepatomegaly may be suspected.
The wedge-shaped liver is an organ that is situated in the right upper quadrant of the belly (figure 1). The right costal margin of the midclavicular line to the fifth intercostal space is where the liver usually lies.
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what are two key differences when giving care to an unresponsive choking infant compared to an unresponsive choking adult or child? select 2 answers. use encircling thumbs cpr technique use a pinky finger to do a finger sweep there are no differences. the technique is the same. give compressions only give breaths only
Two key differences when giving care to an unresponsive choking infant compared to an unresponsive choking adult or child are there are no differences, the technique is the same
What is CPR ?If someone's breathing or heart stops, cardiopulmonary resuscitation (CPR) is a life-saving emergency technique. Cardiovascular arrest occurs when the heart stops beating. The heart is unable to pump blood to the brain and lungs during cardiac arrest and to the rest of the body.
Infants and children both require CPR, essentially. CPR must be administered to an infant who remains motionless in response to loud talking or tapping. Give "hands-only" CPR as a rescuer if you are untrained in performing CPR. Continuous compressions without any breaths are referred to as "hands-only" CPR.
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to protect against cvd, americans should limit blank fats to just 7% of daily calories. a. trans b. unsaturated c. dietary d. saturated
Americans should consume no more than 7% of their daily calories from fat in order to prevent CVD. Trans fat usage should be restricted.
What proportion of saturated fat is acceptable for both the general population and those who are suffering from cardiovascular disease?5% to 6% of calories should come from saturated fat, according to the American Heart Association's advice on eating. As an illustration, out of 2,000 calories per day, no more than 120 should be from saturated fat. That translates to around 13 grams of saturated fat daily.
What is the suggested daily allowance of fat for Americans?According to the 2015-2020 Dietary Guidelines for Americans, total fat should not exceed 20 to 35 percent of daily calories and saturated fat shouldn't exceed 10 percent.
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a person who is inactive, with a body mass index (bmi) of 25 or more, may experience a reduced sensitivity to insulin in the muscles, fat, and liver, a condition known as insulin resistance or
According to recent studies, stopping regular physical exercise negatively affects glycemic control (regulation of blood sugar levels), raising the possibility that inactivity may be a major factor in the emergence of Type 2 diabetes.
What does more insulin sensitivity mean?The sensitivity of the body to the effects of insulin is known as insulin sensitivity. A person who is considered to be insulin sensitive will need less insulin to reduce blood sugar levels than a person who has poor sensitivity.
An initiating factor for diabetes linked to insulin resistance is obesity. Adipose tissue in obese people releases increased levels of non-esterified fatty acids, glycerol, hormones, and pro-inflammatory cytokines that may contribute to the emergence of insulin resistance.
Insulin is produced by the pancreas in type 2 diabetes.
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when making rounds on the pediatric neurology unit, the nurse manager notes that, when giving iv medications, many of the staff nurses are disconnecting the flush syringe first and then clamping the intermittent infusion device. the nurse manager is concerned that the nurses do not understand the benefits of positive pressure technique and turbulence flow flush in preventing clots. after the nurse manager discusses the problem with the staff educator, which intervention would be the most effective way to improve the nursing practice?
Reduce the I.V. flow rate and hang the recommended treatment intervention would be the most effective way to improve the nursing practice.
What should the nurse do?
The nurse should keep the I.V. access open and start the correct solution when a client is receiving the incorrect solution. The catheter does not need to be taken out by the nurse. The client would experience pointless needle sticks if this were done. Waiting until the next bottle is scheduled to be delivered is improper and puts both the client and the nurse in legal danger. The nurse should write out an incident report describing the precise problem after beginning the correct solution.
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what is the best way for health care workers to help their facility ensure that its patients have positive experiences when receiving care?
Always pay close attention to what and how patients are saying.Patient education should aim to: motivate patients to change for the better.
What significance does healthcare quality improvement have?Quality improvement is the plan for gradually raising the bar of care.Quality improvement seeks to standardize organizational structure and procedures in order to decrease variance, produce predictable results, and improve patient outcomes, health systems, and businesses.
Why is it crucial to establish a good rapport with a patient?Cooperation is easier to achieve and there are more opportunities to understand each patient's particular health needs when there is a good patient-provider relationship.This enables healthcare professionals to more effectively link patients to the therapies and resources
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the nurse evaluates the gastric residual on an infant with a nasogastric tube and finds the volume to be high. in what position should the nurse place the infant to promote gastric emptying?
Right recumbent position is the best position to place the infant to promote gastric emptying.
Gastric residual refers to the volume of fluid remaining in the stomach at a point in time during enteral nutrition feeding. Nurses withdraw this fluid via the feeding tube by pulling back on the plunger of a large (usually 60 mL) syringe at intervals typically ranging from four to eight hours.
Gastric residual volume is the amount aspirated from the stomach following administration of enteral feed. An aspirated amount of ≤ 500ml 6 hourly is safe and indicates that the GIT is functioning While most patients will tolerate enteral nutrition (EN) via a gastric tube, some patients will experience delayed.
In such patients, enteral nutrition (EN) or parenteral nutrition (PN) may be used to compensate for nutritional intake. Critical care guidelines recommend EN over PN in hospitalized patients who require non-oral nutrition therapy, except in cases where EN is contraindicated. EN is generally a riskless and well-tolerated approach in patients with normal gastrointestinal (GI) function.
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the nurse is providing home care instructions to the mother of a child who is recovering from reye's syndrome. which instruction should the nurse provide to the mother?
The mother of a child with Reye's syndrome should receive the following home care advice from the nurse. Every day, check the child's eyes and skin for any yellow discolouration.
A rare yet deadly illness called Reye's syndrome results in liver and brain enlargement. Children and teenagers recovering from a viral infection, most frequently the flu or chickenpox, are most frequently affected by Reye's syndrome. Jaundice testing will help to detect the presence of liver problems, which are indicative of Reye's syndrome. If vomiting occurs, it is a symptom of intracranial pressure and is brought on by cerebral edoema in Reye's syndrome. The brain tissue is less stressed when stimuli are reduced and rest is provided.
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the nurse is providing education to a patient with newly diagnosed t1dm. which statement by the patient indicates teaching is successful? a. i need to carry hard candy when i go jogging b. i should wait to eat until after i finish exercising c. i do not need to worry about testing my urine for ketones d. i do not need a medic alert bracelet, it could cause my boss to discriminate against me
Should wait to eat until after I finish exercising is the correct option which indicates teaching is successful.
What exactly is a diabetic?
When you have diabetes, your body either produces insufficient insulin or uses it improperly. Too much blood sugar remains in your bloodstream when there is insufficient insulin or when cells stop responding to insulin. That can eventually lead to serious health issues like kidney disease, vision loss, and heart disease.
What are the four diabetes warning signs?
High blood sugar levels are a common symptom of type 2 diabetes. Early warning signs and symptoms may include fatigue, hunger, increased thirst, frequent urination, vision issues, slow wound healing, and yeast infections.
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the nurse understands that which type of anticancer drugs can act during any phase of the cell cycle?
Nurse understands the type of anticancer drugs that can act during any phase of the cell cycle is : Phase-nonspecific.
What do you mean by phase-nonspecific?Alkylating agents are commonly considered to be cell cycle phase nonspecific which means that they kill the cell in multiple phases of the cell cycle. Although alkylating agents may be used for most types of cancer, but they are of greatest value in treating slow-growing cancers.
Alkylating agents are cell-cycle non-specific. There are various types of alkylating agents used in chemotherapy treatments like mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan and Ifosfamide.
Chemotherapy drugs that can kill cancer cells when they are at rest are known as cell-cycle non-specific.
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you are alone with a client who is in crisis. you remember that your body language is an important crisis intervention strategy. how should you adjust your body language towards the client?
Body languages are the simplest to read and are highly helpful when working with people who are unable to communicate verbally because of a handicap.
How to assess body language?
Watch for indications of frustration or anxiousness. Train yourself to search for these three characteristics since it can be challenging to tell if someone is physically irritated, but other emotions, like melancholy, are much more clear. Hands, posture, and eyes.
As crucial as watching your client's kinesics is making sure you're in control of your own nonverbal communication. If you give your client the wrong nonverbal cues, they might react defensive and exacerbate their risky conduct.
Hence, body languages are the simplest to read and are highly helpful when working with people who are unable to communicate verbally because of a handicap.
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a client has recently been diagnosed with gastric cancer. on palpation, the nurse would note what two signs that confirm metastasis to the liver? select all that apply.
Symptoms and diagnosis of liver metastases include fever, weakness, weakness, abdominal pain, or loss of appetite.
Which of the following appears to play a major role in the emergence of stomach cancer?There are a number of risk factors for stomach cancer, but the two most important ones are Helicobacter pylori infection and a family history of the disease.
How are stomach ulcers assessed?Endoscopy. To inspect your upper digestive tract, your doctor might use a scope (endoscopy). A hollow tube (endoscope) with a lens is passed down your neck, into your esophagus, stomach, and small intestine during an endoscopy. Your doctor checks for ulcers using the endoscope.
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a client with aids has been tested for cytomegalovirus (cmv) with positive titers. what severe complication should the nurse be alert for with cytomegalovirus?
The herpes virus known as CMV, sometimes known as cytomegalovirus, is spread via direct contact with an infected person's blood, spit, urine, semen, or breast milk.The most vulnerable people are those who are immunocompromised and/or have a damaged immune system.
CMV primarily affects who?One was in three children by the age of five has CMV, though most do not show any symptoms,After an infection, the virus can persist in a child's bodily fluids including saliva or urine for months.
Must I be concerned about cytomegalovirus?A typical virus is the (CMV),Once infected, the virus stays in your body permanently,The majority of people are unaware that they have CMV so it rarely creates issues in healthy individuals,CMV is a problem if you're expecting a child or if your immune response is compromised.
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cpco which of the following is not a purpose of the requisition lab slip? a. ensure the physician or other authorized individual has made an independent medical necessity decision with regard to each test the organization will bill b. encourage physicians or other authorized individuals to submit the diagnosis information for all tests ordered c. capture the correct program information d. contain a statement that indicates medicare generally covers all routine screening tests
The correct answer is:
(d) contain a statement that indicates medicare generally covers all routine screening tests.
The above stated is not a purpose of the requisition slip.
What is a lab requisition?
A lab requisition form is a written request for a medical test or procedure made to a laboratory. It is drafted by a physician or healthcare facility and then completed in the lab.
A screening test is carried out to look for potential diseases or health issues when a person shows no symptoms of a sickness. To reduce the risk of disease or to discover it early enough to obtain the best care, the goal is early identification, lifestyle changes, or surveillance. Before any symptoms or signs arise, doctors use screens, which are physical examinations, to check for illnesses and other problems.
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5. which nursing interventions are required by the joint commission (tjc) when the decision is made that a patient will benefit from the use of physical restraints? select all that apply.
The nursing interventions required by the joint commission (tjc) are: The family of the patient is telephoned and told that restraints are applied. A staff member is assigned until the restraints are removed to sit next to the patient. The nurse also provides the patient with a timetable that shows when the restraints will be removed.
What is the joint commission?
The Joint Commission (TJC) enterprise mission is to enable and empower health care organizations all around the world to build a foundation for patient safety and quality care.
As per the joint commission (TJC) standards, it is required that the family of the patient and legal representatives as well be informed when restraints are being used.
The staff is required as well to make in person observations of the patient in restraints for the entire duration of when the patient is in restraints.
So, therefore, the nursing interventions required by the joint commission (tjc) are: The family of the patient is telephoned and told that restraints are applied. A staff member is assigned until the restraints are removed to sit next to the patient. The nurse also provides the patient with a timetable that shows when the restraints will be removed.
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a patient was body surfing in the ocean and sustained a cervical spinal cord fracture. a halo traction device was applied. how does the patient benefit from the application of the halo device?
The halo device allows for stabilization of the cervical spine along with early ambulation.
What is a cervical spine injury?
Cervical spine injury is caused due to deformation of the cervical spinal column that can damage the spinal cord. Cervical spinal cord injuries are the most severe kinds of spinal cord injuries.
These kinds of injuries causes permanent change in strength, sensation and other functions of the body below the site of the injury.
Spinal cord injuries may lead to quadriplegia or tetraplegia and paraplegia. These are associated with loss of muscle strength in all four extremities. quadriplegia or tetraplegia and paraplegia are paralysis caused by spinal cord injuries.
Quadriplegia or tetraplegia affects the arms, hands, trunk, legs and pelvic organs.
Paraplegia affects all or a part of the trunk, legs and pelvic organs.
Therefore, the halo device allows for stabilization of the cervical spine along with early ambulation.
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the nurse provides teaching for a client diagnosed with rheumatoid arthritis (ra) about the prescribed methotrexate. which client statement determines the need for further teaching?
Most patients who experience the early stages of rheumatoid arthritis complain of stiffness in the morning or discomfort after spending some time sitting motionless. Limited joint range of motion is one of the latter rheumatoid arthritis symptoms.
For a patient with rheumatoid arthritis, which nursing action is suitable?Offer a range of comfort measures (eg, application of heat or cold; massage, position changes, rest; foam mattress, supportive pillow, splints; relaxation techniques, diversional activities). administer painkillers, slow-acting anti-rheumatic drugs, and anti-inflammatory drugs as directed
When instructing a client with arthritis, which symptom would the nurse mention?In more than one joint, there is discomfort, edema, stiffness, and tenderness. stiffness, particularly in the morning or after prolonged hours of sitting. On both sides of your body, you have stiffness and pain in the same joints.
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