•Mrs. Soto is a 46-year-old Asian woman with rheumatoid arthritis (RA). The following data were collected by the nurse during an interview and examination. Subjective Data story of Present Illness •Mrs. Soto was diagnosed with RA at age 30. Her mother and grandmother had osteoporosis. She has been taking oral medication to treat her RA. She complains of a great deal of pain in her joints, particularly in her hands, and says that she has “just learned to live with the pain because it will always be there.” •She states that the stiffness and pain in her joints are always worse in the morning or if she sits for too long. She denies muscle weakness other than the fact that her stiffness and soreness prevent her from doing much. •Mrs. Soto reports that the RA is progressing to the point at which she is having difficulty doing things requiring fine-motor dexterity such as changing clothes, holding eating utensils, and cutting up her food. She had different faucet handles installed in her home so she could turn the water on and off. Mrs. Soto says that she rarely goes out because she feels ugly. Examination Data •Patient is able to stand, but standing erect is not possible. Gait is slow, steady, and purposeful. Significant edema and pain are noted on palpation of wrists, hands, knees, and ankles bilaterally. Hand grips are weak bilaterally. Subcutaneous nodules are noted at ulnar surface of elbows bilaterally. Clinical Reasoning •Which data deviate from normal findings, suggesting a need for further investigation? •For which additional information should the nurse ask or assess? •Based on the data, which risk factors for rheumatoid arthritis does Mrs. Soto have? •With which team members would the nurse collaborate to meet this patient’s needs?