A client with gouty arthritis reports tenderness and swelling of the right ankle and great toe. The nurse observes the area of inflammation extends above the ankle area. The client receives prescriptions for colchicine and indomethacin. Which instruction should the nurse include in the discharge teaching?
Return for periodic liver function studies.
Massage joints to relax muscles and decrease pain.
Limit use of mobility equipment to avoid muscle atrophy.
Substitute natural fruit juices for carbonated drinks.
The Correct Answer is A
Choice A reason: Returning for periodic liver function studies is an important instruction for a client with gouty arthritis who is taking colchicine and indomethacin. These medications can cause liver toxicity, which can manifest as jaundice, abdominal pain, nausea, vomiting, and dark urine. The nurse should advise the client to monitor for these signs and symptoms, and to have regular blood tests to check the liver enzymes and function.
Choice B reason: Massaging joints to relax muscles and decrease pain is not a recommended instruction for a client with gouty arthritis who has acute inflammation of the right ankle and great toe. Massage can increase the blood flow and pressure to the affected joints, which can worsen the pain and swelling. The nurse should advise the client to avoid touching or moving the inflamed joints, and to apply ice packs or cold compresses to reduce the inflammation.
Choice C reason: Limiting use of mobility equipment to avoid muscle atrophy is not a necessary instruction for a client with gouty arthritis who has acute inflammation of the right ankle and great toe. Mobility equipment such as crutches, walkers, or canes can help the client to ambulate safely and comfortably, and to prevent further injury or damage to the affected joints. The nurse should encourage the client to use mobility equipment as needed, and to perform gentle range of motion exercises when the inflammation subsides.
Choice D reason: Substituting natural fruit juices for carbonated drinks is not a helpful instruction for a client with gouty arthritis who is taking colchicine and indomethacin. Fruit juices can contain high amounts of fructose, which can increase the uric acid levels in the blood and trigger gout attacks. Carbonated drinks are not a major risk factor for gout, unless they contain high-fructose corn syrup or alcohol. The nurse should advise the client to drink plenty of water, and to avoid foods and beverages that are high in purines, such as organ meats, seafood, beer, and wine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Irregular ulcer shapes and severe edema are characteristic of venous ulcers, which are caused by impaired venous return and increased capillary pressure. Venous ulcers are usually located near the medial malleolus and have a shallow depth.
Choice B reason: Hairless lower extremities and cool feet are signs of arterial insufficiency, which reduces blood flow and oxygen delivery to the tissues. Arterial ulcers are usually located on the toes, heels, or lateral malleoli and have a deep, punched-out appearance.
Choice C reason: Black ulcers and dependent rubor are also signs of arterial insufficiency, indicating tissue necrosis and inflammation. Dependent rubor is a reddish-blue color of the lower extremity that occurs when the leg is lowered below the level of the heart.
Choice D reason: Absent pedal pulses and shiny skin are also signs of arterial insufficiency, indicating reduced blood flow and atrophy of the skin. The skin may also be dry, scaly, or cracked.
Correct Answer is D
Explanation
Choice A reason: Fasting blood sugar of 200 mg/dL (11.1 mmol/L) indicates hyperglycemia, which is a high level of glucose in the blood. It can be caused by diabetes mellitus, stress, infection, or medication. Hyperglycemia can cause symptoms such as thirst, hunger, frequent urination, fatigue, and blurred vision. However, it does not affect the safety or accuracy of MRI with contrast.
Choice B reason: Glycosylated hemoglobin A1c of 8% indicates poor glycemic control over the past three months. It can be caused by diabetes mellitus, chronic kidney disease, or hemoglobinopathy. Glycosylated hemoglobin A1c reflects the average blood glucose level over the lifespan of red blood cells, which is about 120 days. However, it does not affect the safety or accuracy of MRI with contrast.
Choice C reason: Blood urea nitrogen of 22 mg/dL (7.9 mmol/L) indicates mild azotemia, which is a high level of nitrogenous waste products in the blood. It can be caused by dehydration, high protein intake, gastrointestinal bleeding, or kidney impairment. Azotemia can cause symptoms such as nausea, vomiting, confusion, and lethargy. However, it does not affect the safety or accuracy of MRI with contrast.
Choice D reason: Serum creatinine of 1.9 mg/dL (169 umol/L) indicates moderate renal insufficiency, which is a reduced ability of the kidneys to filter and excrete waste products and fluids from the body. It can be caused by diabetes mellitus, hypertension, glomerulonephritis, or nephrotoxic drugs. Renal insufficiency can cause symptoms such as edema, anemia, electrolyte imbalance, and acidosis. It can also increase the risk of contrast-induced nephropathy, which is a sudden deterioration of kidney function after exposure to contrast media used for imaging studies such as MRI. Contrast-induced nephropathy can lead to acute kidney injury, dialysis requirement, or even death. Therefore, serum creatinine should be reported to the healthcare provider before MRI with contrast to assess the risk and benefit of the procedure and to take preventive measures such as hydration, medication adjustment, or alternative imaging modalities.

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