A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for the management of gout. Which of the following statements indicates the client understands the teaching?

I should choose red meat instead of poultry.

I can drink only white wine.

I should avoid eating liver and other organ meats.

I don’t need to limit the number of fruit servings each day.

Answer and Explanation

The Correct Answer is C

Choice A reason: Choosing red meat over poultry is incorrect, as both are high in purines, which increase uric acid levels, triggering gout attacks. Red meat, like beef, is particularly purine-rich, worsening hyperuricemia. A low-purine diet emphasizes plant-based proteins and low-purine options like eggs or dairy, indicating the client misunderstands dietary restrictions for gout management.

Choice B reason: Stating only white wine is allowed is incorrect, as all alcohol, including white wine, increases uric acid production and reduces its excretion, exacerbating gout. Beer and liquor are particularly high-risk, but no alcohol is recommended. This statement reflects a misunderstanding of the low-purine diet, which advises complete alcohol avoidance to prevent flare-ups.

Choice C reason: Avoiding liver and organ meats is correct, as these are extremely high in purines, which metabolize into uric acid, promoting gout attacks. A low-purine diet excludes organ meats, shellfish, and certain fish to reduce uric acid levels. This statement demonstrates accurate understanding of dietary restrictions essential for managing gout and preventing recurrent episodes.

Choice D reason: Not limiting fruit servings is generally true, as most fruits are low in purines. However, this statement is less specific to gout management than avoiding organ meats, which directly addresses a primary purine source. Fruits like cherries may even reduce gout risk, but this choice is less indicative of comprehensive dietary understanding.

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Correct Answer is D

Explanation

Choice A reason: Applying ice reduces swelling and pain in a possible fracture, which is beneficial but not the first priority. Ice application does not assess the limb’s viability or detect complications like vascular injury or nerve damage. A neurovascular check is critical to ensure circulation and nerve function before interventions like ice, which could mask symptoms.

Choice B reason: Elevating the arm minimizes swelling by promoting venous return, aiding in pain relief and reducing pressure. However, it is secondary to a neurovascular check, which assesses circulation, sensation, and movement. Elevation without confirming vascular integrity risks missing critical injuries like arterial compression, which could lead to ischemia if untreated.

Choice C reason: Notifying the health care provider is necessary for diagnostic imaging and treatment planning but is not the first action. A neurovascular check provides immediate data on limb status, guiding urgency of notification. Delaying assessment risks missing acute complications like compartment syndrome, which requires prompt intervention to prevent permanent damage.

Choice D reason: Performing a neurovascular check first assesses distal pulses, sensation, movement, and capillary refill, detecting complications like vascular occlusion or nerve injury from a possible fracture. Fractures can compress arteries or nerves, risking ischemia or neuropathy. Early identification ensures timely intervention, making this the priority before splinting or other actions to preserve limb function.

A. Pitting edema of the hands and fingers. B. A dry, red rash across the bridge of the nose and on the cheeks. C. A grey colored, non-purpuric papular rash. D. Subcutaneous nodules on the ulnar side of the arm.

Correct Answer is B

Explanation

Choice A reason: Pitting edema of the hands and fingers is not a typical SLE finding. It may occur in conditions like heart failure or nephrotic syndrome, but SLE more commonly causes joint swelling or effusions due to synovitis. Expecting edema misdirects assessment, potentially overlooking SLE’s hallmark cutaneous and musculoskeletal symptoms critical for diagnosis.

Choice B reason: A dry, red rash across the nose and cheeks, known as a malar or butterfly rash, is a hallmark of SLE, present in 30-60% of patients. This photosensitive rash results from autoimmune-mediated cutaneous inflammation, aiding diagnosis. Its distinct pattern distinguishes SLE from other dermatologic conditions, guiding targeted treatment.

Choice C reason: A grey, non-purpuric papular rash is not characteristic of SLE. SLE rashes are typically erythematous and photosensitive, like the malar rash, or discoid with scaling. A grey papular rash suggests conditions like lichen planus, not SLE, and including it risks misdiagnosis, delaying appropriate immunosuppressive therapy.

Choice D reason: Subcutaneous nodules on the ulnar arm are more typical of rheumatoid arthritis, not SLE. SLE may cause cutaneous lupus lesions, but nodules are rare. Expecting this finding could lead to confusion with other connective tissue diseases, misguiding assessment and delaying SLE-specific treatments like hydroxychloroquine

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A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for the management of gout. Which of the following statements indicates the client understands the teaching?

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