A nurse is teaching a client who has chronic tophaceous gout about his new prescription for allopurinol. The nurse should explain that the purpose of this medication is to reduce blood levels of which of the following substances?

Choice A reason: Plaster of Paris casts must be kept dry, as water weakens the material, causing breakdown or skin maceration. Covering the cast with a waterproof barrier during showering is essential. This instruction is incorrect, as it risks cast damage and skin infections, which could complicate recovery.

Choice B reason: Applying ice after walking may reduce swelling, but it is not a standard instruction for a walking cast unless edema is present. Ice can dampen the cast, risking structural integrity. Monitoring neurovascular status is more critical, making this less essential compared to reporting symptoms.

Choice C reason: A musty odor is not normal and may indicate moisture, skin breakdown, or infection beneath the cast. Patients should report odors, as they suggest complications requiring evaluation. This instruction is incorrect, as it dismisses a potential sign of serious issues like bacterial growth or tissue damage.

Choice D reason: Reporting numbness or pain in the toes is critical, as these symptoms may indicate neurovascular compromise, such as compartment syndrome or nerve compression from a tight cast. Early reporting ensures timely intervention to prevent permanent damage, making this a key instruction for safe cast management and recovery.

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