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: Applying heat for 10 minutes every hour is insufficient to relieve back strain and may not prevent recurrent pain. Heat therapy requires 15-20 minutes to relax muscles and improve blood flow effectively. This strategy is not a primary recommendation, as it does not address posture, movement, or ergonomic factors critical for back health.

Choice B reason: Padded shoe insoles absorb shock and support proper foot alignment, reducing stress on the spine during standing or walking. By improving biomechanics, insoles help distribute weight evenly, minimizing strain on the lower back. This is a practical strategy for nurses who stand for long periods, preventing repetitive back pain episodes.

Choice C reason: Sleeping on a soft mattress exacerbates back pain by failing to support spinal alignment, causing excessive curvature. A medium-firm mattress maintains neutral spine position, reducing strain on lumbar muscles and ligaments. This strategy is incorrect, as it does not contribute to minimizing back strain or preventing pain.

Choice D reason: Avoiding prolonged sitting reduces pressure on lumbar discs and prevents muscle stiffness. Prolonged sitting compresses spinal structures, weakening core muscles and increasing strain. Regular movement or standing breaks improve circulation and maintain flexibility, making this a key strategy to prevent recurrent low back pain in workplace settings.

Choice E reason: Sleeping in a side-lying position with flexed knees aligns the spine and reduces lumbar strain. This position, often supported by a pillow between the knees, maintains neutral pelvic alignment, minimizing stress on spinal ligaments and discs. It is an effective strategy for preventing back pain during rest, promoting 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