A patient is admitted with acute gouty arthritis. Which medication does the nurse anticipate the health care provider may prescribe to prevent and treat an acute attack of gout?

Choice A reason: Tennis involves high-impact movements, twisting, and sudden directional changes, which stress the lumbar spine and exacerbate low back pain. These actions increase pressure on intervertebral discs and strain paraspinal muscles, risking further injury. For clients with back pain, low-impact exercises are preferred to avoid aggravating the condition.

Choice B reason: Swimming is a low-impact aerobic exercise that strengthens core and back muscles without stressing the spine. Buoyancy in water reduces gravitational load on vertebrae, minimizing disc compression. Freestyle or backstroke promotes spinal alignment and flexibility, making it an ideal recommendation for managing low back pain safely and effectively.

Choice C reason: Rowing involves repetitive forward flexion and rotation, which can strain lumbar muscles and compress spinal discs, worsening low back pain. The seated position and pulling motion increase intradiscal pressure, risking injury. This high-intensity activity is not suitable for clients seeking back pain relief through exercise.

Choice D reason: Canoeing requires prolonged sitting and repetitive twisting, which stress the lower back. The forward paddling motion increases lumbar flexion, straining muscles and discs. This activity is not recommended, as it can exacerbate pain and lacks the supportive, low-impact qualities needed for safe back pain management.

Choice A reason: Hepatomegaly is not a typical finding in early to moderate rheumatoid arthritis (RA). It may occur in advanced RA with systemic complications like Felty’s syndrome, but early RA focuses on joint inflammation. Expecting hepatomegaly misguides assessment, potentially overlooking RA’s articular signs critical for early diagnosis and DMARD therapy to prevent joint damage.

Choice B reason: Heberden’s nodes, bony growths at distal interphalangeal joints, are characteristic of osteoarthritis, not RA. RA involves synovial inflammation, causing soft tissue swelling, not bony nodes. Assuming nodes risks misdiagnosis, delaying RA-specific treatments like methotrexate, which target inflammation to prevent progressive joint erosion and deformity.

Choice C reason: Crepitus, a grating sound from joint movement, is more typical in osteoarthritis due to cartilage loss, not early RA, where synovial inflammation dominates. Expecting crepitus misaligns assessment, potentially missing RA’s soft tissue swelling and stiffness, delaying interventions like biologics critical for controlling inflammation and joint destruction.

Choice D reason: Spindle-shaped fingers, from synovial inflammation and swelling in proximal interphalangeal joints, are a classic early to moderate RA finding. This soft tissue swelling reflects autoimmune synovitis, aiding diagnosis. Recognizing this guides timely DMARD or corticosteroid use, reducing inflammation, preventing joint damage, and improving function in RA patients.