Assessment findings that the nurse would expect in a patient with rheumatoid arthritis who has articular involvement include

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.

Choice A reason: An oblique fracture involves a diagonal break across the bone, typically from twisting forces, not splintering into multiple pieces. Comminuted fractures, as described, involve multiple fragments. Misidentifying as oblique risks inappropriate treatment, like simple casting instead of surgical fixation, delaying healing and increasing nonunion risk in complex tibial fractures.

Choice B reason: An impacted fracture occurs when bone ends are driven together, often in compression injuries, not splintered into pieces. The described tibial fracture with multiple fragments is comminuted. Assuming impacted misguides management, potentially overlooking the need for surgical stabilization, complicating recovery and alignment in severe fractures.

Choice C reason: A comminuted fracture, where the bone splinters into multiple fragments, matches the x-ray description. Common in high-energy trauma like falls, it requires surgical fixation to align fragments and ensure healing. Accurate identification guides appropriate intervention, preventing complications like malunion or infection in complex tibial fractures.

Choice D reason: A transverse fracture is a straight, horizontal break, not involving multiple fragments. The described splintered tibia indicates a comminuted fracture. Misdiagnosing as transverse risks inadequate treatment, like casting instead of surgery, leading to poor alignment, delayed healing, or chronic pain in severe tibial injuries.