The client has been diagnosed with type 1 diabetes mellitus and has been prescribed Humulin R insulin. The patient will take the dose at 0900. When should the client be sure to have a snack or meal?

Choice A reason: Allopurinol does not directly target inflammation or pain in acute gout attacks; it lowers uric acid levels to prevent future attacks. Anti-inflammatories like NSAIDs or colchicine manage acute symptoms. This statement is inaccurate, as allopurinol’s role is preventive, not for acute symptom relief.

Choice B reason: Allopurinol inhibits xanthine oxidase, reducing uric acid production, which prevents urate crystal formation and gout attacks. It is used for long-term management of hyperuricemia. This statement is accurate, as decreased uric acid production is the primary mechanism, critical for patient education on its purpose.

Choice C reason: Kidney function tests are necessary with allopurinol, as it is renally excreted, and impaired renal function can increase toxicity risk (e.g., rash, interstitial nephritis). Monitoring ensures safe use, especially in gout patients with potential renal issues, making this statement inaccurate for discharge instructions.

Choice D reason: Limiting fluid intake to 1000cc daily is inappropriate; high fluid intake (2-3L/day) is recommended with allopurinol to prevent urate kidney stones by diluting urine. This statement is inaccurate, as it contradicts the need for hydration to support uric acid excretion and prevent complications.

Choice A reason: Furosemide, a loop diuretic, inhibits the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle, preventing sodium and water reabsorption. This increases urine output significantly, often within minutes, making it highly effective for conditions like edema or heart failure, producing a rapid diuresis of up to 20% of filtered sodium.

Choice B reason: Spironolactone, a potassium-sparing diuretic, inhibits aldosterone in the distal tubule, reducing sodium reabsorption and increasing urine output. However, its diuretic effect is weaker than furosemide, as it affects only 2-3% of filtered sodium. It is primarily used for managing hyperaldosteronism or potassium retention, not rapid urine flow increase.

Choice C reason: Hydrochlorothiazide, a thiazide diuretic, inhibits sodium-chloride reabsorption in the distal convoluted tubule, increasing urine output. Its effect is milder than furosemide, impacting about 5-10% of filtered sodium. It is commonly used for hypertension but is less potent for rapid diuresis in conditions requiring significant urine flow.

Choice D reason: Mannitol, an osmotic diuretic, increases urine flow by preventing water reabsorption in the proximal tubule and loop of Henle. It is effective in acute settings like cerebral edema but less commonly used for routine diuresis compared to furosemide, which has a broader and more rapid effect on urine output.