The nurse examines a client’s right great toe.

The joint is red, edematous, and very painful with limited range of motion. The client’s serum uric acid levels are elevated.

Which action should the nurse tell the client to make?

Increase intake of red meat.

Splint the affected joint.

Encourage fluid intake.

Measure urine output.

Answer and Explanation

The Correct Answer is C

Choice C rationale
Encouraging fluid intake is essential for clients with elevated serum uric acid levels, as it helps to dilute the urine and promote the excretion of uric acid, reducing the risk of gout attacks.
Choice A rationale
Increasing the intake of red meat is not advisable for clients with elevated serum uric acid levels, as red meat is high in purines, which can exacerbate gout symptoms.
Choice B rationale
Splinting the affected joint may provide temporary relief from pain, but it does not address the underlying issue of elevated serum uric acid levels.
Choice D rationale
Measuring urine output is important for monitoring kidney function, but it does not directly address the management of elevated serum uric acid levels.

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Correct Answer is A

Explanation

Choice A rationale
Epigastric region is the correct answer. The epigastric region is the area of the abdomen located between the lower part of the ribcage and the navel (umbilicus). Pain localized in the middle section of the abdomen below the xiphoid process corresponds to the epigastric region.
Choice B rationale
The umbilical region is located around the navel (umbilicus) in the center of the abdomen. Pain in the umbilical region may be associated with conditions affecting the small intestine or structures around the navel, such as umbilical hernias.
Choice C rationale
The hypogastric region is located in the lower part of the abdomen, below the umbilical region. Pain in the hypogastric region typically corresponds to the lower abdomen, around the pubic bone.
Choice D rationale
The hypochondriac regions are located on each side of the upper abdomen, beneath the ribs. Pain in the hypochondriac region may be associated with conditions affecting the liver, gallbladder, or spleen.

A. Observe pupil size when focusing on a near object and then a far object. B. Determine if dilation of the pupils occurs when the room is darkened. C. Note the speed of pupil constriction when a penlight is shined into the eye. D. Compare the shape of each of the pupils bilaterally with normal room light.

Correct Answer is A

Explanation

Choice A rationale
Observing pupil size when focusing on a near object and then a far object assesses the accommodation reflex. This reflex involves the pupils constricting when focusing on a near object and dilating when focusing on a far object. This response is mediated by the parasympathetic nervous system and is a normal physiological reaction to changes in focal distance.
Choice B rationale
Determining if dilation of the pupils occurs when the room is darkened assesses the pupillary light reflex, not accommodation. The pupillary light reflex involves the pupils dilating in low light conditions to allow more light to enter the eye, which is controlled by the sympathetic nervous system.
Choice C rationale
Noting the speed of pupil constriction when a penlight is shined into the eye assesses the direct and consensual light reflexes. This test evaluates the function of the optic and oculomotor nerves and is not related to the accommodation reflex.
Choice D rationale
Comparing the shape of each of the pupils bilaterally with normal room light assesses for anisocoria or differences in pupil size, which can indicate neurological issues. This assessment does not evaluate the accommodation reflex.

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The nurse examines a client’s right great toe. The joint is red, edematous, and very painful with limited range of motion. The client’s serum uric acid levels are elevated. Which action should the nurse tell the client to make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client reports experiencing stomach pain and it is localized in the middle section of the abdomen below the xiphoid process. The nurse should describe the pain as occurring in which region of the abdomen?

Correct Answer is A

Explanation

To assess a client’s pupillary reaction to accommodation, which action should the nurse take?

Correct Answer is A

Explanation

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The nurse examines a client’s right great toe.

The joint is red, edematous, and very painful with limited range of motion. The client’s serum uric acid levels are elevated.

Which action should the nurse tell the client to make?