A 55-year-old male presents to the emergency department with severe pain and swelling in his left big toe. The pain is excruciating, and the joint is warm to touch. He mentions a history of occasional joint pain but has never experienced anything like this before. Laboratory results reveal an elevated serum uric acid level. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid Arthritis
C) Gout
D) Septic Arthritis
E) Psoriatic Arthritis
Rationale:
This patient’s sudden-onset severe pain, swelling, and warmth in the big toe, along with an elevated serum uric acid level, are indicative of an acute gout attack. Gout is characterized by the deposition of urate crystals in joints, leading to inflammation. The other options do not typically present with the acute, monoarticular symptoms seen in gout.
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Understanding Gout: NCLEX Priority Questions
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A 62-year-old female with a history of hypertension and hyperlipidemia is prescribed allopurinol for gout prevention. Which of the following statements by the patient indicates a need for further education?
A) “I will take my allopurinol with food.”
B) “I should drink plenty of water while on allopurinol.”
C) “I’ll stop taking allopurinol if I have an acute gout attack.”
D) “I need regular blood tests to monitor my uric acid levels.”
E) “Allopurinol may take a few weeks to show its full effect.”
Rationale:
Allopurinol is a xanthine oxidase inhibitor used for long-term management and prevention of gout. Stopping allopurinol during an acute attack is counterproductive, as its benefit lies in reducing uric acid levels over time. The other statements demonstrate understanding of allopurinol’s administration, side effects, and the need for monitoring.
Understanding Gout: NCLEX Delegation Questions
A 48-year-old male with a history of gout presents with persistent joint pain and swelling despite lifestyle modifications and allopurinol therapy. On examination, tophi are noted over the elbows and knees. What is the most appropriate next step in management?
A) Increase the dose of allopurinol
B) Start colchicine therapy
C) Initiate corticosteroid injections
D) Recommend lifestyle modifications only
E) Perform joint aspiration and analysis
Rationale:
The presence of tophi indicates inadequately controlled gout, and increasing the dose of allopurinol is a common next step to further lower uric acid levels. Tophi are deposits of urate crystals and are associated with chronic, poorly managed gout. The other options may address symptoms but do not target the underlying cause of tophi formation.
Understanding Gout: Causes and Symptoms
A 45-year-old male complains of recurrent episodes of intense pain and swelling in his right ankle. The pain is often described as excruciating and is associated with redness and warmth in the affected joint. Laboratory results reveal an elevated serum uric acid level. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid Arthritis
C) Gout
D) Lyme Disease
E) Ankylosing Spondylitis
Rationale:
The patient’s symptoms, including recurrent episodes of severe pain, swelling, redness, and an elevated serum uric acid level, are consistent with gout. Gout is caused by the deposition of urate crystals in joints, leading to inflammation. The other conditions listed do not typically present with the sudden and episodic nature seen in gout.
NCLEX Practice Questions: Understanding Gout Causes and Symptoms
A 60-year-old female is admitted to the hospital with an acute gout attack affecting her left knee. In addition to pharmacological management, what dietary advice should the nurse provide to the patient?
A) Increase red meat consumption
B) Limit alcohol intake
C) Consume high-purine vegetables
D) Avoid hydration
E) Include shellfish in the diet
Rationale:
Limiting alcohol intake is essential in managing gout as alcohol can interfere with the elimination of uric acid. Red meat, high-purine vegetables, and shellfish can contribute to elevated uric acid levels and should be limited. Adequate hydration is important in preventing gout attacks, making the option to avoid hydration incorrect.
NCLEX Questions: Focus on Medications for Gout
A 50-year-old male with a history of gout is prescribed colchicine for an acute flare-up. What instruction should the nurse prioritize when educating the patient about colchicine?
A) Take colchicine on an empty stomach
B) Avoid grapefruit while on colchicine
C) Use colchicine prophylactically during gout attacks
D) Report muscle weakness or pain immediately
NCLEX Focus Exploring Gout: Causes and Diagnosis
Rationale:
Colchicine can cause myopathy, a potentially serious side effect characterized by muscle weakness or pain. Patients should be instructed to report these symptoms promptly to prevent complications. The other options are incorrect; colchicine can be taken with or without food, there is no specific interaction with grapefruit, using colchicine prophylactically is not recommended, and discontinuing medication when symptoms improve can lead to inadequate treatment.