Question 1.
Gout usually affects the 1st metatarsophalangeal joint and is a result of hypouricemic serum uric acid levels less < 6.8 mg/dl.
T
F
Answer: F.
Gout is related to a hyperuricemic serum acid level but it does usually affect the 1st metatarsophalangeal joint.
Question 2.
When monitoring a patient with gout, which test would not be needed?
A. renal function test
B. glucose levels
C. Urinalysis
D. CBC
Answer: B
Even though insulin resistance can result in reduced renal rate excretion which leads to hyperuricemia, it is not necessary to monitor glucose in these patients.
A CBC can tell us whether the WBC is elevated. Increased WBC can occur with gout flare ups. Urate crystals can precipitate an immune response.
A urinalysis will show high level of uric acid due to the body’s inability to break down purines usually found in foods like liver, dried beans and beer.
Renal disease can cause reduced urate excretion to damage to glomerular arteriolar damage.
Question 3.
When educating a patient about managing gout, the nurse recommends that the patient avoid foods high in purine. What are the foods that the patient should limit. (Check all that apply)
A. Beer
B. Organ meats
C. Dried beans
D. Whole grain bread
E. Shellfish
F. Watermelon
Answer: A B C E
These are all foods high in purine. Purine metabolism in the body produces Monosodium urate crystals. These MSU crystals accumulate in the joints and soft tissues and cause pain.
Question 4.
When assessing the patient with gout, the nurse notices subcutaneous nodules and that cause the patient pain. These nodules are called
A. Gout bodies
B. Lewy bodies
C. Tophi
D. Uric acid stones
Answer: C
Tophi occur when Monosodium urate crystals accumulate in the soft tissue.
Question 5.
Overproduction or underexcretion of urate or both can cause hyperuricemia (too much uric acid in the blood). A genetic factor called Lesch-Nyan Syndrome that can lead to hyperuricemia. How does hyperuricemia occur in patients with this syndrome?
A. Patients overproduce uric acid due to in inherited enzyme defect.
B. Patients have an inherited kidney disorder that leads to the overexcretion of uric acid.
C. Patients have trisomy of the 21 chromosome and are unable to excrete uric acid.
D. Patients have an inherited gene that causes addiction and they can’t stop drinking beer.
Answer: A
Patients with Lesch-Nyan Syndrome can inherit an enzyme deficit and over produce uric acid
Question 6.
During an acute gouty arthritis attack, treatments to lower urate levels should be administered within the next 24 hours. The patient is receiving treatment and is feeling better within hours. He does not want to take any more of this medicine and wishes to return home. What should the nurse do first?
A. Advise the patient to avoid meats and alcohol and she will be back to normal in a few days. Take NSAIDs for pain as needed.
B. Restrain the patient and force her to take her medications.
C. Explain that during an acute gout attack, urate lowering therapy should not be interrupted even if you are feeling better, it is important to follow the protocol.
D. Ask the provider if the patient will be ok just taking corticosteroids
Answer: C
Urate lowering therapy should not be interrupted after implementation. Corticosteroids are administered after no tophi on an exam and achieving an appropriate serum urate, or for 6 months exam shows greater or equal to 1 tophi. Merely avoiding meats and alcohol will not resolve acute symptoms. Restraining the patient is not recommended.
Question 7.
Sometimes patients present with similar symptoms of severe joint pain with gout and septic arthritis. What test would help differentiate the two illnesses.
A. Radiograph of the kidney to check for kidney stones
B. Synovial fluid analysis of WBC in order to rule out infection
C. Ultrasound of the joint to see the anatomy
D. Serum Uric Acid levels in order to see if the patient has gout
Answer: B
A patient with sepsis will have a much higher WBC upwards of 50,000 cells/mm3. Without infection, WBC is usually 2,000 to 5,000 cell/mm3. Patients with gout can have a slightly elevated WBC; however, a patient with septic arthritis has exceedingly high WBC numbers. Serum uric acid levels can be normal with an acute flair of gout thus not being a definitive test.
(Golding, 2019)