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A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

A.

Replace dietary table salt with salt substitutes.

B.

Encourage active range of motion to limit stiffness.

C.

Take prescribed pain medication after exercising joints.

D.

Avoid the consumption of wine, beer, and coffee.

Answer and Explanation

The Correct Answer is D

Choice A reason: Replacing dietary table salt with salt substitutes is not specifically related to managing gout. Gout is caused by the accumulation of uric acid crystals in the joints, leading to inflammation and pain. The primary dietary factor influencing gout is purine intake, not sodium. While reducing sodium intake is generally beneficial for overall cardiovascular health, it does not directly impact uric acid levels or the management of gout. Therefore, recommending salt substitutes does not address the underlying cause or prevention of gout attacks. Moreover, some salt substitutes contain potassium chloride, which can have its own health implications, particularly for individuals with kidney issues.

Choice B reason: Encouraging active range of motion to limit stiffness is important for maintaining joint function in many conditions, but during an acute gout attack, the primary focus should be on reducing inflammation and pain. Gout attacks cause severe pain and swelling, particularly in the affected joint, and encouraging active movement during an acute phase can exacerbate the pain and inflammation. It is more appropriate to rest the affected joint and manage pain and inflammation with medications and other supportive measures. Once the acute phase has resolved, gradual reintroduction of movement and exercise can help maintain joint function and prevent long-term stiffness.

Choice C reason: Taking prescribed pain medication after exercising joints is not appropriate advice for managing gout. Pain medication, such as NSAIDs (nonsteroidal anti-inflammatory drugs), should be taken as prescribed by the healthcare provider to effectively manage pain and inflammation. It is crucial to follow the prescribed regimen for pain management, regardless of exercise or activity. Furthermore, during an acute gout attack, it is advisable to avoid activities that may aggravate the affected joint. Pain management should be proactive, and medications should be taken at regular intervals to maintain pain relief rather than in response to specific activities like exercise.

Choice D reason: Avoiding the consumption of wine, beer, and coffee is crucial for managing gout. Alcohol, particularly beer and wine, contains high levels of purines, which can increase uric acid production and exacerbate gout symptoms. Alcohol also promotes dehydration, which can lead to higher uric acid concentrations in the blood. Both of these factors can trigger gout attacks. Coffee has mixed effects on gout; while some studies suggest that moderate coffee consumption may not significantly impact uric acid levels, it is generally advised to be cautious with its intake. Educating the client to avoid or limit these beverages can help prevent future gout attacks and manage symptoms more effectively. Dietary modifications are a key component of gout management, and avoiding high-purine foods and beverages is essential in reducing the frequency and severity of gout attacks.


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Related Questions

Correct Answer is []

Explanation

Condition: Transient ischemic stroke (d)

2 actions:

  1. Request a prescription for a computerized tomography (CT) scan of the client's head and neck (d)
  2. Perform a National Institute of Health Stroke Scale (NIHSS) assessment (e)

2 parameters:

  1. Neurological status (a)
  2. Blood pressure (c)

Rationale for correct condition: A transient ischemic stroke (TIA) is a temporary period of symptoms similar to those of a stroke and is often a precursor to a full-blown stroke. The patient's symptoms of dizziness, weakness, and a horrible headache, combined with his history of hypertension and atrial fibrillation, suggest a high risk for a TIA. The patient's confusion about the date and time also supports this condition. Immediate assessment and intervention are crucial to prevent a possible stroke.

Rationale for the two correct actions:

  1. Request a prescription for a CT scan: This is essential to identify any blockages or abnormalities in the blood vessels of the brain, confirming the presence and extent of a TIA or stroke.
  2. Perform an NIHSS assessment: This standardized tool is used to evaluate the severity of a stroke and to monitor changes in the patient's neurological status over time.

Rationale for parameters to monitor:

  1. Neurological status: Monitoring this parameter helps track changes in the patient's cognitive and motor functions, which are critical in assessing the progression or improvement of the stroke symptoms.
  2. Blood pressure: Hypertension is a major risk factor for strokes. Keeping a close watch on the blood pressure helps in managing and reducing the risk of further complications.

Rationale for incorrect conditions:

  1. Hypoglycemia: While it can cause dizziness and weakness, the patient's recent UTI and headache are not typical for hypoglycemia.
  2. Hemorrhagic stroke: This would typically present with more severe neurological symptoms and possible loss of consciousness.
  3. Urinary tract infection: The patient's symptoms go beyond those of a UTI, especially given the headache, dizziness, and confusion.

Rationale for incorrect actions to take:

  1. Administer 0.9% sodium chloride IV: Not specific to stroke management and doesn't address the immediate risk.
  2. Administer oxygen via nasal cannula: The patient's oxygen saturation is normal; thus, this is not immediately necessary.
  3. Request a prescription for the client's home medication of aspirin: While aspirin is used for stroke prevention, administering it without confirming the stroke type (ischemic vs hemorrhagic) could be harmful.

Rationale for incorrect parameters to monitor:

  1. Respiratory rate: This is not directly related to stroke assessment.
  2. Urine output: Irrelevant to the immediate management of TIA.
  3. Oxygen saturation: The patient's oxygen levels are normal, so monitoring it won't provide further insights.

Correct Answer is C

Explanation

Choice A reason: Central line insertion is not the appropriate intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates airway obstruction, which requires immediate airway management, not central venous access.

Choice B reason: Nasogastric tube (NGT) insertion is not the correct intervention for stridor. NGT insertion is typically used for gastrointestinal decompression or feeding, not for managing airway obstruction.

Choice C reason: Tracheostomy placement is the correct intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates a potential airway obstruction, which can be life-threatening. A tracheostomy provides a secure airway and ensures adequate ventilation.

Choice D reason: Pacemaker placement is not relevant to managing stridor. Pacemakers are used for cardiac rhythm management and do not address airway obstruction.

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