You are working in a busy outpatient clinic and performing assessment on a new patient. The patient reports pain in the left ankle and big toe. You see what looks like a large tophi on the left toe. The patient's BMI is 38, and the patient reports drinking beer several nights a week. What is your patient's MOST LIKELY diagnosis?

Gouty arthritis

Rheumatoid arthritis

Lupus

Osteoarthritis

Answer and Explanation

The Correct Answer is A

A.   Gouty arthritis, or gout, is characterized by the accumulation of uric acid crystals in the joints, leading to sudden and severe pain, especially in the big toe (podagra). The presence of tophi (deposits of uric acid crystals under the skin) on the left toe is a classic sign of chronic gout. The patient's high BMI and frequent beer consumption also increase the risk for elevated uric acid levels, contributing to gout.
B.   Rheumatoid arthritis is an autoimmune condition that typically causes symmetric joint pain and stiffness, often involving the small joints of the hands and feet. It is less likely to present with tophi and is usually not linked to a history of beer consumption or a specific joint (like the big toe) in isolation.
C.   Systemic lupus erythematosus (SLE) can cause joint pain, but it usually involves multiple joints in a symmetrical pattern and is associated with a range of other systemic symptoms. The presence of tophi and the specific pain in the big toe point more toward gout.
D.   Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints and can cause pain, especially with movement. However, it does not typically cause the acute attacks or the presence of tophi that are characteristic of gout.

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Correct Answer is D

Explanation

A. While patients with latent TB may be treated to prevent progression to active TB, the treatment duration is generally shorter—typically around 3 to 9 months, depending on the medication regimen (e.g., isoniazid for 9 months or rifampin for 4 months).
B. Individuals with latent TB will usually test positive on a Mantoux test (also known as a tuberculin skin test), indicating they have been exposed to the TB bacteria. However, those with latent TB do not have active disease and may not have symptoms.
C. Individuals with latent TB do not spread the bacteria to others because the infection is contained and does not cause active disease. Only those with active TB can transmit the bacteria, regardless of sputum test results.
D. Patients with latent TB are not contagious and cannot spread the bacteria to others. The bacteria remain inactive in the body, and only a small percentage of these individuals may develop active TB in the future.

A. The MTX will stop the pain but not the progression of your disease, so we also give you NSAIDS and steroids B. You have good insurance so we like to prescribe you a whole bunch of medications just in case C. The MTX helps treat the nausea associated with the other meds that actually treat your disease D. The MTX takes several weeks or months to reach full effect, so the other meds are started now to help your symptoms

Correct Answer is D

Explanation

A. Methotrexate (MTX) is a disease-modifying antirheumatic drug (DMARD) that helps slow disease progression but does not provide immediate pain relief. NSAIDs and steroids may be used for symptomatic relief, but MTX alone can manage both pain and disease progression over time.
B. This response is unprofessional and dismissive. It implies that the medication regimen is based solely on the patient's insurance coverage rather than their medical needs. It does not address the patient’s question and could undermine trust in the healthcare team.
C. Methotrexate does not primarily treat nausea; rather, it is used to manage rheumatoid arthritis. While some patients may experience nausea as a side effect of MTX or other medications, this is not its primary purpose.
D. Methotrexate is indeed a DMARD that can take weeks to months to show its full benefits in controlling inflammation and slowing disease progression. Meanwhile, NSAIDs or corticosteroids may be prescribed to provide quicker relief from symptoms such as pain and swelling.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

As a nurse, you understand that when patients have latent TB:

Correct Answer is D

Explanation

Your patient has just received a new diagnosis of Rheumatoid Arthritis. They are confused about their prescriptions, however. They ask you "Why am I receiving so many medications? I thought this 'MTX' drug was the one that would treat my arthritis?". What is your BEST response?

Correct Answer is D

Explanation

A nurse is caring for a patient who, upon awakening, was disoriented to person, place, and time. The client reports chills and chest pain that is worse upon inspiration. Which of the following actions is the nursing PRIORITY?

A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate? (Select all that apply)

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A nurse is teaching the client with systemic lupus erythematosus about prednisone. What information is the priority?