INSTRUCTIONS Gout diagnosis and management: What NPs need to know
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Gout diagnosis and management: What NPs need to know
General Purpose: To provide NPs with updated information about gout. Learning Objectives: After reading the preceding article and taking the following test, you should be able to: 1. Identify the basic cause of and risk factors for gout. 2. List the characteristics of acute gout. 3. Describe the diagnosis of gout. 4. Discuss acute and long-term treatment of gout.
1. The root cause of gout is hyperuricemia from
a. overproduction or underexcretion of urate.
b. excessive ingestion of urate.
c. overexcretion of urate.
d. kidney disease.
2. Which of the following is a nonmodifiable risk factor for gout?
a. premenopausal woman
b. organ donor
c. end-stage kidney disease
d. metabolic syndrome
3. Modifiable risk factors for gout include consumption of
a. moderate amounts of red wine.
d. high-purine legumes.
4. Asymptomatic hyperuricemia
a. should always be treated.
b. is not usually treated.
c. precedes gout in 90% of patients.
d. precedes gout in 50% of patients.
5. Which is least likely to trigger a gout attack?
6. As time progresses attacks of gout become
a. more frequent and last longer.
b. less frequent but involve more joints.
c. more frequent but have shorter duration.
d. less frequent but last longer.
7. An attack of gout is commonly characterized by pain
a. with gradual onset.
b. in multiple joints, mostly in the feet.
c. lasting 3 weeks if not treated.
d. with nighttime onset.
8. Which is one criterion for confirming a diagnosis of gout attack?
a. urate crystals in blood serum
b. positive synovial fluid cultures
c. moderate white blood cell count in synovial fluid
d. elevated serum uric acid level
9. When should serum uric acid levels be drawn?
a. at any time
b. during an acute attack
c. immediately after an attack
d. 2 weeks after an attack
10. Which drug is not included in the standard for initial treatment of acute gout flares?
11. Lower doses of colchicine should be used
a. when initiating treatment.
b. if the patient has hepatic or renal impairment.
c. if the patient has taken the drug previously.
d. if its analgesic effect causes sedation.
12. When used to treat acute gout, NSAIDs and corticosteroids should be
a. discontinued as soon as symptoms subside.
b. given in slowly increasing doses for symptom management.
c. continued for a short time after the patient is asymptomatic.
d. discontinued abruptly.
13. Urate-lowering therapy should be started
a. 1–2 weeks after an acute attack of gout has resolved.
b. as soon as an acute attack of gout has resolved.
c. as soon as the patient develops symptoms.
d. to maintain serum uric acid levels between 6 and 7 mg/dL.
14. Which drug is not used for long-term uric acid reduction?
15. When initiating probenecid therapy, the NP should tell patients
a. to drink eight glasses of water daily.
b. to take aspirin when analgesia is needed.
c. to limit fluid intake to increase the drug effect.
d. that when indicated, penicillin is the antibiotic of choice.
16. NPs can help patients with the long-term management of gout by
a. stressing the importance of taking urate-lowering drugs for life.
b. teaching the importance of limiting physical activity.
c. encouraging protein consumption, especially seafood.
d. teaching the importance of maintaining a healthy weight.
17. Hypertensive patients may be at risk for gout attacks because
a. hypertension increases the frequency of attacks.
b. hypertension increases serum urate levels.
c. only 30% of patients make needed lifestyle changes.
d. diuretics can precipitate a gout attack.