Chapter 38: Gout Medications

Chapter 38: Gout Medications

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient who has hypertension is taking a thiazide diuretic. The patient has a serum uric acid level of 8 mg/dL. The primary care nurse practitioner (NP) caring for this patient should:

ANS:  C

Patients who have hypertension or who take thiazide diuretics are at increased risk for gout. An elevated uric acid level alone is not diagnostic, and a 24-hour urine collection should be ordered. Colchicine should not be prescribed until the diagnosis is confirmed. It is not necessary to discontinue the thiazide diuretic. A referral to a specialist is not indicated.

DIF:    Cognitive Level: Applying (Application)                           REF:   423

2. A patient comes to the clinic reporting sudden pain and swelling of one knee joint. The primary care NP suspects gout. When preparing to order diagnostic tests, the most important initial test the primary care NP should order is:

ANS:  D

Although the other tests are part of the diagnostic process, the most important differential diagnosis to be made in a patient with gout is the exclusion of a septic joint.

DIF:    Cognitive Level: Applying (Application)                           REF:   423

3. Gout is diagnosed in a patient, and tests show the cause to be an underexcretion of uric acid. The primary care NP should prescribe:

ANS:  D

A uricosuric agent is indicated to increase the excretion of uric acid. Probenecid is a uricosuric medication. Febuxostat and allopurinol are xanthine oxidase inhibitors. Colchicine is not a uricosuric agent.

DIF:    Cognitive Level: Applying (Application)                           REF:   423

4. A primary care NP prescribes probenecid to treat a patient who has gout. The patient comes to the clinic 2 weeks later with severe flank pain. The NP should:

ANS:  A

Uricosuric agents are tubular blocking agents and decrease serum uric acid levels by increasing urinary excretion of uric acid. During this process, high concentrations of uric acid develop in the proximal renal tubules and may predispose the patient to the development of urinary stones. Patients should be encouraged to drink plenty of fluids. The patient who presents with flank pain should be questioned about fluid intake. If fluid intake is sufficient and renal stones are ruled out, a urinary tract infection may be considered. Allopurinol is not indicated. NSAIDs are not indicated.

DIF:    Cognitive Level: Applying (Application)                           REF:   423