Lesson 8-G: Musculoskeletal System
The nurse notices bone growths on the distal interphalangeal joints of a client with osteoarthritis. How should the nurse document these findings? A. Heberden's nodes B. Dermatofibromas C. Bouchard's nodes D. Neurofibromatosis
Correct Answer: A Rationale: Bony outgrowths found on the distal interphalangeal joint (closest to the fingernail and furthest away from the body) are called Heberden's nodes. If the bony outgrowth was found on the proximal interphalangeal joint (the middle joint of the finger, closest to the body), they would be Bouchard's nodes.
The nurse is caring for a client with osteoporosis who has been prescribed alendronate. When providing care, which intervention would be a priority? A. Notify the health care provider if the client reports jaw pain. B. Encourage the client to increase their intake of vitamin D. C. Monitor the client's serum calcium levels. D. Administer the alendronate 30 to 60 minutes before the client eats.
Correct Answer: A Rationale: Alendronate is a bisphosphonate that helps slow down bone resorption, decreasing osteoporosis. Osteonecrosis of the jaw is a rare, adverse reaction to alendronate, and jaw pain can be a symptom of this. Therefore, notifying the health care provider of the jaw pain is the priority. The other interventions are also correct for a client with osteoporosis, but are not as important as reporting the potential adverse drug effect.
The nurse is caring for a client who is recovering from a below-knee amputation. Which is the best way for the nurse to apply the prescribed elastic bandage to the stump? A. Wrap the bandage in a figure-eight manner. B. Wrap the bandage in a chevron manner. C. Wrap the bandage in a simple spiral manner. D. Wrap the bandage in a triangular manner.
Correct Answer: A Rationale: An amputation is the removal of part of the body. The limb should be wrapped with an elastic bandage applied in a figure-eight manner. This approach reduces the risk of cutting off circulation to the stump area. Although wrapping a bandage in a simple spiral, chevron and triangular manner are appropriate techniques in other circumstances, they are not recommended for use on an amputation stump.
A client has received instructions for the management of osteoarthritis. Which statement by the client would indicate a need for additional teaching? A. "Early surgical intervention is the preferred treatment." B. "Gradual weight loss may help my pain." C. "It is important for me to balance my exercise and rest periods." D. "I will avoid driving after I have taken cyclobenzaprine."
Correct Answer: A Rationale: Clients with osteoarthritis experience the erosion of cartilage in their joints, which leads to pain and swelling of the joints. Weight loss has shown to decrease pressure on the joints, which can decrease pain. Balancing exercise and rest periods allows the client to be active to help decrease joint stiffness while decreasing the likelihood of more inflammation in the joint. Cyclobenzaprine is a muscle relaxant used to manage pain and muscle spasms in clients with osteoarthritis. Cyclobenzaprine can cause drowsiness, fatigue and dizziness. For safety reasons, the client should not drive after taking cyclobenzaprine. Initial management of osteoarthritis includes physical therapy, medications and weight loss. Surgical management is typically not considered until all medical interventions have failed.
The nurse is caring for a client who is experiencing an acute gout attack. Which action should the nurse implement? A. Administer indomethacin. B. Monitor liver enzymes. C. Restrict sodium intake. D. Provide a high-protein diet.
Correct Answer: A Rationale: Gout is a disease where uric acid crystals form and accumulate in joints and other tissues. During an acute gout attack, the client experiences pain and inflammation in the joints. The nurse should administer a non-steroidal anti-inflammatory medication such as indomethacin to help decrease pain and inflammation. Restricting sodium would not benefit the client and providing a high-protein diet may make the situation worse. There is no need to monitor liver enzymes with an acute gout attack.
The nurse should provide which dietary instruction to a client with osteoporosis? A. "Eat more dairy products to increase your calcium intake." B. "Decrease your intake of foods that contain vitamin D." C. "Eat more bananas to increase your potassium intake." D. "Decrease your intake of nuts and seeds."
Correct Answer: A Rationale: Osteoporosis causes a reduction in skeletal bone mass, leading to porotic and brittle bones. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. Decreasing vitamin D intake is incorrect as vitamin D helps facilitate calcium utilization. None of the other options would stop osteoporosis from worsening.
The nurse in the outpatient clinic is following up on a client with a fractured arm. The client's arm was placed in a cast four hours ago. The client states, "my fingers are tingling and feel cold." Which action should the nurse take first? A. Check the capillary refill in the client's fingers. B. Elevate the client's arm above the level of the heart. C. Apply an ice pack to the cast to reduce swelling. D. Notify the health care provider.
Correct Answer: A Rationale: The client with a cast on an extremity is at risk for development of compartment syndrome. Compartment syndrome occurs when the swelling underneath the cast becomes so great that it will decrease circulation and tissue perfusion to the extremity, distal to the cast. This is a medical emergency. Using the nursing process, the nurse should first collect more data by checking the client's capillary refill, which can support the possibility of compartment syndrome. After obtaining the additional information, the nurse can make the best decision about what to do next.
During a conversation with a client who has osteoarthritis, the client says, "I am so frustrated with this disease and my disabilities." What is the best response by the nurse? A. "Do you use any assistive devices to help you walk?" B. "Can you tell me more about what is frustrating you?" C. "What medications have you been taking for pain?" D. "Has your spouse been supportive of your diagnosis?"
Correct Answer: B Rationale: Osteoarthritis (OA) is characterized by the progressive deterioration and loss of cartilage in one or more joints. OA is a chronic condition that may cause permanent changes in lifestyle. In this scenario, the nurse should collect more data about the specific cause of the client's frustration and disabilities to help develop an appropriate plan of care. The other options about pain medications, assistive devices and spousal support are relevant but the nurse first needs to collect more data about what specifically is frustrating the client.
A client who has osteoarthritis, affecting both knees, is reporting constant pain at a level of 4 on a 0 to 10 scale. Which nonpharmacological intervention should the nurse implement for this client to help alleviate the pain? A. Place the client on strict bedrest with bathroom privileges only. B. Provide opportunity for the client to participate in hydrotherapy. C. Position the client with the knee joints in a flexed position. D. Collaborate with physical therapy for paraffin dips to the knees.
Correct Answer: B Rationale: Osteoarthritis (OA) means the degeneration of cartilage in the joints, primarily the weight-bearing joints. These degenerative changes lead to swelling and pain in the joint. To prevent joint stiffness, it is important to encourage the client to balance activity and rest. Strict bedrest would only increase joint stiffness and further decrease in joint mobility. Paraffin (a type of wax) dips are helpful for clients with OA in the hands, but are not usually used for OA in the knees. The joints should be placed in a neutral, not flexed, position to prevent contractures. Soaking in a hot bathtub or doing hydrotherapy with physical therapy provides warmth that will decrease pain. The buoyancy of the client's body in water decreases weight on the joints, which will also decrease pain.
The nurse is reinforcing teaching for a client who has a diagnosis of gout. Which foods should be restricted in the client's diet? (Select all that apply.) A. Vegetables B. Liver C. Shrimp D. Sardines E. Eggs
Correct Answer: B,C,D Rationale: Gout is a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation. High levels of uric acid in the blood are found in clients who have gout. Clients with gout should follow a low-purine diet. Purine-rich foods such as organ meats (liver), shellfish (shrimp), red meat and oily fish with bones (sardines) should be restricted. Vegetables and dairy, including eggs, do not need to be restricted or limited with gout.
The nurse is assisting in the development of a plan of care for a client with acute rheumatoid arthritis. Which priority interventions should the nurse include? (Select all that apply.) A. Establishing a weight loss goal B. Preserving joint function C. Relieving pain D. Preventing joint deformity E. Managing stress
Correct Answer: B,C,D Rationale: Pain relief is a high priority during the acute phase of RA because the pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Managing stress and establishing a goal for a healthy weight are also important, but can wait to be addressed until the acute episode has resolved.
A client who has been newly diagnosed with carpal tunnel syndrome asks the nurse why they are having pain and tingling in their fingers. Which is the best response from the nurse? A. "The pain and tingling is caused by uric acid crystals collecting in the small joints of your fingers." B. "The pain and tingling is caused by the fluid build-up in the soft tissue of your fingers." C. "The pain and tingling is caused by compression of the median nerve in your wrist." D. "The pain and tingling is due to sclerotic plaques along the nerves in your hand."
Correct Answer: C Rationale: Carpal tunnel syndrome (CTS) is a common, repetitive motion-related condition in the wrist. The carpal tunnel is a rigid canal lying between the carpal bones and a fibrous tissue sheet called the flexor retinaculum. A group of nine tendons, enveloped by synovium, share space with the median nerve in the carpal tunnel. When the synovium becomes swollen or thickened, the median nerve is compressed. This causes pain, numbness and painful tingling in the client's fingers and hand. CTS typically does not cause soft tissue fluid build-up. Uric acid crystals collecting in small joints is seen with gout. Sclerotic plaques along nerve fibers tend to occur with multiple sclerosis (MS). Therefore, the best response includes information about the median nerve in the wrist being compressed.
The nurse in the urgent care clinic is reinforcing teaching for a client who is being discharged with a new cast on the left arm due to a spiral fracture. Which statement indicates that the client correctly understands how to care for the cast? A. "I should be able to fit three fingers between the cast and my skin." B. "A moderate amount of daily drainage from my cast is expected." C. "I will notify my health care provider if my hand becomes pale." D. "I will avoid using ice the first 24 hours that my cast is on."
Correct Answer: C Rationale: Clients being discharged with a cast on their arm should be instructed to elevate their arm above the level of the heart, to apply ice to their cast to help decrease swelling and to monitor for signs and symptoms of decreased perfusion. A pale hand can signal a decrease in perfusion and the client should report this to their health care provider. The client with a cast should not expect drainage and any drainage should be reported. The nurse should explain that the gap between the cast and skin should not be greater than one finger width.
The nurse is reviewing the chart of a client with suspected osteoporosis. Which diagnostic test to confirm the diagnosis should the nurse plan for? A. Magnetic resonance imaging scan B. Computerized axial tomography scan C. Dual-energy X-ray absorptiometry scan D. Positron-emission tomography scan
Correct Answer: C Rationale: Osteoporosis is a metabolic disease in which bone mineralization results in decreased bone density. A dual-energy X-ray absorptiometry (DEXA) scan is a painless scan that measures bone mineral density (BMD) in the hip, wrist or vertebral column. It is the recommended test for the diagnosis of osteoporosis. Magnetic resonance imaging (MRI), computerized axial tomography (CAT) and positron-emission tomography (PET) scans are imaging tests used for evaluating a range of musculoskeletal diseases, but they are not typically used to diagnose osteoporosis.
A client has received education from the nurse about their new diagnosis of systemic lupus erythematosus. Which statement by the client indicates that additional teaching is needed? A. "I will monitor my body temperature carefully." B. "I will protect my skin from the sun when I'm outside." C. "I will avoid foods that contain high levels of vitamin K." D. "I may feel more tired and fatigued than I used to."
Correct Answer: C Rationale: Systemic lupus erythematosus (SLE) is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Clients with SLE should avoid prolonged sun exposure. The nurse should instruct clients to wear long sleeves and a large brimmed hat when outdoors. They should use sun blocking agents with a sun protection factor (SPF) of 30 or higher on exposed skin surfaces. It is expected for clients with SLE to experience fatigue, so they should allow time to rest when needed. Clients with SLE should monitor their body temperature carefully because this is typically the first sign of an exacerbation, during which the client can become critically ill. There is no established diet recommendation for clients with SLE, except to eat a well-balanced diet. Avoiding foods that contain vitamin K is not necessary, so this statement should be followed up on.
A client is admitted to the orthopedic nursing unit with a fractured right tibia. The client is complaining of pain. Which action should the nurse take first? A. Contact the health care provider. B. Place an ice pack on the fracture site to reduce edema. C. Check the pulse and capillary refill in the right foot. D. Administer acetaminophen 650 mg PO as ordered.
Correct Answer: C Rationale: The nurse should first collect more data about the client's pain. Compartment syndrome is a potential complication with an acute fracture and the nurse should evaluate tissue perfusion in the affected extremity to make sure that the pain is solely related to the acute fracture. Signs of compartment syndrome include worsening pain, weak peripheral pulses, edema, slow capillary refill and paresthesia (i.e., numbness, tingling). If the nurse suspects that compartment syndrome is occurring, the health care provider (HCP) must be notified immediately. After ruling out compartment syndrome, the nurse can proceed with administering an analgesic and applying ice.
The nurse observes an unlicensed assistive person (UAP) providing care to a client who had a total hip arthroplasty 24 hours ago. Which action by the UAP would require the nurse to intervene immediately? A. Placing non-slip foot wear on the client prior to ambulation. B. Placing a raised toilet seat in the client's bathroom. C. Standing by the client's non-operative side during ambulation. D. Reminding the client not to cross their legs.
Correct Answer: C Rationale: When assisting the client during ambulation following a total hip arthroplasty, the UAP should stand on the operative side (i.e., the side of the surgery) to help provide support to the client because that is the client's weaker side. The other actions are appropriate for this client and do not require intervention by the nurse.
The nurse in an urgent care clinic is evaluating a client's understanding of discharge instructions for a second-degree ankle sprain. Which statement by the client requires follow-up by the nurse? A. "I will apply a compression bandage and wear an ankle brace." B. "I will apply ice intermittently for the first 24 to 48 hours." C. "I will elevate my ankle to decrease pain and swelling." D. "I will do gentle stretching and range of motion exercises daily."
Correct Answer: D Rationale: A sprain is excessive stretching of the ligament with tearing of the ligament fibers. Twisting motions from a fall or sports activity typically precipitate the injury. A second-degree sprain is classified as moderate. Second-degree sprains require immobilization with an elastic bandage and ankle brace, splint or cast. Recommendations for caring for a client with a sprain include rest, use of ice for the first 24 to 48 hours, application of a compression bandage for a few days to reduce swelling and provide joint support and elevation of the affected extremity (RICE). It is recommended not to stretch or use the sprained joint for approximately a week, sometimes longer, to allow it to heal properly. The nurse should follow up and advise the client not to perform stretching and range of motion exercises.
The nurse in a rehabilitation facility is caring for a client who had a total left hip arthroplasty, using a posterior approach, three days ago. Which intervention should the nurse make sure to include in the client's plan of care? A. Instruct the client to cross their legs at their ankles only. B. Keep the client's affected hip bent at least 90 degrees. C. Rest the client's heels flat on the bed, in line with the hip. D. Apply an abduction pillow while the client is in bed.
Correct Answer: D Rationale: Clients who have had a total hip arthroplasty (THA), i.e., hip replacement, are at risk for post-operative hip joint dislocation. An abduction pillow should be used to prevent the client from closing or crossing their legs while in bed, causing adduction beyond the midline of the body, which can lead to dislocation of the new joint. The client's heels should be elevated off the bed, not flat on the bed, to prevent pressure injury to the heels. The affected hip should not be flexed to 90 degrees. Even crossing the legs at the ankles should be discouraged and prevented with this type of hip surgery.
The nurse comes upon an 85-year-old client lying on the bathroom floor. The nurse observes a deformity in the left leg and the client is unable to move the leg. The client is alert and oriented but in severe pain. Which action should the nurse take first? A. Apply an ice pack to the site. B. Elevate the extremity above heart level. C. Administer pain medication. D. Immobilize the fracture with a splint.
Correct Answer: D Rationale: It appears that the client suffered a bone fracture in the left leg. After confirming that the client's respiratory and neurologic status is stable, the nurse should immobilize the fracture with a splinting device. This will prevent movement of the extremity by the client and further pain or bleeding along the fracture into the surrounding tissues. Next, the nurse will notify the health care provider and implement the other actions as prescribed and appropriate.
The nurse is reinforcing teaching regarding the use of methotrexate with a female client who has systemic lupus erythematosus. Which statement by the client indicates an understanding of the teaching? A. "I should not use contraception that contains estrogen." B. "Lab work won't be necessary while I take this medication." C. "I will not take any vitamin that contains folic acid." D. "I will avoid interacting with people in large crowds."
Correct Answer: D Rationale: Methotrexate is an immunosuppressant medication that is used to treat systemic lupus erythematosus (SLE). Due to immunosuppression, clients taking methotrexate should avoid large crowds of people to prevent becoming ill. Methotrexate should be taken with folic acid to decrease gastrointestinal and hepatic toxicity. Clients who are taking this medication should have a complete blood count test done regularly to monitor for decreased white blood cells and platelets, which can indicate bone marrow suppression. Methotrexate is teratogenic, therefore, pregnancy should be avoided while taking this medication. Oral contraceptives that contain estrogen are not contraindicated with this medication or disease.
The nurse is reviewing the chart of a client who was admitted after having been found lying on the bathroom floor in their home. The client's family reports that the client could have been lying on the floor for over 12 hours. Which laboratory result should be of greatest concern to the nurse? A. Serum hemoglobin level of 10.8 g/dL B. Serum white blood cell count of 14,000/mm3 C. Serum glucose level of 162 mg/dL D. Serum creatinine level of 4.2 mg/dL
Correct Answer: D Rationale: When a person falls and lies immobile for an extended period of time, muscle tissue will start to break down. This is called rhabdomyolysis. Rhabdomyolysis leads to the release of myoglobin (muscle protein) into the bloodstream. Myoglobin breaks down into substances that will damage the kidneys, causing acute kidney injury (AKI) as evidenced by the client's severely elevated creatine level. (A normal range would be between 0.5 to 1.2 mg/dL). Although the client's other lab values are also outside of the normal range, the values are not as severely elevated or decreased as the creatinine level which represents the greatest concern to the client's condition at this time.
The nurse is reviewing the medical record of a client who has been diagnosed with systemic lupus erythematous (SLE). The nurse would expect which findings associated with this disease? (Select all that apply.) A. A red, raised rash on the face B. Generalized weakness C. A temperature of 100.6° F (38° C) D. Polydipsia for the last month E. A recent ten pound weight gain F. Reports of pain in the hands and knees
Correct Answers: A, B, C, F Rationale: Systemic lupus erythematous (SLE) is an autoimmune, inflammatory disorder of the connective tissue. It can affect multiple organs. This disorder has remission periods and flare-ups. A client who was recently diagnosed often presents during an exacerbation. Common assessment findings during exacerbation include a red, raised, rash on the face, commonly known as the "butterfly rash" and generalized weakness that can be associated with the fever and joint inflammation that are also present. SLE most frequently affects small joints (such as the hands) and the knees. Clients tend to experience anorexia which often leads to reports of weight loss, not weight gain. Polydipsia (excessive thirst) is not associated with SLE.
The nurse in the urgent care center is caring for a 20-year-old client who sustained a sprained ankle while playing sports. Which instructions should the nurse give the client to prevent a future sprain injury? (Select all that apply.) A. Encourage stretching before and after any sports activity. B. Take ibuprofen 30 minutes before starting any sports activity. C. Wear snug, well-fitting shoes that go up to the ankle. D. Use appropriate protective equipment with the activity. E. Warm up for several minutes before starting the activity.
Correct Answers: A, C, D, E Rationale: A sprain occurs when there is a sudden, abnormal movement around the joint that can lead to stretching and/or tearing of the ligaments attached to the joint. Stretching before and after exercising increases the ligaments pliability and decreases the risk for injury. Gradually warming up prior to engaging in physical activity provides the muscles with increased circulation and loosens up joints; both will decrease the risk for strains or sprains. Wearing proper fitting shoes enhances stability and wearing appropriate protective gear provides protection and decreases the likelihood of sprains. Taking ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), to decrease inflammation would be appropriate after a musculoskeletal injury, but will not help to prevent one.
The home health nurse is discussing safety concerns with a client who has osteoporosis. Which interventions should the nurse recommend to the client? (Select all that apply.) A. Enroll in a smoking cessation program. B. Go for a jog or run several times a week. C. Increase intake of dairy products. D. Provide assistive devices, if needed. E. Request a referral for physical therapy.
Correct Answers: A, C, D, E Rationale: Clients with osteoporosis have fragile bones and are at risk for fractures. The nurse should encourage coordination with physical therapy to increase muscle strength, balance and decrease the likelihood of a fall. The nurse would also provide assistive devices if the client requires them. Not all clients with osteoporosis will need an assistive device. Due to the impact on joints that occurs with running, the nurse should not recommend jogging or running to a client with osteoporosis. Low-impact activities such as walking would be better. Since smoking decreases tissue perfusion in general and impacts bone development, the client should stop smoking. Dairy products are high in calcium and will help with strengthening bones.
The nurse is assisting in the admission of a 73-year-old client who has a fractured right hip. Which interventions should the nurse include in the client's plan of care? (Select all that apply.) A. Palpate the client's bilateral pedal pulses every four hours. B. Reposition the client every hour to prevent skin breakdown. C. Place the client on continuous pulse oximetry. D. Perform daily circulation, motion and sensation checks on the client's right leg. E. Ask about the client's pain level with every set of vital signs.
Correct Answers: A, C, E Rationale: The client with a hip fracture is at risk for impaired perfusion to the affected extremity. Monitoring bilateral pedal pulses allows the nurse to compare the pulse strength in the injured site with that in the non-injured site. A decrease in the injured leg could signal a decrease in circulation that would require immediate intervention. A fat embolism is also a risk with a hip fracture and continuous pulse oximetry would allow the nurse to identify hypoxia quickly which could be associated with a fat embolism. Clients with a hip fracture usually experience great pain and assessing pain with each set of vital signs is key to effective pain management. Circulation, motion and sensation checks should be completed at least every four hours, not daily. Repositioning the client every hour is unnecessary and will only increase the client's pain level even more
The nurse is caring for a client with a femur fracture. Which of the following findings require the nurse's immediate action? (Select all that apply.) A. Shortness of breath B. Pain level of 5 (0 to 10 scale) C. Palpable hard mass near fracture site D. Allergy to penicillin E. Absent pulse in affected extremity F. History of deep vein thrombosis G. Blood pressure of 88/54 mm Hg
Correct Answers: A, C, E, G Rationale: Complications related to fractures, especially of the long bones such as the femur, can include fat embolism, compartment syndrome and hemorrhage. Findings seen with compartment syndrome will include worsening pain, paresthesia (numbness, tingling), pallor (coolness and loss of color) and weak, diminished or absent pulse. A fat embolism will typically travel to the pulmonary vasculature and cause respiratory symptoms. Hemorrhage near the fracture site will manifest with swelling, bruising/hematoma, hypotension and tachycardia. The other findings are important to note but are not life-threatening and should be addressed at a later time.
The nurse is reviewing the medical record of a client who has been diagnosed with osteoporosis. The nurse identifies which risk factors for this condition? (Select all that apply.) A. The client is a 75-year-old Caucasian female B. The client performs weight-bearing exercises six days a week. C. The client weighs 200 lbs. (90.7 kg) with a height of 5 feet 2 inches (157 cm). D. The client takes 10 mg of prednisone daily. E. The client has a 30 pack per year smoking history.
Correct Answers: A, D, E Rationale: Osteoporosis is the loss of bone density that leads to weakness of the bone. Risk factors for osteoporosis include being a postmenopausal woman (lack of estrogen), smoking, thin stature, steroid use, lack of weight-bearing exercise, such as prolonged immobility or a sedentary lifestyle, and ethnicity. Steroid use is associated with osteoporosis because it impacts the body's ability to rebuild new bone. Smoking is also associated with osteoporosis. Performing weight-bearing exercise increases bone strength and promotes bone development. A client who is 5 feet 2 inches (157 cm) in height and weighs 200 lbs. (90.7 kg) is considered obese and obesity is associated with osteoarthritis, not osteoporosis.
The nurse is assisting in the preoperative plan of care for an older adult client who will be undergoing a total hip arthroplasty. To improve the client's postoperative course, which interventions should the nurse plan for? (Select all that apply.) A. Administration of subcutaneous warfarin B. Instruction on plantar and dorsiflexion exercises C. Preoperative pain control with naproxen D. The use of assistive devices for ambulation E. Application of sequential compression devices
Correct Answers: B, D, E Rationale: Due to the client's age and the surgical procedure, the client is at risk for a venous thromboembolism. The nurse should include the use of sequential compression devices to decrease venous stasis along with providing instruction on plantar and dorsiflexion exercises. Warfarin is administered orally; it does not come in an injectable form. The client will most likely need assistive devices initially for safe ambulation postoperatively. Preoperatively, the nurse should not use naproxen to control pain because it is a nonsteroidal anti-inflammatory drug (NSAID) and can increase the risk of bleeding during surgery.
The office nurse is discussing how to prevent an acute gouty attack with a client who has gout. Which actions should the nurse recommend to the client? (Select all that apply.) A. Take the prescribed prednisone regularly. B. Limit their consumption of alcohol. C. Make sure to drink at least 2,000 mL of water daily. D. Limit their intake of shellfish and red meats. E. Implement stress reduction techniques.
Correct Answers: B, D, E Rationale: Gout is a disease where uric acid crystals form and accumulate in joints and other tissues. Gout attacks may be brought on by excessive alcohol intake, increased stress and a diet high in purine. Clients should be encouraged to have a low-purine diet by limiting red meats and shellfish, along with drinking alcohol in moderation. The client should be encouraged to drink at least 2,000 mL of water daily to maintain hydration and prevent the buildup of uric acid. Stress management can decrease the likelihood of triggering an acute attack. Prednisone is used during an acute attack, but it does not prevent an attack from occurring.