This is a quiz that contains NCLEX review questions for gout. As a nurse providing care to a patient with gout, it is important to know the signs and symptoms, pathophysiology, nursing management, patient education, and treatment for this condition.
In the previous NCLEX review series, I explained about other musculoskeletal disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.
Don’t forget to watch the gout lecture before taking the quiz.
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Gout NCLEX Practice Questions
1. During a home health visit you are helping a patient with gout identify foods in their pantry they should avoid eating. Select all the foods below the patient should avoid:A. Sardines
B. Whole wheat bread
C. Sweetbreads
D. Crackers
E. Craft beer
F. Bananas
The answers are A, C, and E. A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer).
2. Gout is a type of arthritis that occurs due to the accumulation of ____________ in the blood that causes needle-like crystals to form around the joints.
A. purines
B. creatinine
C. uric acid
D. amino acids
The answer is C. In gout, uric acid accumulates in the blood, which leads to the formation of needle-like crystal around the joints.
3. Identify which patient below is at MOST risk for developing gout:
A. A 56 year old male who reports consuming foods low in purines.
B. A 45 year old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin.
C. A 39 year old female hospitalized with bulimia that has a BMI of 24.
D. A 27 year old female with ulcerative colitis.
The answer is B. Gout is due to high levels of uric acid in the blood. This can either be due to the kidney’s inability to excrete uric acid out of the body or the body is producing too much uric acid. Some causes that can lead to increased uric acid levels include: being overweight (BMI >25 is considered overweight), usage of aspirin or diuretics (thiazides (hydrochlorothiazide) or loop), HIGH consumption of purines, dehydration, renal problems. Option B is the only patient MOST at risk for developing gout.
4. A patient is post-op from surgery. The patient has a history of gout. While performing a head-to-toe assessment, you assess the patient for signs and symptoms of gout. As the nurse, you know that gout tends to start at what site?
A. Elbow
B. Big toe
C. Thumb or index finger
D. Knees
The answer is B. Most patients tend to have an acute attack of gout that begins in the big toe. Remember that patients who have a history of gout or who are experiencing a hospitalization (due to the physical stress on the body) are at risk for an acute gout attack. Therefore, the nurse should assess the patient for this during the head-to-toe assessment.
5. A 75 year old male is admitted for chronic renal failure. You note that the patient has white/yellowish nodules on the helix of the ear and fingers. The patient reports they are not painful. As you document your nursing assessment findings, you will document this finding as?
A. Nodosa
B. Keloid
C. Dermoid
D. Tophi
The answer is D. Tophi are white/yellowish nodules that are urate crystals. They start to form together in large masses and can be found under the skin (helix ears, elbows, fingers, toes etc.), joints, bursae, bones, which can lead to bone deformity and joint damage. Patients with chronic renal failure are at risk for chronic gout due to the kidney’s inability to remove uric acid remove the body.
6. You’re developing a nursing care plan for a patient with gout present in the right foot. What specific nursing interventions will you include in this patient’s plan of care? Select all that apply:
A. Encourage fluid intake of 2-3 liter per day.
B. Provide patient with foods high in purine with each meal daily.
C. Place patient’s right foot in a foot board while patient is in bed.
D. Administer PRN dose of Aspirin for a pain rating greater than 5 on 1-10 scale.
E. Apply alternating cold and warm compresses to right foot as tolerated by the patient daily.
The answers are A, C, E. These options are correct nursing intervention for this patient. Option B is wrong because the patient should consume food LOW in purines (remember purines increase uric acid levels). Option D is wrong because patient should AVOID aspirin. Aspirin (even low doses) increase uric acid levels.
7. A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You’ve provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication?
A. “This medication will help relieve the inflammation and pain during an acute attack.”
B. “It is important I have regular eye exams while taking this medication.”
C. “I will not take large doses of vitamin C supplements while taking this medication.”
D. “Allopurinol decreases the production of uric acid.”
The answer is A. Allopurinol is used to PREVENT gout attacks….not treat an acute attack. NSAIDs and Colchicine are best for treating the inflammation and pain during a gout attack. Allopurinol can cause vision changes, therefore the patient should receive annual eye exams along with avoiding large doses of vitamin C due to the risk of renal calculi formation.
8. During the 1000 medication pass, your patient reports to you that he is having muscle pain and tingling in his fingers and toes. You note that the patient also has a grayish color to his lips. You immediately notify the doctor. In addition, you would hold which medication that is scheduled to be administered at 1000?
A. Ibuprofen
B. Prednisone
C. Colchicine
D. Aspirin
The answer is C. The signs and symptoms presenting in this patient are classic signs of Colchicine toxicity. Therefore, the nurse should not administer Colchicine. This medication can also cause GI upset and neutropenia.
9. It is important a patient with gout avoid medications that can increase uric acid levels. Which medication below is NOT known to increase uric acid levels?
A. Aspirin
B. Niacin
C. Cyclosporine
D. Tylenol
The answer is D. Option A-C increase uric acid. Option D does not.
10. You are providing a free clinic seminar to participants about gout. Which statement by a participant about the occurrence of gout is correct?
A. “Gout attacks tend to awake the person out of their sleep in the middle of the night.”
B. “The pain felt with gout tend to be intense during the first 30 minutes.”
C. “It is best for a patient experiencing gout to tightly bandage the affected extremity.”
D. “Typically acute gout attacks are predictable and tend to occur once or twice a week.”
The answer is A. This is the only correct statement about gout. Option B is wrong because the pain felt with gout tends to intensify within 4-24 hours (not 30 minutes). Option C is wrong because any type of pressure (even the pressure of bed linens) can majorly increase the pain felt with gout. Option D is wrong because gout attacks come on suddenly and may only occur once and tend to have several months or a year between attacks.
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Medically Reviewed by Carol DerSarkissian, MD on November 02, 2020
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Only men get gout.
Only men get gout.
Both men and women can get gout, but it's much more common in men. Gout usually develops in middle age or later in men and after menopause in women.
It's rare to develop gout before age 30. For people who develop gout that young, the disease can be more severe.
What kind of deposits in your body cause gout?
What kind of deposits in your body cause gout?
Uric acid can form when your body breaks down purines -- a substance found in many foods. Normally, uric acid dissolves in your blood and passes easily through your kidneys. But when too much uric acid builds up in your body, forming sharp crystals in and around your joints, you can have painful gout attacks -- also known as flares.
You may be able to tell when a gout attack is coming by:
A tingling feeling in your toe
You may be able to tell when a gout attack is coming by:
Many people with gout say they have a tingling feeling in a joint right before a flare starts. The pain can be so sudden and severe that it often wakes up people in the middle of the night. The affected joint is usually red, swollen, hot, and painful to touch.
Gout can be diagnosed with a simple blood test.
Gout can be diagnosed with a simple blood test.
A blood test can measure your uric acid level, but that's not enough to diagnose gout. Even people without gout can have high uric acid. And people with a flare can have temporarily normal or low levels.
To find out if you have gout, your health care provider will draw fluid from an inflamed joint with a needle and look for uric acid crystals. The shape, color, and appearance of the crystals can help diagnose gout.
You can get gout in your:
You can get gout in your:
The most common place to have a gout flare is the big toe. But you also can have an attack in your ankle, wrist, knee, elbow, or any other joint.
Taking aspirin can help ease a gout attack.
Taking aspirin can help ease a gout attack.
When you have a gout attack, a non-steroidal anti-inflammatory medicine (NSAID) like ibuprofen (Advil, Motrin) might help with the pain. Your health care provider also may give you a prescription for a stronger NSAID; steroids (like prednisone); or a drug called colchicine to have on hand in case of a gout attack.
Taking aspirin, however, can be a bad idea. Aspirin can cause your uric acid levels to increase, which can bring on a gout flare or make a flare worse. Other medicines, such as diuretics (water pills) and cyclosporine, also can trigger a flare. That’s why it’s important that your rheumatologist knows about all your medications and that all your doctors know you have gout -- especially if they're going to start you on new medications.
When you're having a gout flare, it may help to:
When you're having a gout flare, it may help to:
If you can bear the pressure, an ice pack may offer some pain relief. Gout flares often hurt so much, though, that you can’t move your joint. That's why it's better to rest it than to stretch it. Many people say it hurts just to feel a sheet on their joint at night, so you may want to take off bedcovers. And you definitely don't want to wrap the joint.
Why is gout known as the "disease of kings"?
Because it was diagnosed by a king's doctor
Because of its association with rich food
Why is gout known as the "disease of kings"?
You may be more likely to have gout because of your genes, but that's not how gout earned its royal nickname. Historically, gout has been associated with a lifestyle full of rich foods and plenty of alcohol -- the kind of diet that only kings and the wealthy could afford. While diet can trigger a flare, we now know that gout affects people regardless of their social status.
Which foods may trigger a gout attack?
Which foods may trigger a gout attack?
Foods that are high in a substance called purines can raise the uric acid in your blood, and that can trigger a gout attack. Some seafood -- like sardines, anchovies, mussels, and salmon -- is rich in purines, as are organ meats, like liver and kidneys.
It’s hard to avoid purines completely because they are in many foods. Instead, your health care provider may suggest you follow a low-purine diet. People with gout should try to avoid foods that trigger an attack.
Drinking beer can trigger a gout attack.
Drinking beer can trigger a gout attack.
Beer and liquor are high in purines, which can raise uric acid and trigger gout attacks. They also tend to cause dehydration -- another common gout trigger. When you don't drink enough fluids, uric acid builds up in your body, and you can be more prone to a flare. Some fructose-sweetened drinks also can trigger a flare. Water is your best bet for staying hydrated.
Which food might protect against gout?
Which food might protect against gout?
Eating a diet high in low-fat dairy foods -- like cheese and milk -- might lower uric acid levels in your blood and lower your chance of gout. One study found that people with gout who drank an enriched skim milk shake every day had fewer flares and less painful symptoms.
The more gout attacks you have, the worse they'll get.
The more gout attacks you have, the worse they'll get.
Your first gout attack usually will affect just one joint and should get better after a few days. But as gout attacks become more frequent, they can affect several joints at once and can last for several weeks if they aren't treated.
You're more likely to get gout if you have:
You're more likely to get gout if you have:
You're more likely to get gout if you are overweight, have high blood pressure or high cholesterol, or have diabetes. Gout often runs in families. Drinking lots of beer and liquor or taking certain medications also may make you more likely to develop gout.
The only way to prevent a gout attack is to change your diet.
The only way to prevent a gout attack is to change your diet.
Cutting out foods that might trigger a flare is a great step to help prevent gout. But if you've had several attacks in one year, your health care provider may recommend medication, such as febuxostat (Uloric), allopurinol (Aloprim, Zyloprim), colchicine (Colcrys), or probenecid (Benemid). The drugs actually may cause an attack when you first start taking them, so your doctor might give you other medicine in case that happens. Pegloticase (Krystexxa) given by IV can be used for people who can’t take or do not respond to other treatments.
Obesity raises your risk of having gout, so losing weight is another way to reduce the risk.
Uric acid also can affect your:
Uric acid also can affect your:
Besides causing gout, uric acid also can collect in the kidneys and cause kidney stones. About one in five people with gout will develop kidney stones. They can be very painful and, if left untreated, can lead to kidney infections or damage.