NSG 555 - Nurse Practitioners in Primary Care II
Exam 3
Question:
A postmenopausal female patient has a blood test that reveals hyperuricemia, although the patient has no symptoms of gout. What will the provider do initially?
- Ask the patient about medications and medical history
- Begin therapy with colchicine and an NSAID
- Recommend a low-purine, alcohol-restricted diet
- Treat for gout prophylactically to prevent a flare
Answer:
a.Patients without symptoms of gout but with hyperuricemia do not need treatment, since most of these patients will never have a gout flare. It is important, however, to determine the cause of this finding and correct it if possible, since it is a risk factor for gout. Certain medications and medical conditions can predispose patients to gout. Colchicine and NSAIDs are used to treat symptoms of gout. Dietary changes are not necessary and are difficult to follow. Prophylaxis for prevention of flares is for patients who have gout and who are between flares.
- / 4
Question:
A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment?
- Administration of intraarticular corticosteroid
- Discontinuing ULT while treating the flare
- Oral colchicine for 5 days
- Therapy with NSAIDs begun within 24 hours
Answer:
a.Intraarticular steroids are practical and beneficial when only one or two joints are involved and are safe for patients who cannot use NSAIDs or colchicine. NSIADs are contraindicated in patients with renal disease and colchicine should not be used in those with low glomerular filtration rates. It is not necessary to discontinue urate-lowering therapy during an acute attack.
Question:
A patient experiences a second gouty flare and the provider decides to begin urate-lowering therapy (ULT). How should this be prescribed?
- Begin with a high-loading dose and gradually decrease.
- Start ULT during the current flare for best results.
- Start ULT in 5 weeks along with an anti-inflammatory drug.
- ULT should be suspended during future gouty flares.
Answer:
- 2 / 4
Beginning therapy with a urate-lowering drug during an acute flare will prolong the flare. Typically, ULT is begun 5 to 6 weeks after a flare and should be given with an anti-inflammatory drug, since the initial period of ULT administration is associated with flares. ULT dosing should start low and gradually increase. It is not recommended to stop ULT during future flares, but to treat those flares while continuing the ULT.
Question:
A patient reports the sudden onset of pain, redness, and swelling in one knee joint but denies a fever. The provider elicits exquisite pain with manipulation of the joint and notes no decrease in pain when the joint is at rest. Which is the likely cause of this arthritis?
- Bacterial infection
- Gout
- Lyme disease
- Rheumatoid arthritis
Answer:
a.Septic arthritis is usually painful both with movement and at rest and is accompanied by swelling and erythema. Fever is not always present. The other causes of arthritis are not painful at rest.
- / 4
Question:
An adolescent patient reports intermitted pain and swelling in various joints on the right side including the knee, elbow, wrist, and ankle. A physical examination reveals tenosynovitis and a maculopapular rash. Which diagnostic tests will be most helpful in determining a diagnosis in this patient?
- Blood cultures and a complete blood count
- Cultures of the urethra, pharynx, cervix, and rectum
- Skin lesion scrapings and cultures
- Urine cultures and renal function studies
Answer:
b.This patient has signs of gonococcal arthritis. Cultures of the urethra, pharynx, cervix, and rectum will be positive in 80% of patients with this infection. Blood cultures are likely to be negative. Culturing skin lesions is not helpful. Renal involvement is not part of this infection.
Question:
A patient has marked swelling of a shoulder joint with erythema and severe pain. The provider suspects a bacterial cause. Which culture will be most helpful to determine the cause of these symptoms?
- Blood culture
- Synovial fluid culture
- Urethral culture
- Urine culture
Answer:
- / 4