Nokea
In gout, a man has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:
- A. asymptomatic.
- B. acute flare.
- C. the intercritical period.
- D. chronic gout.
Correct Answer: D
Rationale: The man's presentation of large, hard nodules around his toes and elbows is indicative of tophi formation, which is characteristic of chronic gout. Tophi are deposits of uric acid crystals that can develop over time in untreated or poorly managed gout. During the chronic phase of gout, tophi can form in joints, soft tissues, and organs. Asymptomatic refers to a phase where there are no symptoms present. Acute flare is characterized by sudden and severe joint pain and inflammation. The intercritical period is the time between gout attacks when the patient is symptom-free.
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What is a cause of the crystallization within the synovial fluid of the joint affected by gouty arthritis?
- A. Destruction of proteoglycans
- B. Underexcretion of uric acid
- C. Overexcretion of uric acid
- D. Increased absorption of uric acid
Correct Answer: B
Rationale: The correct answer is B: Underexcretion of uric acid. Gouty arthritis is primarily caused by the underexcretion of uric acid, leading to its accumulation in joints and subsequent crystallization. Choices A, C, and D are incorrect as they do not directly relate to the pathophysiology of gout. Destruction of proteoglycans, overexcretion of uric acid, and increased absorption of uric acid are not primary causes of gouty arthritis.
Which of the following outcome criteria is appropriate for a client with dementia?
- A. The client will return to an established schedule for activities of daily living.
- B. The client will learn new coping mechanisms to handle anxiety.
- C. The client will seek out resources in the community for support.
- D. The client will follow an established schedule for activities of daily living.
Correct Answer: D
Rationale: The correct answer is D. For clients with dementia, following an established schedule for activities of daily living is appropriate as it helps maintain routine and structure, which can be beneficial for their condition. Choice A has been rephrased to align better with the context of dementia care. Choice A is incorrect as expecting a return to a previous level of self-functioning may not be realistic for clients with dementia. Choice B is not the most appropriate outcome criteria as handling anxiety, while important, may not be the primary focus when working with clients with dementia. Choice C, seeking out resources in the community for support, is also important but may not be as directly related to the day-to-day care and management of activities for a client with dementia.
Which of the following is a clinical manifestation in a patient with renal impairment associated with polycystic kidney disease?
- A. Suprapubic pain
- B. Periorbital edema
- C. Low serum creatinine level
- D. Palpable kidneys
Correct Answer: D
Rationale: The correct answer is D: Palpable kidneys. Polycystic kidney disease often leads to the development of multiple fluid-filled cysts within the kidneys, causing them to enlarge. Enlarged kidneys can be palpated during a physical examination. Choices A, B, and C are incorrect. Suprapubic pain is not a typical clinical manifestation of polycystic kidney disease. Periorbital edema is more commonly associated with conditions like nephrotic syndrome or heart failure. Low serum creatinine level is not expected in patients with renal impairment due to polycystic kidney disease; instead, elevated serum creatinine levels are more likely.
A patient with a history of hypertension presents with a severe headache, confusion, and visual disturbances. His blood pressure is 220/120 mm Hg. Which of the following is the most likely diagnosis?
- A. Migraine
- B. Cluster headache
- C. Hypertensive emergency
- D. Tension headache
Correct Answer: C
Rationale: A patient with a history of hypertension presenting with a severe headache, confusion, and visual disturbances, along with a blood pressure of 220/120 mm Hg, likely has a hypertensive emergency. In this situation, the severely elevated blood pressure can lead to end-organ damage, causing symptoms such as headache and confusion. Migraine and tension headaches are not associated with such high blood pressure levels. Cluster headaches typically do not present with visual disturbances and confusion in the setting of severe hypertension.
Anemia of chronic inflammation is generally classified as:
- A. hypochromic and microcytic.
- B. hypochromic and macrocytic.
- C. normochromic and microcytic.
- D. normochromic and normocytic.
Correct Answer: D
Rationale: Anemia of chronic inflammation is characterized by normochromic and normocytic red blood cells. In chronic inflammation, the body typically produces enough red blood cells, but they are often smaller and paler than normal (normocytic and normochromic). Choices A, B, and C are incorrect because hypochromic and microcytic, hypochromic and macrocytic, and normochromic and microcytic anemias are not typically associated with chronic inflammation.