A client who has a history of gout is also diagnosed with urolithiasis. The stones are of uric acid type. A nurse gives the client instructions in foods to limit which include?

1. A

   Liver

2. B

   Apples

3. C

   Carrots

4. D

   Milk

Appeared in: RAK Nursing Officer - 2019

Explanation

• The core issue for this patient is an excess of uric acid, which causes both gout and uric acid kidney stones.
• Uric acid is the end product of purine metabolism. Therefore, managing the condition requires limiting the intake of high-purine foods.
• Liver is an organ meat, which is one of the foods with the highest concentration of purines.
• Consuming liver would increase the patient's uric acid levels, worsening both their gout and the risk of forming more uric acid stones.

Why Other Options Were Wrong

• Option B: Apples are fruits, which are low in purines and are considered safe and even healthy for patients with gout and uric acid stones.
• Option C: Carrots are vegetables that have a negligible purine content. They are a recommended part of a healthy diet for this condition.
• Option D: Milk and other dairy products are low in purines. Some studies suggest that low-fat dairy can even help reduce uric acid levels and decrease the risk of gout attacks.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Dietary management for a patient with gout and uric acid urolithiasis to guide bedside assessment, documentation, and the next nursing action.
• Patient education is a critical nursing role in managing chronic conditions like gout. Nurses must provide clear, practical dietary instructions to improve patient adherence and outcomes.
• It's important to assess the patient's understanding and cultural dietary habits to tailor the recommendations effectively.
• What if the patient's stones were calcium oxalate type? The advice would change completely. Instead of limiting purines, the nurse would instruct the patient to limit high-oxalate foods (like spinach, almonds, rhubarb) and ensure adequate calcium intake with meals.

How to Approach the Question

• First, identify the key conditions mentioned in the question: 'gout' and 'urolithiasis' of the 'uric acid type'.
• Recognize that both conditions are related to high levels of uric acid in the body.
• Recall or deduce that uric acid is a breakdown product of purines, which are found in food.
• The question asks which food to 'limit'. This means you need to identify the food with the highest purine content among the options.
• Evaluate each option for its purine content: Liver (organ meat) is very high; apples (fruit), carrots (vegetable), and milk (dairy) are very low.
• Conclude that liver is the food that must be limited.

Concept Tested & Keywords

• Concept Tested: Dietary management for a patient with gout and uric acid urolithiasis.
• Stem keywords: gout, urolithiasis, uric acid type, foods to limit
• Lead-in keywords: limit
• Clinical cues: The patient has two conditions (gout and uric acid stones) linked by a single metabolic issue (high uric acid).

Question ID

QUvCP1GdXlJOPc0aSjCfJ8

Copy ID

Reference Book

E6 Nutrition Monika Sharma 3e p. 247-249

E6 Medicine Harrison 22e Part 2 pp. 357-359, 353-355