# Situation: A 52-year-old man comes to the clinic with sudden, severe pain, redness and swelling of the right big toe that began during the night after a party with beer and grilled meat. He takes hydrochlorothiazide for hypertension. His kidney function is normal. Two months after starting daily allopurinol with low-dose colchicine prophylaxis, he calls to report a mild flare in the left ankle. What should the nurse instruct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630437  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 52-year-old man comes to the clinic with sudden, severe pain, redness and swelling of the right big toe that began during the night after a party with beer and grilled meat. He takes hydrochlorothiazide for hypertension. His kidney function is normal.

Two months after starting daily allopurinol with low-dose colchicine prophylaxis, he calls to report a mild flare in the left ankle. What should the nurse instruct?

## 보기

1. Stop allopurinol until the ankle flare has fully settled
2. Keep taking allopurinol; treat the flare as prescribed **✔ 정답**
3. Double the daily allopurinol dose for the next 3 days
4. Stop colchicine, since it did not prevent the flare

**정답: 2**

## 해설

Flares are common in the first months of urate-lowering therapy. Allopurinol that is already established is not stopped during a flare; the flare is treated early with the prescribed plan, and prophylaxis continues for at least 3–6 months.

## 심화 해설

Flares are expected early in therapy
Two months after starting allopurinol, the client has a mild flare in the left ankle. Flares are common in the first months of urate-lowering therapy, because falling serum urate mobilizes crystals from deposits in the joints. This does not mean the drug is failing. The correct instruction is to keep taking allopurinol and treat the flare promptly with the plan the prescriber has given, such as an anti-inflammatory dose.

Why allopurinol is not stopped
Allopurinol is a xanthine oxidase inhibitor that lowers uric acid production. Stopping it during a flare lets serum urate rise again and then fall when it is restarted, and these swings themselves provoke more flares and prolong the problem. Once urate-lowering therapy is established, the guideline is to continue it without interruption. Starting allopurinol is usually deferred until a flare settles or begun with anti-inflammatory cover, but an existing dose is not stopped.

Why prophylaxis continues
Low-dose colchicine prophylaxis reduces the number and severity of early flares but does not abolish them. It is continued for at least 3–6 months after starting urate-lowering therapy, and longer if flares persist or tophi are present. A single mild flare is therefore not a reason to stop colchicine.

| Option | Effect | Verdict |
| --- | --- | --- |
| Stop allopurinol until settled | Urate fluctuates; flares continue | Wrong |
| Continue allopurinol, treat flare | Stable urate lowering with prompt flare control | Correct |
| Double allopurinol for 3 days | Rapid urate drop can worsen flares; dose changes belong to the prescriber | Wrong |
| Stop colchicine | Removes protection during the high-risk period | Wrong |

Watch out! Doubling the allopurinol dose seems logical, but allopurinol does not treat an acute flare. It is titrated gradually by the prescriber, and a sudden large drop in urate can trigger more flares.

Client teaching
The nurse explains that early flares are expected and are a sign of crystals dissolving, encourages adherence to both drugs, advises adequate fluid intake, and reviews the flare plan: start the prescribed treatment at the first sign of pain, rest and elevate the joint, and call if the flare is severe or does not improve. Key point! Do not stop established allopurinol during a gout flare; treat the flare and continue prophylaxis for at least 3 to 6 months.

## 임상 시나리오

Flare on Urate-Lowering TherapyKeep allopurinol going
A mild ankle flare 2 months after starting allopurinol is common: falling urate mobilizes crystals from joint deposits.

Established allopurinol is continued; stopping it makes urate fluctuate and prolongs flares. The flare is treated early with the prescribed plan.

Colchicine prophylaxis reduces but does not abolish flares and continues for at least 3–6 months.

CautionDo not tell the client to double the allopurinol dose; it does not treat a flare, and dose changes are made by the prescriber.

## 핵심 개념

- **Allopurinol** — A xanthine oxidase inhibitor that lowers uric acid production for long-term gout control.
- **Urate-lowering therapy** — Long-term drug treatment that reduces serum uric acid to dissolve crystals and prevent gout flares.
- **Flare prophylaxis** — Low-dose anti-inflammatory treatment, often colchicine, given in the early months of urate-lowering therapy.
- **Xanthine oxidase** — The enzyme that converts hypoxanthine and xanthine into uric acid.

## 같은 주제 문제

- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630316)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630317)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630318)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630319)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630320)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630321)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630322)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630323)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._