# 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. His serum urate results on allopurinol are shown below. The treatment target is below 6 mg/dL; 1 mg/dL equals 59.5 µmol/L. Month 1: 8.4 mg/dL Month 3: 6.3 mg/dL Month 6: 340 µmol/L Which evaluation is correct at month 6?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630438  
> 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.

His serum urate results on allopurinol are shown below. The treatment target is below 6 mg/dL; 1 mg/dL equals 59.5 µmol/L.
Month 1: 8.4 mg/dL
Month 3: 6.3 mg/dL
Month 6: 340 µmol/L
Which evaluation is correct at month 6?

## 보기

1. The target is met; continue the current dose **✔ 정답**
2. The target is met; allopurinol can now be tapered off
3. The target is not met; raise the allopurinol dose
4. The target was met at month 3; lower the dose now

**정답: 1**

## 해설

Converting 340 µmol/L gives 340 ÷ 59.5 = about 5.7 mg/dL, which is below the treat-to-target goal of 6 mg/dL. The dose that reached target is continued long-term, because stopping urate-lowering therapy lets urate rise again.

## 심화 해설

Convert before you judge
The month 6 result is reported in SI units, 340 µmol/L, while the target is given in conventional units, below 6 mg/dL. The stem gives the conversion: 1 mg/dL = 59.5 µmol/L. Converting: 340 ÷ 59.5 = about 5.7 mg/dL. A serum urate of about 5.7 mg/dL is below the treat-to-target goal of 6 mg/dL, so the target is met and the current dose is continued.

Treat-to-target in gout
Gout is managed with a treat-to-target strategy: the dose of urate-lowering therapy is adjusted until serum urate falls below 6 mg/dL, the level at which monosodium urate crystals dissolve over time. A lower target may be set for clients with tophi. Once the target is reached, the effective dose is maintained long-term, with periodic monitoring. The trend here is good: 8.4 at month 1, 6.3 at month 3 (still above target), and about 5.7 at month 6.

| Time | Value | Converted | Target below 6 mg/dL? |
| --- | --- | --- | --- |
| Month 1 | 8.4 mg/dL | — | Not met |
| Month 3 | 6.3 mg/dL | — | Not met |
| Month 6 | 340 µmol/L | about 5.7 mg/dL | Met |

Why the other evaluations are wrong
Option 2 states the target is met but tapers allopurinol off. Urate-lowering therapy is long-term; stopping it lets urate rise again and flares return. Option 3 reads the larger number 340 as being above target without converting it. Option 4 claims the target was met at month 3, but 6.3 mg/dL is above a target of below 6 mg/dL, and lowering the dose now would risk losing control.

Watch out! Unit-switching is a common exam trap. When results appear in different units, convert to the unit of the target before comparing. Large SI numbers are not automatically high.

Nursing role
The nurse checks units on every result, explains to the client that reaching the target is a reason to keep taking the drug rather than to stop, and reinforces lifestyle measures such as limiting alcohol, especially beer, and sugary drinks. Key point! In treat-to-target gout care, once serum urate is below 6 mg/dL the effective dose is continued long-term.

## 임상 시나리오

Treat-to-Target UrateUnit conversion at month 6
Target: serum urate below 6 mg/dL. Month 6 shows 340 µmol/L; 340 ÷ 59.5 = about 5.7 mg/dL, so the target is met.

Month 3 (6.3 mg/dL) was still above target; the trend shows the dose is working.

The effective dose is continued long-term. Stopping urate-lowering therapy lets urate rise and flares return.

CautionAlways convert to the target's units before comparing; do not judge a µmol/L value against a mg/dL target.

## 핵심 개념

- **Treat-to-target** — A strategy of adjusting therapy until a measurable goal, such as serum urate below 6 mg/dL, is reached and kept.
- **Serum urate** — The concentration of uric acid in the blood, the main marker for monitoring gout treatment.
- **SI units** — The International System of Units; for urate, results are given in µmol/L.
- **Tophi** — Deposits of monosodium urate crystals in soft tissue, a sign of long-standing gout.

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