Question

a nurse is teaching a client who is taking allopurinol for the treatment of gout. which of the following information should the nurse include in the teaching?

plan to increase the dosage each week by 200 mg increments.
prolonged use of the medication can cause glaucoma.
drink 2 l of water daily.
a fine red rash is transient and can be treated with antihistamines.

Explanation:

Analyze the mechanism of allopurinol

Allopurinol is a xanthine oxidase inhibitor used to lower serum uric acid levels in patients with gout. By reducing uric acid production, it prevents the formation of uric acid crystals in joints and kidneys.

Evaluate renal risks and hydration

High concentrations of uric acid in the urine can lead to the formation of uric acid renal calculi (kidney stones) and renal injury. To prevent crystalluria and stone formation, patients taking allopurinol must maintain a high fluid intake to ensure adequate urine output. Drinking at least 2 to 3 liters of water daily is a standard clinical recommendation.

Assess alternative options

• Dosage increments: Allopurinol is typically started at a low dose (e.g., 100 mg daily) and titrated slowly based on serum uric acid levels, but weekly self-increases of 200 mg by the patient are incorrect and unsafe.
• Glaucoma risk: Prolonged use of allopurinol is not clinically associated with causing glaucoma.
• Rash management: A skin rash is a sign of a potentially life-threatening hypersensitivity reaction (such as Stevens-Johnson syndrome or DRESS syndrome). Any rash must be reported immediately, and the drug must be discontinued, rather than being dismissed as transient and self-treated with antihistamines.

Answer:

• Plan to increase the dosage each week by 200 mg increments.
• Prolonged use of the medication can cause glaucoma.
• Drink 2 L of water daily. (Correct answer)
• A fine red rash is transient and can be treated with antihistamines.