A patient with joint inflammation is prescribed an anti-inflammatory drug. The patient asks you how this drug works to address this problem. What is your best response?
a. “Anti-inflammatory drugs reduce pain and limit blood vessel responses to joint injury.”
b. “Anti-inflammatory drugs limit the body’s response to cortisol in the body.”
c. “Anti-inflammatory drugs increase the release of TNF and other mediators.”
d. “Anti-inflammatory drugs contain antibacterial and anti-inflammatory properties.”
ANS: A
Anti-inflammatory drug’s primary purpose is to reduce pain and prevent or limit the tissue and blood vessel responses to injury or invasion.
- A patient with a history of cardiovascular disease has been prescribed aspirin daily. What specific risk should this patient be informed of because of taking aspirin?
a. Risk of infection
b. Risk of bleeding
c. Risk of liver impairment
d. Risk of cognitive impairment
ANS: B
Patients who take aspirin must be monitored for bleeding due to irreversible platelet inhibition for the lifespan of the platelet so as long as 7 to 8 days.
- A male patient taking daily aspirin for the prevention of cardiovascular complications informs you that he is planning to have a tooth extraction next week. What correct information should be provided to this patient?
a. “Aspirin is associated with tooth loss following dental surgery.”
b. “Stop taking the aspirin 7 days before the dental procedure.”
c. “You may require aspirin plus additional pain drug after the dental procedure.”
d. “Taking enteric-coated aspirin ensures you will not be at risk for any complications.”
ANS: B
Patients who take aspirin must be monitored for bleeding due to irreversible platelet inhibition for the lifespan of the platelet as long as 7 to 8 days. This is very important if a patient is scheduled for an invasive procedure or surgery so make sure to notify the prescriber if the patient has an upcoming surgery.
- You are preparing a teaching plan for a patient prescribed the nonselective NSAID ibuprofen 800 mg orally daily. Which of the following instructions should be included in this teaching plan?
a. Avoid eating excessive amounts of protein as this can interfere with the drug’s action.
b. This drug can increase serum blood sugar levels in patients with diabetes.
c. Taking this drug before bed can cause excessive night-time urination.
d. Take this drug with food to prevent GI upset.
ANS: D
If taking NSAIDS causes mild GI upset, the patient may take the drug with a small amount of food or milk. These drugs decrease blood sugar, making diabetics at high risk for hypoglycemia. NSAIDs can cause fluid retention.
- A patient who has been taking aspirin several times daily for arthritis pain reports ringing in her ears. What action should you take?
a. Instruct the patient to reduce the dose of aspirin by half until the ringing stops.
b. No action is needed; this is an expected response to this dose of aspirin.
c. Call the healthcare provider, as this is adverse reaction to the drug.
d. Instruct the patient to take the full dose before bed.
ANS: C
Tinnitus (ringing in the ears) is an adverse reaction to anti-inflammatory analgesics.
- A mother brings her febrile infant to the pediatric clinic for evaluation. The infant has a temperature of 102 degrees. The mother tells you that she wishes she had given the baby a dose of liquid aspirin before leaving the house to bring down the baby’s temperature. What is your best response?
a. “We can give the baby a dose now before you leave the clinic.”
b. “Only give aspirin alternating with acetaminophen every 4 hours for fever.”
c. “Aspirin should not be given to infants with acute illness.”
d. “Aspirin will need to be given with a proton-pump inhibitor to prevent bleeding.”
ANS: C
Aspirin should not be given to infants or children who have an acute illness because of its association with development of a very serious problem known as Reye syndrome. This disorder can lead to mental deficits, coma, or death.
- A patient with a history of alcoholism is taking aspirin on a regular basis for general aches and pains. The patient reports feeling weak and dizzy, and has developed abdominal pain 7 days ago, which is increasing in severity. What adverse drug effect might this patient be experiencing?
a. Liver damage due to the combination of aspirin and alcohol
b. Reye syndrome due to the combination of aspirin and alcohol
c. Gastrointestinal bleeding due to the combination of aspirin and alcohol
d. Gastroesophageal reflux disease due to the combination of aspirin and alcohol
ANS: C
Alcohol taken with any of the anti-inflammatory analgesics greatly increases the risk for gastrointestinal bleeding.
- A patient with diabetes has been prescribed a course of prednisone to treat an acute exacerbation of asthma. Which of the following instructions should you give to the patient before he is discharged home?
a. “Monitor your blood sugar regularly.”
b. “Take this drug on an empty stomach.”
c. “You may stop this drug when your symptoms improve.”
d. “You may experience a change in the color of your urine.”
ANS: A
The patient should be instructed to monitor blood sugar regularly because corticosteroids reduce the sensitivity of insulin receptors and increase blood glucose levels. Adjustments to oral antidiabetic drug or insulin may be needed while taking corticosteroids.Warn patients to not stop taking the oral drug suddenly (without the guidance of the healthcare provider) to prevent possible adrenal insufficiency. Corticosteroids should be taken with food or milk to reduce the risk for gastric ulcers. There is no effect of corticosteroids on the color of urine.
- A patient with a chronic inflammatory condition has been taking corticosteroids for several months. Which of the following side effects should you monitor this patient for?
a. Weight loss
b. Increased muscle mass
c. Hypotension
d. Fat redistribution
ANS: D
After a month of therapy, patients taking corticosteroids experience fat redistribution (moon face and “buffalo hump” between the shoulders), weight gain, hypertension (after 1 week), and decreased muscle mass.
- A patient on long-term corticosteroid therapy appears to have frequent colds and upper respiratory infections and is concerned that something may be wrong. What is your best response?
a. “Taking corticosteroids for a long time can reduce your immunity.”
b. “There is no relationship between the treatment for your condition and frequent colds.”
c. “Corticosteroids affect the production of protective mucus.”
d. “Corticosteroids increase adrenal gland function and result in infections.”
ANS: D
The most important problems are associated with long-term use and include adrenal gland suppression and reduced immunity that can make patients susceptible to infections.
- A patient with severe asthma who has been taking systemic corticosteroids for 2 weeks tells you he is feeling better and would like to stop taking this drug today. What is your best response?
a. “Take the last dose today, and then you can stop the drug.”
b. “The dose of this drug will need to be tapered down over time to prevent complications.”
c. “As long as your asthma symptoms have resolved, you can stop the drug.”
d. “Skip the drug on the days you feel better and take it only if symptoms reoccur.”
ANS: B
To prevent adrenal insufficiency, doses of systemic corticosteroids must be tapered rather than stopped abruptly. Tapering of the drug allows the atrophied adrenal gland cells to gradually begin producing cortisol again and prevents acute adrenal insufficiency.
- A patient who has been prescribed a topical corticosteroid cream for the treatment of a rash tells you that he now has a small, reddened, open wound located on the anterior aspect of the right foot. He asks you if he can apply this same cream to this new wound to reduce the redness. What is your best response?
a. “You should not apply topical steroids to open wounds.”
b. “You may use the same topical steroid on this wound but apply it with a gloved hand.” c. “Dispose of at least 1
/2 inch of the topical steroid before applying it elsewhere.”
d. “Mix the topical steroid with an antibiotic cream for the best effect.”
ANS: A
Topical steroids should not be applied to open wounds. They should be avoided if there are any signs of infection as they may increase the risk of the infection spreading due to their effect on the immune/inflammatory response.
- A patient is beginning a prescribed disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis. The patient asks you how these drugs work to help this condition. What is your best response?
a. “These drugs modify the immune system by decreasing T-cell response.”
b. “These drugs act to increase the body’s immune response to rheumatoid factor.”
c. “These drugs work by inhibiting the inflammatory mediator tumor necrosis factor.”
d. “These drugs reduce the amount of an enzyme that controls the production of purines.”
ANS: C
DMARDS inhibit the inflammatory mediator tumor necrosis factor (TNF). They bind to the TNF molecules produced by white blood cells (WBCs) and prevent them binding to TNF receptor sites on inflammatory cells and other cells. This prevents the cells from continuing to produce even more TNF and other substances that enhance the inflammatory responses and cause direct tissue destruction.
- What would be an appropriate nursing action to prevent complications in an elderly person taking long-term corticosteroid therapy?
a. Protect the skin from skin tears.
b. Bathe the patient twice daily.
c. Check the patient’s blood pressure before giving the drug.
d. Ask the patient about the presence of constipation.
ANS: A
Make sure to carefully protect skin of patients who are taking corticosteroids while transferring or positioning to prevent skin tears.
- You are teaching a patient with rheumatoid arthritis about giving subcutaneous adalimumab (Humira) at home. What instructions should be included in this patient’s teaching plan?
a. Before drawing up drug, shake the vial well to distribute the drug.
b. Rotate the injection site of the thighs and abdomen frequently.
c. Do not discontinue this drug if you have an infection.
d. Rub the injection site well to prevent bleeding.
ANS: B
Instruct the patient to rotate injection sites on the front of the thighs and the abdomen to ensure best absorption and prevent skin problems. Avoid giving within 2 inches of the umbilicus because this area has many blood vessels and absorption can be too rapid.
- A patient who is taking a disease-modifying antirheumatic drug (DMARD) has just returned from surgery. What potential complication would you report to the RN or healthcare provider directly related to the use of DMARDs before surgery?
a. Redness and drainage at the incision site
b. A low blood pressure
c. A decreased urinary output
d. Excessive sleepiness
ANS: A
Because DMARDs reduce the immune response, patients having surgery are at increased risk for infection. Redness and drainage at the incisions site is an indication of a wound infection.
- You are preparing to give a subcutaneous injection of etanercept to a patient with rheumatoid arthritis. Which of the following actions is contraindicated in giving this injection?
a. Telling the patient to expect pain at the injection site
b. Rotating the injection sites
c. Making sure not to shake the vial
d. Rubbing the site after the injection
ANS: D
Rubbing the site after giving a DMARD injection is contraindicated because it may cause bleeding and bruising at the injection site.
- Which laboratory value is most likely to be elevated in a patient presenting with acute gout?
a. Potassium
b. Uric acid
c. Calcium
d. Glucose
ANS: B
High serum uric acid levels lead to the formation of uric acid crystals, usually in the kidneys and joint spaces. These crystals are long and jagged and cause the swelling, inflammation, and severe pain of gout.
- A patient with acute gout asks you why allopurinol cannot be used at this time. What is your best response?
a. “Allopurinol does not lower uric acid levels.”
b. “Allopurinol is useful in rheumatoid arthritis, but not gout.”
c. “Allopurinol is used only for the prevention of gout attacks.”
d. “Allopurinol can cause swelling of the feet, worsening your gout symptoms.”
ANS: C
Allopurinol is used to prevent gout attacks by reducing the amount of an enzyme that converts the purines in protein into uric acid, and to maintain a lower blood uric acid level.
- A patient with gout requires dietary teaching to help control flare ups of the illness. What instructions should you give to this patient regarding a diet plan?
a. “Increase your intake of organ meats for protein.”
b. “Avoid foods that are high in purine, such as tuna.”
c. “Avoid drinking fruit juices while taking antigout drugs.”
d. “Increase your intake of vegetables such as cauliflower and asparagus.”
ANS: B
Avoid foods that are high in purines as those foods may precipitate an acute attack. High purine foods are organ meats (liver, kidneys), and certain vegetables such as cauliflower, asparagus, mushrooms, and spinach.
- A 62-year-old female presents with intense fatigue, increased joint stiffness, pain, aching, tenderness, and swelling in more than one joint, limited movement in joints and decreased range of motion, and pain throughout the body. After thorough exam and diagnostic testing, the patient is diagnosed with rheumatoid arthritis.
Although there is no cure for RA, patients may be prescribed for treatment of symptoms. If a patient is on long-term corticosteroids, they may develop a cushingoid appearance, which is exhibited by ———– –.
A. antibiotics, Ace inhibitor, or NSAIDs; weight loss, jaundice, and/or truncal obesity
b. NSAIDs, Corticosteroids, or DMARDs; moon face, buffalo hump, and/or truncal obesity
c. DMARDs, NSAIDs, or Ace inhibitor; buffalo hump, moon face, and/or weightloss
D. corticosteroids, Ace inhibitor, or DMARDs; jaundice, truncal obesity, and/or moonface
ANS: B
Although there is no cure for rheumatoid arthritis, patients may be prescribed the following drugs (or a combination): NSAIDs, steroids, DMARDs, or biologics. If a patient is on long-term corticosteroids, they may develop a “cushingoid appearance” or Cushing syndrome, which occurs when your body is exposed to high levels of cortisol. A “cushingoid appearance” has certain distinguishable signs and symptoms including: moon face, buffalo hump, and truncal obesity. Other signs and symptoms of Cushing syndrome include: weight gain, slow wound healing, easy bruising, muscle weakness, acne, hair thinning, red stretch marks (striae), and immunosuppression.
MULT RESP
1. Inflammation is the result of tissue and blood vessel reactions to white blood cells. What are the symptoms associated with inflammation? (Select all that apply.)
a. Pain
b. Warmth
c. Redness
d. Swelling
e. Elevated temperature
f. Bacteria in the bloodstream
ANS: A, B, C, D
Inflammation is a predictable set of tissue and blood vessel actions caused by white blood cells (leukocytes) and their products as a response to injury or infection. These tissue and blood vessel actions cause the five major symptoms of inflammation: pain, redness, warmth, swelling, and loss of function.
MULT RESP
2. When caring for a patient who is taking anti-inflammatory drugs, what should be included in the patient’s teaching plan? (Select all that apply.)
a. “You should take this drug without food.”
b. “Take this drug with a full glass of water.”
c. “Only take this drug when you have pain.”
d. “This drug may interact with anticoagulants.”
e. “Contact your healthcare provider if you develop dark stools.”
ANS: B, D, E
These drugs should be taken exactly as ordered on a regular schedule to keep blood levels of the drug stable. Dark stools can be a sign of GI bleeding, and adverse effect of the drug. To decrease stomach upset, take with a full glass of water. These drugs can be taken with food or milk. Anti- inflammatory drugs can interact with anticoagulants and cause bleeding.
MULT RESP
3. A patient is taking an anti-inflammatory drug and calls the clinic to tell the LPN/LVN that he missed some of the doses last week.
The LPN/LVN instructs the patient about what to do in this situation. List the appropriate response from the nurse. (Select all that apply.)
a. Skip all missed drug doses.
b. If it is close to the next time the drug is due, skip the missed dose.
c. All missed doses of the drug should be returned to the pharmacy.
d. Never take a double dose of this drug.
e. If possible, take the missed dose within an hour of the scheduled time.
f. Once you miss a dose, you should double up on the drug dose at the next time it is due.
ANS: B, D, E
Never take a double dose of this drug. If a drug dose is missed, it may be taken within an hour when it was scheduled. If the patient remembers the missed dose close to the time when the next dose is to be taken, he should take the regular dose and miss the skipped dose.
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FINAL ch 14 pharm19
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FINAL CH19 PHARM17
