Test 6 ch 13 Flashcards
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.
