Question 1

The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient's medical record and will be concerned about which of the following findings?

Accepted Answer

Allopurinol is metabolized in the liver and excreted by the kidneys, so patients with renal impairment should be carefully monitored. Patients with a history of kidney stones are at increased risk for renal impairment and may require dosage adjustments or close monitoring when taking allopurinol. Increased serum uric acid is actually an indication for allopurinol therapy, not a concern. A slight increase in the white blood count or increased serum glucose are not directly related to the use of allopurinol.

Question 2

A nursing student asks how nonsteroidal anti-inflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs:

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs) work by inhibiting the enzyme cyclooxygenase (COX), which is necessary for the synthesis of prostaglandins. Prostaglandins are chemicals that contribute to inflammation and pain. By blocking COX, NSAIDs reduce the production of prostaglandins and therefore help to reduce inflammation and relieve pain. NSAIDs do not directly cause relaxation of smooth muscle, interfere with neurological pathways, or block tissue receptor sites.

Question 3

A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action?

Accepted Answer

A serum salicylate level of 35 mg/dL is within the therapeutic range for treating rheumatoid arthritis with aspirin. However, the nurse should assess the patient for signs of toxicity, such as tinnitus, because toxicity can occur at levels above 30-40 mg/dL. Monitoring for Reye's syndrome is not necessary for a patient with rheumatoid arthritis who is taking aspirin, as this syndrome is associated with aspirin use in children with viral illnesses. Notifying the provider of severe aspirin toxicity is not necessary in this case, as the salicylate level is within the therapeutic range. Requesting an increased aspirin dose is not appropriate without consulting the provider, as this could potentially increase the risk of toxicity.

Question 4

The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?

Accepted Answer

A major adverse effect of colchicine is gastrointestinal distress, including nausea, vomiting, and diarrhea. Increasing fluid intake can help alleviate these symptoms and prevent dehydration. A and B are not relevant to the use of colchicine, and D is incorrect as colchicine should be taken with food to prevent gastrointestinal upset.

Question 5

The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching?

Accepted Answer

Indomethacin should be taken with food or milk to decrease gastrointestinal upset. The other statements demonstrate appropriate understanding of the medication.

Question 6

The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action?

Accepted Answer

While the NSAID may have helped with pain relief, it is not effectively treating the swelling in the affected joints. The provider should be notified that a different treatment plan may need to be considered. Assuming drug-seeking behavior or providing false reassurance may not address the underlying issue. Reminding the patient of the drug's purpose does not address the ongoing swelling.

Question 7

Which antigout medication is considered first-line to treat chronic tophaceous gout?

Accepted Answer

Allopurinol is considered first-line for treating chronic tophaceous gout because it inhibits the production of uric acid and helps to reduce the formation of tophi. Colchicine is used to treat acute gout attacks, while probenecid is used to increase excretion of uric acid, and celecoxib is a nonsteroidal anti-inflammatory drug that can be used to manage pain during acute gout attacks but is not effective at reducing uric acid levels.

Question 8

The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?

Accepted Answer

The nurse should inform the patient that they may need to stop taking high-dose aspirin a week prior to surgery to avoid an increased risk of bleeding. Option A is incorrect because normal serum aspirin levels are between 5 and 20 mg/dL, not 30 to 40 mg/dL. Option C is incorrect because high-dose aspirin does not require monitoring of aspirin levels with warfarin. Option D is partially correct that dark stools may be a side effect of aspirin, but it is important to inform the patient that this can also be a sign of gastrointestinal bleeding and they should notify their healthcare provider.

Question 9

A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient?

Accepted Answer

The nurse should inform the patient that it may take several weeks to achieve maximum therapeutic effects with ibuprofen. The other options are not accurate or safe recommendations.

Question 10

A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2:

Accepted Answer

COX-2 is an enzyme that is responsible for converting arachidonic acid into chemical mediators called prostaglandins, which are involved in the process of inflammation. COX-2 is induced during inflammation and injury, and these prostaglandins play a key role in promoting the pain, swelling, and fever associated with inflammation. COX-2 inhibitors are used as anti-inflammatory drugs, and can help reduce the symptoms of inflammation and pain.

Question 11

A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin:

Accepted Answer

Aspirin inhibits both COX-1 and COX-2, which can cause gastrointestinal upset by disrupting the protective lining of the stomach and increasing production of stomach acid.

Question 12

Which of the following DMARD medications is an IL-1 receptor antagonist?

Accepted Answer

Anakinra (Kineret) is an IL-1 receptor antagonist, whereas Etanercept (Enbrel) is a TNF inhibitor, Infliximab (Remicade) is a TNF inhibitor, and Rituximab (Rituxan) is a B-cell depleting agent.

Question 13

A patient is taking aspirin for secondary prevention of myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient's provider to discuss changing from aspirin to which of the following?

Accepted Answer

Enteric-coated aspirin can decrease gastrointestinal upset by delaying the release of the medication until it reaches the small intestine. COX-2 inhibitors and celecoxib are not recommended for long-term use due to increased risk of cardiovascular events. Ibuprofen is not typically used for secondary prevention of myocardial infarction.

Question 14

A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?

Accepted Answer

The patient's reported decreased effectiveness of ibuprofen indicates possible tolerance, which may require an adjustment in dose or medication. The nurse should counsel the patient to discuss this with their provider to explore alternative treatments. Adding aspirin is not recommended due to the increased risk of adverse effects. Suggesting corticosteroids is premature and is not the first line of treatment for moderate arthritis pain. Telling the patient to increase the ibuprofen dose without healthcare provider direction can lead to adverse effects and is not recommended.

Question 15

The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication?

Accepted Answer

Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug (NSAID) that can be given parenterally or orally. It is potent and effective in managing moderate to severe pain, especially in postpartum patients as it does not interfere with lactation. It does not cause the respiratory depression associated with opioids, and it has a lower risk of causing addiction. However, it does have a risk of gastrointestinal (GI) bleeding, so it should be used cautiously in patients with a history of GI ulcers or bleeding.

Question 16

The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Allopurinol can cause ocular toxicity, so it is important for patients to have regular eye exams while taking this medication. Increasing vitamin C intake may help prevent gout attacks but is not specifically related to allopurinol therapy. Increasing protein intake and limiting fluids are not appropriate recommendations for a patient taking allopurinol.

Question 17

The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need?

Accepted Answer

Patients receiving infliximab are at risk for hematological side effects, including leukopenia, thrombocytopenia, and anemia. Therefore, the nurse should anticipate the patient needing a complete blood count (CBC) to monitor for these potential adverse effects. Calcium, electrolytes, and potassium levels are not directly related to the use of infliximab for rheumatoid arthritis.

Question 18

The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication?

Accepted Answer

Aspirin (Bayer) is known to cause tinnitus as an adverse effect, especially at higher doses. Acetaminophen (Tylenol) is not associated with tinnitus. Anakinra (Kineret) is used for rheumatoid arthritis and should not cause tinnitus. Prednisone (Deltasone) may cause many adverse effects, but tinnitus is not generally reported as one of them.

Quiz 24: Antiinflammatories

The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim) . The nurse reviews the patient's medical record and will be concerned about which of the following findings?