DD Chapter 2

A risk factor for NSAID-related gastropathy is the use of

(b) Antidepressants Antidepressants are divided into three groups: tricyclics, monoamine oxidase inhibitors (MAOIs), and miscellaneous antidepressants. The tricyclics work by blocking reuptake of norepinephrine and serotonin into nerve endings and increasing the action of norepinephrine and serotonin in nerve cells. Any of the antidepressants can have gastrointestinal adverse effects, but especially, the selective serotonin uptake inhibitors (SSRIs) such as Paxil, Zoloft, Prozac, and Celexa.

Instruct clients with a history of hypertension and arthritis to:

(c) Inform the primary care provider of both conditions the therapist can also screen for potential adverse effects of NSAIDs and can monitor blood pressure.

You should assess clients who are receiving NSAIDs for which physiologic effect associated with increased risk of hypertension?

(d) Water retention. Look for sacral and pedal edema.

With what final question should you always end your interview?

1) Are any other symptoms of any kind anywhere else in your body that we haven't discussed yet? 2)Is there anything else you think is important about your condition that we have not discussed yet? 3)Is there anything else you think I should know?

A 52-year-old man with low back pain and sciatica on the left side has been referred to you by his family physician. He has had a discectomy and laminectomy on two separate occasions about 5 to 7 years ago. No imaging studies have been performed (e.g., x-ray examination or MRI) since that time. What follow-up questions should you ask to screen for medical disease?

1) The first question should always be, "Did you actually see your physician?" 2) Then ask questions directed at assessing for the presence of constitutional symptoms. For example, after paraphrasing what the client has told you, ask, "Are you having any other symptoms of any kind in your body that you haven't mentioned?" 2b) If no, ask more specifically about the presence of associated signs and symptoms, including naming constitutional symptoms one by one.

Screening for alcohol use would be appropriate when the client reports a history of accidents.

True

Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.

True. This includes any woman who has experienced a surgical menopause (e.g., oophorectomy for ovarian cancer) or any postmenopausal woman who is not taking hormone replacements.

What is the significance of sweats?

a. A sign of systemic disease b. Side effect of chemotherapy or other medications c. Poor ventilation while sleeping (d.) All of the above

Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms:

a. Fever, (night) sweats, dizziness b. Symptoms are out of proportion to the injury c. Insidious onset d. No position is comfortable (e.) All of the above

Most of the information needed to determine the cause of symptoms is contained in the:

a. Subjective examination Although all details obtained from the Family/Personal History form, interview, and objective examinations provide important information, it is well documented that 80% (or more) of the information needed to determine the cause of symptoms is actually gathered during the Core Interview of the Subjective Examination.

Alcohol screening tools should be:

b. Brief, easy to administer, and nonthreatening It may be appropriate to ask, "I smell alcohol on your breath. How many drinks have you had?" Screening questions should be asked privately and confidentially without other family and friends listening.

What is the effect of NSAIDs (e.g., Naprosyn, Motrin, Anaprox, ibuprofen) on blood pressure?

b. Increases blood pressure Nonsteroidal antiinflammatory drugs (NSAIDs) can be potent renal vasoconstrictors that cause increased blood pressure and resultant lower extremity edema as sodium and water are conserved by the body.

After interviewing a new client, you summarize what she has told you by saying, "You told me you are here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You also have a 'pins and needles' sensation in your third and fourth fingers but no other symptoms at this time. You have noticed a considerable decrease in your grip strength, and you would like to be able to pick up a pot of coffee without fear of spilling it." This is an example of:

c. A paraphrasing technique