Pharm prepu

The client with chronic gout asks how he can reduce the uric levels in his body when he begins to self-administer colchicine. What would be the nurse's response?

"Drink 2 to 3 quarts of fluid daily; this will decrease uric acid levels and help prevent formation of uric acid kidney stones." Explanation: Drink 2 to 3 quarts of fluid daily with Anti-gout drugs. An adequate fluid intake helps prevent formation of uric acid kidney stones. Fluid intake is especially important initially, when uric acid levels in the blood are high and large amounts of uric acid are being excreted in the urine.

The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client?

"Take it first thing in the morning." Explanation: Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach.

A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond?

"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose?

81-325 mg Explanation: The recommended daily dose for prophylaxis of MI, TIA, and CVA is 81-325 mg. The indication stems from aspirin's ability to decrease formation of blood clots.

A nurse should question an order for fludrocortisone for which client?

A 30-year-old male with a systemic fungal infection Explanation: Fludrocortisone is contraindicated in clients with systemic fungal infections and cardiovascular diseases, not respiratory diseases. Fludrocortisone should also be used cautiously in pregnant women and older adults. Urticaria is an adverse effect of fludrocortisone. Hyperlipidemia is a possible adverse effect of prednisone.

A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?

Acetaminophen has no effect on inflammation

A patient comes to the clinic reporting throbbing pain that started at night and intolerance to covers on the foot. The nurse observes swelling at the site of the first metatarsophalangeal (MTP) joint. For what disorder does the nurse anticipate the patient will be treated?

Acute gouty arthritis Explanation: The onset of acute gouty arthritis is rapid. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. In more than half of the initial attacks, the onset is in the first MTP, and overall 90% of patients have the MTP affected at some point.

What is an important nursing action for the administration of colchicine to the patient in the acute care setting?

Administer the medication with a full glass of water at evenly spaced intervals throughout the day. Explanation: In an acute care setting, administer colchicine with a full glass of water at evenly spaced intervals throughout the day.

Which properties do salicylate analgesics and acetaminophen share? (Select all that apply.)

Analgesic Antipyretic

The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?

Aspirin Explanation: Tinnitus (ringing of the ears) is a symptom of salicylism. It is not seen with the use of acetaminophen, steroids, or antibiotics.

The development of gout has four distinct phases. Place in order each phase of the development of gout.

Asymptomatic hyperuricemia Acute gouty arthritis Intercritical gout Chronic advanced gout

The nurse is educating the patient who will be taking colchicine at home. What important information should the nurse be sure to include in the education?

Avoid the use of alcohol because it will decrease the antigout effects of colchicine. Explanation: Ethanol ingestion increases the risk of adverse GI effects and can increase serum urate concentration, thus decreasing the antigout effects of colchicine.

Aspirin (ASA) is an over-the-counter drug that is found in many other drugs. What is the mechanism of action for aspirin?

Blocking the transmission of pain impulses Explanation: Aspirin acts both centrally and peripherally to block the transmission of pain impulses. Aspirin does not increase adrenal function or while blood cell production. Aspirin does not suppress the function of the hypothalamus.

Your client is diagnosed with gout. He calls the office requesting you to obtain a prescription for a month's supply of colchicine. As part of his medication education, you would inform the client of the following:

Colchicine is limited to only 7 days of therapy. Explanation: Because colchicine is toxic to the bone marrow, it is limited to only 7 days of therapy. In acute attacks, colchicine may be used for relieving inflammation, joint pain and edema, although it is no longer considered a first-line medication to treat gout due to drug toxicities. Allopurinol is used to prevent or treat hyperuricemia, which occurs with gout and with antineoplastic drug therapy.

You are caring for a client with cerebral edema caused by trauma. Which of the following medications would you anticipate being administered?

Dexamethasone Explanation: Dexamethasone is considered the corticosteroid of choice for cerebral edema associated with brain tumors, craniotomy, or head injury because dexamethasone is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues.

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

Dietary habits Explanation: The nurse must consider the patient's dietary habits because foods high in purines increase uric acid concentrations in the blood, making a gouty attack more likely. Assessing the patient's work environment, fluid intake, and ethnicity are not as important as assessing his dietary habits.

A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate?

Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.

The client reports severe pain from an acute lumbar spasm. The nurse would anticipate which drug to be ordered for this client?

Ketorolac (Toradol) Explanation: Aspirin, other NSAIDs, and acetaminophen are effective in treating mild to moderate pain associated with conditions such as headache, minor trauma, minor surgery, and other acute and chronic conditions. Ketorolac is used for moderate or severe pain, and although it can be given orally, its unique characteristic is that it can be given by injection. Parenteral ketorolac reportedly compares with morphine and other opioids in analgesic effectiveness.

A nurse suspects that a client is experiencing 274. What would the nurse assess for?

Mental confusion Explanation: Salicylism can occur with high levels of aspirin and be manifested by ringing in the ears, dizziness, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude. Excitement, tachypnea, and convulsions suggest acute salicylate toxicity.

While caring for a client taking NSAIDs, a nurse should monitor which of the following renal adverse effects? Select all that apply:

Oliguria Dysuria Hematuria Polyuria

A nurse caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition?

Prolonged temperature elevation Explanation: If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur. Prolonged immobility, reduced intake of fibrous food, and intake of food with antacids do not cause a decrease in urinary output.

A patient with muscular pain has been prescribed an NSAIDs. What advice should the nurse give the patient to promote an optimal response to NSAID therapy?

Suggest the patient take the NSAID with food and milk. Explanation: The nurse should suggest that the patient take the drug with food and milk to promote an optimal response to NSAID therapy; this helps minimize the risk of GI effects. The patient does not need to take an NSAID with fiber-rich food or with calcium supplements.

A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that:

This time mimics the normal peak diurnal concentration levels. Explanation: Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. A glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Drug absorption is not affected by time of administration. The rationale for morning administration is to mimic the normal peak diurnal concentration levels.

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

To balance urate concentration and prevent gout attacks Explanation: Uricosuric drugs such as allopurinol help to balance urate levels and thus prevent gout attacks. They do not influence the remodeling of synovial membrane, provide analgesia, or affect the metabolism of purines.

A nurse is presenting an educational event for a group of new parents. One factor that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do?

To check the label of ove-the-counter medications carefully to watch for inclusions of acetaminophen Explanation: Inadvertent overdose with acetaminophen frequently occurs because of the combining of over-the-counter drugs that contain the same ingredients. Parents should be taught to carefully check the labels of over-the-counter products and follow the dosage guidelines. A prescription is not required for acetaminophen, and the dosage guidelines are the best guide to follow in preventing overdosing.

A client is taking long-term corticosteroid therapy. Which finding would alert the nurse to a potential Cushing's syndrome manifestation?

Truncal obesity Explanation: Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders; depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain.

A 60-year-old man has told the nurse that he has been treating his joint pain with regular doses of ibuprofen. In order to ascertain the man's risks of experiencing adverse effects, the nurse should assess the patient's

alcohol intake.

A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:

allergy to sulfonamides. Explanation: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.

A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?

arthritis Explanation: Meloxicam is administered for the treatment of osteoarthritis and rheumatoid arthritis. It has no effect on any of the other options.

Which drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction?

aspirin

Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy?

buffalo hump Explanation: Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders (buffalo hump); depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain. Cushing's syndrome is not associated with insomnia, hair loss, or weight loss.

A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief?

cyclooxygenase-2 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

A nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved?

stomach

A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?

tarry stool Serious GI events are also listed as a Black Box warning. Gastropathies are commonly associated with ibuprofen. Nausea, vomiting, diarrhea, constipation, flatulence, and abdominal pain may be representative of minor adverse effects in some clients or serious GI toxicity in others. During long-term administration, the most serious effects are peptic ulcer disease or gastritis that leads to GI bleeding or even perforation. These events can occur at any time, with or without warning.