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The nurse is reviewing the history of a patient who has a new order for a nonsteroidal anti-inflammatory drug (NSAID). Which conditions, if present, are contraindications to the use of NSAIDs? (Select all that apply.)
- A. Vitamin K deficiency
- B. Arthralgia
- C. Peptic ulcer disease
- D. Documented aspirin allergy
Correct Answer: A,C,D
Rationale: Contraindications to NSAIDs include known drug allergy as well as conditions that place the patient at risk for bleeding, such as vitamin K deficiency and peptic ulcer disease. Patients with documented aspirin allergy should not receive NSAIDs. NSAIDs may be used to treat arthralgia.
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A 55-year-old woman has been given a nonsteroidal anti-inflammatory drug (NSAID) for the treatment of rheumatoid arthritis. The nurse is reviewing the patient's medication history and notes that which types of medications could have an interaction with the NSAID? (Select all that apply.)
- A. Antibiotics
- B. Decongestants
- C. Anticoagulants
- D. Beta blockers
- E. Diuretics
- F. Corticosteroids
Correct Answer: C,E,F
Rationale: Anticoagulants taken with NSAIDs may cause increased bleeding tendencies because of platelet inhibition and hypoprothrombinemia. NSAIDs taken with diuretics may cause reduced hypotensive and diuretic effects. NSAIDs taken with corticosteroids may cause increased ulcerogenic effects.
A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder?
- A. Type 2 diabetes mellitus
- B. Hypothyroidism
- C. Hypertension
- D. Angina
Correct Answer: A
Rationale: Glucosamine may reduce the effectiveness of antidiabetic drugs by worsening insulin resistance, necessitating closer monitoring of blood glucose levels in patients with type 2 diabetes mellitus.
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct?
- A. Aspirin is given to reduce anxiety.
- B. It helps to reduce inflammation.
- C. Aspirin is given to relieve pain.
- D. It will help to prevent clot formation.
Correct Answer: D
Rationale: Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever.
A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal anti-inflammatory drug and misoprostol, also called Cytotec. The patient asks the nurse, 'Why am I now taking two pills for arthritis?' What is the nurse's best response?
- A. Cytotec will also reduce the symptoms of your arthritis.
- B. Cytotec helps the action of the NSAID so that it will work better.
- C. Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation.
- D. Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.
Correct Answer: D
Rationale: Cytotec inhibits gastric acid secretions and stimulates mucous secretions; it has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs.
The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session?
- A. Fluids should be restricted while on colchicine therapy.
- B. Take colchicine with meals.
- C. The drug will be discontinued when symptoms are reduced.
- D. Call your doctor if you have increased joint pain or blood in the urine.
Correct Answer: D
Rationale: Colchicine may cause renal effects; therefore, the presence of blood in the urine must be reported immediately. In addition, the therapeutic effect should be decreased joint pain, not increased pain. The drug is taken on an empty stomach for better absorption, and fluids should be increased unless contraindicated. Successful treatment depends upon continuing the medication as ordered.