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Silvestri Chapter 59 Ed#577

Silvestri Chapter 59 Ed#577

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 059 (edited file)—"Musculoskeletal Medications"10/14/08, Page 1 of 11, 0 Figure(s), 0 Table(s), 5 Box(es)
59: Musculoskeletal Medications
PRACTICE QUESTIONS
1. Allopurinol (Zyloprim) has been prescribed for the client and the client asks the nurse aboutthe action of the medication. The nurse responds, knowing that it:1. Is used for the lysis of thrombi obstructing coronary arteries2. Prevents calcium ion entry across cell membranes of the cardiac smooth muscle3. Decreases sympathetic outflow from the central nervous system (CNS)4. Decreases uric acid production and reduces uric acid concentrations in both the serum andurineAnswer: 4Rationale: Allopurinol is an antigout medication. It decreases uric acid production by inhibitingthe enzyme xanthine oxidase, and reduces uric acid concentrations in both serum and urine.Options 1, 2, and 3 are not actions of this medication.Test-Taking Strategy: Use the process of elimination. Note that options 1 and 2 are similar inthat they both address a cardiac situation. This leaves option 3 and 4. Recalling that thismedication is in the antigout classification will assist in directing you to the correct option fromthose remaining. If you had difficulty with this question, review the action of allopurinol.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 30.2. A nurse is caring for a client who is taking allopurinol (Zyloprim). Which of the followingmedications, if prescribed for the client, would the nurse question?1. Mebendazole (Vermox)2. Ergonovine maleate (Ergotrate)3. Warfarin sodium (Coumadin)4. Pentazocine (Talwin)Answer: 3Rationale: Allopurinol is an antigout medication that may increase the effect of oralanticoagulants. Warfarin sodium (Coumadin) is an anticoagulant, and if this medication was prescribed for the client, the nurse would question the order. Ergonovine maleate is anantimigraine medication. Pentazocine is an opioid analgesic. Mebendazole is an anthelmintic.Test-Taking Strategy: Knowledge regarding the medication interactions related to allopurinol isneeded to answer this question. Remember, allopurinol will increase the effect of oralanticoagulants. If you had difficulty with this question, review the interactions associated withthis medication.Level of Cognitive Ability: AnalysisClient Needs: Safe, Effective Care EnvironmentIntegrated Process: Nursing Process/Implementation
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 059 (edited file)—"Musculoskeletal Medications"10/14/08, Page 2 of 11, 0 Figure(s), 0 Table(s), 5 Box(es)
Content Area: PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St.Louis: Mosby, p. 687.3. A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim).The nurse plans to include which of the following in the instructions?1. Inform the client that the effect of the medication will occur immediately.2. Instruct the client to drink 3000 mL of fluid per day.3. Instruct the client to take the medication on an empty stomach.4. Instruct the client that, if swelling of the lips occur, this is a normal expected response.Answer: 2Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A fulltherapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediatelyfollowing meals or milk to prevent gastrointestinal irritation. If the client develops a rash,irritation of the eyes, or swelling of the lips or mouth, he or she should contact the physician, because this may indicate hypersensitivity.Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated first because itindicates a hypersensitivity, which is not a normal expected response. From the remainingoptions, recalling that this medication is used to treat gout will direct you to option 2. If you haddifficulty with this question, review client instructions related to allopurinol.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/PlanningContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 31.4. A client with rheumatoid arthritis is taking acetylsalicylic acid (Aspirin) on a daily basis.Which medication dose would the nurse expect the client to be taking?1. 1 g daily2. 1000 mg daily3. 325 mg daily4. 4 g dailyAnswer: 4Rationale: Aspirin may be used to treat client with rheumatoid arthritis. It may also be used toreduce the risk of recurrent transient ischemic attach (TIA) or stroke or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. Thenormal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.2 to 6 g/day in divided doses.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 because theyare similar. From the remaining options, noting the client’s diagnosis will direct you to option 4.If you had difficulty with this question, review aspirin dosages.Level of Cognitive Ability: AnalysisClient Needs: Physiological Integrity
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 059 (edited file)—"Musculoskeletal Medications"10/14/08, Page 3 of 11, 0 Figure(s), 0 Table(s), 5 Box(es)
Integrated Process: Nursing Process/Data CollectionContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 87.5. Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client’smedical history in the health record, knowing that the medication would be contraindicated inwhich disorder?1. Renal failure2. Hypothyroidism3. Diabetes mellitus4. MyxedemaAnswer: 1Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders or blood dyscrasias. Clients with impaired renal function may exhibitmyopathy and neuropathy manifested as generalized weakness. This medication should be usedwith caution in clients with impaired hepatic function, the older client, and the debilitated.Test-Taking Strategy: Use the process of elimination. Note that options 2, 3, and 4 are allendocrine-related disorders. Option 1, the correct option, is different from the others. Reviewthis medication if you had difficulty with this question.Level of Cognitive Ability: AnalysisClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 256.6. A nurse is caring for a client who is taking probenecid (Benemid). The client has beeninstructed to restrict the diet to low-purine foods. Which of the following foods would the nurseinstruct the client to avoid while taking this medication?1. Potatoes2. Ice cream3. Spinach4. ScallopsAnswer: 4Rationale: Benemid is a medication used for clients with gout to inhibit the reabsorption of uricacid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purineintake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops,anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.Test-Taking Strategy: Note the key word,
avoid 
. Options 1 and 3 are high-nutrient foods, soeliminate these options first. From this point, use knowledge regarding the purpose of themedication, the treatment for gout, and food sources high in purine to select the correct option.If you had difficulty with this question, review foods that are high in purine.Level of Cognitive Ability: Application

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