NURSING 6005 CHAPTER 74: DRUG THERAPY OF GOUT Test Bank

NURSING 6005 CHAPTER 74: DRUG THERAPY OF GOUT Test Bank MULTIPLE CHOICE 1. A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do? a. Contact the provider to discuss giving a lower dose of colchicine. b. Hold the medication and notify the prescriber. c. Explain that this is a common side effect that will soon stop. d. Request an order for an antiemetic so that the next dose of colchicine may be given. ANS: B Colchicine should be discontinued immediately, regardless of the status of the joint pain, if gastrointestinal (GI) symptoms occur. The patient’s symptoms indicate injury to the GI endothelium. Once damage begins to occur, lowering the dose is not indicated. GI toxicity will not abate over time. An antiemetic may be useful for stopping the vomiting; however, continued administration of the drug can lead to further damage to the GI endothelium. DIF: Cognitive Level: Analysis REF: Colchicine | Adverse Effects | Gastrointestinal Effects TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol (Zyloprim) and colchicine. The nurse will include which statement when teaching the patient about this drug regimen? a. “Allopurinol helps reduce the gastrointestinal side effects of colchicine.” b. “Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy.” c. “The colchicine is given to enhance the effects of the allopurinol.” d. “You will take both drugs initially and then stop taking the colchicine.” ANS: D Colchicine is used for prophylaxis when urate-lowering drugs, such as allopurinol, are initiated, because gouty episodes have a tendency to increase during this time. Patients start with both drugs, and ultimately the colchicine is withdrawn. Allopurinol does not affect the GI side effects caused by colchicine. Allopurinol may precipitate an acute gouty attack when treatment is begun; colchicine is given to prevent a gouty episode. Colchicine does not enhance the effects of allopurinol. DIF: Cognitive Level: Application REF: Colchicine | Therapeutic Use | Prophylaxis of Gouty Attacks | Drugs for Hyperuricemia (Urate-Lowering Therapy) TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? a. Colchicine b. Glucocorticoids c. Nonsteroidal anti-inflammatory drugs d. Urate-lowering drugs ANS: D The provider will order a urate-lowering drug for this patient. The medication should be diluted and administered with 20 mL of sterile sodium chloride and administered over 5 minutes or longer. DIF: Cognitive Level: Analysis REF: Overview of Drug Therapy TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do? a. Contact the provider to discuss using a different antibiotic while this patient is taking colchicine. b. Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine. c. Request an order for cardiorespiratory monitoring, because the patient is taking digoxin. d. Suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) be withdrawn during colchicine therapy. ANS: B Colchicine can cause rhabdomyolysis, and this risk is increased in patients who also take simvastatin or other statin drugs. Amoxicillin does not interact with colchicine. The side effects of digoxin are not increased by concurrent use with colchicine. NSAIDs can safely be taken with colchicine. DIF: Cognitive Level: Application REF: Colchicine | Adverse Effects | Drug Interactions TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. A patient is being treated with warfarin (Coumadin) to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol (Zyloprim). The nurse will contact the provider to discuss _____ the _____ dose. a. increasing; allopurinol b. increasing; warfarin c. reducing; allopurinol d. reducing; warfarin ANS: D Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay the inactivation of other drugs. This is a particular concern in patients taking warfarin; therefore, the warfarin dose should be reduced when allopurinol is also used. It is not correct to increase the allopurinol dose, increase the warfarin dose, or reduce the allopurinol dose. DIF: Cognitive Level: Application REF: Allopurinol | Drug Interactions TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential