Author Question: A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol ... (Read 128 times)

Frost2351 · **on:** Jul 23, 2018

A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine, and the prescriber orders pegloticase (Krystexxa).

Before administering this drug, the nurse will expect to:
a. administer an antihistamine and a glucocorticoid.
b. discontinue the colchicine.
c. increase the dose of colchicine.
d. prepare to administer a bronchodilator if needed.

Question 2

A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9.5 mg/dL.

The serum vitamin D level is 18 ng/mL. The nurse will recommend adding _____ daily and _____ IU of vitamin D3 each day.
a. 1200 mg of calcium once; 10,000
b. 1500 mg of calcium twice; 1000
c. 600 mg of calcium once; 10,000
d. 600 mg of calcium twice; 2000

Bigfoot1984 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
Because pegloticase poses a risk of triggering anaphylaxis, patients should be pretreated with an antihistamine and a glucocorticoid. Colchicine is indicated at the initiation of treatment with pegloticase to reduce the intensity of gout flare-ups. Bronchodilators are not indicated.

Answer to Question 2

ANS: C
Women older than 50 years need 1200 mg of calcium per day. This patient is getting 600 mg/day. She should add 600 mg/day to compensate for what she does not get in her diet, because the amount of a supplement should be enough to make up the difference. Her vitamin D level is low, so she needs a vitamin D supplement. To treat deficiency, adults older than 19 years should get 10,000 IU/day. An additional intake of 1200 mg of calcium once daily is too much calcium. An additional intake of 1500 mg of calcium twice daily is too much calcium, and 1000 IU of vitamin D is not enough to treat deficiency. An additional intake of 600 mg of calcium twice daily is too much calcium, and 2000 IU of vitamin D is not sufficient to treat deficiency.