A patient comes to the clinic with a 4-day history of 10 to 12 ...

[bobypop]

A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.
 
  9 C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP's priority should be to: a. obtain stool cultures.
  b. begin rehydration therapy.
  c. consider prescribing metronidazole.
  d. administer opioid antidiarrheal medications.

Question 2

A patient who is being treated for RA reports having continued pain, which the patient describes as moderate and persistent. The NP should prescribe:
 
  a. acetaminophen.
  b. a cyclooxygenase-2 (COX-2) inhibitor.
  c. an opioid analgesic.
  d. an NSAID.

[Sassygurl126]

Answer to Question 1

B
Acute diarrhea is usually mild and self-limited. Nonpharmacologic measures, especially bowel rest and adequate hydration, are helpful and should be a priority. Stool cultures may be ordered after hydration therapy is begun. Metronidazole is indicated if C. difficile is present. Opioid antidiarrheals may prolong symptoms.

Answer to Question 2

D
NSAIDs are recommended for RA pain because RA is an inflammatory disease. Acetaminophen may be used for mild pain. COX-2 inhibitors appear to cause more stomach ulcers and gastrointestinal (GI) bleeds in patients with RA and so should not be used unless other therapies are ineffective. Opioids should be used for patients with RA when other medications and nonpharmacologic interventions produce inadequate pain relief and the patient's quality of life is affected by pain.

[bobypop]

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[Sassygurl126]

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