A patient with arthritis asks a nurse which nonsteroidal ...

[Yolanda]

A patient with arthritis asks a nurse which nonsteroidal anti-inflammatory medication is best to take. The nurse learns that this patient has a family history of cardiovascular disease. The nurse will recommend which NSAID?
 
  a. Celecoxib (Celebrex)
  b. Diclofenac (Voltaren)
  c. Ketorolac intranasal (Sprix)
  d. Naproxen (Aleve)

Question 2

An older male patient with an increased risk of MI is taking furosemide (Lasix) and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg.
 
  The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss:
  a. adding an antihypertensive medication.
  b. obtaining serum electrolytes.
  c. ordering a potassium-sparing diuretic.
  d. withdrawing the aspirin.

[peter]

Answer to Question 1

ANS: B
Naproxen is COX-1 selective, and the risk of MI and stroke appear lower with this drug than with other NSAIDs. Celecoxib is a COX-2 inhibitor and has increased risks of cardiovascular effects. Cardiovascular risks appear to be increased with diclofenac. Ketorolac carries the same risk as other NSAIDs, even with intranasal dosing.

Answer to Question 2

ANS: D
This patient shows signs of renal impairment, as evidenced by weight gain despite the use of diuretics, decreased urine output, hypertension, and elevated serum creatinine and BUN. ASA can cause acute, reversible renal impairment and should be withdrawn. Hypertensive medications do not treat the underlying cause. Serum electrolytes are not indicated. Addition of a potassium-sparing diuretic is not indicated.

[Yolanda]

Excellent

[amit]

Gracias!