Author Question: A patient who has a history of stomach ulcers is taking a nonselective NSAID along with a DMARD for ... (Read 25 times)

Davideckstein7 · **on:** Jul 24, 2018

A patient who has a history of stomach ulcers is taking a nonselective NSAID along with a DMARD for RA. The primary care NP should:

a. order a glucocorticoid.
b. change to acetaminophen.
c. order a proton pump inhibitor (PPI).
d. change to a selective COX-2 inhibitor.

Question 2

A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult with a pediatric endocrinologist to discuss:

a. increasing the dose to 90 mcg/day.
b. decreasing the dose to 30 mcg/day.
c. stopping the medication and checking TSH and T4 in 4 weeks.
d. discussing the need for lifetime replacement therapy with the child's parents.

sarajane1989 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
If GI risk factors are present, a prophylactic PPI should be given along with the nonselective NSAID. Glucocorticoids make ulcers worse. Acetaminophen is used only for mild pain or as adjunct pain therapy. A selective COX-2 inhibitor has an increased risk of stomach ulcers.

Answer to Question 2

C
In congenital hypothyroidism, therapy may be stopped for 2 to 8 weeks after the patient reaches 3 years of age. If TSH levels remain normal, thyroid supplementation may be discontinued permanently.