A patient has recent weight loss, fatigue, and recurrent ...

[Sufayan.ah]

A patient has recent weight loss, fatigue, and recurrent low-grade fever along with pain and stiffness of knees and hands. The primary care nurse practitioner (NP) notes symmetric joint swelling and warmth of these joints. The NP should:
 
  a. refer the patient to a specialist.
  b. order erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and antinuclear antibody (ANA) tests.
  c. begin therapy with methotrexate.
  d. order x-rays of the affected joints.

Question 2

A patient who has experienced five to seven liquid stools for 3 days is seen in the clinic by the primary care NP. The patient reports having had fever, mucoid stools, and nausea without vomiting.
 
  The patient has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should prescribe: a. diphenoxylate (Lomotil).
  b. attapulgite (Kaopectate).
  c. bismuth subsalicylate (Pepto-Bismol).
  d. loperamide hydrochloride (Imodium).

[Eunice618]

Answer to Question 1

B
ESR is a very nonspecific but sensitive indication of inflammation. RF is positive in 75 to 85 of patients with rheumatoid arthritis (RA). ANAs are elevated in approximately 20 of patients with RA. These tests help confirm the diagnosis of RA. Once the diagnosis is more likely, referral to a specialist is warranted. Drug therapy is not begun until the diagnosis is confirmed. X-rays are usually the earliest way to detect changes but are not diagnostic in the early stages of the disease.

Answer to Question 2

C
Bismuth reduces symptoms through antidiarrheal and antibacterial properties and can decrease nausea and vomiting. Opioid antidiarrheals should be given after the cause of infectious diarrhea is treated; these can actually prolong symptoms because they slow transit of the causative organisms through the gut. Attapulgite can be used because it binds bacteria and toxins in the gastrointestinal tract, but bismuth is a better choice in this case because it helps to treat nausea. The patient is drinking Gatorade and is getting electrolyte replacement.

[Sufayan.ah]

Gracias!

[steff9894]

TYSM