An 80-year-old patient has been taking naproxen (Naprosyn) for ...

[joe]

An 80-year-old patient has been taking naproxen (Naprosyn) for osteoarthritis for 6 months. The patient reports adequate pain relief but complains of feeling tired. The primary care NP will order:
 
  a. liver function tests.
  b. a serum potassium level.
  c. a complete blood count (CBC).
  d. a creatinine clearance and urinalysis.

Question 2

A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child's linear growth rate. The NP should consult the child's asthma specialist about:
 
  a. gradually tapering the child off the prednisone.
  b. a referral for possible growth hormone therapy.
  c. giving a double dose of prednisone every other day.
  d. dividing the prednisone dose into twice-daily dosing.

[ankilker]

Answer to Question 1

C
Elderly patients are more susceptible to the adverse effects of NSAIDs, especially slow GI bleeds leading to anemia (manifested as fatigue, lethargy). Patients complaining of fatigue should have a CBC to evaluate for anemia.

Answer to Question 2

C
Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression.

[joe]

Both answers were spot on, thank you once again

[ankilker]

Great! Please up vote