Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators

Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. 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:

ANS:  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.

DIF:    Cognitive Level: Applying (Application)                           REF:   416

2. The primary care NP follows a patient who is being treated for RA with methotrexate. The patient asks the NP why the medication does not seem to alleviate pain. The NP tells the patient that:

ANS:  D

Disease-modifying antirheumatic drugs (DMARDs) have antiinflammatory effects that may slow disease progression and preserve joint function. Acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are common adjuncts to therapy to treat pain.

DIF:    Cognitive Level: Applying (Application)                           REF:   417

3. A patient who is being treated for RA reports having continued pain, which the patient describes as moderate and persistent. The NP should prescribe:

ANS:  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.

DIF:    Cognitive Level: Applying (Application)                           REF:   418

4. 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:

ANS:  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.

DIF:    Cognitive Level: Applying (Application)                           REF:   418