Chapter 73: Drug Therapy of Gout

Chapter 73: Drug Therapy of Gout

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1. A patient experiencing an acute gout attack has received several doses of hourly oral colchicine. As the nurse prepares to administer the next dose, the patient begins vomiting. What action should the nurse take?

ANS:   C

If gastrointestinal (GI) symptoms develop, such as nausea, vomiting, diarrhea, or abdominal pain, colchicine should be discontinued immediately, regardless of status of joint pain.

GI symptoms are seen in up to 80% of patients during colchicine treatment of an acute gout attack. These symptoms are indicative of injury to the rapidly proliferating cells of the GI endothelium. The drug should be discontinued.

An antiemetic may be useful for abating the vomiting; however, continued administration of the drug can lead to further damage to the GI endothelium.

GI symptoms are characteristic side effects of colchicine, therefore a recent meal is highly unlikely to have precipitated the vomiting.

DIF:    Cognitive Level: Analysis                  REF:    p. 865

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. For which adverse effects should the nurse monitor the patient receiving intravenous (IV) colchicine? (Select all that apply.)

ANS:   B, D, E

Intravenous administration of colchicine can be especially hazardous, causing bone marrow suppression, renal failure, hepatic necrosis, seizures, and death.

Visual disturbances are not associated with IV administration of colchicine.

Hypoglycemia is not an adverse effect of IV administration of colchicine.

DIF:    Cognitive Level: Application             REF:    p. 865

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient admitted to the medical-surgical unit is being treated with warfarin (Coumadin) for prevention of thrombus. The patient develops hyperuricemia, and allopurinol (Zyloprim) is prescribed. The nurse should anticipate which change in the drug regimen?

ANS:   A

The nurse should anticipate a reduction in the warfarin dose, because allopurinol may enhance its effects.

Increasing the dose of warfarin would further increase the risk for bleeding while the patient is receiving allopurinol.

Because the patient needs treatment for hyperuricemia, discontinuing the allopurinol is not feasible; therefore, other options need to be considered.

Increasing the dose of allopurinol would further potentiate the effect of warfarin.

DIF:    Cognitive Level: Analysis                  REF:    pp. 865-866

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse prepares to administer IV colchicine. Which precaution is correct?

ANS:   D

The nurse should confirm that the IV catheter is in the vein and patent. Extravasation of the drug can cause local necrosis, with sloughing of the skin and subcutaneous tissue.

The medication should be diluted and administered with 20 mL of sterile sodium chloride.

The medication should be diluted with sterile sodium chloride; no specific solution is identified here.

The medication should be administered over 5 minutes or longer.

DIF:    Cognitive Level: Application             REF:    p. 865

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies