A 53-year-old patient who is receiving ibuprofen 400 mg twice a day for chronic, low back pain develops lower-extremity edema. The pain management nurse suspects that the edema is caused by:

Correct Answer: A

Rationale: The correct answer is option A) a decrease in renal function. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can have adverse effects on the kidneys. Prolonged use of NSAIDs like ibuprofen can lead to renal impairment, causing fluid retention and edema. This is due to the drug's mechanism of action, which can disrupt normal renal function and lead to decreased kidney function. Option B) a low creatinine level is incorrect because a low creatinine level would not typically be associated with the development of lower-extremity edema in this scenario. Creatinine levels are more indicative of kidney function rather than fluid retention. Option C) an increase in glomerular filtration rate is incorrect because an increase in GFR would not typically lead to lower-extremity edema. An increase in GFR would suggest improved kidney function rather than impairment. Option D) an increase in plasma proteins is incorrect because an increase in plasma proteins would more likely lead to fluid shifting into the vascular space rather than causing peripheral edema. In an educational context, understanding the potential adverse effects of medications like ibuprofen on renal function is crucial for healthcare professionals, especially those working in pain management or administering medications. Recognizing the signs of renal impairment, such as edema, is essential for early intervention and prevention of further complications in patients with chronic pain conditions. This knowledge helps ensure safe and effective patient care and medication management.

Correct Answer: B

Rationale: The correct answer is B) dizziness and increased feelings of anxiety. In patients with fibromyalgia, it is common to experience a range of symptoms beyond just pain, including dizziness and anxiety. These symptoms are often interconnected and can significantly impact a patient's quality of life. By asking about dizziness and anxiety, the pain management nurse can gain a more comprehensive understanding of the patient's condition and tailor treatment accordingly. Option A) constipation and pruritus are not typically associated symptoms of fibromyalgia. While these symptoms can occur in some individuals, they are not as commonly linked to the condition as pain, dizziness, and anxiety. Option C) evening pain and stiffness are common symptoms of fibromyalgia, but they do not encompass the broader range of symptoms that patients may experience, such as dizziness and anxiety. Option D) hyperactivity followed by periods of heavy sleep is not a typical symptom pattern seen in fibromyalgia. While sleep disturbances are common in fibromyalgia patients, the specific pattern described in this option is not characteristic of the condition. Educationally, understanding the range of symptoms associated with fibromyalgia is crucial for healthcare professionals, especially those working in medical administration or pain management. By recognizing the interconnected nature of symptoms like pain, dizziness, and anxiety, professionals can provide more holistic care and support to patients with fibromyalgia, ultimately improving their overall well-being and treatment outcomes.

Correct Answer: B

Rationale: The correct answer is B) Z-track method. This technique is used to minimize skin irritation by sealing the medication in muscle tissue. The Z-track method involves displacing the skin laterally before administering the medication, which helps to prevent leakage of the medication into subcutaneous layers. This technique ensures that the medication is delivered accurately into the muscle, reducing irritation and potential harm. Option A) Any right drug is incorrect because the type of drug is not the primary factor in minimizing skin irritation. The administration technique plays a crucial role in this aspect. Option C) Some drugs combined with steroids is incorrect because the addition of steroids to certain medications does not necessarily minimize skin irritation through sealing in muscle tissue. It is the method of administration that matters most. Option D) A drug that you prepared is incorrect as the preparation of the drug does not automatically ensure that it will minimize skin irritation. The technique of injection delivery is what determines the efficacy of minimizing skin irritation. Educationally, understanding the Z-track method and its purpose in minimizing skin irritation is essential for medical administrative assistants. By mastering this technique, they can ensure accurate and safe medication administration, which is a critical aspect of their role in healthcare settings. It is important for medical administrative assistants to be knowledgeable about various medication administration techniques to provide quality patient care and prevent potential complications.

Correct Answer: D

Rationale: Your first duty is to keep the patient fully informed about her health care. Unless there is significant evidence of possible psychological harm to a patient, you have an absolute duty to the patient first, not the family. One of the only examples of possible psychological harm to a patient would be an actively suicidal person who was given significant bad news. The motives of the family members are irrelevant. Whether they are kind and loving or vindictive and evil makes no difference. This is true whether their request to withhold information is in writing or is from the hospital ethics committee. In this case, the ethics committee is not necessary because there is no substantive question of the right action to inform the patient first. The health-care proxy's opinion and participation are only mandated if the patient loses decision-making capacity. If the patient has decision-making capacity, the health-care proxy's opinion is not different from anyone else's.

Correct Answer: B

Rationale: Small gifts from patients of limited value are ethically acceptable. Food, plants, and small articles of clothing such as a scarf are all acceptable. Refusing such signs of gratitude would be hurtful to the doctor/patient relationship if they are a sign of the good relationship with you. Gifts can never be tied to a specific expectation of care such as a particular prescription or the successful completion of paperwork such as disability forms. There is no reporting or disclosure requirement for small gifts of nominal value.