Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Alleve) to reduce inflammation and joint pain. Which of these symptoms is the strongest indicator that a change in therapy may be necessary?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) The patient has stools that are very dark in color. Dark stools indicate gastrointestinal bleeding, a serious side effect of NSAIDs like naproxen. This is a critical symptom that requires immediate attention and may necessitate a change in therapy to prevent further complications. Option A is incorrect as morning stiffness is a common feature of RA and not necessarily an indicator for changing therapy. Option B about dry eyes is more likely related to Sjogren's syndrome, which can coexist with RA but is not a strong indicator for changing therapy in this case. Option C refers to rheumatoid nodules, a common manifestation of RA but not a direct indicator for changing therapy. Educationally, it is crucial for healthcare providers to recognize and monitor for adverse effects of medications used in RA treatment, especially NSAIDs like naproxen. Understanding the significance of symptoms like dark stools can help prevent serious complications and optimize patient care. Regular monitoring and patient education on potential side effects are essential in managing RA pharmacotherapy effectively.

Correct Answer: B

Rationale: In this question, the correct answer is B) Small joints of hands and feet. Rheumatoid arthritis is a chronic autoimmune disorder that primarily affects the small joints of the hands and feet. The synovial lining of these joints becomes inflamed, leading to pain, swelling, and eventually joint deformity. This characteristic pattern of joint involvement distinguishes rheumatoid arthritis from other types of arthritis. Option A) Symmetrical involvement of major joints is incorrect because while rheumatoid arthritis can involve major joints, it typically presents with a symmetrical pattern affecting the small joints first. Option C) Involvement of the spine from the sacrum upward to the cervical region is more characteristic of ankylosing spondylitis, a different type of inflammatory arthritis. Option D) Slightly movable joints of the axial skeleton is a vague description and not specific to the pattern of joint involvement seen in rheumatoid arthritis. Understanding the pattern of joint involvement in rheumatoid arthritis is crucial for healthcare professionals in diagnosing and managing this condition effectively. By knowing which joints are commonly affected, healthcare providers can tailor treatment plans to address the specific needs of the patient and improve their quality of life. This knowledge also helps in differentiating rheumatoid arthritis from other types of arthritis, guiding appropriate referrals and interventions.

Correct Answer: C

Rationale: In the context of pharmacology and understanding the role of nutrients in wound healing, it is crucial to recognize the specific functions of different nutrients in the body. In this case, the correct answer is option C) Vitamin C. Vitamin C is essential for wound healing as it plays a key role in collagen synthesis by fibroblasts, which are crucial for capillary synthesis and wound repair. Collagen is a structural protein that provides strength and support to tissues, including in the formation of new capillaries during wound healing. Options A) Fats and B) Proteins are important for overall health and play various roles in the body, but they do not directly aid in collagen production by fibroblasts in wound healing. Vitamin A (option D) is important for maintaining healthy skin and mucous membranes, but it is not specifically known for its role in collagen synthesis in wound healing. Understanding the specific functions of nutrients in wound healing not only enriches our knowledge of pharmacology but also highlights the importance of a balanced diet in supporting the body's natural healing processes. This knowledge is vital for healthcare professionals involved in patient care, as they can provide dietary recommendations to support optimal wound healing outcomes.

Correct Answer: C

Rationale: In pharmacology, understanding key terms related to genetics and the immune system is crucial. The correct answer to the question "Physical traits expressed by an individual is the definition for which term?" is C) Phenotype. Rationale: - Phenotype refers to the observable physical or biochemical characteristics of an organism, influenced by both genetics and environmental factors. It is what we can see or measure about an individual. - Allele (Option A) refers to different forms of a gene and is a component of an individual's genotype, not the physical traits themselves. - Genomics (Option B) is the study of an organism's entire genetic makeup, including genes, their functions, and interactions. It is a broader term than just physical traits. - Chromosomes (Option D) are thread-like structures in the cell nucleus that carry genetic information but do not directly represent physical traits. Educational Context: Understanding the concept of phenotype is essential in pharmacology as it influences how individuals respond to medications based on their genetic makeup. By grasping the distinction between genotype (genetic composition) and phenotype (observable traits), healthcare professionals can better tailor treatment plans to patients. This knowledge is especially relevant in precision medicine, where therapies are personalized based on an individual's genetic profile to optimize efficacy and minimize adverse effects.

Correct Answer: A

Rationale: In the context of pharmacology and personalized medicine, pharmacogenetic testing is the most appropriate suggestion for the nurse to make in this scenario. Pharmacogenetic testing involves analyzing a patient's genetic makeup to determine how they may respond to certain medications. In the case of warfarin, which has a narrow therapeutic index and can exhibit variability in response among individuals, pharmacogenetic testing can help identify genetic factors that influence how the patient metabolizes the drug. This information can guide dosing decisions and help optimize the effectiveness and safety of warfarin therapy for the individual patient. Option B, starting bivalirudin IV, is incorrect because bivalirudin is not a direct substitute for warfarin in this context. Bivalirudin is a direct thrombin inhibitor typically used in specific settings like percutaneous coronary intervention, and it does not serve the same anticoagulant purpose as warfarin. Option C, changing from warfarin to clopidogrel and aspirin, is not an appropriate solution to the dosing issue with warfarin. Clopidogrel and aspirin are antiplatelet agents, not anticoagulants like warfarin, and switching to this combination would not address the underlying issue of determining the appropriate warfarin dose for the patient. Option D, changing from warfarin to enoxaparin injections, is also not the best course of action. Enoxaparin is a low molecular weight heparin that works differently from warfarin and is usually used in different clinical scenarios, such as venous thromboembolism prophylaxis or treatment. Understanding the principles of pharmacogenetics and its application in individualizing drug therapy is essential for healthcare professionals to optimize patient outcomes and minimize adverse effects. By choosing pharmacogenetic testing in this case, the nurse can contribute to a more tailored and effective treatment plan for the patient taking warfarin.