The nurse is caring for a client who is diagnosed with an autoimmune disease that causes significant joint pain. The client reports that they take prednisone daily at home and occasionally take ibuprofen when the pain is extreme. What is the best response by the nurse?
Prednisone can exacerbate pain by increasing prostaglandin synthesis, so the provider may want to discontinue the prednisone
I will talk to the provider about having your prednisone switched to alternate day dosing so that your pain is better controlled
Ibuprofen is not a very strong analgesic so if your pain is severe, the provider may want to start you on a prescription-strength ibuprofen
Taking steroids and NSAIDs can increase the risk for stomach ulcers so we need to discuss an alternate plan for pain management
The Correct Answer is D
Choice A reason: Prednisone reduces pain by inhibiting prostaglandin synthesis via phospholipase A2 suppression, not increasing it. Discontinuing prednisone may worsen autoimmune joint pain. This statement is inaccurate, as prednisone’s anti-inflammatory action is beneficial, and the issue lies in its combination with NSAIDs.
Choice B reason: Alternate-day prednisone dosing reduces side effects but may not adequately control chronic autoimmune joint pain, as consistent suppression of inflammation is needed. This statement is less appropriate, as it does not address the primary concern of gastrointestinal risk from combining prednisone with ibuprofen.
Choice C reason: Ibuprofen is a potent NSAID, but its strength is not the issue. Combining it with prednisone increases gastrointestinal bleeding risk due to additive mucosal damage. Suggesting stronger ibuprofen is inappropriate and ignores the ulcer risk, making this statement inaccurate for safe pain management.
Choice D reason: Prednisone and NSAIDs like ibuprofen increase gastric ulcer risk by suppressing mucosal protective prostaglandins and increasing acid production. This combination can lead to bleeding or perforation, especially in autoimmune patients on chronic steroids. This statement is accurate, as it prioritizes discussing safer pain management alternatives.
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Related Questions
Correct Answer is A
Explanation
Choice A reason: Osteoporosis causes bone density loss, leading to fractures, not primary joint pain. Pain occurs secondary to fractures, not joint inflammation or degeneration. This condition is the least likely to cause joint pain directly, as its pathology focuses on bone fragility rather than synovial or cartilage issues.
Choice B reason: Systemic lupus erythematosus (SLE) causes joint pain due to autoimmune-mediated synovitis, affecting multiple joints symmetrically. Inflammatory cytokines drive pain and swelling, making SLE a common cause of joint pain, unlike osteoporosis, which primarily affects bone structure without direct joint involvement.
Choice C reason: Osteoarthritis causes joint pain due to cartilage degeneration and bone-on-bone friction, particularly in weight-bearing joints like knees. Mechanical stress and inflammation contribute to chronic pain, making osteoarthritis a frequent cause of joint pain, unlike osteoporosis, which lacks primary joint pathology.
Choice D reason: Rheumatoid arthritis causes significant joint pain through autoimmune synovial inflammation, leading to swelling, stiffness, and cartilage damage. This systemic condition affects multiple joints, making it a primary cause of joint pain, unlike osteoporosis, which is associated with bone loss, not joint inflammation.
Correct Answer is A
Explanation
Choice A reason: Gout results from hyperuricemia, leading to urate crystal deposition in joints. A 45-year-old male with obesity (BMI 40) has increased purine turnover, elevating uric acid. Hydrochlorothiazide reduces urate excretion, and aspirin impairs renal uric acid clearance, significantly increasing gout risk, making this patient the most susceptible due to multiple risk factors.
Choice B reason: Bulimia may cause electrolyte imbalances, but it is not strongly linked to hyperuricemia or gout. A BMI of 24 is normal, reducing obesity-related purine production. This 39-year-old female has fewer gout risk factors compared to an obese male on medications that elevate uric acid, making her less likely to develop gout.
Choice C reason: Ulcerative colitis may cause systemic inflammation, but it is not a direct risk factor for gout. Hyperuricemia is not typically associated with inflammatory bowel diseases unless complicated by other factors like diuretic use. This 27-year-old female has a lower gout risk compared to the obese male with predisposing medications.
Choice D reason: Limiting purine-rich foods like smoked meat and cheeses reduces uric acid production, lowering gout risk. This 56-year-old male’s dietary habits mitigate hyperuricemia, making him the least likely to develop gout compared to the obese patient on medications that impair uric acid metabolism and excretion.
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