Chapter 14 Frandsen PrepU
A female client complains of a mild headache. The physician orders acetaminophen 325 mg, two tablets by mouth every 4 to 6 hours. The client states that she usually takes ibuprofen for her headaches and asks why the physician ordered acetaminophen. Which explanation would the nurse give?
"Acetaminophen is often the initial drug of choice for relieving mild to moderate pain."
A 16-year-old client asks the nurse if she can take two Tylenol every 2 hours during exams, because it helps relieve her tension headaches. What is the nurse's most appropriate response?
"Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage."
The client has been prescribed celecoxib for osteoarthritis. Which of the following statements by the client indicate the need for further client education?
"I will stop taking the medication when I feel better."
The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse?
"It is an aspirin substitute for pain and fever."
A patient being placed on drug therapy for rheumatoid arthritis (RA) asks the nurse why she will have to take methotrexate as well as naprosyn (Naproxyn). What is the best response by the nurse?
"NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts."
A female patient treated with leflunomide decides that she wants to become pregnant. What should the nurse inform the patient?
"Prior to becoming pregnant, you must undergo a drug elimination process with cholestyramine."
The client states that he does not have a back injury; it is his leg that hurts. He feels the physician is not listening to him. What is the best response of the nurse?
"Sometimes when there is nerve damage, it shows up as pain in a different part of the body."
A female client asks why she must consult with her physician when she uses cold products for her children. What is the nurse's best response?
"There is a risk of overdose, because acetaminophen is a very common ingredient in OTC cold, flu, fever, and pain remedies."
After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state which of the following?
"These drugs are relatively safe since they don't have adverse effects."
A nurse is presenting an educational event for a group of new parents. One factor that the nurse addresses is the over use of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do?
'Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients."
A male client presents to the physician's office with inflammation and edema in his left great toe, lasting several days. The physician orders a uric acid level and diagnoses the client with gout, and orders oral colchicine. The nurse is responsible for developing an education plan. The client asks how long it will take for the pain and swelling to subside from his toe. When colchicine is taken for acute gout, how long does it usually take until pain is relieved?
3 to 5 days
Which of the following clients is at highest risk for developing hepatotoxicity related to the use of acetaminophen?
A male 30 years of age who drinks four beers per day
Which of the following patients would the nurse determine has the highest risk of cumulative toxicity if prescribed colchicine?
A patient with hepatic disease
A male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain?
Acetaminophen
A patient comes to the clinic reporting throbbing pain that started at night and intolerance to covers on the foot. The nurse observes swelling at the site of the first metatarsophalangeal (MTP) joint. For what disorder does the nurse anticipate the patient will be treated?
Acute gouty arthritis
What is an important nursing action for the administration of colchicine to the patient in the acute care setting?
Administer the medication with a full glass of water at evenly spaced intervals throughout the day
You are a home care nurse seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. You know that it is important for you to assess the patient's knowledge of which of the following things?
Adverse effects of nonsteroidal anti-inflammatory drugs
Mr. Conn, age 65, is taking probenecid for treatment of chronic gouty arthritis. When providing patient and family education, what should a nurse advise the patient to do if he misses a dose and it is almost time for the next dose?
Advise the patient to take only the second dose and ignore the missed dose
Mr. Conn, age 65, is taking probenecid for treatment of chronic gouty arthritis. When providing patient and family education, what should a nurse advise the patient to do if he misses a dose and it is almost time for the next dose?
Advise the patient to take only the second dose and ignore the missed dose.
Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen?
Anti-inflammatory and antiplatelet effects
A hypersensitivity to which of the following medications is a contraindication for all NSAIDs? (Choose one)
Aspirin
The development of gout has four distinct phases. Place in order each phase of the development of gout.
Asymptomatic hyperuricemia Acute gouty arthritis Intercritical gout Chronic advanced gout
A patient with arthritis is on NSAID therapy. Which of the following should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility
What is the difference between COX-1 and COX-2 enzymes?
COX-1 enzymes secrete cytoprotective mucus.
The client is diagnosed with osteoarthritis and is complaining of joint pain and stiffness. Which of the following medications would be most appropriate for the client to take?
Celecoxib
Which of the following NSAIDs appears to work by specifically inhibiting cyclooxygenase-2, without inhibiting cyclooxygenase-1? (Choose one)
Celecoxib (Celebrex)
In which of the following phases of cellular response in acute inflammation does cellular debris or bacteria become more "attractive" to the white blood cells (WBCs)?
Chemotaxis
Blocking of which of the following is responsible for the pain relieving effects of NSAIDs? (Choose one)
Cyclooxygenase-2
Martha, a 25-year-old woman with rheumatoid arthritis, is being treated with acetaminophen and salicylates. The physician has switched her medication regimen to include DMARDs. What is the advantage of DMARDs over salicylates?
DMARDs can arrest the progression of rheumatoid arthritis.
A nurse is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient?
Drink plenty of water every day
Gold compounds are commonly used as first line therapy for the treatment of rheumatoid arthritis.
False
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?
Gold salts
What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals?
Gold salts
Your client is being discharged following an allergic reaction after ingesting aspirin. Included in your patient education about his allergy, you would inform him that:
He should not take aspirin or non-aspirin NSAIDs
Matt, age 35, is being treated with methotrexate for osteosarcoma. He has a history of alcohol abuse, drinking 6 to 10 beers per day. Based on Matt's history, which adverse effects is he at a risk for?
Hepatic dysfunction
A nurse has admitted a 10-year-old to the short-stay unit. The child has complained of chronic headaches and his mother reports that she gives him Tylenol at least twice a day. Which of the following will the nurse evaluate?
Hepatic function
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
Hepatic function
A patient with rheumatoid arthritis is receiving cyclophosphamide (Cytoxan) for treatment of his disease. When administering an immunosuppressant, the nurse must be alert to which of the following side effects of this medication?
Infection
Which of the following best describes the action of NSAIDs?
Inhibits prostaglandin synthesis
While providing client teaching relative to inflammatory disorders, you would explain the presence of inflammation as:
It is an attempt by the body to remove the damaging agent and repair the damaged tissue.
A patient being treated for psoriasis with methotrexate tells the nurse that she thought methotrexate was only for arthritis. What action does the methotrexate have for psoriasis?
Methotrexate targets rapidly proliferating epithelial cells.
A patient is receiving auranofin as treatment for rheumatoid arthritis. The nurse would expect this drug to be given by which route?
Oral
A nurse is administering an anti-inflammatory medication to a patient who has severe rheumatoid arthritis. Which of the following would the nurse question if ordered by the physician?
Oral anticoagulant
A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. In which of the following cases is the use of celecoxib contraindicated?
Patients with allergy to sulfonamides
A nurse caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition?
Prolonged temperature elevation
The patient informs the nurse that he has been taking methotrexate for 1 week and it is not working to control the rheumatoid arthritis (RA) symptoms. What should the nurse explain to the patient about the onset of action?
Relief of symptoms should occur within 3-6 weeks
Marge, a 38-year-old woman, is seen in the physician's office for the first time. She complains of fatigue, decreased range of motion in her hands, pain with activities that require her to use her hands, loss of strength in her hands and arms, and a low-grade fever. What is the most likely diagnosis that would explain Marge's symptoms?
Rheumatoid arthritis
Which of the following diffuse connective tissue diseases is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?
Rheumatoid arthritis (RA)
A nurse suspects that a client is experiencing salicylism. Which of the following would the nurse assess?
Ringing in the ears
A 15-year-old client is brought to the emergency department by his friends. He complains of visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?
Salicylate intoxication
A black client is receiving a high dose of NSAID for pain relief. Which of the following would be most important for the nurse to include in the teaching plan?
Signs and symptoms of gastrointestinal bleeding
A patient with muscular pain has been prescribed an NSAIDs. What advice should the nurse give the patient to promote an optimal response to NSAID therapy?
Suggest the patient take the NSAID with food and milk
A client with the diagnosis of chronic gout asks how long he should take his colchicine when he experiences symptoms. What are the correct instructions for this client?
Take as directed when pain begins until relief is obtained or nausea, vomiting, and diarrhea occur
Mr. Jones, a 65-year-old man who just had a heart attack, is placed on aspirin, 81 mg daily. The nurse is explaining to Mr. Jones the purpose of this medication. What would be the best explanation?
The aspirin is being prescribed because it reduces your risk of a second heart attack.
The nurse is obtaining nutritional information prior to the patient beginning methotrexate therapy for psoriatic arthritis. What information obtained by the nurse would be of greatest concern?
The patient drinks six cups of coffee daily.
The nurse teaches a patient with rheumatic disease who is being prescribed salicylate therapy to monitor themself for what?
Tinnitus
The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?
To balance urate concentration and prevent gout attacks
The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?
To inhibit platelet aggregation
Danny has been diagnosed with rheumatoid arthritis and begins methotrexate drug therapy. Why should the nurse document the severity of joint inflammation and any restriction in the range of motion when assessing Danny's health status?
To later compare and assess the efficacy of methotrexate therapy
What is chrysotherapy?
Treatment with gold salts
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.
True
A patient with gout has been prescribed colchicine, which he is to take orally each day. When providing relevant health education for this patient, the nurse should emphasize the need to avoid
alcohol.
A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the nurse is responsible for facilitating this new aspect of the patient's drug regimen. This will involve the administration of
weekly subcutaneous injections.
Which of the following are effects exerted by aspirin? Select all that apply:
• Anti-inflammatory • Analgesic • Antipyretic
During discharge counseling, the nurse should tell the client which of the following about the cardiovascular effects of ibuprofen (Motrin)? Select all that apply:
• Blood pressure may increase. • Blood pressure may decrease. • Congestive heart failure may worsen. • Myocardial infarction may occur.
A 7-year-old client is admitted to the pediatric critical care unit with a probable diagnosis of Reye's syndrome. The nurse will be assessing the child for what symptoms? (Select all that apply.)
• Brain swelling • Jaundice • Elevated liver enzymes
The nurse identifies that salicylates are effective in the management of which of the following? Select all that apply.
• Fever • Inflammation • Pain
