Chapter 14: Nonopioid Analgesics: NSAIDS and Migraine Headache Medications

The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed acetaminophen-aspirin-caffeine combination for abortive therapy. Which statement made by the client establishes the need for further clarification? "The caffeine in the drug helps the vessels in my brain to constrict and helps stop the headache." "I can take my over-the-counter cold remedies in addition to this drug for cold symptoms." "I should not take this drug if I plan on becoming pregnant, or later want to breast-feed." "While I am taking this drug, I should not consume any foods or drinks high in caffeine."

"I can take my over-the-counter cold remedies in addition to this drug for cold symptoms."

A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works? "The medication causes bronchiole constriction." "The medication impairs the reuptake of norepinephrine." "It produces vascular constriction of cranial blood vessels." "It relaxes smooth muscles of the cardiovascular system."

"It produces vascular constriction of cranial blood vessels."

The client has had an open reduction internal fixation (ORIF) of the right hip. Which statement by the client identifies that the use of celecoxib is effective? "My hip aches all of the time." "I do not have a fever any longer." "My hip pain has decreased." "My stomach doesn't burn today."

"My hip pain has decreased."

The client states he was told that the pain in his leg is referred pain and that he does not understand what that means. The nurse provides which explanations to the client? "Referred pain is pain that identifies an internal injury has occurred." "Referred pain is pain that is deeper into the muscle area." "Referred pain is pain related to an injury that is felt elsewhere in the body." "Referred pain is actually from an injury that occurred to that site long ago."

"Referred pain is pain related to an injury that is felt elsewhere in the body."

The nurse is caring for a client with a gastric ulcer. The client asks about using Capsaicin on the joints of the knees for arthritis, but says he has heard that spicy foods should be avoided because of his ulcer and that Capsaicin has hot pepper in it. What is the best response by the nurse? "People with ulcers should avoid spicy foods, and this drug does have hot pepper in it, avoid it." "I would not use it if I had a ulcer." "I think you are looking for trouble." "Research has suggested that Capsaicin produces the opposite effect. It might protect against ulcers, so I think it is fine to use it."

"Research has suggested that Capsaicin produces the opposite effect. It might protect against ulcers, so I think it is fine to use it."

A client with a migraine took a prescribed dose of eletriptan, and 1-hour later, the headache is still intense. The client's spouse calls the clinic and asks the nurse what they should do. What is an appropriate nursing response? "Tell them to lie down in a quiet cool room and just wait it out. It will subside." "They can take another dose of the drug 2 hours after the initial dose if the headache continues." "Give them a dose of an ergot drug if you have it. It will decrease the intensity of the pain." "Ibuprofen may increase the action of the triptan."

"They can take another dose of the drug 2 hours after the initial dose if the headache continues."

A client who has been prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, but I feel like a headache is returning. Can I take another pill?" How should the nurse respond? "Wait at least half-an-hour before you take another pill." "Yes, it's likely safe to take one more dose of your sumatriptan." "You should probably go to the emergency department." "You can take another pill now and one more in 1 hour, but then no more." TAKE ANOTHER QUIZ

"Wait at least half-an-hour before you take another pill."

A client has taken sumatriptan and does not feel it is working. The client wants to know when more medication can be administered. Which response should the nurse prioritize? "You can double the dose within a few minutes of administration." "You can only take one dose safely." "If it does not work with the first dose, we will add a different medication." "You can take a second dose 2 hours after the first."

"You can take a second dose 2 hours after the first."

The nurse is caring for a client with a history of migraine headaches. The client asks what is happening during the migraine. The nurse's best response would be which? A migraine headache is caused by vascular spasms. Migraine headaches are just especially severe normal headaches. Migraine headaches are a complication indicating another underlying illness. Migraine headaches are exaggerated by clients.

A migraine headache is caused by vascular spasms.

A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area? Use of herbal supplements Exercise routine Nutrition and health Adverse effects of NSAIDs

Adverse effects of NSAIDs

The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Inhibiting impulses to the brain Inhibiting the synthesis of prostaglandins Blocking the neuronal terminal Decreasing nerve stimulation

Inhibiting the synthesis of prostaglandins

The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? Assessing the client for migraine pain Assessing the client for narcotic withdrawal syndrome Assessing the client for respiratory depression Assessing the client's lying, sitting and standing blood pressure

Assessing the client for migraine pain

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? Eletriptan Ergotamine Sumatriptan Celecoxib

Celecoxib

A client discharged to home is recovering from a coronary artery bypass graft (CABG). The client calls the nurse and wants to take something for mild pain and states he is considering Celecoxib, which he used successfully in the past for arthritis. Why would the nurse advise the client against doing this? Select all that apply. Celecoxib can cause thrombosis. Celecoxib can cause renal failure. Celecoxib can cause MI. Celecoxib can cause a stroke. Celecoxib can cause an elevation in blood glucose level.

Celecoxib can cause thrombosis. Celecoxib can cause MI. Celecoxib can cause a stroke.

The client is suffering from a migraine headache. The nurse is to administer Sumatriptan 3 mg SQ. The medication comes in prefilled syringes of 6 mg. What should the nurse do with the remaining medication after administering the dose? Save the remaining 3 mg in the syringe for the client's next dose. Discard the medication and syringe. Give the other 3 mg to another client who has been ordered the same drug. Give all of it to the client so as not to waste the drug.

Discard the medication and syringe.

A client has been prescribed naproxen for relief from migraines. The nurse should recognize that the drug achieves a therapeutic effect through which means? Demyelinating pain fibers in the CNS Selectively antagonizing opioid receptors in the CNS Inhibiting the synthesis of COX-1 and COX-2 Slowing the reuptake of serotonin and acetylcholine in brain synapses TAKE ANOTHER QUIZ

Inhibiting the synthesis of COX-1 and COX-2

The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout? Follow a low purine diet For an acute gouty flare up take double the dose and then another dose in 1 hour Alcohol can be used in moderation only Severe diarrhea is an expected response

Follow a low purine diet

The nurse educates the client with joint pain about additional comfort measures. Which may provide comfort? Select all that apply. Heat Cold Joint rest Joint overuse Splints

Heat Cold Joint rest Splints

What information should be provided to a client diagnosed with an acetylsalicylic acid allergy? Nonsteroidal anti-inflammatory drugs (NSAIDs) should always be taken with food. It is safe to use only buffered forms of acetylsalicylic acid. Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be taken for only short periods of time.

Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.

A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication? Vital signs Pain scale Glasgow coma scale Subjective assessment

Pain scale

The nurse instructs the client that with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) some adverse reactions can occur. Which are they? Select all that apply. Somnolence Ecchymosis Dysmenorrhea Hematuria Purpura

Somnolence Ecchymosis Hematuria Purpura

The client on an NSAID reports to the nurse that her skin is reddened, blistered, and peeling. The nurse suspects which of the following? Purpura Ecchymosis Dysuria Stevens-Johnson syndrome

Stevens-Johnson syndrome

The nurse is providing education to a client who has been prescribed sumatriptan. In order to maximize therapeutic benefit while reducing the risk of adverse effects, the nurse should encourage the client to implement which intervention? Take the medication before breakfast each day. Take the medication on days when migraines may be anticipated. Take the medication as soon as the earliest symptoms of migraine are sensed. Take the medication when the pain of a migraine becomes too much to bear.

Take the medication as soon as the earliest symptoms of migraine are sensed.

Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention? Take the pills with meals to minimize stomach upset. Crush the pills and mix with applesauce to reduce gastritis. Report any new onset of constipation promptly. Arrange for monthly blood work.

Take the pills with meals to minimize stomach upset.

A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client's history should prompt the nurse to discourage the client from taking the drug? The client has not adhered to previous treatment regimens. The client has a chronic venous ulcer on the lower leg. The client has a diagnosis of liver cirrhosis. The client is a smoker.

The client has a diagnosis of liver cirrhosis.

What client should not receive a nonsteroidal anti-inflammatory medication as ordered for migraine relief? The client with a gastric ulcer The client who drinks 10 cups of coffee a day The client who has arthritis The client who takes one aspirin per day for the prevention of heart disease

The client with a gastric ulcer

A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the client is experiencing adverse effects of long-term therapy? There is an increase in the client's neutrophils but no increase in temperature. The client's stool tests positive for occult blood. The client complains of itchy, dry skin. The client has peripheral edema, and there is a steady increase in the client's weight.

The client's stool tests positive for occult blood.

What statement is correct concerning the use of sumatriptan (Imitrex) for migraine headache relief? An anti-nausea medication should be taken first. An antiemetic should be taken with the medication. Dark glasses should be worn to prevent photophobia. The medication causes vasoconstriction.

The medication causes vasoconstriction.

The nurse is to give ibuprofen to a client with moderate pain. The pharmacy only stocks the drug under its trade name. Which should the nurse administer to the client? Tylenol Advil Aspirin Bufferin

advil

You are speaking with a 28-year-old male who sustained a musculoskeletal injury while playing baseball. He tells you that he has taken an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). Which of the following actions, in addition to taking an NSAID, would you recommend that he take? Practice relaxation techniques Apply cold therapy Practice passive range of motion exercises Apply moist heat

apply cold therapy

When the nurse teaches a client who has just been diagnosed with migraine headaches and placed on a selective serotonin agonist, an important part of the teaching plan should include that these drugs: help with the pain and also will prevent future migraine headaches. are used to treat actual migraine headaches but will not prevent or reduce the number of headaches. will reduce the number of migraines in the future. should be taken 1 hour after the headache starts.

are used to treat actual migraine headaches but will not prevent or reduce the number of headaches.

Prior to administering NSAIDs, the nurse asks the client about an allergy to: acetaminophen. aspirin. antibiotics. analgesics.

aspirin

A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated? Celecoxib Ibuprofen Naproxen Diclofenac

celecoxib

Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)? celecoxib ibuprofen naproxen meloxicam

celecoxib

A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief? cyclooxygenase-1 cyclooxygenase-2 cyclooxygenase-3 cyclooxygenase-4

cyclooxygenase-2

A client is ordered to receive an nonsteroidal anti-inflammatory drug (NSAID) for pain. The client states that NSAIDs are taken only to decrease inflammation. The nurse instructs the client that these medications are also used for which? decrease blood pressure. decrease body temperature. increase appetite. increase platelet production.

decrease body temperature.

The nurse assesses the client taking a nonsteroidal anti-inflammatory drug (NSAID) for: confusion. urinary retention. dyspepsia. increased appetite.

dyspepsia

A client experiencing arthritic pain and who is taking a nonsteroidal anti-inflammatory drug (NSAID) would be most likely to have which nursing diagnoses? Select all that apply. acute pain related to incision impaired physical mobility related to muscle stiffness impaired skin integrity related to poor circulation ineffective family coping related to change in daily activities risk of falls due to impaired physical movement

impaired physical mobility related to muscle stiffness ineffective family coping related to change in daily activities risk of falls due to impaired physical movement

When NSAIDs are combined with lithium, there is a potential for: decreased antihypertensive effect. increased diuretic effect. lithium toxicity. anaphylactoid reactions.

lithium toxicity.

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route? Oral Subcutaneous Transdermal patch Sublingual

oral

The nursing instructor teaches the students that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking COX-1 and COX-2. The teacher further instructs that by blocking COX-2, which effects will be achieved? Adverse reactions Pain relief Maintenance of the lining of the stomach Increased inflammation

pain relief

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? anemia. peptic ulcer disease or gastritis. interstitial nephritis. constipation.

peptic ulcer disease or gastritis.

A nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved? stomach lungs liver peripheral nerves

stomach

COX-1 inhibitor has known protective effects on what organ? Select all that apply. stomach kidneys heart liver ovaries

stomach kidneys

A boy 5 years of age states his leg hurts. Which pain scale would be most appropriate for this client to use? Wong-Baker Visual analog Simple descriptive 0 to 10 numeric

wong baker