Chapter 16 PrepU 1, Pharm ch16 2, Chapter 16: 3
A patient with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this patient?
"The drug has no effect on inflammation." Explanation: The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.
A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug?
Acetaminophen
While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as:
An attempt by the body to remove the damaging agent and repair the damaged tissue. Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Local manifestations are redness, heat, edema, and pain. Inflammation may be a component of virtually any illness. Inflammation can be a result of an infection, which may require antibiotic therapy.
A nurse is assessing a patient who has been taking nonsteroidal anti-inflammatory drugs (NSAID). What statement by the patient indicates to the nurse that the patient has a good understanding of the use of this therapy? A) "I drink a glass of wine just about every night." B) "I asked my doctor to check for blood in my stool regularly." C) "I do not like to swallow tablets so I crush them." D) "I drink as little water as possible when I take my medication."
B
A nurse is presenting an educational event for a group of new parents. One topic that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do? A) "Do not give acetaminophen (Tylenol) unless you receive a doctor's order." B) "Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients." C) "Monitor their child's temperature carefully and regulate the Tylenol dose based on the fever." D) "Mix OTC children's medications to get the best coverage for their child's symptoms."
B
A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility
A patient arrives at the emergency department brought by his or her friends. The friends tell the nurse that the patient has taken a whole bottle of aspirin. Blood work for salicylate toxicity is run. What does the nurse expect the results to be? A) >5 g B) >10 g C) >15 g D) >20 g
D
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.
False
African Americans are at lower risk for developing GI adverse effects with NSAIDs.
False Explanation: African Americans have an increased risk of developing GI adverse effects with any anti-inflammatory agent.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?
Gold salts
The client reports severe pain from an acute lumbar spasm. The nurse would anticipate which drug to be ordered for this client?
Ketorolac (Toradol)
A nurse suspects that a client is experiencing salicylism. What would the nurse assess?
Ringing in the ears Explanation: Salicylism can occur with high levels of aspirin and be manifested by ringing in the ears, dizziness, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude. Excitement, tachypnea, and convulsions suggest acute salicylate toxicity.
The most common side effects caused by NSAIDs involve the:
Stomach. Explanation: The most common side effects caused by the NSAIDs involve the GI tract, including the stomach.
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.
NSAIDs have anti-inflammatory, antipyretic, and analgesic properties.
True Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) drugs block prostaglandin synthesis and act as antiinflammatory, antipyretic, and analgesic agents.
The nurse is checking the orders for pain management for a client that had coronary surgery 24 hours ago. The nurse identifies that the client has been receiving Celebrex and a narcotic postoperatively for pain management. What is the most appropriate response of the nurse?
Withhold the Celebrex and notify the physician.
A nurse will instruct a patient taking allopurinol to take each dose
after a meal.
A 60-year-old man has told the nurse that he has been treating his joint pain with regular doses of ibuprofen. In order to ascertain the man's risks of experiencing adverse effects, the nurse should assess the patient's
alcohol intake.
A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:
allergy to sulfonamides.
A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?
arthritis
A nurse is preparing to teach a client about the adverse effects of prescribed 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
A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which?
liver damage.
The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?
Aspirin
Which NSAID should the nurse know are not used to treat osteoarthritis or rheumatoid arthritis? (Select all that apply.)
-Ketorolac (Toradol) -Mefenamic (Ponstel)
How should the nurse counsel a client concerning a new prescription for celecoxib and its affect on long-standing low-dose acetylsalicylic acid therapy?
"Continue both therapies as prescribed."
A 16-year-old female 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 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."
Which statement by the client identifies that the use of celecoxib is effective?
"My hip pain has decreased." Explanation: Celecoxib is used in the treatment of acute pain, not for gastrointestinal burning. If the client's pain is reduced, treatment has been effective. The goal of treatment is to help get the pain to a manageable level. Celecoxib is not used to reduce a fever.
A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client?
"The drug has no effect on inflammation."
A female client asks why she must consult with the health care provider 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."
A nursing student correctly identifies what as the recommended dose of aspirin for the adult patient?
325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult patient receiving aspirin orally is 325 to 650 mg every 4 hours. The other options would not be recommended and would be medication errors if given.
Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose?
81-325 mg
A patient has been diagnosed with severe rheumatoid arthritis and hylan G-F 20 has been ordered. How is this drug given? A) Injected into the joint B) Orally C) IM D) Sub Q
A
A patient, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. What salicylates does the nurse anticipate will be ordered for this patient? A) Balsalazide (Colazal) B) Sodium thiosalicylate (generic) C) Choline magnesium trisalicylate (Tricosal) D) Salsalate (Argesic)
A
The nurse is preparing to administer a nonsteroidal anti-inflammatory drug (NSAID) to an older patient. What NSAID is associated with increased toxicity and should be avoided if possible? A) Naproxen (Aleve) B) Ibuprofen (Motrin) C) Indomethacin (Indocin) D) Etodolac (Lodine)
A
The patient has been diagnosed with rheumatoid arthritis. She also reports pain in various muscle groups secondary to a diagnosis of fibromyalgia and dysmenorrhea with painful cramping during menses. What drug would be most effective in treating all three of this patient's problems? A) Naproxen (Naprosyn) B) Acetaminophen (Tylenol) C) Etanercept (Enbrel) D) Sodium hyaluronate (Hyalgan)
A
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
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.
What effects are exerted by aspirin? (Select all that apply.)
Analgesic Antipyretic Anti-inflammatory
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
The nurse teaches the client to do which of the following prior to surgery?
Avoid salicylates for at least one week.
The pediatric patient has a fever and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this patient? A) Balsalazide (Colazal) B) Naproxen (Naprosyn) C) Indomethacin (Indocin) D) Aspirin
B
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.
The nurse is teaching the patient, who has been newly prescribed etanercept (Enbrel), how to administer the medication. What statement is accurate? A) "Be sure to drink a whole glass of water when swallowing the pill." B) "Do not take this medication for at least 1 hour after taking an antacid." C) "You can use each of the subcutaneous injection sites to avoid tissue damage." D) "Inject this medication deeply into the muscle to promote absorption."
C
A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving?
Gold salts
A 78-year-old male client calls the clinic and reports severe pain and swelling in his right great toe. The client states that the pain is worse at night and has been present for at least 2 weeks. The nurse understands that this client has what type of inflammatory disorder?
Gout
The client has been taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolac has been added to the treatment regimen. The nurse evaluates the client for which potential interaction?
Hypertension Explanation: When combined with NSAIDs, antihypertensive medications are less effective. The client's blood pressure must be assessed to identify any increase. Antihypertensives do not affect the effectiveness of NSAIDs.
A patient who is on long-term acetaminophen therapy has been taking etodolac for joint pain. Which effect is likely to occur due to an interaction between the two drugs?
Increased risk of renal impairment
The client is diagnosed with rheumatoid arthritis of the hands and elbows. The nurse recognizes that which nonsteroidal anti-inflammatory drug (NSAID) is not used in the treatment of rheumatoid arthritis?
Ketorolac
What information should be provided to a client diagnosed with an acetylsalicylic acid allergy?
Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.
An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?
Nonsalicylates
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
Which diffuse connective tissue disease 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 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?
Tarry stool
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
A nurse is presenting an educational event for a group of new parents. One factor that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do?
To check the label of OTC medications carefully to watch for inclusions of acetaminophen
The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?
To inhibit platelet aggregation
A nurse is assessing a client's pain. Which situations would the nurse identify as most likely suggestive of chronic pain? Select all that apply.
fibromyalgia rheumatoid arthritis osteoarthritis
When teaching a client about common adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs), the nurse should include information on what condition?
heartburn
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)
-Anti-inflammatory -Analgesic -Antipyretic
The nursing student demonstrates understanding when choosing what as the effect of a salicylate? (Select all that apply.)
-analgesic effect -antipyretic effect -anti-inflammatory effect
The nurse is caring for a patient who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What lab results will the nurse find most significant in assessing this patient? A) Complete blood count B) White blood cell differential C) Arterial blood gas D) Cholesterol and triglyceride profile
A
The nurse is discussing ethnic differences in response to medication with your nursing students. What group of people would the nurse tell the students may have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs? A) African Americans B) White Americans C) Hispanics D) Asians
A
The nurse teaches a patient with rheumatic disease who is being prescribed salicylate therapy to monitor himself or herself for what? A) Tinnitus B) Visual changes C) Stomatitis D) Hirsutism
A
The nursing instructor is discussing COX-2 inhibitors with her nursing students. Where would the instructor tell her students that COX-2 inhibitors work? A) At sites of trauma and injury B) Wherever prostaglandins are present C) At the sites of blood clotting D) In the kidney
A
What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals? A) Gold salts B) COX-2 inhibitors C) Propionic acids D) Fenamates
A
When caring for a patient diagnosed with rheumatoid arthritis, the patient tells the nurse that he or she has had insufficient response to nonsteroidal anti-inflammatory drugs (NSAIDs) and his or her condition continues to worsen. What drug does the nurse anticipate will be ordered next for this patient? A) Auranofin (Ridaura) B) Ibuprofen (Motrin) C) Acetaminophen (Tylenol) D) Ketorolac (Toradol)
A
The nurse assesses laboratory results related to blood clotting when the assigned patient takes what drug regularly? (Select all that apply.) A) Salicylates B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Gold compounds D) Acetaminophen E) Disease-modifying antirheumatic drugs (DMARDs)
A,B
A patient with rheumatoid arthritis is taking gold salts. What drugs should the nurse teach this patient that are contraindicated when taking gold salts? (Select all that apply.) A) Antimalarials B) Cytotoxic drugs C) Salicylates D) Penicillamine E) Anticoagulants
A,B,D
The clinic nurse is caring for a patient who is taking a COX-2 inhibitor and knows that this patient needs to be assessed for what? (Select all that apply.) A) Bleeding time B) Liver function C) Altered hearing D) Gastrointestinal (GI) effects E) Water retention
A,D,E
Which agent would be least appropriate to administer to a client with joint inflammation and pain?
Acetaminophen Explanation: Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.
A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?
Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.
Which drugs DO NOT cause inhibition of platelet aggregation, interference with blood coagulation, or increase the risk of bleeding?
Acetaminophen and the COX-2 inhibitors
Which is the antidote for acetaminophen (Tylenol) poisoning?
Acetylcysteine (Mucomyst) Explanation: A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.
A child has symptoms of the flu with fever. Which medication should not be administered to the child because of the risk of Reye syndrome?
Acetylsalicylic acid (aspirin) Explanation: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye syndrome. Acetaminophen (Tylenol) is safe to administer for fever reduction and pain relief in children and adolescents. Ibuprofen (Motrin) is safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children, but is not used to reduce fever or pain.
A patient is taking a nonsteroidal anti-inflammatory agent. Which instruction should the patient be given in regards to administration?
Administer the medication with food. Explanation: To prevent gastrointestinal irritation, instruct the patient to administer the medication with food. The administration of an NSAID with orange juice will increase gastric acid and not protect the gastric mucosa. Crushing enteric-coated tablets will eliminate the protection of the gastric mucosa. Nonsteroidal anti-inflammatory agents administered every other day will not protect the patient from gastric irritation.
A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the patient's knowledge of which area?
Adverse effects of nonsteroidal anti-inflammatory drugs
A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:
Allergy to sulfonamides. Explanation: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.
What effects are exerted by aspirin? (Select all that apply.)
Analgesic Antipyretic Anti-inflammatory Explanation: Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.
A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?
Blocks interleukin-1 Explanation: Anakinra blocks the increased interleukin-1 responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating tumor necrosis factor released by active leukocytes in autoimmune inflammatory disease to prevent damage caused by tumor necrosis factor. Leflunomide directly inhibits an enzyme, dihydroorotate dehydrogenase (DHODH), that is active in the autoimmune process. Penicillamine lowers immunoglobulin M rheumatoid factor levels.
A mother asks the nurse how acetaminophen works. What statement best describes the therapeutic action of acetaminophen? A) Acetaminophen (Tylenol) works by blocking the increase of interleukin-1. B) Acetaminophen reacts with free-floating tumor necrosis (TNF) factor released by active leukocytes. C) Acetaminophen acts directly on the hypothalamus to cause vasodilation and sweating. D) Acetaminophen is taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal enzymes.
C
A mother brings her 3-year-old child to the emergency department telling the nurse the child has eaten a bottle of baby aspirin. The mother cannot tell the nurse how many tablets were in the bottle. What dose of salicylate would be toxic in a child? A) 2 g B) 3 g C) 4 g D) 5 g
C
A mother has brought her 6-year-old child to the clinic. The child has a fever of 102.8ºF and is diagnosed with the flu. What medication will the nurse suggest for this child? A) Etanercept (Enbrel) B) Penicillamine (Depen) C) Acetaminophen (Tylenol) D) Aspirin (Bayer)
C
A nurse is caring for a patient with severe rheumatoid arthritis who takes anti-inflammatory agents on a regular basis. What medication should the nurse question if ordered by the physician to be taken in addition to the anti-inflammatory agent? A) Oral antidiabetic agent B) Calcium channel blocker C) Beta-blocker D) Antibiotic
C
A patient presents at the emergency department complaining of dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is wrong with the patient? A) Anakinra toxicity B) Ibuprofen toxicity C) Salicylism D) Acetaminophen toxicity
C
The nurse is caring for a 66-pound child with orders for choline magnesium trisalicylate (Tricosal). The orders read 50 mg/kg/d PO in two divided doses. How many milligram will the patient receive per dose? A) 250 mg B) 500 mg C) 750 mg D) 1,000 mg
C
Which of these anti-inflammatory drugs have geriatric warnings? (Select all that apply.) A) Sulindac (Clinoril) B) Indomethacin (Indocin) C) Ketorolac (Toradol) D) Naproxen (Naprosyn) E) Ketoprofen (Orudis)
C,D,E
A patient with muscle ache would like to use an over-the-counter NSAID. The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?
It causes decreased effectiveness of the antihypertensive drug. Explanation: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drug, or decreased metabolism of NSAID.
A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in:
Liver damage. Explanation: A patient taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?
Oral Explanation: Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is not given via the subcutaneous, intramuscular, or intravenous routes.
A 70-year-old woman who is on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. 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:
Peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in patients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in patients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.
A client is ordered to receive an NSAID for pain. The client states that NSAIDs are taken to decrease inflammation. The nurse identifies that these medications are also used to:
Decrease body temperature. Explanation: NSAIDs are used to treat pain and inflammation but may also be prescribed to reduce body temperature. They are not used to treat appetite, blood pressure, or decreased platelets.
A nurse is caring for a 10-year-old boy who reports chronic headaches. His mother reports that she gives him Tylenol at least three times a day. What will the nurse work with the physician to evaluate?
Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
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." Explanation: Do not exceed recommended doses of acetaminophen due to risk of life-threatening liver damage. People with liver disorders such as hepatitis or those who ingest alcoholic beverages frequently should use it with extreme caution.
A patient taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse?
"Do not take any more of the medication and come into the clinic immediately to see the physician." Explanation: Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.
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:
"These drugs are relatively safe since they don't have adverse effects." Explanation: All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.
A male client is taking aspirin 81 mg by mouth each day for prevention of recurrent myocardial infarction. He makes a dentist appointment for a tooth extraction. He calls the physician's office and asks the nurse if he is at risk for bleeding. Which response is correct?
"Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new physician's orders." Explanation: If a client has a history of taking aspirin, including the low doses prescribed for antithrombotic effects, there is a risk of bleeding from common therapeutic procedures (e.g., intramuscular injections, venipuncture, insertion of urinary catheters or GI tubes) or diagnostic procedures (e.g., drawing blood, angiography).
Which client 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 Explanation: Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.
A male 16 years of age presents to the physician's office with nausea, vomiting and pain in the right upper quadrant. He states he has had flu-like symptoms for four to five days. What is the most appropriate action of the nurse?
Ask for a medication history. Explanation: The client is stating he has been ill for four to five days, so it is important that the nurse identify all medications he has taken. Many medications contain acetaminophen and adolescents may not realize that they are exceeding the recommended daily dosages. It is important to initally take a thorough history of symptoms and treatments. Alcohol ingestion and exposure to infections may be assessed later.
A hypersensitivity to which medication is a contraindication for all NSAIDs?
Aspirin Explanation: A hypersensitivity to aspirin is a contraindication for all NSAIDs.
A nurse has admitted a 10-year-old child to the short-stay unit. The child has complained of chronic headaches and his or her mother reports that he or she gives him or her acetaminophen (Tylenol) at least twice a day. What will the nurse evaluate? A) Renal function B) Hepatic function C) Respiratory function D) Cardiac function
B
A nurse is caring for a patient in the early stage of rheumatoid arthritis. The nurse would expect what medication classification to be used in the treatment of this patient? A) Antimalarial agents B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Xanthine oxidase inhibitors D) Uricosuric agents
B
What medication used to treat rheumatic arthritis not only has anti-inflammatory effects but is also used in premature infants to close a patent ductus arteriosus? A) Penicillamine B) Indomethacin C) Antimalarials D) Prednisone
B
When nonsteroidal anti-inflammatory drugs (NSAIDs) are combined with loop diuretics, there is a potential for what? A) Decreased antihypertensive effect B) Decreased diuretic effect C) Lithium toxicity D) Anaphylactoid reactions
B
When the nurse learns that the patient with rheumatic arthritis is complaining of stomatitis, the nurse should further assess the patient for the adverse effects of what medication? A) Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy
B
Why do COX-2 inhibitors increase the risk for cardiovascular problems? (Select all that apply.) A) Vasoconstriction is blocked. B) Vasodilation is blocked. C) Platelet clumping is blocked. D) Water and sodium balance is altered. E) Gastrointestinal (GI) integrity is altered.
B,C
A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility Explanation: The nurse should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.
A student nurse asks the nurse why acetaminophen and NSAIDs help to reduce cancer pain. What is the nurse's best explanation?
Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Explanation: Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment (chemotherapy, surgery, or radiation). As with acute pain, acetaminophen, aspirin, or other NSAIDs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. NSAIDs are especially effective for pain associated with bone metastases.
The client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be most appropriate for the client to take?
Celecoxib Explanation: Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
The use of which NSAID is contraindicated in patients with a sulfonamide allergy?
Celecoxib (Celebrex)
Which of the following NSAIDs is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke?
Celecoxib (Celebrex) Explanation: Celecoxib (Celebrex) is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however all NSAIDs may carry a similar risk.
Blocking of what is responsible for the pain-relieving effects of NSAIDs?
Cyclooxygenase-2 Explanation: Blocking cyclooxygenase-2 is responsible for the pain-relieving effects of NSAIDs.
A salicylate has been prescribed for a 15-year-old patient who has been diagnosed with arthritis. The mother is concerned about giving her child a salicylate. What salicylates could the nurse tell this mother are recommended for use in children? A) Salsalate (Argesic) B) Olsalazine (Dipentum) C) Sodium thiosalicylate (generic) D) Choline magnesium trisalicylate (Tricosal)
D
Antipyretic drugs (e.g., aspirin, ibuprofen, acetaminophen) often are used to alleviate the discomforts of fever and to protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the use of aspirin in children is limited due to the possibility of what disease? A) Munchausen's syndrome B) Guillain-Barré syndrome C) Angelman's syndrome D) Reye's syndrome
D
The nurse is caring for a patient who receives anakinra (Kineret) for arthritis. By what route will the nurse administer this medication? A) Into the affected joint directly B) Oral C) Intramuscular D) Subcutaneous
D
What is chrysotherapy? A) Treatment with antimalarials B) Treatment with salicylates C) Treatment with disease-modifying antirheumatic drugs (DMARDs) D) Treatment with gold salts
D
A client on NSAIDs is experiencing congestive heart failure. The health care provider has decided to add a diuretic to the treatment plan. The nurse evaluates the client for:
Decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.
An 80-year-old male client presents to the physician's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The physician orders a stool test for guaiac, which yields positive results. The physician discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs?
GI bleed Explanation: Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.
A 21-year-old female is admitted after taking 25 aspirin tablets in an attempt to take her life. She is admitted with tinnitus, nausea, and vomiting. The physician diagnoses Kelly with salicylate poisoning. What can be used as a treatment for salicylate poisoning due to an overdose of aspirin? (Select all that apply.)
Gastric emptying Administration of activated charcoal Life support, if indicated Explanation: Salicylate poisoning is a life-threatening event. Treatment of salicylate poisoning includes gastric emptying, either with syrup of ipecac or gastric lavage; administration of activated charcoal; and life support, if indicated. There is no antidote for salicylate poisoning.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?
Gold salts Explanation: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.
A salicylate is contraindicated in clients who have had surgery within the past week for which reason?
Increased risk for bleeding Explanation: Salicylates are contraindicated for clients who have had surgery within the past week because of the increased risk for bleeding. Their use in clients with an allergy to salicylates or tartrazine would increase the risk for an allergic reaction. Their use in clients with impaired renal function may increase the risk for toxicity because the drug is excreted in the urine. There is no associated risk for fluid imbalance and salicylate therapy.
Which are important points for the nurse to cover with the client during discharge counseling for salicylate analgesics? (Select all that apply.)
Inform all health care providers of salicylate use. Discard salicylates if they smell like vinegar. Take salicylates with food. Keep salicylate container closed tightly. Explanation: The nurse should include the following in discharge counseling for clients receiving salicylates: take drug as prescribed, take drug with food or milk and a full glass of water, inform all health care providers (including dentists) of salicylate use, discard salicylates that smell like vinegar, and store in tightly closed container away from air, moisture, and heat.
The nurse is aware that aspirin not only lowers the patient's fever but can also reduce pain the patient is experiencing by:
Inhibiting the production of prostaglandins. Explanation: Salicylates inhibit production of prostaglandins, making pain receptors less likely to send the pain message to the brain. This reduction also is thought to account for the anti-inflammatory effect. Aspirin does also prolong the bleeding time by inhibiting the aggregation of platelets. This, however, does not have anything to do with decreasing pain in the patient.
The nurse explains to the client that NSAIDs act by which actions?
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
A patient with chickenpox and visiting the pediatrician's office should not be prescribed aspirin because of which known complications?
Reye syndrome
An 11-year-old client is going to have a cavity filled in the left mandibular first molar. The physician has prescribed aspirin for pain relief after the procedure. The nurse finds out that the child is suffering from a flulike illness. The nurse contacts the physician about the prescribed medication for pain. What is the risk if aspirin is administered to Diane?
Reye syndrome Explanation: Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.
A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?
Salicylate intoxication Explanation: Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.
A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:
Salicylate intoxication. Explanation: Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
A black client is receiving a high dose of NSAID for pain relief. Which would be most important for the nurse to include in the teaching plan?
Signs and symptoms of gastrointestinal bleeding Explanation: Although adequate hydration is important to promote renal function and drug excretion, it would be more important to instruct the client in the signs and symptoms of GI bleeding. Blacks have a documented decreased sensitivity to the pain-relieving effects of many anti-inflammatory agents and have an increased risk of developing GI adverse effects to these drugs. Increased dosages may be needed to achieve pain relief, but the increased dosage increases the client's risk for developing adverse GI effects. The drug should not be combined with an OTC salicylate, as this would further increase the client's risk for adverse GI effects. The client should be instructed to use nonpharmacologic measures to relieve pain, such as warm soaks and positioning.
A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client. What would be the best explanation?
The aspirin is being prescribed because it reduces your risk of a second heart attack. Explanation: Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for patients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.
A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that:
The client should not take aspirin or non-aspirin NSAIDs. Explanation: In people who have demonstrated hypersensitivity to aspirin, all non-aspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
An older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin two to three times each day. What aspect of this patient's medical history may contraindicate the use of aspirin?
The patient has a history of peptic ulcer disease. Explanation: Due to the risk of bleeding, aspirin is contraindicated in patients with peptic ulcer disease or bleeding disorders. SSRIs, previous surgery, and type 2 diabetes do not preclude the use of aspirin.
The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?
To inhibit platelet aggregation Explanation: Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage. If the client is having elevated temperatures daily, the cause would need to be investigated.
What would the nurse identify as the primary purpose of administering penicillamine (Cuprimine)?
To treat early, mild, and nonerosive rheumatoid arthritis Explanation: Penicillamine (Cuprimine) is used in treating patients with early, mild, and nonerosive rheumatoid arthritis.
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.
True Explanation: RF interacts with circulating IgG to form immune complexes, which tend to deposit in the synovial fluid of joints, as well as in the eye and other small vessels.
What is classified as a nonsalicylate analgesic?
Tylenol Explanation: Tylenol (acetaminophen) is classified as a nonsalicylate analgesic.
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.