P&P 1 chapters 33-34
A client is prescribed acetaminophen (Tylenol). For which therapeutic response should the nurse monitor?
Decrease in moderate pain Acetaminophen will decrease moderate pain. Acetaminophen does not decrease inflammation. Since acetaminophen is an antipyretic, the medication decreases body temperature. Acetaminophen does not affect platelet aggregation.
A client is prescribed aspirin (acetylsalicylic acid). Which therapeutic response should the nurse anticipate?
Decrease in body temperature A therapeutic response of aspirin is a lower body temperature. Aspirin does not decrease bacterial growth rate. Aspirin is indicated for the relief of mild to moderate inflammation, and it may increase the effect of anticoagulants.
A preschool age client is experiencing a high fever. Which type of immune response should the nurse recognize is characterized by fever?
Nonspecific defenses Fever, complement, phagocytes, and inflammation are all examples of process barriers in the nonspecific immune system. Inflammation is also a type of nonspecific immune response, but fever is not associated with inflammation. Humoral immunity is mediated by antibodies/immunoglobulins. Cell-mediated immunity contains the T cell line.
A client is experiencing a bleeding gastric ulcer. Which medication should the nurse question before administering? (Select all that apply.)
Oxaprozin (Daypro) Ibuprofen (Motrin) Diflunisal Etodolac Etodolac, diflunisal, ibuprofen, and oxaprozin are nonsteroidal anti-inflammatory drugs (NSAIDs) and will further increase the client's risk for GI ulcers. Misoprostol is a medication that may be prescribed to provide GI protection.
A client is prescribed an immunosuppressant. Which instruction should the nurse provide this client to reduce the risk of developing an opportunistic infection? (Select all that apply.)
Practice proper oral hygiene Wash hands frequently Avoid large crowds, especially indoors Avoid people with a known infection Clients who are taking immunosuppressants are at a higher risk of acquiring opportunistic infections. Actions to reduce the risk of an infection include frequent hand washing, practicing proper oral hygiene, avoiding others with a known infection, and avoiding large crowds indoors. Taking the medication at the same time will not reduce the risk of developing an infection.
A client is receiving interferon therapy. Which client statement should cause the nurse concern? (Select all that apply.)
"I've been feeling too sad to get out of bad." "I've been experiencing hallucinations." "Sometimes I feel like I should just end my life." Adverse effects to the neurologic system and mental status can occur in clients receiving interferon therapy. Psychoses, depression, and suicidal ideations are signs of adverse effects. Headaches, nausea, and diarrhea are not typical adverse effects in interferon therapy.
The nurse is teaching about nonsteroidal anti-inflammatory drugs (NSAIDs). Which statement should the nurse include?
"Most NSAIDs exhibit the same inhibitory actions." Most NSAIDs exhibit the same inhibitory actions, meaning they perform the same action in the body (inhibiting prostaglandins) whether the inflammation is caused by an injury, autoimmune disease, or allergy. Since NSAIDs perform the same action, they do not work differently in the body. NSAIDs, except for first-generation salicylates, increase cardiovascular risk. Corticosteroids are most effective at treating severe, disabling, painful inflammation.
A client's nonsteroidal anti-inflammatory medication is changed from diclofenac (Cataflam, Voltaren) to celecoxib (Celebrex). Which conclusion should the nurse draw?
. Gastrointestinal (GI) irritation may decrease. The risk for GI irritation, GI bleeding, and ulcer formation is lower with celecoxib than diclofenac because celecoxib inhibits cyclooxygenase-2 (COX-2) but does not inhibit cyclooxygenase-1 (COX-1). Cardiovascular events and renal failure are potential risks of both medications. Neither medication cures RA.
The nurse has administered a vaccine to a client. Which outcome should the nurse use to evaluate if the vaccine successfully produced immunity?
A positive titer A titer measures the amount of antibodies produced in response to a vaccine. A positive titer verifies the effectiveness of the vaccine and indicates that immunity has been achieved. A normal WBC and normal temperature indicate that the client is free from infection. An elevated platelet count indicates the presence of thrombocytosis.
A client takes acetaminophen (Tylenol) for arthritic pain. Which laboratory value should the nurse monitor for this client? (Select all that apply.)
Alanine aminotransferase (ALT) Hematocrit Aspartate aminotransferase (AST) Hemoglobin Ibuprofen may increase bleeding time as well as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. It may decrease hemoglobin and hematocrit. C-reactive protein measures the amount of inflammation. It is not affected by acetaminophen use.
A client is prescribed aspirin (acetylsalicylic acid). Which factor should the nurse recognize increases the risk of gastrointestinal (GI) bleeding with this medication? (Select all that apply.)
Alcohol use Smoking Helicobacter pylori infection Smoking, alcohol use, and Helicobacter pylori infection increase the risk for aspirin-induced GI bleeding. Age greater than 60, not 40, is a risk factor. The risk for GI bleeding is not increased when acetaminophen (Tylenol) is taken with aspirin (acetylsalicylic acid), because acetaminophen does not affect platelets.
The nurse is discussing the pathophysiology of inflammation. Which information should the nurse include?
Antigen exposure causes permeability of vessels and allows phagocytic cells to reach the antigen. When the body is exposed to a foreign substance (antigen), nearby blood vessels become permeable to allow phagocytic cells to reach and neutralize the antigen. The increased permeability of blood vessels causes increased tissue edema. There is a correlation between the amount of tissue damage from the antigen and the amount of inflammation: the greater the tissue damage, the greater the degree of inflammation. Massive release of chemical mediators throughout the entire body occurs with anaphylaxis, a life-threatening allergic response that can cause cardiovascular shock and death.
A client is receiving cyclosporine therapy. Which instruction should the nurse provide this client to prevent toxicity?
Avoid grapefruit and grapefruit juice Mixing grapefruit with cyclosporine can cause a significant increase in the drug levels and could result in toxicity. Clients can mix their medication with milk if desired. Returning for follow-up laboratory visits is important for neutropenia and leukopenia monitoring but not for toxicity. Taking the medication at the same time each day will not prevent toxicity.
A client has an elevated interleukin level. Which type of chemical mediator should the nurse recognize is elevated?
Cytokine Interleukins are an example of cytokines, which are chemical mediators produced by macrophages, leukocytes, and dendritic cells in order to regulate immune and inflammatory reactions. Leukotrienes, prostaglandins, and C-reactive proteins are other chemical mediators of inflammation but do not include interleukins.
The nurse is discussing recombinant technology vaccines. Which information should the nurse include?
Do not contain viral DNA so they cannot cause infection Recombinant technology produces vaccines that contain viral subunits or proteins created in a laboratory. The vaccines do not contain viral DNA, so the viruses cannot replicate or become infectious. Inactivated (killed) vaccines contain organisms killed by heat or chemicals. Attenuated (live) vaccines are created with organisms rendered less likely to cause disease. Toxoid vaccines are developed from bacterial toxins, not the bacteria itself.
The nurse is teaching a client who is prescribed pegIFN alfa-2b (Pegintron) about adverse effects to report to the healthcare provider. Which adverse effect should the nurse include? (Select all that apply.)
Fatigue Headache Injection site reactions Emotional lability The most frequently reported adverse effects with pegIFN alfa-2b are injection-site reactions, fatigue, headache, rigors, fever, nausea, myalgia, and emotional liability. Constipation is no a common adverse effect of this drug.
The parent of an infant asks how many doses are recommended in the initial series of the diphtheria, tetanus, and pertussis (DTaP) vaccines. Which response should the nurse provide?
Five Five doses during the first 6 years of a child's life are recommended as part of the initial series of the DTaP vaccine. The measles, mumps, rubella, hepatitis A, human papillomavirus, and varicella vaccines are given in two doses. The hepatitis B vaccination is given in three doses.
The nurse is teaching a client about herbal preparations to avoid when taking ibuprofen (Advil, Motrin). Which herb should the nurse include in the discussion? (Select all that apply.)
Garlic Feverfew Ginger Herbal medications such as feverfew, ginger, garlic, and ginkgo increase the risk of bleeding when combined with ibuprofen. Saint John's wort and echinacea do not react with ibuprofen.
The nurse is reviewing the report of a client's lymphatic tissue biopsies. In which body system should the nurse expect to see large concentrations of lymphoid tissue? (Select all that apply.)
Gastrointestinal Genitourinary Respiratory Large collections of lymphoid tissue are found in the gastrointestinal, genitourinary, and respiratory systems, which are portals of entry to the body. Lymphocytes patrol these regions to look for possible foreign pathogens or material. The cardiovascular and musculoskeletal systems do not contain large amounts of this type of tissue.
A client is prescribed aspirin (acetylsalicylic acid) for fever control. Which client risk factor should the nurse address before administering the medication?
Gastrointestinal (GI) bleeding A potential adverse effect of aspirin is GI bleeding, and this risk increases with higher doses. The risk versus benefit of the medication should be considered. Aspirin is often used as prophylaxis for clients at risk for stroke, MI, and arterial thromboembolism.
The nurse is starting a first nursing job. Which vaccine should the nurse expect to receive?
Hepatitis B The hepatitis B virus (HBV) is transmitted via blood and body fluids. Healthcare workers have a 10-fold increased risk of HBV. The HBV vaccine is therefore recommended for all healthcare workers. The meningococcal vaccine is recommended for children age 11 and 12 with a booster at age 16. The pneumococcal disease vaccine is recommended for people over the age of 65. The HPV vaccine is recommended for teens age 14 to 19.
A client's medication is switched from celecoxib (Celebrex) to ibuprofen (Advil, Motrin). Which change should the nurse expect? (Select all that apply.)
Increased platelet aggregation New onset gastrointestinal (GI) irritation Ibuprofen is a cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitor, but celecoxib only blocks COX-2. Unlike celecoxib (Celebrex), ibuprofen (Advil, Motrin) can cause platelet aggregation and GI irritation. Since both medications have analgesic, anti-inflammatory, and antipyretic effects, no change would be expected with respect to those outcomes.
A client is experiencing inflammation. Which statement should the nurse include when teaching the client about this health problem?
Inflammation is a natural process for ridding the body of antigens. Inflammation is a self-limiting, natural process for ridding the body of antigens. Inflammation is a symptom of an underlying disorder; it is not a disease. When applicable, topical medications should be used instead of oral medications because they have fewer adverse effects. Ice packs and rest are nonpharmacologic, useful treatments for inflammation.
The nurse notes a client is prescribed the hepatitis B (HBV) vaccine (Recombivax HB). For which health problem should the nurse realize this vaccination is indicated? (Select all that apply.)
Injectable drug use End-stage renal disease Healthcare employment High-risk sexual practices HBV is transmitted through blood and body fluid exposure. Clients who are healthcare workers, inject drugs, engage in high-risk sexual practices, or have end-stage renal diseases are at risk for blood exposure and contracting the virus. Gallbladder disease is not a risk factor for contracting HBV.
A client is taking aldesleukin (Proleukin). Which action should the nurse expect to occur?
Promotes proliferation of B and T cells, macrophages, and natural killer (NK) cells Interleukins such as aldesleukin initiate activation of interferons, tumor necrosis factor, and other interleukins to promote proliferation of B cells and T cells, macrophages, and NK cells. Interferons inhibit viral replication and increase phagocytic activity. Cyclosporines inhibit DNA synthesis, which causes DNA destruction and breakage of chromosomes.
A client is taking tacrolimus (Prograf) to prevent transplant rejection. For which reason should the nurse recognize this medication is the treatment choice?
Reduces the dose for corticosteroids Although newer medications have been developed, the calcineurin inhibitors remain the preferred drug for use in transplants because they allow for reduced dosage of corticosteroids, which results in a reduced incidence of post-transplant opportunistic infections. Calcineurin inhibitors do not particularly have fewer adverse effects. They promote both B cell and T cell proliferation, along with macrophages and natural killer cells.
An older client has been prescribed a nonsteroidal anti-inflammatory drug (NSAID) for acute shoulder pain. Which assessment should the nurse include before administering the medication? (Select all that apply.)
Renal function Cardiovascular risk Bleeding risk Hearing acuity Ibuprofen-like NSAIDs inhibit platelet aggregation and increase the risk for bleeding, nephrotoxicity, ototoxicity, and myocardial infarction. Cardiac enzymes do not specifically require measuring before starting NSAID therapy.
A client is prescribed interferon alfa-2b (Intron A). Which statement should the nurse use to explain the naming convention for this drug?
Represents specific interferon structures Biological response modifiers (natural cytokines) are represented by the alpha and beta lettering and numbering distinguishing interferon structures and their specific function in the immune system. They are not representations of the drug class or mechanism of action, nor are they chemical compound names.
A client has an allergy to salicylates. Which medication prescription should the nurse question? (Select all that apply.)
Salsalate (Mono-Gesic, Salsitab) Meloxicam (Mobic) Ketorolac (Sprix, Toradol) Choline magnesium trisalicylate (Trilisate) Clients with a hypersensitivity to aspirin (acetylsalicylic acid) will also likely be hypersensitive to other nonsteroidal anti-inflammatory drugs (NSAIDs). Meloxicam, ketorolac, salsalate, and choline magnesium trisalicylate are NSAIDs. Acetaminophen is not an NSAID and would be safe to prescribe.
The nurse is preparing a lecture on immunity for high school students. Which organ should the nurse describe as being part of the lymphatic system? (Select all that apply.)
Spleen Tonsils Thymus The tonsils, spleen, and thymus are the main organs in the lymphatic system. The jugular vein and abdominal aorta are structures within the arterial system.
The nurse prepares to administer pegIFN alfa-2a (Pegasys). Through which route of administration should the nurse give this medication?
Subcutaneous PegIFN alfa-2a (Pegasys) comes in single-use prefilled syringes to be administered subcutaneously. This medication is not given intradermally, intravenously, or intramuscularly.
A client is taking a nonsteroidal anti-inflammatory drug (NSAID) for osteoarthritis. Which instruction should the nurse provide?
"Take the medication with food or milk." NSAIDs should be taken with food or milk to prevent gastrointestinal (GI) upset. Taking ginkgo with an NSAID increases the risk for bleeding. Black stools indicate GI bleeding. Decreased urine output indicates possible nephrotoxicity.
The nurse teaches an infant's parents about vaccine recommendations. Which schedule should the nurse describe for the measles, mumps, and rubella (MMR) vaccine?
Two doses, one at 12 to 15 months and the other at 4 to 6 years of age. The recommended schedule for infants to receive the MMR vaccine is two subcutaneous doses, one at 12 to 15 months and the other at 4 to 6 years of age. The recommended schedule for the hepatitis B vaccine is three doses in a series, one each at 0, 1, and 6 to 18 months of age. The recommended schedule for the polio vaccine is four doses, one each at 2, 4, and 6 to 18 months, the last at 4 to 6 years of age. The schedule for the diphtheria, tetanus, and pertussis vaccine is five doses, one each at 2, 4, 6 and 15 to 18 months and the last at 4 to 6 years of age.
A client is prescribed an immunosuppressant drug. Which instruction should the nurse include to minimize adverse effects of this medication? (Select all that apply.)
Wash hands frequently Actions to take if dizziness occurs Report temperature over 101 degrees F Monitor blood pressure To minimize adverse effects, the client should be instructed on blood pressure measurement and when to report adverse effects to the healthcare provider. Monitoring temperature assesses for an infection, and dizziness is an adverse effect that could cause a fall. Washing hands frequently helps minimize the risk of infection. A fluid restriction is not required for this medication.
The nurse is caring for clients with inflammatory health problems. Which client statement should concern the nurse?
"I have been taking a corticosteroid for the past 3 months." Corticosteroids may have serious long-term adverse effects and are usually prescribed for only 1 to 3 weeks. The nurse should be concerned if a client has been taking a corticosteroid for the past 3 months. Ankylosing spondylitis and Hashimoto's thyroiditis are health problems that may benefit from anti-inflammatory medications. If a corticosteroid were prescribed to bring severe inflammation under control, a nonsteroidal anti-inflammatory medication such as ibuprofen (Motrin) may be prescribed after the corticosteroid is finished.
A client is prescribed acetaminophen (Tylenol) for a headache. Which client statement should indicate that teaching about this medication was effective?
"I should report any skin rash or itching." Acetaminophen may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash. Skin blistering should be immediately reported to the healthcare provider because Stevens-Johnson syndrome is a rare but serious adverse effect of the medication. Caffeine is not identified to be avoided when taking acetaminophen. The client should not take extra doses because risk of adverse effects due to acetaminophen poisoning is dose related; hepatic failure and death could occur.
A client is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for ophthalmic inflammation. Which client statement should indicate to the nurse that teaching was effective?
"My feet should not swell while taking the medication." Edema is not expected or a desired response of NSAID therapy. Edema and dark-colored urine indicates the NSAID is affecting the client's renal system. Vomiting and blurred vision are not expected responses of the medication; they are both adverse effects that should be reported to the healthcare provider.
A client is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for rheumatoid arthritis. For which client statement should the nurse provide follow-up teaching?
"Taking two NSAIDs together will provide greater pain relief." Taking two NSAIDs together should be avoided as this may cause serious adverse gastrointestinal (GI) effects. Since NSAIDs are pregnancy category C or D (depending on the trimester and specific NSAID) they are not safe for use during pregnancy. Certain medications (e.g., digoxin, lithium, beta blockers, anticoagulants) can interact with NSAIDs. Taking an NSAID with a corticosteroid may cause serious adverse GI effects.
The nurse is teaching about the immune system. Which statement should indicate that teaching was effective? (Select all that apply.)
"The cell-mediated immune response is mediated by T lymphocytes and includes the secretion of cytokines." "The humoral immune response is mediated by B lymphocytes and includes the secretion of antibodies." "Both the humoral and cell-mediated immune response utilize memory cells to prevent reinfection with the same pathogen." The humoral immune system is mediated by B lymphocytes and includes the secretion of antibodies. The cell-mediated immune response is mediated by T lymphocytes and involves the secretion of cytokines. Both the humoral and cell-mediated immune responses involve the use of memory cells to prevent reinfection with the same pathogen.
A client is diagnosed with severe salicylate poisoning. Which treatment prescription should the nurse expect?
N-acetylcysteine Urine alkalization is used for severe salicylate poisoning. Naloxone is the treatment for opioid overdose. Flumazenil is the treatment for benzodiazepine overdose. N-acetylcysteine is the treatment for acetaminophen overdose.
