PrepU Chapter 16

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

sardines.

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 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.

The nurse teaches a client with rheumatic disease who is being prescribed salicylate therapy to monitor for:

tinnitus.

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 female client reports a mild headache and is prescribed 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 health care provider ordered acetaminophen. Which explanation would the nurse give?

"Acetaminophen is often the initial drug of choice for relieving mild to moderate pain."

Which instruction would be most important to include when teaching parents about OTC anti-inflammatory agents?

"Be sure to read the label for the ingredients and dosage."

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 with chronic gout asks how he can reduce the uric levels in his body when he begins to self-administer colchicine. What would be the nurse's response?

"Drink 2 to 3 quarts of fluid daily; this will decrease uric acid levels and help prevent formation of uric acid kidney stones."

The client has been prescribed celecoxib for osteoarthritis. Which statement by the client indicates 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 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."

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."

The nurse has conducted a health education session for new parents. After learning about the safe and effective use of anti-inflammatories, which statement by the parents indicates effective teaching?

"We need to read the labels carefully for the ingredients and dosages."

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 health care provider'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 prescriber's orders."

The development of gout has four distinct phases. Place in order each phase of the development of gout.

1 Asymptomatic hyperuricemia 2 Acute gouty arthritis 3 Intercritical gout 4 Chronic advanced gout

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

A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?

Acetaminophen has no effect on inflammation.

A hospitalized client who is being treated for a urinary tract infection has developed a fever. The nurse has responded by administering a dose of acetaminophen. In what way does acetaminophen contribute to a reduction in fever?

Acetaminophen inhibits prostaglandin synthesis.

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

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 client's knowledge of which area?

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.

While you are speaking with a client diagnosed with gout, she states that she has no symptoms of the disease and asks you to explain why she was prescribed Allopurinol (Zyloprim). Your best response is:

Allopurinol is used to prevent or treat hyperuricemia, which occurs with gout.

What effects are exerted by aspirin?

Analgesic Antipyretic Anti-inflammatory

What effects are exerted by aspirin? (Select all that apply.)

Analgesic Antipyretic Anti-inflammatory

Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen?

Anti-inflammatory and antiplatelet effects

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 drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction?

Aspirin

A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

Better mobility

Aspirin (ASA) is an over-the-counter drug that is found in many other drugs. What is the mechanism of action for aspirin?

Blocking the transmission of pain impulses

Which of the following is a serious risk involved in the use of NSAIDs?

Cardiovascular thrombosis

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?

Celecoxib

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

Dietary habits

A nurse is caring for a patient who has been administered ibuprofen for fever reduction. Which should the nurse monitor the patient for?

Dyspepsia

An 80-year-old male client presents to the health care provider'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 provider orders a stool test for guaiac, which yields positive results. The provider 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

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 suspect the health care provider to evaluate in this client?

Hepatic function

A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?

Hepatotoxicity

Prior to administration of Celecoxib, what should the nurse assess for? (Select all that apply.)

History of myocardial infarction History of bleeding disorders History of renal disorders

An older adult male patient has begun treatment for gout after an extensive diagnostic workup. The nurse who is contributing to the patient's care should understand that gout is a result of what pathophysiological process?

Hyperuricemia causes crystals to precipitate in the synovial fluid.

Which key assessments about pain does a nurse needs to obtain from the client to insure the proper prescribing of analgesics for effective pain management? Select all that apply:

Location Intensity

A nurse suspects that a client is experiencing salicylism. What would the nurse assess for?

Mental confusion

What conditions are salicylates are effective in managing? (Select all that apply.)

Pain Fever Inflammation

A client who is taking salicylates comes to the emergency department for evaluation. What assessment findings should lead the nurse to suspect acute salicylate toxicity? Select all that apply.

Respiratory rate of 38 breaths per minute Muscle spasms Agitation

An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?

Reye syndrome

Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, often are used to alleviate the discomforts of fever and 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?

Reye syndrome

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

Terry, age 43, has been taking colchicine for the past few years. He also suffers from renal impairment. What should the nurse specifically monitor in Terry, considering his renal status?

Serum creatine kinase levels

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

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 and his wife. What would be the nurses best explanation?

The aspirin is being prescribed because it reduces your risk of a second heart attack.

The nurse would question the health care provider who prescribed NSAIDs for which client?

The client diagnosed with peptic ulcers

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

Aspirin has been prescribed for a 69-year-old client with a diagnosis of arthritis. The nurse monitors the client for which assessment finding that would indicate the presence of toxicity from this medication? (Select all that apply.)

Tinnitis Impaired hearing Tachycardia

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.

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 health care provider.

The client has a history of gastrointestinal bleeding. What would be the best response by the nurse when the health care provider prescribes Indocin as treatment for rheumatoid arthritis?

Withhold the medication and notify the provider.

A group of nursing students are reviewing information about how pain is classified. The group demonstrates understanding when they identify which type based on duration? Select all that apply.

acute chronic

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.

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.

A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?

arthritis

A nurse is reviewing the medical record of a client who is prescribed NSAID therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found?

aspirin

A nurse is reviewing a journal article about an NSAID that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug?

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-2

When NSAIDs are combined with lithium, there is a potential for:

lithium toxicity.

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.

A client is prescribed piroxicam for osteoarthritis. The nurse would assess the client for which adverse reaction?

nausea

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?

peptic ulcer disease or gastritis.