Unit 3: ATI Pain and Inflammation

A client is about to begin celecoxib therapy for osteoarthritis. You should instruct the client to watch for and report which of the following possible indications of a serious reaction to this drug. A. Black, tarry stool B. Polyuria C. Bone pain D. Dry mouth

A

A client is about to start taking tramadol to treat moderate pain. Which of the following instructions should you include when talking with the client about taking this drug? A. Allow 1 hr for it to take effect B. Take it on an empty stomach C. Chew the extended-release tablets D. Do not take it with grapefruit juice

A

As the health care provider prepares to give the client morphine IV for pain, she makes sure she has which of the following drugs available? A. Naloxone B. Protamine sulfate C. Flumazenil D. Physostigmine

A

A nurse is teaching a client who has a new prescription for allopurinol. Which of the following instructions should the nurse include? A. Avoid driving or activities that require mental alertness. B. Avoid crushing the tablets. C. Limit fluid intake during therapy. D. Limit potassium while taking allopurinol.

A Allopurinol can cause drowsiness. The nurse should instruct the client to avoid driving or activities that require mental alertness until they know the effect the drug will have on them.

A client is about; to start taking oral morphine to treat acute pain from an injury. Which of the following instructions should you include when talking with the client about taking morphine? (Select all that apply). A. Take it with food B. Rise slowly from sitting or reclining C. Take it on a fixed schedule D. Increase fluid and fiber intake E. Do not take it before driving

A, B, D and E

A client who is receiving chemotherapy takes allopurinol prior to the chemotherapy to reduce the risk for which condition? A. Agranulocytosis B. Hyperuricemia C. Aplastic anemia D. Thrombocytopenia

B

Butorphanol is an unsafe analgesic choice for clients who A. take glucocorticoids for rheumatoid arthritis B. use a fentanyl patch for chronic pain C. have type 1 diabetes mellitus and use an insulin pump D. take warfarin for thrombophlebitis

B

Which of the following instructions should the health care provider give the client regarding the use of aspirin prior to surgery? A. Continue to take it once a day B. Stop taking 1 week before surgery C. Increase the dose to twice a day D. Reduce the dose to every other day

B

A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should monitor the client for which of the following manifestations of hypersensitivity syndrome? A. Muscle pain B. Fever C. Anxiety D. Tremors

B Allopurinol, an antigout drug, can cause hypersensitivity syndrome. The nurse should monitor the client for rash, itching, or fever, as manifestations of hypersensitivity syndrome, which can lead to renal or liver dysfunction. Clients who develop this type of reaction should stop taking the drug.

Because a client is taking celecoxib (Celebrex) for osteoarthritis, he knows to watch for and report which of the following possible indications of an adverse reaction? A. Tinnitus B. Weight gain C. Anxiety D. Tremor

B Celecoxib can impair renal function, so it is essential for clients to watch for and report weight gain, edema, and reduced urine output. Also monitor client's BUN and creatine clearance periodically and track fluid intake and output. Can also cause drowsiness, headache, and insomnia.

A nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell the client to report which of the following adverse drug reactions? A. Tinnitus B. Chest pain C. Constipation D. Diaphoresis

B Celecoxib, a COX-2 inhibitor, can cause cardiovascular or cerebrovascular events. Clients should report chest pain, shortness of breath, headache, numbness, weakness, or confusion. Providers should prescribe the lowest effective dosage of the drug for the shortest time period possible.

A nurse is caring for a client who takes low-dose aspirin to prevent cardiovascular events. The client asks the nurse about taking ibuprofen to treat rheumatoid arthritis. Which of the following responses should the nurse make? A. "Ibuprofen will increase your risk for developing salicylism." B. "Ibuprofen will reduce the cardioprotective effects of low-dose aspirin." C. "Low-dose aspirin will reduce the anti-inflammatory effects of ibuprofen." D. "Low-dose aspirin will reduce the analgesic effects of ibuprofen."

B Ibuprofen, an NSAID, reduces the cardioprotective effects of low-dose aspirin. Clients taking low-dose aspirin for its ability to decrease platelet aggregation should not take ibuprofen.

A client arrives at the emergency room immediately following an acetaminophen overdose. Which drug should you prepare to administer? A. Atropine B. Naloxone C. Acetylcysteine D. Flumazenil

C

A nurse is caring for a client who has a new prescription for prednisone for long-term treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following adverse drug reactions? A. Pulmonary embolism B. Hepatitis C. Bone loss D. Breast cancer

C Prednisone, a glucocorticoid, can cause osteoporosis, especially with long-term use. Clients who are taking the drug should increase weight-bearing activity and report back pain. The nurse should monitor the client's bone density.

A client is about to start taking aspirin to prevent cardiovascular events. You should instruct the client to watch for and report which adverse drug reaction of aspirin? A. Dyspnea B. Constipation C. Calf pain D. Petechiae

D

The health care provider prepares to give the client morphine IV for pain. Knowing the adverse drug reactions of morphine, a nurse should monitor the client for which of the following? A. Jaundice B. Fever C. Hypertension D. Respiratory depression

D

A nurse is reviewing the medical record of a client who reports taking acetaminophen at home. The nurse should identify that which of the following client conditions is a contraindication for acetaminophen? A. Asthma B. Diabetes mellitus C. Heart failure D. Alcohol use disorder

D Acetaminophen can cause liver toxicity. Clients who have a history of alcohol use disorder should not take acetaminophen.

A nurse is caring for a child who has a viral infection. The nurse should identify which of the following drugs can increase the risk for Reye Syndrome in children who have viral infections. A. Butorphanol B. Acetaminophen C. Tramadol D. Aspirin

D Aspirin can increase the risk for Reye syndrome in children who have a viral infection, particularly chickenpox or influenza. Manifestations of Reye syndrome include lethargy and persistent vomiting.

A nurse is teaching a client who is taking allopurinol about minimizing adverse effects. Which of the following instructions should the nurse include? A. Eat a small meal before taking the drug. B. Suck on hard candy or chew gum. C. Take a stool softener daily. D. Avoid the use of NSAIDs.

A Taking allopurinol after eating a meal or drinking a glass of milk can prevent stomach upset.

A nurse is reviewing the medical record of a client who has a new prescription for tramadol. The nurse should identify that which of the following conditions is a contraindications for tramadol? A. Hyperthyroidism B. Seizure disorder C. Rheumatoid arthritis D. Urinary incontinence

B Tramadol, a nonopioid analgesic, can cause seizure activity. Clients who have seizure disorders, head injuries, or increased intracranial pressure should not take tramadol.

A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should monitor client for which of the following adverse drug reactions? (Select all the apply). A. Diarrhea B. Urinary retention C. Respiratory depression Sedation D. Orthostatic hypotension

B, C, D, and E Diarrhea is incorrect. Morphine causes constipation instead of diarrhea. Clients who are taking the drug should increase fluid and fiber intake to minimize constipation. Urinary retention is correct. Morphine can cause urinary retention. The nurse should monitor the client's fluid intake and output and assess for bladder distention. Respiratory depression is correct. Morphine can cause severe respiratory depression. The nurse should withhold the drug for a respiratory rate below 12/min. Sedation is correct. Morphine can cause sedation, dizziness, and lightheadedness. Clients who are taking the drug should avoid activities that require alertness. Orthostatic hypotension is correct. Morphine can cause hypotension and postural hypotension. Clients who are taking the drug should change positions gradually.

In addition to celecoxib, the client takes low-dose aspirin daily for which of the following purposes? A. Decreases the risk for anaphylaxis B. Potentiates the therapeutic effects of celecoxib C. Reduces the risk of a cardiovascular event D. Increases renal perfusion

C Celecoxib can cause cardiovascular and cerebrovascular events. Provides cardioprotective properties and reduces these risks.

A nurse is reviewing the medical record of a client who has a new prescription for celecoxib. The nurse should identify which of the following conditions is a contraindication to celecoxib. A. Rheumatoid arthritis B. Ankylosing spondylitis C. Sulfonamide allergy D. Adrenocortical insufficiency

C Clients who are allergic to sulfonamides can have severe allergic reactions to celecoxib, a COX-2 inhibitor. Clients who are allergic to salicylates can also react adversely to celecoxib.

A provider prescribes prednisone for a client with type 1 diabetes Mellitus—recognizing the risk for an adverse drug reaction to the prednisone, which of the following precautions should the primary care provider take for this client? A. Reduce the insulin dose B. Increase carbohydrate intake C. Reduce the prednisone dose D. Increase the serum glucose monitoring

D

A nurse is teaching a client who has a new prescription for allopurinol. The nurse should instruct the clients to report which of the following adverse drug reactions? (Select all that apply) A. Palpitations B. Sore throat C. Vertigo D. Bruising E. Vision changes

B, C, D, and E Palpitations is incorrect. Allopurinol, an antigout drug, is not known to cause palpitations. It can cause liver or kidney dysfunction, so clients should increase fluid intake and report any abdominal pain, jaundice, or reduced urine output. Sore throat is correct. Allopurinol, an antigout drug, can cause agranulocytosis. The nurse should monitor the client's WBC count, and instruct the client to report fever or sore throat. The nurse should also instruct the client to avoid crowds or exposure to people who might have communicable diseases. Vertigo is correct. Allopurinol, an antigout drug, can cause drowsiness and vertigo. The nurse should instruct the client to report these adverse effects and avoid activities that require mental alertness until they know how the drug will affect them. Bruising is correct. Allopurinol, an antigout drug, can cause thrombocytopenia. The nurse should monitor the client's platelet count and instruct the client to report any bleeding or bruising. Vision changes is correct. Allopurinol, an antigout drug, can cause cataracts with extended use. The nurse should instruct the client to report vision changes, such as cloudiness or halos around lights, and have eye examinations at recommended intervals.

A nurse is caring for a client who is about to begin taking aspirin. The nurse should instruct the client to report which of the following manifestations of salicylism? (Select all that apply). A. Fever B. Tinnitus C. Diaphoresis D. Thrombophlebitis E. Dizziness

A, B, C, and E Fever is correct. Late manifestations of acute aspirin poisoning, or salicylism, include fever. Tinnitus is correct. Tinnitus, or ringing or buzzing in the ears, can indicate salicylism. Clients should report this reaction and stop taking aspirin at least until tinnitus resolves. Diaphoresis is correct. Sweating and headache can indicate salicylism. Clients should report these effects and stop taking aspirin at least until the effects resolve. Thrombophlebitis is incorrect. Aspirin is unlikely to cause thrombophlebitis. However, nonaspirin NSAIDs can cause thromboembolic events. Clients should report chest pain, shortness of breath, or confusion, and watch for redness or swelling in the calf. Dizziness is correct. Dizziness can indicate salicylism. Clients should report this effect and stop taking aspirin at least until dizziness resolves.

A nurse is caring for a client who is taking naloxone to treat acute morphine toxicity. The nurse should monitor the client for which of the following adverse drug reactions? (Select all that apply). A. Increased respiratory rate B. Increased pain C. Thrombophlebitis D. Ventricular arrhythmias E. Hypertension

A, B, D, and E Increased respiratory rate is correct. Naloxone treats respiratory depression, but it can cause hyperventilation. It is essential for the nurse to monitor the client's respiration and oxygenation. Increased pain is correct. Naloxone reverses the analgesic effects of opioids and can cause increased pain and discomfort. The nurse should assess the client's pain frequently. Thrombophlebitis is incorrect. Naloxone can increase partial thromboplastin time, causing bleeding. It is not known to cause blood clots. Ventricular arrhythmias is correct. Naloxone can cause ventricular arrhythmias. The nurse should monitor the client's heart rate and ECG. Hypertension is correct. Naloxone can cause hypertension. The nurse should monitor the client's blood pressure.

A nurse is caring for a client who is taking acetaminophen at regular intervals for mild discomfort. The nurse should tell the client to report which of the following early indications of acetaminophen toxicity. (Select all that apply) A. Diaphoresis B. Palpitations C. Shortness of breath D. Nausea E. Diarrhea

A, D, and E Diaphoresis is correct. Acetaminophen toxicity can cause diaphoresis, anorexia, and, eventually, liver damage. Clients should follow the dosage guidelines on the labels of over-the-counter drugs carefully to avoid toxicity. Palpitations is incorrect. Acetaminophen toxicity is unlikely to cause tachycardia or palpitations. Shortness of breath is incorrect. Acetaminophen toxicity is unlikely to cause shortness of breath. Nausea is correct. Acetaminophen toxicity can cause nausea, vomiting, and anorexia, and can lead to liver damage. Diarrhea is correct. Acetaminophen toxicity can cause diarrhea, lethargy, and, eventually, liver damage.

A nurse is caring for a client who has a new prescription for butorphanol. The nurse should monitor the client for which of the following adverse drug reactions? (Select all that apply) A. Infection B. Nausea C. Tachycardia D. Dizziness E. Headache

B, D, and E Infection is incorrect. Butorphanol, an opioid agonist-antagonist, is not known to cause infection. Prednisone, a glucocorticoid, is a drug that suppresses the immune response and increases a client's susceptibility to infection. Nausea is correct. Butorphanol, an opioid agonist-antagonist, can cause nausea. Clients who are taking the drug should lie down when feeling nauseated. Tachycardia is incorrect. Butorphanol, an opioid agonist-antagonist, causes bradycardia, not tachycardia. Dizziness is correct. Butorphanol, an opioid agonist-antagonist, can cause dizziness and drowsiness. Clients who are taking the drug should avoid activities that require alertness. Headache is correct. Butorphanol, an opioid agonist-antagonist, can cause headaches and increased intracranial pressure. Clients who are taking the drug should report severe headaches.

A nurse is caring for a client who is opioid dependent and has a new prescription for butorphanol. The nurse should monitor the client for which of the following manifestations of abstinence syndrome? (Select all that apply) A. Bronchospasm B. Vomiting C. Peripheral edema D. Abdominal cramps E. Hypertension

B, D, and E Bronchospasm is incorrect. Bronchospasm is not a manifestation of abstinence syndrome, a syndrome resulting from sudden withdrawal from an opioid agonist-antagonist, such as butorphanol, by a client who is opioid dependent. It can, however, cause fever and tremors. Vomiting is correct. Abstinence syndrome can cause nausea, vomiting, and anorexia. Peripheral edema is incorrect. Abstinence syndrome can cause fever, anxiety, and restlessness. However, it is not known to cause peripheral edema. Abdominal cramps is correct. Abstinence syndrome can cause abdominal cramps and anorexia. Hypertension is correct. Abstinence syndrome can cause hypertension, tremors, and fever.

A nurse is reviewing the drug list for a client who has a new prescription for allopurinol. The nurse should identify that which of the following drugs interacts with allopurinol? A. Warfarin B. Ibuprofen C. Insulin D. Furosemide

A Allopurinol can increase the effectiveness of warfarin. A lower dosage of warfarin might be required.

A nurse is caring for a client who asks about taking acetaminophen. The nurse should identify that acetaminophen is indicated for which of the following conditions? (Select all that apply) A. To reduce fever B. To decrease inflammation C. To relieve mild pain D. To promote sedation E. To alleviate anxiety

A and C To reduce fever is correct. Acetaminophen reduces fever. It is important, however, to monitor clients taking the drug for signs of hepatotoxicity. To decrease inflammation is incorrect. Acetaminophen does not have anti-inflammatory properties. Aspirin and ibuprofen are drugs that reduce inflammation. To relieve mild pain is correct. Acetaminophen relieves mild to moderate pain. It is important, however, to monitor clients who take high doses for early signs of toxicity, including sweating, nausea, diarrhea, and abdominal discomfort. To promote sedation is incorrect. Acetaminophen does not cause sedation. Morphine, an opioid analgesic, promotes sedation. To alleviate anxiety is incorrect. Acetaminophen does not reduce anxiety. Morphine, an opioid analgesic, reduces anxiety.

A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The nurse should instruct the client to report which of the following adverse drug reactions? A. Polyuria B. Bone pain C. Weight gain D. Infection

C Aspirin use can cause renal impairment, which can result in the retention of salt and water. Clients should report reduced urine output, weight gain, edema, or bloating. The nurse should monitor BUN and creatinine levels and stop aspirin therapy for clients who develop signs of renal dysfunction.

A nurse is caring for a group of postoperative clients. The nurse should identify that morphine is contraindicated for which of the following clients? A. A client who had a mastectomy B. A client who had a knee arthroplasty C. A client who had a colectomy D. A client who had a cholecystectomy

D Morphine can cause biliary colic. It should not be administered to a client who has just had biliary tract surgery, such as a cholecystectomy.

A nurse is teaching a client who has a new prescription for tramadol. Which of the following instructions should the nurse include? (Select all that apply) A. Increase fiber and fluid intake. B. Take the drug with food. C. Avoid driving after taking the drug. D. Change positions gradually. E. Reduce exercise level temporarily.

A, B, C, and D Increase fiber and fluid intake is correct. Tramadol can cause constipation and dry mouth. Clients taking the drug should increase fluid and fiber intake to minimize constipation, and sip water, suck on hard candy, or chew gum to relieve dry mouth. Take the drug with food is correct. Tramadol can cause nausea and vomiting. Clients should take the drug with food or milk and lie down if feeling nauseated. Avoid driving after taking the drug is correct. Tramadol can cause sedation and drowsiness. Clients taking the drug should avoid driving or other activities that require alertness. Change positions gradually is correct. Tramadol can cause sedation and dizziness. Clients taking the drug should use caution when changing positions and ambulating. Reduce exercise level temporarily is incorrect. Tramadol can cause constipation. Clients taking the drug should increase exercise as tolerated to minimize constipation.

A nurse is caring for a client who currently takes furosemide and has a new prescription for prednisone. The nurse should monitor the client for which of the following manifestations during concurrent use of the 2 drugs? A. Hypercalcemia B. Hypoglycemia C. Hypothermia D. Hypokalemia

D Prednisone, a glucocorticoid, can cause hypokalemia. The risk for this electrolyte imbalance increases when the client is taking potassium-depleting diuretics, such as furosemide. The nurse should clarify the prescription with the provider and monitor the client's potassium levels.

A nurse is planning care for client who has started taking prednisone. Which of the following interventions should the nurse include? A. Monitor the client's blood glucose. B. Administer an antacid 30 min prior to prednisone. C. Administer aspirin rather than NSAIDs if the client has pain. D. Monitor the client for hyperkalemia.

A Prednisone can cause hyperglycemia. The nurse should monitor the client's blood glucose regularly.

A nurse is teaching a client who has a new prescription for prednisone. Which of the following instructions should the nurse include? (Select all that apply). A. Reduce the dose during periods of stress. B. Discontinue the drug gradually. C. Report illness or infection. D. Increase intake of calcium and vitamin D. E. Monitor for signs of gastric bleeding.

B, C, D, and E Reduce the dose during periods of stress is incorrect. Clients might need higher doses of prednisone during times of stress. The nurse should tell the client to report stressful events. Discontinue the drug gradually is correct. Prednisone, a glucocorticoid, suppresses adrenal function. The nurse should instruct the client to taper the dosage before discontinuing it to allow for resumption of adrenal activity. Report illness or infection is correct. Clients can need higher doses of prednisone during illness or infection. The nurse should instruct the client to report signs of infection. Increase intake of calcium and vitamin D is correct. Prednisone, a glucocorticoid, can cause bone loss and reduced calcium absorption. The nurse should instruct the client to increase their intake of calcium and vitamin D. Monitor for signs of gastric bleeding is correct. Prednisone, a glucocorticoid, can cause peptic ulcer disease. The nurse should instruct the client to report signs of gastric bleeding, such as hematemesis or black tarry stools.