Week 6 Ch 16 Anti-Inflammatory, Anti-arthritis, and related agents
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 quite a few adverse effects." "This drug is reserved for long-term therapy." "The drug can increase your risk for bleeding." "The drug has no effect on inflammation."
"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.
Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen? A female 50 years of age with hypoprothrombinemia A male 30 years of age who drinks four beers per day A male 40 years of age with arthritis A female 62 years of age with a vitamin K deficiency
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 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 Aspirin Ibuprofen Diflunisal (Dolobid)
Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.
Which is the antidote for acetaminophen poisoning? Acetylcysteine Ketorolac Diclofenac sodium Allopurinol
Acetylcysteine Explanation: A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites.
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.) Antibacterial Antipruritic Analgesic Anti-inflammatory Antipyretic SUBMIT ANSWER
Anti-inflammatory Analgesic Antipyretic Explanation: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects.
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? Sumatriptan Celecoxib Eletriptan Ergotamine
Celecoxib Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Azathioprine Gold salts Humira Hydroxychloroquine
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.
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? Nabumetone Ketorolac Meloxicam Etodolac
Ketorolac Explanation: Ketorolac is not used in the treatment of rheumatoid arthritis. Nabumetone, Etodolac, and meloxicam are used to treat rheumatoid arthritis.
The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client? The client diagnosed with diabetes The client diagnosed with peptic ulcers The client diagnosed with psoriasis The postpartum woman who had a vaginal birth
The client diagnosed with peptic ulcers Explanation: The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely and the nurse would not question the order. NSAIDs are often ordered for pain control for clients following vaginal birth and this order need not to be questioned.
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: acute gout. cataract. allergy to sulfonamides. diabetic retinopathy.
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.
How should a nurse best explain the presence of the inflammation process? as a typical response to bacterial infection as a normal response to infection or trauma, which results in necrotic tissue formation as the initial stage of infection, requiring antibiotic medication for resolution as an attempt by the body to remove the damaging agent and repair the damaged tissue
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. The remaining options are either incorrect or incomplete descriptions of the inflammation process.
A client is ordered to receive an nonsteroidal anti-inflammatory drug (NSAID) for pain. The client states that NSAIDs are taken only to decrease inflammation. The nurse instructs the client that these medications are also used for which? increase platelet production. increase appetite. decrease blood pressure. decrease body temperature.
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 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. cognitive deficits. gastrointestinal distress. acute renal failure.
liver damage. Explanation: A client 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 nurse suspects that a client is experiencing salicylism. What would the nurse assess for? mental confusion excitement tachypnea convulsions
mental confusion 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.
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? constipation. anemia. peptic ulcer disease or gastritis. interstitial nephritis.
peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in clients 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 clients 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 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: caffeine overdose. salicylate intoxication. ibuprofen overdose. acute acetaminophen toxicity.
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 49-year-old woman has been diagnosed with myalgia. The health care provider has recommended aspirin. The client is concerned that the aspirin will upset her stomach. The nurse will encourage the client to take this medication by: avoiding drinking milk for 3 hours after swallowing the tablet. crushing the tablet before swallowing. swallowing the tablet whole. swallowing the tablet with milk or food.
swallowing the tablet with milk or food. Explanation: Taking aspirin with milk or food minimizes the stomach upset because it buffers the stomach wall from direct contact with the medication, decreasing gastric distress. Chewable tablets can be chewed before swallowing or crushed and then advised to be taken with food or mixed in a drink. Swallowed whole, extended-release tablets are enteric coated to delay release of the aspirin, which again buffers the stomach wall from the medication, decreasing gastric distress. Nonchewable tablets should be swallowed whole and should never be advised to be crushed or chewed.
A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed? "Allopurinol is used to cure hyperuricemia, which commonly occurs with gout." "Allopurinol promotes formation of uric acid. It is used in combination with another drug to prevent reoccurrences of the symptoms of gout." "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." "Allopurinol is not a first-line drug but can be used to cure gout."
"Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." Explanation: Allopurinol is used to prevent or treat (but not cure) hyperuricemia, which occurs with gout and with antineoplastic drug therapy. Allopurinol prevents formation of uric acid. The drug promotes resorption of urate deposits and prevents their further development. Allopurinol is among the first-line drugs used in the treatment of gout but does not cure the condition.
Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents? "Make sure to give the drug on an empty stomach or before meals." "Be sure to read the label for the ingredients and dosage." "Aspirin is best for treating your child's flulike symptoms." "Refrain from using acetaminophen for the child's symptoms."
"Be sure to read the label for the ingredients and dosage." Explanation: Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.
A nurse is assessing a client who has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy? "I asked my doctor to check for blood in my stool regularly." "I do not like to swallow whole tablets, so I crush them." "I drink as little water as possible when I take my medication so I don't dilute their effect." "I'm careful not to eat grapefruit or drink grapefruit juice."
"I asked my doctor to check for blood in my stool regularly." Explanation: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; by asking the health care provider to check the stool for bleeding, the client demonstrates awareness of this. Crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. Grapefruit juice does not interfere with NSAID metabolism.
A nurse is assessing a client who has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy? "I asked my doctor to check for blood in my stool regularly." "I'm careful not to eat grapefruit or drink grapefruit juice." "I do not like to swallow whole tablets, so I crush them." "I drink as little water as possible when I take my medication so I don't dilute their effect."
"I asked my doctor to check for blood in my stool regularly." Explanation: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; by asking the health care provider to check the stool for bleeding, the client demonstrates awareness of this. Crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. Grapefruit juice does not interfere with NSAID metabolism.
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? "Your dentist must extract the tooth in a hospital setting to reduce the risk of hemorrhage." "No, the dose of aspirin is too low to increase your risk of bleeding." "Yes, you need to stop the aspirin immediately." "Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders."
"Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber'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 is the antidote for acetaminophen poisoning? Diclofenac sodium Acetylcysteine Allopurinol Ketorolac
Acetylcysteine Explanation: A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites.
A neonate is born at 28 weeks' gestation and has been diagnosed with patent ductus arteriosus. The nurse should anticipate the administration of which? Meloxicam administration Intramuscular injection of ketorolac IV administration of naproxen Administration of indomethacin IV
Administration of indomethacin IV Explanation: Patent ductus arteriosus can be treated with IV indomethacin in premature neonates. Ketorolac and meloxicam and not used for this purpose. Naproxen does not treat this health problem and is only administered orally.
A group of students is reviewing information about cyclooxygenase receptors. The students demonstrate understanding of the information when they identify what as an effect of COX-2 receptors? Maintenance of renal function Promotion of vascular hemostasis Blockage of platelet clumping Provision of gastric mucosal integrity
Blockage of platelet clumping Explanation: COX-2 receptors block platelet clumping. COX-1 receptors maintain renal function, provide for gastric mucosal integrity, and promote vascular hemostasis.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Humira Azathioprine Hydroxychloroquine Gold salts
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 nurse is conducting a medication reconciliation for an older adult client who has just relocated to the long-term care facility. The nurse notes that the resident has been taking colchicine on a regular basis. Which medication regimen should signal the nurse to the possibility of what diagnosis? Gout Inflammatory bowel disease (IBD) Osteoarthritis Bursitis or tendonitis
Gout Explanation: Colchicine, the prototype agent for the treatment and prevention of gout, is the most commonly administered anti-gout medication. This medication is thought to block neutrophil-mediated inflammation. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis since they are not a result of neutrophil-mediated inflammation.
A patient is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is most common in acute or chronic overdose of acetaminophen? Hepatotoxicity Pulmonary insufficiency Pancreatitis Nephrotoxicity
Hepatotoxicity Explanation: Acetaminophen is normally metabolized in the liver to metabolites that are excreted by the kidneys, and these metabolites may accumulate in clients especially those diagnosed with renal failure. In acute or chronic overdose of acetaminophen, the client can develop hepatotoxicity. None of the other options are associated with an adverse effect of an acetaminophen overdose since none are associated with the liver.
The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Blocking the neuronal terminal Decreasing nerve stimulation Inhibiting the synthesis of prostaglandins Inhibiting impulses to the brain
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
In which children or teenagers is the use of salicylates, particularly aspirin, contraindicated because their use appears to be associated with Reye syndrome? Patients with high BP Patients with diabetes Patients with hepatic dysfunction Patients with chickenpox
Patients with chickenpox Explanation: Children or teenagers with influenza or chickenpox should not take salicylates, particularly aspirin, because their use appears to be associated with Reye syndrome, a life-threatening condition characterized by vomiting and lethargy progressing to coma. Even though salicylates need to be administered with caution in patients with hepatic dysfunction, high blood pressure, and diabetes, their use does not lead to Reye syndrome.
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? Asthma Excess antiplatelet action Salicylate poisoning Reye syndrome
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.
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 Asthma Excess antiplatelet action Salicylate poisoning
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.
The nurse is educating an African-American client about the safe and effective use of anti-inflammatories. In order to address the known ethnic factors relating to this client's drug therapy, the nurse should do what? Teach the client about the importance of maximizing fluid intake during treatment. Teach the client about the heightened risk for GI adverse effects. Encourage the client to use ibuprofen rather than acetaminophen whenever possible. Encourage the client to discuss the use of opioids rather than OTC anti-inflammatories with the healthcare provider.
Teach the client about the heightened risk for GI adverse effects. Explanation: African Americans have a documented decreased sensitivity to pain-relieving effects of many anti-inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. There is no specific reason why opioids or ibuprofen should be preferred over other options. The role of fluid intake during treatment is unrelated to ethnicity.
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 will protect your heart. The aspirin is being prescribed to relieve the pain from the heart attack. The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed because it reduces your risk of a second heart attack.
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 clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.
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? Discontinue the Celebrex. Administer the Celebrex and narcotic because it is his pain management regimen. Administer the Celebrex. Withhold the Celebrex and notify the health care provider.
Withhold the Celebrex and notify the health care provider. Explanation: Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.
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? Discontinue the Celebrex. Administer the Celebrex. Administer the Celebrex and narcotic because it is his pain management regimen. Withhold the Celebrex and notify the health care provider.
Withhold the Celebrex and notify the health care provider. Explanation: Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.
A group of nursing students are reviewing information about nonopioid analgesics. The students demonstrate understanding of the information when they identify which drug as a nonsalicylate analgesic? diflunisal aspirin magnesium salicylate acetaminophen
acetaminophen Explanation: Acetaminophen is classified as a nonsalicylate analgesic. Aspirin, diflunisal, and magnesium salicylate are salicylates.
A nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug? oxaprozin ketorolac celecoxib sulindac
celecoxib Explanation: Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk. Sulindac carries the risk of headache, dizziness, and GI upset. Oxaprozin carries the risk of headache, dizziness, insomnia, and ringing in the ears. Ketorolac carries the risk of GI upset, renal effects, and congestive heart failure.
An adult client is brought to the emergency department after deliberately overdosing on acetaminophen. The care team should prioritize interventions based on the client's risk for which adverse reaction? acute GI bleed liver failure seizures gastric perforation
liver failure Explanation: Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose and is most likely with doses of 20 g or more. None of the other options are associated with acetaminophen overdosing.
An adult client is brought to the emergency department after deliberately overdosing on acetaminophen. The care team should prioritize interventions based on the client's risk for which adverse reaction? gastric perforation seizures acute GI bleed liver failure
liver failure Explanation: Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose and is most likely with doses of 20 g or more. None of the other options are associated with acetaminophen overdosing.
