Ch 16 Karch
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." Explanation: Acetaminophen is often the initial drug of choice for relieving mild to moderate pain and fever, because it does not cause gastric irritation or bleeding. It may be taken on an empty stomach.
Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents?
"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 client with a history of chronic pain is scheduled to undergo a colonoscopy. What health education should the nurse provide the client?
"Confirm with your provider, but you'll likely have to stop taking aspirin one week before the procedure." Explanation: Salicylates are contraindicated for clients who have had surgery or invasive procedures within 1 week because of the risk for increased bleeding. Thus the nurse would inform that client that she can resume taking the aspirin after 1 week. There is no need to avoid acetaminophen and the client's allergies do not necessarily need to be written down by the client. Anti-inflammatories may or may not be given before the procedure.
A client is being discharged following an allergic reaction after ingesting aspirin. When providing client education about the allergy, the nurse would provide the client with what information?
"Do not take any NSAIDs." Explanation: In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
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." Explanation: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.
The client has had an open reduction internal fixation (ORIF) of the right hip. 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." 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.
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.
Which statement by a client receiving gold salts indicates understanding of the drug therapy?
"These drugs will help prevent further damage from my disease." Explanation: Gold salts do not repair damage but rather help to prevent further damage. They are indicated for clients whose disease has been unresponsive to standard therapy. They are most effective if used early in the disease. Gold salts are highly toxic.
A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond?
"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.
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." 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).
Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery?
1 to 2 weeks Explanation: Aspirin should generally be avoided for 1 to 2 weeks before and after surgery, because it increases the risk of bleeding. Most other NSAIDs should be discontinued approximately 3 days before surgery; nabumetone and piroxicam have long half-lives and must be discontinued approximately 1 week before surgery. NSAIDs, administered intraoperatively, have been shown to reduce postoperative pain and use of opioids after abdominal surgery.
A nursing student correctly identifies a normal dose of aspirin for the adult client as which?
325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult client 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.
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 male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain?
Acetaminophen Explanation: Acetaminophen is not an anti-inflammatory medication. It is an analgesic and an antipyretic. Aspirin, naproxen sodium, and ibuprofen decrease pain and inflammation.
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 Explanation: Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children but they are not the most commonly used medications. Indomethacin is not indicated for fever control.
A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome?
Acetylsalicylic acid 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's syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye's syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.
A neonate is born at 28 weeks' gestation and has been diagnosed with patent ductus arteriosus. The nurse should anticipate the administration of which?
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 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 Explanation: In addition, adverse drug effects should be reviewed with clients, and clients should be assessed for characteristics (e.g., older age group, renal impairment, overuse of the drugs) that increase the risks of adverse effects.
The nurse knows, that as a COX-1 inhibitor, indomethacin inhibits prostaglandins associated with which tissues?
All tissues and cell types Explanation: COX-1 is present in all tissues and cell types, especially platelets, endothelial cells, the GI tract, and the kidneys. Prostaglandins produced by COX-1 are important in numerous homeostatic functions and are associated with protective effects on the stomach and kidneys.
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.
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)
Anti-inflammatory Analgesic Antipyretic Explanation: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects.
A male 16 years of age presents to the health care provider'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 initially take a thorough history of symptoms and treatments. Alcohol ingestion and exposure to infections may be assessed later.
A male patient has been prescribed methotrexate. The nurse should caution the patient against using which over-the-counter medication?
Aspirin Explanation: Salicylates decrease the renal clearance of MTX, resulting in an increased risk of MTX toxicity.
Which drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction?
Aspirin Explanation: Aspirin is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction. Diflunisal, magnesium salicylate, or salsalate do not significantly decrease the risk of myocardial infarction
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 Explanation: Tinnitus (ringing of the ears) is a symptom of salicylism. It is not seen with the use of acetaminophen, steroids, or antibiotics
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 student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (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 concerned about taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain due to possible GI upset. The nurse identifies which medication causes the least gastrointestinal distress?
Celecoxib Explanation: Celecoxib is a COX-2 inhibitor that works without inhibiting the COX-1 enzyme, which helps to maintain the stomach lining. Ibuprofen, meloxicam, and naproxen inhibit the COX-1 enzyme
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 Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated?
Celecoxib Explanation: Celecoxib is contraindicated for use in clients who are allergic to sulfonamides. Ibuprofen, naproxen, and diclofenac are not contraindicated in the client with a sulfonamide allergy.
Prostaglandins are:
Chemical mediators found in most body tissues; they participate in the inflammatory response. Explanation: Prostaglandins are chemical mediators found in most body tissues; they help regulate many cell functions and participate in the inflammatory response. They are formed when cellular injury occurs and phospholipids in cell membranes release arachidonic acid.
A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?
Correct response: 5 Explanation: The client's weight must be converted to kilograms: 88 lbs ÷ 2.2 = 40 kg. To calculate the daily dose, multiply the child's weight by the prescribed dose: 0.125 mg X 40 kg = 5 mg
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." 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 client is being treated for severe rheumatoid arthritis. The nurse could anticipate treatment with which of the following:
Etanercept—TNF blocker Gold therapy Hylan G-F 20—hylans with elastic properties Methotrexate
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.
False Explanation: Gold compounds are used for a client with rheumatoid arthritis who does not respond to the usual anti-inflammatory agents and in whom the conditions worsen despite weeks or months of standard pharmacologic treatment.
Temperature regulation occurs in the hypothalamus. Normally, when the body temperature increases the body will respond by causing vasodilation in the periphery. What physiologic change is occurring with fever that allows the body's temperature to increase?
Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. Explanation: Fever is the result of fever-inducing substances called pyrogens, which activate certain monocytes/macrophages, which in turn secrete cytokines. Cytokines increase the synthesis and secretion of prostaglandin E2 (PGE2) in the hypothalamus, and PGE2 stimulates the hypothalamus to reset the regulating mechanism to tolerate a higher body temperature.
Prior to administering a nonsteroidal anti-inflammatory drug (NSAID) to a client, what should the nurse obtain from the client? (Select all that apply.)
History of allergies Pain assessment Current medical conditions Past medical conditions Vital signs Explanation: Prior to administering an NSAID to a client, the nurse should obtain a thorough history from the client that includes allergies (especially to aspirin or other NSAIDs), a pain assessment (including type, onset, intensity, and location), current and past medical conditions (paying close attention to a history of GI bleeding, cardiovascular disease, stroke, hypertension, peptic ulceration, or impaired renal or hepatic function), and vital signs.
A neonate is diagnosed with patent ductus arteriosus. What nonsteroidal anti-inflammatory agent is administered intravenously for treatment of this congenital heart defect?
Indomethacin Explanation: Intravenous indomethacin is approved for treatment of patent ductus arteriosus in premature infants. Sulindac is not approved for the treatment of patent ductus arteriosus. Etodolac is not approved for treatment of patent ductus arteriosus. Nabumetone is not approved for the treatment of patent ductus arteriosus.
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.
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 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.
Which of the following agents would be least appropriate to use as treatment for ulcerative colitis?
Salsalate Explanation: Salsalate is used to treat pain, fever, and inflammation in adults. Balsalazide can be used to treat mild to moderate acute ulcerative colitis in adults. Olsalazine can be used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Mesalamine is used to treat ulcerative colitis and other inflammatory bowel diseases in adults.
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. 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 would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client?
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 client has developed a fever. What aspect of the client's health history would contraindicate the safe and effective use of acetaminophen?
The client has hepatitis C and abuses alcohol Explanation: Liver disease and alcoholism contraindicate the use of acetaminophen. An allergy to penicillin would not pose a problem. Similarly, a history of seizures, benzodiazepine use and diclofenac would not rule out the use of acetaminophen.
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.
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. 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?
acetaminophen Explanation: Acetaminophen is classified as a nonsalicylate analgesic. Aspirin, diflunisal, and magnesium salicylate are salicylates.
A client is experiencing bursitis in the right elbow. Which orally administered medication will diminish inflammation and assist in relieving this pain?
acetylsalicylic acid Explanation: Acetylsalicylic acid is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders, such as bursitis. Acetylsalicylic acid is administered orally. Acetaminophen will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation.
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 Explanation: The salicylates are drugs derived from salicylic acid. They are useful in pain management because of their analgesic (pain-relieving) effect, antipyretic (fever-reducing) effect, and anti-inflammatory effect. They are not known to dilate the bronchioles, nor do they have any effect on infection.
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?
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.
A client has a sulfonamide allergy. Which drug would the nurse identify as being contraindicated?
celecoxib Explanation: Celecoxib is contraindicated in clients with a sulfonamide allergy. Ibuprofen, ketorolac, and meloxicam are not contraindicated
Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)?
celecoxib Explanation: Celecoxib is the NSAID that appears to work by specifically inhibiting cyclooxygenase-2 without inhibiting cyclooxygenase-1. Naproxen, meloxicam, and ibuprofen inhibit both COX-1 and COX-2.
The nurse knows that acetaminophen should not be used in older adults with which condition?
cirrhosis. Explanation: An adverse effect of acetaminophen is hepatotoxicity. Therefore, an older adult with cirrhosis should not be prescribed acetaminophen. Having diabetes, a history of MI, or COPD does not restrict use of acetaminophen in the older adult.
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 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.
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?
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.
The nursing student demonstrates understanding of salicylism when listing which symptoms of this condition? Select all that apply.
dizziness ringing in the ears impaired hearing mental confusion Explanation: Toxicity can develop from taking too much aspirin, resulting in salicylism. Signs and symptoms of this condition include dizziness, ringing in the ears, impaired hearing, nausea, vomiting, flushing, sweating, rapid and deep breathing, tachycardia, diarrhea, mental confusion, lassitude, drowsiness, respiratory depression, and coma. Weight gain is not a sign of this condition.
The nurse assesses the client taking a nonsteroidal anti-inflammatory drug (NSAID) for:
dyspepsia. Explanation: Dyspepsia includes heartburn, indigestion, bloating, and discomfort in the abdominal area. Confusion, increased appetite, and urinary retention are not side effects of NSAIDs.
The nurse is aware that aspirin not only lowers the client's fever but can also reduce the pain the client 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 client.
. Patients taking NSAIDs should be taught to avoid the use of OTC medications without checking with their prescriber because
many of the OTC preparations contain NSAIDs, and inadvertent toxicity could occur.
A nurse suspects that a client is experiencing salicylism. What would the nurse assess for?
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 nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (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 Explanation: The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver while taking NSAIDs.
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. Explanation: Etanercept is a weekly subcutaneous injection
A client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify?
willow bark Explanation: Willow bark has analgesic, antipyretic, and anti-inflammatory properties and was the plant from which the chemical structure of aspirin (salicylic acid) was derived. Kava kava is used for anxiety and stress. Feverfew is used for the treatment of migraines and headache. Black cohosh is used for menopausal symptoms and hot flashes.
A nurse is reviewing the medical record of a client who is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found?
aspirin Explanation: A hypersensitivity to aspirin is a contraindication for all NSAIDs. The alternative to aspirin for fever and pain when aspirin is contraindicated is usually acetaminophen. Hydrochlorothiazide and lisinopril are antihypertensives.
Prior to administering NSAIDs, the nurse asks the client about an allergy to:
aspirin. Explanation: Aspirin allergy is a contraindication for all NSAIDs. Antibiotics and acetaminophen allergies do not affect NSAID use. Analgesics include a wide variety of medications.
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.
The nurse notes an order for oxaprozin (Daypro) for the treatment of arthritis. Before administering the drug the nurse would assess the patient for which problems that could be cautions or contraindications?
Active peptic ulcer disease Renal impairment Bleeding disorders
An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention?
Administration of acetylcysteine as prescribed Explanation: Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate. Lactated Ringer's would not be therapeutically beneficial.
A patient with arthritis is on nonsteroidal anti-inflammatory drug (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.
An antipyretic is a drug that can
Block fever
A nurse might not see a salicylate used as an anti-inflammatory if a drug was needed for its
parenteral availability.
The nonsteroidal NSAIDs affect the COX-1 and COX-2 enzymes. By blocking COX-2 enzymes the NSAIDs block inflammation and the signs and symptoms of inflammation at the site of injury or trauma. By blocking COX-1 enzymes, these drugs block
prostaglandins that protect the stomach lining.
A drug could be classified as an analgesic if it
reduces pain
. Chronic or excessive activity by the inflammatory response can lead to
release of lysosomal enzymes and tissue destruction.
. Your patient has been receiving ibuprofen for many years to relieve the pain of osteoarthritis. Assessment of the patient should include
renal evaluation
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 client of African descent has been prescribed a high dose of an 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. Persons of African descent 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 because this would further increase the client's risk for adverse GI effects. The client should be instructed to use nonpharmacologic measures, such as warm soaks and positioning, to relieve pain.
A 21-year-old female is admitted after taking 25 aspirin tablets at one time. She is admitted with tinnitus, nausea, and vomiting. The health care provider diagnoses the client with salicylate poisoning. What can be used as a treatment for salicylate poisoning? 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.
What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)?
Inhibit prostaglandin synthesis Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.
A client is prescribed acetylsalicylic acid for fever and headache. What is the action of acetylsalicylic acid?
Inhibiting prostaglandin synthesis in the central and peripheral nervous system Explanation: Acetylsalicylic acid inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Acetylsalicylic acid does not inhibit the release of norepinephrine to increase blood pressure. Acetylsalicylic acid does not suppress the function of the hypothalamus to decrease inflammation.
What would be appropriate to use in combination with gold salts?
Low-dose corticosteroids Explanation: Gold salts should not be combined with penicillamine, cytotoxic drugs, immunosuppressive agents, or antimalarials other than low-dose corticosteroids because of the potential for severe toxicity.
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. Explanation: In people who have demonstrated hypersensitivity to acetylsalicylic acid, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. This makes all the other options incorrect.
An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?
Nonsalicylates Explanation: Nonsalicylate analgesics, such as acetaminophen (Tylenol, Atasol), have the same analgesic and antipyretic properties as aspirin, but fewer side effects and are a good choice for mild to moderate pain in children. Salicylates or aspirin is not recommended for children because it is believed to contribute to the development of Reye syndrome in children. Morphine and barbiturates are used for severe pain and would not be appropriate in this situation.
What conditions are salicylates are effective in managing? (Select all that apply.)
Pain Fever Inflammation Explanation: Salicylates are effective in the management of pain, fever, and for inflammation. They are contraindicated in gastrointestinal disorders and are not indicated for infection.
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 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.
A client with dysmenorrhea has been prescribed naproxen 1250 mg PO b.i.d. What is the nurse's best action?
Question the prescriber about the dose Explanation: For adults, naproxen is given 250-500 mg PO b.i.d. As a result, the nurse should question the prescriber about the dose before proceeding.
The nurse should advise the client or caregiver to notify the prescribing health care provider if which adverse reactions occur? (Select all that apply.)
Skin rash Visual disturbances Edema Chest pain Diarrhea Explanation: The nurse should advise the client or caregiver to notify the physician if any of the following adverse reactions occur: skin rash, itching, visual disturbances, weight gain, edema, diarrhea, black stools, nausea, vomiting, chest or leg pain, numbness or persistent headache.
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.
A patient has been diagnosed with rheumatoid arthritis and is experiencing pain and decreased mobility. Etanercept has been proposed as possible treatment option. Which characteristic of this patient would likely preclude the use of etanercept?
The patient has chronic osteomyelitis resulting from a diabetic foot ulcer. Explanation: Infection is a major contraindication for the use of etanercept. Obesity, family history of cancer, and occasional use of topical corticosteroids do not preclude the use of etanercept.
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.
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.
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 patient with rheumatoid arthritis who is on a fixed income and who is being treated with aspirin should be advised
to use generic aspirin.
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 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." Explanation: Acetaminophen has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does not increase a person's risk for bleeding. Relief of pain and fever occur quickly.
