Chapter 16 Anti-Inflammatory, Antiarthritis, and Related Agents PrepU
A neonate is diagnosed with patent ductus arteriosus. What nonsteroidal anti-inflammatory agent is administered intravenously for treatment of this congenital heart defect?
Indomethacin
What conditions are salicylates are effective in managing? (Select all that apply.)
Inflammation Pain Fever
When NSAIDs are combined with lithium, there is a potential for: decreased antihypertensive effect. increased diuretic effect. lithium toxicity. anaphylactoid reactions.
lithium toxicity. Explanation: NSAIDS have interactions with a variety of drugs and the efficacy of the medications. When an NSAID is taken with lithium for a bipolar disorder, there can be an increased effectiveness leading to lithium toxicity. When NSAIDS are taken with diuretics, there often is a decreased diuretic effect. There is a potential for decreased anti hypertensive effect with NSAIDS and anti hypertensive drugs. The NSAIDs are so named because they have antiinflammatory effects and do not cause anaphylaxis.
A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which?
liver damage.
A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which?
peptic ulcer disease or gastritis
The nurse is reviewing the health record of a client with a prolonged history of rheumatoid arthritis. The health care provider's notes state that the client may be an appropriate candidate for chrysotherapy. The nurse should anticipate what treatment?
prescription of auranofin
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
A male patient has been prescribed methotrexate. The nurse should caution the patient against using which over-the-counter medication?
Aspirin
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."
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 prevent or treat hyperuricemia, which commonly occurs with gout."
Which instruction would be most important to include when teaching parents about OTC anti-inflammatory agents?
"Be sure to read the label for the ingredients and dosage."
A 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."
Which NSAID should the nurse know are not used to treat osteoarthritis or rheumatoid arthritis? (Select all that apply.)
-Ketorolac (Toradol) -Mefenamic (Ponstel)
A student nurse asks the nurse why acetaminophen and 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."
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."
How should the nurse counsel a client concerning a new prescription for celecoxib and its affect on long-standing low-dose acetylsalicylic acid therapy? "Continue both therapies as prescribed." "Stop taking the acetylsalicylic acid for at least 7 days before starting the celecoxib." "Because celecoxib interferes with the absorption of acetylsalicylic acid, increase that daily dosage to 325 mg." "Take the acetylsalicylic acid within 4 hours of taking the celecoxib."
"Continue both therapies as prescribed." Celecoxib is a COX-2 inhibitor. In general, clients taking low-dose acetylsalicylic acid to prevent myocardial infarction or stroke should continue to take the aspirin if their prescribers order a COX-2-inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs) because the COX-2 inhibitors have little effect on platelet function. This information makes all the remaining options incorrect.
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? "Why do you feel so tense regarding exams?" "Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." "Consult your health care provider." "Acetaminophen is a benign drug and will relieve your pain."
"Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." 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 16-year-old 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 male client taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse?
"Do not take any more of the medication and come into the clinic immediately to see the health care provider."
A male client taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse? "This is a common side effect of this medication. You should take diphenhydramine 50 mg and omit the next dose." "Do not take any more of the medication and come into the clinic immediately to see the health care provider." "Are you sure that you do not have another disease such as myasthenia gravis?" "This is an allergic reaction to the medication and is no cause for concern."
"Do not take any more of the medication and come into the clinic immediately to see the health care provider." Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.
A patient taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse?
"Do not take any more of the medication and come into the clinic immediately to see the physician." Explanation: Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.
Which statement by the client indicates a clear understanding of the primary adverse effect of aspirin therapy? "I drink a glass of wine every night." "I ask my health care provider to check for blood in my stool on a regular basis." "I don't like to swallow tablets so I crush them." "I take as little water as possible when I take my medication."
"I ask my health care provider to check for blood in my stool on a regular basis." Explanation: Taking nonsteroidal anti-inflammatory drugs can increase the risk of bleeding; therefore, the client asking her health care provider to check her stool for blood lets the nurse know that the client is aware of this adverse effect. Alcohol consumption and crushing the tablets can interfere with anti-inflammatory metabolism. Water can safely be taken with aspirin.
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."
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."
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."
After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state:
"These drugs are relatively safe since they don't have adverse effects."
The 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
A male client is taking aspirin 81 mg by mouth each day for prevention of recurrent myocardial infarction. He makes a dentist appointment for a tooth extraction. He calls the health care provider's office and asks the nurse if he is at risk for bleeding. Which response is correct?
"Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders."
The nurse is teaching the client, who has been newly prescribed etanercept, how to administer the medication. What statement is accurate?
"You can rotate subcutaneous injection sites to avoid tissue damage."
What effects are exerted by aspirin? (Select all that apply.)
-Analgesic -Antipyretic -Anti-inflammatory
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)
-Anti-inflammatory -Analgesic -Antipyretic
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
The nurse administering ibuprofen should assess an adult client for which potential symptoms? Select all that apply.
-fever -inflammation -moderate pain
Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery?
1 to 2 weeks
A client is receiving a salicylate for fever reduction. The nurse would instruct the client to notify the primary health care provider if the fever continues past which time frame?
24 hours
A nursing student correctly identifies what as the recommended dose of aspirin for the adult patient?
325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult patient 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.
A mother brings her 3-year-old to the emergency department telling the nurse the child has eaten a bottle of baby aspirin. The mother cannot tell the nurse how many tablets were in the bottle. What dose of salicylate would be toxic in a child?
4 g
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?
5 mg
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
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
A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug?
Acetaminophen
A 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
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 Ibuprofen Naproxen Indomethacin
Acetaminophen 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 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? Aspirin Diflunisal (Dolobid) Acetaminophen Ibuprofen
Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.
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.
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 Ibuprofen Naproxen Indomethacin
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.
Which drugs DO NOT cause inhibition of platelet aggregation, interference with blood coagulation, or increase the risk of bleeding?
Acetaminophen and the COX-2 inhibitors
A child has symptoms of the flu with fever. Which medication should not be administered to the child because of the risk of Reye syndrome?
Acetylsalicylic acid (aspirin) 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 syndrome. Acetaminophen (Tylenol) is safe to administer for fever reduction and pain relief in children and adolescents. Ibuprofen (Motrin) is safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children, but is not used to reduce fever or pain.
A patient is taking a nonsteroidal anti-inflammatory agent. Which instruction should the patient be given in regards to administration?
Administer the medication with food. Explanation: To prevent gastrointestinal irritation, instruct the patient to administer the medication with food. The administration of an NSAID with orange juice will increase gastric acid and not protect the gastric mucosa. Crushing enteric-coated tablets will eliminate the protection of the gastric mucosa. Nonsteroidal anti-inflammatory agents administered every other day will not protect the patient from gastric irritation.
An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of Tylenol. The nurse should prepare for what intervention?
Administration of acetylcysteine as prescribed
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 Watchful waiting Administration of naloxone as prescribed Intravenous administration of Lactated Ringer's
Administration of acetylcysteine as prescribed 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 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
A client is taking Indocin for arthritis. The nurse knows that as a COX-1 inhibitor, this drug inhibits prostaglandins associated with which functions?
All tissues and cell types, especially platelets, endothelial cells, the GI tract, and the kidneys
A male 16 years of age presents to the physician'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.
Which drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction? Aspirin Diflunisal Magnesium salicylate Salsalate
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.
When acetylsalicylic acid (aspirin) is administered, what action prevents the synthesis of thromboxane A2?
Aspirin's acetyl portion dissociates, binding to COX-1 to decrease aggregation.
A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate?
Assess the client's use of salicylates.
A healthcare provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about safe and effective use of acetaminophen?
Avoid taking more than 3000 mg in any 24-hour period
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
The nurse is discussing ethnic differences in response to medication with nursing students. What group of people would the nurse tell the students have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs?
Black Americans
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?
Blockage of platelet clumping
A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?
Blocks interleukin-1
What is classified as a nonsalicylate analgesic?
Tylenol Explanation: Tylenol (acetaminophen) is classified as a nonsalicylate analgesic.
What is the difference between COX-1 and COX-2 enzymes?
COX-1 enzymes secrete cytoprotective mucus.
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
The client is concerned about taking NSAIDs for pain due to possible GI upset. The nurse identifies which medication causes the least gastrointestinal distress?
Celecoxib
A client has a sulfonamide allergy. Which drug would the nurse identify as being contraindicated?
Celecoxib (Celebrex)
Which of the following NSAIDs is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke?
Celecoxib (Celebrex) Explanation: Celecoxib (Celebrex) is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however all NSAIDs may carry a similar risk.
Prostaglandins are:
Chemical mediators found in most body tissues; they participate in the inflammatory response.
A 25-year-old woman with rheumatoid arthritis is being treated with acetaminophen and salicylates. The health care provider has switched her medication regimen to include DMARDs. What is the advantage of DMARDs over salicylates?
DMARDs can arrest the progression of rheumatoid arthritis.
A client is ordered to receive an NSAID for pain. The client states that NSAIDs are taken to decrease inflammation. The nurse identifies that these medications are also used to:
Decrease body temperature.
A client on NSAIDs is experiencing congestive heart failure. The health care provider has decided to add a diuretic to the treatment plan. The nurse evaluates the client for:
Decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.
A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?
Dietary habits
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.
False
African Americans are at lower risk for developing GI adverse effects with NSAIDs.
False Explanation: African Americans have an increased risk of developing GI adverse effects with any anti-inflammatory agent.
The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?
Follow a low purine diet
An 80-year-old male client presents to the physician's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The physician orders a stool test for guaiac, which yields positive results. The physician discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs?
GI bleed Explanation: Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.
A 21-year-old female is admitted after taking 25 aspirin tablets in an attempt to take her life. She is admitted with tinnitus, nausea, and vomiting. The physician diagnoses Kelly with salicylate poisoning. What can be used as a treatment for salicylate poisoning due to an overdose of aspirin? (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.
A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving?
Gold salts
What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals?
Gold salts
A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate?
Hepatic function
A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?
Hepatotoxicity
Which conditions would contraindicate the use of gold salts? Select all that apply.
Hypertension Uncontrolled diabetes Blood dyscrasias
The client has been taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolac has been added to the treatment regimen. The nurse evaluates the client for which potential interaction?
Hypertension Explanation: When combined with NSAIDs, antihypertensive medications are less effective. The client's blood pressure must be assessed to identify any increase. Antihypertensives do not affect the effectiveness of NSAIDs.
A client with rheumatoid arthritis is prescribed penicillamine. What should the nurse teach the client about this medication?
Improvement in symptoms may take two to three months
A salicylate is contraindicated in clients who have had surgery within the past week for which reason? Increased risk for allergic reaction Increased risk for toxicity Increased risk for bleeding Increased risk for fluid imbalance
Increased risk for bleeding 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.
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.
A 60-year-old patient with rheumatoid arthritis visits the health care facility for a regular checkup. The patient informs the nurse that the patient has been using an over-the-counter NSAID for the last few days. Why should the nurse caution the patient against the use of NSAIDs on a long-term basis?
Increased risk of GI bleeding
A patient who is on long-term acetaminophen therapy has been taking etodolac for joint pain. Which effect is likely to occur due to an interaction between the two drugs?
Increased risk of renal impairment
Which are important points for the nurse to cover with the client during discharge counseling for salicylate analgesics? (Select all that apply.)
Inform all health care providers of salicylate use. Discard salicylates if they smell like vinegar. Take salicylates with food. Keep salicylate container closed tightly. Explanation: The nurse should include the following in discharge counseling for clients receiving salicylates: take drug as prescribed, take drug with food or milk and a full glass of water, inform all health care providers (including dentists) of salicylate use, discard salicylates that smell like vinegar, and store in tightly closed container away from air, moisture, and heat.
What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)?
Inhibit prostaglandin synthesis
The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions?
Inhibiting the synthesis of prostaglandins
The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Inhibiting impulses to the brain Inhibiting the synthesis of prostaglandins Blocking the neuronal terminal Decreasing nerve stimulation
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
The nurse explains to the client that NSAIDs act by which actions?
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
A patient with muscle ache would like to use an over-the-counter NSAID. The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?
It causes decreased effectiveness of the antihypertensive drug. Explanation: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drug, or decreased metabolism of NSAID.
The client reports severe pain from an acute lumbar spasm. The nurse would anticipate which drug to be ordered for this client?
Ketorolac (Toradol)
Which NSAID should the nurse know are NOT used to treat osteoarthritis or rheumatoid arthritis? (Select all that apply.)
Ketorolac (Toradol) Mefenamic (Ponstel)
What would be appropriate to use in combination with gold salts?
Low-dose corticosteroids
A nurse suspects that a client is experiencing salicylism. What would the nurse assess for?
Mental confusion
A nurse suspects that a client is experiencing salicylism. What would the nurse assess for? Excitement Mental confusion 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.
An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?
Nonsalicylates
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?
Oral
What conditions are salicylates are effective in managing? (Select all that apply.) Pain Fever Inflammation GI upset Infection
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.
When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action?
Platelet aggregation is inhibited.
A client is receiving acetaminophen for fever. The client also has inflammation in the knees and elbows with pain. Why will acetaminophen assist in reducing fever but not in decreasing the inflammatory process?
Prostaglandin inhibition is limited to the central nervous system.
A patient with chickenpox and visiting the pediatrician's office should not be prescribed aspirin because of which known complications?
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?
Reye syndrome
Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?
Rheumatoid arthritis (RA)
A nurse suspects that a client is experiencing salicylism. What would the nurse assess?
Ringing in the ears
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/Salicylism
The client has been diagnosed with ulcerative colitis. What salicylates would be appropriate for treating inflammation in a client with ulcerative colitis? Select all that apply. Salsalate Balsalazide Olsalazine Mesalamine Aspirin
Salsalate Balsalazide Olsalazine Melamine Salsalate is used to treat pain, fever, and inflammation in adults but is not indicated for use as ulcerative colitis treatment. Balsalazide can be used to treat mild to moderate acute ulcerative colitis in adults. Olsalazine and mesalamine are used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Aspirin would be inappropriate because of the risk for GI bleeding.
A black client is receiving a high dose of 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. Blacks 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, as this would further increase the client's risk for adverse GI effects. The client should be instructed to use nonpharmacologic measures to relieve pain, such as warm soaks and positioning.
The most common side effects caused by NSAIDs involve the:
Stomach. Explanation: The most common side effects caused by the NSAIDs involve the GI tract, including the stomach.
A nurse monitoring a client taking Dolobid (diflunisal) should monitor the client for which adverse reaction? (Select all that apply.)
Tarry stools Weight loss Heartburn
A parent states that they generally give their children "half an aspirin" in the event that any of them has a fever. What is the nurse's best response to the client's statement?
Teach the client to avoid giving aspirin due to the risk of Reye syndrome.
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.
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 the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the heart attack.
The aspirin is being prescribed because it reduces your risk of a second heart attack. 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.
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 the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the 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.
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. What would be the 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 patients 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 NSAIDs for which client?
The client diagnosed with peptic ulcers
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
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 diagnosis of type 2 diabetes. The patient has a history of peptic ulcer disease. The patient had a total abdominal hysterectomy 2 years ago. The patient takes an SSRI for depression.
The patient has a history of peptic ulcer disease. 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.
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.
A nurse should recognize which signs in a client with salicylism? (Select all that apply.)
Tinnitus Sweating Mental confusion
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.
NSAIDs have anti-inflammatory, antipyretic, and analgesic properties.
True
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.
True
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 physician.
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
Which is the antidote for acetaminophen poisoning?
acetylcysteine
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
A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:
allergy to sulfonamides.
While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as:
an attempt by the body to remove the damaging agent and repair the damaged tissue.
A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?
arthritis
How should a nurse best explain the presence of the inflammation process? as an attempt by the body to remove the damaging agent and repair the damaged tissue. 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 a typical response to bacterial infection
as an attempt by the body to remove the damaging agent and repair the damaged tissue 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 nurse is reviewing the medical record of a client who is prescribed NSAID therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found?
aspirin
Prior to administering NSAIDs, the nurse asks the client about an allergy to:
aspirin
Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)?
celecoxib
A client's current drug regimen includes a nonsteroidal anti-inflammatory drug (NSAID) and a loop diuretic. What assessment should the nurse consequently prioritize?
blood pressure
When assessing a client who is to receive celecoxib, a history of which disease process or condition would be most important to assess?
cardiac disease
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
The nurse knows that acetaminophen should not be used in older adults with which condition?
cirrhosis
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
A client on NSAIDs is experiencing congestive heart failure. The healthcare provider has ordered a diuretic to the treatment plan. The nurse evaluates the client for what reaction? NSAID toxicity. decreased effectiveness of the diuretic. diuretic toxicity. decreased effectiveness of NSAIDs.
decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.
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 weight gain mental confusion
dizziness ringing in the ears impaired hearing mental confusion 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 understands that the primary adverse reaction with the use of salicylates is which?
gastric distress
A client is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is the most common in acute or chronic overdose of acetaminophen?
hepatotoxicity
A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?
ibuprofen
The pharmacology instructor is discussing disease-modifying antirheumatic drugs (DMARDs). According to the instructor, these drugs are prescribed in the treatment of rheumatoid arthritis (RA) because of their:
immunosuppressive properties.
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
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
A client has been diagnosed with severe rheumatoid arthritis, and hylan G-F 20 has been ordered. How is this drug given?
injected into joint
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?
liver failure
The pediatric client has a fever, and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this client?
naproxen
A nurse is preparing to teach a client about the adverse effects of prescribed NSAID therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved?
stomach
A 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 lungs liver peripheral nerves
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 COX-1 inhibitor has known protective effects on what organ? Select all that apply.
stomach kidneys
The most common side effects caused by NSAIDs involve the: stomach. lungs. liver. peripheral nerves.
stomach. The most common side effects caused by the NSAIDs involve the GI tract, including the stomach.
A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that:
the client should not take aspirin or non-aspirin NSAIDs.
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.
A client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify?
willow bark