Chapter 33: Drugs for Inflammation and Fever

Due to a black box warning on acetaminophen, the strength of acetaminophen in prescription combination products is set at __________mg per tablet.

325 (mg)

A patient reports taking acetaminophen (Tylenol) every 2 hours to reduce fever. Which response should the nurse make? A. "Do not take more frequently than every 4 to 6 hours, due to the risk for liver damage." B. "Do not take more frequently than every 4 to 6 hours, due to the risk for Reye's syndrome." C. "It is okay to take the medication every 2 hours as long as you don't experience gastrointestinal irritation." D. "Do not take more frequently than every 4 to 6 hours, because of the risk for ototoxicity."

A. "Do not take more frequently than every 4 to 6 hours, due to the risk for liver damage." Acetaminophen doses can be repeated every 4-6 hours, not every 2-3 hours. Too-frequent dosing increases the risk for hepatotoxicity. Acetaminophen does not cause Reye's syndrome or ototoxicity. Even if the patient does not experience gastrointestinal irritation, it is unsafe to take the medication every 2 hours due to the risk for hepatotoxicity.

The nurse teaches a patient how to take a liquid anti-inflammatory medication. For which patient statement should the nurse provide additional teaching? A. "I can use a household spoon to measure the dose." B. "I will notify the healthcare provider if I develop a rash." C. "Liquid anti-inflammatory medications are not safer than pills." D. "I will notify the healthcare provider if my stools become black."

A. "I can use a household spoon to measure the dose." Because teaspoon sizes differ significantly, they should not be used to measure the amount of a medication. A dosage cup should be used. The healthcare provider should be notified if the patient develops a rash because this is a sign of an allergic reaction to the medication. Liquid anti-inflammatory medications are not necessarily safer, because recommended dosages are the same with liquid and pill formulations. Black stools are not normal and indicate gastrointestinal bleeding.

A client is prescribed acetaminophen​ (Tylenol) for a headache. Which client statement should indicate that teaching about this medication was​ effective? A. "I should report any skin rash or​ itching." B. "Caffeine decreases the effect of the​ medication." C. "The medication may cause some skin​ blistering." D. "If my headache​ doesn't go​ away, I can take extra doses of​ acetaminophen."

A. "I should report any skin rash or​ itching." Acetaminophen may cause serious allergic reactions with symptoms of​ angioedema, difficulty​ breathing, itching, or rash. Skin blistering should be immediately reported to the healthcare provider because​ Stevens-Johnson syndrome is a rare but serious adverse effect of the medication. Caffeine is not identified to be avoided when taking acetaminophen. The client should not take extra doses because risk of adverse effects due to acetaminophen poisoning is dose​ related; hepatic failure and death could occur.

A patient asks why a nonsteroidal anti-inflammatory drug (NSAID) was prescribed for ankylosing spondylitis instead of acetaminophen (Tylenol). Which information about acetaminophen should the nurse include in response? A. "It does not decrease inflammation." B. "It increases the risk for heart attack and death." C. "It causes gastrointestinal ulcers." D. "It is recommended only to treat fevers."

A. "It does not decrease inflammation." Unlike NSAIDs, acetaminophen does not decrease inflammation. Acetaminophen does not cause cardiotoxicity or gastrointestinal ulcers. Although acetaminophen is a preferred medication to reduce fever, it is still recommended to treat mild to moderate pain.

A client is taking a nonsteroidal​ anti-inflammatory drug​ (NSAID) for osteoarthritis. Which instruction should the nurse​ provide? A. "Take the medication with food or​ milk." B. "Take the medication with​ ginkgo." C. "Decreased urine output is​ expected." D. "It is normal if your stools become​ black."

A. "Take the medication with food or​ milk." NSAIDs should be taken with food or milk to prevent gastrointestinal​ (GI) upset. Taking ginkgo with an NSAID increases the risk for bleeding. Black stools indicate GI bleeding. Decreased urine output indicates possible nephrotoxicity.

The nurse is explaining the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) in treating inflammation. Which pharmacologic principle of NSAIDs should the nurse include in the response? A. "They inhibit the synthesis of prostaglandins." B. "They block the neuromuscular junction." C. "They block calcium release within the muscle." "D. They work directly at the site of pain."

A. "They inhibit the synthesis of prostaglandins." All NSAIDs inhibit prostaglandins, which are local hormones found in virtually every tissue. Preventing the formation of prostaglandins is responsible for the therapeutic and adverse effects of NSAIDs. NSAIDs do not block the neuromuscular junction, block calcium release within the muscle, or work directly at the site of pain.

The nurse is discussing the pathophysiology of inflammation. Which information should the nurse​ include? A. Antigen exposure causes permeability of vessels and allows phagocytic cells to reach the antigen. B. The amount of inflammation is independent of the degree of tissue damage from an antigen. C. Massive release of chemical mediators throughout the body occurs with chronic inflammation. D. The increased permeability of blood vessels causes decreased tissue edema.

A. Antigen exposure causes permeability of vessels and allows phagocytic cells to reach the antigen. When the body is exposed to a foreign substance​ (antigen), nearby blood vessels become permeable to allow phagocytic cells to reach and neutralize the antigen. The increased permeability of blood vessels causes increased tissue edema. There is a correlation between the amount of tissue damage from the antigen and the amount of​ inflammation: the greater the tissue​ damage, the greater the degree of inflammation. Massive release of chemical mediators throughout the entire body occurs with​ anaphylaxis, a​ life-threatening allergic response that can cause cardiovascular shock and death.

A patient is prescribed prednisone. For which reason should the nurse question providing this medication to the patient? A. Bacteria infection B. Elevated blood glucose C. Osteoarthritis D. Pain

A. Bacteria infection Patients with active viral, bacterial, fungal, or protozoan infections should not take prednisone. Prednisone can cause the blood glucose level to increase however it is not contraindicated. Prednisone is not contraindicated in patients with osteoarthritis or pain.

A patient is being treated for an infected leg wound. Which chemical mediator should the nurse recall as the reason for this patient to experience pain? A. Bradykinin B. Complement C. Cytokines D. Leukotrienes

A. Bradykinin Bradykinin is present in an inactive form in plasma and mast cells. It is a vasodilator that causes pain. Complement is a series of proteins that combine in a cascade fashion to neutralize or destroy an antigen and stimulates histamine release by mast cells. Cytokines are proteins produced by macrophages, leukocytes, and dendritic cells that mediate and regulate immune and inflammatory reactions. Leukotrienes are stored and released by mast cells with effects similar to those of histamine.

A patient is experiencing symptoms of an inflammation. Which laboratory test should the nurse expect to be prescribed? A. C-reactive protein B. Hemoglobin level C. Platelet count D. Serum sodium

A. C-reactive protein C-Reactive protein is a protein found in the plasma that is an early marker of inflammation. Hemoglobin, platelet count, and serum sodium are not laboratory tests used to confirm the presence of inflammation.

A client has an allergy to salicylates. Which medication prescription should the nurse​ question? (Select all that​ apply.) A. Choline magnesium trisalicylate​ (Trilisate) B. Meloxicam​ (Mobic) C. Salsalate​ (Mono-Gesic, Salsitab) D. Acetaminophen​ (Tylenol) E. Ketorolac​ (Sprix, Toradol)

A. Choline magnesium trisalicylate​ (Trilisate) B. Meloxicam​ (Mobic) C. Salsalate​ (Mono-Gesic, Salsitab) E. Ketorolac​ (Sprix, Toradol) Clients with a hypersensitivity to aspirin​ (acetylsalicylic acid) will also likely be hypersensitive to other nonsteroidal​ anti-inflammatory drugs​ (NSAIDs). Meloxicam,​ ketorolac, salsalate, and choline magnesium trisalicylate are NSAIDs. Acetaminophen is not an NSAID and would be safe to prescribe.

A client is experiencing a bleeding gastric ulcer. Which medication should the nurse question before​ administering? (Select all that​ apply.) A. Diflunisal B. Etodolac C. Misoprostol​ (Cytotec) D. Ibuprofen​ (Motrin) E. Oxaprozin​ (Daypro)

A. Diflunisal B. Etodolac D. Ibuprofen​ (Motrin) E. Oxaprozin​ (Daypro) ​Etodolac, diflunisal,​ ibuprofen, and oxaprozin are nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) and will further increase the​ client's risk for GI ulcers. Misoprostol is a medication that may be prescribed to provide GI protection.

A client takes acetaminophen​ (Tylenol) for arthritic pain. Which laboratory value should the nurse monitor for this​ client? (Select all that​ apply.) A. Hematocrit B. Alanine aminotransferase​ (ALT) C. Aspartate aminotransferase​ (AST) D. Hemoglobin E. C-reactive protein

A. Hematocrit B. Alanine aminotransferase​ (ALT) C. Aspartate aminotransferase​ (AST) D. Hemoglobin Ibuprofen may increase bleeding time as well as aspartate aminotransferase​ (AST) and alanine aminotransferase​ (ALT) levels. It may decrease hemoglobin and hematocrit.​ C-reactive protein measures the amount of inflammation. It is not affected by acetaminophen use.

A patient's acetaminophen (Tylenol) dose is increased from 325 mg every 6 hours to 650 mg every 4 hours. For which effect should the nurse monitor? A. Hepatotoxicity B. Blood clots C. Reye's syndrome D. Cardiotoxicity

A. Hepatotoxicity Hepatotoxicity is a risk with acetaminophen use, and the risk increases with dose increases and long-term use. Acetaminophen has no effect on platelet aggregation and does not cause cardiotoxicity or Reye's syndrome.

A​ client's medication is switched from celecoxib​ (Celebrex) to ibuprofen​ (Advil, Motrin). Which change should the nurse​ expect? (Select all that​ apply.) A. New onset gastrointestinal​ (GI) irritation B. Increased pain relief C. Decrease in inflammation D. Increased platelet aggregation E. Improved fever control

A. New onset gastrointestinal​ (GI) irritation D. Increased platelet aggregation Ibuprofen is a​ cyclooxygenase-1 (COX-1) and​ cyclooxygenase-2 (COX-2)​ inhibitor, but celecoxib only blocks​ COX-2. Unlike celecoxib​ (Celebrex), ibuprofen​ (Advil, Motrin) can cause platelet aggregation and GI irritation. Since both medications have​ analgesic, anti-inflammatory, and antipyretic​ effects, no change would be expected with respect to those outcomes.

A group of patients have been prescribed a salicylate. For which patient should the nurse question this medication? A. Pending surgery for acute appendicitis B. Suspected myocardial infarction (MI) C. Diagnosis of paroxysmal atrial fibrillation D. Diagnosis of transient ischemic attacks (TIAs)

A. Pending surgery for acute appendicitis Because the antiplatelet action of salicylates is irreversible and increases bleeding risk, the medication should be questioned before surgery. The salicylate aspirin (acetylsalicylic acid) is administered to patients with suspected MI and as stroke prophylaxis for patients with paroxysmal atrial fibrillation and TIAs.

An older client has been prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for acute shoulder pain. Which assessment should the nurse include before administering the​ medication? (Select all that​ apply.) A. Renal function B. Hearing acuity C. Cardiac enzymes D. Bleeding risk E. Cardiovascular risk

A. Renal function B. Hearing acuity D. Bleeding risk E. Cardiovascular risk ​Ibuprofen-like NSAIDs inhibit platelet aggregation and increase the risk for​ bleeding, nephrotoxicity,​ ototoxicity, and myocardial infarction. Cardiac enzymes do not specifically require measuring before starting NSAID therapy.

A client is prescribed aspirin​ (acetylsalicylic acid). Which factor should the nurse recognize increases the risk of gastrointestinal​ (GI) bleeding with this​ medication? (Select all that​ apply.) A. Smoking B. Concurrent acetaminophen​ (Tylenol) use C. Age greater than 40 D. Alcohol use E. Helicobacter pylori infection

A. Smoking D. Alcohol use E. Helicobacter pylori infection ​Smoking, alcohol​ use, and Helicobacter pylori infection increase the risk for​ aspirin-induced GI bleeding. Age greater than​ 60, not​ 40, is a risk factor. The risk for GI bleeding is not increased when acetaminophen​ (Tylenol) is taken with aspirin​ (acetylsalicylic acid), because acetaminophen does not affect platelets.

A patient is prescribed prednisone. Which teaching should the nurse provide? A. Two or more eye exams per year are needed. B. Take the medication on an empty stomach. C. Chew enteric-coated tablets. D. Dark, tarry stools are normal.

A. Two or more eye exams per year are needed. Monitor vision periodically in patients on corticosteroids. These drugs may cause increased intraocular pressure and an increased risk of glaucoma and may cause cataracts. The patient should be instructed to maintain eye exams twice yearly or more frequently as instructed by the healthcare provider. Immediately report any eye pain, rainbow halos around lights, diminished vision, or blurring and inability to focus. The medication should be taken with food or milk to prevent gastrointestinal (GI) irritation. There is not an enteric-coated form of the medication. Dark, tarry stools should be reported to the healthcare provider because this indicates GI bleeding.

The nurse is caring for clients with inflammatory health problems. Which client statement should concern the​ nurse? A. ​"I have been taking a corticosteroid for the past 3​ months." B. ​"I was prescribed ibuprofen after I finished taking a corticosteroid​ medication." C. ​"I take an​ anti-inflammatory medication for ankylosing​ spondylitis." D. "I take an​ anti-inflammatory medication for​ Hashimoto's thyroiditis."

A. ​"I have been taking a corticosteroid for the past 3​ months." Corticosteroids may have serious​ long-term adverse effects and are usually prescribed for only 1 to 3 weeks. The nurse should be concerned if a client has been taking a corticosteroid for the past 3 months. Ankylosing spondylitis and​ Hashimoto's thyroiditis are health problems that may benefit from​ anti-inflammatory medications. If a corticosteroid were prescribed to bring severe inflammation under​ control, a nonsteroidal​ anti-inflammatory medication such as ibuprofen​ (Motrin) may be prescribed after the corticosteroid is finished.

A patient taking an antibiotic for an infection develops a fever. Which should the nurse explain about the reason for the fever? A. "The fever means the infection is getting worse." B. "The antibiotic releases fever-producing chemicals." C. "A fever means that the incorrect antibiotic was prescribed." D. "The fever has nothing to do with the antibiotic."

B. "The antibiotic releases fever-producing chemicals." When antibiotics kill microorganisms, fever-producing chemicals known as pyrogens may be released. Anti-infectives are the most common drugs known to induce fever. The fever does not mean that the infection was getting worse or that the incorrect antibiotic was prescribed. The fever is caused by the antibiotic releasing pyrogens.

The nurse provides a patient with a prescribed antibiotic. Which assessment finding should the nurse expect? A. Pain B. Fever C. Drop in blood pressure D. Increased heart rate

B. Fever When antibiotics kill microorganisms, fever-producing chemicals known as pyrogens may be released. Anti-infectives are the most common drugs known to induce fever. The antibiotic does not cause pain or alters blood pressure or heart rate.

A patient seeks medical attention for an acute inflammatory reaction. Which chemical should the nurse recall is the major chemical mediator of this reaction? A. White blood cells B. Histamine C. Red blood cells D. Immunoglobulins

B. Histamine Histamine is a key chemical mediator of inflammation. It is stored and released by mast cells and causes vasodilation, smooth-muscle constriction, tissue swelling, and itching. Certain white blood cells respond to the site of inflammation however they are not the major chemical mediators of this reaction. Red blood cells are not chemical mediators. Immunoglobulins have a role in immunity.

A patient's medication is changed from acetaminophen (Tylenol) to meloxicam (Mobic). Which patient statement should indicate to the nurse that teaching about the new medication was effective? A. "My risk for bleeding is now lower." B. My joint inflammation should decrease." C. "My risk for stroke is now lower." D. "I can start taking ginger and ginkgo."

B. My joint inflammation should decrease." Acetaminophen is a centrally acting COX inhibitor that has antipyretic and analgesic properties. It is not an anti-inflammatory. Meloxicam is classified as a non-steroidal anti-inflammatory drug (NSAID) which will reduce joint inflammation. The risk for bleeding is the same as acetaminophen. The risk for a stroke is still elevated. Ginger and ginkgo may increase the risk of bleeding and should not be taken with an NSAID.

A client is diagnosed with severe salicylate poisoning. Which treatment prescription should the nurse​ expect? A. Naloxone B. N-acetylcysteine C. Flumazenil D. Urine alkalization

B. N-acetylcysteine Urine alkalization is used for severe salicylate poisoning. Naloxone is the treatment for opioid overdose. Flumazenil is the treatment for benzodiazepine overdose.​ N-acetylcysteine is the treatment for acetaminophen overdose.

A patient seeks medical attention for a new onset of of symptoms. Which symptom should the nurse associate with the release of leukotrienes? A. Flushing B. Sneezing C. Warm dry skin D. Low urine output

B. Sneezing Leukotrienes are stored and released by mast cells. These chemical mediators have similar effects to those of histamine and contribute to symptoms seen in asthma and allergies. Sneezing would be a symptom associated with allergies. Leukotrienes would not cause flushing, warm dry skin, or a low urine output.

A patient is prescribed acetaminophen (Tylenol) to control a fever. Which patient statement should indicate to the nurse that teaching is effective? A. "I can take as many doses of Tylenol as I need to treat my fever." B." I will not drink alcohol while taking the medication." C. "I will decrease my fluid intake while taking the medication D. "I understand that the medication will affect my heart."

B." I will not drink alcohol while taking the medication." Acetaminophen should never be administered to a patient who consumes alcohol due to the potential for drug-induced hepatotoxicity. There is a maximum daily dose for the medication, about which the nurse should inform the patient. The patient does not have to decrease fluid intake while taking acetaminophen. If the patient is taking acetaminophen to treat a fever, fluids should be increased to replace insensible fluid losses. Acetaminophen has the risk of causing liver damage.

The nurse reviews nonsteroidal anti-inflammatory drugs (NSAIDs) with a new colleague. Which statement should indicate to the nurse that teaching is effective?' A. "Not all NSAIDs have analgesic properties." B. "Some NSAIDs do not have antipyretic properties." C. "Most NSAIDs are metabolized in the liver and excreted by the kidneys." D. "NSAIDs decrease the risk for myocardial infarction and stroke."

C. "Most NSAIDs are metabolized in the liver and excreted by the kidneys." Because most NSAIDs are metabolized by the liver to inactive metabolites and are secreted by the kidneys, it is important to periodically monitor the patient's liver and kidney function. All NSAIDs have analgesic and antipyretic properties. A U.S. Food and Drug Administration (FDA) black box warning states that ibuprofen and other NSAIDs are associated with an increased risk of thromboembolic events (including stroke and MI) and that the drugs may cause or worsen HTN.

A patient has been prescribed ibuprofen (Advil, Motrin) for pain. For which symptom should the nurse question the appropriateness of this medication? A. Dental pain B. Rheumatoid arthritis (RA) C. Dysmenorrhea D. Perioperative pain related to coronary artery bypass graft (CABG)

D. Perioperative pain related to coronary artery bypass graft (CABG) NSAIDs such as ibuprofen are contraindicated for the treatment of perioperative pain in those undergoing coronary arterybypass graft surgery. The medication is indicated to treat dental pain, chronic symptomatic RA, and dysmenorrhea.

The nurse is teaching about nonsteroidal​ anti-inflammatory drugs​ (NSAIDs). Which statement should the nurse​ include? A. "Depending on why they are​ given, NSAIDs work differently in the​ body." B. "Most NSAIDs decrease cardiovascular​ risk." C. "Most NSAIDs exhibit the same inhibitory​ actions." D. "NSAIDs effectively treat​ severe, disabling, painful​ inflammation."

C. "Most NSAIDs exhibit the same inhibitory​ actions." Most NSAIDs exhibit the same inhibitory​ actions, meaning they perform the same action in the body​ (inhibiting prostaglandins) whether the inflammation is caused by an​ injury, autoimmune​ disease, or allergy. Since NSAIDs perform the same​ action, they do not work differently in the body.​ NSAIDs, except for​ first-generation salicylates, increase cardiovascular risk. Corticosteroids are most effective at treating​ severe, disabling, painful inflammation.

The nurse is assessing a patient. Which finding should the nurse associate with a release of histamine? A. Bleeding B. Elevated blood glucose C. Area of inflammation D. Low blood pressure

C. Area of inflammation Histamine is a key chemical mediator of inflammation. It is stored and released by mast cells and causes vasodilation, smooth-muscle constriction, tissue swelling, and itching. Histamine does not cause bleeding, raises blood glucose, or lowers blood pressure.

A client is prescribed aspirin​ (acetylsalicylic acid). Which therapeutic response should the nurse​ anticipate? A. Decrease in bacterial growth rate B. Reversal of anticoagulant effect C. Decrease in body temperature D. Relief of severe inflammation

C. Decrease in body temperature A therapeutic response of aspirin is a lower body temperature. Aspirin does not decrease bacterial growth rate. Aspirin is indicated for the relief of mild to moderate​ inflammation, and it may increase the effect of anticoagulants.

A client is prescribed acetaminophen​ (Tylenol). For which therapeutic response should the nurse​ monitor? A. Increase in body temperature B. Decrease in inflammation C. Decrease in moderate pain D. Increase in platelet aggregation

C. Decrease in moderate pain Acetaminophen will decrease moderate pain. Acetaminophen does not decrease inflammation. Since acetaminophen is an​ antipyretic, the medication decreases body temperature. Acetaminophen does not affect platelet aggregation.

A​ client's nonsteroidal​ anti-inflammatory medication is changed from diclofenac​ (Cataflam, Voltaren) to celecoxib​ (Celebrex). Which conclusion should the nurse​ draw? A. Cardiovascular risk will decrease. B. Rheumatoid arthritis​ (RA) will be cured. C. Gastrointestinal​ (GI) irritation may decrease. D. Renal failure is no longer a risk.

C. Gastrointestinal​ (GI) irritation may decrease. The risk for GI​ irritation, GI​ bleeding, and ulcer formation is lower with celecoxib than diclofenac because celecoxib inhibits​ cyclooxygenase-2 (COX-2) but does not inhibit​ cyclooxygenase-1 (COX-1). Cardiovascular events and renal failure are potential risks of both medications. Neither medication cures RA.

The nurse is teaching a client about herbal preparations to avoid when taking ibuprofen​ (Advil, Motrin). Which herb should the nurse include in the​ discussion? (Select all that​ apply.) A. Echinacea B. Saint​ John's wort C. Ginger D. Feverfew E. Garlic

C. Ginger D. Feverfew E. Garlic Herbal medications such as​ feverfew, ginger,​ garlic, and ginkgo increase the risk of bleeding when combined with ibuprofen. Saint​ John's wort and echinacea do not react with ibuprofen. Next question

A client is experiencing inflammation. Which statement should the nurse include when teaching the client about this health​ problem? A. Oral medications are the preferred treatment for inflammation. B. Ice packs and rest are not useful in treating symptoms of inflammation. C. Inflammation is a natural process for ridding the body of antigens. D. Inflammation is a​ self-limiting disease.

C. Inflammation is a natural process for ridding the body of antigens. Inflammation is a​ self-limiting, natural process for ridding the body of antigens. Inflammation is a symptom of an underlying​ disorder; it is not a disease. When​ applicable, topical medications should be used instead of oral medications because they have fewer adverse effects. Ice packs and rest are​ nonpharmacologic, useful treatments for inflammation. Next question

A patient is taking acetaminophen (Tylenol). For which adverse effect should the nurse monitor? A. Dyspepsia B. Tinnitus C. Lethargy D. Blood dyscrasias

C. Lethargy Lethargy is a sign of acute acetaminophen poisoning. Dyspepsia, tinnitus, and blood dyscrasias are adverse effects of nonsteroidal anti-inflammatory drugs.

A patient reports taking a medication to decrease joint inflammation. Which medication should the nurse expect to be prescribed for this patient? A. Acetaminophen (Tylenol) B. Carboprost (Cervidil) C. Meloxicam (Mobic) D. Misoprostol (Cytotec)

C. Meloxicam (Mobic) Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that decreases inflammation. Acetaminophen relieves mild to moderate pain, but does not decrease inflammation. Carboprost and misoprostol are prostaglandins that are not used to decrease joint inflammation.

The nurse reviews data provided on assigned patients. For which patient health problem should the nurse expect a nonsteroidal anti-inflammatory drug (NSAID) to be prescribed? A. Hemophilia B. Chronic kidney disease (CKD) C. Rheumatoid arthritis (RA) D. Hemorrhagic stroke

C. Rheumatoid arthritis (RA) Since an NSAID is the preferred medication class to treat mild to moderate pain, an NSAID will likely first be prescribed if the patient has RA. Because hemophilia is a bleeding disorder, an NSAID should not be prescribed, due to the risk of decreased platelet aggregation and bleeding. NSAIDs are potentially nephrotoxic, can worsen kidney function, and would not be prescribed for a patient with CKD. A hemorrhagic stroke is a type of stroke in which there is bleeding in the brain. An NSAID should not be administered.

A patient is brought to the emergency department for a suspected acetaminophen overdose. Which medication should the nurse prepare to administer to this patient? A. Any alkaline drug B. Dextrose solution C. Oxygen D. N-acetylcysteine (Acetadote)

D. N-acetylcysteine (Acetadote) The specific treatment for overdose of acetaminophen is the oral or intravenous (IV) administration of N-acetylcysteine(Acetadote) as soon as possible after the overdose. This drug protects the liver from toxic metabolites of acetaminophen. An alkaline drug may be used for an overdose of a non-steroidal anti-inflammatory drug. Dextrose solution and oxygen are not used to treat an overdose of acetaminophen.

Which patient health assessment finding would alert the nurse prior to recommending ibuprofen to treat arthritic pain? a. CHF b. Asthma c. Diabetes type II d. Cholelithiasis

b. Asthma

The nurse reviews the use of ibuprofen (Advil, Motrin) with a new colleague. For which statement by the colleague should the nurse provide additional teaching? A. "Ibuprofen decreases cardiovascular risk." B. "Ibuprofen causes fewer gastrointestinal effects than aspirin." C. "It takes 4 hours for ibuprofen to start working." D. "Extra doses of ibuprofen provides better fever control."

D. "Extra doses of ibuprofen provides better fever control." Extra doses of ibuprofen may cause adverse gastrointestinal (GI) effects (e.g., bleeding, anorexia, heartburn, nausea, vomiting, constipation or diarrhea) or adverse central nervous system effects (e.g., dizziness, headache, drowsiness, tinnitus). Unlike aspirin, ibuprofen does not decrease cardiovascular risk. Ibuprofen generally causes fewer GI effects than aspirin (acetylsalicylic acid), and its onset of action is 30 to 60 minutes.

The nurse is counseling an adolescent patient about over-the-counter medications that can be used to treat fever. Which patient statement indicates that teaching is effective? A. "I will not take naproxen, due to the risk of rheumatoid arthritis." B. "I will not take ibuprofen, due to the risk of migraine headaches." C. "I will not take acetaminophen, due to the risk of gastric irritation." D. "I will not take aspirin, due to the risk of Reye's syndrome."

D. "I will not take aspirin, due to the risk of Reye's syndrome." Children under age 19 should never be administered products that contain aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye's syndrome, a potentially fatal disease. Naproxen (Naprosyn), ibuprofen (Motrin), and acetaminophen (Tylenol) can treat fever and can be dosed appropriately for children. Naproxen is a treatment for rheumatoid arthritis. Ibuprofen is a treatment for migraine headaches. Acetaminophen is not expected to cause gastric irritation.

A client is prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for ophthalmic inflammation. Which client statement should indicate to the nurse that teaching was​ effective? A. "My vision may be blurred at​ first, but that should clear​ up." B. "Vomiting is an expected consequence of the​ medication." C. "The medication will turn my urine a darker​ color." D. "My feet should not swell while taking the​ medication."

D. "My feet should not swell while taking the​ medication." Edema is not expected or a desired response of NSAID therapy. Edema and​ dark-colored urine indicates the NSAID is affecting the​ client's renal system. Vomiting and blurred vision are not expected responses of the​ medication; they are both adverse effects that should be reported to the healthcare provider.

A client is prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for rheumatoid arthritis. For which client statement should the nurse provide​ follow-up teaching? A. "I know that some medications interact with​ NSAIDs." B. "I should not take a corticosteroid and NSAID​ together." C. "It is not safe to take an NSAID during​ pregnancy." D. "Taking two NSAIDs together will provide greater pain​ relief."

D. "Taking two NSAIDs together will provide greater pain​ relief." Taking two NSAIDs together should be avoided as this may cause serious adverse gastrointestinal​ (GI) effects. Since NSAIDs are pregnancy category C or D​ (depending on the trimester and specific​ NSAID) they are not safe for use during pregnancy. Certain medications​ (e.g., digoxin,​ lithium, beta​ blockers, anticoagulants) can interact with NSAIDs. Taking an NSAID with a corticosteroid may cause serious adverse GI effects.

A client is prescribed aspirin​ (acetylsalicylic acid) for fever control. Which client risk factor should the nurse address before administering the​ medication? A. Myocardial infarction​ (MI) B. Arterial thromboembolism C. Stroke D. Gastrointestinal​ (GI) bleeding

D. Gastrointestinal​ (GI) bleeding A potential adverse effect of aspirin is GI​ bleeding, and this risk increases with higher doses. The risk versus benefit of the medication should be considered. Aspirin is often used as prophylaxis for clients at risk for​ stroke, MI, and arterial thromboembolism.

The nurse discusses the pathophysiology of inflammation. Which statement about severe inflammation should the nurse emphasize? A. It has an immediate onset. B. Can last between 8 to 10 days. C. Causes a release of chemicals from the gastrointestinal tract. D. Lymphocytes and macrophages are the primary cause.

D. Lymphocytes and macrophages are the primary cause. Lymphocytes and macrophages are the primary cause of severe inflammation. Acute inflammation has an immediate onset and can last between 8 to 10 days. An influx of neutrophils results in acute inflammation. Histamine is released in response to acute inflammation.

A patient is taking aspirin (acetylsalicylic acid). Which effect should the nurse consider? A. The risk for bleeding is localized to the gastrointestinal (GI) tract. B. The medication causes increased prostaglandin production. C. Renal blood flow through the kidneys increases. D. The medication has prolonged antiplatelet action.

D. The medication has prolonged antiplatelet action. The antiplatelet action of aspirin may be prolonged because aspirin is a potent inhibitor of thromboxane, a substance secreted by platelets. The inhibition of thromboxane is particularly prolonged in platelets; a single dose of aspirin may cause total inhibition for the entire 8- to 11-day lifespan of a platelet. Bleeding can occur in the GI tract, but it can also occur in other sites. Aspirin inhibits the synthesis of prostaglandins. Prostaglandins help maintain blood flow through the kidneys, so blocking the synthesis of prostaglandins does not cause increased renal blood flow through the kidneys.

The nurse has provided education for a client prescribed a nonsteroidal anti-inflammatory. Which statement made by the client indicates an understanding of the information? a. "I will make sure I increase my fluid intake." b. "I may experience dark tarry stools." c. "If I experience lightheadedness I will sit down immediately." d. "I will cut back on my alcohol intake while taking this prescription."

a. "I will make sure I increase my fluid intake." NSAIDs can produce nephrotoxicity. The client should be instructed to increase their fluid intake to help clear the drug from their system.

Which education should the nurse provide a client that has been prescribed a second 10-day course of a corticosteroid? Select all that apply. a. "Make certain you do weight-bearing exercises at least three times each week." b. "Weigh yourself every day." c. "Let us know if you develop a fever." d. "Monitor the color of your urine." e. "If you feel jittery or anxious, discontinue the medication."

a. "Make certain you do weight-bearing exercises at least three times each week." b. "Weigh yourself every day." c. "Let us know if you develop a fever."

Which education should the nurse provide a client that has been prescribed a second 10-day course of a corticosteroid? Select all that apply. a. "Make certain you do weight-bearing exercises at least three times each week." b. "Weigh yourself every day." c. "Let us know if you develop a fever." d. "Monitor the color of your urine." e. "If you feel jittery or anxious, discontinue the medication."

a. "Make certain you do weight-bearing exercises at least three times each week." b. "Weigh yourself every day." c. "Let us know if you develop a fever." Corticosteroid may affect bone density. Weight-bearing exercises help to prevent this effect. Corticosteroids may result in fluid retention. Daily weights help to monitor this effect. Corticosteroids can result in immune depression.

Which client statement made by the client indicates the treatment with an anti-inflammatory has been successful? Select all that apply. a. "My fever went away yesterday." b. "I've not been coughing up so much phlegm." c. "The skin over my knee is only slightly red and hot to the touch." d. "The pain in my shoulder is gone." e. "My rash has not spread any further."

a. "My fever went away yesterday." d. "The pain in my shoulder is gone." Fever reduction is a goal of treatment with an anti-inflammatory prescription. Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory prescription has been successful.

A client tells the nurse they would prefer to indefinitely take prednisone to treat their inflammatory disease. Which is the best response by the nurse? a. "This is not recommended due to the serious side effects." b. "The best treatment for your condition is to alternate prescriptions." c. "The prescription will lose its effect after your body builds up a tolerance to it." d. "When you experience remission you will not need the prescription."

a. "This is not recommended due to the serious side effects." Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects.

A client with severe inflammation of the knee prescribed a corticosteroid asks why they need to return to the clinic for a 10-day follow-up. Which information should the nurse provide the client? Select all that apply. a. "Your prescribed treatment will be evaluated." b. "The knee should be re-examined." c. "Corticosteroids should only be taken for 1 to 3 weeks." d. "Your prescription may be changed to an NSAID." e. "You may require additional treatment for several more weeks with a corticosteroid."

a. "Your prescribed treatment will be evaluated." b. "The knee should be re-examined." c. "Corticosteroids should only be taken for 1 to 3 weeks." d. "Your prescription may be changed to an NSAID." The client's prescribed treatment will be evaluated at the follow-up visit. The client's knee should be reexamined to ensure no complications have occurred. Corticosteroid therapy can have serious adverse effects if taken for extended periods of time. The client should be switched to an NSAID as soon as possible.

Which symptom should the nurse instruct the client prescribed a salicylate to report immediately to the healthcare provider? a. Edema b. Drowsiness c. Fatigue d. Decreased urine output e. Darkening of urine

a. Edema d. Decreased urine output e. Darkening of urine Salicylates may be nephrotoxic so the client should be instructed to immediately report changes in the quantity of urine output, darkening of urine, or edema. Salicylates may be nephrotoxic so the client should be instructed to immediately report changes in the quantity of urine output, darkening of urine, or edema. Salicylates may be nephrotoxic so the client should be instructed to immediately report changes in the quantity of urine output, darkening of urine, or edema.

Which information in the health history should the nurse be concerned about for a client prescribed ibuprofen for a mild ankle sprain? Select all that apply. a. Hypertension b. History of injury to the same ankle c. Alcohol abuse d. Allergy to aspirin e. Recent history of a peptic ulcer

a. Hypertension c. Alcohol abuse d. Allergy to aspirin e. Recent history of a peptic ulcer Ibuprofen should be used cautiously in a client with hypertension. A history of alcohol abuse is of concern for the client prescribed ibuprofen. The client is at risk for bleeding if they are currently consuming alcohol and if there is any residual damage to the liver from alcohol abuse, this further increases the client's risk for bleeding. Clients who have an allergy to aspirin are more likely to be hypersensitive to ibuprofen. Ibuprofen increases the risk of serious gastrointestinal bleeding, especially in someone with a recent history of a peptic ulcer.

A client tells the nurse they have been taking aspirin to treat muscle pain. Based on this statement, which findings in the client's history should the nurse be concerned about? Select all that apply. a. Myocardial infarction at age 61 b. Helicobacter pylori infection treatment last month c. No influenza vaccine in last 2 years d. Mild hypertension e. History of migraine headaches

a. Myocardial infarction at age 61 b. Helicobacter pylori infection treatment last month Clients over age 60 are at higher risk of aspirin-induced GI bleeding. Clients with Helicobacter pylori infection are at higher risk of aspirin-induced GI bleeding.

A client tells the nurse they have been taking aspirin to treat muscle pain. Based on this statement, which findings in the client's history should the nurse be concerned about? Select all that apply. a. Myocardial infarction at age 61 b. Helicobacter pylori infection treatment last month c. No influenza vaccine in last 2 years d. Mild hypertension. e. History of migraine headaches

a. Myocardial infarction at age 61 b. Helicobacter pylori infection treatment last month d. Mild hypertension

Which complementary medicine has been studied and shown to lower triglyceride levels? a. Omega-3 b. St. John's Wort c. CoQ10 d. B12

a. Omega-3

Which prescription may be a causative factor in a client's fever of unknown origin? Select all that apply. a. Paroxetine (Paxil) b. Chlorpromazine (Thorazine) c. Penicillin G d. Metformin (Glucophage) e. Furosemide (Lasix)

a. Paroxetine (Paxil) b. Chlorpromazine (Thorazine) c. Penicillin G SSRIs may result in high fever. Conventional antipsychotic drugs can result in neuroleptic malignant syndrome. Penicillin G may be seen as a foreign body and produce a fever.

Which findings are symptoms of inflammation? Select all that apply. a. Redness b. Warmth c. Itching d. Rash e. Pain

a. Redness b. Warmth c. Itching e. Pain Redness occurs from antigen reaction during inflammation. Warmth occurs as a result of vasodilation during inflammation. Itching occurs as a result of the histamine that is released. Pain is associated with inflammation.

Which describes the mechanism of action of corticosteroids on the inflammatory response? Select all that apply. a. Suppress the release of histamine b. Inhibit certain functions of phagocytes c. Inhibit the release of C-Reactive protein d. Inhibit the biosynthesis of prostaglandins e. Inhibit certain functions of lymphocytes

a. Suppress the release of histamine b. Inhibit certain functions of phagocytes d. Inhibit the biosynthesis of prostaglandins e. Inhibit certain functions of lymphocytes Corticosteroids suppress the release of histamine. Corticosteroids inhibit certain functions of phagocytes. Corticosteroids inhibit biosynthesis of prostaglandins. Corticosteroids inhibit certain functions of lymphocytes

Which describes the mechanism of action of corticosteroids on the inflammatory response? Select all that apply. a. Suppress the release of histamine. b. Inhibit certain functions of phagocytes. c. Inhibit the release of C-Reactive protein. d. Inhibit the biosynthesis of prostaglandins. e. Inhibit certain functions of lymphocytes.

a. Suppress the release of histamine. b. Inhibit certain functions of phagocytes. d. Inhibit the biosynthesis of prostaglandins. e. Inhibit certain functions of lymphocytes.

Which signs of inflammation should the nurse anticipate for a client that has experienced a sports-related injury to their leg? Select all that apply. a. Swelling b. Pain c. Warmth d. Pallor e. Pitting edema

a. Swelling b. Pain c. Warmth Swelling is a sign of inflammation. Pain is a sign of inflammation. Warmth is a sign of inflammation.

Which instructions should the nurse include in the teaching for a client prescribed aspirin (ASA)? a. Take the aspirin with a glass of milk. b. Discontinue taking the aspirin if you experience stomach upset. c. Take the aspirin with orange juice in the morning. d. Take the aspirin on an empty stomach in the morning.

a. Take the aspirin with a glass of milk. Aspirin should be taken with milk or food to avoid GI upset.

Acetaminophen has no effect on platelet aggregation and does not cause bleeding. a. True b. False

a. True

NSAIDS are implicated in nearly 25% of all adverse drug reactions a. True b. False

a. True

For which finding should the nurse notify the healthcare provider for a client prescribed prednisone? a. Unexplained fever b. History of heart failure c. Asthma d. Arthritis

a. Unexplained fever Prednisone should not be used in a client with a suspected systemic infection. An unexplained fever is concerning and the healthcare provider should be notified immediately.

Which information should the nurse include in the explanation of inflammation for a client? Select all that apply. a. When cells are damaged, nearby vessels get bigger. b. The vessels in the area allow fluids to escape. c. Inflammation produces pus. d. Inflammation causes bleeding and the inability to clot. e. Inflammation causes pain.

a. When cells are damaged nearby vessels get bigger. b. The vessels in the area allow fluids to escape. c. Inflammation produces pus. e. Inflammation causes pain. Histamine and other chemical mediators are released and result in vasodilation. Vessels become more permeable. Pus develops from cellular infiltration and death of white cells. Inflammation damages tissues, stimulating nerve endings and causing pain.

The nurse has provided education about the action of histamines for a client. Which statement indicates an understanding of the information? a. "Histamine is inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs)." b. "Histamine dilates the vessels in the nose, so it is congested and stuffy." c. "Histamine constricts vessels, causing capillaries to become more permeable." d. "Histamine is primarily stored in phagocyte cells in the skin."

b. "Histamine dilates the vessels in the nose, so it is congested and stuffy." Histamine dilates blood vessels causing capillaries to become more permeable. The affected area may become congested with blood.

Which statement should the nurse include in the parental teaching for the administration of acetaminophen (Tylenol) to a child? a. "Acetaminophen (Tylenol) should be administered with a high-carbohydrate meal." b. "Read the labels of all over-the-counter medications for the amount of acetaminophen (Tylenol)." c. "Due to the lasting effects, acetaminophen (Tylenol) should only be given to children once a day." d. "Baby aspirin can be substituted for acetaminophen (Tylenol)."

b. "Read the labels of all over-the-counter medications for the amount of acetaminophen (Tylenol)." All prescription labels should be evaluated for the amount of acetaminophen to avoid overdosing the child.

Which laboratory tests should the nurse anticipate evaluating prior to a client receiving ibuprofen (Advil) for long-term therapy? Select all that apply. a. Electrolytes b. Hemoglobin and hematocrit c. Bleeding times d. Liver function tests e. Serum amylase

b. Hemoglobin and hematocrit c. Bleeding times d. Liver function tests Ibuprofen may result in a decrease in hemoglobin and hematocrit. Baseline levels should be documented. Ibuprofen may increase bleeding times. Baseline values should be documented. AST and ALT may be increased so it is important to document baseline levels.

Which describes the mechanism of action for Ibuprofen (Advil)? a. Directly acts on the hypothalamus b. Inhibition of prostaglandin synthesis c. Blocks pain impulses sent to the brain d. Decreases stimulation of sensory nerve fibers

b. Inhibition of prostaglandin synthesis Anti-inflammatory drugs such as ibuprofen inhibit the synthesis of prostaglandins.

Which should the nurse monitor a client for that is receiving a salicylate? Select all that apply. a. Neurotoxicity b. Ototoxicity c. Nephrotoxicity d. Cardiotoxicity e. Pulmonary toxicity

b. Ototoxicity c. Nephrotoxicity Salicylates may be ototoxic. The client should be monitored for tinnitus, difficulty hearing, light headedness, or difficulty with balance. Urine output and periodic kidney functions should be evaluated because salicylates may be nephrotoxic during long-term or high-dose therapy.

Which of the client's current prescriptions should the nurse consult the healthcare provider about who has prescribed acetaminophen (Tylenol) four times a day? a. Heparin 5000 units subcutaneously every 8 hours b. Warfarin (Coumadin) 2 mg orally every day c. Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time d. Paroxetine (Paxil) 37.5 mg orally every day

b. Warfarin (Coumadin) 2 mg orally every day Acetaminophen inhibits the metabolism of warfarin. Concomitant use of these two medications could result in a toxic accumulation of warfarin.

Which statement made by a client indicates an understanding of the maximum daily amount of ibuprofen (Motrin)? a. "I cannot take over 4000 mg/day." b. "I cannot take over 3600 mg/day." c. "I cannot take over 3200 mg/day." d. "I cannot take over 3000 mg/day."

c. "I cannot take over 3200 mg/day." The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg.

A client that is experiencing inflammation from an injury asks the nurse how long it will take to respond to treatment. Which is the best response by the nurse? a. "With proper care, it will take about a month for symptoms to resolve." b. "It will depend on your response to the prescriptions." c. "It will take about a week and a half for the symptoms to resolve." d. "The inflammatory process is too complex to predict a time frame for healing."

c. "It will take about a week and a half for the symptoms to resolve." During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin.

Which statement should the nurse include in the education for a client prescribed a nonsteroidal anti-inflammatory drug (NSAID)? a. "Constipation is common; include roughage in your diet." b. "Dizziness may occur due to a decrease in blood pressure." c. "Take your medication with food." d. "The prescription may exacerbate your asthma."

c. "Take your medication with food." Taking the medication with food will decrease gastrointestinal irritation.

Which should a client be monitored for when prescribed a glucocorticoid? a. Hypoglycemia b. Hypotension c. Bruising d. Weight loss

c. Bruising Long-term glucocorticoid use can result in the susceptibility to bruising.

Which is an early laboratory marker of inflammation? a. Prostaglandins b. Bradykinin c. C-Reactive protein d. Histamine

c. C-Reactive protein C-Reactive protein is a protein that is found in the plasma and is an early marker of inflammation.

Which describes the direct action of acetaminophen (Tylenol) for fever reduction? Select all that apply. a. Constriction of peripheral blood vessels b. Increase activity of the sweat glands c. Dilation of peripheral blood vessels d. Direct action at the level of the hypothalamus e. Decreases tissue inflammation

c. Dilation of peripheral blood vessels d. Direct action at the level of the hypothalamus Acetaminophen reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels, which enables sweating and dissipation of heat. Acetaminophen reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels, which enables sweating and dissipation of heat.

Which finding is a common adverse effect of an anti-inflammatory prescription? a. Diarrhea b. Palpitations c. Heartburn d. Hypotension

c. Heartburn Heartburn and other GI upset are common adverse effects of anti-inflammatory prescriptions.

Which outcome should the nurse include in the plan of care for the older client receiving nonsteroidal anti-inflammatory drug (NSAID) therapy? a. The client will refrain from taking other medications with the nonsteroidal anti- inflammatory drug (NSAID). b. The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID). c. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). d. The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).

c. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). Older adults are at risk for increased bleeding with nonsteroidal anti-inflammatory drug therapy.

A client asks the nurse if they can use liquid acetaminophen (Tylenol) that is used for an older child for their 4-month-old baby with a fever. Which response should the nurse provide? a. "Infants should not be given acetaminophen (Tylenol) because it damages the liver." b. "You can use the same medication, just use half the recommended dosage." c. "You can use the same prescription for both children." d. "Infant drops should be used because they are different from liquid medicine."

d. "Infant drops should be used because they are different from liquid medicine." Infant drops should be used because it has a different concentration than the children's formula.

When teaching a patient about interactions while taking ibuprofen for pain, which of the following herbs increases the risk for bleeding? a. Bergamot b. Oregano c. Marjoram d. Gingko

d. Gingko

Aspirin belongs to the chemical family known as ________________.

salicylates