NCLEX Ch 33

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

"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.

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? "They block calcium release within the muscle." "They block the neuromuscular junction." "They inhibit the synthesis of prostaglandins." "They work directly at the site of pain."

"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.

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? Cardiotoxicity Blood clots Reye's syndrome Hepatotoxicity

Hepatotoxicity Rationale: Excessive doses of acetaminophen or regular consumption of alcohol may increase the risk of hepatotoxicity when acetaminophen is used.

The nurse teaches a patient about acetaminophen (Tylenol) prescribed for fever control. For which patient statement should the nurse provide additional teaching? "I can repeat dosing every 2 to 3 hours." "I will read the ingredients of all over-the-counter medications that I take." "It will take 30 minutes for the medication to start working." "The medication should not affect my hearing."

"I can repeat dosing every 2 to 3 hours." Acetaminophen doses can be repeated every 4-6 hours, not every 2-3 hours. Too-frequent dosing increases the risk for hepatotoxicity. The patient should be instructed to read the ingredients of all over-the-counter (OTC) medications because OTC cough and cold medications often contain acetaminophen. The medication's onset of action is 30 to 60 minutes. Ototoxicity is not a risk with acetaminophen.

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

"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 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? "It causes gastrointestinal ulcers." "It does not decrease inflammation." "It increases the risk for heart attack and death." "It is recommended only to treat fevers."

"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 patient with a history of hypertension is to start drug therapy for rheumatoid arthritis. Which drug(s) would be contraindicated, or used cautiously, for this patient? (Select all that apply.) 1. Aspirin 2. Ibuprofen (Advil, Motrin) 3. Acetaminophen (Tylenol) 4. Naproxen (Aleve) 5. Methylprednisolone (Medrol)

2, 4, 5 Rationale: NSAIDs such as ibuprofen and naproxen have been shown to increase the risk of serious thrombotic events, MI, and stroke which can be fatal. These drugs should be used cautiously or avoided in patients with HTN. Corticosteroids such as methylprednisolone may cause fluid retention, which may increase the patient's blood pressure. Cautious and frequent monitoring will be required if the patient takes this drug. Options 1 and 3 are incorrect. Aspirin or acetaminophen will not increase the patient's blood pressure. Acetaminophen would only provide pain relief without treating the underlying inflammation associated with RA.

The nurse is counseling a mother regarding antipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? 1. It is not as good an antipyretic as is acetaminophen. 2. It may increase fever in children under age 10. 3. It may produce nausea and vomiting. 4. It increases the risk of Reye's syndrome in children under 19 with viral infections.

4 Rationale: Aspirin and salicylates are associated with an increased risk of Reye's syndrome in children under 19, especially in the presence of viral infections. Options 1, 2, and 3 are incorrect. Acetaminophen is not significantly different from aspirin or salicylates for the treatment of fever. Use of aspirin or salicylates should not increase fever although it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason.

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

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.

A nurse is caring for 9-year-old child who is brought in to the clinic by the parent for uncontrolled high fever. The parent reports administering over-the-counter children's aspirin the last 5 days to manage the child's fever. What should be the nurse's priority assessment of this client? a. Symptoms of Reye syndrome b. Cardiovascular status c. Hepatic and kidney functions d. Metabolic alkalosis

a. Symptoms of Reye syndrome

A client is prescribed dexamethasone (Decadron) 2 mg twice daily by mouth. Which important point should the nurse include when teaching the client about taking this medication? a. Report changes in hearing or ringing in the ears. b. Avoid abrupt withdrawal of the medication. c. St. John's wort can increase drug levels. d. Do not use saline nasal sprays while on this drug.

b. Avoid abrupt withdrawal of the medication.

A client receiving chemotherapy treatment for leukemia has been taking prednisone for the last 6 months. During the assessment, the nurse concludes that the client may be experiencing adrenal crisis based on which findings? a. Hyperglycemia with polyuria and polydipsia b. Shortness of breath and shallow respirations c. Profound hypotension and increased heart rate d. Eye pain accompanied by visual disturbances

c. Profound hypotension and increased heart rate

The nurse is counseling a mother regarding antipyretic choices for her 8-year old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? a. It is not as good an antipyretic as is acetaminophen b. It may increase fever in children under age 10 c. It may produce nausea and vomiting d. It increases the risk of Reye's syndrome in children under 19 with viral infections

d. It increases the risk of Reye's syndrome in children under 19 with viral infections

The nurse reviews medication prescriptions for patients seen in the community health clinic. For which situation should the nurse intervene if aspirin (acetylsalicylic acid) is prescribed? A 35-year-old patient stopped taking horse chestnut. A 55-year-old patient is at high risk for colorectal cancer .An adolescent patient has a fever and influenza. A 45-year-old patient currently takes a proton pump inhibitor (PPI) medication

An adolescent patient has a fever and influenza .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. Colorectal cancer prevention is an off-label use of aspirin. A PPI medication provides some degree of protection against gastrointestinal damage from aspirin by reducing stomach acid secretion. Because horse chestnut can increase the risk of bleeding when taken with aspirin (acetylsalicylic acid), stopping the herbal medication helps lower bleeding risk.

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

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

C-reactive protein

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

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.

Acetaminophen reduces fever by 1. directly acting on the hypothalamus. 2. inhibiting prostaglandins. 3. blocking impulses to the brain. 4. affecting nerve fibers.

Correct Answer: 1 Rationale 1: Acetaminophen (Tylenol) directly acts on the fever center of the hypothalamus and dilates peripheral blood vessels. Rationale 2: Anti-inflammatory drugs such as ibuprofen (Advil) inhibit prostaglandins. Rationale 3: Blocking impulses to the brain is not a mechanism of action of drugs for inflammation and fever. Rationale 4: Acetaminophen dilates blood vessels, not nerve fibers.

A client is taking aspirin (ASA) for arthritis. The nurse will advise the client to take the medication 1. with a glass of milk. 2. with other medications. 3. with orange juice at bedtime. 4. on an empty stomach in the morning.

Correct Answer: 1 Rationale 1: Aspirin is an acid, which can cause GI distress, so it is best to take it with milk or food. Rationale 2: Several medications can interact with aspirin. Rationale 3: Orange juice is highly acidic, and so can increase the risk for GI distress. Rationale 4: Taking aspirin on an empty stomach can increase the risk of gastric acid production.

Type: MCSA The client has been taking hydrocortisone (Cortef) for a month, and abruptly stops it. What will the best assessment by the nurse include? 1. Fatigue and anorexia 2. Hyperglycemia and depression 3. Dilated pupils and auditory hallucinations 4. Tachycardia and weight gain

Correct Answer: 1 Rationale 1: Glucocorticoids must be discontinued gradually. Abrupt withdrawal can result in acute lack of adrenal function. Fatigue and anorexia are signs of adrenal insufficiency. Rationale 2: Hyperglycemia and depression are not signs of adrenal insufficiency. Rationale 3: Dilated pupils and auditory hallucinations are not signs of adrenal insufficiency. Rationale 4: Tachycardia and weight gain are not signs of adrenal insufficiency.

The nurse teaches clients with rheumatoid arthritis about the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse evaluates that education has been effective when the clients make which statement? 1. We must have our blood tests monitored with this medication. 2. We must be careful about falling with this medication. 3. We must take the medicine just as the doctor said to take it. 4. We must be sure and keep all scheduled doctors appointments.

Correct Answer: 1 Rationale 1: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause bleeding, so blood tests must be monitored. Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cause sedation, so falling is not a concern. Rationale 3: Taking the medication as prescribed is important, but this does not address the side effects. Rationale 4: Keeping scheduled doctors appointments is important, but this does not address the side effects.

The client receives prednisone as treatment for his inflammatory disease. He has experienced great relief and asks the nurse if he can just keep taking this medication. What is the best response by the nurse? 1. No, because this medication has serious adverse effects. 2. No, your doctor said the best treatment for your illness is to alternate medications. 3. No, your body would get used to it and it would lose its effectiveness. 4. No, because your illness is in remission and you dont need medication now.

Correct Answer: 1 Rationale 1: Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects. Rationale 2: Medications are alternated due to the serious effects of glucocorticoids, not because this is the best treatment for the illness. Rationale 3: The body does not get used to systemic glucocorticoids. Rationale 4: There is no evidence that the clients illness is in remission.

The client experienced a sports-related injury to his leg. During the morning assessment, what signs of inflammation will the nurse most likely assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Swelling 2. Pain 3. Warmth 4. Pallor 5. Pitting edema

Correct Answer: 1,2,3 Rationale 1: Swelling is a sign of inflammation. Rationale 2: Pain is a sign of inflammation. Rationale 3: Warmth is a sign of inflammation. Rationale 4: Pallor is not a sign of inflammation; redness is. Rationale 5: Pitting edema is not a sign of inflammation

A client presents with a rash and is prescribed an over-the-counter ointment for treatment. The client says, I thought I would need a shot or an expensive prescription. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Medications that go on your skin dont usually have as many side effects. 2. Mild rashes often respond well to topical ointments. 3. Many of the products used on the skin are available over-the-counter. 4. You should try to discover what caused your rash. 5. Prescription ointments are usually better at healing.

Correct Answer: 1,2,3,4 Rationale 1: Topical drugs should be used when applicable because they cause few adverse effects. Rationale 2: Inflammation of the skin is best treated with topical medication if possible. Rationale 3: Many products used on the skin are fairly inexpensive and are available over-the-counter. Rationale 4: Inflammation is not a disease, but is a symptom. The cause of the inflammation should be identified and treated. In this case, the client should avoid the offending substance. Rationale 5: Many over-the-counter anti-inflammatory medications exist and do a good job of helping the client heal.

Which client statement would the nurse evaluate as indicating the goal of treatment with an anti-inflammatory drug has been met? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. My fever went away yesterday. 2. Ive not been coughing up so much phlegm. 3. The skin over my knee is red and hot to the touch. 4. The pain in my shoulder is much relieved. 5. My rash is spreading.

Correct Answer: 1,4 Rationale 1: Fever reduction is a goal of treatment with anti-inflammatory drugs. Rationale 2: Reduction of secretions is not a goal of treatment with anti-inflammatory drugs. Rationale 3: Redness and heat are symptoms of inflammation. The therapy may not be working in this client. Rationale 4: Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory medication is working. Rationale 5: The goal of anti-inflammatory medications would be that the rash resolved. Since it is spreading, the goal has not been met.

A client has just been prescribed ibuprofen for a mild ankle sprain. Which health history information should alert the nurse to question this prescription? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client has asthma. 2. The client had a similar ankle strain a year ago. 3. The client reports getting a rash when eating strawberries. 4. The client is allergic to aspirin. 5. The client reports having a peptic ulcer 6 months ago.

Correct Answer: 1,4,5 Rationale 1: Clients with asthma are more likely to have hypersensitivity to ibuprofen. Rationale 2: There is no reason a previous injury would change the decision to prescribe ibuprofen. Rationale 3: There is no cross-sensitivity between ibuprofen and strawberries. Rationale 4: Clients who have an allergy to aspirin are more likely to be hypersensitive to ibuprofen. Rationale 5: Ibuprofen increases the risk of serious gastrointestinal bleeding, especially in someone with a recent history of this problem.

The client receives a nonsteroidal anti-inflammatory drug (NSAID) for treatment of arthritis. What is a priority for the nurse to include when doing medication education? 1. Constipation is common; include roughage in your diet. 2. Drink at least eight glasses of water a day. 3. Take your medication with food. 4. Take your medication on an empty stomach.

Correct Answer: 2 Rationale 1: Constipation is not an issue with nonsteroidal anti-inflammatory drugs (NSAIDS). Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDS) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage. Rationale 3: Taking the medication with food will decrease gastrointestinal (GI) irritation, but kidney damage is more of a priority. Rationale 4: Taking the medication on an empty stomach will increase gastrointestinal (GI) irritation.

The nurse conducts group education for clients with seasonal allergies, and teaches about the role of histamine. The nurse evaluates that the education has been effective when the clients make which statement? 1. Histamine is inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs). 2. Histamine dilates the vessels in the nose, so it is congested and stuffy. 3. Histamine constricts vessels, causing capillaries to become more permeable. 4. Histamine is primarily stored in phagocyte cells in the skin.

Correct Answer: 2 Rationale 1: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins, and do not affect histamine. Rationale 2: Histamine dilates blood vessels causing capillaries to become more permeable. The affected area may become congested with blood. Rationale 3: Histamine dilates, not constricts, vessels, causing capillaries to become more permeable. Rationale 4: Histamine is primarily stored in mast cells, not phagocyte cells.

The physician orders acetaminophen (Tylenol) for a client with a fever. The nurse would plan to validate which other order with the physician? 1. Heparin 5,000 units subcutaneously every 8 hours 2. Warfarin (Coumadin) 2 mg orally every day 3. Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time 4. Paroxetine (Paxil) 37.5 mg orally every day

Correct Answer: 2 Rationale 1: There is no contraindication to the use of heparin and acetaminophen (Tylenol). Rationale 2: Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin). Rationale 3: There is no contraindication to the use of penicillin G benzathine (Bicillin LA) and acetaminophen (Tylenol). Rationale 4: There is no contraindication to the use of paroxetine (Paxil) and acetaminophen (Tylenol).

The nurse plans to teach a class on acetaminophen (Tylenol) to mothers with young children. What will the best plan by the nurse include? 1. It is best to give your child acetaminophen (Tylenol) with a high-carbohydrate meal. 2. Read the labels of all over-the-counter (OTC) medications for the amount of acetaminophen (Tylenol) in them. 3. Acetaminophen (Tylenol) will only need to be given once a day because it is long-lasting. 4. It is okay to substitute a baby aspirin for acetaminophen (Tylenol) if you run out of acetaminophen (Tylenol).

Correct Answer: 2 Rationale 1: There is no indication that Tylenol should be given with high-carbohydrate foods. Rationale 2: It is very easy for parents of young children to overdose them with acetaminophen (Tylenol). All medication labels should be read. Rationale 3: The duration of action of acetaminophen (Tylenol) is only 34 hours. Rationale 4: Aspirin is not recommended for children due to the possibility of Reyes Syndrome.

A client presents with severe inflammation of the knee. The physician prescribes a corticosteroid and asks the client to return to the office in 10 days for follow-up. How does the nurse explain these instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. We need to check to see if this is the correct treatment. 2. We need to re-examine the knee after a few days of treatment. 3. Corticosteroids should only be taken for 1 to 3 weeks. 4. You may be able to change to an NSAID at that visit. 5. You may need a 3 month prescription for a stronger corticosteroid at that time.

Correct Answer: 2,3,4 Rationale 1: There is no evidence that treatment is not correct. Rationale 2: It is necessary to see if the treatment is working. Rationale 3: Corticosteroid therapy can have serious adverse effects if taken for extended periods of time. Rationale 4: The client should be switched to an NSAID as quickly as possible. Rationale 5: Corticosteroid therapy should be discontinued after 13 weeks.

The nurse is managing care for clients who will receive ibuprofen (Advil) for long term therapy. What are the primary laboratory tests the nurse will assess prior to initiation of therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electrolytes 2. Hemoglobin and hematocrit 3. Bleeding times 4. Liver function tests 5. Serum amylase

Correct Answer: 2,3,4 Rationale 1: There is no specific reason to monitor the clients electrolytes. Rationale 2: Ibuprofen may result in a decrease in hemoglobin and hematocrit. Baseline levels should be documented. Rationale 3: Ibuprofen may increase bleeding times. Baseline values should be documented. Rationale 4: AST and ALT may be increased so it is important to document baseline levels. Rationale 5: It is not necessary to draw baseline serum amylase levels.

The client has experienced a sports-related injury. He asks the nurse how long it will take for him to heal and feel better. What is the best response by the nurse? 1. With proper care, it will take about a month for symptoms to resolve. 2. It will depend on your response to the medications. 3. It will take about a week and a half for symptoms to resolve. 4. The inflammatory process is too complex to predict a time frame for healing.

Correct Answer: 3 Rationale 1: A month is longer than it takes for acute symptoms to resolve. Rationale 2: Medications will relieve some symptoms, but the time frame for repair to begin is the same. Rationale 3: During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin. Rationale 4: The inflammatory process is complex, but the time frame is still 8 to 10 days.

A client is placed on aspirin. A toxic reaction to this medication that the nurse will teach the client to report is 1. blurred vision. 2. muscle cramps. 3. tinnitus. 4. joint pain.

Correct Answer: 3 Rationale 1: Blurred vision is not a sign of toxicity. Rationale 2: Muscle cramps are not a sign of toxicity. Rationale 3: Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity. Rationale 4: Joint pain is not a sign of toxicity.

Which of the following is a common adverse effect of anti-inflammatory drugs, such as ibuprofen? 1. Diarrhea 2. Palpitations 3. Heartburn 4. Hypotension

Correct Answer: 3 Rationale 1: Diarrhea is not a common adverse effect. Rationale 2: Palpitations are not an adverse effect. Rationale 3: Heartburn and other GI upset are common adverse effects of these drugs. Rationale 4: Hypotension is not an adverse effect.

The nurse plans care for the elderly client receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. What is the best outcome for this client as it relates to side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)? 1. The client will refrain from taking other medications with the nonsteroidal anti-inflammatory drug (NSAID). 2. The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID). 3. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). 4. The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).

Correct Answer: 3 Rationale 1: Elderly clients are often on several medications, and refraining from taking them with nonsteroidal anti-inflammatory drugs (NSAIDs) is an unrealistic outcome. Rationale 2: There is no reason for avoiding use of caffeine while using a nonsteroidal anti-inflammatory drug (NSAID). Rationale 3: Elderly clients are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy. Rationale 4: Mood changes are not a side effect of nonsteroidal anti-inflammatory drug (NSAID) therapy.

After the client begins taking glucocorticoid medications, the nurse would observe for adverse effects of 1. hypoglycemia. 2. hypotension. 3. bruising of the skin. 4. weight loss.

Correct Answer: 3 Rationale 1: Hyperglycemia, not hypoglycemia, can occur. Rationale 2: Hypertension, not hypotension, can occur as a result of Cushings syndrome. Rationale 3: Bruising of the skin can result due to depressed immune response. Rationale 4: Weight gain, not weight loss, can occur.

The nurse in the emergency department frequently sees clients who have overdosed on acetaminophen (Tylenol). Which client is at highest risk for developing hemolysis? 1. A Native American client 2. A Jewish client 3. An African American client 4. A Caucasian client

Correct Answer: 3 Rationale 1: Native Americans are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol). Rationale 2: Jewish clients are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol). Rationale 3: African Americans have higher rates of G6PD enzyme deficiency. Clients with this deficiency are at risk for developing hemolysis after ingestion of certain drugs, including acetaminophen (Tylenol). Rationale 4: Caucasians are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol).

Question 9 Type: MCSA The nurse teaches a group of clients with arthritis about the use of ibuprofen (Motrin), emphasizing the maximum daily amount. The nurse evaluates that education has been most effective when the clients make which statement? 1. We cannot take over 4,000 mg/day. 2. We cannot take over 3,600 mg/day. 3. We cannot take over 3,200 mg/day. 4. We cannot take over 3,000 mg/day.

Correct Answer: 3 Rationale 1: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 4,000 mg. Rationale 2: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 3,600 mg. Rationale 3: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg. Rationale 4: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg, not 3,000 mg.

A mother calls the clinic and tells the nurse that her 4-month-old baby has a fever. The mother asks if she can use the liquid acetaminophen (Tylenol) that is used for her 10-year-old child. What is the best response by the nurse? 1. Infants should not have acetaminophen (Tylenol) because it damages the liver. 2. It is best if the pediatrician is called; he can be asked this question. 3. It is fine to use the same medicine for both children. 4. Infant drops should be used for the baby; they are different from liquid medicine.

Correct Answer: 4 Rationale 1: Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children. Rationale 2: The nurse can answer the mothers question; it is not necessary to refer to the pediatrician. Rationale 3: It is not fine to use the same medicine for both children because the concentration of medication is different. Rationale 4: Infant drops should be used for the baby; they have a different concentration of medication than the liquid preparations.

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

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.previous

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

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.

A patient recently diagnosed with rheumatoid arthritis (RA) rates pain as 3 on a scale of 0 to 10. Which type of medication should the nurse anticipate will be prescribed first? Long-term corticosteroids Over-the-counter topical medications Nonsteroidal anti-inflammatory drug (NSAID) Disease-modifying antirheumatic medications

Nonsteroidal anti-inflammatory drug (NSAID) An NSAID is the preferred medication class to treat mild to moderate pain caused by inflammatory health problems. Because of its adverse effects, a corticosteroid is reserved for severe or disabling inflammation. Over-the-counter topical medications are more likely to be recommended for osteoarthritis. Disease-modifying anti-rheumatic medications are not typically the initial treatment of choice.

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

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.

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

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.