Pain, fever and inflammation
A nurse is caring for several pediatric clients. The nurse would question an order for aspirin for a client with which disorder?
Chicken pox Children or teenagers with influenza or chickenpox should not take salicylates, particularly aspirin, because their use appears to be associated with Reye syndrome.
A nurse is presenting an educational event for a group of new parents. A participant has asked about the safe use of acetaminophen in children. What should the nurse teach the parents?
"Check the label of over-the-counter medications carefully to see if they include acetaminophen." Inadvertent overdose with acetaminophen frequently occurs because of the combining of OTC drugs that contain the same ingredients. Parents should be taught to carefully check the labels of OTC products and follow the dosage guidelines. A prescription is not required for acetaminophen. Dosage guidelines are the best guide to follow to prevent overdose; doses should not be "matched" to the severity of a fever.
The client has been prescribed celecoxib for osteoarthritis. Which statement by the client indicates the need for further client education?
"I will stop taking the medication when I feel better." Osteoarthritis is a chronic condition and it is important the client understand that celecoxib be taken even when the symptoms have subsided. All other statements are correct.
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." All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.
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." If a client has a history of taking aspirin, including the low doses prescribed for antithrombotic effects, there is a risk of bleeding from common therapeutic procedures (e.g., intramuscular injections, venipuncture, insertion of urinary catheters or GI tubes) or diagnostic procedures (e.g., drawing blood, angiography).
The nurse is likely to administer NSAIDs for the treatment of which conditions? Select all that apply: -Osteoarthritis -Fever -Rheumatoid arthritis -Moderate postoperative pain -Primary dysmenorrhea
-Osteoarthritis -Fever -Rheumatoid arthritis -Moderate postoperative pain -Primary dysmenorrhea NSAIDs are used to treat fever and mild to moderate pain, which may be associated with osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, and surgical procedures.
A client seeks medical attention after accidentally taking several 500-mg doses of a salicylate. Which assessment finding(s) indicates to the nurse that the client is experiencing salicylism? Select all that apply. tetany (muscle spasm) nausea dizziness confusion ringing in the ears
-nausea -dizziness -ringing in the ears The adverse effects of salicylates may be caused by direct effects on the stomach and on clotting systems. Salicylism can occur with high levels of aspirin. Assessment findings of salicylism include nausea, dizziness, and ringing in the ears. Acute salicylate toxicity may occur at doses of 20-25 g in adults or 4 g in children. Signs of salicylate toxicity include tetany and confusion.
While assessing the medication history of an older adult client, the nurse notes the client takes acetaminophen daily. The nurse will further question the client to determine how much and how often to ensure the client is not exceeding what daily amount?
3 grams The maximum daily dose of acetaminophen for those older than 65 years should not exceed 3 grams.
A client is scheduled for outpatient surgery for a toenail removal. When performing the preoperative teaching with the client, the nurse would instruct the client to avoid taking any salicylates for at least how many days before the surgery?
7 days The client should be instructed to avoid salicylates for at least 1 week before any type of major or minor surgery, including dental surgery, because of the possibility of postoperative bleeding.
Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose?
81-325 mg The recommended daily dose for prophylaxis of MI, TIA, and CVA is 81-325 mg. The indication stems from aspirin's ability to decrease formation of blood clots.
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 Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.
The nurse is preparing discharge teaching for a client with unstable angina. Which medication will the nurse include in this teaching?
ASA Aspirin is used to decrease the risk of myocardial infarction in clients with unstable angina or previous myocardial infarction. Diflunisal, magnesium salicylate, and acetaminophen do not significantly decrease the risk of myocardial infarction.
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 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 would be the safest to prescribe a client with a high risk for bleeding? Select all that apply. toradol naproxen acetaminophen COX-2 inhibitors acetylsalicylic acid
Acetaminophen Cox 2 inhibitors Acetylsalicylic acid and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) have antiplatelet effects that differ in mechanism and extent. Most other NSAIDs bind reversibly with platelet COX-1 so that antiplatelet effects occur only while the drug is present in the blood. Thus, acetylsalicylic acid has greater effects, but all the drugs except acetaminophen and the COX-2 inhibitors inhibit platelet aggregation, interfere with blood coagulation, and increase the risk of bleeding.
A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area?
Adverse effects of NSAIDs The nurse should review adverse drug effects with client. The other factors are also important but the priority is to esnure the client is aware of and understands which adverse effects need to be reported immediately if detected.
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 Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.
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 Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with acetaminophen toxicity or an exacerbation of rheumatoid arthritis itself. This constellation of symptoms is not suggestive of an allergic reaction.
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? A. RR B. Better motility
B The nurse should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.
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 should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.
A 78-year-old male client calls the clinic and reports severe pain and swelling in his right great toe. The client states that the pain is worse at night and has been present for at least 2 weeks. The nurse understands that this client has what type of inflammatory disorder?
Gout Severe pain and swelling in the great toe that is worse at night and lasts longer than 10 days is most likely gout.
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 Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose and is most likely with doses of 20 g or more. None of the other options are associated with acetaminophen overdosing.
A nurse caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition?
Prolonged temperature elevation If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur. Prolonged immobility, reduced intake of fibrous food, and intake of food with antacids do not cause a decrease in urinary output.
Terry, age 43, has been taking colchicine for the past few years. He also suffers from renal impairment. What should the nurse specifically monitor in Terry, considering his renal status?
Serum creatine kinase levels Because the patient has a history of renal impairment, he must be closely monitored for signs of myoneuropathy, which is characterized by proximal weakness and elevated serum creatine kinase levels. This reaction usually occurs in patients who have been taking colchicine for several years. It is necessary for the nurse to assess for signs of hypothyroidism and malnourishment and obtain a platelet count for all patients, not just those suffering from renal dysfunction.
A patient with muscular pain has been prescribed an NSAIDs. What advice should the nurse give the patient to promote an optimal response to NSAID therapy?
Suggest the patient take the NSAID with food and milk. The nurse should suggest that the patient take the drug with food and milk to promote an optimal response to NSAID therapy; this helps minimize the risk of GI effects. The patient does not need to take an NSAID with fiber-rich food or with calcium supplements.
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. 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.
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." All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.
The nurse is reviewing laboratory values of a client receiving salicylate. The results show salicylate 200 mcg/mL, prolonged aPTT, and elevated leukocytes. When further assessing this client, which signs and symptoms should the nurse prioritize? Select all that apply. Tinnitus Bradycardia Sweating Impaired vision Mental confusion
Tinnitus Sweating Mental confusion Signs and symptoms of salicylism include dizziness; tinnitus; impaired hearing; nausea; vomiting; flushing; sweating; rapid, deep breathing; tachycardia; diarrhea; mental confusion; lassitude; drowsiness; respiratory depression; and coma (from large doses of salicylate). Salicylates will also increase the bleeding time which will result in a prolonged aPTT. A salicylate value of 150 to 249 mcg/mL is considered mild salicylism.
A client with rheumatic disease (arthritis) is being prescribed salicylate therapy. The nurse should teach the client to monitor for which adverse effects?
Titinitis (Ring in the ear) Tinnitus is associated with salicylates. The disease-modifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Eighth cranial nerve damage and stomatitis are associated with gold therapy. Hirsutism is associated with corticosteroid therapy.
The client has a history of gastrointestinal bleeding. What would be the best response by the nurse when the health care provider prescribes Indocin as treatment for rheumatoid arthritis?
Withhold the medication and notify the provider. The most appropriate action of the nurse is to hold the medication and notify the provider of the client's history of GI bleeding. An adverse reaction associated with Indocin is GI bleeding. The nurse cannot discontinue or add medications to the treatment plan without prescriptive authority.
A client has had minor surgery and asks the nurse what can be used for pain. Which would be most appropriate for the nurse to suggest?
acetaminophen After minor or major surgery, the client should avoid salicylates to reduce the risk for bleeding and use acetaminophen for pain control.
A 6-year-old client is presenting with signs and symptoms of fever, cough, stuffy nose, general malaise, and muscle aches. The nurse prepares to administer which medication to this client?
acetaminophen The known actions of acetaminophen include treating mild to moderate pain and reducing fever. Children and teenagers with influenza or chickenpox should not take salicylates, particularly aspirin, because of the association of developing Reye syndrome. Magnesium salicylate and diflunisal are also salicylates.
The nurse is developing a plan of care for a client ordered to take acetaminophen for pain relief. The nurse will monitor the client for liver failure if there is a history of which disorder?
alcoholism he risk of liver failure during acetaminophen therapy increases in clients who drink alcohol habitually. Clients with diabetes, high blood pressure, or urinary tract infections are not at a significantly greater risk for liver failure.
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. Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Local manifestations are redness, heat, edema, and pain. Inflammation may be a component of virtually any illness. Inflammation can be a result of an infection, which may require antibiotic therapy.
What effects are exerted by aspirin? (Select all that apply.) Analgesic Antipyretic Anti-inflammatory Anti-infective Antiviral
analgesic, antipyretic, anti-inflammatory Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.) Anti-inflammatory Analgesic Antipruritic (relieve itching) Antipyretic Antibacterial
anti-inflammatory, analgesic, antipyretic
A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?
arthritis Meloxicam is administered for the treatment of osteoarthritis and rheumatoid arthritis. It has no effect on any of the other options.
The nurse understands that the primary adverse reaction with the use of salicylates is which?
gastric distress Gastric distress is the primary adverse reaction of salicylates. Tinnitus, tachycardia, and diarrhea are symptoms of salicylate toxicity.
A nurse is preparing to teach a client about the adverse effects of the prescribed NSAID therapy. Which system would the nurse include as being involved?
gastrointestinal 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 or hepatobiliary system while taking NSAIDs.
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 The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.
A salicylate is contraindicated in clients who have had surgery within the past week for which reason?
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.
What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)?
inhibit prostaglandin synthesis Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.
The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions?
inhibiting the synthesis of prostaglandins NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
A client has just returned from x-ray after reporting pain in her joints. The x-rays indicate damage of the joint spaces. This is indicative of which disease process?
osteoarthritis Osteoarthritis is characterized by a progressive loss of joint cartilage, which appears on x-ray as a narrowing damage to the joint space.
A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?
tarry stool Serious GI events are also listed as a Black Box warning. Gastropathies are commonly associated with ibuprofen. Nausea, vomiting, diarrhea, constipation, flatulence, and abdominal pain may be representative of minor adverse effects in some clients or serious GI toxicity in others. During long-term administration, the most serious effects are peptic ulcer disease or gastritis that leads to GI bleeding or even perforation. These events can occur at any time, with or without warning.
A 60-year-old client with rheumatoid arthritis reveals to the nurse the recent use of an OTC NSAID. The nurse should point out the client is at an increased risk for developing which disorder related to the use of NSAIDs?
ulcer disease Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease in adults older than 65 years is increased with higher doses of NSAIDs. CNS disorders, hearing impairment, and blindness are not effects associated with using NSAIDs on a long-term basis in older clients.