drugs for inflammation and fever ch 33
22) 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? "I will make sure I increase my fluid intake." "I may experience dark tarry stools." "If I experience lightheadedness I will sit down immediately." "I will cut back on my alcohol intake while taking this prescription."
Answer: 1 Explanation: NSAIDs can produce nephrotoxicity. The client should be instructed to increase their fluid intake to help clear the drug from their system. Dark tarry stools are a symptom of gastrointestinal bleeding and should be reported immediately. NSAIDs are ototoxic. Lightheadedness may be a symptom of ototoxicity and should be reported to the healthcare provider immediately. Alcohol should be avoided or eliminated for a client prescribed an NSAID due to the risk of GI bleeding.
7) 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? "This is not recommended due to the serious side effects." "The best treatment for your condition is to alternate prescriptions." "The prescription will lose its effect after your body builds up a tolerance to it." "When you experience remission you will not need the prescription."
Answer: 1 Explanation: Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects. Prescriptions are alternated due to the serious effects of glucocorticoids. The body does not build up a tolerance to systemic glucocorticoids. There is no evidence that the client's illness is in remission.
20) Which instructions should the nurse include in the teaching for a client prescribed aspirin (ASA)? Take the aspirin with a glass of milk. Discontinue taking the aspirin if you experience stomach upset. Take the aspirin with orange juice in the morning. Take the aspirin on an empty stomach in the morning.
Answer: 1 Explanation: Aspirin should be taken with milk or food to avoid GI upset. The client should contact their healthcare provider if they experience GI upset that cannot be resolved. Orange juice is highly acidic and can increase the risk for GI distress. Taking aspirin on an empty stomach can increase the risk of gastric acid production further causing GI upset.
12) For which finding should the nurse notify the healthcare provider for a client prescribed prednisone? Unexplained fever History of heart failure Asthma Arthritis
Answer: 1 Explanation: 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. Prednisone is not contraindicated for a client with a history of heart failure. Prednisone is a corticosteroid that can be used in the treatment of asthma. Prednisone can be used in the treatment of arthritis.
27) 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? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Myocardial infarction at age 61 Helicobacter pylori infection treatment last month No influenza vaccine in last 2 years Mild hypertension History of migraine headaches
Answer: 1, 2 Explanation: 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. There is no association between lack of influenza vaccine and use of aspirin. There is no association between mild hypertension and use of aspirin. There is no association between migraine headache and use of aspirin.
29) Which education should the nurse provide a client that has been prescribed a second 10- day course of a corticosteroid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Make certain you do weight-bearing exercises at least three times each week." "Weigh yourself every day." "Let us know if you develop a fever." "Monitor the color of your urine." "If you feel jittery or anxious, discontinue the medication."
Answer: 1, 2, 3 Explanation: 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. Urine color is not affected. The client should not abruptly discontinue the prescription.
28) Which prescription may be a causative factor in a client's fever of unknown origin?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Paroxetine (Paxil) Chlorpromazine (Thorazine) Penicillin G Metformin (Glucophage) Furosemide (Lasix)
Answer: 1, 2, 3 Explanation: 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. Metformin does not directly cause fever. Furosemide does not cause fever.
4) Which signs of inflammation should the nurse anticipate for a client that has experienced a sports-related injury to their leg? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Swelling Pain Warmth Pallor Pitting edema
Answer: 1, 2, 3 Explanation: Swelling is a sign of inflammation. Pain is a sign of inflammation. Warmth is a sign of inflammation. Pallor is not a sign of inflammation; redness is. Pitting edema is not a sign of inflammation.
23) 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? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Your prescribed treatment will be evaluated." "The knee should be re-examined." "Corticosteroids should only be taken for 1 to 3 weeks." "Your prescription may be changed to an NSAID." "You may require additional treatment for several more weeks with a corticosteroid."
Answer: 1, 2, 3, 4 Explanation: 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. Corticosteroid therapy should be discontinued after 1-3 weeks. Page Ref: 480
26) Which information should the nurse include in the explanation of inflammation for a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. When cells are damaged nearby vessels get bigger. The vessels in the area allow fluids to escape. Inflammation produces pus. Inflammation causes bleeding and inability to clot. Inflammation causes pain.
Answer: 1, 2, 3, 5 Explanation: 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. Clots form in vessels involved in inflammation. Inflammation damages tissues, stimulating nerve endings and causing pain.
15) Which findings are symptoms of inflammation?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Redness 2. Warmth 3. Itching 4. Rash 5. Pain
Answer: 1, 2, 3, 5 Explanation: 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. A rash is not associated with inflammation. Pain is associated with inflammation.
30) Which describes the mechanism of action of corticosteroids on the inflammatory response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Suppress the release of histamine Inhibit certain functions of phagocytes Inhibit the release of C-Reactive protein Inhibit the biosynthesis of prostaglandins Inhibit certain functions of lymphocytes
Answer: 1, 2, 4, 5 Explanation: Corticosteroids suppress the release of histamine. Corticosteroids inhibit certain functions of phagocytes. Corticosteroids do not inhibit the release of C-Reactive protein. Corticosteroids inhibit biosynthesis of prostaglandins. Corticosteroids inhibit certain functions of lymphocytes
24) Which information in the health history should the nurse be concerned about for a client prescribed ibuprofen for a mild ankle sprain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Hypertension History of injury to the same ankle Alcohol abuse Allergy to aspirin Recent history of a peptic ulcer
Answer: 1, 3, 4, 5 Explanation: Ibuprofen should be used cautiously in a client with hypertension. Treatment with ibuprofen for a client with previous injury to the same ankle is not concerning. 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.
25) Which client statement made by the client indicates the treatment with an anti- inflammatory has been successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "My fever went away yesterday." "I've not been coughing up so much phlegm." "The skin over my knee is only slightly red and hot to the touch." "The pain in my shoulder is gone." "My rash has not spread any further."
Answer: 1, 4 Explanation: Fever reduction is a goal of treatment with an anti-inflammatory prescription. Reduction of secretions is not a goal of treatment with an anti-inflammatory prescription. Redness and heat are symptoms of inflammation indicating the therapy has not been successful. Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory prescription has been successful. The goal of anti-inflammatory prescriptions is to resolve the rash. A rash that has not been resolved indicates the therapy has not been successful.
21) Which symptom should the nurse instruct the client prescribed a salicylate to report immediately to the healthcare provider? Edema Drowsiness Fatigue Decreased urine output Darkening of urine
Answer: 1, 4, 5 Explanation: 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. Drowsiness is not associated with the use of salicylates. Fatigue is not associated with the use of salicylates. 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. Page Ref: 480
19) Which describes the mechanism of action for Ibuprofen (Advil)? Directly acts on the hypothalamus Inhibition of prostaglandin synthesis Blocks pain impulses sent to the brain Decreases stimulation of sensory nerve fibers
Answer: 2 Explanation: Acetaminophen (Tylenol) directly acts on the fever center of the hypothalamus and dilates peripheral blood vessels. Anti-inflammatory drugs such as ibuprofen inhibit the synthesis of prostaglandins. Ibuprofen does not block pain impulses that are sent to the brain. Ibuprofen does not decrease stimulation of the sensory nerve fibers.
6) The nurse has provided education about the action of histamines for a client. Which statement indicates an understanding of the information? "Histamine is inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs)." "Histamine dilates the vessels in the nose, so it is congested and stuffy." "Histamine constricts vessels, causing capillaries to become more permeable." "Histamine is primarily stored in phagocyte cells in the skin."
Answer: 2 Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins and do not affect histamine. Histamine dilates blood vessels causing capillaries to become more permeable. The affected area may become congested with blood. Histamine dilates, not constricts, vessels, causing capillaries to become more permeable. Histamine is primarily stored in mast cells, not phagocyte cells.
13) Which of the client's current prescriptions should the nurse consult the healthcare provider about who has prescribed acetaminophen (Tylenol) four times a day? Heparin 5000 units subcutaneously every 8 hours Warfarin (Coumadin) 2 mg orally every day Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time Paroxetine (Paxil) 37.5 mg orally every day
Answer: 2 Explanation: There is no contraindication to the use of heparin and acetaminophen. Acetaminophen inhibits the metabolism of warfarin. Concomitant use of these two medications could result in a toxic accumulation of warfarin. There is no contraindication to the use of penicillin G benzathine and acetaminophen. There is no contraindication to the use of paroxetine and acetaminophen. Page Ref: 479
10) Which statement should the nurse include in the parental teaching for the administration of acetaminophen (Tylenol) to a child? "Acetaminophen (Tylenol) should be administered with a high-carbohydrate meal." "Read the labels of all over-the-counter medications for the amount of acetaminophen (Tylenol)." "Due to the lasting effects, acetaminophen (Tylenol) should only be given to children once a day." "Baby aspirin can be substituted for acetaminophen (Tylenol)."
Answer: 2 Explanation: There is no indication that Tylenol should be given with high-carbohydrate foods. All prescription labels should be evaluated for the amount of acetaminophen to avoid overdosing the child. The duration of action of acetaminophen is 4-6 hours. Aspirin is not recommended for children due to the possibility of contracting Reye's syndrome.
14) Which should the nurse monitor a client for that is receiving a salicylate?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Neurotoxicity Ototoxicity Nephrotoxicity Cardiotoxicity Pulmonary toxicity
Answer: 2, 3 Explanation: Salicylates are not associated with neurotoxicity. 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. Salicylates are not associated with cardiotoxicity. Salicylates are not associated with pulmonary toxicity. Page Ref: 480
3) Which laboratory tests should the nurse anticipate evaluating prior to a client receiving ibuprofen (Advil) for long-term therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Electrolytes Hemoglobin and hematocrit Bleeding times Liver function tests Serum amylase
Answer: 2, 3, 4 Explanation: There is no specific reason to monitor the clients' electrolytes. 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. It is not necessary to draw baseline serum amylase levels. Page Ref: 480
5) 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? "With proper care, it will take about a month for symptoms to resolve." "It will depend on your response to the prescriptions." "It will take about a week and a half for the symptoms to resolve." "The inflammatory process is too complex to predict a time frame for healing."
Answer: 3 Explanation: A month is longer than it takes for acute symptoms to resolve. Prescriptions will relieve some symptoms, but the time frame for repair to begin is the same. During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin. The inflammatory process is complex, but the time frame is still 8 to 10 days. Page Ref: 471
1) Which statement should the nurse include in the education for a client prescribed a nonsteroidal anti-inflammatory drug (NSAID)? "Constipation is common; include roughage in your diet." "Dizziness may occur due to a decrease in blood pressure." "Take your medication with food." "The prescription may exacerbate your asthma."
Answer: 3 Explanation: Constipation is not associated with the use of nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs have a black box warning that states that hypertension may worsen. Taking the medication with food will decrease gastrointestinal irritation. Clients with asthma or allergies to aspirin are more likely to exhibit a hypersensitivity to ibuprofen. Page Ref: 480
18) Which should a client be monitored for when prescribed a glucocorticoid? Hypoglycemia Hypotension Bruising Weight loss
Answer: 3 Explanation: Hyperglycemia is associated with the use of glucocorticoids. Hypertension can occur as a result of Cushing's syndrome. Long-term glucocorticoid use can result in the susceptibility to bruising. Weight gain is associated with the use of glucocorticoids. Page Ref: 477
11) Which outcome should the nurse include in the plan of care for the older client receiving nonsteroidal anti-inflammatory drug (NSAID) therapy? The client will refrain from taking other medications with the nonsteroidal anti- inflammatory drug (NSAID). The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID). The client will report any bleeding or bruising while taking the nonsteroidal anti- inflammatory drug (NSAID). The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).
Answer: 3 Explanation: Older adults are often on several medications, and refraining from taking them with nonsteroidal anti-inflammatory drugs is an unrealistic outcome. There is no reason for avoiding use of caffeine while using a nonsteroidal anti- inflammatory drug. Older adults are at risk for increased bleeding with nonsteroidal anti-inflammatory drug therapy. Mood changes are not a side effect of nonsteroidal anti-inflammatory drug therapy. Page Ref: 480
16) Which is an early laboratory marker of inflammation? Prostaglandins Bradykinin C-Reactive protein Histamine
Answer: 3 Explanation: Prostaglandins are present in most tissues and stored and released by mast cells, they increase capillary permeability and attract white blood cells to the site of the inflammation. Bradykinin is present in an inactive form in plasma and mast cells and acts as a vasodilator. C-Reactive protein is a protein that is found in the plasma and is an early marker of inflammation. Histamine is stored and released by mast cells. Histamine causes vasodilation and smooth muscle constriction, tissue swelling, and itching.
9) Which statement made by a client indicates an understanding of the maximum daily amount of ibuprofen (Motrin)? "I cannot take over 4000 mg/day." "I cannot take over 3600 mg/day." "I cannot take over 3200 mg/day." "I cannot take over 3000 mg/day."
Answer: 3 Explanation: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg, not 4000 mg. The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg, not 3600 mg. The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg. The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg, not 3000 mg.
17) Which finding is a common adverse effect of an anti-inflammatory prescription? 1. Diarrhea 2. Palpitations 3. Heartburn4. Hypotension
Answer: 3 Explanation: Diarrhea is not a common adverse effect of an anti-inflammatory. Palpitations are not a common adverse effect of an anti-inflammatory. Heartburn and other GI upset are common adverse effects of anti-inflammatory prescriptions. Hypotension is not a common adverse effect of an anti-inflammatory. Page Ref: 473
8) Which describes the direct action of acetaminophen (Tylenol) for fever reduction?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply Constriction of peripheral blood vessels Increase activity of the sweat glands Dilation of peripheral blood vessels Direct action at the level of the hypothalamus Decreases tissue inflammation
Answer: 3, 4 Explanation: Heat is conserved when the blood vessels are constricted. Acetaminophen does not affect the activity of the sweat glands. 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. Acetaminophen does not decrease tissue inflammation.
2) 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? "Infants should not be given acetaminophen (Tylenol) because it damages the liver." "You can use the same medication, just use half the recommended dosage." "You can use the same prescription for both children." "Infant drops should be used because they are different from liquid medicine."
Answer: 4 Explanation: Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children. Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children. The prescription has varying concentrations so it is not safe to administer the same prescription a child takes to an infant. Infant drops should be used because it has a different concentration than the children's formula. Page Ref: 481
