Ch 16 Test Bank
A neonate is diagnosed with patent ductus arteriosus. What nonsteroidal anti-inflammatory agent is administered intravenously for treatment of this congenital heart defect?
Indomethacin Explanation: Intravenous indomethacin is approved for treatment of patent ductus arteriosus in premature infants. Sulindac is not approved for the treatment of patent ductus arteriosus. Etodolac is not approved for treatment of patent ductus arteriosus. Nabumetone is not approved for the treatment of patent ductus arteriosus.
A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which?
peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.
A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?
"Acetaminophen has no effect on inflammation." Explanation: Acetaminophen has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does not increase a person's risk for bleeding. Relief of pain and fever occur quickly.
A client is being discharged following an allergic reaction after ingesting aspirin. When providing client education about the allergy, the nurse would provide the client with what information?
"Do not take any NSAIDs." Explanation: In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
A nurse is assessing a client who has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy?
"I asked my doctor to check for blood in my stool regularly." Explanation: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; by asking the health care provider to check the stool for bleeding, the client demonstrates awareness of this. Crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. Grapefruit juice does not interfere with NSAID metabolism.
The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse?
"It is an aspirin substitute for pain and fever." Explanation: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.
A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond?
"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.
A client is receiving a salicylate for fever reduction. The nurse would instruct the client to notify the primary health care provider if the fever continues past which time frame?
24 hours Explanation: If the drug is used to reduce fever, the client should contact the primary health care provider if the temperature continues to remain elevated for more than 24 hours. Temperatures that decrease in 4 to 12 hours with salicylate use usually signify there is a short-term viral response but no underlying infection. Fever lasting over 24 hours need to be investigated for infection or disease process that the body's immune response cannot overcome.
A client began taking acetylsalicylic acid several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is the client most likely taking daily?
81 mg Explanation: The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 8081 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke. Doses higher than 81 mg would produce undesired side effects while not adding additional benefit to the prevention of platelet aggregation.
A male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain?
Acetaminophen Explanation: Acetaminophen is not an anti-inflammatory medication. It is an analgesic and an antipyretic. Aspirin, naproxen sodium, and ibuprofen decrease pain and inflammation.
A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?
Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.
Which is the antidote for acetaminophen poisoning?
Acetylcysteine Explanation: A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites. Reference:
A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome?
Acetylsalicylic acid Explanation: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye's syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.
What effects are exerted by aspirin? (Select all that apply.)
Analgesic Antipyretic Anti-inflammatory Explanation: Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.
The nurse is discussing ethnic differences in response to medication with nursing students. What group of people would the nurse tell the students have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs?
Black Americans Explanation: Black clients have a documented decreased sensitivity to the pain-relieving effect of many anti-inflammatory drugs. They also have an increased risk of developing gastrointestinal adverse effects to these drugs. In general, White, Hispanic, and Asian clients do not
A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?
Blocks interleukin-1 Explanation: Anakinra blocks the increased interleukin-1 responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating tumor necrosis factor released by active leukocytes in autoimmune inflammatory disease to prevent damage caused by tumor necrosis factor. Leflunomide directly inhibits an enzyme, dihydroorotate dehydrogenase (DHODH), that is active in the autoimmune process. Penicillamine lowers immunoglobulin M rheumatoid factor levels.
A student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation?
Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Explanation: Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment (chemotherapy, surgery, or radiation). As with acute pain, acetaminophen, aspirin, or other NSAIDs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. NSAIDs are especially effective for pain associated with bone metastases.
The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take?
Celecoxib Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?
Follow a low purine diet Explanation: The nurse should encourage the client to follow a low-purine diet which would exclude items such as any alcohol products, organ and game meat, sardines, anchovies, scallops, asparagus, spinach, and peas. Alcohol should not be used at all even in moderation to avoid future attacks of gout. For acute gouty flare-ups, take one dose and the second dose 1 hour later. The dose should not be doubled. Although severe diarrhea may occur, it is not an expected or therapeutic response and should be immediately reported to the health care provider.
An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac, which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs?
GI bleed Explanation: Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.
A 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 Explanation: 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 client is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is the most common in acute or chronic overdose of acetaminophen?
Hepatotoxicity Explanation: Acetaminophen is normally metabolized in the liver to metabolites that are excreted by the kidneys, and these metabolites may accumulate in clients especially those diagnosed with renal failure. In acute or chronic overdose of acetaminophen, the client can develop hepatotoxicity. None of the other options are associated with an adverse effect of an acetaminophen overdose since none are associated with the liver.
Prior to administering a nonsteroidal anti-inflammatory drug (NSAID) to a client, what should the nurse obtain from the client? (Select all that apply.)
History of allergies Pain assessment Current medical conditions Past medical conditions Vital signs Explanation: Prior to administering an NSAID to a client, the nurse should obtain a thorough history from the client that includes allergies (especially to aspirin or other NSAIDs), a pain assessment (including type, onset, intensity, and location), current and past medical conditions (paying close attention to a history of GI bleeding, cardiovascular disease, stroke, hypertension, peptic ulceration, or impaired renal or hepatic function), and vital signs.
A patient with muscle ache would like to use an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?
It causes decreased effectiveness of the antihypertensive drug. Explanation: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drug, or decreased metabolism of NSAID.
Which NSAID should the nurse know are not used to treat osteoarthritis or rheumatoid arthritis? (Select all that apply.)
Ketorolac (Toradol) Mefenamic (Ponstel) Explanation: Ketorolac and mefenamic are NSAIDs that are not used to treat osteoarthritis or rheumatoid arthritis.
What information should be provided to a client diagnosed with an acetylsalicylic acid allergy?
Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Explanation: In people who have demonstrated hypersensitivity to acetylsalicylic acid, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. This makes all the other options incorrect.
An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?
Reye syndrome Explanation: Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.
A 4-year-old client with chickenpox and visiting the pediatrician's office. The nurse knows that this client should not be prescribed aspirin because of which known complications?
Reye syndrome Explanation: Children or teenagers with influenza or chickenpox should not be given salicylates, particularly aspirin, because their use appears to be associated with Reye syndrome, a life-threatening condition characterized by vomiting and lethargy and progressing to coma. Guillain-Barre syndrome is often preceded by an infectious illness (e.g., respiratory infection), after which the body's immune system attacks the nerves. Cushing syndrome is characterized by increased secretion of ACTH from the anterior pituitary. Alstrom syndrome is a progressive genetic disorder that affects many body systems.
Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?
Rheumatoid arthritis (RA) Explanation: Chrysotherapy results in inhibition of phagocytosis. Because phagocytosis is blocked, the release of lysosomal enzymes is inhibited and tissue destruction is decreased.
A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?
Salicylate intoxication Explanation: Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.
A client enters the emergency department with reports of visual changes, drowsiness, and tinnitus. The client is found to be confused and hyperventilating. These signs and symptoms may be attributable to which condition?
Salicylism Explanation: Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia. Clients demonstrating acute acetaminophen toxicity will present with continued nausea and vomiting, abdominal pain, and a tender hepatic edge.
After teaching a group of students about disease-modifying antirheumatic drugs, the instructor determines that the students need additional teaching when they identify which as an example?
Sulindac Explanation: Sulindac is an NSAID. Etanercept, adalimumab, and methotrexate are classified as disease-modifying antirheumatic drugs.
The nurse is educating an African-American client about the safe and effective use of anti-inflammatories. In order to address the known ethnic factors relating to this client's drug therapy, the nurse should do what?
Teach the client about the heightened risk for GI adverse effects. Explanation: African Americans have a documented decreased sensitivity to pain-relieving effects of many anti-inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. There is no specific reason why opioids or ibuprofen should be preferred over other options. The role of fluid intake during treatment is unrelated to ethnicity.
How should the nurse best describe prostaglandins when asked to do so?
They are chemical mediators that participate in the inflammatory response and that are found in most body tissues. Explanation: Prostaglandins are chemical mediators found in most body tissues; they help regulate many cell functions and participate in the inflammatory response. They are formed when cellular injury occurs and phospholipids in cell membranes release arachidonic acid. None of the remaining options accurately and/or fully describe a prostaglandin.
What is chrysotherapy?
Treatment with gold salts Explanation: Some of these patients respond to treatment with gold salts, also known as chrysotherapy, in which gold is taken up by macrophages, which then inhibit phagocytosis. It is reserved for use in patients who are unresponsive to conventional therapy and can be very toxic.
The nurse is checking the orders for pain management for a client that had coronary surgery 24 hours ago. The nurse identifies that the client has been receiving Celebrex and a narcotic postoperatively for pain management. What is the most appropriate response of the nurse?
Withhold the Celebrex and notify the health care provider. Explanation: Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.
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. Explanation: 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 nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?
arthritis Explanation: Meloxicam is administered for the treatment of osteoarthritis and rheumatoid arthritis. It has no effect on any of the other options.
How should a nurse best explain the presence of the inflammation process?
as an attempt by the body to remove the damaging agent and repair the damaged tissue Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. The remaining options are either incorrect or incomplete descriptions of the inflammation process.
A nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug?
celecoxib Explanation: Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk. Sulindac carries the risk of headache, dizziness, and GI upset. Oxaprozin carries the risk of headache, dizziness, insomnia, and ringing in the ears. Ketorolac carries the risk of GI upset, renal effects, and congestive heart failure.
A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief?
cyclooxygenase-2 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.
A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?
ibuprofen Explanation: NSAIDs such as ibuprofen are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Balsalazide is used to treat ulcerative colitis. Ketorolac is used to treat acute pain in the short term. Auranofin is a gold salt that is not a first-line treatment
When monitoring the efficacy of allopurinol therapy, the nurse should prioritize the results of what diagnostic test?
serum uric acid levels Explanation: It is vital to assess serum uric acid levels in the client being treated with allopurinol. Efficacy is not determined by analysis of CRP levels, liver enzymes, or neutrophil levels since none monitor uric acid levels.serum uric acid levels