NSAIDS

A client taking ibuprofen for rheumatoid arthritis asks the nurse if acetaminophen can be substituted. Which response by the nurse is appropriate? A. "Yes, both are antipyretics and have the same effect." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Acetaminophen is the preferred treatment for rheumatoid arthritis." D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

D. Ibuprofen has an anti-inflammatory action that relieves the inflammation and pain associated with arthritis. Ibuprofen is not an antipyretic. Acetaminophen does not cause gastritis; this is an effect of aspirin. Acetaminophen is not a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are preferred for the treatment of rheumatoid arthritis.

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statements? Select all that apply. One, some, or all responses may be correct. A. "I need to report any dark tarry stools." B. "I will need to stop taking this medication before any scheduled surgery." C. "I should change positions slowly." D. "I will take the medication on an empty stomach." E. "I need to stop taking low-dose aspirin while I take this medication."

A, B Ibuprofen increases the risk for bleeding, so clients need to report any signs or symptoms of bleeding such as dark tarry stools. They also will need to stop taking this medication before scheduled surgery to prevent excessive bleeding. Ibuprofen does not cause postural hypotension, so there is no need to change positions slowly. Ibuprofen may cause epigastric distress; it should be taken with meals or milk to reduce this adverse effect. Clients should continue to take low-dose aspirin to reduce myocardial infarction or stroke risk; however, they will need to take this 2 hours before taking ibuprofen because ibuprofen can reduce the antiplatelet effects of aspirin by blocking access of aspirin to COX-1 in platelets.

Which medications increase the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One, some, or all responses may be correct. A. Aspirin B. Ibuprofen C. Ciprofloxacin D. Acetaminophen E. Methylprednisolone

A, B, E Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding.

The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn't being given ibuprofen. Which response by the nurse is most appropriate? A. "It could prolong bleeding time." B. "It's contraindicated for young children." C. "It can suppress the healing of the incision." D. "It becomes ineffective when given for long periods."

A. Acetaminophen is not associated with bleeding complications like ibuprofen is, but if used long term, it can result in liver toxicity. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) prolongs bleeding time; in the postoperative period, medications that interfere with clotting and prolong bleeding are contraindicated. Ibuprofen is safe for young children when administered in appropriate doses. Ibuprofen exerts an anti- inflammatory action; it does not interfere with the healing process. Tolerance for ibuprofen does not develop.

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. A. Diuresis B. Pain relief C. Temperature reduction D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B,C,F Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

The nurse is reviewing the home medication list for a client admitted with peptic ulcer disease (PUD). Which medication would the nurse question? A. Iron B. Ibuprofen C. Famotidine D. Acetaminophen

B. Clients with PUD should refrain from taking aspirin or nonsteroidal anti-inflammatory drug (NSAID) products as this can cause gastrointestinal (GI) bleeding. This includes ibuprofen. Iron helps with the production of more red blood cells, and famotidine is an H2 blocker that decreases gastric acid secretion. Acetaminophen does not irritate the GI mucosa and is safe for clients with PUD.

Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? A. Anaphylaxis B. Gastrointestinal (GI) bleeding C. Cardiac dysrhythmia D. Disulfiram reaction

B. Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage. Cardiac dysrhythmias and anaphylaxis are not typically associated with high-dose or long-term administration of ibuprofen. Disulfiram reactions are associated with alcohol intake, not ibuprofen.

The mother of a toddler with hemophilia A asks the nurse, "Can I give my child ibuprofen for fever or pain?" How will the nurse respond? A. "Ibuprofen is a good choice for fever or pain." B. "Give your child acetaminophen. Ibuprofen may cause bleeding." C. "No. I'll explain why your child isn't allowed pain medications." D. "You seem concerned about giving medications to your child."

B. The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? A. Alcohol B. Caffeine C. Diphenhydramine D. Ibuprofen

A. Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Diphenhydramine may be taken with acetaminophen. Ibuprofen may be taken with acetaminophen.

Which antipyretic medication may cause Reye syndrome in children? A. Aspirin B. Naproxen C. Ibuprofen D. Dantrolene

A. Aspirin increases the risk of swelling in the brain and liver, which are the main symptoms of Reye syndrome in children. Aspirin is not recommended in children. Medications such as naproxen and ibuprofen do not induce swelling in the brain and liver; therefore, these medications may not cause Reye syndrome. Dantrolene does not induce swelling in the brain and liver; instead, it decreases calcium levels during malignant hyperthermia conditions.