Pharmacology Ch. 16 Practice Questions
The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?
Aspirin
A 16-year-old client asks the nurse if she can take two Tylenol every 2 hours during exams because it helps relieve her tension headaches. What is the nurse's most appropriate response?
"Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." Explanation: Do not exceed recommended doses of acetaminophen due to risk of life-threatening liver damage. People with liver disorders such as hepatitis or those who ingest alcoholic beverages frequently should use it with extreme caution.
A patient taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse?
"Do not take any more of the medication and come into the clinic immediately to see the physician." Explanation: Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.
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."
Which statement by the client identifies that the use of celecoxib is effective?
"My hip pain has decreased." Explanation: Celecoxib is used in the treatment of acute pain, not for gastrointestinal burning. If the client's pain is reduced, treatment has been effective. The goal of treatment is to help get the pain to a manageable level. Celecoxib is not used to reduce a fever.
A patient with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this patient?
"The drug has no effect on inflammation." Explanation: The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.
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." Explanation: 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 physician'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 physician's orders." Explanation: 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).
What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)
-Anti-inflammatory -Analgesic -Antipyretic
Which NSAID should the nurse know are not used to treat osteoarthritis or rheumatoid arthritis? (Select all that apply.)
-Ketorolac (Toradol) -Mefenamic (Ponstel)
The nursing student demonstrates understanding when choosing what as the effect of a salicylate? (Select all that apply.)
-analgesic effect -antipyretic effect -anti-inflammatory effect
A nursing student correctly identifies what as the recommended dose of aspirin for the adult patient?
325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult patient receiving aspirin orally is 325 to 650 mg every 4 hours. The other options would not be recommended and would be medication errors if given.
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 Explanation: 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.
Which agent would be least appropriate to administer to a client with joint inflammation and pain?
Acetaminophen Explanation: Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.
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 drugs DO NOT cause inhibition of platelet aggregation, interference with blood coagulation, or increase the risk of bleeding?
Acetaminophen and the COX-2 inhibitors
Which is the antidote for acetaminophen (Tylenol) poisoning?
Acetylcysteine (Mucomyst) Explanation: A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.
A child has symptoms of the flu with fever. Which medication should not be administered to the child because of the risk of Reye syndrome?
Acetylsalicylic acid (aspirin) 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 syndrome. Acetaminophen (Tylenol) is safe to administer for fever reduction and pain relief in children and adolescents. Ibuprofen (Motrin) is safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children, but is not used to reduce fever or pain.
A patient is taking a nonsteroidal anti-inflammatory agent. Which instruction should the patient be given in regards to administration?
Administer the medication with food. Explanation: To prevent gastrointestinal irritation, instruct the patient to administer the medication with food. The administration of an NSAID with orange juice will increase gastric acid and not protect the gastric mucosa. Crushing enteric-coated tablets will eliminate the protection of the gastric mucosa. Nonsteroidal anti-inflammatory agents administered every other day will not protect the patient from gastric irritation.
A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the patient's knowledge of which area?
Adverse effects of nonsteroidal anti-inflammatory drugs
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.
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. Explanation: 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 Explanation: Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.
A male 16 years of age presents to the physician's office with nausea, vomiting and pain in the right upper quadrant. He states he has had flu-like symptoms for four to five days. What is the most appropriate action of the nurse?
Ask for a medication history. Explanation: The client is stating he has been ill for four to five days, so it is important that the nurse identify all medications he has taken. Many medications contain acetaminophen and adolescents may not realize that they are exceeding the recommended daily dosages. It is important to initally take a thorough history of symptoms and treatments. Alcohol ingestion and exposure to infections may be assessed later.
A hypersensitivity to which medication is a contraindication for all NSAIDs?
Aspirin Explanation: A hypersensitivity to aspirin is a contraindication for all NSAIDs.
A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility Explanation: 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 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 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 client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be most appropriate for the client to take?
Celecoxib Explanation: Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
The use of which NSAID is contraindicated in patients with a sulfonamide allergy?
Celecoxib (Celebrex)
Which of the following NSAIDs is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke?
Celecoxib (Celebrex) Explanation: Celecoxib (Celebrex) is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however all NSAIDs may carry a similar risk.
Blocking of what is responsible for the pain-relieving effects of NSAIDs?
Cyclooxygenase-2 Explanation: Blocking cyclooxygenase-2 is responsible for the pain-relieving effects of NSAIDs.
A client is ordered to receive an NSAID for pain. The client states that NSAIDs are taken to decrease inflammation. The nurse identifies that these medications are also used to:
Decrease body temperature. Explanation: NSAIDs are used to treat pain and inflammation but may also be prescribed to reduce body temperature. They are not used to treat appetite, blood pressure, or decreased platelets.
A client on NSAIDs is experiencing congestive heart failure. The health care provider has decided to add a diuretic to the treatment plan. The nurse evaluates the client for:
Decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.
False
African Americans are at lower risk for developing GI adverse effects with NSAIDs.
False Explanation: African Americans have an increased risk of developing GI adverse effects with any anti-inflammatory agent.
An 80-year-old male client presents to the physician'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 physician orders a stool test for guaiac, which yields positive results. The physician 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 21-year-old female is admitted after taking 25 aspirin tablets in an attempt to take her life. She is admitted with tinnitus, nausea, and vomiting. The physician diagnoses Kelly with salicylate poisoning. What can be used as a treatment for salicylate poisoning due to an overdose of aspirin? (Select all that apply.)
Gastric emptying Administration of activated charcoal Life support, if indicated Explanation: Salicylate poisoning is a life-threatening event. Treatment of salicylate poisoning includes gastric emptying, either with syrup of ipecac or gastric lavage; administration of activated charcoal; and life support, if indicated. There is no antidote for salicylate poisoning.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?
Gold salts Explanation: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.
A nurse is caring for a 10-year-old boy who reports chronic headaches. His mother reports that she gives him Tylenol at least three times a day. What will the nurse work with the physician to evaluate?
Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
The client has been taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolac has been added to the treatment regimen. The nurse evaluates the client for which potential interaction?
Hypertension Explanation: When combined with NSAIDs, antihypertensive medications are less effective. The client's blood pressure must be assessed to identify any increase. Antihypertensives do not affect the effectiveness of NSAIDs.
A salicylate is contraindicated in clients who have had surgery within the past week for which reason?
Increased risk for bleeding Explanation: 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.
A patient who is on long-term acetaminophen therapy has been taking etodolac for joint pain. Which effect is likely to occur due to an interaction between the two drugs?
Increased risk of renal impairment
Which are important points for the nurse to cover with the client during discharge counseling for salicylate analgesics? (Select all that apply.)
Inform all health care providers of salicylate use. Discard salicylates if they smell like vinegar. Take salicylates with food. Keep salicylate container closed tightly. Explanation: The nurse should include the following in discharge counseling for clients receiving salicylates: take drug as prescribed, take drug with food or milk and a full glass of water, inform all health care providers (including dentists) of salicylate use, discard salicylates that smell like vinegar, and store in tightly closed container away from air, moisture, and heat.
The nurse is aware that aspirin not only lowers the patient's fever but can also reduce pain the patient is experiencing by:
Inhibiting the production of prostaglandins. Explanation: Salicylates inhibit production of prostaglandins, making pain receptors less likely to send the pain message to the brain. This reduction also is thought to account for the anti-inflammatory effect. Aspirin does also prolong the bleeding time by inhibiting the aggregation of platelets. This, however, does not have anything to do with decreasing pain in the patient.
The nurse explains to the client that NSAIDs act by which actions?
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
A patient with muscle ache would like to use an over-the-counter 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.
A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in:
Liver damage. Explanation: A patient taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.
An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?
Nonsalicylates
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?
Oral Explanation: Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is not given via the subcutaneous, intramuscular, or intravenous routes.
A 70-year-old woman who is on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. 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:
Peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in patients 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 patients 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 patient with chickenpox and visiting the pediatrician's office should not be prescribed aspirin because of which known complications?
Reye syndrome
An 11-year-old client is going to have a cavity filled in the left mandibular first molar. The physician has prescribed aspirin for pain relief after the procedure. The nurse finds out that the child is suffering from a flulike illness. The nurse contacts the physician about the prescribed medication for pain. What is the risk if aspirin is administered to Diane?
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 nurse suspects that a client is experiencing salicylism. What would the nurse assess?
Ringing in the ears Explanation: Salicylism can occur with high levels of aspirin and be manifested by ringing in the ears, dizziness, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude. Excitement, tachypnea, and convulsions suggest acute salicylate toxicity.
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 patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:
Salicylate intoxication. Explanation: Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
A black client is receiving a high dose of NSAID for pain relief. Which would be most important for the nurse to include in the teaching plan?
Signs and symptoms of gastrointestinal bleeding Explanation: Although adequate hydration is important to promote renal function and drug excretion, it would be more important to instruct the client in the signs and symptoms of GI bleeding. Blacks have a documented decreased sensitivity to the pain-relieving effects of many anti-inflammatory agents and have an increased risk of developing GI adverse effects to these drugs. Increased dosages may be needed to achieve pain relief, but the increased dosage increases the client's risk for developing adverse GI effects. The drug should not be combined with an OTC salicylate, as this would further increase the client's risk for adverse GI effects. The client should be instructed to use nonpharmacologic measures to relieve pain, such as warm soaks and positioning.
The most common side effects caused by NSAIDs involve the:
Stomach. Explanation: The most common side effects caused by the NSAIDs involve the GI tract, including the stomach.
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. What would be the best explanation?
The aspirin is being prescribed because it reduces your risk of a second heart attack. Explanation: 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 patients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.
A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that:
The client should not take aspirin or non-aspirin NSAIDs. Explanation: In people who have demonstrated hypersensitivity to aspirin, all non-aspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
An older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin two to three times each day. What aspect of this patient's medical history may contraindicate the use of aspirin?
The patient has a history of peptic ulcer disease. Explanation: Due to the risk of bleeding, aspirin is contraindicated in patients with peptic ulcer disease or bleeding disorders. SSRIs, previous surgery, and type 2 diabetes do not preclude the use of aspirin.
The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?
To inhibit platelet aggregation Explanation: Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage. If the client is having elevated temperatures daily, the cause would need to be investigated.
What would the nurse identify as the primary purpose of administering penicillamine (Cuprimine)?
To treat early, mild, and nonerosive rheumatoid arthritis Explanation: Penicillamine (Cuprimine) is used in treating patients with early, mild, and nonerosive rheumatoid arthritis.
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.
True Explanation: RF interacts with circulating IgG to form immune complexes, which tend to deposit in the synovial fluid of joints, as well as in the eye and other small vessels.
NSAIDs have anti-inflammatory, antipyretic, and analgesic properties.
True Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) drugs block prostaglandin synthesis and act as antiinflammatory, antipyretic, and analgesic agents.
What is classified as a nonsalicylate analgesic?
Tylenol Explanation: Tylenol (acetaminophen) is classified as a nonsalicylate analgesic.
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 physician.
A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the nurse is responsible for facilitating this new aspect of the patient's drug regimen. This will involve the administration of:
weekly subcutaneous injections.
