Summer 2024 review

Digoxin toxicity

-Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision (think van Gogh), arrhythmias, AV block. -Can lead to hyperkalemia, which indicates poor prognosis.

fat embolus s/s

- Respiratory compromise - change in behavior/disorientation - petechial rash - Snowstorm infiltrate on x-ray

Pulse grading scale

0 = Absent 1+ = Barely palpable 2+ = Easily palpable/normal 3+ = Full/increased 4+ = Bounding/Aneurysmal

Anal stage

1 to 3 years

Formal operational stage

11 years to adulthood

Genital stage

12 years and beyond

Preoperational stage

2-7 years

Which intervention would the nurse include in the plan of care for a client admitted with herpes zoster? Select all that apply. One, some, or all responses may be correct. Acyclovir Silvadene Gabapentin Wet compresses Contact isolation

ALL A client with herpes zoster would receive antiviral medications such as acyclovir. Silvadene can be applied to open vesicles. Gabapentin can be used to treat the nerve pain associated with herpes zoster. Wet compresses can be applied to the vesicles to relieve discomfort. Herpes zoster is highly contagious, and the client would be placed in contact isolation precautions.

Phallic stage

3-6 years

Which adverse effect would the nurse monitor for after administering vitamin K to a newborn? Select all that apply. One, some, or all responses may be correct. Pain Edema Jaundice Erythema Hemolysis

ALL Adverse reactions associated with vitamin K injections rarely occur, but can include pain at the injection site, edema, and erythema. Jaundice and hemolysis have also been associated with Vitamin K administration, especially in neonates.

Latency stage

6-12 years

Concrete operational

7-11 years

Normal blood sugar

70-100 mg/dL

While assessing a 5-year-old child, which clinical finding would the nurse recognize as indicative of a verbal response score of 3 on the Glasgow Coma Scale? Oriented Confused Inappropriate words Incomprehensible sounds

A verbal response score of 3 on the Glasgow Coma Scale signifies that the child speaks inappropriate words. A score of 5 shows that the child's speech is well oriented. A confused state is equal to a score of 4. Incomprehensible sounds are recorded as a score of 2.

Which organization provides scope and practice guidelines on the roles and responsibilities for nursing and nursing specialties? State Nursing Association National League of Nursing American Nurses Association Academy of Medical Surgical Nurses

ANA Rationale The American Nurses Association develops and publishes scope and standards of practice guidelines for nursing and nursing specialties. Many professional organizations have state-level nursing associations, but they do not publish standards and scope of practice. The National League of Nursing is a professional organization related to the education of nurses. The Academy of Medical Surgical Nurses publishes scope and standards of practice for general medical surgical nursing, but not nursing and nursing specialties.

Leopold maneuver

Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning

HMG-CoA Reductase Inhibitors

Also known as Statins, They inhibit the body's cholesterol production and usually have the suffix "STATIN".

Tylenol method of action

Analgesic via inhibition of central prostaglandin synthesis at COX-2 to elevate pain threshold

Which antipyretic medication may cause Reye syndrome in children? Aspirin Naproxen Ibuprofen Dantrolene

Aspirin Rationale 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.

When the nurse is caring for a client who had an open cholecystectomy, which assessment finding most indicates the need for action by the nurse? Bile-colored drainage from T-tube Serosanguinous drainage on dressing Incisional pain rated 5 (0-10 scale) Decreased breath sounds at lung bases

Atelectasis is the most common postoperative complication after abdominal surgery. Decreased breath sounds after a high abdominal surgical incision indicate atelectasis, and the nurse would implement actions to improve client efforts to deep breath and cough. Bile-colored drainage from the T-tube would be expected after open cholecystectomy. Serosanguinous drainage on a dressing may require a dressing change, but would not be unusual. Incisional pain at a level of 5 out of 10 indicates the need to administer analgesics, but is not as concerning as decreased breath sounds.

Erikson's: 18 months to 3 years

Autonomy vs shame/doubt

Sensorimotor stage

Birth to 2 years

Aspirin risks

Bleeding (gastric, Reye's syndrome)

The nurse provided education to a client with peptic ulcer disease (PUD) regarding foods and substances to avoid that would increase the secretion of gastric acid. Which food choice for breakfast selection made by the client indicates a need for further teaching? Coffee and toast Grapes and cheese Apple juice and pancakes Cheese and crackers

Caffeine-containing drinks such as coffee, tea, and soda can increase the production of gastric acid. Therefore, this menu choice indicates a need for further education. Grapes, apple juice, and cheese with crackers do not cause more acid to be produced.

Which common side effect would the nurse instruct a patient about who is taking clomiphene citrate? Irritability Headache Vasomotor flushing Vaginal bleeding

Clomiphene citrate is a medication used to stimulate the ovary to produce follicles as part of the management of fertility concerns in women trying to conceive. Common side effects of the medication include vasomotor flushing, abdominal discomfort, nausea and vomiting, breast tenderness, and ovarian enlargement. Irritability is a side effect of hCG therapy. Headache is a side effect of hCG, progesterone, GnRH antagonist, and metformin therapy. Vaginal bleeding may be experienced by women using GnRH antagonist therapies.

Which medication used to promote fertility would the nurse identify as a potential cause of esophageal burns? Estrogen Clomiphene Nifedipine Indomethacin

Clomiphene is a serum selective receptor modulator that may cause esophageal burns. Estrogen may cause a thromboembolism. Nifedipine may cause maternal-fetal problems. Indomethacin may cause birth defects.

Which assessment would the triage nurse perform first for a client brought to the emergency room with a bone protruding from the right lower leg? Vital signs Pain level Neurologic check Pedal pulses

Distal pulses in the fractured leg must be quickly assessed to determine perfusion adequacy. Weakened or absent distal pulses could be an indicator of subsequent compression syndrome of the right lower leg. Vital signs and pain should be assessed, but not until after the pulse check is performed. A neurological check might be required based on the events of the trauma or any additional injuries.

NSAIDs Risk (naproxen, ibuprofen, celecoxib)

Dizziness, nausea, GI ulceration, Increased liver enzymes Diarrhea / Renal function Fluid retention (affects kidneys) Hypertension (affects kidneys)

A nursing student is learning about expected postpartum anatomical and physiological changes. Which statement made by the nursing student indicates a need for further learning? "The capacity of the bladder increases postpartum." "The uterus involutes to approximately 350 g by 2 weeks after birth." "The cervical dilation decreases to 2 to 3 cm by the second or third postpartum day." "After birth, the vagina gradually decreases in size and returns to its prepregnancy state."

During the postpartum period, normal anatomical and physiological changes occur. After a birth, the vagina gradually decreases in size; however, it does not return to its prepregnancy state. The capacity of the bladder increases postpartum, which may lead to a decreased urge to void. The uterus returns to a nonpregnant state after birth in a process known as involution. The uterus involutes to approximately 350 g by 2 weeks after birth. During labor, the cervix dilates to approximately 10 cm; the dilation decreases to 2 to 3 cm by the second or third postpartum day.

Which would be included in the plan of care for an obstetrical client who has been taking carbamazepine throughout the first trimester of pregnancy? Evaluation for fetal hydramnios Evaluation for a neural tube defect Evaluation for cardiac malformation Chromosomal assessment for Down syndrome

Evaluation for a neural tube defect Rationale Carbamazepine is associated with neural tube defects. Fetal hydramnios, cardiac malformation, and Down syndrome are not related to the use of carbamazepine.

Immediately after birth, a newborn is dried before being placed in skin-to-skin contact with the mother. Which type of heat loss would this intervention prevent? Radiatio Convection Conduction Evaporation

Evaporative heat loss is a result of the conversion of moisture into vapor, which is avoided when the newborn is dried. Radiation is the loss of heat to colder solid surfaces that are not in direct contact. Convective heat loss is a result of contact of the exposed skin with cooler surrounding air currents. Conductive heat loss is a result of direct skin contact with a cold solid object.

Which occurs immediately after birth that increases the risk for cardiac decompensation in a client with a compromised cardiac system? Increased pressure is placed on the veins. Intra-abdominal pressure is significantly increased. The blood flow to the heart is decreased considerably. Extravascular fluid is remobilized into the vascular compartment.

Extravascular fluid is remobilized into the vascular compartment. Rationale During the immediate period after birth the extravascular fluid is remobilized into the vascular compartment, increasing the client's risk for cardiac decompensation. At the moment of birth, the pressure on the veins is removed, the intra-abdominal pressure decreases dramatically, and the blood flow to the heart is significantly increased.

The nurse recommends that, when in bed, a client who has osteoarthritis should lie in the supine or prone position. The client states that these positions are uncomfortable for the knees and hips. Which action would the nurse take? Encourage the client to maintain extension for specific periods of time. Urge the client to lie in whatever position is most comfortable. Insert a pillow under the client's knees to relieve discomfort. Place the client in the semi-Fowler position most of the time.

Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi-Fowler position can cause flexion contractures of the hips.

Where will the nurse place the V 1 lead when obtaining a 12-lead electrocardiogram? Fifth intercostal space, left midaxillary line Second intercostal space, left sternal border Fourth intercostal space, right sternal border Fifth intercostal space, left midclavicular line

Fourth intercostal space, right sternal border Positions for these 6 leads are as follows: V 1: fourth intercostal space, right sternal border; V 2: fourth intercostal space, left sternal border; V 3: halfway between V 2 and V 4; V 4: fifth intercostal space, left midclavicular line; V 5: fifth intercostal space, left anterior axillary line; V 6: fifth intercostal space, left midaxillary line.

Digoxin toxicity

GI effects (anorexia, n/v, abdominal pain), CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects)

Erikson's: 35-65 years

Generativity versus stagnation

The overproduction of which hormone is associated with carpal tunnel syndrome in clients? Growth hormone Antidiuretic hormone Parathyroid hormone Aldosterone hormone

Growth hormone Overproduction of growth hormone is associated with carpal tunnel syndrome. Overproduction of aldosterone hormone is associated with Conn syndrome. Antidiuretic hormone overproduction can result in syndrome of inappropriate antidiuretic hormone. Overproduction of parathyroid hormone results in hyperparathyroidism.

Which option would the nurse offer a client with acute glomerulonephritis who reports thirst? Ginger ale Milkshake Hard candy Cup of broth

Hard candy Sucking on a hard candy will relieve thirst and increase carbohydrates but will not supply extra fluid. The client with acute glomerulonephritis needs to maintain a low protein diet, low sodium diet, and fluid restrictions. The goal is to minimize unnecessary fluid intake. Carbonated beverages contain sodium and provide additional fluid, which must be restricted. A milkshake contains both fluid and protein, which must be restricted. Broth contains sodium, which increases fluid retention.

tylenol adverse effects

Hepatic failure w/high doses; nephrotoxicity w/overdose; overdose treatment Mucomyst (orally)

Which finding is indicative of hypothermia in a newborn? Seizures Diaphoresis Flushed skin Hypoglycemia

Hypoglycemia in a newborn can indicate hypothermia or cold stress. Seizures, diaphoresis, and flushed skin are indicative of hyperthermia.

Which cardiovascular manifestation is observed in a client with adrenal insufficiency? Fatigue Salt craving Weight loss Hyponatremia

Hyponatremia Hyponatremia is a decrease in serum sodium levels, which is the cardiovascular manifestation of adrenal insufficiency. Fatigue is a neuromuscular manifestation observed in clients with adrenal insufficiency, whereas salt cravings and weight loss are the abdominal manifestations observed in clients with adrenal insufficiency.

Erikson's: 12-20 years

Identify versus role confusion

Which manifestation would the nurse expect when a preschooler thinks that they have done something wrong? Guilt Mistrust Isolation Shame and doubt

If a preschooler thinks that they have done something wrong, this can result in a child feeling guilty. Mistrust can develop in infants if the caregivers fail to fulfill the infant's basic needs. If a young adult is unable to establish companionship and intimacy, isolation may result. Limiting choices and enacting harsh punishments lead to feelings of shame and doubt in toddlers.

When assessing a client's blood pressure, obtained via the client's unsupported left arm, which reading error would the nurse expect? False high readin False low diastolic reading False high systolic reading False high diastolic reading

If the client's arm is unsupported, or if the arm is below the heart level, the resulting outcome is a false high reading. Application of the stethoscope too firmly against antecubital fossa will result in a false low diastolic reading. Repeated assessments of blood pressure too often result in a false high systolic reading. Deflating the cuff too slowly results in a false high diastolic reading.

Which condition is correlated with a positive Babinski sign in a newborn infant? Hypoxia during labor Neurological injury during birth Hyperreflexia of the muscular system Immaturity of the central nervous system (CNS)

Immaturity of the central nervous system (CNS) Stimulation of the newborn's immature neuromuscular system causes dorsiflexion of the big toe and fanning of the remaining toes ( Babinski sign). CNS damage resulting from hypoxia may manifest as a lack of Babinski sign. The newborn would not elicit the Babinski reflex if there were neurological injury during birth. Hyperreflexia is an abnormal increase in reflexes; it is not related to the Babinski reflex.

How would the nurse describe cardiogenic shock when a family member of a client asks for more information about the condition? An irreversible phenomenon A failure of the circulatory pump Usually a fleeting reaction to tissue injury Generally caused by decreased blood volume

In cardiogenic shock, ineffective cardiac pumping or contraction is the cause of poor peripheral circulation. In the early stages, cardiogenic shock is reversible. Cardiogenic shock indicates a severe and usually chronic decrease in cardiac function and is not a fleeting reaction to tissue injury (such as might occur with anaphylactic shock). Cardiogenic shock is caused by poor cardiac function and results in hypervolemia. A decrease in blood volume would cause hypovolemic shock.

Erikson's: 6-12 years

Industry versus inferiority

Erikson's: 3-6 years

Initiative versus guilt

Erikson's: 65-death

Integrity versus despair

Erikson's: 20-35 years

Intimacy versus isolation

hich information is important for the nurse to consider when caring for a client after a thyroidectomy for cancer of the thyroid? Hypercalcemia may result from parathyroid damage. Hypotension and bradycardia may result from thyroid storm. Tetany may result from underdosage of thyroid hormone replacement. Hoarseness and airway obstruction may result from laryngeal nerve damage.

Laryngeal nerve injury can cause laryngeal spasms, resulting in airway obstruction. Parathyroid damage results in hypocalcemia, not hypercalcemia. Thyroid storm (thyroid crisis) is characterized by the release of excessive levels of thyroid hormone, which increases the metabolic rate. An increase in the metabolic rate increases vital signs, resulting in hypertension, not hypotension, and tachycardia, not bradycardia. Tetany is caused by a decrease in parathormone, a parathyroid hormone, not a thyroid hormone.

Acetaminophen risks

Liver failure Liver toxicity if combined with alcohol Kidney failure

Which medication would the nurse identify as one that can be prescribed for the elective termination of a pregnancy? Mifepristone Raloxifene Methylergonovine Clomiphene

Mifepristone helps stimulate uterine contractions; this medication can be used for the elective termination of a pregnancy. Raloxifene may be used to prevent postmenopausal osteoporosis. Methylergonovine may be used to reduce postpartum uterine hemorrhage. Clomiphene may induce ovulation.

Pressure ulcer staging

Stage I: intact skin, change in skin color, temp, stiffness or sensation, Stage II: partial thickness skin loss that involves epidermis and/or dermis. superficial and presents as an abrasion, blister or shallow crater. Stage III: full thickness skin loss involving damage or necrosis of subcutaneous tissue that may go down to underlying fascia. Stage IV: full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures.

Which response would the nurse provide to the spouse of a client with chronic kidney disease admitted to the hospital with severe infection and anemia with reports of feeling depressed and irritable, when asked about the anticipated plan of care? "The staff will provide total care, because the infection causes severe fatigue." "Mood elevators will be prescribed to improve the depression and irritability." "Vitamin B 12 will be prescribed for the anemia, and the stools will be dark." "Protein foods will be restricted so the kidneys can clear the waste products."

One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B 12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark.

Which cardiac disease has the lowest risk for maternal mortality? Endocarditis Aortic stenosis Patent ductus arteriosus Pulmonary hypertension

Patent ductus arteriosus A client with patent ductus arteriosus has the lowest risk for maternal mortality. A client with aortic stenosis has a higher risk of maternal mortality. A client with endocarditis or pulmonary hypertension has the highest risk of maternal mortality.

In which period will the adolescent have a prevalence of egocentric thoughts according to Piaget's theory? Sensorimotor Preoperational Formal operations Concrete operations

Piaget's theory divides child development into four periods. During the period of formal operations, there is a prevalence of egocentric thought in adolescents. During the sensorimotor period, infants develop a schema or action pattern for dealing with the environment. During the preoperational period, a toddler has egocentric thoughts. During the concrete operations period, the child thinks about an action before it is performed physically.

Aspirin class

Platelet inhibitor, anti-inflammatory agent, NSAID

Which change would the nurse expect when a child transitions from toddlerhood to the stage of preschooler? Begins sleeping soundly at night Naps frequently during the day Develops later bedtime Sleeps less, about 9 hours each night

Preschoolers naturally develop later bedtimes, based on their biological sleep-wake cycles and circadian rhythm. Preschoolers have very active sleep and may appear restless rather than soundly sleeping. Daytime naps are infrequent in preschoolers. Preschoolers sleep around 12 hours each night.

Healing by intention

Primary: Wound edges approximated and held in place (sutures) until healing occurs, wound easily closed and dead space eliminated Secondary: Tissue loss and require gradual filling in of the dead space with connective tissue Tertiary: Delayed primary closure, wound intentionally left open for several days for irrigation/removal of debris, after removed debris and inflammation stops -> wound closes by primary intention

A client with chronic obstructive pulmonary disease (COPD) is breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. Which action would the nurse take? Encourage the client to take slow, deep breaths and administer 5 L/min oxygen per nasal cannula. Place the client in a side-lying position and perform chest physiotherapy using clapping and vibration. Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. Assist the client in assuming a position of comfort and perform postural drainage.

Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. Sitting facilitates breathing by increasing lung expansion; 2 L of oxygen promotes respirations while preventing carbon dioxide narcosis. However, the results of one recent study of clients with stable COPD indicate that the hypercarbic drive is preserved with oxygen higher than 2 L. More research is needed before this theory is applied clinically. Five liters of oxygen may cause respiratory depression and carbon dioxide narcosis in a client with COPD. Chest physiotherapy (postural drainage) may be done later after the client's condition improves. Delaying intervention is likely to worsen the respiratory distress.

Which surgery is used to treat excessive wrinkling or sagging of facial skin? Rhinoplasty Rhytidectomy Dermabrasion Blepharoplasty

Rhytidectomy is the removal of excess skin and tissue from the face; this is the surgery used to treat wrinkling or sagging of facial skin. Rhinoplasty is the removal of excessive tissue or cartilage from the nose. Dermabrasion is the process of removing the facial epidermis or a portion of the dermis to treat acne scars. Blepharoplasty is the removal of bulging fat in the periorbital area; this is used to treat bags under the eyes.

As a part of an informed consent, a surgeon explains the details of the surgery and related care to the client. The nurse leader witnesses the complete process. The nurse leader would ensure the surgeon provided which information to the client? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Surgical procedure Name of the surgeon Explanation of the possible risks Anesthetic medication used during preoperation Name of the staff members who will be in the surgery

Surgical procedure Name of the surgeon Explanation of the possible risks Informed consent must be done according to legal guidelines. It is an authorization by the client to perform a surgery or procedure on them. The detail about the procedure of the surgery must be provided. It also informs the client about the name of the person who is performing the procedure. A description of the possible risks of the procedure is conveyed through informed consent. The name and type of anesthetic medication to be used may not be included in the informed consent. The name of the staff members involved in the surgery may not be a part of the informed consent.

Which information would the nurse give a pregnant client about having a chorionic villus sampling (CVS)? The test can lead to spontaneous abortion. The results are not as accurate. The information it provides is inadequate. It must be done with the use of laparoscopic surgery.

The American Congress of Obstetricians and Gynecologists recommends that CVS not be performed before 9 weeks' gestation and should be performed between 10 to 12 weeks. The test, if successfully performed, is 100% accurate, and it provides enough information for a diagnosis. A laparoscopic procedure is not necessary, because CVS is performed either by means of transcervical catheter aspiration or transabdominal needle aspiration. The risks of the procedure include spontaneous abortion, infection, and Rh sensitization.

A client is admitted in active labor. The nurse, performing Leopold maneuvers, determines that the fetus is in the left occiput anterior (LOA) position. Where would the nurse place the transducer of the electronic fetal monitor? Right lower midline Left lower quadrant Left upper quadrant Right upper quadrant

The LOA position indicates that the fetus is on the left side of the mother and in a head presentation with the occiput anterior; therefore fetal heart sounds are best found in the left lower quadrant of the woman's abdomen. If the fetal heartbeat is found toward the right lower midline of the mother's abdomen, the fetus is probably in a shoulder presentation, in the right scapular anterior position. If the fetal heartbeat is found in the left upper quadrant of the mother's abdomen, the fetus is in the breech presentation on the left side of the mother (left sacrum anterior). If the fetal heartbeat is found in the right upper quadrant of the mother's abdomen, the fetus is in the breech presentation on the right side of the mother (right sacrum anterior).

Which respiratory rate is the minimum normal in an adolescent

The minimum acceptable respiratory rate in a normal adolescent is 16 breaths/minute.

Which step would the nurse undertake during the administration of eardrops in children ages 1 to 3 years? Pulling the auricle down and backward Placing the cotton ball in the innermost part of the canal Keeping the toddler in the side-lying position for 10 to 15 minutes Holding the dropper 3 cm above the child's ear canal to instill the drops

To administer eardrops to a toddler, pull the auricle down and back. The cotton ball is placed in the outermost part of the ear canal. The toddler is kept in the side-lying position for 2 to 3 minutes. The dropper is held 1 cm above the ear canal for the instillation of drops.

Erikson's: birth to 18 months

Trust versus mistrust

Why is it important for the nurse to encourage a client with preeclampsia to lie in the left-lateral recumbent position? Uterine and kidney perfusion are maximized, and compression of the major vessels is relieved. Intra-abdominal pressure on the iliac veins is maximized, and there is increased blood flow to the pelvic area. Aortic compression is maximized, thereby decreasing uterine arterial pressure and increasing uterine blood flow. Hemoconcentration is maximized, thereby reducing blood volume and cardiac output and increasing placental perfusion.

Uterine and kidney perfusion are maximized, and compression of the major vessels is relieved. In the left-lateral position the gravid uterus no longer compresses major vessels; cardiac output is maintained; glomerular filtration and uterine perfusion rates increase. Maximizing intra-abdominal pressure on the iliac veins will decrease, not increase, blood flow to the pelvic area. Maximizing aortic compression will decrease, not increase, uterine blood flow. Hemoconcentration occurs and uterine perfusion decreases in the standing and sitting positions.

Reye syndrome

acute encephalopathy and fatty infiltration of the brain, liver, and possibly, the pancreas, heart, kidney, spleen, and lymph nodes

Acetaminophen class

analgesic, antipyretic

Oral stage

birth to 1 year

Common NSAIDs

ibuprofen, naproxen, aspirin

Cholecystomy

incision into the gallbladder

serosanguineous drainage

mixture of serum and red blood cells

NSAIDs

nonsteroidal anti-inflammatory drugs