PREPU: Chapter 13: Nonopioid Analgesics: Salicylates and Nonsalicylates

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? a. Ibuprofen b. Acetaminophen c. Diflunisal (Dolobid) d. Aspirin

Acetaminophen Acetaminophen is the analgesic of choice during pregnancy 4

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? a. Acetaminophen has no effect on inflammation b. Acetaminophen's only clinical use is for pain treatment c. Keep taking it as ordered, and watch for any signs of bleeding d. It takes some people a few weeks to feel a difference

Acetaminophen has no effect on inflammation 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 occurs quickly.

The physician has ordered Tylenol to the client for a fever in excess of 101 degrees Fahrenheit. The nurse administering acetaminophen should do which? a. Give it to the client who has an empty stomach b. Give it to the client who has eaten a full meal c. Give it to the client with a full glass of water d. Give it to the client with orange juice

Give it to the client with a full glass of water The nurse administers acetaminophen with a full glass of water. The client may take this drug with meals or on an empty stomach. 8

1. The nurse teaches a client with rheumatic disease who is being prescribed salicylate therapy to monitor for: a. Stomatitis b. Hirsutism c. Tinnitus d. Visual changes

Tinnitus The DMARD category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Tinnitus is associated with salicylates and eighth cranial nerve damage, stomatitis is associated with gold therapy, and hirsutism is associated with corticosteroid therapy. 2

When assessing a client's pain, what would the nurse evaluate? SATA a. Quality of pain b. Intensity of pain c. Nurse's beliefs about pain d. Location of pain e. Client's description of the pain

a, b, d, e Guidelines for the initial pain assessment include the client's subjective description of pain, location, intensity, factors that influence the pain, quality, patterns of coping, effects of previous therapy, and nurse's observations of client's behavior. The nurse's own personal beliefs about pain are not relative for assessing the client's pain. 6

The nurse working in the pain unit and realizes that the ability of an opioid analgesic to relieve pain depends on several factors including which? SATA a. The drug b. The cost of the drug c. The client d. The dose e. The route of administration

a, c, d, e The ability of an opioid analgesic to relieve pain depends on several factors: the drug, the dose, the client, the route of administration, the type of pain, and the length of time the drug has been administered. The cost has no bearing on how the drug works. 5

A client is admitted with a bleeding ulcer. The client is experiencing mild epigastric pain and is asking for an aspirin. Which would be the drug of choice for this client? a. Dolobid b. Bufferin c. Aspirin d. Acetaminophen

acetaminophen Acetaminophen does not inhibit platelet aggregation and therefore is the drug of choice when bleeding tendencies are an issue. The other drugs listed are salicylates and contraindicated in clients with any type of gastric bleeding. 7

20 of 20 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? • nephrotoxicity • pancreatitis • hepatotoxicity • pulmonary insufficiency

hepatotoxicity 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.

A 49-year-old woman has been diagnosed with myalgia. The health care provider has recommended aspirin. The client is concerned that the aspirin will upset her stomach. The nurse will encourage the client to take this medication by: a. Swallowing the tablet whole b. Swallowing the tablet with milk or food c. Avoiding drinking milk for 3 hours after swallowing the tablet d. Crushing the tablet before swallowing

swallowing the tablet with milk or food Minimizes the stomach upset because it buffers the stomach wall from direct contact with the medication, decreasing gastric distress. 3

16 of 20 A 5-year-old has a fever. What instructions does the nurse provide to the parents? Select all that apply. • "Aspirin is the best for reducing fever." • "You may give tepid baths to bring the temperature down." • "Do not give the child any medication with aspirin in it." • "If the child has chills, wrap in a warm blanket." • "You may administer acetaminophen."

• "Do not give the child any medication with aspirin in it." • "You may administer acetaminophen." • "You may give tepid baths to bring the temperature down." Explanation: The use of aspirin in children puts them at risk for developing Reye's syndrome, which can be life threatening. Acetaminophen and tepid baths are indicated for treating a fever. Using a warm blanket will increase the fever.

9 of 20 Which statement by the client indicates a clear understanding of the primary adverse effect of aspirin therapy? • "I don't like to swallow tablets so I crush them." • "I ask my health care provider to check for blood in my stool on a regular basis." • "I take as little water as possible when I take my medication." • "I drink a glass of wine every night."

• "I ask my health care provider to check for blood in my stool on a regular basis." Explanation: Taking nonsteroidal anti-inflammatory drugs can increase the risk of bleeding; therefore, the client asking her health care provider to check her stool for blood lets the nurse know that the client is aware of this adverse effect. Alcohol consumption and crushing the tablets can interfere with anti-inflammatory metabolism. Water can safely be taken with aspirin.

17 of 20 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 used to treat chronic pain." • "It is an anti-inflammatory medication." • "It is used to treat severe arthritis." • "It is an aspirin substitute for pain and fever."

• "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.

1 of 20 A female client 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 client? • "This drug is reserved for long-term therapy." • "The drug has quite a few adverse effects." • "The drug has no effect on inflammation." • "The drug can increase your risk for bleeding."

• "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.

1 of 20 The nurse has conducted a health education session for new parents. After learning about the safe and effective use of anti-inflammatories, which statement by the parents indicates effective teaching? • "We need to read the labels carefully for the ingredients and dosages." • "We need to give the drug on an empty stomach or two hours after meals." • "We can temporarily give our child extra doses of acetaminophen if we need to do so." • "We should use aspirin if our child develops symptoms of the flu."

• "We need to read the labels carefully for the ingredients and dosages." Explanation: Anti-inflammatory agents can be found in a number of combination products to treat pain, cold, flu, and nasal congestion. It is important for parents to read the label of each medication carefully to avoid overdosing the child with multiple products containing the same anti-inflammatory agent. Children are more susceptible to the GI and CNS effects of these drugs so the drugs should be given with food or meals. Aspirin for flu-like symptoms in children is to be avoided due to the increased risk for Reye syndrome. Acetaminophen is the most commonly used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

20 of 20 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? • 4 hours • 12 hours • 8 hours • 24 hours

• 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.

9 of 20 A nursing student correctly identifies a normal dose of aspirin for the adult client as which? • 325 to 650 mg orally q 4 hours • 1000 mg orally every morning • 650 to 1000 mg orally q 4 hours • 81 mg orally q 4 hours

• 325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult client 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.

18 of 20 Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen? • A male 40 years of age with arthritis • A female 62 years of age with a vitamin K deficiency • A male 30 years of age who drinks four beers per day • A female 50 years of age with hypoprothrombinemia

• 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.

19 of 20 A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug? • Naproxen • Acetaminophen • Indomethacin • Ibuprofen

• Acetaminophen Explanation: Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children but they are not the most commonly used medications. Indomethacin is not indicated for fever control.

8 of 20 A hospitalized client who is being treated for a urinary tract infection has developed a fever. The nurse has responded by administering a dose of acetaminophen. In what way does acetaminophen contribute to a reduction in fever? • Acetaminophen increases the production and release of interferons. • Acetaminophen causes the lysis of fever-producing cells. • Acetaminophen inhibits prostaglandin synthesis. • Acetaminophen inhibits the thermoregulatory function of the hypothalamus.

• Acetaminophen inhibits prostaglandin synthesis. Explanation: The antipyretic activity of acetaminophen results from inhibiting prostaglandin synthesis in the CNS. It does not cause cell lysis, change the function of the hypothalamus, or modulate the function of interferons.

20 of 20 An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of Tylenol. The nurse should prepare for what intervention? • Intravenous administration of Lactated Ringer's • Administration of acetylcysteine as prescribed • Watchful waiting • Administration of naloxone as prescribed

• Administration of acetylcysteine as prescribed Explanation: Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate. Lactated Ringer's would not be therapeutically beneficial.

17 of 20 The client states that aspirin is no longer working for the joint pain. To best determine the ineffectiveness of the aspirin therapy, the nurse assesses for the possible co-use of which drug classification? • Antipyretic • Carbonic anhydrase inhibitors • Anticoagulants • Antacids

• Antacids Explanation: Antacids decrease the effectiveness of salicylates. There is increased risk of bleeding when salicylates are combined with anticoagulants. There is increased risk for salicylism when used with carbonic anhydrase inhibitors. There is no interaction between aspirin and antipyretics.

15 of 20 The client has been ordered salicylate therapy. Prior to administration of salicylates, the nurse assesses the client for which? Select all that apply. • Peptic ulcer • Allergy • Chemotherapy treatments • Anticoagulant use • Gout

• Anticoagulant use • Gout • Peptic ulcer • Chemotherapy treatments • Allergy Explanation: Salicylates are contraindicated in clients using anticoagulant and chemotherapeutic agents. It is also contraindicated in clients with gout and peptic ulcer disease. It is important to identify allergies prior to administration.

14 of 20 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? • Steroids • Antibiotics • Acetaminophen • Aspirin

• Aspirin Explanation: Tinnitus (ringing of the ears) is a symptom of salicylism. It is not seen with the use of acetaminophen, steroids, or antibiotics.

18 of 20 A healthcare provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about safe and effective use of acetaminophen? • Avoid taking more than 3000 mg in any 24-hour period • Avoid drinking grapefruit juice with acetaminophen • Take the medication with food to prevent GI upset • Avoid excessive doses because there is no antidote

• Avoid taking more than 3000 mg in any 24-hour period Explanation: Clients should avoid taking more than 3000 mg of acetaminophen daily to avoid hepatic damage. Acetylcysteine is an antidote for overdose and there is no need to avoid grapefruit juice. GI upset is rare, so there is no particular need to take it with food.

1 of 20 Prostaglandins are: • Chemical mediators found in most body tissues; they participate in the inflammatory response. • Sensitized pain receptors; they participate in the inflammatory response. • Chemical mediators released in the periphery, which prevent sensitization of pain receptors to various chemical substances released by damaged cells. • Chemical mediators which produce chronic, painful, inflammatory disorders that affect the synovial tissue of hinge-like joints.

• Chemical mediators found in most body tissues; they participate in the inflammatory response. 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.

6 of 20 A 21-year-old female is admitted after taking 25 aspirin tablets at one time. She is admitted with tinnitus, nausea, and vomiting. The health care provider diagnoses the client with salicylate poisoning. What can be used as a treatment for salicylate poisoning? Select all that apply. • Administration of activated charcoal • Administration of an anticoagulant • Life support, if indicated • Gastric emptying

• 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.

6 of 20 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 suspect the health care provider to evaluate in this client? • Cardiac function • Renal function • Hepatic function • Respiratory function

• Hepatic function Explanation: The nurse would expect the provider to evaluate the client's hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.

16 of 20 The client is taking isoniazid and rifampin for treatment of tuberculosis. The nurse identifies that these medications when administered with acetaminophen have what effect? • Decreased effectiveness and increased effect of acetaminophen • Increased toxicity and decreased effect of acetaminophen • Increased toxicity and increased effect of acetaminophen • Increased effectiveness and decreased effect of acetaminophen

• Increased toxicity and decreased effect of acetaminophen Explanation: When acetaminophen is combined with isoniazid and rifampin, there is an increased possibility of toxicity and decreased effectiveness of acetaminophen.

5 of 20 An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client? • Morphine • Salicylates • Barbiturates • Nonsalicylates

• Nonsalicylates Explanation: Nonsalicylate analgesics, such as acetaminophen (Tylenol, Atasol), have the same analgesic and antipyretic properties as aspirin, but fewer side effects and are a good choice for mild to moderate pain in children. Salicylates or aspirin is not recommended for children because it is believed to contribute to the development of Reye syndrome in children. Morphine and barbiturates are used for severe pain and would not be appropriate in this situation.

12 of 20 What conditions are salicylates are effective in managing? (Select all that apply.) • GI upset • Infection • Inflammation • Fever • Pain

• Pain • Fever • Inflammation Explanation: Salicylates are effective in the management of pain, fever, and for inflammation. They are contraindicated in gastrointestinal disorders and are not indicated for infection.

10 of 20 The nursing instructor is teaching students about pain relief. The instructor also identifies which barriers to proper pain management? (Select all that apply.) • Primary health care providers do not prescribe proper pain medicine doses. • Clients always fear reporting pain. • Clients do not report accurate levels of pain. • Nurses do not administer adequate medication for relief of pain. • Nurses always give too much pain medication.

• Primary health care providers do not prescribe proper pain medicine doses. • Nurses do not administer adequate medication for relief of pain. • Clients do not report accurate levels of pain. Explanation: In managing pain, the nurse needs to overcome the three main barriers to proper pain management, which involve assessment, intervention, and evaluation. Primary health care providers do not prescribe proper pain medicine doses, nurses do not administer adequate medication for relief of pain, and clients do not report accurate levels of pain. Nurses infrequently give too much pain medication. Although some clients, especially the elderly, might fear reporting pain, this is not always the case.

3 of 20 Which ongoing assessments are the most appropriate interventions a nurse should perform for a client who is receiving salicylate therapy? Select all that apply. • Monitor for decrease in inflammation and mobility in joints. • Assess and record the symptoms of anxiety. • Document the severity, location, and intensity of the pain. • Report adverse reactions, such as prolonged bleeding. • Record the body temperature every 45 minutes after administration of drug.

• Report adverse reactions, such as prolonged bleeding. • Document the severity, location, and intensity of the pain. • Monitor for decrease in inflammation and mobility in joints. Explanation: The nurse should report adverse reactions such as prolonged bleeding to the primary health care provider; document the severity, location, and intensity of the pain; and assess for a decrease in inflammation and mobility in the joints. There is no need to assess and record symptoms of anxiety or check body temperature every 45 minutes.

11 of 20 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? • Ibuprofen overdose • Salicylate intoxication • Acute acetaminophen poisoning • Caffeine abuse

• 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.

4 of 20 A client presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is the client's issue? • Acetaminophen toxicity • Anakinra toxicity • Salicylism • Ibuprofen toxicity

• Salicylism Explanation: Salicylism can occur with high levels of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur.

15 of 20 The nurse is caring for an elderly client with a history of osteoarthritis. The client has been taking nonopioid analgesics for the last 12 years. What should the nurse instruct the client to do to decrease the gastric effects of these drugs? • Ask the primary care provider to order a stronger medication. • Take the medication only on an empty stomach. • Stop taking these medications. • Take the medication with a full glass of water or food.

• Take the medication with a full glass of water or food. Explanation: Salicylates are prescribed for pain and inflammation associated with arthritis. Older adults who use these drugs on a long-term basis are particularly vulnerable to gastrointestinal bleeding. The nurse should encourage the client to take the drug with a full glass of water or with food to decrease gastric effects.

16 of 20 The nurse teaches the client to avoid which when taking aspirin products? • Tea • Spinach • Coffee • Grapefruit

• Tea Explanation: Tea, paprika, licorice, prunes, and curry powder contain salicylates, which may increase the risk for adverse reactions. Coffee, grapefruit, and spinach do not contain salicylates.

7 of 20 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 and his wife. What would be the nurses best explanation? • The aspirin is being prescribed because it reduces the prostaglandins in your body. • The aspirin is being prescribed because it reduces your risk of a second heart attack. • The aspirin is being prescribed because it will protect your heart. • The aspirin is being prescribed to relieve the pain from the heart attack.

• 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 clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures. Reference:

10 of 20 How do prostaglandins influence pain? • They decrease pain associated with other chemical mediators of inflammation. • They block pain receptors. • The sensitize pain receptors. • They decrease inflammation.

• The sensitize pain receptors. Explanation: Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin and histamine. Prostaglandins do not decrease inflammation.

20 of 20 How should the nurse best describe prostaglandins when asked to do so? • They sensitize pain receptors that participate in the inflammatory response. • They are chemical mediators that participate in the inflammatory response and that are found in most body tissues. • They are chemical mediators that produce chronic, painful, inflammatory disorders that affect the synovial tissue of hinge-like joints. • They are chemical mediators released in the periphery, which prevent sensitization of pain receptors to various chemical substances released by damaged cells.

• 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.

14 of 20 Aspirin has been prescribed for a 69-year-old client with a diagnosis of arthritis. The nurse monitors the client for which assessment finding that would indicate the presence of toxicity from this medication? (Select all that apply.) • Tinnitis • Impaired hearing • Photophobia • Diarrhea • Tachycardia

• Tinnitis • Impaired hearing • Tachycardia Explanation: Symptoms of salicylism include tinnitus, impaired hearing, dizziness, nausea, vomiting, flushing, tachycardia, and mental confusion. Diarrhea and photophobia are not associated with salicylism.

13 of 20 The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following? • To inhibit platelet aggregation • To decrease pain • To treat osteoarthritis • To decrease temperature

• 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.

6 of 20 A client is prescribed acetaminophen to reduce an elevated body temperature. Which instruction should the nurse give to the client regarding the drug's use? • Instruct the client to eat foods that are rich in salicylates. • Urge the client to refrain from drinking alcohol. • Ask the client to avoid taking calcium supplements. • Inform the client to take NSAIDs if pain increases.

• Urge the client to refrain from drinking alcohol. Explanation: The nurse should instruct the client to avoid consumption of alcohol during the drug regimen due to the increased risk for hepatotoxicity. There is no need to avoid taking calcium supplements. Foods that are rich in salicylates and NSAIDs should be avoided while the client is taking salicylates.

18 of 20 A client experiences intense knee pain due to arthritis and the use of a hyaluronidase derivative is being considered. What assessment finding must be considered? • The client's expectations for future mobility • Whether the client is comfortable having an injection into the knee joint • The client's adherence to previous medication regimens • Allergies to shellfish or diagnostic contrast solution

• Whether the client is comfortable having an injection into the knee joint Explanation: Hyaluronidase is injected directly into the knee once a week for three weeks to relieve arthritis pain in the knee when unresponsive to conventional treatment. Adherence is less of an issue because of the infrequent administration. An allergy to shellfish or contrast dye is not a contraindication. The client's expectations must be assessed, but this would not be as significant an issue as the delivery method.

4 of 20 A client is experiencing bursitis in the right elbow. Which orally administered medication will diminish inflammation and assist in relieving this pain? • acetylsalicylic acid • acetaminophen • morphine sulfate • codeine

• acetylsalicylic acid Explanation: Acetylsalicylic acid is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders, such as bursitis. Acetylsalicylic acid is administered orally. Acetaminophen will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation. Reference:

8 of 20 The nursing student demonstrates understanding when choosing what as the effect of a salicylate? (Select all that apply.) • analgesic effect • anti-inflammatory effect • bronchodilating effect • anti-infective effect • antipyretic effect

• analgesic effect • antipyretic effect • anti-inflammatory effect Explanation: The salicylates are drugs derived from salicylic acid. They are useful in pain management because of their analgesic (pain-relieving) effect, antipyretic (fever-reducing) effect, and anti-inflammatory effect. They are not known to dilate the bronchioles, nor do they have any effect on infection.

11 of 20 The nursing student demonstrates understanding of salicylism when listing which symptoms of this condition? Select all that apply. • mental confusion • ringing in the ears • dizziness • impaired hearing • weight gain

• dizziness • ringing in the ears • impaired hearing • mental confusion Explanation: Toxicity can develop from taking too much aspirin, resulting in salicylism. Signs and symptoms of this condition include dizziness, ringing in the ears, impaired hearing, nausea, vomiting, flushing, sweating, rapid and deep breathing, tachycardia, diarrhea, mental confusion, lassitude, drowsiness, respiratory depression, and coma. Weight gain is not a sign of this condition.

12 of 20 The nurse understands that the primary adverse reaction with the use of salicylates is which? • tinnitus. • gastric distress. • tachycardia. • diarrhea.

• gastric distress. Explanation: Gastric distress is the primary adverse reaction of salicylates. Tinnitus, tachycardia, and diarrhea are symptoms of salicylate toxicity.

20 of 20 A client is admitted to the emergency department with suspect salicylism. The client's plasma salicylate level is 300 mcg/mL. Which sign/symptom would the nurse expect to assess? Select all that apply. • tetany • asterixis • flushing • headache • thirst

• headache • thirst • flushing Explanation: A client with a plasma salicylate level of 300 mcg/mL would exhibit the following: tinnitus, difficulty hearing, dizziness, nausea, vomiting, diarrhea, mental confusion, central nervous system depression, headache, sweating, and hyperventilation and flushing. Asterixis is noted with plasma salicylate levels above 400 mcg/mL. Tetany would be noted with plasma salicylate levels above 400 mcg/mL.

3 of 20 A client is prescribed acetylsalicylic acid for fever and headache. What is the action of acetylsalicylic acid? • inhibiting the release of norepinephrine to increase blood pressure • providing selective action by inhibiting prostaglandin synthesis in the CNS • suppressing the function of the hypothalamus to decrease inflammation • inhibiting prostaglandin synthesis in the central and peripheral nervous system

• inhibiting prostaglandin synthesis in the central and peripheral nervous system Explanation: Acetylsalicylic acid inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Acetylsalicylic acid does not inhibit the release of norepinephrine to increase blood pressure. Acetylsalicylic acid does not suppress the function of the hypothalamus to decrease inflammation.

11 of 20 The nurse is aware that aspirin not only lowers the client's fever but can also reduce the pain the client is experiencing by: • inhibiting the production of prostaglandins. • promoting the production of prostaglandins. • inhibiting the aggregation of platelets. • prolonging the bleeding time.

• 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 client.

4 of 20 Salicylates exert their anti-inflammatory and analgesic effects by which mechanism? • inhibition of central temperature receptors • inhibition of prostaglandins • inhibition of platelet aggregation • dilation of peripheral blood vessels

• inhibition of prostaglandins Explanation: The analgesic action of the salicylates is due to the inhibition of prostaglandins. The reduction in prostaglandins is also thought to account for the anti-inflammatory activity of salicylates. Salicylates lower body temperature by dilating peripheral blood vessels. The blood flows out to the extremities, resulting in the dissipation of the heat of fever, which in turn cools the body. Salicylates inhibit platelet aggregation, leading to an increased risk for bleeding. Aspirin does not affect the central temperature receptors.

8 of 20 A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which? • cognitive deficits. • acute renal failure. • gastrointestinal distress. • liver damage.

• liver damage. Explanation: A client 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.

9 of 20 The nurse knows that salicylate therapy is relatively safe. However, it can cause adverse reactions that include which? Select all that apply. • gastrointestinal bleeding • weight gain • nausea • anorexia • orange-colored urine

• nausea • anorexia • gastrointestinal bleeding Explanation: Although salicylates are relatively safe when taken as recommended on the label or by the provider their use can occasionally result in more serious reactions that include gastrointestinal bleeding, anorexia, and gastric upset such as nausea and diarrhea. Weight gain is not an adverse reaction; however, weight loss may result from accompanying anorexia.

1 of 20 Which types of pain are classified as acute pain? Select all that apply. • postoperative pain • procedural pain • diabetic neuropathic pain • osteoarthritis pain • fibromyalgia pain

• postoperative pain • procedural pain Explanation: Acute pain is brief and lasts less than 3 to 6 months. Postoperative pain and procedural pain represent acute pain. Osteoarthritis pain, fibromyalgia pain, and diabetic neuropathic pain are considered chronic.

3 of 20 A client is being administered salicylates for pain relief. The nurse should inform the client about which foods that are contraindicated during salicylate therapy? • green, leafy vegetables • fruits containing citric acid • prunes and raisins • milk and other milk products

• prunes and raisins Explanation: For a client who is taking salicylates, the nurse should ensure that foods containing salicylates (curry powder, paprika, licorice, prunes, raisins, and tea) are avoided in the client's diet as they may increase the risk of adverse reactions. There is no need to avoid green vegetables, milk products, or fruits containing citric acid.

8 of 20 The instructor is teaching about nonopioid analgesics. The student nurse identifies the following as uses for salicylates? Select all that apply. • helping to maintain pregnancy in special at-risk populations • reducing pain of peptic ulcer disease • decreasing risk of myocardial infarction (MI) • reducing elevated body temperature • relieving mild to moderate pain

• relieving mild to moderate pain • reducing elevated body temperature • decreasing risk of myocardial infarction (MI) • helping to maintain pregnancy in special at-risk populations Explanation: Some uses for salicylate nonopioid analgesics are relieving mild to moderate pain, reducing fever, treating certain inflammatory diseases such as osteoarthritis, decreasing risk of myocardial infarction, reducing risk of transient ischemic attacks, and helping to maintain pregnancy in special at-risk populations (ie, they may be used to treat or prevent inadequate uterine-placental blood flow). They are contraindicated in clients with peptic ulcer disease. Reference:

19 of 20 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? • ibuprofen overdose • salicylism • acute acetaminophen toxicity • caffeine overdose

• 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.

2 of 20 A client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify? • feverfew • willow bark • kava kava • black cohosh

• willow bark Explanation: Willow bark has analgesic, antipyretic, and anti-inflammatory properties and was the plant from which the chemical structure of aspirin (salicylic acid) was derived. Kava kava is used for anxiety and stress. Feverfew is used for the treatment of migraines and headache. Black cohosh is used for menopausal symptoms and hot flashes.