Chapter 16: Anti-Inflammatory, Antiarthritis, and Related Agents

A female client reports a mild headache and is prescribed acetaminophen 325 mg, two tablets by mouth every 4 to 6 hours. The client states that she usually takes ibuprofen for her headaches and asks why the health care provider ordered acetaminophen. Which explanation would the nurse give?

"Acetaminophen is often the initial drug of choice for relieving mild to moderate pain." Explanation: Acetaminophen is often the initial drug of choice for relieving mild to moderate pain and fever, because it does not cause gastric irritation or bleeding. It may be taken on an empty stomach.

Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents?

"Be sure to read the label for the ingredients and dosage." Explanation: Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

A client with a history of chronic pain is scheduled to undergo a colonoscopy. What health education should the nurse provide the client?

"Confirm with your provider, but you'll likely have to stop taking aspirin one week before the procedure." Explanation: Salicylates are contraindicated for clients who have had surgery or invasive procedures within 1 week because of the risk for increased bleeding. Thus the nurse would inform that client that she can resume taking the aspirin after 1 week. There is no need to avoid acetaminophen and the client's allergies do not necessarily need to be written down by the client. Anti-inflammatories may or may not be given before the procedure.

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse?

"It is an aspirin substitute for pain and fever." Explanation: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.

The client has had an open reduction internal fixation (ORIF) of the right hip. 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 client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond?

"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

A 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 health care provider'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 prescriber'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).

The nurse is teaching the client, who has been newly prescribed etanercept, how to administer the medication. What statement is accurate?

"You can rotate subcutaneous injection sites to avoid tissue damage." Explanation: Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to the amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.

A nursing student correctly identifies a normal dose of aspirin for the adult client as which?

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.

A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?

5 Explanation: The client's weight must be converted to kilograms: 88 lbs ÷ 2.2 = 40 kg. To calculate the daily dose, multiply the child's weight by the prescribed dose: 0.125 mg X 40 kg = 5 mg

A patient arrives at the emergency department brought by their friends. The friends tell the nurse that the patient has taken a whole bottle of aspirin. Blood work for salicylate toxicity is run. What result would the nurse expect?

>20 g Explanation: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children.

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.

A male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain?

Acetaminophen Explanation: Acetaminophen is not an anti-inflammatory medication. It is an analgesic and an antipyretic. Aspirin, naproxen sodium, and ibuprofen decrease pain and inflammation.

A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?

Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.

A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome?

Acetylsalicylic acid Explanation: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye's syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.

A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area?

Adverse effects of NSAIDs Explanation: The nurse should review adverse drug effects with client. The other factors are also important but the priority is to esnure the client is aware of and understands which adverse effects need to be reported immediately if detected.

The nurse knows, that as a COX-1 inhibitor, indomethacin inhibits prostaglandins associated with which tissues?

All tissues and cell types Explanation: COX-1 is present in all tissues and cell types, especially platelets, endothelial cells, the GI tract, and the kidneys. Prostaglandins produced by COX-1 are important in numerous homeostatic functions and are associated with protective effects on the stomach and kidneys.

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.

What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)

Anti-inflammatory Analgesic Antipyretic Explanation: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects.

Which drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction?

Aspirin Explanation: Aspirin is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction. Diflunisal, magnesium salicylate, or salsalate do not significantly decrease the risk of myocardial infarction.

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

Which statements are true of aspirin's effects on platelets? (Select all that apply.)

Aspirin inhibits platelet aggregation. The effect of aspirin on platelets is irreversible. Explanation: Aspirin prolongs bleeding time by inhibiting the aggregation of platelets. The effect of aspirin on platelets is irreversible and lasts for the life of the platelet (7 to 10 days).

When acetylsalicylic acid (aspirin) is administered, what action prevents the synthesis of thromboxane A2?

Aspirin's acetyl portion dissociates, binding to COX-1 to decrease aggregation. Explanation: When aspirin is absorbed into the bloodstream, the acetyl portion dissociates and then binds irreversibly to platelet COX-1. This action prevents synthesis of thromboxane A2, a prostaglandin derivative, thereby inhibiting platelet aggregation. Aspirin does not have an effect on vasodilation by decreasing platelet aggregation. Aspirin does not affect the pH of the blood to diminish platelet aggregation. Aspirin's acetyl portion does not dissociate and bind to COX-1 to decrease aggregation of the platelets.

A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate?

Assess the client's use of salicylates. Explanation: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with acetaminophen toxicity or an exacerbation of rheumatoid arthritis itself. This constellation of symptoms is not suggestive of an allergic reaction.

A patient with arthritis is on nonsteroidal anti-inflammatory drug (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.

The nurse is discussing ethnic differences in response to medication with nursing students. What group of people would the nurse tell the students have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs?

Black Americans Explanation: Black clients have a documented decreased sensitivity to the pain-relieving effect of many anti-inflammatory drugs. They also have an increased risk of developing gastrointestinal adverse effects to these drugs. In general, White, Hispanic, and Asian clients do not.

A group of students is reviewing information about cyclooxygenase receptors. The students demonstrate understanding of the information when they identify what as an effect of COX-2 receptors?

Blockage of platelet clumping Explanation: COX-2 receptors block platelet clumping. COX-1 receptors maintain renal function, provide for gastric mucosal integrity, and promote vascular hemostasis.

A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?

Blocks interleukin-1 Explanation: Anakinra blocks the increased interleukin-1 responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating tumor necrosis factor released by active leukocytes in autoimmune inflammatory disease to prevent damage caused by tumor necrosis factor. Leflunomide directly inhibits an enzyme, dihydroorotate dehydrogenase (DHODH), that is active in the autoimmune process. Penicillamine lowers immunoglobulin M rheumatoid factor levels.

A student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation?

Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Explanation: Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment (chemotherapy, surgery, or radiation). As with acute pain, acetaminophen, aspirin, or other NSAIDs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. NSAIDs are especially effective for pain associated with bone metastases.

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take?

Celecoxib Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.

A 25-year-old woman with rheumatoid arthritis is being treated with acetaminophen and salicylates. The health care provider has switched her medication regimen to include DMARDs. What is the advantage of DMARDs over salicylates?

DMARDs can arrest the progression of rheumatoid arthritis. Explanation: DMARDs have the advantage of actually halting the progression of inflammatory diseases and the potential damage they may cause, while salicylates, PSIs, and acetaminophen control only the symptoms of the disease. DMARDs do not have a lower risk of adverse effects. The frequency of potentially serious adverse effects is high. Using DMARDs in combination with methotrexate, rather than lower doses of DMARDs alone, is an advantage because it reduces the risk of adverse effects.

The nurse is caring for a client with joint pain whose primary health care provider has recommended the use of ibuprofen 400 mg PO t.i.d. What is the nurse's best response to this prescription?

Educate the client about possible adverse effects. Explanation: This order is appropriate with regard to dose and frequency. In most circumstances, it is inappropriate for the nurse to initiate the exploration into alternatives to treatments that have been prescribed. Education about potential adverse effects is necessary to ensure safety.

A client is to receive etanercept. What characteristic of the client may contraindicate the use of this medication?

Fear of injections Explanation: Etanercept can only be administered subcutaneously . Because it is given subcutaneously, dysphagia is not a problem. CNS effects are unlikely, so operating machinery is not dangerous. A client's lack of social support must be addressed, but does not necessarily preclude treatment.

Temperature regulation occurs in the hypothalamus. Normally, when the body temperature increases the body will respond by causing vasodilation in the periphery. What physiologic change is occurring with fever that allows the body's temperature to increase?

Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. Explanation: Fever is the result of fever-inducing substances called pyrogens, which activate certain monocytes/macrophages, which in turn secrete cytokines. Cytokines increase the synthesis and secretion of prostaglandin E2 (PGE2) in the hypothalamus, and PGE2 stimulates the hypothalamus to reset the regulating mechanism to tolerate a higher body temperature.

The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?

Follow a low purine diet Explanation: The nurse should encourage the client to follow a low-purine diet which would exclude items such as any alcohol products, organ and game meat, sardines, anchovies, scallops, asparagus, spinach, and peas. Alcohol should not be used at all even in moderation to avoid future attacks of gout. For acute gouty flare-ups, take one dose and the second dose 1 hour later. The dose should not be doubled. Although severe diarrhea may occur, it is not an expected or therapeutic response and should be immediately reported to the health care provider.

A nurse is conducting a medication reconciliation for an older adult client who has just relocated to the long-term care facility. The nurse notes that the resident has been taking colchicine on a regular basis. Which medication regimen should signal the nurse to the possibility of what diagnosis?

Gout Explanation: Colchicine, the prototype agent for the treatment and prevention of gout, is the most commonly administered anti-gout medication. This medication is thought to block neutrophil-mediated inflammation. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis since they are not a result of neutrophil-mediated inflammation.

A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate?

Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.

What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)?

Inhibit prostaglandin synthesis Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.

A patient with muscle ache would like to use an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?

It causes decreased effectiveness of the antihypertensive drug. Explanation: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drug, or decreased metabolism of NSAID.

Which of the anti-inflammatory drugs have geriatric warnings been associated with? (Select all that apply.)

Ketorolac (Tordal) Naproxen (Naprosyn) Ketoprofen (Orudis) Explanation: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These NSAIDs should be avoided if possible. Clinoril and indocin are not associated with toxicity in older patients.

What would be appropriate to use in combination with gold salts?

Low-dose corticosteroids Explanation: Gold salts should not be combined with penicillamine, cytotoxic drugs, immunosuppressive agents, or antimalarials other than low-dose corticosteroids because of the potential for severe toxicity.

What information should be provided to a client diagnosed with an acetylsalicylic acid allergy?

Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Explanation: In people who have demonstrated hypersensitivity to acetylsalicylic acid, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. This makes all the other options incorrect.

An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?

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.

A nurse is caring for a client in the early stage of rheumatoid arthritis. The nurse would expect which medication classification to be used in the treatment of this client?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: The NSAIDs are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Antimalarial agents are used in the treatment of systemic lupus erythematosus. Xanthine oxidase inhibitors and uricosuric agents are used in the treatment of gout.

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 nurse is administering an anti-inflammatory medication to a client who has severe rheumatoid arthritis. Which would the nurse question if ordered by the health care provider?

Oral anticoagulant Explanation: There is an increased risk of bleeding when taking an oral anticoagulant with an anti-inflammatory. Antidiabetic agents, antihypertensives, and most antibiotics can be given safely with anti-inflammatory agents.

After teaching a group of nursing students about pain and pain assessment, the instructor determines that the teaching was successful when the students identify which statements as true about pain? Select all that apply.

Pain experienced by one person is different from another. Failure to assess pain is often a major factor in undertreating pain. Explanation: Pain is a highly individualized experience. Pain is often undertreated because of a failure in assessing pain adequately. Two basic measures are needed in any pain assessment: location and intensity. Pain is subjective. Children may have difficulty interpreting numbers, so a visual analog scale would be most appropriate.

An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?

Reye syndrome Explanation: Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.

A 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.

The nurse is educating an African-American client about the safe and effective use of anti-inflammatories. In order to address the known ethnic factors relating to this client's drug therapy, the nurse should do what?

Teach the client about the heightened risk for GI adverse effects. Explanation: African Americans have a documented decreased sensitivity to pain-relieving effects of many anti-inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. There is no specific reason why opioids or ibuprofen should be preferred over other options. The role of fluid intake during treatment is unrelated to ethnicity.

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 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.

A client has developed a fever. What aspect of the client's health history would contraindicate the safe and effective use of acetaminophen?

The client has hepatitis C and abuses alcohol Explanation: Liver disease and alcoholism contraindicate the use of acetaminophen. An allergy to penicillin would not pose a problem. Similarly, a history of seizures, benzodiazepine use and diclofenac would not rule out the use of acetaminophen.

A patient has been diagnosed with rheumatoid arthritis and is experiencing pain and decreased mobility. Etanercept has been proposed as possible treatment option. Which characteristic of this patient would likely preclude the use of etanercept?

The patient has chronic osteomyelitis resulting from a diabetic foot ulcer. Explanation: Infection is a major contraindication for the use of etanercept. Obesity, family history of cancer, and occasional use of topical corticosteroids do not preclude the use of etanercept.

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.

A group of nursing students are reviewing information about nonopioid analgesics. The students demonstrate understanding of the information when they identify which drug as a nonsalicylate analgesic?

acetaminophen Explanation: Acetaminophen is classified as a nonsalicylate analgesic. Aspirin, diflunisal, and magnesium salicylate are salicylates.

A client is experiencing bursitis in the right elbow. Which orally administered medication will diminish inflammation and assist in relieving this pain?

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.

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.

The nurse correctly identifies which medications used in the treatment of pain?

analgesics. Explanation: Analgesics are medications used to treat and relieve pain. ACE inhibitors are cardiac drugs. Cephalosporins are a classification of anti-infectives, while bronchodilators are respiratory drugs.

How should a nurse best explain the presence of the inflammation process?

as an attempt by the body to remove the damaging agent and repair the damaged tissue Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. The remaining options are either incorrect or incomplete descriptions of the inflammation process.

A client has a sulfonamide allergy. Which drug would the nurse identify as being contraindicated?

celecoxib Explanation: Celecoxib is contraindicated in clients with a sulfonamide allergy. Ibuprofen, ketorolac, and meloxicam are not contraindicated.

Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)?

celecoxib Explanation: Celecoxib is the NSAID that appears to work by specifically inhibiting cyclooxygenase-2 without inhibiting cyclooxygenase-1. Naproxen, meloxicam, and ibuprofen inhibit both COX-1 and COX-2.

The nurse knows that acetaminophen should not be used in older adults with which condition?

cirrhosis. Explanation: An adverse effect of acetaminophen is hepatotoxicity. Therefore, an older adult with cirrhosis should not be prescribed acetaminophen. Having diabetes, a history of MI, or COPD does not restrict use of acetaminophen in the older adult.

A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief?

cyclooxygenase-2 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

The nurse administers ibuprofen to adult clients experiencing a variety of health disorders. Following administration, the nurse should assess for therapeutic effects related to what symptoms? Select all that apply.

fever inflammation moderate pain Explanation: Ibuprofen is used to relieve mild to moderate pain or inflammation related to rheumatoid arthritis or osteoarthritis. In addition, it is effective in reducing fever. During initial attacks of acute gout, ibuprofen may be administered, but it does not directly reduce uric acid levels. Pruritus (itching) management is not a primary indication for ibuprofen use.

What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals?

gold salts Explanation: Gold salts can be quite toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation.

A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?

ibuprofen Explanation: NSAIDs such as ibuprofen are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Balsalazide is used to treat ulcerative colitis. Ketorolac is used to treat acute pain in the short term. Auranofin is a gold salt that is not a first-line treatment.

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. 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.

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?

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.

An adult client is brought to the emergency department after deliberately overdosing on acetaminophen. The care team should prioritize interventions based on the client's risk for which adverse reaction?

liver failure Explanation: Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose and is most likely with doses of 20 g or more. None of the other options are associated with acetaminophen overdosing.

The pediatric client has a fever, and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this client?

naproxen Explanation: Naproxen is approved for pediatric use and has antipyretic properties. Balsalazide is used to treat ulcerative colitis and would not be appropriate for treating a fever. Indomethacin has antiinflammatory effects but does not have antipyretic effects. Aspirin would not be appropriate for treating a child with a fever of unknown origin due to risk of Reye's syndrome.

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which?

peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.

A 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 client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify?

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.