Chapter 16: Drug Therapy to Decrease Pain, Fever, and Inflammation Supplement

What principle should guide the possible use of indomethacin in an older adult client? This client should be prescribed intravenous (IV), rather than oral, administration of indomethacin. Indomethacin should be avoided in a client of this age. The client must be cautioned against taking the drug on an empty stomach. Indomethacin is among the preferred nonsteroidal anti-inflammatory drugs (NSAIDs) for this client.

Indomethacin should be avoided in a client of this age. Rationale: The Beers Criteria indicate that indomethacin is inappropriate in the geriatric population and is associated with a high risk of severity. This information makes all the other options incorrect.

When NSAIDs are combined with lithium, there is a potential for: decreased antihypertensive effect. increased diuretic effect. lithium toxicity. anaphylactoid reactions.

lithium toxicity. Explanation: NSAIDS have interactions with a variety of drugs and the efficacy of the medications. When an NSAID is taken with lithium for a bipolar disorder, there can be an increased effectiveness leading to lithium toxicity. When NSAIDS are taken with diuretics, there often is a decreased diuretic effect. There is a potential for decreased anti hypertensive effect with NSAIDS and anti hypertensive drugs. The NSAIDs are so named because they have antiinflammatory effects and do not cause anaphylaxis.

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." "Some clients have some discomfort during a colonoscopy, but the provider will likely give you an anti-inflammatory before it." "It's very important that you write down every drug that you're allergic to and bring it to your appointment." "Make sure not to take any Tylenol for at least three days before the day of the procedure."

"Confirm with your provider, but you'll likely have to stop taking aspirin one week before the procedure." 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 Tylenol 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 nurse should monitor laboratory results related to blood clotting when the client takes what drugs regularly?

-Salicylates -Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which statement by the client indicates a clear understanding of the primary adverse effect of aspirin therapy? "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." "I don't like to swallow tablets so I crush them." "I take as little water as possible when I take my medication."

"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.

The client has been prescribed celecoxib for osteoarthritis. Which statement by the client indicates the need for further client education?

"I will stop taking the medication when I feel better."

An older adult client has presented to the emergency department reporting frank blood in his stool over the past 24 hours. What assessment question should the nurse prioritize?

"What medications do you take for pain or inflammation?"

A clinic nurse is caring for a patient who is taking a COX-2 inhibitor. The nurse knows that this patient needs to be evaluated for what conditions? (Select all that apply.)

- Bleeding time - GI effects - Water retention Explanation: Experience has shown that the COX-2 inhibitors still have some effect on these other functions, and patients should still be evaluated for GI effects, changes in bleeding time, and water retention. Patients taking COX-2 inhibitors do not need to be evaluated for liver function or inflammatory response, which COX-2 inhibitors block

The nurse instructs the client that with the use of NSAIDs some adverse reactions can occur. Which are they? Select all that apply. A. Dysmenorrhea B. Somnolence C. Hematuria D. Purpura E. Ecchymosis

-Somnolence -Hematuria -Purpura -Ecchymosis

A patient takes ibuprofen at approximately 10 A.M. The patient would most likely feel peak effects of the drug at which time?

12 P.M.

A patient is prescribed penicillamine. The nurse instructs the patient that they will not experience the full effect of the drug for how long?

2 to 3 months

What is the max daily dose for acetaminophen? Antidote if you go over and become toxic?

4 grams!!! acetylcysteine

A home care nurse is visiting an 88-year-old man, who is taking acetaminophen for arthritic pain in his knees. Which of the following patient teaching statements is most appropriate to implement? A. "Acetaminophen will only relive pain but not the inflammation from arthritis." B. "Acetaminophen is appropriate for the treatment of inflammation from arthritis." C. "Your primary health care provider should consider a prescription of Vicodin (acetaminophen/hydrocodone)." D. "The acetaminophen should be administered on an empty stomach."

A. Acetaminophen is effective in reducing pain but not decreasing inflammation. Acetaminophen is commonly taken for osteoarthrosis; it works as an analgesic but will NOT have any anti-inflammatory effects.

Which of the following is the antidote for acetaminophen (Tylenol) poisoning? A. Acetylcysteine (Mucomyst) B. Allopurinol (Zyloprim) C. Diclofenac sodium (Voltaren) D. Ketorolac (Toradol)

A. Acetylcysteine (Mucomyst) A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.

A patient is taking systemic corticosteroids. Which of the following nursing interventions is the most important? A. Assess for s/sx of adrenocortical excess B. Hold cortisone before surgery C. Assess for fluid volume deficit D. Decrease intake of vitamin

A. Assess for s/sx of adrenocortical excess Rational: Systemic corticosteroids are stronger and will influence the entire body. Signs of excess are skin problems(poor wound healing), high blood pressure (fluid retention), bone weakness (osteoporosis), high glucose. Remember you would want to give steroids in time of stress like surgery.

A patient is receiving prednisone 10mg orally every day to reduce the symptoms of Crohn's disease. Which of the following effects is associated with daily prednisone? A. Atrophy of adrenal gland B. Decrease serum glucose C. Weight loss D. Fluid volume deficit

A. Atrophy of adrenal gland Rational: Taking daily corticosteroids will make the adrenal glands stop producing their own hormone leading to the shrinking of the gland... if you don't use it, you lose it. That's why it is important to taper the steroid does down gradually.

A patient suffers from pain in the elbow related to inflammation. What are the chemical mediators of inflammation? A. Bradykinin, histamine, and leukotrienes B. Insulin, thyroid hormone, and calcitonin C. Red blood cells, lymph, and serosa D. Phospholipids, arachidonic acid, and platelets

A. Bradykinin, histamine, and leukotrienes Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes. Insulin, thyroid hormone, and calcitonin are not chemical mediators of inflammation. Phospholipids, arachidonic acid, and platelets are not chemical mediators of inflammation. Red blood cells, lymph, and serosa are not chemical mediators of inflammation.

A newborn infant has been treated with parenteral indomethacin for treatment of patent ductus arterioles. Which of the following symptoms would be indicative of a reopening of the ductus arterioles in 12 hours after the original dosage? A. dyspnea B. pain C. elevated creatinine level D. hepatic failure

A. Dyspnea is a sign of heart failure and the reopening of the ductus arteriosus.

Which of the following medications is contraindicated with acetaminophen? A. oxycodone with acetaminphen B. furosemide C. phenytoin D. ampicillin

A. Percocet contains acetaminophen, and the two medications should not be administered together.

A 76-year-old woman is taking celecoxib for arthritic pain in her back. When administering celecoxib, which of the following patient teaching points is most important? A. Any chest pain should be reported to the prescriber immediately B. Celecoxib can only be administered with warfarin. C. Increased mobility should be reported to the prescriber D. Celecoxib can be administered with aspirin during periods of infection

A. The client should report chest pain because COX-2 inhibitors are associated with an increased risk of myocardial infarction and cerebrovascular accident.

A patient is being treated with colchicine for acute gouty flare-up. Which of the following statements indicates the need for increased patient education? A. "I am going to stop taking the colchicine because of the diarrhea I am having" B. "The gastrointestinal effects are difficult to deal with, but I know they will decrease my gouty symptoms." C. "I will continue my colchicine just as it has been prescribed to me." D. "The diarrhea I am experiencing can result in dehydration. If I have lethargy, I will call my prescriber."

A. The client who states that he or she will stop taking the colchicine because of diarrhea requires client education about the medication. Colchicine is used to decrease the infammation by eliminating the serum uric acid.

The nurse knows that acetaminophen should not be used in older adults with which condition? A. cirrhosis. B. diabetes. C. myocardial infarction (MI). D. chronic obstructive pulmonary disease (COPD).

A. cirrhosis.

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? Aspirin Diflunisal (Dolobid) Acetaminophen Ibuprofen

Acetaminophen

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? What is classified as a nonsalicylate analgesic? Acetaminophen Ibuprofen Naproxen Indomethacin

Acetaminophen 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.

Mr. Conn, age 65, is taking probenecid for treatment of chronic gouty arthritis. When providing patient and family education, what should a nurse advise the patient to do if he misses a dose and it is almost time for the next dose? Advise the patient to take only the second dose and ignore the missed dose. Double the dose next time Undergo blood or urine tests Stop the medication

Advise the patient to take only the second dose and ignore the missed dose. Explanation: If a patient misses a dose, it should be taken as soon as possible. If it is almost time for the next dose, however, only that dose should be taken; the patient should never take double or extra doses. It is not essential to undergo blood or urine tests or stop the medication unless symptoms of any adverse effects occur.

A male 16 years of age presents to the physician's office with nausea, vomiting and pain in the right upper quadrant. He states he has had flu-like symptoms for four to five days. What is the most appropriate action of the nurse?

Ask for a medication history.

Which drug is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction? Aspirin Diflunisal Magnesium salicylate Salsalate

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 development of gout has four distinct phases. Place in order each phase of the development of gout. 1. Asymptomatic hyperuricemia 2. Intercritical gout 3. Chronic advanced gout 4. Acute gouty arthritis

Asymptomatic hyperuricemia Acute gouty arthritis Intercritical gout Chronic advanced gout Rationale: Gout has four distinct phases: asymptomatic hyperuricemia, acute gouty arthritis (flares), intercritical gout (interval between flares), and chronic advanced gout (uncontrolled hyperuricemia with chronic arthritis tophi).

An elderly patient has taken ibuprofen (Motrin) 800 mg two times per day for the past 3 years. Which of the following laboratory tests is the priority assessment? A. Renin and aldosterone levels B. Blood urea nitrogen and serum creatinine C. 24-hour urine for microalbumin D. Complete blood count

B. Blood urea nitrogen and serum creatinine Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The patient should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen. A complete blood count may not be necessary.

A toddler is running a fever of 103 degrees F. Which of the following medications is alternated to treat the fever? A. aspirin and acetaminophen B. acetaminophen and ibuprofen C. naproxen sodium and ibuprofen D. aspirin and ibuprofen

B. Toddlers with high fevers should be treated with acetaminophen and ibuprofen. The medications are administered in an alternating schedule.

A prescriber in an orthopedic care practice orders meloxicam for the treatment of osteoarthritis. Which of the following medications when combined with meloxicam places the patient at greatest risk? A. antimicrobials B. lithium C. selective serotonin inbhibitors D. hydrochlorothiazide

B. lithium B. Lithium toxicity will result when combined with meloxicam.

A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner? Interferes with free-floating tumor necrosis factor Inhibits the DHODH enzyme Blocks interleukin-1 Lowers immunoglobulin M factor levels

Blocks interleukin-1 Rationale: 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.

During discharge counseling, the nurse should tell the client which of the following about the cardiovascular effects of ibuprofen (Motrin)? Select all that apply: A) My blood pressure may increase. B) My blood pressure won't change. C) I could develop congestive heart failure. D) I could experience a heart attack.

Blood pressure may increase. Congestive heart failure may worsen. Myocardial infarction may occur.

A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A. 180 mg B. 650 mg C. 80 mg D. 325 mg

C. 80 mg The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 80 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.

A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)? A. Pancreatitis B. Pulmonary insufficiency C. Hepatotoxicity D. Nephrotoxicity

C. Hepatotoxicity In acute or chronic overdose of acetaminophen (Tylenol), the patient can develop hepatotoxicity. Nephrotoxicity is not an adverse effect associated with Tylenol overdose. Pulmonary insufficiency is not an adverse effect associated with Tylenol overdose. Pancreatitis is not an adverse effect associated with Tylenol overdose.

A child who is diagnosed with pneumonia is taking ibuprofen for a fever. The nurse observes a rash. Which of the following reactions does the nurse suspect? A. thromboembolism B. streptococcal reaction C. hypersensitivity D. viral infection

C. The child has developed a hypersensitivity reaction to ibuprofen. This places him at risk for salicylate hypersensitivity in the future.

A man is taking allopurinol for acute gout. He has also been receiving anticoagulant therapy since having a myocardial infarction. What is the priority assessment? A. diminished pain in the inflamed joint B. adherence to the medication regimen C. bleeding D. abdominal pain

C. The client who has an acute gout flare-up is treated with a uricosuric agent. In the event, he is status postmyocardial infarction and is administered anticoagulant agent, and it is important to assess the client for bleeding.

The nurse is caring for a client who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What laboratory results should the nurse prioritize when assessing the client?

Complete blood count

A patient is suffering from bursitis in the right elbow. Which medication administered orally will diminish inflammation and assist in relieving pain? A. Acetaminophen (Tylenol) B. Codeine C. Morphine sulfate D. Acetylsalicylic acid (aspirin)

D. Acetylsalicylic acid (aspirin) Aspirin is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders. Aspirin is administered orally. Acetaminophen (Tylenol) 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 child has symptoms of the flu with fever. Which medication should not be administered to the child because of the risk of Reye syndrome? A. Acetaminophen (Tylenol) B. Ibuprofen (Motrin) C. Ascorbic Acid (vitamin C) D. Acetylsalicylic acid (aspirin)

D. Acetylsalicylic acid (aspirin) 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 (Tylenol) and ibuprofen (Motrin) are safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children but is not used to reduce fever or pain.

A man with an acute gouty flare-up is taking allopurinol. Which of the following subjective statements indicates that he has developed uric acid kidney stones? A. "I have pain in my right toe and left elbow." B. "I am dizzy and feel like I am going to faint." C. "I am urinating ever hour approximately8 oz." D. "I have excruciating pain in my lower abdomen."

D. Excruciating pain in the lower abdomen is indicative of the development of uric acid stones in clients receiving a uricosuric agent.

A patient with osteoarthritis has been prescribed meloxicam (Mobic). Which of the following instructions should the patient be given? A. Take the medication at bedtime. B. Crush enteric-coated tablets to aid swallowing. C. Take the medication with orange juice. D. Take the medication with food.

D. Take the medication with food. Meloxicam should be taken with food. Enteric-coated tablets are never crushed, and it is not always necessary to take this medication at bedtime. Orange juice is not of particular benefit.

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Hydroxychloroquine Humira Gold salts Azathioprine

Gold salts Rationale: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose. Gold compounds are used for a client with rheumatoid arthritis who does not respond to the usual anti-inflammatory agents and in whom the conditions worsen despite weeks or months of standard pharmacologic treatment. Not a 1st-line drug.

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

Ibuprofen

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

It causes decreased effectiveness of the antihypertensive drug.

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

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.

The client reports severe pain from an acute lumbar spasm. The nurse would anticipate which drug to be ordered for this client?

Ketorolac (Toradol)

Which of the anti-inflammatory drugs have geriatric warnings been associated with? (Select all that apply.) Indomethacin (Indocin) Sulindac (Clinoril) Ketorolac (Tordal) Ketoprofen (Orudis) Naproxen (Naprosyn)

Ketorolac (Tordal) Naproxen (Naprosyn) Ketoprofen (Orudis) Rationale: 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.

Which of the following would be appropriate to use in combination with gold salts? -Penicillamine -Cytotoxic agents -Immunosuppressants -Low-dose corticosteroids

Low-dose corticosteroids 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.

A client is diagnosed with inflammatory bowel disease. Which agent would the nurse expect to administer? Diflunisal Aspirin Choline magnesium trisalicylate Mesalamine

Mesalamine Rationale: Mesalamine or olsalazine would be appropriate for a client with inflammatory bowel disease. Diflunisal is indicated for the treatment of moderate pain and arthritis in adults; aspirin is used for the treatment of fever, pain, and inflammatory conditions. Choline magnesium trisalicylate is indicated for the relief of mild pain, fever, and arthritis.

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.

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

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 caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition? Prolonged immobility Reduced intake of fibrous food Intake of food with antacids Prolonged temperature elevation

Prolonged temperature elevation Explanation: If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur. Prolonged immobility, reduced intake of fibrous food, and intake of food with antacids do not cause a decrease in urinary output.

A client who is taking salicylates comes to the emergency department for evaluation. What assessment findings should lead the nurse to suspect acute salicylate toxicity? Select all that apply.

Respiratory rate of 38 breaths per minute Muscle spasms Agitation

Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?

Rheumatoid arthritis (RA)

Terry, age 43, has been taking colchicine for the past few years. He also suffers from renal impairment. What should the nurse specifically monitor in Terry, considering his renal status?

Serum creatine kinase levels

The client has gouty arthritis. Which of the following medications may be prescribed? -sulindac -etanercept -adalimumab -methotrexate

Sulindac

A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?

Tarry stool

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 The client had an allergic reaction to penicillin during a previous admission The client's most recent hospital admission was because seizures which were treated with benzodiazepines The client was prescribed diclofenac for back pain and did not experience pain relie

The client has hepatitis C and abuses alcohol Rationale: 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. 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.

A nurse is presenting an educational event for a group of new parents. One factor that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do? A) "Do not give acetaminophen (Tylenol) unless you receive a doctor's order." B) "Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients." C) "Monitor their child's temperature carefully and regulate the Tylenol dose based on the fever." D) "Mix OTC children's medications to get the best coverage for their child's symptoms."

To check the label of OTC medications carefully to watch for inclusions of acetaminophen Explanation: Inadvertent overdose with Tylenol frequently occurs because of the combining of over-the-counter drugs that contain the same ingredients. Parents should be taught to carefully check the labels of over-the-counter products and follow the dosage guidelines. A prescription is not required for Tylenol, and the dosage guidelines are the best guide to follow in preventing overdosing.

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

You are speaking with a 28-year-old male who sustained a musculoskeletal injury while playing baseball. He tells you that he has taken an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). Which of the following actions, in addition to taking an NSAID, would you recommend that he take? a) Apply cold therapy b) Practice passive range of motion exercises c) Apply moist heat d) Practice relaxation techniques

a) Apply cold therapy Rationale: Application of cold therapy to an acute musculoskeletal injury can help decrease pain, swelling, and inflammation. Resting and elevating the injured body part, as well as applying compression, can also help.

A patient is being seen in the clinic with a new onset of rheumatoid arthritis. The patient has a documented severe allergy to aspirin. Which medication is contraindicated for this patient? a) Sulfasalazine (Azulfidine) b) Penicillamine (Cuprimine) c) Etanercept (Enbrel) d) Cyclosporine (Sandimmune)

a) Sulfasalazine (Azulfidine) Rationale: Sulfasalazine (Azulfidine) is a sulfonamide antibiotic considered a first-line treatment for both adult and juvenile rheumatoid arthritis. It is contraindicated in patients with salicylic hypersensitivity, sulfonamide hypersensitivity, furosemide hypersensitivity, thiazide diuretic hypersensitivity, sulfonylurea hypersensitivity, or carbonic anhydrase inhibitor hypersensitivity, because it is broken down to a salicylate component and a sulfonamide component.

A patient is scheduled for surgery tomorrow. Which medication may increase risk of bleeding? Select all that apply. a. aspirin b. acetaminophen c. indomethacin d. meloxicam

a. aspirin c. indomethacin d. meloxicam Acetaminophen is the only drug that will NOT affect bleeding. Generally these medications are held at least 1 week before and after surgery.

What is important to teach our patients about antigout medications? select all that apply. a. avoid alcohol b. avoid grapefruit juice c. increase fluid intake d. take with food e. increase potassium in diet f. decrease sodium in diet a-d alc and grapefruit juice are high in uric acid, increase fluid to flush out crystals and food reduces GI upset

a. avoid alcohol b. avoid grapefruit juice c. increase fluid intake d. take with food alc and grapefruit juice are high in uric acid, increase fluid to flush out crystals and food reduces GI upset

what are some big adverse effects we worry about with corticosteroids? select all that apply. a. hyperglycemia b. fluid retension c. thing skin, delayed wound healing d. osteoporosis e. CNS effects (dizzy) f. decreased immunity g. dysrhythmias

a. hyperglycemia b. fluid retension c. thing skin, delayed wound healing d. osteoporosis e. CNS effects (dizzy) f. decreased immunity g. dysrhythmias

The inflammatory response includes which of the following? select all that apply a. redness b. coolness c. warmth d. dry skin e. pain f. swelling

a. redness c. warmth e. pain f. swelling

What are the effects of corticosteroids? select all that apply. a. suppress inflammatory hormones b. reduce capillary permeability c. imapir phagocytosis d. inhibit tissue repair e. impair neutrophils f. impair lymphocytes g. decrease immune & inflammatory response

a. suppress inflammatory hormones b. reduce capillary permeability c. imapir phagocytosis d. inhibit tissue repair f. impair lymphocytes g. decrease immune & inflammatory response

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 aspirin diflunisal magnesium salicylate

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

A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem? A. fever B. a chronic wound C. migraine D. arthritis

arthritis Explanation: Meloxicam is administered for the treatment of osteoarthritis and rheumatoid arthritis. It has no effect on any of the other options.

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? a) Fever occurs as a result of basophile release. b) Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. c) Fever occurs because the body allows the set point to be changed. d) Fever occurs because of the activation of lymphocytes.

b) Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. Rationale: 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.

A client with dysmenorrhea has been prescribed naproxen 1250 mg PO b.i.d. What is the nurse's best action? a) Assess the client's baseline renal and hepatic status b) Question the prescriber about the dose c) Question the prescriber about the route d) Question the prescriber about the frequency

b) Question the prescriber about the dose Rationale: For adults, naproxen is given 250-500 mg PO b.i.d. As a result, the nurse should question the prescriber about the dose before proceeding.

Which of the following agents would be least appropriate to use as treatment for ulcerative colitis? a) Mesalamine b) Salsalate c) Olsalazine d) Balsalazide

b) Salsalate (Others are fine) Rationale: Salsalate is used to treat pain, fever, and inflammation in adults. Balsalazide can be used to treat mild to moderate acute ulcerative colitis in adults. Olsalazine can be used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Mesalamine is used to treat ulcerative colitis and other inflammatory bowel diseases in adults.

A patient is to receive aurothioglucose. The nurse would administer this drug by which route? -oral -subcutaneous -intramuscular -intravenous

intramuscular

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? a) >10 g b) >15 g c) >20 g d) >5 g

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

The client is concerned about taking NSAIDs for pain due to possible GI upset. The nurse identifies which medication causes the least gastrointestinal distress?

celecoxib Explanation: Celecoxib is a COX-2 inhibitor that works without inhibiting the COX-1 enzyme, which helps to maintain the stomach lining. Ibuprofen, meloxicam, and naproxen inhibit the COX-1 enzyme.

A client on NSAIDs is experiencing congestive heart failure. The healthcare provider has ordered a diuretic to the treatment plan. The nurse evaluates the client for what reaction? NSAID toxicity. decreased effectiveness of the diuretic. diuretic toxicity. decreased effectiveness of NSAIDs.

decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.

What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals? gold salts cox 2 inhibitors propionic Acids fenamates

gold salts Rationale: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 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?

hepatotoxicity Explanation: Aspirin has been associated with hepatotoxicity in patients with juvenile arthritis, active systemic lupus erythematosus, rheumatic fever, or preexisting hepatic impairment. The hepatotoxicity is thought to be a direct toxicity to the liver and is associated with high-dose therapy. Bronchoconstriction is one of the hypersensitivity responses to aspirin, while patients with hemophilia are at risk for agranulocytosis and aplastic anemia.

A client has been diagnosed with severe rheumatoid arthritis, and hylan G-F 20 has been ordered. How is this drug given? injected into joint orally IM sub Q

injected into joint Rationale: Hyaluronidase derivatives, such as hylan G-F 20 and sodium hyaluronate, have elastic and viscous properties. These drugs are injected directly into the joints of clients with severe rheumatoid arthritis of the knee. They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis. They are given weekly for 3 to 5 weeks.

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 Flushing Dizziness Feelings of tingling, heat, and fatigue

liver damage. 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.

A client is prescribed piroxicam for osteoarthritis. The nurse would assess the client for which adverse reaction?

nausea

A client is diagnosed with migraine headaches. Which class of medication would the nurse expect to be prescribed as treatment for the acute pain associated with migraine headaches? a) calcium channel blockers b) beta blockers c) selective serotonin agonists d) anticonvulsants

selective serotonin agonists Rationale: Selective serotonin agonists are used to treat the acute pain associated with migraine headaches. Beta blockers are used for prophylactic migraine treatment. Calcium channel blockers are used for prophylactic migraine treatment. Anticonvulsants are used for prophylactic migraine treatment.

A black patient is receiving a high dose of NSAID for pain relief. Which of the following would be the most important for the nurse to include in the teaching plan? the need to combine the drug with an OTC salicylate signs and symptoms of GI bleeding avoidance of warm soaks for additional pain relief importance of adequate hydration

signs and symptoms of GI bleeding

A patient with severe rheumatoid arthritis of the knees has arrives at the facility for an injection of a drug into the joint. Which agent would the nurse most likely expect to be used? -auranofin -penicillamine -etanercept -sodium hyaluronate

sodium hyaluronate

Which statement by which a patient receiving gold salts indicates understanding of the drug therapy? -these drugs are used first to try to control my severe disease -these drugs will help prevent further damage from my disease -these drugs should help because I've has the disease for so long -these drugs are safer than most of the other drugs for arthritis

these drugs will help prevent further damage from my disease

A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the nurse is responsible for facilitating this new aspect of the patient's drug regimen. This will involve the administration of: daily, outpatient intravenous therapy. weekly subcutaneous injections. weekly administration of an enteric coated tablet. daily, oral administration .

weekly subcutaneous injections.

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

willow bark Rationale: 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.

Nurses need to understand the basic mechanism of how a drug exerts its effects. Which are mechanisms by which NSAIDs elicit their effects? (Select all that apply.) A. Inhibition of platelet aggregation B. Inhibition of prostaglandins C. Inhibition of cyclooxygenase-1 D. Synthesis of cyclooxygenase-3 E. Synthesis of cyclooxygenase-2

• Inhibition of prostaglandins • Inhibition of cyclooxygenase-1

The nurse identifies that mefenamic is indicated for:

acute pain

The client with chronic gout asks how he can reduce the uric levels in his body when he begins to self-administer colchicine. What would be the nurse's response?

"Drink 2 to 3 quarts of fluid daily; this will decrease uric acid levels and help prevent formation of uric acid kidney stones."

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 aches all of the time." "I do not have a fever any longer." "My hip pain has decreased." "My stomach doesn't burn today."

"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 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? a) 24 hours b) 8 hours c) 4 hours d) 12 hours

24 hours Rationale: 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.

A nursing student correctly identifies what as the recommended dose of aspirin for the adult patient?

325 to 650 mg orally q 4 hours

When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A. Pain is relieved. B. Core body temperature is reduced. C. Platelet aggregation is inhibited. D. Inflammation is relieved.

C. Platelet aggregation is inhibited. At low doses, aspirin blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet.

A nurse is conducting a medication reconciliation for a 79-year-old man who has just relocated to the long-term care facility. The nurse notes that the man has been taking colchicine (Colcrys) on a regular basis. This aspect of the man's medication regimen should signal the nurse to the possibility that he has a diagnosis of A. inflammatory bowel disease. B. bursitis or tendonitis. C. gout. D. osteoarthritis.

C. gout. Colchicine (Colcrys), the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medication. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis.

A patient suffers from gouty arthritis. Why is probenecid (Benemid) administered? A. To diminish the temperature B. To increase protein metabolism C. To decrease the level of liver enzymes D. To increase urinary excretion of uric acid

D. To increase urinary excretion of uric acid Probenecid (Benemid) increases the urinary excretion of uric acid. Probenecid (Benemid) will not decrease the level of liver enzymes, diminish temperature, or increase protein metabolism.

A nurse is teaching a childcare class to prospective grandparents. Which of the following medications is contraindicated in children? A. ibuprofen B. acetaminophen C. amoxicillin D. aspirin

D. aspirin The nurse should instruct the grandparents that aspirin increases children's risk of developing Reye's syndrome, and they should not give the drug to children.

A patient is admitted to the emergency department with dehydration. Which of the following assessments of the patient's vital signs does the nurse expect to assess? A. elevated blood pressure B. diminished pulse C. diminished respiration D. elevated temperature

D. elevated temperature A client who is dehydrated has a fever with an elevation in body temperature.

The nurse in the neonatal intensive care unit is assessing a neonate with patent ductus arteriosus. The nurse should anticipate the possible administration of which medication? a) balsalazide b) penicillamine c) prednisone d) indomethacin

d) indomethacin Rationale: Indomethacin given IV is used in premature infants to close a patent ductus arteriosus and avoid a surgical procedure. Penicillamine, balsalazide, and prednisone are not used for this purpose.

The nurse teaches a client with rheumatic disease who is being prescribed salicylate therapy to monitor for:

tinnitus Explanation: 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.

A female client reports a mild headache. The physician orders 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 physician ordered acetaminophen. Which explanation would the nurse give? "Acetaminophen is more effective than ibuprofen for headaches." "Acetaminophen is less expensive and more efficient for pain relief." "Acetaminophen is often the initial drug of choice for relieving mild to moderate pain." "Acetaminophen will reduce the inflammation causing your headache."

"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.

How should the nurse counsel a client concerning a new prescription for celecoxib and its affect on long-standing low-dose acetylsalicylic acid therapy? "Continue both therapies as prescribed." "Stop taking the acetylsalicylic acid for at least 7 days before starting the celecoxib." "Because celecoxib interferes with the absorption of acetylsalicylic acid, increase that daily dosage to 325 mg." "Take the acetylsalicylic acid within 4 hours of taking the celecoxib."

"Continue both therapies as prescribed." Celecoxib is a COX-2 inhibitor. In general, clients taking low-dose acetylsalicylic acid to prevent myocardial infarction or stroke should continue to take the aspirin if their prescribers order a COX-2-inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs) because the COX-2 inhibitors have little effect on platelet function. This information makes all the remaining options incorrect.

A patient taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse

"Do not take any more of the medication and come into the clinic immediately to see the physician." Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.

After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state: "These drugs are relatively safe since they don't have adverse effects." "We can easily overdose on them if we don't follow the directions." "Other signs and symptoms of an illness might not appear with these drugs." "The drugs might interact with other drugs and cause problems."

"These drugs are relatively safe since they don't have adverse effects." Explanation: All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.

The nurse administers ibuprofen to adult clients experiencing a variety of health disorders. The nurse administering ibuprofen should assess an adult client for which potential symptoms? Select all that apply. -pruritus -hyperuricemia -inflammation -fever -moderate pain

-inflammation -fever -moderate pain Rationale: Ibuprofen is used to relieve mild to moderate pain, including dysmenorrhea (painful menstruation). It is also used to treat inflammation related to rheumatoid arthritis 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 cause for ibuprofen use.

A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving?

Gold salts

A student nurse asks the nurse why acetaminophen and NSAIDs help to reduce cancer pain. What is the nurse's best explanation? A. Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent the sensitization of peripheral pain receptors by inhibiting prostaglandin formation. B. Cancer rarely produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs eliminate sensitization of peripheral pain receptors by inhibiting prostaglandin formation. C. Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs potentiate sensitization of peripheral pain receptors by increasing prostaglandin formation. D. Cancer rarely produces severe pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.

A. 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.

A patient is diagnosed with familial adenomatous polyposis. Which nonsteroidal anti-inflammatory agents will reduce the number of polyps and decrease the risk of colon cancer? A. Celecoxib (Celebrex) B. Probenecid (Benemid) C. Nabumetone (Relafen) D. Ibuprofen (Motrin)

A. Celecoxib (Celebrex) Celecoxib (Celebrex), a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen (Motrin) and nabumetone (Relafen) are not recommended for use in preventing familial adenomatous polyposis. Probenecid (Benemid) is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.

A patient is allergic to acetylsalicylic acid (aspirin). Which of the following medications is contraindicated due to cross-hypersensitivity reactions? A. Naproxen sodium (Naprosyn) B. Acetaminophen (Tylenol) C. Naloxone (Narcan) D. Morphine sulfate (MS Contin)

A. Naproxen sodium (Naprosyn) In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. Acetaminophen (Tylenol) does not have cross-sensitivity with acetylsalicylic acid (aspirin) because it is not an NSAID. Morphine sulfate (MS Contin) does not have a cross-sensitivity to aspirin because it is an opioid, not an NSAID. Naloxone (Narcan) is an opioid antagonist and does not have cross-sensitivity with aspirin.

A perinatal nurse is preparing a dose of IV indomethacin for administration to a neonate. What is the most plausible indication for this treatment? A. Patent ductus arteriosus B. Cardiomyopathy C. Patent foramen ovale D. Tetralogy of Fallot

A. Patent ductus arteriosus The FDA has approved IV indomethacin for treatment of patent ductus arteriosus in premature infants.

An automobile worker visits an occupational health nurse. He has pain in his right hand due to repetitive moments for which he has been taking aspirin 650 mg every 2 hours. Which of the following symptoms is indicative of salicylate toxicity? A. ringing in the ears B. halos around lights C. edema D. dysrhythmia

A. Tinnitus is ringing in the ears and is indicative of salicylate toxicity, also known as salicylism.

Which drugs DO NOT cause inhibition of platelet aggregation, interference with blood coagulation, or increase the risk of bleeding?

Acetaminophen and the COX-2 inhibitors

A patient is administered acetylsalicylic acid (aspirin) for fever and headache. What is the action of acetylsalicylic acid (aspirin)? A. Inhibiting the release of norepinephrine to increase blood pressure B. Inhibiting prostaglandin synthesis in the central and peripheral nervous system C. Providing selective action by inhibiting prostaglandin synthesis in the CNS D. Suppressing the function of the hypothalamus to decrease inflammation

B. Inhibiting prostaglandin synthesis in the central and peripheral nervous system Aspirin 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. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation. 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 is admitted to a neurological unit with a confirmed cerebrovascular bleed. Which of the following medications used to treat inflammation is contraindicated in this patient? A. Furosemide (Lasix) B. Ketorolac (Toradol) C. Hydrochlorothiazide with triamterene D. Digoxin (Lanoxin)

B. Ketorolac (Toradol) Ketorolac (Toradol) should not be administered to a patient with a suspected or confirmed cerebrovascular bleed. Furosemide (Lasix) is administered to reduce fluid volume and is not administered to treat inflammation. Hydrochlorothiazide with triamterene is administered to reduce fluid volume and is not administered to treat inflammation. Digoxin (Lanoxin) is administered to increase cardiac output, not to treat inflammation.

A physician tells a patient to take aspirin for back pain. It is most important to instruct the patient to A. take the medication on an empty stomach to enhance absorption. B. take the medication after a meal to prevent gastric irritation. C. crush the enteric-coated tablet for increased effectiveness. D. take the medication 2 hours after a meal to enhance absorption.

B. The client should take aspirin with food to prevent gastric irritation.

A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that: A. the client can take NSAIDs, as long as it is with food. B. the client should not take aspirin or non-aspirin NSAIDs. C. the client should not take regular aspirin, but can take buffered aspirin. D. the client can take medications containing aspirin, as long as it is on a full stomach.

B. the client should not take aspirin or non-aspirin NSAIDs. Explanation: In people who have demonstrated hypersensitivity to aspirin, all non-aspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.

Aspirin (ASA) is an over-the-counter drug that is found in many other drugs. What is the mechanism of action for aspirin? Blocking the transmission of pain impulses Increasing white blood cell production Increasing adrenal function Suppressing the function of the hypothalamus

Blocking the transmission of pain impulses Explanation:Aspirin acts both centrally and peripherally to block the transmission of pain impulses. Aspirin does not increase adrenal function or white blood cell production. Aspirin does not suppress the function of the hypothalamus.

A patient is taking ibuprofen (Motrin) for knee pain. The patient is admitted to the hospital with abdominal pain. Which assessment of symptoms is most important for the nurse to make? A. Assessment for diarrhea B. Assessment of the patient's urine for hematuria C. Assessment for occult blood in the patient's stool D. Assessment for hemoptysis

C. Assessment for occult blood in the patient's stool Alternative: Assess for hematemesis Nonsteroidal anti-inflammatory agents that block COX-1 and COX-2 place the patient at risk for gastrointestinal bleed. Patients who have symptoms of abdominal pain and are taking NSAIDs should be assessed for signs and symptoms of gastrointestinal bleed. Assessing the patient for diarrhea is not related to ibuprofen (Motrin) administration. Assessing the patient for hematuria or hemoptysis is not a priority.

A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of salicylate overdose? A. Intravenous meperidine (Demerol) B. Inhaled acetylcysteine (Mucomyst) C. Intravenous sodium bicarbonate D. Intravenous furosemide (Lasix

C. Intravenous sodium bicarbonate Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted in patients with salicylism.

A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees and elbows with pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process? A. Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. B. Acetaminophen has an antiplatelet effect to decrease edema. C. Prostaglandin inhibition is limited to the central nervous system. D. Prostaglandins decrease the gastric acid secretion.

C. Prostaglandin inhibition is limited to the central nervous system. The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

A man arrives in the emergency department with a swollen right ankle from a fall. He is complaining of pain and limited mobility. What factor is contributing to the pain in the right ankle? (Select all that apply.) A. blocking of cyclooxygenae-1 (COX 1) B. blocking of COX-1 and COX-2 C. release of prostaglandin E2 D. release of cytochrome P450 E. release of arachidonic acid

C. release of prostaglandin E2 E. release of arachidonic acid C and E. Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Prostaglandins E2, D2, F2alpha, and I2 induce inflammation and also enhance the effects of other mediators of the infammatory response. In addition, there is a release of arachidonic acid.

Blocking of what is responsible for the pain-relieving effects of NSAIDs?

Cyclooxygenase-2

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider? Dietary habits Work environment Fluid intake Ethnicity

Dietary habits Explanation:The nurse must consider the patient's dietary habits because foods high in purines increase uric acid concentrations in the blood, making a gouty attack more likely. Assessing the patient's work environment, fluid intake, and ethnicity are not as important as assessing his dietary habits.

A nurse is caring for a patient who has been administered ibuprofen for fever reduction. Which should the nurse monitor the patient for?

Dyspepsia

African Americans are at lower risk for developing GI adverse effects with NSAIDs. False/True

False

Prior to administration of Celecoxib, what should the nurse assess for? (Select all that apply.)

History of myocardial infarction History of bleeding disorders History of renal disorders

A nurse suspects that a client is experiencing salicylism. What would the nurse assess for? Excitement Mental confusion Tachypnea Convulsions

Mental Confusion Explanation: Salicylism can occur with high levels of aspirin and be manifested by ringing in the ears, dizziness, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude. Excitement, tachypnea, and convulsions suggest acute salicylate toxicity.

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? A. Intravenous B. Subcutaneous C. Intramuscular D. Oral

Oral It's a gold salt. 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.

Which ongoing assessments are the most appropriate interventions a nurse should perform for a patient who is being administered salicylates? (Select all that apply.) 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.

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.

An 11-year-old client is going to have a cavity filled in the left mandibular first molar. The physician has prescribed aspirin for pain relief after the procedure. The nurse finds out that the child is suffering from a flulike illness. The nurse contacts the physician about the prescribed medication for pain. What is the risk if aspirin is administered to Diane? Reye syndrome Excess antiplatelet action Asthma Salicylate poisoning

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 black client is receiving a high dose of NSAID for pain relief. Which would be most important for the nurse to include in the teaching plan?

Signs and symptoms of gastrointestinal bleeding Although adequate hydration is important to promote renal function and drug excretion, it would be more important to instruct the client in the signs and symptoms of GI bleeding. Blacks have a documented decreased sensitivity to the pain-relieving effects of many anti-inflammatory agents and have an increased risk of developing GI adverse effects to these drugs. Increased dosages may be needed to achieve pain relief, but the increased dosage increases the client's risk for developing adverse GI effects. The drug should not be combined with an OTC salicylate, as this would further increase the client's risk for adverse GI effects. The client should be instructed to use nonpharmacologic measures to relieve pain, such as warm soaks and positioning.

A patient with muscular pain has been prescribed an NSAIDs. What advice should the nurse give the patient to promote an optimal response to NSAID therapy? 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: Suggest the patient take the NSAID with food and milk. Take an NSAID with fiber-rich food Take an NSAID with calcium supplements

Suggest the patient take the NSAID with food and milk. Explanation: The nurse should suggest that the patient take the drug with food and milk to promote an optimal response to NSAID therapy; this helps minimize the risk of GI effects. The patient does not need to take an NSAID with fiber-rich food or with calcium supplements.

A nurse monitoring a client taking Dolobid (diflunisal) should monitor the client for which adverse reaction? (Select all that apply.) A) Diarrhea B) Tarry stools C) Weight loss D) Heartburn E) Constipation

Tarry stools Weight loss Heartburn Feedback:A nurse monitoring a client taking a salicylate like diflunisal should monitor the client for adverse effects including gastric upset, heartburn, nausea, vomiting, anorexia, and GI bleeding (dark, tarry stools).

An older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin two to three times each day. What aspect of this patient's medical history may contraindicate the use of aspirin? The client diagnosed with peptic ulcers The client diagnosed with diabetes The client diagnosed with psoriasis The postpartum woman who had a vaginal birth

The patient has a history of peptic ulcer disease. Explanation: The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely and the nurse would not question the order. NSAIDs are often ordered for pain control for clients following vaginal birth and this order need not to be questioned.

How do prostaglandins influence pain?

They 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.

Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction. True/False

True Explanation:RF interacts with circulating IgG to form immune complexes, which tend to deposit in the synovial fluid of joints, as well as in the eye and other small vessels.

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

a) Chemical mediators found in most body tissues; they participate in the inflammatory response. Rationale: 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.

A client has a sulfonamide allergy. Which drug would the nurse identify as being contraindicated? a) celecoxib b) meloxicam c) ibuprofen d) ketorolac

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

What is the most effective treatment for a febrile episode in a child aged 6 to 36 months? a) Ibuprofen alone b) Alternating acetaminophen and ibuprofen every 2 hours over a 3-day period c) Acetaminophen alone d) Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period

d) Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period Rationale: Ibuprofen also may be given for fever. Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period to control fever in young children (aged 6-36 months) has been shown to be more effective than monotherapy with either agent.

A client is ordered to receive an NSAID for pain. The client states that NSAIDs are taken to decrease inflammation. The nurse identifies that these medications are also used to: decrease blood pressure. decrease body temperature. increase appetite. increase platelet production.

decrease body temperature. Explanation: NSAIDs are used to treat pain and inflammation but may also be prescribed to reduce body temperature. They are not used to treat appetite, blood pressure, or decreased platelets.

A nurse is assessing a client's pain. Which situations would the nurse identify as most likely suggestive of chronic pain? Select all that apply. fibromyalgia rheumatoid arthritis osteoarthritis postoperative status trauma

fibromyalgia rheumatoid arthritis osteoarthritis

When teaching a client about common adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs), the nurse should include information on what condition?

heartburn

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

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 has just returned from x-ray after reporting pain in her joints. The x-rays indicate damage of the joint spaces. This is indicative of which disease process?

osteoarthritis Explanation: Osteoarthritis is characterized by a progressive loss of joint cartilage, which appears on x-ray as a narrowing damage to the joint space.