Karch: Ch. 16 - Anti-inflammatory, antiarthritis, and related agents
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. as a normal response to infection or trauma, which results in necrotic tissue formation as the initial stage of infection, requiring antibiotic medication for resolution as a typical response to bacterial infection
as an attempt by the body to remove the damaging agent and repair the damaged tissue 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 nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug? celecoxib sulindac oxaprozin ketorolac
celecoxib Explanation: Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk. Sulindac carries the risk of headache, dizziness, and GI upset. Oxaprozin carries the risk of headache, dizziness, insomnia, and ringing in the ears. Ketorolac carries the risk of GI upset, renal effects, and congestive heart failure.
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? Acetaminophen Ibuprofen Naproxen Indomethacin
Acetaminophen Explanation: Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children but they are not the most commonly used medications. Indomethacin is not indicated for fever control.
An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention? Administration of acetylcysteine as prescribed Watchful waiting Administration of naloxone as prescribed Intravenous administration of Lactated Ringer's
Administration of acetylcysteine as prescribed Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate. Lactated Ringer's would not be therapeutically beneficial.
A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the client's knowledge of which area? Medication regimen for herbal supplements Exercise routine Nutrition and health Adverse effects of nonsteroidal anti-inflammatory drugs
Adverse effects of nonsteroidal anti-inflammatory drugs Explanation: In addition, adverse drug effects should be reviewed with clients, and clients should be assessed for characteristics (e.g., older age group, renal impairment, overuse of the drugs) that increase the risks of adverse effects.
What effects are exerted by aspirin? (Select all that apply.) Analgesic Antipyretic Anti-inflammatory Anti-infective Antiviral
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 Antipruritic Antipyretic Antibacterial
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 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.
A healthcare provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about safe and effective use of acetaminophen? Avoid taking more than 3000 mg in any 24-hour period Avoid drinking grapefruit juice with acetaminophen Take the medication with food to prevent GI upset Avoid excessive doses because there is no antidote
Avoid taking more than 3000 mg in any 24-hour period Explanation: Clients should avoid taking more than 3000 mg of acetaminophen daily to avoid hepatic damage. Acetylcysteine is an antidote for overdose and there is no need to avoid grapefruit juice. GI upset is rare, so there is no particular need to take it with food.
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? Blood sugar Respiratory rate Body temperature Better mobility
Better mobility Explanation: The nurse should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.
A 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. *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. *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. *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.
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? Eletriptan Ergotamine Sumatriptan Celecoxib
Celecoxib Explanation: Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
Prostaglandins are: Chemical mediators found in most body tissues; they participate in the inflammatory response. Sensitized pain receptors; they participate in the inflammatory response. Chemical mediators released in the periphery, which prevent sensitization of pain receptors to various chemical substances released by damaged cells. Chemical mediators which produce chronic, painful, inflammatory disorders that affect the synovial tissue of hinge-like joints.
Chemical mediators found in most body tissues; they participate in the inflammatory response. Explanation: Prostaglandins are chemical mediators found in most body tissues; they help regulate many cell functions and participate in the inflammatory response. They are formed when cellular injury occurs and phospholipids in cell membranes release arachidonic acid.
The nurse is aware that aspirin not only lowers the client's fever but can also reduce the pain the client 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.
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 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: acute acetaminophen toxicity. salicylate intoxication. ibuprofen overdose. caffeine overdose.
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 nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved? stomach lungs liver peripheral nerves
stomach Explanation: The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver while taking NSAIDs.
A neonate is diagnosed with patent ductus arteriosus. What nonsteroidal anti-inflammatory agent is administered intravenously for treatment of this congenital heart defect? Sulindac Etodolac Nabumetone Indomethacin
Indomethacin Explanation: Intravenous indomethacin is approved for treatment of patent ductus arteriosus in premature infants. Sulindac is not approved for the treatment of patent ductus arteriosus. Etodolac is not approved for treatment of patent ductus arteriosus. Nabumetone is not approved for the treatment of patent ductus arteriosus.
What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)? Blocks hypothalamus activity Act directly on thermoregulatory cells Inhibit phagocytosis Inhibit prostaglandin synthesis
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.
The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Inhibiting impulses to the brain Inhibiting the synthesis of prostaglandins Blocking the neuronal terminal Decreasing nerve stimulation
Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.
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.
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.
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.
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 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 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? Acute acetaminophen poisoning Salicylate intoxication Ibuprofen overdose Caffeine abuse
Salicylate intoxication Explanation: Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.
A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the heart attack.
The aspirin is being prescribed because it reduces your risk of a second heart attack. Explanation: Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.
The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client? 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 client diagnosed with peptic ulcers 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.
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.
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.
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. diabetic retinopathy. cataract. acute gout.
allergy to sulfonamides. Explanation: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.
While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as: the initial stage of infection, requiring antibiotic medication for resolution. a normal response to infection or trauma, which results in necrotic tissue formation. a typical response to bacterial infection. an attempt by the body to remove the damaging agent and repair the damaged tissue.
an attempt by the body to remove the damaging agent and repair the damaged tissue. Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Local manifestations are redness, heat, edema, and pain. Inflammation may be a component of virtually any illness. Inflammation can be a result of an infection, which may require antibiotic therapy.
A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that: the client can take NSAIDs, as long as it is with food. the client should not take aspirin or non-aspirin NSAIDs. the client should not take regular aspirin, but can take buffered aspirin. the client can take medications containing aspirin, as long as it is on a full stomach.
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.
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 Explanation: Acetaminophen is the analgesic of choice during pregnancy.
A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client? "The drug has no effect on inflammation." "The drug has quite a few adverse effects." "This drug is reserved for long-term therapy." "The drug can increase your risk for bleeding."
"The drug has no effect on inflammation." Explanation: The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.
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 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.
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 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.
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.
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." "No, the dose of aspirin is too low to increase your risk of bleeding." "Yes, you need to stop the aspirin immediately." "Your dentist must extract the tooth in a hospital setting to reduce the risk of hemorrhage."
"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).
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? _____ mg
5
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 A male 40 years of age with arthritis A female 50 years of age with hypoprothrombinemia A female 62 years of age with a vitamin K deficiency
A male 30 years of age who drinks four beers per day Explanation: Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.
Which is the antidote for acetaminophen poisoning? acetylcysteine allopurinol diclofenac sodium ketorolac
acetylcysteine Explanation: A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites.
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? acetaminophen acetylsalicylic acid ibuprofen ascorbic acid
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 client is ordered to receive an nonsteroidal anti-inflammatory drug (NSAID) for pain. The client states that NSAIDs are taken only to decrease inflammation. The nurse instructs the client that these medications are also used for which? 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 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.
