Topic 11: Anti-inflammatories and Analgesics PDF

Performance Exit Topic 11: Anti-inflammatories and Analgesics Due Jul 21, 2024 by 11:59 pm Final Score 46% 16 out of 35 questions answered correctly Com...

Performance Exit Topic 11: Anti-inflammatories and Analgesics Due Jul 21, 2024 by 11:59 pm Final Score 46% 16 out of 35 questions answered correctly Completed on Jul 21, 2024 1:15 pm Incorrect (19)  Report content error Which is considered a cardinal sign of inflammation? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Pain Swelling Redness Numbness Increase in function Rationale Pain, swelling, and redness are three of the five cardinal signs of inflammation. In addition, the patient will experience a decrease in function, not an increase, and pain, not numbness. p. 279  Report content error Which serious illness would the nurse suspect in a 6- year-old patient with influenza if the nurse learns that the patient’s parents gave the child “baby aspirin” for fever and the patient is vomiting, delirious, extremely lethargic, and experiencing dermatologic symptoms? Petechiae Rotavirus Reye syndrome Intracranial hemorrhage Rationale The nurse would suspect Reye syndrome in this case. Children should not be given aspirin, especially when febrile, because of the risk for Reye syndrome, which is characterized by vomiting, lethargy, delirium, and coma. Petechiae are a side effect of ibuprofen and are not a serious illness on their own. Rotavirus presents with vomiting but is not related to aspirin administration. Although vomiting and altered consciousness can be a sign of increased intracranial pressure related to intracranial hemorrhage, the question stem does not indicate that head trauma has occurred. p. 285 Report content error Which response would the nurse have if a family visits a patient in a long-term care facility and becomes alarmed after noticing several large bruises on the patient, who is on a moderate dose of aspirin daily? “We have already called 911.” “There is nothing to worry about.” “This is common with people taking aspirin.” “The patient is very clumsy and always getting hurt.” Rationale Aspirin inhibits platelet aggregation, so bruising is common, even with small tissue injuries. Thus the nurse would respond by telling the family that bruising is common in people taking aspirin. Telling the family not to worry would be dismissive and would not answer the question. There would be no reason to call 911, unless there is active bleeding, a suspected head injury, or profound bruising. Calling the patient clumsy would be unprofessional and inappropriate. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. p. 285 Report content error Which supporting evidence would the nurse provide to the patient regarding a proposed change in pain medication if the nurse encourages the patient to switch from over-the-counter aspirin to over-the- counter ibuprofen? Aspirin is associated with more gastric bleeding than ibuprofen. Aspirin may cause more damage to the kidneys than ibuprofen. Aspirin causes more blood disorders compared with ibuprofen. Aspirin has a shorter duration of action compared with ibuprofen. Rationale The nurse would inform the patient that the risk for gastrointestinal bleeding increases with aspirin. Ibuprofen causes gastric irritation, but it is less severe than that caused by aspirin. Consumption of both aspirin and ibuprofen can lead to life- threatening conditions such as liver and kidney damage. Blood disorders can be caused by aspirin as well as ibuprofen, and both aspirin and ibuprofen have the same duration of action of 4 to 6 hours. p. 285 Report content error Which phrase describes the mechanism of action of allopurinol? Reduces uric acid biosynthesis Inhibits prostaglandin synthesis Reduces infiltration of inflammatory cells Inhibits the hypothalamic heat-regulating center Rationale Allopurinol effectively treats gout and hyperuricemia by reducing uric acid biosynthesis. Ibuprofen helps relieve pain by inhibiting prostaglandin synthesis. Infliximab helps treat rheumatoid arthritis by reducing the infiltration of inflammatory cells and delaying the inflammatory process. Aspirin inhibits the hypothalamic heat-regulating center, which helps in reducing pain and inflammatory symptoms. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 288 Report content error Which statement made by the female patient, who is at risk for stroke and on aspirin therapy, indicates an understanding of the nurse’s instructions regarding the correct use of aspirin? “I should take aspirin at mealtime.” “I should take aspirin with warfarin.” “I should discontinue aspirin for the first 2 days of my menstrual cycle.”  “I should avoid large doses of vitamin C during aspirin therapy.” Rationale Aspirin is used to prevent blood clotting. It should be administered at mealtime or with plenty of fluids to avoid gastrointestinal disturbances. This is because aspirin inhibits cyclooxygenase-1 (COX-1), which protects the stomach lining. Thus the patient’s statement regarding taking aspirin at mealtime indicates an understanding of the nurse’s instructions. Administration of aspirin with warfarin should be strictly avoided because aspirin increases the effect of warfarin; this results in increased anticoagulant levels. Aspirin administration should be discontinued for 2 days before menstrual periods and for the first 2 days of menstrual periods because it can cause heavy menstrual bleeding. During this period, the patient can take acetaminophen. A large dose of vitamin C will not cause any effect during aspirin therapy; it should be avoided during the administration of allopurinol because it can cause kidney stones. p. 285 Report content error Which action performed by a patient could cause Which action performed by a patient could cause complications if the patient is on ibuprofen therapy for arthritis? Eating more ginger and garlic Increasing vitamin C in the diet Avoiding aspirin 2 days before menstruation Taking acetaminophen in place of aspirin during the menstrual period Rationale Including more ginger and garlic in the diet while taking nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen,could cause bleeding. Increasing vitamin C in the diet during ibuprofen therapy would not cause any complications. Avoiding aspirin 2 days before menstruation would help prevent heavy bleeding. Taking acetaminophen in place of aspirin during menstruation would effectively prevent heavy bleeding, which could occur due to aspirin administration. p. 286 Report content error Which medication would the nurse anticipate the Which medication would the nurse anticipate the primary health care provider prescribing if a patient is determined to be at an increased risk for ischemic stroke? Aspirin Multivitamin Celecoxib Allopurinol Rationale Aspirin helps reduce the risk for stroke. It thins the blood and dissolves blood clots. Therefore the nurse would anticipate the primary health care provider prescribing a low dose of aspirin to the patient. Multivitamin tablets would not help reduce the risk for stroke; they provide nutritional support. Celecoxib therapy would not help reduce the risk for stroke either; instead it would lead to adverse drug reactions, such as peripheral edema. Allopurinol is an antigout drug and is not effective for preventing stroke. p. 284 Report content error Which assessment finding indicates that the nonsteroidal antiinflammatory drug (NSAID) has been effective? Partial thromboplastin time (PTT) is 100 seconds. Patient’s bleeding time is prolonged. Patient has increased circulation to the legs. Pain has decreased from a 6 to a 1 on a scale of 10. Rationale Prostaglandins are produced in response to the activation of the arachidonic acid pathway. NSAIDs work by blocking cyclooxygenase, the enzyme responsible for the conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. Thus an assessment finding of decreased pain indicates that the NSAID has been effective. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication. p. 280 Report content error A patient with Crohn’s disease presents to the outpatient infusion clinic to receive their first dose of infliximab. Which action will the nurse take first? Perform a pain assessment Draw baseline CBC, LFTs, and BUN/Creatinine Administer the dose of infliximab over 2 hours using a small filter Ensure the patient has a negative TB test Rationale Before starting infliximab, the nurse will conduct a thorough medical history and ensure that the patient has had a negative TB test. The nurse will assess the patient’s pain level within an hour of administration to confirm the treatment has decreased the patient's pain level. Before starting the infusion, the nurse would draw a complete blood count, liver function tests, and renal function tests. These levels will be monitored while the patient is treatment and will require that the patient has a current baseline on file. The medication should be administered over 2 hours using a 1.2 micron filter or smaller. pp. 288,291,290  Report content error Which patient(s) would be at high risk for respiratory depression with the use of intravenous morphine therapy? Select all that apply. One, some, or all responses may be correct. 57-year-old patient with thyroid cancer 65-year-old patient with myocardial infarction (MI) 77-year-old patient with chronic renal failure (CRF) 32-year-old patient with ruptured ectopic pregnancy 45-year-old patient with chronic obstructive pulmonary disease (COPD) Rationale Approximately 90% of morphine sulfate is excreted in the urine. Therefore patients with CRF would be at higher risk, as morphine is retained, resulting in suppression of the respiratory center of the brain. Morphine sulfate would be avoided in patients with COPD because it decreases the respiratory drive, causing retention of carbon dioxide and increased risk for respiratory arrest. Morphine is not a concern in patients with thyroid cancer. Morphine sulfate is a beneficial drug to help control MI pain because it lowers blood pressure, decreases the workload of the heart, and increases myocardial oxygenation. Morphine sulfate is appropriate for treating moderate to severe pain that a patient may experience with a ruptured ectopic pregnancy. p. 302 Report content error Which question is a priority for the nurse to ask a patient who has been prescribed sumatriptan for migraine headaches? “Do you have a history of diabetes?” “What other medications are you on?” “Have you ever taken sumatriptan before?” “Do you have a history of coronary artery disease?” Rationale Sumatriptan works to decrease migraine pain by constricting arteries in the brain. A history of coronary disease (CAD) is a contraindication for taking this medication because the medication could cause the patient to experience a myocardial infarction by constricting the coronary arteries. Thus the nurse’s priority question is asking the patient if the patient has a history of CAD. Diabetes mellitus is a condition that warrants proceeding cautiously in prescribing sumatriptan, but sumatriptan can still be taken by individuals with diabetes if they are closely monitored. Asking about other medications provides information about possible drug-drug interactions, but the priority is finding out if the patient has CAD. Asking the patient if the patient has ever taken sumatriptan before will provide information about results from taking the medication and allergic reactions to the medication, but this is not the priority question. pp. 309-310 Report content error Which type of pain originates from the skin and mucous membranes? Deep pain Somatic pain Visceral pain Superficial pain Rationale Pain is an unpleasant sensory and emotional experience that is associated with either actual or potential tissue damage. Superficial pain originates from the skin and mucous membranes. Deep pain occurs in tissues below the skin level. Somatic pain originates from skeletal muscles, ligaments, and joints. Visceral pain originates from organs and smooth muscles. p. 296 Report content error Which statement about somatic pain is accurate? “It originates from organs and smooth muscles.” “It originates from skin and mucous membranes.” “It originates from vascular or perivascular tissues.” “It originates from skeletal muscles, ligaments, and joints.” Rationale Somatic pain is pain that originates from skeletal muscles, ligaments, and joints. Somatic pain does not originate from organs and smooth muscles; skin and mucous membranes; or vascular or perivascular tissues. Pain that originates from organs and smooth muscles is called visceral pain. Pain that originates from skin and mucous membranes is called superficial pain. Pain that originates from vascular or perivascular tissues is called vascular pain. p. 296 Report content error Which assessment finding indicates that a patient has overdosed on morphine sulfate? Blood in urine Pinpoint pupils Increased peristalsis Increased urinary output Rationale Morphine sulfate is an opioid drug used for pain management. After administering morphine sulfate, the nurse should assess the patient’s pupillary reaction to light. Pinpoint pupils indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine. Increased peristalsis is not a sign of morphine sulfate overdose. Constipation due to decreased peristalsis is an adverse effect associated with morphine sulfate. Administration of opioid drugs causes urinary retention; therefore increased urinary output would not be observed in the patient. p. 302 Report content error Which condition would the nurse expect to see in a patient who ingested 14 grams of acetaminophen? Renal failure Kidney stones Acute hepatotoxicity Metabolic alkalosis Rationale Acetaminophen in large doses is extremely hepatotoxic. Thus the nurse would expect to see acute hepatotoxicity in the patient. Renal failure does not occur because of an overdose of acetaminophen. Instead, renal failure increases the risk for toxicity in patients. Calcium antacids can cause kidney stones. Long-term use of sodium bicarbonate may cause metabolic alkalosis. p. 297 Report content error Which finding would the nurse expect when assessing a patient for adverse effects of morphine sulfate? Diarrhea Insomnia Drowsiness Increased bowel sounds Rationale The nurse would expect to find drowsiness, as morphine sulfate depresses the central nervous system. It also causes a decrease in gastrointestinal motility, leading to constipation, not diarrhea. Morphine sulfate does not cause insomnia; it is an opioid and causes drowsiness. Morphine sulfate can cause constipation, not increased bowel sounds. p. 304  Report content error Which condition is a contraindication for the administration of acetaminophen? Anemia Asthma Joint pain Liver disease Rationale The administration of acetaminophen is contraindicated in patients who have liver disease. Hepatotoxicity is an adverse effect of acetaminophen. If it is administered to a patient with liver disease, it increases the risk for liver failure. Therefore acetaminophen should not be administered to a patient who has liver disease. Acetaminophen is safe for a patient who has anemia, asthma, or joint pain. pp. 297-298  Report content error Which opioid is used in mild to moderate pain and as an antitussive? Hydrocodone bitartrate Hydromorphone hydrochloride Oxycodone hydrochloride Codeine sulfate Rationale Codeine sulfate is used in mild to moderate pain and as an antitussive. Hydrocodone bitartrate, hydromorphone hydrochloride, and oxycodone hydrochloride are used in moderate to severe pain and are not used as antitussives. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. pp. 303,298 Correct (16)  Report content error Which substance do antiinflammatories inhibit? Prolactin Serotonin Prostaglandin Gamma-aminobutyric acid (GABA) Rationale Antiinflammatory drugs inhibit prostaglandin biosynthesis. GABA and serotonin are both neurotransmitters unaffected by antiinflammatories. Prolactin is a reproductive hormone not involved in inflammation. p. 280 Report content error Which drug is considered a cyclooxygenase-2 (COX-2) inhibitor? Etodolac Naproxen Celecoxib Meloxicam Rationale Celecoxib is a COX-2 inhibitor. Meloxicam is part of the oxicam class. Naproxen is a propionic acid derivative. Etodolac is a phenylacetic acid derivative. p. 283 Report content error Which response by the nurse would be most appropriate if a patient with rheumatoid arthritis who is considering treatment with infliximab expresses concern because a television ad mentions several infections as potential side effects? “Don’t worry; it is exaggerated.” “The medication suppresses your immune system.” “The government requires that information to be in ads.” “The only serious illness you can contract is tuberculosis.” Rationale Because rheumatoid arthritis is an autoimmune disorder, drugs that successfully treat its symptoms are immunosuppressants, which can lead to infections. Thus the nurse would respond by informing the patient that the medication suppresses the immune system. Although the nurse should try to calm the patient’s fears, it is dismissive to tell the patient not to worry and does not answer the question. A patient should be screened for tuberculosis before initiating immunosuppressive treatment, but tuberculosis is not the only serious illness that a patient can contract. The US Food and Drug Administration (FDA) requires the most prominent adverse reactions to be listed in television ads, but the full explanation can never be conveyed in the time it takes for a commercial to air. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these keywords are rarely correct. p. 288 Report content error Which drug is most appropriate for a patient with back pain caused by inflammation? Aspirin Ketorolac Ibuprofen Diclofenac sodium Rationale For a patient with back pain caused by inflammation, ibuprofen is the most appropriate drug. The effect of ibuprofen is stronger than that of aspirin, and it causes less gastric irritation. Aspirin is not preferred because it causes gastric irritation when used as an analgesic. Both ketorolac and diclofenac sodium are phenylacetic acid derivatives and are less preferred because of aspirin-like effects, such as gastric irritation. p. 286 Report content error Which instruction given by the nurse would ensure effective treatment if the nurse is teaching a patient with gout about dietary management during the administration of allopurinol? “Eat more meat.” “Eat more oranges.” “Take the medication with lots of fluids.” “Take the medication with coffee.” Rationale Antigout medications, such as allopurinol, should be taken with lots of fluids to avoid the development of kidney stones. Thus the nurse would instruct the patient to take the medication with lots of fluids. Meat should be avoided because it increases uric acid levels. Oranges should also be avoided because they are rich in vitamin C, and consuming large doses of vitamin C while taking allopurinol can lead to kidney stones. Allopurinol should not be taken with coffee, as coffee is rich in caffeine, which increases uric acid levels. p. 293 Report content error Which assessment finding in a patient taking nonsteroidal antiinflammatory drugs (NSAIDs) requires intervention? Headache Palpitations Black, tarry stools Nonproductive cough Rationale A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed and require intervention. A headache, a nonproductive cough, and palpitations would not result from the use of NSAIDs. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 287 Report content error Which drug would the nurse expect to be added to a patient’s regimen if the nurse finds through review of laboratory reports that the patient, who has pain in multiple joints and has been prescribed indomethacin, has hyperuricemia and deposition of sodium urate crystals in the synovial fluid? Tolmetin Celecoxib Nabumetone Allopurinol Rationale Pain in multiple joints, hyperuricemia, and deposition of sodium urate crystals in the synovial fluids indicate that the patient has gouty arthritis. Allopurinol is prescribed for this condition; thus the nurse would expect allopurinol to be added to the patient’s medication regimen. It reduces uric acid levels and prevents the formation of kidney stones. Indomethacin is a nonsteroidal antiinflammatory drug (NSAID) that is more effective than other NSAIDs for pain relief. It also reduces inflammation in patients with gouty arthritis. Celecoxib, nabumetone, and tolmetin are NSAIDs; they are prescribed for pain relief and to reduce inflammation when a patient has rheumatoid arthritis or primary dysmenorrhea. Adding any of these drugs to the patient’s medication regimen along with indomethacin would not be as effective as adding allopurinol, which helps reduce uric acid levels in the serum. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. p. 288 Report content error Which antiinflammatory agent inhibits cyclooxygenase- 2 (COX-2) but not cyclooxygenase-1 (COX-1)? Etodolac Tolmetin Meloxicam Celecoxib Rationale Cyclooxygenase (COX) is the enzyme that helps convert arachidonic acid into prostaglandins and their products. These prostaglandins cause inflammation and pain at the tissue injury site. Celecoxib is a second-generation nonsteroidal antiinflammatory drug (NSAID) known as a selective COX-2 inhibitor. Celecoxib inhibits only COX-2. Usually, NSAIDs, such as etodolac, tolmetin, and meloxicam, inhibit both COX-1 and COX- 2, but celecoxib is a selective COX-2 inhibitor. p. 288 Report content error Which food(s) or dietary supplement(s) would the nurse identify as potentially causing increased sedation with opioid therapy? Select all that apply. One, some, or all responses may be correct. Kava Valerian Bananas Grapefruit St. John’s wort Rationale The nurse would identify kava, valerian, and St. John’s wort as potentiallycausative of increased sedation when taken with opioid preparations. Bananas are high in potassium and should be avoided in the presence of renal failure or potassium-retaining conditions. Grapefruit should be avoided when taking certain drugs, such as statin drugs or Janus kinase 2 inhibitors. p. 301 Report content error Which test would the nurse anticipate the health care provider (HCP) ordering for a patient who has been chronically taking high doses of acetaminophen? Chest radiograph Kidney function test Liver function test Lung spirometry Rationale One major adverse effect associated with acetaminophen overdose is hepatotoxicity. Therefore the nurse would anticipate the HCP ordering a liver function test to determine whether the patient’s liver has been affected by the overdose. A chest radiograph need not be taken because acetaminophen overdose does not cause any complications in the lungs and heart that are visible on a radiograph. Renal dysfunction is not associated with acetaminophen overdose. Thus the nurse need not refer the patient for kidney function tests. Acetaminophen overdose does not alter lung functions. p. 297 Report content error Which action would the nurse take if a patient receiving 1 to 2 mg of morphine sulfate intravenously every 2 hours PRN has a respiratory rate of 8 breaths/min and a pain scale of 8 out of 10 an hour after the last 2-mg dose of morphine sulfate was given? Hold the drug, record the assessment, and recheck in 1 hour. Administer 2 mg of morphine and notify the primary health care provider. Administer another 1 mg of morphine and reevaluate the pain scale in 15 minutes. Consult the primary health care provider and obtain another drug prescription. Rationale The nurse would consult with the primary health care provider, who may prescribe another type of analgesic, such as a nonsteroidal antiinflammatory drug. The patient is in severe pain, so the patient needs to be given an analgesic. The drug should not simply be withheld and the patient rechecked in 1 hour. If respirations are depressed, it would be hazardous to give more morphine. p. 301  Report content error Which rationale describes why a nurse would record baseline vital signs before administering 5 mg of morphine sulfate intravenously to a patient who underwent surgery 30 minutes prior? Morphine sulfate causes the release of histamines. Morphine sulfate dilates vascular smooth muscle. Morphine sulfate depresses the respiratory center. Morphine sulfate reduces the level of consciousness. Rationale Respiratory depression is the most important reason why the nurse would record baseline vital signs before administeringmorphine intravenously. Opioid analgesics can cause respiratory depression when administered in standard dosages and can cause death when administered in overdoses. Because this patient is in the immediate postoperative period and is likely to be experiencing residual effects of anesthesia, including an inability to maintain an airway, the risk for respiratory depression is high. The patient is also at risk because the intravenous (IV) route of administration is being used. IV administration of an opioid means that the onset of action occurs quickly, the peak drug level occurs more quickly, and the risk for respiratory depression increases as a result of a generally high plasma drug concentration. The nurse would record baseline data for comparison with vital signs taken 15 minutes after IV administration of morphine to determine whether the patient is experiencing adverse effects of therapy. Morphine dilates vascular smooth muscle, releases histamines, and causes sedation; however, airway and breathing issues are more important. Death after overdose is almost always a result of respiratory arrest. p. 298 Report content error Which drug may cause tinnitus as a side effect? Aspirin Tramadol Indomethacin Acetaminophen Rationale Aspirin is associated with side effects such as tinnitus and vertigo. Tramadol causes nausea, vomiting, constipation, dizziness, and headache. Indomethacin causes gastric distress. Overdose of acetaminophen causes hepatotoxicity. pp. 299-300 Report content error Which medication is used to treat severe adverse effects of an opioid analgesic? Naloxone Flumazenil Acetylcysteine Methylprednisolone Rationale Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. p. 306  Report content error Which medication would the nurse anticipate incorporating into the plan of care for a postoperative patient who received fentanyl and subsequently developed respiratory depression? Morphine sulfate Polyethylene glycol Naloxone Meperidine hydrochloride Rationale The patient has respiratory depression caused by fentanyl, an opioid drug that can depress the respiratory center. Therefore the nurse would anticipate incorporatingnaloxoneinto the patient’s plan of care. Naloxone should be administered to reverse the action of fentanyl and improve the patient’s respiratory status. Morphine sulfate and meperidine hydrochloride are opioid drugs that would worsen respiratory depression. Polyethylene glycol is a laxative used to treat constipation. p. 306  Report content error Which symptom is an adverse effect associated with excessive doses of acetaminophen? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Nausea Vomiting Blurred vision Hepatotoxicity Polyuria Rationale Acetaminophen is a nonsteroidal antiinflammatory drug. Nausea, vomiting, and hepatotoxicity are the effects of an excess dose of acetaminophen. Acetaminophen does not affect vision. It causes oliguria, not polyuria.