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chapter 3 & 71 nclex questions
Terms in this set (16)
The nurse is providing care to a patient prescribed aspirin. Which of the following prescribed drugs would alert the nurse that a possible drug interaction can occur? Select all that apply.
warfarin, elalapril, and naproxen
aspirin suppresses platelet function and can decrease prothrombin production, which intensifies the effects of warfarin. aspirin and enalapril together can increase the risk of renal failure. Naproxen is a non steroidal anti-inflammatory drug (NSAID) which negates to the benefits of aspirin.
The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply.
a) "Use of this drug can prevent heart attack and stroke."
b) "The most common side effect of treatment with this drug is kidney failure."
c) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain."
d) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow."
e) "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."
Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.
Which statement(s) about the care of a patient with aspirin poisoning does the nurse identify as correct? Select all that apply.
a) Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
b) Warming blankets are routinely used to raise the patient's temperature.
c) Activated charcoal is contraindicated in the treatment of aspirin poisoning.
d) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate.
e) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning.
A, D Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.
A patient is receiving Caldolor. What intervention is essential for this patient? Select all that apply.
a) Assess for respiratory depression.
b) Administer the medication continuously.
c) Dilute the medication before administering.
d) Administer the medication on a PRN basis.
e) Assess for pain level prior to administration.
C, D, E
Caldolor is administered IV for patients in pain or with fever. The drug can be used alone for mild-to-moderate pain or combined with an opioid for moderate-to-severe pain. The medication must be diluted prior to administration and infused slowly over 30 minutes. It is administered as needed and does not cause respiratory depression.
A patient who takes daily aspirin for stroke risk and nabumetone [Relafen] for arthritis is concerned after reading that aspirin should not be taken with other nonsteroidal antiinflammatory drugs. What is the nurse's best response to the patient?
a) "You are correct; you shouldn't take aspirin."
b) "You should take Tylenol instead of aspirin."
c) "Ask your provider to increase your dose of Relafen."
d) "Take an aspirin every day even though you are on Relafen."
Relafen inhibits COX-2 and does not inhibit platelet aggregation. Patients at risk for stroke or heart attack who take aspirin to prevent blood clotting (decrease platelet aggregation) would not benefit from COX-2 inhibitors. The nurse should not reinforce the patient's erroneous ideas about the medication. Tylenol does not inhibit platelet aggregation, so it would not be an adequate substitute for aspirin. Increasing the dose of Relafen will not change the action.
A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedure(s)? Select all that apply.
b) cataract surgery
d) removal of a skin mole
e) routine dental cleaning
Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding such as dental cleaning or dermatologic or cataract surgery.
A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider?
a) temperature 97.9 F
b) heart rate 99 beats/min
c) blood glucose level 78 mg/dL
d) blood pressure 160/94 mm Hg
An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke.
Which intervention is most appropriate for a patient who needs treatment for acute postoperative pain?
a) administer ketorolac IV every 6 hours PRN.
b) Administer acetaminophen PO every 4 hours.
c) Administer celecoxib [Celebrex] PO every 6 hours.
d) Administer indomethacin [Indocin] PO every 4 hours
Ketorolac is the only nonsteroidal anti-inflammatory drug (NSAID) that can be administered by injection (intramuscularly or intravenously) and is indicated for short-term use for severe-to-moderate pain. Acute postoperative pain cannot be effectively managed on oral medication.
Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective?
a) PTT is 100 seconds.
b) Patient's bleeding time is prolonged.
c) Patient has increased circulation to his legs.
d) Pain has decreased from a 6 to a 1 on a scale of 10.
Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication.
Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for which condition?
b) Diabetes mellitus
c) A history of hepatitis C
d) An allergy to sulfonamides
Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. Hypothyroidism, diabetes mellitus, and hepatitis C should be part of the nurse's assessment but are not the most important.
The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately?
Ibuprofen is a member of the nonaspirin, first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause drowsiness or jaundice.
The patient has been taking aspirin long term for a chronic inflammatory illness. Which adverse effects should the nurse teach the patient to report? Select all that apply.
b) black, tarry stools
c) ringing in the ears
d) bleeding of the gums
e) increase in urine output
B, C, D
Increase in bleeding is an adverse effect of aspirin. Black, tarry stools and bleeding of the gums are both indications this could be occurring. Ringing in the ears is a symptom of salicylism, a syndrome that occurs when therapeutic levels are slightly elevated. Diaphoresis could indicate reduction of fever, which is a desired effect of aspirin. Aspirin can cause renal impairment, which is characterized by decreased urine output.
A patient has been prescribed celecoxib [Celebrex] to treat arthritis. The nurse will contact the healthcare provider if the patient shows symptoms of which condition?
Celecoxib [Celebrex] is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding, which can worsen anemia. The other conditions are not contraindications for use of the COX-2 inhibitor.
A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. Which condition, if found in the patient's medical record, would prompt the nurse to hold the medication and consult with the prescribing provider?
b) Allergy to penicillin
c) Recent heart bypass surgery
d) Positive tuberculin skin test result
Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].
The nurse is responsible for dispensing medications and notes that the patient has a Schedule IV drug. What should the nurse interpret from this? Select all that apply.
a) The drug is a controlled substance.
b) The drug has a high potential for abuse.
c) The prescription is valid for only 1 year.
d) The drug can be filled without a prescription.
e) The drug is dispensed via an approved protocol.
Controlled drugs are classified into five categories. A Schedule IV drug is a controlled substance whose use is limited. The drug has a high potential for abuse. Schedule I drugs need to be dispensed via an approved protocol because they have a high potential for causing dependency. The prescription of a Schedule IV drug is valid for only 6 months with a maximum of five refills during that period. Schedule IV drugs must have a valid prescription before being filled.
A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing which complication?
b) renal failure
c) liver toxicity
d) congestive heart failure
High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.
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