Nonopioid Analgesics

Every question here, with the answer

1. A client takes acetaminophen for back pain and also uses an over-the-counter cold medicine. What is the priority nursing action?

   1. Suggest switching the cold medicine to a larger dose.
   2. Check whether the cold medicine also contains acetaminophen and total all sources.
   3. Tell the client to take the cold medicine at bedtime only.
   4. Advise taking the acetaminophen with milk.

   Answer: Check whether the cold medicine also contains acetaminophen and total all sources.

   Many cough and cold products contain acetaminophen, so the client must count every source to stay under the daily limit and avoid liver injury. Timing, larger doses of the cold product or taking it with milk do nothing about the hidden acetaminophen.

2. A client who takes warfarin asks whether aspirin is a good choice for a headache. What should the nurse teach?

   1. Aspirin is preferred because it works only in the brain.
   2. Be cautious with aspirin because it increases the risk for bleeding and bruising.
   3. Aspirin will cancel out the effect of warfarin.
   4. Aspirin is safe because it has no effect on platelets.

   Answer: Be cautious with aspirin because it increases the risk for bleeding and bruising.

   Aspirin irreversibly inhibits COX in platelets, so a client on a blood thinner has an increased risk for bleeding and bruising. Aspirin does affect platelets, does not cancel warfarin, and acts peripherally as well as centrally.

3. A client has been taking ibuprofen daily for arthritis. Which findings should the nurse tell the client to report to the health care provider? Select all that apply.

   1. Black tarry stools
   2. Throat swelling or chest tightness
   3. Blood-streaked sputum
   4. Mild relief of joint pain
   5. Coffee-ground emesis

   Answer: Black tarry stools, Throat swelling or chest tightness, Blood-streaked sputum, Coffee-ground emesis

   Black tarry stools, coffee-ground emesis and blood-streaked sputum are signs of bleeding, and throat swelling or chest tightness are signs of an allergic reaction; all must be reported. Relief of joint pain is the expected therapeutic effect.

4. A 12-year-old is recovering from a viral illness and has a fever. The parent asks if aspirin can be given. What is the nurse's best response?

   1. Yes, but give it with food.
   2. Yes, aspirin is the preferred fever reducer for children.
   3. No, aspirin does not reduce fever.
   4. No, aspirin in this situation may cause a potentially fatal condition called Reye’s syndrome.

   Answer: No, aspirin in this situation may cause a potentially fatal condition called Reye’s syndrome.

   Aspirin should be avoided in children younger than 16 with a recent viral illness because of the risk of Reye’s syndrome. Giving it with food does not remove this risk, and aspirin does have antipyretic action.

5. The nurse reviews a client's history before starting tramadol. Which findings call for caution or avoidance? Select all that apply.

   1. Neuropathic pain
   2. Allergy to penicillin
   3. Regular alcohol use
   4. History of seizure disorder
   5. History of substance use disorder

   Answer: Regular alcohol use, History of seizure disorder, History of substance use disorder

   Tramadol lowers the seizure threshold, carries a risk of misuse and addiction, and can cause CNS and respiratory depression when mixed with alcohol. Neuropathic pain is a reason to consider tramadol, and a penicillin allergy is not related to it.

6. A client with a history of heavy acetaminophen use reports nausea and fatigue, and the nurse notes yellowing of the sclera. What does the nurse suspect?

   1. Peptic ulcer from COX-1 inhibition
   2. Reye’s syndrome
   3. Hepatotoxicity from acetaminophen
   4. Aspirin-induced asthma

   Answer: Hepatotoxicity from acetaminophen

   Nausea, fatigue and jaundice are how acetaminophen hepatotoxicity presents, and it may need n-acetylcysteine. Peptic ulcers are linked to NSAIDs, Reye’s syndrome to aspirin in children, and asthma exacerbation to NSAIDs.