A client presents to the emergency department with influenza-like ...

[justinmsk]

A client presents to the emergency department with influenza-like symptoms. The nurse assesses the client's medication history and finds that the client has been taking ibuprofen for arthritic pain.
 
  Warfarin (Coumadin) was recently prescribed due to a diagnosis of atrial fibrillation. What is the nurse's rationale for immediately discussing this finding with the health care provider?
  1. If taken with NSAID medications, warfarin can cause a change in the client's oral mucosa and white patchy lesions.
  2. Oral anticoagulants taken with ibuprofen can increase the risk of bleeding.
  3. Taking ibuprofen and warfarin at the same time decreases the client's immune response.
  4. Ibuprofen is contraindicated for patients who have influenza-like symptoms.

Question 2

A client has been started on a first-generation nonsteroidal anti-inflammatory medication for arthritis pain. The client says, I remember something about one of these drugs causing heart attacks and strokes. Which drug was that?
 
  The nurse responds that the drug was celecoxib (Celebrex) but that:
  1. Celebrex causes no problems at lower dosages.
  2. the client has been prescribed a different medication.
  3. the drug has been taken off the market.
  4. newer research has proven that the concerns were unfounded.

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Answer to Question 1

Correct Answer: 2
Rationale 1: Warfarin does not cause oral lesions.
Rationale 2: Ibuprofen inhibits platelet aggregation and prolongs the bleeding time without affecting the prothrombin or whole bloodclotting times. Oral anticoagulants taken with ibuprofen can increase the risk of bleeding.
Rationale 3: Concurrent use of warfarin and ibuprofen does not affect immune response.
Rationale 4: There is no reason ibuprofen should not be taken by clients with influenza-like symptoms.
Global Rationale: Ibuprofen inhibits platelet aggregation and prolongs the bleeding time without affecting the prothrombin or whole bloodclotting times. Oral anticoagulants taken with ibuprofen can increase the risk of bleeding. Ibuprofen's effects on platelets are reversible within 24 hours after discontinuation of the drug. Warfarin does not cause oral lesions or affect the immune response. There is no reason ibuprofen should not be taken by clients with influenza-like symptoms.

Answer to Question 2

Correct Answer: 2
Rationale 1: The adverse effects of Celebrex are not dose dependent.
Rationale 2: Celecoxib (Celebrex) is an effective second-generation NSAID but has limited use due to increased risk of myocardial infarction and stroke.
Rationale 3: Celebrex is still available, but its use is limited due to the increased risk of myocardial infarction and stroke.
Rationale 4: Use of Celebrex is limited due to the increased risk of myocardial infarction or stroke.
Global Rationale: Celecoxib (Celebrex) is a second-generation NSAID and is the sole drug remaining in this class in the United States. Other COX-2 inhibitors are still available outside the U.S. The COX-2 inhibitors have been found to increase the risk of serious cardiovascular events, including fatal MI and stroke. These results are not dose dependent.

[justinmsk]

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