A patient who takes aspirin for rheumatoid arthritis is admitted ...

[Engineer]

A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do?
 
  a. Increase the aspirin dose to treat the patient's headache.
  b. Notify the provider of possible renal toxicity.
  c. Prepare to provide respiratory support, because the patient shows signs of overdose.
  d. Withhold the aspirin until the patient's symptoms have subsided.

Question 2

A nurse is teaching a group of nursing students about cyclooxygenase inhibitors. Which statement by a student indicates understanding of the teaching?
 
  a. Cyclooxygenase-2 inhibition causes gastrointestinal side effects.
  b. Cyclooxygenase-2 is considered the bad COX.'
  c. Inhibition of cyclooxygenase-1 promotes myocardial infarction and stroke.
  d. Inhibition of cyclooxygenase-1 results in suppression of inflammation.

[kardosa007]

Answer to Question 1

ANS: D
This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.

Answer to Question 2

ANS: B
Because cyclooxygenase-2 (COX-2) primarily mediates harmful processes in the body, it is called the bad COX; suppression of COX-2 results in largely beneficial effects. The gastrointestinal (GI) side effects of COX inhibitors are the result of COX-1 inhibition. One of two harmful side effects of COX-2 inhibition is suppression of vasodilation, which leads to an increased risk of myocardial infarction (MI) and stroke. Inhibition of COX-2 causes suppression of inflammation.

[Engineer]

Excellent

[kusterl]

TYSM