A client is about to start taking an NSAID called celecoxib to treat osteoarthritis symptoms.
The nurse should instruct the client to watch for and report which of the following possible indications of a serious reaction to the drug?
Dry mouth.
Bone pain.
Polyuria.
Black tarry stools.
The Correct Answer is D
Choice A rationale
Dry mouth is not a recognized serious adverse reaction associated with the use of celecoxib, which is a selective COX-2 inhibitor. This medication focuses on inhibiting the enzymes responsible for inflammation and pain. Dry mouth is more frequently associated with anticholinergic medications or certain antidepressants. While it can be uncomfortable, it does not represent a life-threatening systemic reaction requiring immediate provider notification.
Choice B rationale
Bone pain is usually a symptom of the underlying osteoarthritis rather than a side effect of celecoxib therapy itself. Celecoxib is intended to reduce the pain associated with musculoskeletal conditions by decreasing prostaglandin synthesis. If a patient experiences new or worsening bone pain, it may indicate disease progression or a different pathology, but it is not a hallmark warning sign of a serious drug reaction.
Choice C rationale
Polyuria, or excessive urination, is not a standard side effect or a warning sign of a serious adverse reaction to celecoxib. While NSAIDs can impact renal function by reducing blood flow to the kidneys through prostaglandin inhibition, this typically manifests as fluid retention, peripheral edema, or decreased urine output rather than increased frequency. Therefore, polyuria would not be the primary serious reaction to report.
Choice D rationale
Black tarry stools, or melena, indicate upper gastrointestinal bleeding which is a serious potential complication of NSAID therapy, including selective COX-2 inhibitors like celecoxib. Although celecoxib is designed to be easier on the stomach than non-selective NSAIDs, it still carries a black box warning for gastrointestinal risks. Bleeding occurs when the drug interferes with the protective mucosal lining, leading to ulceration and hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
Canned split pea soup is extremely high in sodium, which must be restricted in patients with Meniere disease. Excess sodium intake leads to fluid retention throughout the body, including the endolymphatic sac in the inner ear. This increases endolymphatic pressure, potentially triggering an exacerbation of vertigo, tinnitus, and hearing loss. Maintaining a low sodium diet, typically less than 2,000 mg per day, is a cornerstone of managing the fluid balance issues associated with this condition.
Choice B rationale
A baked potato with cheese and bacon contains significant amounts of hidden and added sodium. Bacon is a processed meat cured with salt, and cheese is naturally high in sodium content. For a client with Meniere disease, consuming such a high salt meal can cause a spike in the pressure of the inner ear fluids. These dietary choices are contraindicated because they directly contribute to the endolymphatic hydrops that characterizes the pathophysiology of the frequent dizzy spells.
Choice C rationale
Wine and other alcoholic beverages should be restricted because alcohol can change the fluid transport and concentration in the inner ear. Alcohol consumption can alter the volume and composition of the endolymph, which may aggravate the symptoms of Meniere disease. Additionally, alcohol affects the central nervous system and can worsen the sense of imbalance or dizziness already experienced by these clients. Restricting alcohol helps maintain a stable internal environment within the delicate structures of the vestibular system.
Choice D rationale
Iced coffee contains caffeine, which is a stimulant that can exacerbate the symptoms of Meniere disease. Caffeine has vasoconstrictive properties that can reduce blood flow to the inner ear and may also increase the perceived intensity of tinnitus. By stimulating the nervous system, caffeine can make the symptoms of vertigo more distressing for the patient. Clients are generally advised to eliminate or significantly limit caffeine to help stabilize the fluid dynamics and nerve sensitivity in the ear.
Choice E rationale
Milk is generally permitted in a diet for Meniere disease unless the patient has a specific allergy or intolerance. It provides essential nutrients like calcium and vitamin D without the high sodium levels found in processed foods or the stimulants found in caffeinated beverages. While overall fluid intake should be distributed evenly throughout the day to avoid sudden fluctuations, milk itself is not a primary trigger for endolymphatic hydrops. It is a safer choice compared to caffeinated or high sodium options.
Correct Answer is D
Explanation
Choice A rationale
The Hendrich II Fall Risk Model is a clinical assessment tool used to determine a patient's probability of falling based on factors like confusion, symptomatic depression, and altered elimination. While general safety is important, this tool does not address the specific physiological or systemic changes associated with scleroderma. Scleroderma involves the overproduction of collagen, leading to skin thickening and organ dysfunction, which requires specialized diagnostic criteria rather than a general mobility and fall risk assessment.
Choice B rationale
The Braden Scale is used to predict pressure sore risk by evaluating sensory perception, moisture, activity, mobility, nutrition, and friction. Although scleroderma causes skin changes such as hardening and tightening, the Braden Scale is not the primary tool for assessing the unique vascular and fibrotic manifestations of the disease. While skin integrity is a concern, the nurse must prioritize tools that identify the multi-system involvement and specific diagnostic markers characteristic of this complex autoimmune connective tissue disorder.
Choice C rationale
The Mini-Cog is a rapid screening tool for cognitive impairment and dementia in older adults, consisting of a three-item recall test and a clock-drawing task. Scleroderma is primarily a physical, systemic autoimmune disease affecting the skin, blood vessels, and internal organs like the lungs and kidneys. Cognitive decline is not a hallmark clinical manifestation of scleroderma. Therefore, using a cognitive screen would not provide the nurse with relevant data regarding the progression or severity of the patient's scleroderma.
Choice D rationale
CREST is a specific acronym used to assess the limited cutaneous form of systemic sclerosis. It stands for Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia. Using this tool allows the nurse to systematically evaluate the classic symptoms of the disease. Identifying these specific clinical markers is essential for monitoring disease progression and managing potential complications like dysphagia or digital ulcers. It is the gold standard clinical framework for bedside assessment of patients with this condition.
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