The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding would indicate a severe adverse effect of ibuprofen therapy?

Choice A reason: Diphenhydramine, an antihistamine, does not significantly interact with aspirin’s antiplatelet effects. It primarily blocks histamine receptors, affecting allergies, not platelet aggregation. While it may cause drowsiness, it doesn’t increase bleeding risk or counteract aspirin’s cardiovascular benefits, making it safe to use concurrently with low-dose aspirin.

Choice B reason: Loratadine, a second-generation antihistamine, targets histamine receptors to relieve allergy symptoms. It has no known interaction with aspirin’s antiplatelet mechanism or bleeding risk. Its minimal side effect profile makes it compatible with low-dose aspirin for cardiovascular protection, so avoiding it is unnecessary in this context.

Choice C reason: Ibuprofen, an NSAID, competes with aspirin for COX-1 binding sites, reducing aspirin’s antiplatelet effect critical for preventing myocardial infarction and stroke. It also increases gastrointestinal bleeding risk when combined with aspirin, making it contraindicated for patients on low-dose aspirin therapy, thus the correct choice to avoid.

Choice D reason: Multivitamins do not interfere with aspirin’s antiplatelet action or increase bleeding risk. They provide supplemental nutrients without affecting COX-1 inhibition or platelet aggregation. There’s no pharmacological basis for avoiding multivitamins with low-dose aspirin, making this choice irrelevant for the patient’s cardiovascular regimen.

Choice A reason: Administering captopril risks angioedema, as the patient’s history of tongue and lip swelling with enalapril (another ACE inhibitor) suggests a class effect due to bradykinin accumulation. This is potentially life-threatening, requiring avoidance, not monitoring, making this choice unsafe and incorrect.

Choice B reason: Fosinopril, another ACE inhibitor, carries the same angioedema risk as captopril and enalapril due to similar bradykinin effects. Switching within the same drug class doesn’t address the patient’s history of adverse reactions, making this choice inappropriate and potentially dangerous.

Choice C reason: Holding captopril and notifying the provider is correct, as the patient’s history of angioedema with enalapril indicates a high risk with captopril, another ACE inhibitor. Alternative classes (e.g., ARBs) should be considered to avoid life-threatening reactions, making this the safest and correct action.

Choice D reason: Angioedema (tongue and lip swelling) is a serious, potentially fatal side effect of ACE inhibitors, not benign. Reassuring the patient minimizes the risk, which could delay intervention. The history warrants avoiding captopril and consulting the provider, making this choice incorrect and unsafe.