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: Questioning why allergies aren’t aren’t in the chart is secondary and confrontational. Clarifying the specific allergy ensures safety, so this is incorrect for the first action.

Choice B reason: Identifying the specific antibiotic and reaction verifies the allergy, preventing anaphylaxis or harm. This is the priority safety step, making it the correct first action.

Choice C reason: Lowering the dose doesn’t address the allergy risk; allergic reactions can occur regardless. Verifying the allergy is critical first, so this is incorrect.

Choice D reason: An antihistamine may mitigate mild reactions but doesn’t confirm the allergy. Clarifying the allergy prevents unsafe administration, so this is incorrect for the first step.

Choice A reason: Jaundice indicates liver dysfunction, but ibuprofen rarely causes hepatotoxicity at standard doses. It’s more associated with gastrointestinal issues due to COX-1 inhibition, reducing protective prostaglandins in the stomach lining. While possible with overdose, jaundice is less common than gastrointestinal bleeding, making this choice less likely.

Choice B reason: Ibuprofen, an NSAID, inhibits COX-1, reducing gastric mucosal protection, which can lead to ulcers or gastrointestinal bleeding. Bloody emesis (hematemesis) indicates severe gastrointestinal damage, a well-documented adverse effect requiring immediate intervention, making this the correct choice for a severe ibuprofen-related complication.

Choice C reason: Itching may indicate a mild allergic reaction or skin irritation, not a severe adverse effect of ibuprofen. While possible, it’s less critical than gastrointestinal bleeding, which poses life-threatening risks due to ibuprofen’s impact on gastric mucosa, making this choice less severe and incorrect.

Choice D reason: Dysmenorrhea (painful periods) is a condition ibuprofen treats, not an adverse effect. By inhibiting prostaglandins, ibuprofen reduces uterine contractions and pain. It doesn’t cause dysmenorrhea, making this choice irrelevant as an indicator of a severe adverse effect of ibuprofen therapy.