Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Clinical Scenario
An 83-year-old female patient with a history of Stage 3 chronic
kidney disease (CKD) and chronic osteoarthritis is admitted to
an acute care unit for a severe exacerbation of joint pain. The
healthcare provider's admission orders include naproxen 500
mg orally twice daily as needed for pain. The nurse reviews the
patient’s admission laboratory results, noting a serum
creatinine of $2.1 \text{ mg/dL}$ and an estimated glomerular
filtration rate (eGFR) of $28 \text{ mL/min/1.73m}^2$.
Question Stem
Which action should the nurse take first before administering
this medication?
1. Hold the medication and contact the healthcare provider
to recommend an alternative analgesic.
2. Administer the naproxen with a full glass of water or food
to prevent gastrointestinal upset.
3. Check the patient's current blood pressure and assess for
the presence of peripheral edema.
, 4. Request a prescription for an omeprazole co-therapy to
mitigate the risk of gastric ulceration.
Correct Answer
1
Comprehensive Rationale
Naproxen is a nonselective nonsteroidal anti-inflammatory drug
(NSAID) that exerts its therapeutic effect by inhibiting the
cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing
prostaglandin synthesis. Prostaglandins ($PGE_2$ and $PGI_2$)
play a vital physiological role in the kidneys by maintaining
afferent arteriolar vasodilation. This vasodilation ensures
adequate renal blood flow and preserves the glomerular
filtration rate (GFR), especially in patients with pre-existing
renal impairment or volume depletion.
By blocking prostaglandin synthesis, NSAIDs induce profound
afferent arteriolar vasoconstriction, which significantly
decreases renal perfusion. In an 83-year-old patient with an
eGFR of $28 \text{ mL/min/1.73m}^2$ (indicative of severe
renal impairment), administering naproxen carries a high risk of
precipitating acute-on-chronic kidney injury (AKI), fluid
retention, acute tubular necrosis, and worsening hypertension.
Therefore, the primary nursing action must be to withhold the
drug and collaborate with the interprofessional team to secure
, a safer multimodal analgesic regimen (e.g., acetaminophen or
low-dose topical agents if appropriate).
Distractor Analysis
• Option 2 is incorrect. While administering NSAIDs with
food or fluids is a standard nursing intervention to reduce
local mucosal irritation and COX-1 mediated gastric
distress, it does not mitigate or prevent the severe,
systemic nephrotoxic risks associated with systemic
prostaglandin inhibition in a patient with severe kidney
disease.
• Option 3 is incorrect. Assessing blood pressure and
checking for peripheral edema are important monitoring
parameters for patients receiving NSAID therapy due to
the risk of sodium and water retention. However, because
the patient already has advanced kidney disease (Stage 4
equivalent based on current eGFR), the drug is
fundamentally contraindicated; performing these
assessments does not make administration safe.
• Option 4 is incorrect. Co-prescribing a proton pump
inhibitor (PPI) like omeprazole protects the gastric mucosa
against NSAID-induced peptic ulcer disease. However, it
offers absolutely no protection against the renal
hemodynamics changes and nephrotoxicity induced by
systemic NSAID use.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Clinical Scenario
An 83-year-old female patient with a history of Stage 3 chronic
kidney disease (CKD) and chronic osteoarthritis is admitted to
an acute care unit for a severe exacerbation of joint pain. The
healthcare provider's admission orders include naproxen 500
mg orally twice daily as needed for pain. The nurse reviews the
patient’s admission laboratory results, noting a serum
creatinine of $2.1 \text{ mg/dL}$ and an estimated glomerular
filtration rate (eGFR) of $28 \text{ mL/min/1.73m}^2$.
Question Stem
Which action should the nurse take first before administering
this medication?
1. Hold the medication and contact the healthcare provider
to recommend an alternative analgesic.
2. Administer the naproxen with a full glass of water or food
to prevent gastrointestinal upset.
3. Check the patient's current blood pressure and assess for
the presence of peripheral edema.
, 4. Request a prescription for an omeprazole co-therapy to
mitigate the risk of gastric ulceration.
Correct Answer
1
Comprehensive Rationale
Naproxen is a nonselective nonsteroidal anti-inflammatory drug
(NSAID) that exerts its therapeutic effect by inhibiting the
cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing
prostaglandin synthesis. Prostaglandins ($PGE_2$ and $PGI_2$)
play a vital physiological role in the kidneys by maintaining
afferent arteriolar vasodilation. This vasodilation ensures
adequate renal blood flow and preserves the glomerular
filtration rate (GFR), especially in patients with pre-existing
renal impairment or volume depletion.
By blocking prostaglandin synthesis, NSAIDs induce profound
afferent arteriolar vasoconstriction, which significantly
decreases renal perfusion. In an 83-year-old patient with an
eGFR of $28 \text{ mL/min/1.73m}^2$ (indicative of severe
renal impairment), administering naproxen carries a high risk of
precipitating acute-on-chronic kidney injury (AKI), fluid
retention, acute tubular necrosis, and worsening hypertension.
Therefore, the primary nursing action must be to withhold the
drug and collaborate with the interprofessional team to secure
, a safer multimodal analgesic regimen (e.g., acetaminophen or
low-dose topical agents if appropriate).
Distractor Analysis
• Option 2 is incorrect. While administering NSAIDs with
food or fluids is a standard nursing intervention to reduce
local mucosal irritation and COX-1 mediated gastric
distress, it does not mitigate or prevent the severe,
systemic nephrotoxic risks associated with systemic
prostaglandin inhibition in a patient with severe kidney
disease.
• Option 3 is incorrect. Assessing blood pressure and
checking for peripheral edema are important monitoring
parameters for patients receiving NSAID therapy due to
the risk of sodium and water retention. However, because
the patient already has advanced kidney disease (Stage 4
equivalent based on current eGFR), the drug is
fundamentally contraindicated; performing these
assessments does not make administration safe.
• Option 4 is incorrect. Co-prescribing a proton pump
inhibitor (PPI) like omeprazole protects the gastric mucosa
against NSAID-induced peptic ulcer disease. However, it
offers absolutely no protection against the renal
hemodynamics changes and nephrotoxicity induced by
systemic NSAID use.
