Practice Question
You are the nurse reviewing medication orders for several patients diagnosed with osteoarthritis. Based on their health history, which patient should you question receiving a COX-2 enzyme blocker such as celecoxib (Celebrex)?
Answer Choices:
Correct Answer:
A 68-year-old with a history of cardiovascular disease and myocardial infarctions.
Rationale:
🔹 Celecoxib is a COX-2 selective NSAID that has been associated with an increased risk of thrombotic cardiovascular events, including myocardial infarction and stroke.
🔹 In patients with a history of myocardial infarction or established cardiovascular disease, this risk is significantly higher, making celecoxib relatively contraindicated.
🔹 Guidelines generally recommend avoiding COX-2 inhibitors in individuals with high cardiovascular risk when other analgesic options are available.
🔹 Using celecoxib in this patient could exacerbate ischemic heart disease, potentially leading to recurrent MI or stroke.
🔹 Because of this elevated risk profile, the nurse should question this order and advocate for a safer alternative for pain management.
42-year-old with chronic knee pain and history of peptic ulcer disease
🔹 COX-2 inhibitors like celecoxib were developed to reduce gastrointestinal (GI) toxicity, especially gastric and duodenal ulcers, compared with nonselective NSAIDs.
🔹 Although celecoxib is not completely free of GI risk, it is generally safer for patients with prior peptic ulcer disease than traditional NSAIDs such as ibuprofen or naproxen.
🔹 In a patient with a history of peptic ulcer, celecoxib may be an acceptable option, particularly if combined with gastroprotective therapy such as a proton pump inhibitor.
🔹 The main concern in this case is GI rather than cardiovascular risk, and celecoxib is often preferred over nonselective NSAIDs in such a history.
🔹 Therefore, while the patient needs monitoring for GI symptoms, this is not the patient you would question first compared to one with significant cardiovascular disease.
50-year-old with type I diabetes and mild renal insufficiency
🔹 All NSAIDs, including celecoxib, can reduce renal blood flow by inhibiting prostaglandin synthesis, which can worsen renal function especially in vulnerable patients.
🔹 In mild renal insufficiency, celecoxib must be used with caution, but it is not absolutely contraindicated if the patient is monitored and therapy is short-term.
🔹 The presence of type I diabetes does increase long-term risk of nephropathy, but this alone does not make COX-2 therapy the riskiest among the options.
🔹 Careful assessment of renal function (creatinine, GFR) and limiting dose/duration can make celecoxib a manageable risk in this context.
🔹 Compared to a patient with a prior myocardial infarction, the cardiovascular risk remains the more critical reason to question therapy, not this scenario.
56-year-old with rheumatoid arthritis on low-dose prednisone
🔹 Patients with rheumatoid arthritis often require chronic anti-inflammatory therapy, and COX-2 inhibitors can be considered for long-term pain control in selected individuals.
🔹 Low-dose prednisone is itself associated with bone loss, hyperglycemia, and GI risk, so a COX-2 inhibitor may actually be preferred over nonselective NSAIDs due to lower GI toxicity.
🔹 There is no specific major contraindication to celecoxib based solely on low-dose corticosteroid use, though overall risk profile must still be assessed.
🔹 The nurse should monitor for GI, renal, and cardiovascular effects, but this is not the highest-risk profile among the listed patients.
🔹 Compared to the patient with established cardiovascular disease and MI, this option is less concerning, so it is not the one you would question first.
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This question is from Custom- 2201 FA25 Unit 4 Exam-South LA CC Lafayette RN which contains 31 questions.
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Custom- 2201 FA25 Unit 4 Exam-South LA CC Lafayette RN
31 Questions
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- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Adult Health
- Answer Choices: 4