A nurse is evaluating a client who has fever and is receiving acetaminophen (Tylenol), a nonsalicylate NSAID. What are some of the outcomes that indicate the effectiveness of the therapy?

Acetaminophen (Tylenol) is commonly used to reduce fever. Fever is an elevated body temperature, and one of the main goals of using acetaminophen is to lower the body temperature back to the normal range. Therefore, a decreased temperature within the normal range would indicate the effectiveness of the therapy in reducing fever.

Options B, C, and D, are not directly related to the use of acetaminophen.

B.

Option B refers to the effects of NSAIDs (nonsteroidal anti-inflammatory drugs) in general, which include reducing inflammation, pain, and swelling. Acetaminophen is not primarily an anti-inflammatory drug, so it may not have significant effects on inflammation, pain, or swelling.

C.

Option C refers to the gastrointestinal side effects associated with NSAIDs, such as bleeding and ulceration. Acetaminophen is generally considered safer for the gastrointestinal system compared to NSAIDs, but it does not specifically decrease the risk of gastrointestinal bleeding and ulceration.

D.

Option D refers to the potential adverse effects of acetaminophen on the liver, such as hepatotoxicity and liver impairment. While these are possible risks associated with acetaminophen, decreased risk is not an outcome that directly indicates the effectiveness of the therapy. Monitoring liver function is important when using acetaminophen, especially at higher doses or with prolonged use, but it does not serve as an indicator of the therapy's effectiveness in reducing fever.

Celecoxib is a selective COX-2 inhibitor that blocks the production of prostaglandins that are involved in pain and inflammation, but spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function¹²³⁴⁵. Therefore, celecoxib has less gastrointestinal toxicity than nonselective COX inhibitors, such as ibuprofen and naproxen, that inhibit both COX-1 and COX-2 enzymes¹²³⁴⁵. However, celecoxib still carries some risk of gastrointestinal bleeding and ulceration, especially in patients with a history of peptic ulcer disease, concomitant use of anticoagulants or corticosteroids, or high doses or long-term use of celecoxib¹²³⁴⁵. Therefore, the lowest effective dose and the shortest duration of treatment should be used, and patients should be monitored for signs and symptoms of gastrointestinal adverse events¹²³⁴⁵.

The other options are incorrect because:

B. The drug has more anti-inflammatory and analgesic effects than nonselective COX inhibitors because it blocks both COX-1 and COX-2 enzymes.

This option is wrong because celecoxib is a selective COX-2 inhibitor that does not block COX-1, which is involved in the production of prostaglandins that have anti-inflammatory and analgesic effects . Therefore, celecoxib has less anti-inflammatory and analgesic effects than nonselective COX inhibitors that block both COX-1 and COX-2 enzymes .

C. The drug has less cardiovascular risk than nonselective COX inhibitors because it inhibits vasodilatory and antiplatelet prostaglandins produced by COX-2 in the endothelium.

This option is wrong because celecoxib has more cardiovascular risk than nonselective COX inhibitors because it inhibits the production of prostacyclin, a prostaglandin that has vasodilatory and antiplatelet effects, while leaving the synthesis of thromboxane A2, a prostaglandin that promotes platelet aggregation, vasoconstriction, and smooth-muscle proliferation, unchanged or increased . This imbalance may favor thrombosis and vasoconstriction in the blood vessels and increase the risk of cardiovascular events, such as heart attacks and strokes . Therefore, celecoxib should be used with caution in patients with a history or risk factors for cardiovascular disease, and the lowest effective dose and the shortest duration of treatment should be used .

D. The drug has more antipyretic and antiplatelet effects than nonselective COX inhibitors because it blocks the production of prostaglandins involved in fever and platelet aggregation.

This option is wrong because celecoxib has less antipyretic and antiplatelet effects than nonselective COX inhibitors because it does not block the production of prostaglandins involved in fever and platelet aggregation . Celecoxib is a selective COX-2 inhibitor that spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function