The nurse is caring a client with a diagnosis of rheumatoid arthritis who is receiving aspirin 300 mg orally daily. The nurse recognizes which finding has an adverse effect related to the medication?

Appeared in: PGIMER Sangrur NO - 2023

Explanation

Tinnitus, or ringing in the ears, is a classic early sign of salicylism, which is mild aspirin toxicity.
This symptom often indicates that the therapeutic dose has been exceeded and requires a dosage reduction.
In conditions like rheumatoid arthritis, where higher anti-inflammatory doses of aspirin may be used, monitoring for salicylism is crucial for patient safety.
The nurse should instruct the patient to report ringing in the ears immediately.

Option B: This is the primary symptom of rheumatoid arthritis, which aspirin is prescribed to alleviate, not cause.
Option C: This is not a recognized adverse effect of aspirin. It is more commonly associated with anticholinergic medications or opioids.
Option D: Similar to urinary retention, this is not a typical side effect of aspirin. It points towards other drug classes or underlying urological issues.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of salicylates (Aspirin) to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients on high-dose aspirin therapy to report tinnitus immediately, as it is a warning sign of toxicity that precedes more severe complications.
Patient teaching should include the difference between therapeutic effects (reduced joint pain) and adverse effects (tinnitus, GI upset) to empower self-monitoring.
What if the patient reported dark, tarry stools instead of tinnitus? This would indicate gastrointestinal bleeding, another serious adverse effect of aspirin, and would require immediate medical attention and likely discontinuation of the drug.

How to Approach the Question

First, identify the core of the question: it asks for an adverse effect of a specific drug (aspirin).
Analyze the patient's diagnosis (rheumatoid arthritis). This provides context for why the drug is being given (for joint pain and inflammation).
Evaluate each option against your knowledge of aspirin's side effect profile.
Eliminate 'Joint pains' because this is the symptom the drug is meant to treat, not a side effect.
Recognize that 'Tinnitus' is a well-known, classic sign of salicylate toxicity (salicylism).
Rule out the urinary-related options as they are not characteristic side effects of aspirin.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 3 pp. 70-72, 67-69

Practise the full PGIMER Sangrur NO - 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.