# A 78-year-old client with a peptic ulcer history, hypertension, stage 3 CKD, and a documented sulfa allergy is being considered for chronic NSAID therapy for osteoarthritis. The prescriber is reviewing celecoxib. Which nursing assessment is most important to communicate before the prescription is finalized?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375139&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## Question

A 78-year-old client with a peptic ulcer history, hypertension, stage 3 CKD, and a documented sulfa allergy is being considered for chronic NSAID therapy for osteoarthritis. The prescriber is reviewing celecoxib. Which nursing assessment is most important to communicate before the prescription is finalized?

## Option

1. Celecoxib has no GI risk so the ulcer history is irrelevant.
2. The sulfa allergy must be reported because celecoxib contains a sulfonamide moiety, the renal disease and cardiovascular history mean dose minimization, BP and creatinine monitoring, and lowest effective short-term use are essential, and acetaminophen plus topical agents may be safer first. **✔ Correct answer**
3. The client is left handed.
4. The client should also start a daily low-dose aspirin while taking celecoxib for cardiac protection.

**Correct answer: 2**

## Explanation

Celecoxib is a selective COX-2 inhibitor with reduced GI mucosal injury compared with nonselective NSAIDs, making it an option for patients with prior peptic ulcer. However, celecoxib has a sulfonamide group, which contraindicates it in patients with a sulfa allergy or warrants careful review when allergy is questionable. Other key considerations: (1) cardiovascular risk — selective and most nonselective NSAIDs carry boxed warnings for MI, stroke, and heart failure, so use the lowest effective dose for the shortest duration in patients with CV disease; (2) renal effect — like nonselective NSAIDs, celecoxib decreases renal prostaglandins and can worsen CKD or precipitate acute kidney injury, requires baseline creatinine and ongoing monitoring; (3) hypertension control — NSAIDs blunt antihypertensives and can raise BP; (4) GI protection — even with COX-2 selectivity, concurrent low-dose aspirin negates much of the GI advantage and increases bleeding risk; (5) drug interactions — warfarin (bleeding), lithium (toxicity), methotrexate (toxicity), ACE inhibitors and ARBs (renal function), and diuretics (renal function). For this elderly client with CKD plus CV plus ulcer plus sulfa allergy, the safer first-line plan is acetaminophen, topical NSAIDs (diclofenac gel), physical therapy, and only if those fail, the lowest dose celecoxib (after allergy review) or naproxen with PPI for the shortest needed duration. Adding daily aspirin to celecoxib eliminates the GI advantage and increases bleeding.

## In-depth explanation

Sulfa allergy plus CKD plus CV plus ulcer history means celecoxib is not an automatic answer. Communicate the cluster of contraindications and propose acetaminophen and topical first.

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