Question 1

A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before.What action will the nurse take?

Accepted Answer

The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID.Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset.Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe.A prescription NSAID would be used prior to starting corticosteroids.Increasing the dose will increase side effects but may not increase desired effects.The maximum dose per day is 3200 mg,which would be exceeded when increasing the dose to 800 mg every 4 hours.

Question 2

A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset.The nurse understands that this is because aspirin

Accepted Answer

Aspirin is a COX-1 and COX-2 inhibitor.COX-1 protects the stomach lining,so when it is inhibited,gastric upset occurs.Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions.It is a weak acid.

Question 3

Which are characteristic signs of inflammation?

Accepted Answer

Edema,erythema,and heat are signs of inflammation.The other three are signs of neurocirculatory compromise.

Question 4

The nurse provides teaching for a patient who will begin taking indomethacin (Inderal)to treat rheumatoid arthritis.Which statement by the patient indicates a need for further teaching?

Accepted Answer

Indomethacin is very irritating to the stomach and should be taken with food.It can cause sodium retention and elevated blood pressure,so patients should limit sodium intake.The medication is taken twice daily.

Question 5

The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis.The patient reports decreased pain,but the nurse notes continued swelling of the affected joints.The nurse will perform which action?

Accepted Answer

This medication is effective for both pain and swelling.After 4 weeks,there should be some decrease in swelling,so the nurse should report that this medication is ineffective.There is no indication that this patient is seeking an opioid analgesic.The drug should be effective within several weeks.NSAIDs are given for pain and swelling.

Question 6

The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale.The nurse will contact the provider to request an order for which analgesic medication?

Accepted Answer

Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics.The other NSAIDs listed are not used for postoperative pain.

Question 7

A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset.The nurse will contact the patient's provider to discuss changing from aspirin to which drug?

Accepted Answer

Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction.Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors,since the COX-1 enzyme is responsible for inhibiting platelet aggregation.The patient should take enteric-coated aspirin to lessen the gastrointestinal distress.Celecoxib and nabumetone are both COX-2 inhibitors.

Question 8

The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade)IV every 8 weeks.Which laboratory test will the nurse anticipate that this patient will need?

Accepted Answer

Infliximab is an immunomodulator and can cause agranulocytosis,so patients should have regular CBC evaluation.

Question 9

A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2)and its role in inflammation.The nurse will explain that COX-2

Accepted Answer

COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products,and this synthesis causes pain and inflammation.They do not act directly to cause inflammation.COX-1 irritates the gastric mucosa.COX-2 synthesizes but does not release prostaglandins.

Question 10

A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs)work to suppress inflammation and reduce pain.The nurse will explain that NSAIDs

Accepted Answer

NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis.They do not have direct action on tissues,nor do they interfere with chemical receptor sites or neuronal pathways.

Question 11

A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin).What will the nurse tell this patient?

Accepted Answer

OTC NSAIDs can be effective for mild to moderate arthritis pain,but the effects may not appear for several weeks.NSAIDs carry a risk for bleeding.Ibuprofen is taken TID or QID.Ibuprofen should not be combined with aspirin or acetaminophen.

Question 12

A patient who is 7-month pregnant and who has arthritis asks the nurse if she can take aspirin for pain.The nurse will tell her not to take aspirin for which reason?

Accepted Answer

Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus.It does not increase her risk of Reye's syndrome.Aspirin taken within a week of delivery will increase the risk of bleeding.It can cause gastrointestinal distress,but this is not the reason for caution.

Question 13

The nurse is teaching a patient about using high-dose aspirin to treat arthritis.What information will the nurse include when teaching this patient?

Accepted Answer

Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time.A normal serum level is 15 to 30 mg/dL.Patients taking warfarin and aspirin will have increased amounts of warfarin,so the INR will need to be monitored.Tarry stools are a symptom of gastrointestinal bleeding and should be reported.

Question 14

The nurse is performing a health history on a patient who has arthritis.The patient reports tinnitus.Suspecting a drug adverse effect,the nurse will ask the patient about which medication?

Accepted Answer

Aspirin causes tinnitus at low toxicity levels.The nurse should question the patient about this medication.The other medications do not have this side effect.

Question 15

Which antigout medication is used to treat chronic tophaceous gout?

Accepted Answer

Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout.Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout.Probenecid can be used for chronic gout but is not the first choice.Sulfinpyrazone has many serious side effects.

Question 16

A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL.The nurse will perform which action?

Accepted Answer

Mild toxicity occurs at levels above 30 mg/dL,so the nurse should assess for signs of toxicity,such as tinnitus.This level will not increase the risk for Reye's syndrome.Severe toxicity occurs at levels greater than 50 mg/dL.The dose should not be increased.

Question 17

The nurse provides teaching for a patient who will begin taking allopurinol.Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams.It is not necessary to increase vitamin C.Protein can increase purine intake,which is not recommended.Patients should consume extra fluids.

Question 18

The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim).The nurse reviews the patient's medical record and will be concerned about which laboratory result?

Accepted Answer

Antigout drugs are excreted via the kidneys,so patients should have adequate renal function.

Question 19

The nurse is teaching a patient about taking colchicine to treat gout.What information will the nurse include when teaching this patient about this drug?

Accepted Answer

The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi.Foods rich in purine should be avoided,including beer,and some sea foods,such as salmon.Gastric irritation is a common problem,so colchicine should be taken with food.

Quiz 24: Antiinflammatories

A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before.What action will the nurse take?

A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset.The nurse understands that this is because aspirin

Which are characteristic signs of inflammation?

The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis.Which statement by the patient indicates a need for further teaching?

The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis.The patient reports decreased pain,but the nurse notes continued swelling of the affected joints.The nurse will perform which action?

The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale.The nurse will contact the provider to request an order for which analgesic medication?

A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset.The nurse will contact the patient's provider to discuss changing from aspirin to which drug?

The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks.Which laboratory test will the nurse anticipate that this patient will need?

A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation.The nurse will explain that COX-2

A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain.The nurse will explain that NSAIDs

A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin) .What will the nurse tell this patient?