Question 1

A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis.The patient expresses concerns about possible side effects of this medication.When counseling the patient about the medication,the NP should tell this patient:

A) to avoid taking antacids while taking the NSAID.
B) to take each dose of the NSAID with a full glass of water.
C) that a few glasses of wine each day are allowed while taking the NSAID.
D) to decrease the dose of the NSAID if GI symptoms occur.

Accepted Answer

To avoid GI distress associated with NSAIDs,a full glass of water is recommended.Patients may take NSAIDs with antacids.Patients should avoid alcohol while taking NSAIDs.Patients should report GI symptoms to their provider.

Question 2

A patient is taking 81 mg of aspirin daily to decrease MI risk and uses acetaminophen for mild osteoarthritis symptoms.For flare-ups of osteoarthritis pain,the primary care NP should prescribe:&#10;A) ibuprofen (Motrin).&#10;B) celecoxib (Celebrex).&#10;C) naproxen (Naprosyn).&#10;D) increasing the dose of aspirin.

Accepted Answer

Concomitant use of an NSAID with aspirin has been shown to reduce the cardioprotective effects of aspirin.However,naproxen does not appear to have this risk.

Question 3

A patient who has osteoarthritis is scheduled to have knee surgery.The patient takes aspirin for MI prophylaxis and naproxen (Naprosyn)for pain and inflammation.Which statement by the patient to the primary care NP indicates a need for further teaching?

A) "I should stop taking aspirin at least 5 days before surgery."
B) "I will check with the surgeon to see if I need to stop taking the naproxen."
C) "I will need to stop taking both medications 1 week before I have surgery."
D) "Both of these medications interfere with platelet production and may cause blood clots."

"I will need to stop taking both medications 1 week before I have surgery."

Accepted Answer

Although both medications interfere with platelet formation,some NSAIDs may continue to be taken before surgery,depending on the procedure and the surgeon preference.The patient should stop taking aspirin 5 days before surgery.

Question 4

The primary care NP is performing a medication reconciliation on a patient who takes digoxin for congestive heart failure and learns that the patient uses ibuprofen as needed for joint pain.The NP should counsel this patient to:

A) use naproxen (Naprosyn) instead of ibuprofen.
B) increase the dose of digoxin while taking the ibuprofen.
C) use an increased dose of ibuprofen while taking the digoxin.
D) take potassium supplements to minimize the effects of the ibuprofen.

Accepted Answer

Ibuprofen and indomethacin increase the effects of digoxin,so the NP should recommend another NSAID,such as naproxen,that does not have this effect.Increasing the dose of digoxin or the ibuprofen would increase the likelihood of digoxin toxicity further.Potassium should be monitored while taking NSAIDs long-term,but supplements should not be given unless there is a potassium deficiency.

Question 5

An 80-year-old patient has been taking naproxen (Naprosyn)for osteoarthritis for 6 months.The patient reports adequate pain relief but complains of feeling tired.The primary care NP will order:&#10;A) liver function tests.&#10;B) a serum potassium level.&#10;C) a complete blood count (CBC).&#10;D) a creatinine clearance and urinalysis.

Accepted Answer

Elderly patients are more susceptible to the adverse effects of NSAIDs,especially slow GI bleeds leading to anemia (manifested as fatigue,lethargy).Patients complaining of fatigue should have a CBC to evaluate for anemia.

Question 6

A patient with mild to moderate osteoarthritis pain has been taking acetaminophen for pain.The primary care NP prescribes a nonselective NSAID.At a follow-up visit,the patient reports mild GI side effects.The NP should:

A) order misoprostol to take with the NSAID.
B) discontinue the NSAID and order tramadol.
C) change the medication to a COX-2 inhibitor.
D) change the medication to naproxen (Naprosyn).

Accepted Answer

If the patient experiences GI distress,coadministration of histamine-2 blockers,proton pump inhibitors,or misoprostol may be considered.Tramadol is used for severe pain.A COX-2 inhibitor is generally used for long-term therapy.Naproxen is another nonselective NSAID and would likely have similar GI side effects.

Question 7

A 70-year-old patient describes moderate to severe pain associated with osteoarthritis in fingers,thumbs,hips,and knees.The patient is currently taking high-dose acetaminophen.The patient has a strong family history of cardiovascular disease and has been diagnosed with hypertension.To help alleviate this patient's pain,the primary care NP should consider prescribing:

A) a COX-2 inhibitor and low-dose aspirin.
B) ketorolac (Toradol) and 325 mg of aspirin.
C) naproxen (Naprosyn) and low-dose aspirin.
D) indomethacin (Indocin) and 325 mg of aspirin.

Accepted Answer

Aspirin at the dosage of 325 mg every other day or 81 mg daily is effective in reducing the incidence of myocardial infarction (MI)and stroke.Concomitant use of an NSAID with aspirin has been shown to reduce the cardioprotective effects of aspirin.However,naproxen does not appear to have this risk.

Question 8

A patient who has rheumatoid arthritis begins taking naproxen (Naprosyn)500 mg once daily for pain.After 1 week,the patient calls the primary care NP to report no change in inflammation.The NP should:&#10;A) change the medication to tramadol.&#10;B) change the medication to ketorolac (Toradol).&#10;C) increase the dose of naproxen to 1000 mg daily.&#10;D) counsel the patient that pain relief may not occur for another week.

Accepted Answer

The analgesic effect of NSAIDs should be noticed within 1 to 4 hours of administration.However,the full antiinflammatory effect will not be apparent until after a few weeks.Tramadol and ketorolac are used for severe pain.It is not necessary to increase the dose of naproxen.

Question 9

The primary care NP sees an adolescent who reports moderate to severe dysmenorrhea.The NP recommends an NSAID and counsels the patient about its use.Which statement by the patient indicates a need for further teaching?

A) "I should not take this if I think I might be pregnant."
B) "I should take this medication on a schedule for 2 to 3 days."
C) "I will begin taking this 1 to 3 days before my period begins."
D) "I will take this medicine every 4 to 6 hours as needed for pain."

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Accepted Answer

When treating primary dysmenorrhea,NSAIDs should be started 24 to 72 hours before the patient starts menstrual bleeding.The medication should be taken on a routine basis for 2 to 3 days.It should not be taken during pregnancy.

Question 10

A patient reports having persistent mild to moderate pain in both knees usually associated with standing.The patient reports knee stiffness for 15 to 20 minutes each morning.The primary care nurse practitioner (NP)learns that the patient has used heating pads and acetaminophen,which no longer relieve the pain.The NP orders an erythrocyte sedimentation rate,which is normal.The NP should consider prescribing:

A) aspirin.
B) a cyclooxygenase-2 (COX-2) inhibitor.
C) glucosamine and chondroitin.
D) a topical nonsteroidal antiinflammatory drug (NSAID).

Accepted Answer

Topical NSAIDs,acupuncture,and tramadol are effective for pain relief in knee osteoarthritis.Treatment for osteoarthritis should begin with nonpharmacologic treatment,and acetaminophen should be first-line pharmacologic treatment.NSAIDs should be used when these two measures are no longer effective.COX-2 inhibitors are more expensive and should be used in the presence of gastrointestinal (GI)side effects or for moderate to severe pain.Glucosamine and chondroitin do not relieve most osteoarthritis pain.

Deck 36: Aspirin and Nonsteroidal Antiinflammatory Drugs