Question 1

A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching?&#10;A) &#34;Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase.&#34;&#10;B) &#34;NSAIDs do not increase the risk of MI and stroke; however, unlike ASA, they do not provide protective benefits against those conditions.&#34;&#10;C) &#34;Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions.&#34;&#10;D) &#34;Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation.&#34;

Accepted Answer

Nonaspirin first-generation NSAIDs carry a risk of hypersensitivity reactions similar to the risk posed by ASA. These agents cause reversible COX inhibition, whereas ASA causes irreversible COX inhibition. NSAIDs do not provide protective benefits for MI or stroke, as does ASA. Nonaspirin first-generation NSAIDs do cause suppression of platelet aggregation, but the suppression is reversible.

Question 2

An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following?

A) Acetylcysteine (Mucomyst)
B) Activated charcoal
C) Hemodialysis
D) Respiratory support

Acetylcysteine (Mucomyst)

Accepted Answer

The nurse should anticipate giving acetylcysteine, because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed, so it must be given much sooner. Hemodialysis is not indicated. Respiratory support is used for ASA overdose.

Question 3

A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen?

A) It does not inhibit cyclooxygenase.
B) It has minimal effects at peripheral sites.
C) It is more similar to opioids than to nonsteroidal anti-inflammatory drugs (NSAIDs).
D) It is selective for cyclooxygenase-2.

Accepted Answer

The differences between the effects of acetaminophen and aspirin are thought to result from selective inhibition of cyclooxygenase; acetaminophen has only minimal effects on cyclooxygenase at peripheral sites, which may explain why acetaminophen does not have adverse GI, renal, and antiplatelet effects. Acetaminophen is a selective COX inhibitor. It is not more similar to opioids than NSAIDs. It is not selective for COX-2.

Question 4

A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to:&#10;A) continue to use aspirin as scheduled.&#10;B) reduce the aspirin dosage by half until after surgery.&#10;C) stop using aspirin immediately.&#10;D) stop using aspirin 3 days before surgery.

Accepted Answer

Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. An interval of 3 days is not long enough for the bleeding effects of aspirin to be reversed. Cutting the dose in half would not reduce the effects of bleeding associated with aspirin use.

Question 5

An older male patient with an increased risk of MI is taking furosemide (Lasix) and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss:

A) adding an antihypertensive medication.
B) obtaining serum electrolytes.
C) ordering a potassium-sparing diuretic.
D) withdrawing the aspirin.

Accepted Answer

This patient shows signs of renal impairment, as evidenced by weight gain despite the use of diuretics, decreased urine output, hypertension, and elevated serum creatinine and BUN. ASA can cause acute, reversible renal impairment and should be withdrawn. Hypertensive medications do not treat the underlying cause. Serum electrolytes are not indicated. Addition of a potassium-sparing diuretic is not indicated.

Question 6

A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do?

A) Increase the aspirin dose to treat the patient's headache.
B) Notify the provider of possible renal toxicity.
C) Prepare to provide respiratory support, because the patient shows signs of overdose.
D) Withhold the aspirin until the patient's symptoms have subsided.

Accepted Answer

This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.

Question 7

A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen (Motrin) for discomfort. Which statement by the patient indicates a need for further teaching?

A) "I may experience tinnitus with higher doses of this medication."
B) "I may take up to 800 mg 4 times daily for pain."
C) "I should limit alcohol intake to fewer than three drinks a day."
D) "I will take this medication with meals to help prevent stomach upset."

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Accepted Answer

NSAIDs do not cause salicylism and therefore do not cause tinnitus with higher doses. The maximum dose for adults is 3200 mg/day, or 800 mg 4 times/day. Patients taking NSAIDs should be cautioned to limit alcohol intake. Taking NSAIDs with meals helps prevent GI upset.

Question 8

A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n):

A) different nonsteroidal anti-inflammatory drug for home management of pain.
B) fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication.
C) lower dose of the oral ketorolac for long-term pain management.
D) intranasal preparation of ketorolac for pain management at home.

Accepted Answer

Ketorolac is not indicated for chronic or minor pain and should not be used longer than 5 days. Patients discharged home will be instructed to use other NSAIDs for pain. A fixed-dose opioid/NSAID is not indicated. Low-dose ketorolac would not be used, because 5 days would have passed. The intranasal therapy would not be indicated after 5 days.

Question 9

A nurse is teaching a group of nursing students about cyclooxygenase inhibitors. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Cyclooxygenase-2 inhibition causes gastrointestinal side effects.&#34;&#10;B) &#34;Cyclooxygenase-2 is considered the 'bad COX.'&#34;&#10;C) &#34;Inhibition of cyclooxygenase-1 promotes myocardial infarction and stroke.&#34;&#10;D) &#34;Inhibition of cyclooxygenase-1 results in suppression of inflammation.&#34;

Accepted Answer

Because cyclooxygenase-2 (COX-2) primarily mediates harmful processes in the body, it is called the "bad COX"; suppression of COX-2 results in largely beneficial effects. The gastrointestinal (GI) side effects of COX inhibitors are the result of COX-1 inhibition. One of two harmful side effects of COX-2 inhibition is suppression of vasodilation, which leads to an increased risk of myocardial infarction (MI) and stroke. Inhibition of COX-2 causes suppression of inflammation.

Question 10

A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct?&#10;A) &#34;Aspirin is safe during the second and third trimesters of pregnancy.&#34;&#10;B) &#34;Aspirin may cause premature closure of the ductus arteriosus in your baby.&#34;&#10;C) &#34;Aspirin may induce premature labor and should be avoided in the third trimester.&#34;&#10;D) &#34;You should use a first-generation nonsteroidal anti-inflammatory medication.&#34;

Accepted Answer

Aspirin poses risks to the pregnant patient and her fetus, including premature closure of the ductus arteriosus. ASA is not safe, especially in the third trimester, because it can cause anemia and can contribute to postpartum hemorrhage. ASA does not induce labor but can prolong labor by inhibiting prostaglandin synthesis. NSAIDs have similar effects and also should be avoided.

Question 11

A nurse is providing medication teaching for a patient who will begin taking diclofenac (Voltaren) gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching?

A) "Because this is a topical drug, liver toxicity will not occur."
B) "I should cover areas where the gel is applied to protect them from sunlight."
C) "I will apply equal amounts of gel to all affected areas."
D) "The topical formulation has the same toxicity as the oral formulation."

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Accepted Answer

The answer of A nurse is providing medication teaching for...

Question 12

A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional, recurrent pain. What will the nurse tell the patient?&#10;A) &#34;Do not take more than 2 gm of acetaminophen a day.&#34;&#10;B) &#34;Do not take more than 3 gm of acetaminophen a day.&#34;&#10;C) &#34;Do not take more than 4 gm of acetaminophen a day.&#34;&#10;D) &#34;Do not take a fixed-dose preparation with opioid analgesics.&#34;

Accepted Answer

The answer of A patient who reports regular consumption of...

Question 13

A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest?&#10;A) The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome.&#10;B) The patient should increase the dose to a level that suppresses inflammation.&#10;C) The patient should use a first-generation nonsteroidal anti-inflammatory medication instead.&#10;D) The patient should use acetaminophen because of its selective effects on uterine smooth muscle.

Accepted Answer

The answer of A patient tells the nurse that she...

Question 14

A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss:

A) administering epinephrine.
B) changing to a first-generation NSAID.
C) reducing the dose of aspirin.
D) giving an antihistamine.

Accepted Answer

The answer of A nurse is caring for a patient...

Question 15

A patient with arthritis asks a nurse which nonsteroidal anti-inflammatory medication is best to take. The nurse learns that this patient has a family history of cardiovascular disease. The nurse will recommend which NSAID?

A) Celecoxib (Celebrex)
B) Diclofenac (Voltaren)
C) Ketorolac intranasal (Sprix)
D) Naproxen (Aleve)

Accepted Answer

The answer of A patient with arthritis asks a nurse...

Deck 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-Inflammatory Drugs and Acetaminophen