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?&#10;A) Counsel the patient to discuss a prescription NSAID with the provider.&#10;B) Recommend adding aspirin to increase the antiinflammatory effect.&#10;C) Suggest asking the provider about a short course of corticosteroids.&#10;D) Tell the patient to increase the dose to 800 mg every 4 hours.

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&#10;A) increases gastrointestinal secretions.&#10;B) increases hypersensitivity reactions.&#10;C) inhibits both COX-1 and COX-2.&#10;D) is an acidic compound.

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?&#10;A) Edema&#10;B) Erythema&#10;C) Heat&#10;D) Numbness&#10;E) Pallor&#10;F) Paresthesia

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?&#10;A) &#34;I should limit sodium intake while taking this drug.&#34;&#10;B) &#34;I should take indomethacin on an empty stomach.&#34;&#10;C) &#34;I will need to check my blood pressure frequently.&#34;&#10;D) &#34;I will take the medication twice daily.&#34;

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?

A) Assess the patient for drug-seeking behaviors.
B) Notify the provider that the drug is not effective.
C) Reassure the patient that swelling will decrease eventually.
D) Remind the patient that this drug is given for pain only.

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?

A) Diclofenac sodium (Voltaren)
B) Ketoprofen (Orudis)
C) Ketorolac (Toradol)
D) Naproxen (Naprosyn)

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?

A) A COX-2 inhibitor
B) Celecoxib (Celebrex)
C) Enteric-coated aspirin
D) Nabumetone (Relafen)

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?&#10;A) Calcium level&#10;B) Complete blood count&#10;C) Electrolytes&#10;D) Potassium

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&#10;A) converts arachidonic acid into a chemical mediator for inflammation.&#10;B) directly causes vasodilation and increased capillary permeability.&#10;C) irritates the gastric mucosa to cause gastrointestinal upset.&#10;D) releases prostaglandins, which cause inflammation and pain in tissues.

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&#10;A) exert direct actions to cause relaxation of smooth muscle.&#10;B) inhibit cyclooxygenase that is necessary for prostaglandin synthesis.&#10;C) interfere with neuronal pathways associated with prostaglandin action.&#10;D) suppress prostaglandin activity by blocking tissue receptor sites.

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?&#10;A) &#34;It may take several weeks to achieve therapeutic effects.&#34;&#10;B) &#34;Unlike aspirin, there is no increased risk of bleeding with ibuprofen.&#34;&#10;C) &#34;Take ibuprofen twice daily for maximum analgesic benefit.&#34;&#10;D) &#34;Combine ibuprofen with acetaminophen for best effect.&#34;

Accepted Answer

The answer of A patient who has osteoarthritis with mild...

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?&#10;A) It can result in adverse effects on her fetus.&#10;B) It causes an increased risk of Reye's syndrome.&#10;C) It increases hemorrhage risk.&#10;D) It will cause increased gastrointestinal distress.

Accepted Answer

The answer of A patient who is 7-month pregnant and...

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?&#10;A) &#34;A normal serum aspirin level is between 30 and 40 mg/dL.&#34;&#10;B) &#34;You may need to stop taking this drug a week prior to surgery.&#34;&#10;C) &#34;You will need to monitor aspirin levels if you are also taking warfarin.&#34;&#10;D) &#34;Your stools may become dark, but this is a harmless side effect.&#34;

Accepted Answer

The answer of The nurse is teaching a patient about...

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?&#10;A) Aspirin (Bayer)&#10;B) Acetaminophen (Tylenol)&#10;C) Anakinra (Kineret)&#10;D) Prednisone (Deltasone)

Accepted Answer

The answer of The nurse is performing a health history...

Question 15

Which antigout medication is used to treat chronic tophaceous gout?&#10;A) Allopurinol (Zyloprim)&#10;B) Colchicine&#10;C) Probenecid (Benemid)&#10;D) Sulfinpyrazone (Anturane)

Accepted Answer

The answer of Which antigout medication is used to treat...

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?&#10;A) Assess the patient for tinnitus.&#10;B) Monitor the patient for signs of Reye's syndrome.&#10;C) Notify the provider of severe aspirin toxicity.&#10;D) Request an order for an increased aspirin dose.

Accepted Answer

The answer of A patient who takes high-dose aspirin to...

Question 17

The nurse provides teaching for a patient who will begin taking allopurinol.Which statement by the patient indicates understanding of the teaching?&#10;A) &#34;I should increase my vitamin C intake.&#34;&#10;B) &#34;I will get yearly eye exams.&#34;&#10;C) &#34;I will increase my protein intake.&#34;&#10;D) &#34;I will limit fluids to prevent edema.&#34;

Accepted Answer

The answer of The nurse provides teaching for a patient...

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?&#10;A) Elevated BUN and creatinine&#10;B) Increased serum uric acid&#10;C) Slight increase in the white blood count&#10;D) Increased serum glucose

Accepted Answer

The answer of The nurse is assessing a patient who...

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?&#10;A) Avoid all alcohol except beer.&#10;B) Include salmon in the diet.&#10;C) Increase fluid intake.&#10;D) Take on an empty stomach.

Accepted Answer

The answer of The nurse is teaching a patient about...

Deck 24: Antiinflammatories