Chapter 08: Anti-Inflammatory Drugs Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 08: Anti-Inflammatory Drugs

Test Bank

MULTIPLE CHOICE

1. Why is inflammation considered a nonspecific body response?
a. Inflammation is the basis for almost every type of chronic disease.
b. Infection by bacteria or viruses is always a part of inflammation.
c. The same tissue responses occur regardless of the type of triggering event.
d. The discomfort associated with inflammation can be reduced by over-the-counter drugs.
ANS: C
Inflammation is a syndrome of normal tissue responses that always occur in the same way with any type of injury or invasion, regardless of the location on the body or what caused the response to start.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 121 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. Which symptoms of inflammation are caused by leakage of blood plasma into the tissues at the site of injury or invasion?
a. Increased production and migration of leukocytes
b. Phagocytosis and fever
c. Warmth and redness
d. Swelling and pain
ANS: D
With capillary leak, blood plasma leaks into the tissues causing swelling and pain. The swelling creates a cushion of fluid to prevent more tissue injury. Swelling alone can compress pain receptors (nociceptors) and result in pain perception.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 122 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

3. When is an inflammatory response a health problem rather than a helpful protection?
a. When a patients immune system is suppressed
b. When infection accompanies inflammation
c. When inflammation is prolonged
d. When pain is experienced
ANS: C
Inflammation starts tissue actions that cause visible and uncomfortable symptoms that are important in ridding the body of harmful organisms and helping repair damaged tissue. However, if the inflammatory response is prolonged or excessive, tissue damage may result.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 123 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

4. A patient is prescribed an oral corticosteroid for a chronic inflammatory health problem. Which precaution is most important for the nurse to teach?
a. Never stop taking this drug without consulting your prescriber.
b. Avoid crowds and people who are ill.
c. Be sure to take this drug with food.
d. Reduce your salt intake.
ANS: A
All of the choices are precautions that the nurse should teach the patient taking an oral corticosteroid for the long term. However, the most critical precaution is to not stop taking the drug because long-term corticosteroid use causes atrophy of the adrenal glands. With adrenal gland atrophy, the person no longer makes his or her own normal levels of corticosteroids, which are essential for life. Long-term steroid use is never suddenly stopped.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

5. Which statement about stage I of the inflammatory process is true?
a. Vascular changes occur, including dilation of blood vessels and capillary leak.
b. White blood cells (WBCs) secrete chemicals that trigger resolution of pain and swelling.
c. The body prepares to replace scar tissue with healthy tissue to maintain function.
d. An exudate called pus is formed and white blood cell levels are four to five times above normal.
ANS: A
Stage I of the inflammatory process involves WBC and blood vessel changes. Injured tissues and WBCs release mediators. Each mediator affects tissues differently. Some act on blood vessels, causing changes that include dilation and capillary leak. Blood plasma leaking into the tissues causes swelling and pain. Formation of exudate occurs during stage II.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 122 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

6. Why are corticosteroid drugs usually prescribed for a short period of time?
a. The inflammatory process cannot be controlled with less powerful drugs.
b. Inhalation of corticosteroid drugs causes irreversible damage to the lungs.
c. These drugs work less effectively when given over an extended period.
d. Corticosteroids have many adverse effects and side effects.
ANS: D
When taken orally or parenterally, corticosteroids are usually given for a short period of time because they have many adverse effects and side effects. These drugs can be given over longer periods with the goal that the patient take the lowest dose that will control inflammation, so that side effects and adverse effects can be minimized.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 124 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

7. A patient who has been taking 30 mg of prednisone daily for the last 10 days reports crying more often and then suddenly getting angry at small issues. What is the nurses best action?
a. Document the patients response as the only action.
b. Hold the next dose and notify the prescriber immediately.
c. Reassure the patient that this is an expected drug response.
d. Suggest that the patient see a counselor or attend an anger management class.
ANS: C
Prednisone, a type of corticosteroid, increases a patients emotional responses (emotional lability). It is an uncomfortable but expected side effect that will stop after the drug has been discontinued. Usually, this side effect is not a reason to stop drug therapy and counseling or anger management will not stop the responses. It is helpful for the patient to know this and to be able to tell family members that they are not responsible for the changes in the patients emotional state.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

8. A patient who has been prescribed long-term low-dose prednisone to control inflammation reports concern about the changes in her appearance caused by the drug. What is the nurses best response?
a. This often happens when a person takes this drug. You now have Cushings disease.
b. When you stop taking this drug, the changes will disappear, but it may take a while.
c. You can make use of different styles of clothes to minimize changes in appearance.
d. Changes in your diet and an exercise program will eliminate these changes while you are on this drug.
ANS: B
Changes in appearance are a side effect of corticosteroids. The patient develops a Cushingoid appearance. When a patient stops taking these drugs, the side effects and changes in body appearance disappear, but it may take a year or more for this to occur.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

9. A patient is prescribed topical hydrocortisone 0.1% for skin inflammation. What does the nurse teach the patient for applying this drug?
a. Use a thick layer of drug just to the area that needs treatment.
b. Apply a thin layer to the affected area and to the skin near the area.
c. Apply a thick layer over and 1 inch around the affected area.
d. Use as thin a layer as possible just to the area that needs treatment.
ANS: D
Topical corticosteroids are absorbed through the skin and can have some systemic effects. Thus patients should use only the minimum amount needed to control the skin problem. Teach the patient to apply only a thin layer just to the areas of skin that need treatment.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

10. The nurse is providing care to an older adult patient who has been prescribed a topical corticosteroid. Which assessment is most important for the nurse to perform?
a. Skin assessment
b. Intake and output
c. Cognition or mental status
d. Urinary tract infection
ANS: A
Topical corticosteroid use usually has no systemic effects. The skin exposed to the topical corticosteroid becomes thinner and more fragile, especially in an older adult. This area is at greater risk for injury and loss of integrity.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

11. A nursing home resident has been prescribed to take 20 mg of prednisolone immediately. The facility does not have prednisolone, only prednisone. What is the nurses best action?
a. Substitute prednisone for prednisolone because they are both corticosteroids.
b. Hold the dose until the pharmacy opens the next day.
c. Notify the prescriber immediately of this situation.
d. Administer the parenteral form of the drug.
ANS: C
Although prednisone and prednisolone are both corticosteroids, they are not the same strength and only the prescriber can change the drug or its dose. Because it was ordered to be administered as soon as possible, the nurse should not wait until the next day but should notify the prescriber immediately. It is possible that, if the prednisolone is not available until tomorrow, the prescriber may change the drug, its dose, or its delivery route; however, these decisions must be made by the prescriber, not the nurse.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

12. A patient is prescribed triamcinolone (Kenalog) ointment for an allergic skin rash. Which precaution is most important for the nurse to teach?
a. Always wear gloves when applying this ointment.
b. Do not use the ointment on an infected skin area.
c. Keep the drug refrigerated between applications.
d. Do not wash the ointment off until the area is healed.
ANS: B
Topical corticosteroids lower immunity in the area where it is applied. This means that if there is a skin infection and topical corticosteroids are applied in that area, the infection can spread to surrounding areas more easily. For this reason, do not apply a topical corticosteroid if there is any question that the skin is infected instead of just being irritated or having a rash.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

13. Which statement about corticosteroid use and pediatric patients is true?
a. Adrenal atrophy does not occur during long-term use because this organ is younger and healthier in children.
b. Because these drugs slow cell division, they can interfere with normal growth and are not used in children.
c. Children are at the same risk for every side effect of long-term corticosteroid use that adults experience.
d. Drug doses are usually higher than for adults because children metabolize corticosteroids faster than adults.
ANS: C
Corticosteroids are prescribed for children who have severe or chronic inflammatory problems. Children are at risk for the same corticosteroid side effects as adults, including stomach ulcers.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 128 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

14. The nurse is teaching a patient about the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which statement made by the patient indicates that more teaching is needed?
a. I should avoid taking acetaminophen (Tylenol) any time I am also taking an over-the-counter NSAID.
b. Because aspirin causes me to have asthma, I should never take another NSAID like ibuprofen (Advil).
c. I should try to avoid taking any NSAID, even over-the-counter NSAIDs, for more than a few days or a week.
d. Because Celebrex (celecoxib) has so few side effects, I dont have to worry about how often I take it.
ANS: D
Because celecoxib mostly suppresses the COX-2 pathway, allowing the normal housekeeping functions of the COX-1 pathway to continue, it has fewer side effects than COX-1 NSAIDs. However, if a patient takes more than the prescribed dose, the side effects are the same as for the COX-1 NSAIDs. This drug does not affect platelet action and blood clotting. So, bruising and gum bleeding are not expected side effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

15. A patient is prescribed ibuprofen (Advil) 200 mg four times a day as needed for inflammation and pain related to arthritis. The patient is scheduled for oral surgery. What priority teaching does the nurse provide for this patient?
a. The Advil will help relieve your pain after surgery.
b. Report any bruising to your prescriber immediately.
c. Ask about having the injectable form of this drug after surgery.
d. Stop taking this drug at least 1 week before your scheduled surgery.
ANS: D
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). These drugs inhibit the action of the COX enzyme. Reduced activity of COX-1 decreases platelet clumping and can reduce blood clotting for up to 1 week. Any patient taking a COX-1 NSAID is at increased risk for bleeding and should stop taking the drug a week or more before surgery. There is no injectable form of ibuprofen.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. A patient taking a nonsteroidal anti-inflammatory drug (NSAID) tells the nurse that the drug causes an upset stomach. What is the nurses best response?
a. Always take this drug with food or with milk.
b. Stop taking the drug and notify your prescriber.
c. Try chewing the drug instead of swallowing it whole.
d. Take the drug on an empty stomach to avoid vomiting.
ANS: A
Upset stomach is a common side effect for NSAIDs. Most of the time, this side effect can be reduced or avoided by ensuring that the drug is taken on a full stomach, with food, or with milk.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

17. The nurse asks a patient about an allergy to sulfa drugs before administering which nonsteroidal anti-inflammatory drug (NSAID)?
a. aspirin (Bufferin)
b. ketorolac (Toradol)
c. celecoxib (Celebrex)
d. oxaprozin (Daypro)
ANS: C
Celecoxib (Celebrex) is made from a chemical similar to the sulfa drug type of antibiotic. A patient who is allergic to sulfa drugs is likely to also be allergic to celecoxib.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Safe and Effective Care Environment

18. An older adult is prescribed naproxen (Naprosyn) 250 mg orally twice daily for management of arthritis pain. Which precaution is most important for the nurse to teach?
a. Weigh yourself daily every morning, and if you gain more than 3 to 4 pounds in a week, report it to your prescriber.
b. Avoid taking blood pressure medicine at the same time as this drug because Naprosyn inactivates these drugs.
c. Go to the emergency department for an injection of Naprosyn if you are vomiting and cannot keep the drug down.
d. Drink a full glass of water every time you take a dose of Naprosyn.
ANS: A
Naproxen and other NSAIDs cause salt and water retention that can lead to fluid overload and high blood pressure, increasing the risk for heart attack or heart failure. Teach older adult patients taking NSAIDs to check their weight daily and to report any weight gain of more than 3 to 4 pounds to the prescriber. This amount of weight gain is associated with fluid retention rather than increased body fat. NSAIDs reduce the effectiveness of some blood pressure drugs because of the fluid retention, not because they inactivate the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

19. A patient is prescribed 20 mg of ketorolac (Toradol) intramuscularly. How many milliliters does the nurse draw up from a vial of ketorolac containing 30 mg/mL?
a. 0.5
b. 0.7
c. 1
d. 2
ANS: B
1 is to 30 as X is to 20, so 1/30 = X/20; 20 1 = 20; 20 30 = 0.67 mL, rounded up to 0.7 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

20. Why are aspirin and aspirin-containing drugs avoided for use in children?
a. Aspirin is associated with the development of Reyes syndrome.
b. Aspirin would drop a childs body temperature below normal.
c. Children are at higher risk for bleeding with aspirin use.
d. A childs liver is unable to metabolize aspirin.
ANS: A
When children have a viral infection and are given aspirin, Reyes syndromea liver disease that can lead to coma, mental retardation, and deathmay develop.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 132 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

21. A patient has all of the following health problems and seasonal allergies. Which one must the nurse warn the patient can be made worse by over-the-counter antihistamines?
a. Asthma
b. Breast cancer
c. Rheumatoid arthritis
d. High blood pressure
ANS: D
When antihistamines bind to histamine receptors on blood vessels, they cause blood vessels to constrict. Blood vessel constriction raises blood pressure. When the patient already has high blood pressure, these drugs can make the problem worse.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

22. A 78-year-old man has been taking diphenhydramine (Benadryl) for seasonal allergies. Which new symptom would the nurse report to the prescriber?
a. Decreased urination
b. Drowsiness
c. Dry mouth
d. Cough
ANS: A
Diphenhydramine is an antihistamine with anticholinergic actions that include dry mouth, drowsiness, and urinary retention. An enlarged prostate is common among older men and causes difficulty urinating. This problem can be made much worse when taking a drug that can cause urinary retention.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

23. A patient who has been taking montelukast (Singulair) for 3 months reports having urine the color of coffee. What is the nurses best response?
a. You need to increase your intake of water and decrease your intake of coffee.
b. You need to stop taking this drug and notify your prescriber today.
c. Dont worry. All patients taking this drug have dark urine.
d. Do not take this drug any more often than prescribed.
ANS: B
Montelukast is a leukotriene inhibitor and can cause liver damage. Dark urine is one sign of liver damage. The patient needs to stop taking the drug and see his or her health care provider to determine whether liver damage is present.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

24. A patient with an inflammatory response is prescribed ranitidine (Zantac) 75 mg once a day. What is the nurses best action?
a. Give the drug as ordered.
b. Hold the drug and notify the prescriber.
c. Teach the patient to take the drug first thing in the morning.
d. Ask the patient if he or she is allergic to any drugs or other substances.
ANS: B
Ranitidine (Zantac) is an H2 receptor blocker used to decrease production of stomach acids. The prescriber has confused this drug with cetirizine (Zyrtec), an H1 receptor blocker used to slow or stop tissue effects of inflammation.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

25. A patient who has been prescribed diphenhydramine (Benadryl) reports a dry mouth and feeling sleepy. What is the nurse best action?
a. Document the finding and notify the prescriber.
b. Remind the patient that naps provide needed rest.
c. Suggest sucking on hard candy to relieve dry mouth.
d. Reassure the patient that these are expected side effects.
ANS: D
Diphenhydramine is an H1 receptor blocker commonly used for inflammation triggered by allergic reactions such as hives, watery eyes, and runny nose. Side effects of these drugs include dry mouth and throat as well as drowsiness. Sometimes these drugs are prescribed as a sleep aid.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

26. A patient prescribed zileutin (Zyflo) has yellowing of the sclera. Which laboratory test result is most important for the nurse to check?
a. Kidney function tests
b. Complete blood count
c. Liver function tests
d. Serum electrolytes
ANS: C
Zileutin is a leukotriene inhibitor with rare adverse effects that include liver impairment and allergic reactions.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. Which factors determine the size and severity of the inflammatory response? (Select all that apply.)
a. Intensity of the injury
b. Type of tissue injured
c. Severity of the invasion
d. Gender of the patient
e. Extent of injury
f. Duration of the invasion
ANS: A, C, E, F
The inflammatory response is nonspecific. The same tissue responses occur with any type of invasion or injury. Size and severity of the inflammatory response depend on intensity, severity, duration, and extent of the injury or invasion.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 121 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which conditions are examples of an inflammatory response to injury, but without infection? (Select all that apply.)
a. Appendicitis
b. Bacterial pneumonia
c. Dermatitis
d. Myocardial infarction
e. Otitis media
f. Osteoarthritis
g. Sprained ankle
h. Tonsillitis
ANS: C, D, F, G
The suffix -itis indicates inflammation but not necessarily infection. Appendicitis, bacterial pneumonia, otitis media, and tonsillitis are most commonly caused by bacterial infection, so infection and inflammation are both present at the same time. Dermatitis is usually an allergic response without infection. Myocardial infarction is an injury caused by tissue anoxia and ischemia (lack of oxygen). Osteoarthritis is an inflammatory response to chronic wear and tear injury to a joint. Sprained ankle is a soft tissue injury that often results in a huge inflammatory response but infection is not present when the skin is intact.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 121 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

3. Which main signs and symptoms does the nurse teach a patient to recognize as inflammation? (Select all that apply.)
a. Warmth
b. Redness
c. Headache
d. Swelling
e. Pain
f. Bleeding
g. Decreased function
ANS: A, B, D, E, G
The five main signs and symptoms of inflammation are warmth, redness, swelling, pain, and loss of function.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 121 TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

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