Chapter 25: Antiinflammatory Drugs Nursing School Test Banks

Chapter 25: Antiinflammatory Drugs
Test Bank

MULTIPLE CHOICE

1. 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. converts arachidonic acid into a chemical mediator for inflammation.
b. directly causes vasodilation and increased capillary permeability.
c. irritates the gastric mucosa to cause gastrointestinal upset.
d. releases prostaglandins, which cause inflammation and pain in tissues.
ANS: A
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
ANS: B
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. 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. Counsel the patient to discuss a prescription NSAID with the provider.
b. Recommend adding aspirin to increase the antiinflammatory effect.
c. Suggest asking the provider about a short course of corticosteroids.
d. Tell the patient to increase the dose to 800 mg every 4 hours.
ANS: A
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 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. 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
a. increases gastrointestinal secretions.
b. increases hypersensitivity reactions.
c. inhibits both COX-1 and COX-2.
d. is an acidic compound.
ANS: C
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Nabumetone (Relafen)
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 339
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient who is 7 months 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?
a. It can result in adverse effects on her fetus.
b. It causes an increased risk of Reyes syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS: A
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 Reyes 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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 340
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone)
ANS: A
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
a. A normal serum aspirin level is between 30 and 40 mg/dL.
b. You may need to stop taking this drug a week prior to surgery.
c. You will need to monitor aspirin levels if you are also taking warfarin.
d. Your stools may become dark, but this is a harmless side effect.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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?
a. Assess the patient for tinnitus.
b. Monitor the patient for signs of Reyes syndrome.
c. Notify the provider of severe aspirin toxicity.
d. Request an order for an increased aspirin dose.
ANS: A
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 Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. 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?
a. I should limit sodium intake while taking this drug.
b. I should take indomethacin on an empty stomach.
c. I will need to check my blood pressure frequently.
d. I will take the medication twice daily.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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. Naproxyn (Naprosyn)
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. 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?
a. It may take several weeks to achieve therapeutic effects.
b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen.
c. Take ibuprofen twice daily for maximum analgesic benefit.
d. Combine ibuprofen with acetaminophen for best effect.
ANS: A
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 every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 343
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. 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.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 337
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?
a. Do not take the medication during the first 2 days of your period.
b. The initial dose will be twice the amount of subsequent doses.
c. Take this medication with food to minimize gastrointestinal upset.
d. Take the drug on a regular basis to prevent dysmenorrhea.
ANS: B
The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 345
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. 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. Calcium level
b. Complete blood count
c. Electrolytes
d. Potassium
ANS: B
Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 347
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. 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?
a. Avoid all alcohol except beer.
b. Include salmon in the diet.
c. Increase fluid intake.
d. Take on an empty stomach.
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. Which antigout medication is used to treat chronic tophaceous gout?
a. Allopurinol (Zyloprim)
b. Colchicine
c. Probenecid (Benemid)
d. Sulfinpyrazone (Anturane)
ANS: A
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.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result?
a. Elevated BUN and creatinine
b. Increased serum uric acid
c. Slight increase in the white blood count
d. Increased serum glucose
ANS: A
Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?
a. I should increase my vitamin C intake.
b. I will get yearly eye exams.
c. I will increase my protein intake.
d. I will limit fluids to prevent edema.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Which are characteristic signs of inflammation? (Select all that apply.)
a. Edema
b. Erythema
c. Heat
d. Numbness
e. Pallor
f. Paresthesia
ANS: A, B, C
Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 337
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Test Bank

MULTIPLE CHOICE

1. 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. converts arachidonic acid into a chemical mediator for inflammation.
b. directly causes vasodilation and increased capillary permeability.
c. irritates the gastric mucosa to cause gastrointestinal upset.
d. releases prostaglandins, which cause inflammation and pain in tissues.
ANS: A
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
ANS: B
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. 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. Counsel the patient to discuss a prescription NSAID with the provider.
b. Recommend adding aspirin to increase the antiinflammatory effect.
c. Suggest asking the provider about a short course of corticosteroids.
d. Tell the patient to increase the dose to 800 mg every 4 hours.
ANS: A
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 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 337
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. 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
a. increases gastrointestinal secretions.
b. increases hypersensitivity reactions.
c. inhibits both COX-1 and COX-2.
d. is an acidic compound.
ANS: C
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 337
TOP: NURSING PROCESS: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Nabumetone (Relafen)
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 339
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient who is 7 months 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?
a. It can result in adverse effects on her fetus.
b. It causes an increased risk of Reyes syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS: A
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 Reyes 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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 340
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone)
ANS: A
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
a. A normal serum aspirin level is between 30 and 40 mg/dL.
b. You may need to stop taking this drug a week prior to surgery.
c. You will need to monitor aspirin levels if you are also taking warfarin.
d. Your stools may become dark, but this is a harmless side effect.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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?
a. Assess the patient for tinnitus.
b. Monitor the patient for signs of Reyes syndrome.
c. Notify the provider of severe aspirin toxicity.
d. Request an order for an increased aspirin dose.
ANS: A
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 Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. 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?
a. I should limit sodium intake while taking this drug.
b. I should take indomethacin on an empty stomach.
c. I will need to check my blood pressure frequently.
d. I will take the medication twice daily.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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. Naproxyn (Naprosyn)
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 342
TOP: NURSING PROCESS: Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. 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?
a. It may take several weeks to achieve therapeutic effects.
b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen.
c. Take ibuprofen twice daily for maximum analgesic benefit.
d. Combine ibuprofen with acetaminophen for best effect.
ANS: A
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 every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 343
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. 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.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 337
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?
a. Do not take the medication during the first 2 days of your period.
b. The initial dose will be twice the amount of subsequent doses.
c. Take this medication with food to minimize gastrointestinal upset.
d. Take the drug on a regular basis to prevent dysmenorrhea.
ANS: B
The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 345
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. 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. Calcium level
b. Complete blood count
c. Electrolytes
d. Potassium
ANS: B
Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 347
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. 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?
a. Avoid all alcohol except beer.
b. Include salmon in the diet.
c. Increase fluid intake.
d. Take on an empty stomach.
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. Which antigout medication is used to treat chronic tophaceous gout?
a. Allopurinol (Zyloprim)
b. Colchicine
c. Probenecid (Benemid)
d. Sulfinpyrazone (Anturane)
ANS: A
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.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result?
a. Elevated BUN and creatinine
b. Increased serum uric acid
c. Slight increase in the white blood count
d. Increased serum glucose
ANS: A
Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?
a. I should increase my vitamin C intake.
b. I will get yearly eye exams.
c. I will increase my protein intake.
d. I will limit fluids to prevent edema.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 348
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Which are characteristic signs of inflammation? (Select all that apply.)
a. Edema
b. Erythema
c. Heat
d. Numbness
e. Pallor
f. Paresthesia
ANS: A, B, C
Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 337
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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