University of North Carolina, Wilmington - CLR 440 Chapter 24: Antiinflammatories McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition MULTIPLE CHOICE 1)A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation

University of North Carolina, Wilmington - CLR 440

Chapter 24: Antiinflammatories

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

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

1. 1. converts arachidonic acid into a chemical mediator for inflammation.
   2. directly causes vasodilation and increased capillary permeability.
   3. irritates the gastric mucosa to cause gastrointestinal upset.
   4. releases prostaglandins, which cause inflammation and pain in tissues.
2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
   1. exert direct actions to cause relaxation of smooth muscle.
   2. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
   3. interfere with neuronal pathways associated with prostaglandin action.
   4. suppress prostaglandin activity by blocking tissue receptor sites.
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?
   1. Counsel the patient to discuss a prescription NSAID with the provider.
   2. Recommend adding aspirin to increase the antiinflammatory effect.
   3. Suggest asking the provider about a short course of corticosteroids.
   4. Tell the patient to increase the dose to 800 mg every 4 hours.

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
   1. increases gastrointestinal secretions.
   2. increases hypersensitivity reactions.
   3. inhibits both COX-1 and COX-2.
   4. is an acidic compound.
5. 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?
   1. A COX-2 inhibitor
   2. Celecoxib (Celebrex)
   3. Enteric-coated aspirin
   4. Nabumetone (Relafen)
6. 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?
   1. It can result in adverse effects on her fetus.
   2. It causes an increased risk of Reye’s syndrome.
   3. It increases hemorrhage risk.
   4. It will cause increased gastrointestinal distress.
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?
   1. Aspirin (Bayer)
   2. Acetaminophen (Tylenol)
   3. Anakinra (Kineret)
   4. Prednisone (Deltasone)
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?
   1. “A normal serum aspirin level is between 30 and 40 mg/dL.”
   2. “You may need to stop taking this drug a week prior to surgery.”
   3. “You will need to monitor aspirin levels if you are also taking warfarin.”
   4. “Your stools may become dark, but this is a harmless side effect.”
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?
   1. Assess the patient for tinnitus.
   2. Monitor the patient for signs of Reye’s syndrome.
   3. Notify the provider of severe aspirin toxicity.
   4. Request an order for an increased aspirin dose.
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?
    1. “I should limit sodium intake while taking this drug.”
    2. “I should take indomethacin on an empty stomach.”
    3. “I will need to check my blood pressure frequently.”
    4. “I will take the medication twice daily.”
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?
    1. Diclofenac sodium (Voltaren)
    2. Ketoprofen (Orudis)
    3. Ketorolac (Toradol)
    4. Naproxen (Naprosyn)
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?
    1. “It may take several weeks to achieve therapeutic effects.”
    2. “Unlike aspirin, there is no increased risk of bleeding with ibuprofen.”
    3. “Take ibuprofen twice daily for maximum analgesic benefit.”
    4. “Combine ibuprofen with acetaminophen for best effect.”
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?
    1. Assess the patient for drug-seeking behaviors.
    2. Notify the provider that the drug is not effective.
    3. Reassure the patient that swelling will decrease eventually.
    4. Remind the patient that this drug is given for pain only.
14. 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?
    1. Calcium level
    2. Complete blood count
    3. Electrolytes
    4. Potassium
15. 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?
    1. Avoid all alcohol except beer.
    2. Include salmon in the diet.
    3. Increase fluid intake.
    4. Take on an empty stomach.
16. Which antigout medication is used to treat chronic tophaceous gout?
    1. Allopurinol (Zyloprim)
    2. Colchicine
    3. Probenecid (Benemid)
    4. Sulfinpyrazone (Anturane)
17. 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?
    1. Elevated BUN and creatinine
    2. Increased serum uric acid
    3. Slight increase in the white blood count
    4. Increased serum glucose