Chapter 24: Antiinflammatories

Chapter 24: Antiinflammatories

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

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:    p. 308

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:    p. 308

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 3200 mg, which would be exceeded when increasing the dose to 800 mg every 4 hours.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 308 | p. 311

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:    p. 308

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 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)

 

 

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:    p. 311

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies