Chapter 36: Aspirin and Nonsteroidal Antiinflammatory Drugs

Chapter 36: Aspirin and Nonsteroidal Antiinflammatory Drugs

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient reports having persistent mild to moderate pain in both knees usually associated with standing. The patient reports knee stiffness for 15 to 20 minutes each morning. The primary care nurse practitioner (NP) learns that the patient has used heating pads and acetaminophen, which no longer relieve the pain. The NP orders an erythrocyte sedimentation rate, which is normal. The NP should consider prescribing:

ANS:  D

Topical NSAIDs, acupuncture, and tramadol are effective for pain relief in knee osteoarthritis. Treatment for osteoarthritis should begin with nonpharmacologic treatment, and acetaminophen should be first-line pharmacologic treatment. NSAIDs should be used when these two measures are no longer effective. COX-2 inhibitors are more expensive and should be used in the presence of gastrointestinal (GI) side effects or for moderate to severe pain. Glucosamine and chondroitin do not relieve most osteoarthritis pain.

DIF:    Cognitive Level: Applying (Application)                           REF:   407

2. A 70-year-old patient describes moderate to severe pain associated with osteoarthritis in fingers, thumbs, hips, and knees. The patient is currently taking high-dose acetaminophen. The patient has a strong family history of cardiovascular disease and has been diagnosed with hypertension. To help alleviate this patient’s pain, the primary care NP should consider prescribing:

ANS:  C

Aspirin at the dosage of 325 mg every other day or 81 mg daily is effective in reducing the incidence of myocardial infarction (MI) and stroke. Concomitant use of an NSAID with aspirin has been shown to reduce the cardioprotective effects of aspirin. However, naproxen does not appear to have this risk.

DIF:    Cognitive Level: Applying (Application)                           REF:   409

3. A patient with mild to moderate osteoarthritis pain has been taking acetaminophen for pain. The primary care NP prescribes a nonselective NSAID. At a follow-up visit, the patient reports mild GI side effects. The NP should:

ANS:  A

If the patient experiences GI distress, coadministration of histamine-2 blockers, proton pump inhibitors, or misoprostol may be considered. Tramadol is used for severe pain. A COX-2 inhibitor is generally used for long-term therapy. Naproxen is another nonselective NSAID and would likely have similar GI side effects.

DIF:    Cognitive Level: Applying (Application)                           REF:   408

4. A patient is taking 81 mg of aspirin daily to decrease MI risk and uses acetaminophen for mild osteoarthritis symptoms. For flare-ups of osteoarthritis pain, the primary care NP should prescribe:

ANS:  C

Concomitant use of an NSAID with aspirin has been shown to reduce the cardioprotective effects of aspirin. However, naproxen does not appear to have this risk.

DIF:    Cognitive Level: Applying (Application)                           REF:   409