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WorksheetsWeek 2 Pharm non opioid pain relief NSAIDS
Total questions: 43
Worksheet time: 22mins
A client taking a non-selective NSAID develops gastrointestinal irritation and easy bruising. The nurse explains that these effects result from inhibiting which cyclooxygenase enzyme that is normally constitutively active and protects the stomach lining, aids platelet aggregation, assists the kidneys in excreting sodium and water, and causes vasodilation?
COX-1
COX-2
COX-3
COX-4
A client asks why a COX-2-selective inhibitor like celecoxib is used to reduce pain and inflammation after an injury. Which response best explains the role of COX-2?
COX-2 is inducible and becomes active only during injury, producing painful inflammatory prostaglandins.
COX-2 is constitutively active and protects the stomach lining.
COX-2 aids platelet aggregation and vasodilation.
COX-2 regulates kidney excretion of sodium and water.
A client reports burning pain after a minor hand injury. The nurse recommends gently rubbing the area around the injury. Which explanation best describes why this might reduce the client’s pain?
Rubbing stimulates large sensory fibers that help close the spinal gate, reducing pain impulse transmission.
Rubbing increases release of bradykinin and histamine.
Rubbing encourages more prostaglandin synthesis at the injury site.
Rubbing stimulates endorphin release, opening the gate.
A client asks why rubbing their injured knee seems to lessen discomfort. Which response by the nurse is most accurate?
Rubbing activates large sensory fibers that help close the gate in the dorsal horn of the spinal cord, diminishing pain signals to the brain.
Rubbing releases more pain-producing chemicals at the injury site.
Rubbing encourages prostaglandin production in the brain.
Rubbing increases the release of serotonin into the bloodstream.
During teaching on tissue injury, a nursing student lists substances released when pain is initiated. Which item indicates a need for further instruction?
Bradykinin
Histamine
Dopamine
Serotonin
A parent gives aspirin to a child with influenza to manage a fever. Which potential life-threatening adverse effect should the nurse monitor for?
Reye’s syndrome, characterized by progressive neurologic deficits and possible liver damage.
Stevens–Johnson syndrome
Anaphylactic shock
Hemolytic anemia
A client taking high-dose salicylates reports a ringing in their ears. Which side effect is the client most likely experiencing?
Tinnitus
Photosensitivity
Neutropenia
Nephrotoxicity
A client on daily aspirin therapy is scheduled for elective surgery next week. Which nursing action is most appropriate?
Notify the healthcare provider because irreversible platelet inhibition may increase perioperative bleeding.
Encourage continuation of aspirin to prevent postoperative thromboembolism.
Administer vitamin K injections to counteract aspirin’s effect.
Suggest switching to acetaminophen the morning of surgery only.
A client taking aspirin for arthritis also uses warfarin. Which assessment is the highest priority for the nurse?
Signs of bruising, bleeding or gastrointestinal irritation.
Changes in urine output
Mood alterations
Signs of bronshospasm
The nurse teaches a client starting prophylactic aspirin therapy for cardiac disease. Which client statement indicates understanding?
“This medication can decrease platelet aggregation and reduce my risk of thrombotic events”.
“It will help cure my heart disease by increasing platelet production.”
“I should stop it immediately if I develop mild pain.”
“I can take as much as I want because it does not affect my stomach.”
A client with osteoarthritis is prescribed ibuprofen. Which instruction should the nurse include?
Ibuprofen reversibly inhibits COX-1 and COX-2; you may take it with food if desired to minimize stomach discomfort.
Ibuprofen irreversibly blocks COX enzymes.
You should avoid any food when taking this drug.
This medication does not act peripherally.
A client with hypertension controlled by an ACE inhibitor requires an NSAID for chronic joint pain. Which NSAID has comparatively fewer interactions with ACE inhibitors, according to the presentation?
Naproxen
Ibuprofen
Diclofenac
Ketorolac
A client has a history of sulfa allergy. Which analgesic should be avoided?
Celecoxib
Ibuprofen
Aspirin
Acetaminophen
A client with rheumatoid arthritis is prescribed celecoxib. Which teaching point is most accurate?
Celecoxib primarily inhibits COX-2, reducing prostaglandin synthesis and providing pain relief.
It irreversibly inhibits COX-1 enzymes.
It can be given safely to anyone allergic to sulfonamides.
It is used exclusively for headache relief.
A nurse is counseling a client who takes NSAIDs daily for chronic joint pain. What long-term side effect should be discussed?
Increased risk of hypertension and cardiovascular events, particularly with chronic COX-2 inhibitor use.
Complete immunosuppression
Increased bone density
Hyperthyroidism
A client asks about the maximum acetaminophen dosage. Which response is accurate?
Healthy adults should not exceed 3 000 mg per day; older adults or those with liver disease should limit to 2 000 mg.
There is no daily limit because it is sold over the counter.
Take at least 4 000 mg every day for pain control.
You can double the dose if you are not drinking alcohol.
A client takes multiple cold remedies that contain acetaminophen. Which teaching point is most important?
Be aware of acetaminophen content in all OTC and prescription products to avoid unintentional overdose.
Combining different acetaminophen products prevents liver damage.
Liver failure is unrelated to acetaminophen overdose.
There is no need to read labels on OTC medications.
A client with chronic liver disease asks about using acetaminophen for fever. Which statement should the nurse emphasize?
Acetaminophen is metabolized by the liver; even normal doses can be harmful in liver disease.
Acetaminophen bypasses liver metabolism entirely.
Acetaminophen is safe because it is an NSAID.
Liver disease increases tolerance to acetaminophen.
A client overdoses on acetaminophen. Which treatment is indicated?
An acetylcysteine regimen
Naloxone
Protamine sulfate
Flumazenil
A nurse is caring for a client taking acetaminophen. Which laboratory tests should be monitored to detect toxicity?
Liver function tests, including AST and ALT
Serum potassium
Serum calcium
White blood cell count
A client takes high-dose NSAIDs for chronic pain and participates in ultrarunning events. Which instruction is most appropriate?
Limit NSAID use during prolonged vigorous exercise to reduce renal damage risk.
Increase the dose before the event to prevent pain.
Switch to aspirin to avoid renal issues.
Exercise and NSAID use are unrelated.
A pregnant client in her third trimester asks about taking ibuprofen for headaches. Which response is most appropriate?
Avoid NSAIDs in the second half of pregnancy.
Ibuprofen is completely safe during pregnancy.
Take double the usual dose for efficacy.
Take it only at bedtime.
A client taking salicylates is also on aminoglycoside therapy. Why should the nurse use caution?
Both medications can cause ototoxicity.
Aminoglycosides reduce the analgesic effect.
Salicylates accelerate aminoglycoside absorption.
There are no known interactions.
A client on salicylates experiences easy bruising. Which mechanism explains this effect?
Irreversible inhibition of COX-1 reduces platelet aggregation.
Stimulation of serotonin release
Enhanced prostaglandin synthesis
Decreased histamine release
The nurse plans teaching for a client taking nonselective NSAIDs. Which statement shows correct understanding?
“These drugs reversibly inhibit COX-1 and COX-2, decreasing prostaglandin synthesis”.
“They irreversibly inhibit both COX enzymes.”
“They cause irreversible platelet aggregation.”
“They only work in the brain.”
A client taking celecoxib for ankylosing spondylitis asks why this medication was chosen. The nurse’s best response is:
“Celecoxib selectively inhibits COX-2 and is effective for inflammatory pain”.
“Celecoxib stimulates COX-1 to protect your stomach.”
“Celecoxib is a salicylate derivative.”
“Celecoxib has no effect on prostaglandins.”
A nurse is teaching a client about non-drug methods to help manage chronic pain and reduce NSAID use. Which suggestion is appropriate?
Use distraction, muscle relaxation, heat/cold or visualization techniques.
Increase NSAID dose only on weekends.
Drink alcohol to help sleep.
Add aspirin to the current NSAID regimen.
Which nursing assessment is most important when a client is taking nonselective NSAIDs?
Assess for signs of GI irritation and bleeding, such as black stools or abdominal pain.
Monitor for hyperkalemia.
Assess for decreased urine output exclusively.
Monitor for increased platelet counts.
A client receiving chronic NSAID therapy develops swelling and fluid retention. Which side effect is likely responsible?
Extracellular volume (ECV) excess due to NSAID use
Dehydration
Hyperglycemia
Immunosuppression
A client asks why selective COX-2 inhibitors such as celecoxib should be used cautiously. Which nurse statement is appropriate?
Chronic use of COX-2 inhibitors carries a black-box warning for increased cardiovascular risk.
They reduce the risk of any heart problems.
They have no effect on kidney function.
They are safe in sulfa allergy.
A client asks why NSAIDs should be limited when consuming alcohol. Which response by the nurse is correct?
Both NSAIDs and alcohol are metabolized by the liver, and combining them increases risk of liver damage.
Alcohol enhances the therapeutic effect of NSAIDs.
Alcohol protects the stomach lining from NSAIDs.
NSAIDs prevent alcohol absorption.
A pregnant client asks about using acetaminophen during pregnancy. The nurse responds:
“Avoid NSAIDs but acetaminophen is generally considered safer, yet always consult your provider”.
“Avoid all analgesics during pregnancy.”
“Ibuprofen is preferred over acetaminophen.”
“Double the acetaminophen dose to control pain better.”
A client calls and reports drowsiness after taking ibuprofen. How should the nurse respond?
Inform the client that drowsiness is a possible side effect of NSAIDs and to avoid driving if sleepy.
Advise the client to increase the dose to overcome fatigue.
Tell the client this effect indicates liver failure.
Suggest switching to double-dose aspirin.
A client taking salicylates for rheumatoid arthritis asks how to monitor for toxicity. Which guidance is best?
Observe for ringing in the ears, bruising, bleeding and stomach irritation.
Monitor for weight loss and hair loss.
Check for muscle cramps only.
Assess for increased urine output exclusively.
A nurse assesses a client on nonselective NSAIDs who reports black tarry stools. What is the priority action?
Instruct the client to stop the NSAID and notify the provider due to suspected GI bleeding.
Advise the client to drink milk.
Encourage the client to take a proton pump inhibitor.
Reassure the client this is an expected side effect.
Which client statement indicates a need for further teaching about acetaminophen?
“It reduces fever and pain but has minimal anti-inflammatory effect”.
“I can take two different cold medicines containing acetaminophen without checking the label.”
“Liver damage can occur if I exceed the recommended dose”.
“If I have liver disease, I should consult my provider before using it”.
A client using NSAIDs develops decreased urine output after a marathon. Which explanation is most consistent with the presentation?
High-dose NSAIDs and prolonged vigorous exercise can cause prerenal acute kidney injury.
Dehydration increases platelets.
NSAIDs increase sodium and water excretion.
Marathon running enhances prostaglandin synthesis.
Which finding would prompt the nurse to question an order for salicylates?
Child recovering from influenza
Adult with rheumatoid arthritis
Adult needing prophylaxis for myocardial infarction
Adult experiencing mild pain
A nurse teaches a client about the mechanism of salicylates. Which statement indicates understanding?
“Aspirin irreversibly blocks COX-1 and COX-2, leading to decreased platelet aggregation and reduced inflammation, pain and fever”.
“Aspirin reversibly inhibits COX-2 only.”
“Aspirin enhances prostaglandin production.”
“Aspirin blocks the COX-3 enzyme in the central nervous system.”
A client taking nonselective NSAIDs reports dizziness and confusion. The nurse suspects:
Possible hypersensitivity reaction; instruct the client to discontinue the medication and consult the provider.
Normal central nervous system stimulation
A sign of increased prostaglandin activity
A sign that the medication is not working
Which teaching point is appropriate for a client who is prescribed NSAIDs and antihypertensive medications?
NSAIDs may reduce the efficacy of antihypertensives; monitor blood pressure closely.
NSAIDs enhance the effect of antihypertensives.
There is no interaction between these medications.
Take both medications on an empty stomach.
A nurse reviews a client’s medications and notes aspirin and ibuprofen are taken together daily. Which action is most appropriate?
Advise the client to stop taking both daily together and contact the provider to evaluate therapy and bleeding risk.
Encourage continued use of both medications but take them with food to reduce stomach upset.
No action is needed because daily use of both medications is safe and commonly recommended.
Suggest spacing the aspirin and ibuprofen doses by 12 hours to avoid any interaction.
A client is using multiple NSAIDs. Which nurse action is most appropriate?
Educate the client that using multiple NSAIDs increases risk of side effects and bleeding.
Recommend adding acetaminophen for increased analgesia.
Advise continuing both because they have synergistic effects.
Instruct the client to take aspirin only at bedtime.
