NURSING 6005 Chapter 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen

NURSING 6005 Chapter 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen Test Bank MULTIPLE CHOICE 1. A nurse is teaching a group of nursing students about cyclooxygenase inhibitors. Which statement by a student indicates understanding of the teaching? a. “Cyclooxygenase-2 inhibition causes gastrointestinal side effects.” b. “Cyclooxygenase-2 is considered the ‘bad COX.’” c. “Inhibition of cyclooxygenase-1 promotes myocardial infarction and stroke.” d. “Inhibition of cyclooxygenase-1 results in suppression of inflammation.” ANS: B Because cyclooxygenase-2 (COX-2) primarily mediates harmful processes in the body, it is called the “bad COX”; suppression of COX-2 results in largely beneficial effects. The gastrointestinal (GI) side effects of COX inhibitors are the result of COX-1 inhibition. One of two harmful side effects of COX-2 inhibition is suppression of vasodilation, which leads to an increased risk of myocardial infarction (MI) and stroke. Inhibition of COX-2 causes suppression of inflammation. DIF: Cognitive Level: Analysis REF: Mechanism of Action TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: a. continue to use aspirin as scheduled. b. reduce the aspirin dosage by half until after surgery. c. stop using aspirin immediately. d. stop using aspirin 3 days before surgery. ANS: C Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. An interval of 3 days is not long enough for the bleeding effects of aspirin to be reversed. Cutting the dose in half would not reduce the effects of bleeding associated with aspirin use. DIF: Cognitive Level: Application REF: Aspirin | Adverse Effects | Bleeding TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen? a. It does not inhibit cyclooxygenase. b. It has minimal effects at peripheral sites. c. It is more similar to opioids than to nonsteroidal anti-inflammatory drugs (NSAIDs). d. It is selective for cyclooxygenase-2.ANS: B The differences between the effects of acetaminophen and aspirin are thought to result from selective inhibition of cyclooxygenase; acetaminophen has only minimal effects on cyclooxygenase at peripheral sites, which may explain why acetaminophen does not have adverse GI, renal, and antiplatelet effects. Acetaminophen is a selective COX inhibitor. It is not more similar to opioids than NSAIDs. It is not selective for COX-2. DIF: Cognitive Level: Application REF: Acetaminophen | Mechanism of Action TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should avoid any type of COX inhibitor because of the risk of Reye’s syndrome. b. The patient should increase the dose to a level that suppresses inflammation. c. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead. d. The patient should use acetaminophen because of its selective effects on uterine smooth muscle. ANS: C Aspirin (ASA) has analgesic effects for joint pain, muscle pain, and headache, but it is relatively ineffective against visceral pain, including uterine smooth muscle pain, for which NSAIDs are indicated. The risk of Reye’s syndrome is associated with the use of ASA in children to treat fever. Increasing the ASA dose to anti-inflammatory levels is useful for rheumatic fever, tendonitis, and bursitis. Acetaminophen is not effective for dysmenorrhea. DIF: Cognitive Level: Application REF: Aspirin | Therapeutic Uses | Nonaspirin First-Generation NSAIDs TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the aspirin dose to treat the patient’s headache. b. Notify the provider of possible renal toxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient’s symptoms have subsided. ANS: D This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.DIF: Cognitive Level: Application REF: Aspirin | Adverse Effects | Salicylism TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? a. Acetylcysteine (Mucomyst) b. Activated charcoal c. Hemodialysis d. Respiratory support ANS: A The nurse should anticipate giving acetylcysteine, because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed, so it must be given much sooner. Hemodialysis is not indicated. Respiratory support is used for ASA overdose. DIF: Cognitive Level: Application REF: Acetaminophen | Acute Toxicity: Liver Damage TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 7. An older male patient with an increased risk of MI is taking furosemide (Lasix) and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss: a. adding an antihypertensive medication. b. obtaining serum electrolytes. c. ordering a potassium-sparing diuretic. d. withdrawing the aspirin. ANS: D This patient shows signs of renal impairment, as evidenced by weight gain despite the use of diuretics, decreased urine output, hypertension, and elevated serum creatinine and BUN. ASA can cause acute, reversible renal impairment and should be withdrawn. Hypertensive medications do not treat the underlying cause. Serum electrolytes are not indicated. Addition of a potassium-sparing diuretic is not indicated. DIF: Cognitive Level: Application REF: Aspirin | Adverse Effects | Renal Impairment TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. “Aspirin is safe during the second and third trimesters of pregnancy.” b. “Aspirin may cause premature closure of the ductus arteriosus in your baby.” c. “Aspirin may induce premature labor and should be avoided in the third trimes