Chapter 40 Anti-inflammatory, Antipyretic, and Analgesic Agents
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 dm 337
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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 dm 337
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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 2400
mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.
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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 dm 337
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, 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 patients 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 dm 339
TOP NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
6. A patient who is 7 months 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? a. It can result in
adverse effects on her fetus.
b. It causes an increased risk of Reyes syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS A
Patients should not take aspirin during the third trimester of pregnancy because it can cause
premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes
syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can
cause gastrointestinal distress, but this is not the reason for caution.
DIF COGNITIVE LEVEL Applying (Application) REF dm 340
TOP NURSING PROCESS Nursing Intervention Patient Teaching
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 dm 337
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 dm 337
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 2400
mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.
DIF COGNITIVE LEVEL Applying (Application) REF dm 337
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 dm 337
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 patients 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 dm 339
TOP NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
6. A patient who is 7 months 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? a. It can result in
adverse effects on her fetus.
b. It causes an increased risk of Reyes syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS A
Patients should not take aspirin during the third trimester of pregnancy because it can cause
premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes
syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can
cause gastrointestinal distress, but this is not the reason for caution.
DIF COGNITIVE LEVEL Applying (Application) REF dm 340
TOP NURSING PROCESS Nursing Intervention Patient Teaching
