Rosenthal: Lehne's Pharmacotherapeutics For Advanced
Practice Nurses And Physician Assistants Questions And
Verified Answers And Rationales
A nurse is teaching a group of nursing students about
cyclooxygenase (COX) inhibitors. A student asks the nurse about
characteristics of COX-1 inhibitors. Which statement by the nurse is
true?
a. "COX-1 inhibitors protect against colorectal cancer."
b. "COX-1 inhibitors protect against myocardial infarction and
stroke."
c. "COX-1 inhibitors reduce fever."
d. "COX-1 inhibitors suppress inflammation." -Answer:-B
COX-1 inhibitors have beneficial effect of reducing platelet
aggregation and thus reducing the risk of myocardial infarction and
stroke. COX-2 inhibitors protect against colorectal cancer, reduce
inflammation, and reduce fever. DIF: Cognitive Level: Analysis REF:
p. 603TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
,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. -Answer:-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: p. 616TOP: Nursing Process:
Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
,A nurse is caring for a patient who has been taking low-dose aspirin
for several days. The nurse notes that the patient has copious
amounts of watery nasal secretions and an urticarial rash. The nurse
will contact the provider to discuss:
a. administering epinephrine.
b. changing to a first-generation NSAID.
c. reducing the dose of aspirin.
d. giving an antihistamine. -Answer:-A
Aspirin can cause a hypersensitivity reaction in some patients. This
may start withprofuse watery
rhinorrhea and progress to generalized urticaria, bronchospasm,
laryngeal edema, and shock. It is
not a true anaphylactic reaction, because it is not mediated by the
immune system. Epinephrine is
the treatment of choice. Patients with sensitivity to ASA often also
have sensitivity to NSAIDs; the first indication with this patient is to
treat the potential life-threatening effect, not to change the
medication. Reduction of the dose of ASA is not indicated, because
this reaction is not dose dependent. Antihistamines are not effective,
because this is not an allergic reaction. DIF: Cognitive
, Level: Application REF: p. 608TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
A nurse is providing teaching for an adult patient with arthritis who
has been instructed to take ibuprofen [Motrin] for discomfort.
Which statement by the patient indicates a need for further
teaching?
a. "I may experience tinnitus with higher doses of this medication."
b. "I may take up to 800 mg 4 times daily for pain."
c. "I should limit alcohol intake to fewer than three drinks a day."
d. "I will take this medication with meals to help prevent stomach
upset." -Answer:-A
NSAIDs do not cause salicylism and therefore do not cause tinnitus
with higher doses. The maximum dose for adults is 3200 mg/day, or
800 mg 4 times/day. Patients taking NSAIDs should be cautioned to
limit alcohol intake. Taking NSAIDs with meals helps prevent GI
upset. DIF:
Cognitive Level: Application REF: p. 608TOP: Nursing Process:
Implementation MSC: NCLEX
Practice Nurses And Physician Assistants Questions And
Verified Answers And Rationales
A nurse is teaching a group of nursing students about
cyclooxygenase (COX) inhibitors. A student asks the nurse about
characteristics of COX-1 inhibitors. Which statement by the nurse is
true?
a. "COX-1 inhibitors protect against colorectal cancer."
b. "COX-1 inhibitors protect against myocardial infarction and
stroke."
c. "COX-1 inhibitors reduce fever."
d. "COX-1 inhibitors suppress inflammation." -Answer:-B
COX-1 inhibitors have beneficial effect of reducing platelet
aggregation and thus reducing the risk of myocardial infarction and
stroke. COX-2 inhibitors protect against colorectal cancer, reduce
inflammation, and reduce fever. DIF: Cognitive Level: Analysis REF:
p. 603TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
,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. -Answer:-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: p. 616TOP: Nursing Process:
Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
,A nurse is caring for a patient who has been taking low-dose aspirin
for several days. The nurse notes that the patient has copious
amounts of watery nasal secretions and an urticarial rash. The nurse
will contact the provider to discuss:
a. administering epinephrine.
b. changing to a first-generation NSAID.
c. reducing the dose of aspirin.
d. giving an antihistamine. -Answer:-A
Aspirin can cause a hypersensitivity reaction in some patients. This
may start withprofuse watery
rhinorrhea and progress to generalized urticaria, bronchospasm,
laryngeal edema, and shock. It is
not a true anaphylactic reaction, because it is not mediated by the
immune system. Epinephrine is
the treatment of choice. Patients with sensitivity to ASA often also
have sensitivity to NSAIDs; the first indication with this patient is to
treat the potential life-threatening effect, not to change the
medication. Reduction of the dose of ASA is not indicated, because
this reaction is not dose dependent. Antihistamines are not effective,
because this is not an allergic reaction. DIF: Cognitive
, Level: Application REF: p. 608TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
A nurse is providing teaching for an adult patient with arthritis who
has been instructed to take ibuprofen [Motrin] for discomfort.
Which statement by the patient indicates a need for further
teaching?
a. "I may experience tinnitus with higher doses of this medication."
b. "I may take up to 800 mg 4 times daily for pain."
c. "I should limit alcohol intake to fewer than three drinks a day."
d. "I will take this medication with meals to help prevent stomach
upset." -Answer:-A
NSAIDs do not cause salicylism and therefore do not cause tinnitus
with higher doses. The maximum dose for adults is 3200 mg/day, or
800 mg 4 times/day. Patients taking NSAIDs should be cautioned to
limit alcohol intake. Taking NSAIDs with meals helps prevent GI
upset. DIF:
Cognitive Level: Application REF: p. 608TOP: Nursing Process:
Implementation MSC: NCLEX
