STUVIA 2024/2025
Chapter 24: Antiinflammatories
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.
A nursing student asks how nonsteroidal anti-inflammatory 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 the enzyme 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
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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.
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 change in dose or changing to 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 a possible change in dose or changing to a prescription 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 generally be used prior to starting corticosteroids. Increasing the
dose will increase the potential for side effects but may not increase desired effects. It is important
that the patient discuss any changes with their provider and not self-titrate the NSAID.
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, STUVIA 2024/2025
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. selectively inhibits COX-2. - ✔✔ANS: C
Aspirin is a non-specific COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is
inhibited, gastric upset can occur. Aspirin does not increase gastrointestinal secretions or
hypersensitivity reactions.
A patient is taking aspirin for secondary prevention of myocardial infarction and is experiencing
moderate gastrointestinal upset. The nurse will contact the patient's provider to discuss changing
from aspirin to which of the following?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Ibuprofen - ✔✔ANS: C
Aspirin is often used to inhibit platelet aggregation for cardiovascular prevention. Patients taking
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aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is
responsible for inhibiting platelet aggregation. The patient may benefit from taking an enteric-coated
aspirin product to lessen the gastrointestinal distress. Celecoxib and is a COX-2 selective inhibitor.
Ibuprofen is not indicated for cardiovascular event prevention.
The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus.
Suspecting a drug adverse effect, the nurse will ask the patient about which medication?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone) - ✔✔ANS: A
Aspirin causes tinnitus at low toxicity levels or in patients with hypersensitivity to aspirin. The nurse
should question the patient about this medication. The other medications are less likely to contribute
to this side effect.
The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will
the nurse include when teaching this patient?
a. "A normal serum aspirin level is between 30 and 40 mg/dL."
b. "You may need to stop taking this drug a week prior to surgery."
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