10Qw/exp PREPU: (UNFINISHED) Chapter 14: Nonopioid Analgesics: NSAIDS and Migraine Meds

4 of 20 The nurse knows that NSAIDs are effective in relieving mild to moderate pain. The use of NSAIDs can also produce adverse effects. Some cardiovascular side effects include which? Select all that apply. • Enlarged heart • Decreased or increased BP • Myocardial infarction • Congestive heart failure • Cardiac arrhythmias

• Decreased or increased BP • Congestive heart failure • Cardiac arrhythmias • Myocardial infarction Explanation: Some cardiovascular adverse effects of NSAIDs are decreased or increased BP, congestive heart failure, cardiac arrhytmias, and MI. No evidence shows that they cause an enlarged heart.

12 of 20 The nurse educates the client with joint pain about additional comfort measures. Which may provide comfort? Select all that apply. • Cold • Joint rest • Heat • Splints • Joint overuse

• Heat • Cold • Joint rest • Splints Explanation: The application of heat/cold, reducing joint overuse, joint rest, and the use of splints, braces, and other assistive devices may provide additional comfort to the client.

7 of 20 The client is taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolac has been added to the treatment regimen. The nurse evaluates the client for which potential interaction? • Hypertension • Increased pain • Hypotension • NSAID toxicity

• Hypertension Explanation: When combined with NSAIDs, antihypertensive medications are less effective. The client's blood pressure must be assessed to identify any increase. Antihypertensives do not affect the effectiveness of NSAIDs.

16 of 20 What role does gabapentin play in migraine treatment? • It relieves acute migraine pain. • It lengthens the aura that precedes a migraine. • It reduces the intensity of menstrual migraines. • It prevents migraines from occurring.

• It prevents migraines from occurring. Explanation: Studies have shown that gabapentin is effective in reducing the frequency of migraines. Gabapentin is not an abortive treatment nor does it appear to affect pain or the nature of an aura.

8 of 20 The client is diagnosed with rheumatoid arthritis of the hands and elbows. The nurse recognizes that which NSAID is not used in the treatment of rheumatoid arthritis? • Ketorolac • Nabumetone • Meloxicam • Etodolac

• Ketorolac Explanation: Ketorolac is not used in the treatment of rheumatoid arthritis. Nabumetone, Etodolac, and meloxicam are used to treat rheumatoid arthritis.

10 of 20 The nurse understands that clients with phenylketonuria (PKU) should not take which medication for acute pain related to migraine headaches? • Sumatriptan • Naratriptan • Almotriptan • Rizatriptan

• Rizatriptan Explanation: Rizatriptan and zolmitriptan contain phenylalanine, so those clients with PKU should avoid their usage. All other medications used in the treatment of acute migraine headaches do not contain phenylalanine.

11 of 20 The nurse explains to the client that sumatriptan is administered at the onset of the migraine headache, and may be readministered when? • Two hours after first dose if pain is not relieved • 30 minutes after first dose if pain is not relieved • One hour after first dose if pain is not relieved • 1.5 hours after first dose if pain is not relieved

• One hour after first dose if pain is not relieved Explanation: Sumatriptan should be administered at the onset of the headache and a second dose can be injected after one hour if pain has not been relieved. There cannot be more than two injections in a 24-hour period.

6 of 20 A client on NSAIDs is experiencing congestive heart failure. The healthcare provider has ordered a diuretic to the treatment plan. The nurse evaluates the client for what reaction? • decreased effectiveness of the diuretic. • decreased effectiveness of NSAIDs. • diuretic toxicity. • NSAID toxicity.

• decreased effectiveness of the diuretic. Explanation: When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.

18 of 20 An elderly client experiencing recurrent tension headaches reports taking an over-the-counter (OTC) combination of acetaminophen, aspirin, and caffeine several times a week. The nurse should recognize that this combination medication may be contraindicated if the client has a history of what medical condition? • contact dermatitis • coronary artery disease • peripheral vascular disease • gastrointestinal (GI) bleeding

• gastrointestinal (GI) bleeding Explanation: Aspirin is normally contraindicated in clients who have had a history of GI bleeding. The other listed health problems do not contraindicate the use of combination acetaminophen, aspirin, and caffeine.

14 of 20 When teaching a client about common adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs), the nurse should include information on what condition? • heartburn • dizziness • nausea and vomiting • rapid heart rate

• heartburn Explanation: Heartburn would be the most likely symptom of a common adverse effect to NSAIDs and so should be a part of the client's medication education. None of the other options are directly associated with NSAID use.

4 of 5 A caregiver asks the nurse what the caregiver can give a 9-year-old child for a headache. What is the nurse's best response? • "Ketolac can be prescribed." • "The prescriber can order them a triptan." • "Acetaminophen is appropriate." • "Acetaminophen-aspirin-caffeine works best."

• "Acetaminophen is appropriate." Explanation: Acetaminophen is appropriate. Acetaminophen-aspirin-caffeine is recommended for children older than 12 years of age. Ketolac and triptans are not prescribed for children.

16 of 20 How should the nurse counsel a client concerning a new prescription for celecoxib and its affect on long-standing low-dose acetylsalicylic acid therapy? • "Stop taking the acetylsalicylic acid for at least 7 days before starting the celecoxib." • "Continue both therapies as prescribed." • "Because celecoxib interferes with the absorption of acetylsalicylic acid, increase that daily dosage to 325 mg." • "Take the acetylsalicylic acid within 4 hours of taking the celecoxib."

• "Continue both therapies as prescribed." Explanation: Celecoxib is a COX-2 inhibitor. In general, clients taking low-dose acetylsalicylic acid to prevent myocardial infarction or stroke should continue to take the aspirin if their prescribers order a COX-2-inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs) because the COX-2 inhibitors have little effect on platelet function. This information makes all the remaining options incorrect.

17 of 20 The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed acetaminophen-aspirin-caffeine combination for abortive therapy. Which statement made by the client establishes the need for further clarification? • "I should not take this drug if I plan on becoming pregnant, or later want to breastfeed." • "While I am taking this drug, I should not consume any foods or drinks high in caffeine." • "The caffeine in the drug helps the vessels in my brain to constrict and helps stop the headache." • "I can take my over-the-counter cold remedies in addition to this drug for cold symptoms."

• "I can take my over-the-counter cold remedies in addition to this drug for cold symptoms." Explanation: The nurse needs to clarify the statement that the client made regarding planning to take over-the-counter (OTC) cold remedies because the preparations usually contain acetaminophen, aspirin, or caffeine. The nurse should always teach clients to consult a pharmacist to prevent potential drug interactions or overdoses of same or similar ingredients found in various OTC preparations. The other statements are correct. Caffeine leads to vasoconstriction, which helps stop the migraine, which results from vasodilation of the vessels. The medication is contraindicated during pregnancy and breastfeeding. Consuming foods or drinks high in caffeine would increase risk for restlessness, tremors, tachycardia, hypertension, and palpitations from extra irregular heartbeats.

17 of 20 The nurse is educating an older adult client diagnosed with migraine headaches about the prescribed naproxen sodium for abortive therapy. Which statement made by the client establishes the need for further clarification? • "I will take the drug when I begin to experience my aura of smelling something burning." • "Biofeedback and yoga will also help to decrease the frequency and severity of migraines." • "The tablets should never be crushed, cut, or chewed, and the drug needs to be taken with a meal." • "I can take up to 1200 mg in 24 hours because the package states this as the maximum dosage."

• "I can take up to 1200 mg in 24 hours because the package states this as the maximum dosage." Explanation: The nurse needs to clarify the statement that the client made regarding planning to take up to the maximum dosage of 1200 mg per 24-hour period because older adults should not take more than 200 mg twice a day. The older adult through aging has less renal clearance and decreased liver metabolism. The black box warning of increased risk for the drug to lead to GI bleeding and cardiovascular incidences warrants a careful approach with the older adult and the reduced dosage. The other statements are correct. Taking the drug when the aura or subjective sensation before the migraine begins will help the drug to take effect within 1 hour and peak action of 1 to 2 hours. The client with migraines experiences fewer migraines when gaining adequate rest and relief from stress from various methods, including biofeedback and yoga. The tablets if crushed, cut, or chewed will be less effective because the tablets are sustained release. Taking the tablets with meals will help decrease GI upset.

16 of 20 The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed intranasal sumatriptan for abortive therapy. Which statement made by the client establishes the need for further clarification? • "The intranasal spray will cause irritation to my nose and throat and a bad taste in my mouth and nausea." • "I will alternate the nostril used, and administer 2 sprays in the nostril, and repeat in 2 hours if needed." • "The onset of the drug is quick and it peaks in 90 minutes, so I will take it before lying down." • "I will take my blood pressure after taking the drug and notify my prescriber if I become hypertensive."

• "I will alternate the nostril used, and administer 2 sprays in the nostril, and repeat in 2 hours if needed." Explanation: The nurse needs to clarify the statement that the client made regarding taking the medication because the correct way is one spray each nostril and repeat it if needed in 2 hours, as the last dose for the day. The other statements are correct. The client should take the drug, check the blood pressure, and report hypertension to the prescriber. The drug has a rapid onset and peaks in 90 minutes. The client should lie down and rest after taking the drug in a quiet, dark, cool place for 2 to 3 hours. The drug can cause dizziness and vertigo, so lying down provides safety, too. The intranasal spray irritates the mucosa of the nostrils and throat and has an adverse taste and can cause nausea.

9 of 20 What statement indicates the client understands teaching about naproxen sodium? • "I will crush the pill and put it in applesauce if I have difficulty swallowing." • "I will take the medication with antacids if my stomach is upset." • "I will not drive until I see how the medication affects me." • "I will take the medication at least 2 hours before I eat."

• "I will not drive until I see how the medication affects me." Explanation: The medication can cause drowsiness and dizziness, and the client should determine its effects before driving. The medication should not be crushed. If the medication causes stomach upset, the client should take it with meals, not with antacids.

12 of 20 The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? • Decreasing nerve stimulation • Inhibiting the synthesis of prostaglandins • Blocking the neuronal terminal • Inhibiting impulses to the brain

• Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.

20 of 20 A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works? • "It relaxes smooth muscles of the cardiovascular system." • "The medication impairs the reuptake of norepinephrine." • "The medication causes bronchiole constriction." • "It produces vascular constriction of cranial blood vessels."

• "It produces vascular constriction of cranial blood vessels." Explanation: Sumatriptan binds to the serotonin receptors 5-HT1D, producing vascular constriction of the cranial blood vessels and relieving the pain of a migraine headache. It also relieves the nausea, vomiting, photophobia, and phonophobia that accompany the migraine headache. Sumatriptan does not cause bronchiole constriction or impair the reuptake of norepinephrine. It does not relax smooth muscles of the cardiovascular system.

4 of 5 A client, prescribed several medications for migraines, asks the nurse if there is any herbal supplement the client can take as well. What is the nurse's best response? • "I think you should try them before filling your prescriptions." • "Let's discuss adding a herbal to your prescribed medication." • "We should call the prescriber and ask for guidance." • "I have heard that B complex vitamins help."

• "Let's discuss adding a herbal to your prescribed medication." Explanation: Clients with migraines may use herbal supplements to treat these headaches. In general, it is necessary to encourage clients to try standard methods of preventing and treating migraines before taking products with uncertain benefits and risks. Calling the prescriber is not warranted. Feverfew, butterbur, riboflavin and B2 have been used for migraines.

6 of 20 The nurse is caring for a client with a gastric ulcer. The client asks about using Capsaicin on the joints of the knees for arthritis, but says he has heard that spicy foods should be avoided because of his ulcer and that Capsaicin has hot pepper in it. What is the best response by the nurse? • "Research has suggested that Capsaicin produces the opposite effect. It might protect against ulcers, so I think it is fine to use it." • "I would not use it if I had a ulcer." • "People with ulcers should avoid spicy foods, and this drug does have hot pepper in it, avoid it." • "I think you are looking for trouble."

• "Research has suggested that Capsaicin produces the opposite effect. It might protect against ulcers, so I think it is fine to use it." Explanation: People with ulcers are usually warned to avoid spicy foods. But new research suggests that Capsaicin produces the opposite effect--it might actually protect against peptic ulcers. The other responses are not appropriate.

15 of 20 A client with a migraine took a prescribed dose of eletriptan (Relpax), and one hour later the headache is still intense. The client's husband calls the clinic and asks the nurse what they should do. What is an appropriate nursing response? • "Ibuprofen may increase the action of the triptan." • "She can take another dose of the drug 2 hours after the initial dose if the headache continues." • "Give her a dose of an ergot drug if you have it. It will decrease the intensity of the pain." • "Tell her to lie down in a quiet cool room and just wait it out. It will subside."

• "She can take another dose of the drug 2 hours after the initial dose if the headache continues." Explanation: A client taking eletriptan to relieve a migraine can take another dose in 2 hours if the headache is not relieved. The combination of ergot drugs with triptans is not indicated because of the vasoconstriction caused by both. The client will not get relief by "waiting it out." Ibuprofen is an anti-inflammatory that does not affect the mechanism associated with migraines.

18 of 20 A client prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, and I still don't feel any better. Can I take another?" How should the nurse respond? • "Yes, it's likely safe to take one more dose of your sumatriptan." • "It's probably advisable for you to go to the emergency department." • "You can take another pill now and one more in 1 hour, but then no more." • "Wait at least half-an-hour before you take another pill."

• "Wait at least half-an-hour before you take another pill." Explanation: Administration of a second dose of the oral preparation of sumatriptan when symptoms return is acceptable but not earlier than 2 hours after the first tablet.

10 of 20 A client has taken sumatriptan (Imitrex) and does not feel it is working. The client wants to know when the client can take more of the medication. What should the nurse tell the client? • "If it does not work with the first dose, we will add a different medication." • "You can double the dose within a few minutes of administration." • "You can only take one dose safely." • "You can take a second dose 2 hours after the first."

• "You can take a second dose 2 hours after the first." Explanation: The dose should not exceed 200 mg/day. The second dose can be taken no more than 2 hours after the first.

7 of 20 The client experiencing menstrual cramps has been ordered Advil 400 mg by mouth every 6 hours. The medication comes in 200-mg capsules. How much should the nurse give this client? • 1/2 tablet • 1 tablet • 4 tablets • 2 tablets

• 2 tablets Explanation: Since the medication comes in 200-mg capsules and the physician has ordered twice that amount, the nurse should administer 2 capsules at each dose. 200 mg X 2 = 400 mg.

17 of 20 A clinic client prescribed oral sumatriptan should be taught to expect symptom relief how soon after taking the drug? • 60 to 90 minutes • 45 to 60 minutes • 15 to 30 minutes • 5 to 10 minutes

• 60 to 90 minutes Explanation: The oral preparation of sumatriptan has an onset of action of 60 to 90 minutes and a peak of action of 2 to 4 hours.

19 of 20 A nurse is caring for a client with migraines. The prescriber orders subcutaneous sumatriptan. What type of treatment is this medication considered? • Abortive • Precautionary • Addictive • Preventative

• Abortive Explanation: The abortive agents administered for the treatment of migraine headaches include nonsteroidal anti-inflammatory agents, acetaminophen-aspirin with caffeine medication, the ergot alkaloids, and triptans such as sumatriptan. Preventative therapy is the administration of medications to prevent the development of migraine headaches. Addictive medications and precautionary measures are not treatment medications for migraines.

7 of 20 The nursing instructor is discussing nonsteroidal anti-inflammatory drugs (NSAIDs). According to the instructor, which NSAID can be given intramuscularly (IM) or intravenously (IV)? • Indomethacin • Celecoxib • Naproxen • Ketorolac

• Ketorolac Explanation: Ketorolac is currently the only NSAID that can be administered via the IV and IM routes.

8 of 20 A client reports nausea with a severe headache. On assessment, the nurse learns the client has vomited several times this hour. What is the best way to treat the client's migraine? • Administer a subcutaneous triptan. • Administer the oral medications, then assess to make certain the client retains the medication. • Administer an antacid. • Give the client dry crackers or pretzels prior to taking medication.

• Administer a subcutaneous triptan. Explanation: The client can receive a subcutaneous medication to treat the migraine. This is the best intervention. You would not want to give an antacid with the medication, because absorption could be altered. Making certain the client retains the medication or giving dry crackers prior to the medication does not guarantee the client will not vomit the medication or a portion of it. It is best to prevent the client from vomiting the remedy by administering medication by an alternate route.

6 of 20 A client with a known history of migraine presents to the emergency department with a severe headache. The client reports blurred vision prior to the headache starting. What is the priority nursing intervention? • Have the client drink caffeinated coffee. • Administer a triptan. • Turn off the lights. • Have the client lie down.

• Administer a triptan. Explanation: Administering a drug that is an abortive agent for migraine is a priority to stop the headache. The other options can ease symptoms but will not relieve the headache.

11 of 20 A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache? • Administer naproxen. • Administer ergotamine subcutaneously. • Administer diclofenac. • Administer subcutaneous sumatriptan succinate (Imitrex).

• Administer subcutaneous sumatriptan succinate (Imitrex). Explanation: Sumatriptan succinate (Imitrex) should be administered. Ergotamine is administered sublingually. Diclofenac and naproxen are NSAIDs.

4 of 20 A client is taking a nonsteroidal anti-inflammatory agent. Which instruction should the client be given in regards to administration? • Administer the medication with food. • Administer the medication with orange juice. • Administer the medication every other day. • Crush enteric-coated tablets for impaired swallowing.

• Administer the medication with food. Explanation: To prevent gastrointestinal irritation, instruct the client to administer the medication with food. The administration of an NSAID with orange juice will increase gastric acid and not protect the gastric mucosa. Crushing enteric-coated tablets will eliminate the protection of the gastric mucosa. Nonsteroidal anti-inflammatory agents administered every other day will not protect the client from gastric irritation.

7 of 20 A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the client's knowledge of which area? • Medication regimen for herbal supplements • Adverse effects of nonsteroidal anti-inflammatory drugs • Nutrition and health • Exercise routine

• Adverse effects of nonsteroidal anti-inflammatory drugs Explanation: In addition, adverse drug effects should be reviewed with clients, and clients should be assessed for characteristics (e.g., older age group, renal impairment, overuse of the drugs) that increase the risks of adverse effects.

3 of 20 The nurse is to give ibuprofen to a client with moderate pain. The pharmacy only stocks the drug under its trade name. Which should the nurse administer to the client? • Tylenol • Aspirin • Advil • Bufferin

• Advil Explanation: Advil is a trade name for ibuprofen. Tylenol is the same as acetaminophen and is not an NSAID. Aspirin is a salicylate; Bufferin is a type of aspirin as well.

10 of 20 You are speaking with a 28-year-old male who sustained a musculoskeletal injury while playing baseball. He tells you that he has taken an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). Which of the following actions, in addition to taking an NSAID, would you recommend that he take? • Practice relaxation techniques • Apply cold therapy • Apply moist heat • Practice passive range of motion exercises

• Apply cold therapy Explanation: Application of cold therapy to an acute musculoskeletal injury can help decrease pain, swelling, and inflammation. Resting and elevating the injured body part, as well as applying compression, can also help.

3 of 20 A nurse is caring for a client with joint pain. The client has been prescribed an NSAID. Which additional comfort measures should the nurse suggest to the client for pain relief? Select all that apply. • Avoid overuse of joints. • Use iron supplements. • Apply hot or cold compress. • Use assistive orthopedic devices. • Avoid foods with tyramine.

• Apply hot or cold compress. • Avoid overuse of joints. • Use assistive orthopedic devices. Explanation: The nurse should suggest that the client apply hot or cold compresses, avoid overuse of joints, and use assistive orthopedic devices as additional comfort measures to obtain relief from joint pain while receiving treatment with NSAIDs. Using iron supplements would be appropriate for a client with anemia. Foods with tyramine should be avoided in clients undergoing treatment with MAOI antidepressants.

1 of 20 The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? • Assessing the client for respiratory depression • Assessing the client for narcotic withdrawal syndrome • Assessing the client's lying, sitting and standing blood pressure • Assessing the client for migraine pain

• Assessing the client for migraine pain Explanation: Sumatriptan is indicated for the treatment of acute migraine and cluster headaches. As such, the nurse should assess the client for indications of this health problem, more so than respiratory status or blood pressure. Narcotic withdrawal syndrome is unrelated.

7 of 20 The nurse knows that an important part of pain assessment is to ask what medications the client is currently taking and has tried in the past for pain. Why is this important? • Because the client may need a coupon for the drug if they cannot afford it • To let the client talk and be distracted from pain to get a true assessment • Because herbal and over-the-counter (OTC) medications may affect treatment • For the nurse to know the client's likes and dislikes or what works or does not

• Because herbal and over-the-counter (OTC) medications may affect treatment Explanation: Many clients use herbal remedies and OTC medications that they do not need a prescription for, such as Ibuprofen and many medications used to treat pain purchased without a prescription. The PCP needs to know what medications and herbal remedies the client is taking and if there is any chance of interactions with other drugs. The other reasons listed are not why the nurse needs to asks about other medications and herbs that the client may be taking.

8 of 20 A nurse with osteoarthritis does not like to take many medications for pain relief. However the nurse has found that a certain cream helps the pain during work, making 12-hour shifts more bearable. The ointment used contains a substance found in hot peppers and is known as which of the following? • Icy Hot cream • Capsaicin cream • Bengay cream • Preparation H cream

• Capsaicin cream Explanation: A cream containing capsaicin (substance found in red peppers) when rubbed on the skin penetrates to arthritic joints, where it stops the destruction of cartilage, relieves pain, and increases flexibility. Preparation H is a cream for hemorrhoids and a topical anesthetic and vasoconstrictor. Bengay can be used for arthritis, but it contains methyl salicylate and menthol. Icy Hot also used for arthritis is known to cool and then turn hot. It contains menthol and methyl salicylate.

12 of 20 The client is concerned about taking NSAIDs for pain due to possible GI upset. The nurse identifies which medication causes the least gastrointestinal distress? • Celecoxib • Naproxen • Meloxicam • Ibuprofen

• Celecoxib Explanation: Celecoxib is a COX-2 inhibitor that works without inhibiting the COX-1 enzyme, which helps to maintain the stomach lining. Ibuprofen, meloxicam, and naproxen inhibit the COX-1 enzyme.

2 of 5 The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? • Ergotamine • Sumatriptan • Eletriptan • Celecoxib

• Celecoxib Explanation: Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.

1 of 20 A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated? • Naproxen • Ibuprofen • Celecoxib • Diclofenac

• Celecoxib Explanation: Celocoxib is contraindicated for use in clients who are allergic to sulfonamides. Ibuprofen, naproxen, and diclofenac are not contraindicated in the client with a sulfonamide allergy.

3 of 20 A client discharged to home is recovering from a coronary artery bypass graft (CABG). The client calls the nurse and wants to take something for mild pain and states he is considering Celecoxib, which he used successfully in the past for arthritis. Why would the nurse advise the client against doing this? Select all that apply. • Celecoxib can cause MI. • Celecoxib can cause thrombosis. • Celecoxib can cause a stroke. • Celecoxib can cause renal failure. • Celecoxib can cause an elevation in blood glucose level.

• Celecoxib can cause thrombosis. • Celecoxib can cause MI. • Celecoxib can cause a stroke. Explanation: Celecoxib can cause severe reactions in clients with cardiovascular disease, especially one who has undergone a CABG. Risks are increased for serious cardiovascular thrombosis, myocardial infarction, and stroke, all of which can be fatal. The drug has no effect on blood glucose level and does not cause renal failure.

2 of 20 Blocking of what is responsible for the gastrointestinal side effects caused by NSAIDs? • Cyclooxygenase-4 • Cyclooxygenase-3 • Cyclooxygenase-2 • Cyclooxygenase-1

• Cyclooxygenase-1 Explanation: Blocking cyclooxygenase-1 is responsible for the GI side effects caused by NSAIDs.

10 of 20 The client has been prescribed the NSAID naproxen/esomeprazole (Vimovo). The nurse teaches the client the potential adverse reactions include heartburn, nausea and what other reaction? • Dizziness • Rash • Diarrhea • Vomiting

• Diarrhea Explanation: Naproxen/esomeprazole (Vimovo) is an NSAID combination. Potential adverse reactions include nausea, heartburn, and diarrhea. Dizziness, vomiting, and rash are not associated with naproxen/esomeprazole (Vimovo) use.

14 of 20 The 29-year-old client is experiencing dysmenorrhea. The nurse understands that which medications may be used to treat dysmenorrhea? • Fenoprofen • Etodolac • Diclofenac • Meloxicam

• Diclofenac Explanation: Diclofenac is indicated for dysmenorrhea. Meloxicam is indicated for osteoarthritis. Fenoprofen and etodolac are used for osteoarthritis and rheumatoid arthritis.

15 of 20 A client with lower back pain has been recommended an NSAID. Which NSAID comes in the form for topical application? • Naproxen (Naprosyn) • Etanercept (Enbrel) • Diclofenac (Voltaren) • Sodium hyaluronate (Hyalgan)

• Diclofenac (Voltaren) Explanation: Voltaren is available in a topical patch form as well as in gel form, unlike naproxen, etanercept and sodium hyaluraonate.

12 of 20 The nurse is preparing to medicate a client for migraines. The teaches the client that migraine headaches frequently occur for what reason? • Due to vasoconstriction • Due to ischemia • Due to vasodilation • Due to photophobia

• Due to vasodilation Explanation: Migraine symptoms are caused by vasodilation, not vasoconstriction, and stimulation of the trigeminal nerves. Ischemia is due to decreased oxygenation and photophobia can worsen the migraine.

12 of 20 The client has a history of gastric irritation. The nurse identifies that which medication is most appropriate for this client suffering from mild to moderate pain? • Ketoprofen • Naproxen • Indocin • Duexis

• Duexis Explanation: Duexis is an NSAID combination that provides pain control with gastric/duodenal ulcer protection. Naproxen, ketoprofen, and Indocin all can cause gastrointestinal irritation.

19 of 20 A client diagnosed with a migraine has been prescribed naproxen. What is the nurse's priority when the client reports being allergic to aspirin? • Call the pharmacy for clarification. • Give the medication as prescribed. • Discuss the allergy with the client. • Hold the medication.

• Hold the medication. Explanation: The nurse's priority is to hold the medication. Contraindications to naproxen or naproxen sodium include a known allergy to aspirin or other nonsteroidal anti-inflammatory drugs. The nurse should not discuss this with the client but with the prescriber. The nurse should not give the medication or call the pharmacy for clarification.

9 of 20 Which medication, when combined with an NSAIDs, may cause increased effectiveness or toxicity? • Antihypertensives • Diuretics • Acetaminophen • Lithium

• Lithium Explanation: Lithium, when combined with NSAIDs, can caused increased effectiveness and possibly lithium toxicity. The effectiveness of diuretics and antihypertensives are decreased with the use of NSAIDs. There is increased risk of renal impairment when NSAIDs and acetaminophen are combined.

14 of 20 The nurse is reviewing the treatment plan and medication list of a client with migraine headaches. Which of the following medication classes should not be used with selective serotonin agonists? • Steroids • Diuretics • NSAIDs • Monoamine oxidase inhibitors (MAOIs)

• Monoamine oxidase inhibitors (MAOIs) Explanation: Monoamine oxidase inhibitors (MAOIs) and selective serotonin agonists should not be used together. These medications, when used together, can create a life-threatening condition. Selective serotonin agonists may be used with diuretics, steroids, and NSAIDs.

2 of 20 A nursing student indicates an understanding of nonsteroidal anti-inflammatory drugs (NSAIDs) when listing which as adverse reactions to this group of medications? Select all that apply. • Nausea, vomiting • Epigastric pain • Anorexia • Extreme thirst • Dry mouth • Excessive appetite

• Nausea, vomiting • Dry mouth • Anorexia • Epigastric pain Explanation: The following are known adverse reactions found with NSAIDs: nausea, vomiting, dyspepsia, dry mouth, anorexia, diarrhea, constipation, epigastric pain, indigestion, abdominal distress or discomfort, and bloating. Extreme thirst and excessive appetite are not known adverse reactions to this classification of drugs.

14 of 20 What information should be provided to a client diagnosed with an acetylsalicylic acid allergy? • Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. • Nonsteroidal anti-inflammatory drugs (NSAIDs) should always be taken with food. • Nonsteroidal anti-inflammatory drugs (NSAIDs) should be taken for only short periods of time. • It is safe to use only buffered forms of acetylsalicylic acid.

• Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Explanation: In people who have demonstrated hypersensitivity to acetylsalicylic acid, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. This makes all the other options incorrect.

5 of 20 A nurse is administering an anti-inflammatory medication to a client who has severe rheumatoid arthritis. Which would the nurse question if ordered by the health care provider? • Oral anticoagulant • Antibiotic • Antihypertensive agent • Oral antidiabetic agent

• Oral anticoagulant Explanation: There is an increased risk of bleeding when taking an oral anticoagulant with an anti-inflammatory. Antidiabetic agents, antihypertensives, and most antibiotics can be given safely with anti-inflammatory agents.

13 of 20 The client has migrane headaches and has been prescribed sumatriptan. The nurse knows that sumatriptan may be administered by which method? Select all that apply. • Orally • Rectally • Intraveneously • Subcutaneously

• Orally • Rectally • Subcutaneously Explanation: Sumatriptan may be administered orally, subcutaneously, and rectally. It is not administered intravenously.

1 of 5 The nursing instructor teaches the students that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking COX-1 and COX-2. The teacher further instructs that by blocking COX-2, which effects will be achieved? • Maintenance of the lining of the stomach • Pain relief • Adverse reactions • Increased inflammation

• Pain relief Explanation: Traditional NSAIDs (eg, ibuprofen, maproxen) are thought to regulate pain and inflammation by blocking COX-2. These drugs, however, also inhibit COX-1, the enzyme that helps maintain the lining of the stomach. Therefore, blocking COX-2 produces pain relief, and blocking the effects of COX-1 causes unwanted adverse reactions.

5 of 5 A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication? • Pain scale • Subjective assessment • Glasgow coma scale • Vital signs

• Pain scale Explanation: Following the administration of the acetaminophen-aspirin-caffeine combination, the client should exhibit diminished pain. The nurse assesses for pain using the pain scale. Vital signs do not always align with the pain the client is experiencing. The Glasgow coma scale assesses neurologic function and not pain. The subjective assessment can accompany the pain scale to determine and document exactly what the client states.

6 of 20 The nursing student demonstrates an understanding of nonsteroidal anti-inflammatory drugs (NSAIDs) when stating that NSAIDs should be used cautiously in which clients? Select all that apply. • Clients with bleeding disorders • Clients with renal or cardiovascular disease • Clients with diabetes • Clients active in sports • Older clients • Pregnant clients

• Pregnant clients • Older clients • Clients with bleeding disorders • Clients with renal or cardiovascular disease Explanation: NSAIDs should be used cautiously during pregnancy (category B), by elderly clients (increased risk of ulcer formation in clients older than 65 years), and by clients with bleeding disorders, renal disease, cardiovascular disease, or hepatic impairment. Nothing indicates that NSAIDs should not be given to clients with diabetes or active in sports.

20 of 20 What condition identified in the client's history would be a contraindication for the use of estradiol? • Allergy to penicillin • Pulmonary emboli • Diabetes mellitus • Peptic ulcer disease

• Pulmonary emboli Explanation: Reference: • Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 14: Nonopioid Analgesics: Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) and Migraine Headache Medications, p. 533.

7 of 20 The client has been taking acetaminophen daily for two years. The health care provider has now prescribed ketoprofen in addition to the acetaminophen. The nurse plans to educate the client on NSAIDs and acetaminophen and that their interaction can cause what condition? • Respiratory impairment • Immunologic disorders • Renal impairment • Hematologic disorders

• Renal impairment Explanation: When the client has experienced long-term acetaminophen use and NSAIDs are added, the client is at increased risk of renal impairment. There is no additional risk to the respiratory, hematologic, or immune system.

18 of 20 What are nonpharmacological methods that can be used for tension headaches? Select all that apply. • Stress reduction strategies • Exercise • Rest • Deep breathing exercises • Diet of fruits and vegetables

• Rest • Deep breathing exercises • Stress reduction strategies Explanation: Nonpharmacological methods that can be used for tension headaches include rest, relaxation techniques such as deep breathing, or stress-reduction strategies. Exercise and diet do not impact tension headaches.

18 of 20 What black box risk warnings issued by the US Food and Drug Administration will the nurse discuss with a client prescribed naproxen? Select all that apply. • Risk for gastrointestinal bleeding • Risk for cardiovascular events • Risk for infection • Risk for cognitive impairment • Risk for hepatotoxicity

• Risk for cardiovascular events • Risk for gastrointestinal bleeding Explanation: The FDA has issued a black box warning stating that naproxen sodium may put clients at increased risk for cardiovascular events and GI bleeding. Naproxen is a nonselective inhibitor of cyco-oxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2. Risk for infection, hepatotoxicity and cognitive impairment are not associated with naproxen.

8 of 20 When the nurse is administering Sumatriptan for a migraine attack, the best site and action would be which of the following? • IV before the attack • SQ just below the skin and at the onset of the attack • IV at onset of the attack • PO at the onset of the attack

• SQ just below the skin and at the onset of the attack Explanation: Administration of Sumatriptan should be just below the skin in the SQ tissue. This drug should be given at the onset of the attack, but can be administered any time during the attack. A second injection can be delivered after 1 hour if pain has not been relieved.

13 of 20 The nurse instructs the client that with the use of NSAIDs some adverse reactions can occur. Which are they? Select all that apply. • Somnolence • Dysmenorrhea • Purpura • Hematuria • Ecchymosis

• Somnolence • Hematuria • Purpura • Ecchymosis Explanation: Hematuria, somnolence, purpura, and ecchymosis are all NSAID adverse reactions. NSAIDs are used in the treatment of dysmenorrhea.

2 of 5 The client on an NSAID reports to the nurse that her skin is reddened, blistered, and peeling. The nurse suspects which of the following? • Purpura • Dysuria • Ecchymosis • Stevens-Johnson syndrome

• Stevens-Johnson syndrome Explanation: Stevens-Johnson syndrome is an integumentary system reaction that causes the skin to become reddened and blistered before it peels. This is a medical emergency and the client needs to seek medical attention immediately. Purpura is excessive hemorrhaging causing red-purple patches under the skin. Ecchymosis is subcutaneous hemorrhage. Dysuria is painful urination.

11 of 20 The client suffers from high uric acid deposit in the joints and has developed gouty arthritis. Which medications may be prescribed? • Piroxicam • Oxaprozin • Sulindac • Tolmetin

• Sulindac Explanation: Sulindac is used in the treatment of gouty arthritis. Oxaprozin and piroxicam are used to treat rheumatoid arthritis and osteoarthritis. Tolmetin is used to treat rheumatoid arthritis, osteoarthritis, and juvenile arthritis.

20 of 20 When a client is prescribed ergotamine tartrate, what information should be included in the teaching plan regarding the administration of the medication? • Ingest 8 ounces of water with the medication. • Chewing the tablet can aid in the medication working faster. • Take this medication with meals. • Tablet is placed under the tongue to dissolve.

• Tablet is placed under the tongue to dissolve. Explanation: Administration of ergotamine is sublingual, and the tablets should be dissolved under the tongue. It is important that tablets not be crushed, chewed or swallowed whole. The client should not drink, eat, or smoke while the medication is being dissolved.

3 of 5 In order to maximize therapeutic benefit while reducing the risk of adverse effects of sumatriptan, the nurse should encourage the client to implement which intervention? • Take the medication on days when migraines may be anticipated. • Take the medication as soon as the earliest symptoms of migraine are sensed. • Take the medication when the pain of a migraine becomes too much to bear. • Take the medication before breakfast each day.

• Take the medication as soon as the earliest symptoms of migraine are sensed. Explanation: It is important to administer sumatriptan at the onset of migraine symptoms. The drug is not taken on a daily, scheduled basis and is not used as a preventative treatment.

3 of 5 Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention? • Crush the pills and mix with applesauce to reduce gastritis. • Report any new onset of constipation promptly. • Take the pills with meals to minimize stomach upset. • Arrange for monthly blood work.

• Take the pills with meals to minimize stomach upset. Explanation: Naproxen should be taken on a full stomach. The pills should not be crushed. Constipation is not a noted adverse effect, and regular blood work is not warranted.

15 of 20 A client who is 14 weeks pregnant requests a prescription for ergotamine to help manage migraine headaches that have become increasing more severe and frequent in recent months. How will this client's current health status affect the nurse's response to this request? • The client must use a reduced dose of ergotamine until she has given birth. • The client must wait until she has given birth before taking ergotamine. • The client cannot safely take ergotamine until she has weaned her infant. • The client can safely use ergotamine but must be monitored for blood dyscrasias.

• The client cannot safely take ergotamine until she has weaned her infant. Explanation: Pregnancy and lactation are contraindications to the use of ergotamine.

17 of 20 An adult client with a history of migraines has been prescribed propranolol. The nurse should identify what goal of therapy when planning care for a client prescribed propranolol? • The client's migraines will be lower in intensity than prior to treatment. • The client's migraines will be shorter in duration than prior to treatment. • The client will be able to perform activities of daily living during migraines. • The client will experience significantly fewer migraines.

• The client will experience significantly fewer migraines. Explanation: Propranolol is used for the prevention of migraines. As such, the primary goals are not reduced duration or intensity of migraines. In addition, the nurse would not identify the goal of continuing normal routines during a migraine.

14 of 20 When planning abortive therapy for a client who experiences migraines, what goal should the nurse prioritize? • The client will identify factors that contribute to migraines. • The client will take migraine-related medications on a regular schedule. • The client will obtain rapid relief of migraine symptoms. • The client will remain free of migraines.

• The client will obtain rapid relief of migraine symptoms. Explanation: Abortive therapy is the administration of medications to treat the symptoms of migraine headache. Drugs for abortive therapy are not taken on a regularly scheduled basis. Prevention and identification of causative factors are important, but these are not directly related to abortive therapy.

10 of 20 Which client should not receive sumatriptan (Imitrex) as ordered? • The client with urinary output of 30 mL/hour • The client with a blood pressure of 140/95 mm Hg • The client with an elevated BUN • The client reporting nausea

• The client with an elevated BUN Explanation: The client with renal disease may have difficulty excreting the medication. An elevated BUN is an indication of renal disease. The client with borderline hypertension should be assessed, but can receive the medication. Urinary output of 30 mL/hour is acceptable for adequate renal perfusion. Nausea often accompanies migraines and is not a contraindication for taking this medication.

16 of 20 A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the client on long-term naproxen therapy is experiencing adverse effects of this treatment? • The client complains of itchy, dry skin. • The client's stool tests positive for occult blood. • The client has peripheral edema, and there is a steady increase in the client's weight. • There is an increase in the client's neutrophils but no increase in temperature.

• The client's stool tests positive for occult blood. Explanation: Gastrointestinal (GI) bleeding is a significant adverse effect of naproxen. This drug does not typically cause leukocytosis, dry skin, or fluid imbalances.

13 of 20 What information should the nurse provide when educating a client newly diagnosed about the cause of migraines? • The pathophysiology of migraine headaches involves a disruption in the limbic system. • Migraines are typically the result of prolonged psychosocial stress. • The etiology of migraines is thought to have a genetic component. • Migraines can be a precursor to transient ischemic attacks (TIAs) or stroke.

• The etiology of migraines is thought to have a genetic component. Explanation: Migraines demonstrate a familial pattern, and authorities believe that they are inherited as autosomal dominant traits with incomplete penetrance. Stress may precipitate a migraine, but this is not an aspect of the etiology (cause). They are not a precursor to TIAs or stroke, and they do not involve disruption of the limbic system.

11 of 20 What statement is correct concerning the use of sumatriptan (Imitrex) for migraine headache relief? • The medication causes vasoconstriction. • Dark glasses should be worn to prevent photophobia. • An antiemetic should be taken with the medication. • An anti-nausea medication should be taken first.

• The medication causes vasoconstriction. Explanation: Imitrex relieves nausea, vomiting, and photophobia because it creates vasoconstriction for the relief of migraines. Antiemetic and anti-nausea medications do not have to be taken with the medication, nor does the patient need to wear dark glasses.

9 of 20 A client admitted for a severe migraine reports taking ergotamine tartrate at home. What is most essential information for the nurse to obtain? • The number of ergotamine tablets the client took at home • The client's ability to swallow • How long the client has had the headache • What other medications the client takes

• The number of ergotamine tablets the client took at home Explanation: The client can take 1 to 2 mg every 30 minutes until the headache abates. The nurse needs to determine the total dose. The medication is taken sublingually, so the client's ability to swallow is not a concern. It is not important to determine how long the client has had the headache.

5 of 20 The nursing instructor is talking with the junior nursing class about migraine headaches. What would the instructor tell the students is the method of action of Sumatriptan? • Vasoconstrictive on cranial blood vessels • Works at the site of the migraine to eliminate pain • Dulls the perception of pain in the brain • Causes vasodilation of cranial blood vessels

• Vasoconstrictive on cranial blood vessels Explanation: Actions: Binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels.

17 of 20 What is a priority nursing assessment of a client prescribed oral sumatriptan? • Urinary output • Vital signs • Glasgow coma scale • Head to toe assessment

• Vital signs Explanation: After administration of sumatriptan, the nurse should assess for adverse effects. These include increased blood pressure as well as chest pain, shock, dizziness and vertigo. Urine output and head to toe assessment are not warranted. The Glasgow comas scale is used to determine best neurological function and not migraine pain.

2 of 20 Which NSAID appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)? • ibuprofen • naproxen • meloxicam • celecoxib

• celecoxib Explanation: Celecoxib is the NSAID that appears to work by specifically inhibiting cyclooxygenase-2 without inhibiting cyclooxygenase-1. Naproxen, meloxicam, and ibuprofen inhibit both COX-1 and COX-2.

13 of 20 A boy 5 years of age states his leg hurts. Which pain scale would be most appropriate for this client to use? • 0 to 10 numeric • Simple descriptive • Wong-Baker • Visual analog

• Wong-Baker Explanation: The Wong-Baker FACES scale would be the most appropriate for a child 5 years of age. it is the easiest because it allows the child to point to the face that is associated with how badly he hurts. The other pain scales are typically too difficult for a child.

15 of 20 A client with a history of migraine headaches self-medicates with an over-the-counter (OTC) medication that contains a commonly combined combination of drugs. The nurse recognizes the client is medicating with a combination of which drugs? Select all that apply. • caffeine • aspirin • codeine • acetaminophen • naproxen

• acetaminophen • aspirin • caffeine Explanation: The combination of acetaminophen, aspirin, and caffeine may be effective for the treatment of headaches.

14 of 20 The nurse identifies that mefenamic is indicated for: • rheumatoid arthritis. • osteoarthritis. • acute pain. • chronic pain.

• acute pain. Explanation: Mefenamic is indicated in the treatment of episodic acute (not chronic) pain. Rheumatoid arthritis and osteoarthritis are chronic conditions.

5 of 20 The nurse knows that nonsteroidal anti-inflammatory drugs (NSAIDs) are like salicylates in that they have which of the following effects? (Select all that apply.) • antipyretic • anti-platelet • analgesic • anti-inflammatory

• anti-inflammatory • antipyretic • analgesic Explanation: NSAIDs have the same effects as salicylates, which include anti-inflammatory, antipyretic, and analgesic properties. They do not have any anti-platelet effects.

9 of 20 When the nurse teaches a client who has just been diagnosed with migraine headaches and placed on a selective serotonin agonist, an important part of the teaching plan should include that these drugs: • are used to treat actual migraine headaches but will not prevent or reduce the number of headaches. • help with the pain and also will prevent future migraine headaches. • will reduce the number of migraines in the future. • should be taken 1 hour after the headache starts.

• are used to treat actual migraine headaches but will not prevent or reduce the number of headaches. Explanation: Instructions the nurse gives to clients when using selective serotonin agonists for migraine headaches should include these drugs are used to treat the actual migraine and will not prevent or reduce their number, administer the medication at the onset of the headache, doses can be repeated one time after 1 hour (2 hours for nasal spray), and never take more than 2 doses in a 24-hour period.

2 of 20 A nurse is reviewing the medical record of a client who is prescribed NSAID therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found? • acetaminophen • hydrochlorothiazide • aspirin • lisinopril

• aspirin Explanation: A hypersensitivity to aspirin is a contraindication for all NSAIDs. The alternative to aspirin for fever and pain when aspirin is contraindicated is usually acetaminophen. Hydrochlorothiazide and lisinopril are antihypertensives.

15 of 20 Prior to administering NSAIDs, the nurse asks the client about an allergy to: • analgesics. • aspirin. • antibiotics. • acetaminophen.

• aspirin. Explanation: Aspirin allergy is a contraindication for all NSAIDs. Antibiotics and acetaminophen allergies do not affect NSAID use. Analgesics include a wide variety of medications.

6 of 20 An elderly client has taken ibuprofen 800 mg 2 times per day for longer than 10 years. Which laboratory test is the priority assessment? • blood urea nitrogen and serum creatinine • renin and aldosterone levels • complete blood count • 24-hour urine for microalbumin

• blood urea nitrogen and serum creatinine Explanation: Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The client should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen since protein elimination is not affected by NSAIDs. A complete blood count may not be necessary since its emphasis is not related to renal function.

3 of 20 A nurse could recommend a topical preparation containing which herbal product to a client with painful osteoarthritis with pain who has a contraindication to NSAIDs? • ginger • cinnamon • capsicum • garlic

• capsicum Explanation: A topical preparation containing capsicum could be suggested for a client who has osteoarthritis pain and a contraindication to NSAIDs. Ginger, cinnamon, and garlic have other herbal uses; however, the treatment of pain is not one of them. Ginger is helpful to relieve nausea. Cinnamon is helpful with vomiting, diarrhea, and infection (among others). Garlic is helpful to reduce blood pressure.

11 of 20 When assessing a client who is to receive celecoxib, a history of which disease process or condition would be most important to assess? • respiratory disorder • peptic ulcer • cardiac disease • diabetes

• cardiac disease Explanation: Celecoxib is associated with an increased risk of serious cardiovascular thrombosis, myocardial infarction, and stroke, all of which can be fatal. Hence, the nurse should check for history of cardiac diseases in a client being prescribed celecoxib. Use of celecoxib does not increase any risk in clients with a history of peptic ulcer, diabetes, or respiratory disorders.

1 of 20 A nurse is reviewing a journal article about an NSAID that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug? • oxaprozin • ketorolac • celecoxib • sulindac

• celecoxib Explanation: Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk. Sulindac carries the risk of headache, dizziness, and GI upset. Oxaprozin carries the risk of headache, dizziness, insomnia, and ringing in the ears. Ketorolac carries the risk of GI upset, renal effects, and congestive heart failure.

1 of 20 A client has a sulfonamide allergy. Which drug would the nurse identify as being contraindicated? • meloxicam • ibuprofen • ketorolac • celecoxib

• celecoxib Explanation: Celecoxib is contraindicated in clients with a sulfonamide allergy. Ibuprofen, ketorolac, and meloxicam are not contraindicated.

4 of 20 A client is diagnosed with familial adenomatous polyposis. Which nonsteroidal anti-inflammatory agent will reduce the number of polyps and decrease the risk of colon cancer? • probenecid • ibuprofen • nabumetone • celecoxib

• celecoxib Explanation: Celecoxib, a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen and Nabumetone are not recommended for use in preventing familial adenomatous polyposis since neither have effect on the reduction of polyps. Probenecid is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.

18 of 20 After administration of sumatriptan, the client reports experiencing nausea. Which drug does the nurse anticipate the prescriber to order? • imipramine • amitriptyline • chlorpromazine • feverfew

• chlorpromazine Explanation: Antiemetices and opioids are used as adjuvant medications for severe migraine headaches. Chlorpromazine is a phenothiazine that has been shown to be effective for migraines and for nausea and vomiting. Amitriptyline and imipramine are tricyclic antidepressants. Feverfew is an herbal supplement. None of these options have an antiemetic effect.

1 of 20 A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief? • cyclooxygenase-4 • cyclooxygenase-3 • cyclooxygenase-2 • cyclooxygenase-1

• cyclooxygenase-2 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

19 of 20 A nursing instructor is preparing a teaching plan for a class about NSAIDs and the gastrointestinal adverse reactions that they cause. When describing the substance being blocked and responsible for these reactions, the nurse would include which substance? • cyclooxygenase-4 (COX-4) • cyclooxygenase-1 (COX-1) • cyclooxygenase-3 (COX-3) • cyclooxygenase-2 (COX-2)

• cyclooxygenase-2 (COX-2) Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

11 of 20 The nurse assesses the client taking a nonsteroidal anti-inflammatory drug (NSAID) for: • urinary retention. • dyspepsia. • increased appetite. • confusion.

• dyspepsia. Explanation: Dyspepsia includes heartburn, indigestion, bloating, and discomfort in the abdominal area. Confusion, increased appetite, and urinary retention are not side effects of NSAIDs.

18 of 20 The client's concurrent use of what medication would contraindicate the safe use of frovatriptan? • metformin • fluoxetine • albuterol • atorvastin

• fluoxetine Explanation: Frovatriptan interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Neither albuterol, metformin, nor atorvastatin presents a risk for drug interactions.

2 of 20 A client who is on long-term acetaminophen therapy has been taking etodolac for joint pain. The nurse would be alert to which effect that may occur because of an interaction between the two drugs? • increased effectiveness of NSAID • increased risk of bleeding • increased risk of renal impairment • increased absorption of acetaminophen

• increased risk of renal impairment Explanation: There is an increased risk of renal impairment due to an interaction between acetaminophen and an NSAID, which, in this case, is etodolac. Increased absorption of acetaminophen, increased effectiveness of the NSAID, and increased risk of bleeding are not related effects of the interactions of the two drugs. The increased risk of bleeding occurs when an NSAID is administered with anticoagulants.

14 of 20 The nurse should recognize that naproxen achieves a therapeutic effect through which means? • demyelinating pain fibers in the CNS • selectively antagonizing opioid receptors in the CNS • slowing the reuptake of serotonin and acetylcholine in brain synapses • inhibiting the synthesis of COX-1 and COX-2

• inhibiting the synthesis of COX-1 and COX-2 Explanation: Naproxen, prescribed for migraines, is a nonselective inhibitor of cyclooxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2. It does not involve serotonin, acetylcholine, or opioid receptors.

12 of 20 Which medication is prescribed parenterally for severe pain? • acetylsalicylic acid • naproxen • ketorolac • acetaminophen

• ketorolac Explanation: Acetylsalicylic acid, other NSAIDs, and acetaminophen are effective in treating mild to moderate pain associated with conditions such as headache, minor trauma, minor surgery, and other acute and chronic conditions. Ketorolac is used for moderate or severe pain, and although it can be given orally, its unique characteristic is that it can be given by injection. Parenteral ketorolac reportedly compares with morphine and other opioids in analgesic effectiveness.

3 of 20 A client is prescribed piroxicam for osteoarthritis. The nurse would assess the client for which adverse reaction? • dizziness • rash • nausea • constipation

• nausea Explanation: The nurse should monitor the client being treated with piroxicam for nausea. Rash, constipation, and dizziness are adverse reactions of oxaprozin.

1 of 5 A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? • anemia. • peptic ulcer disease or gastritis. • constipation. • interstitial nephritis.

• peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.

19 of 20 The nurse should teach the client prescribed chlorpromazine hydrochloride that this medication is likely to cause what reaction? • major reduction of reoccurring migraines • ability to resume normal routines during a migraine • faster recovery from migraines • reduction of light-sensitivity experienced during migraines

• reduction of light-sensitivity experienced during migraines Explanation: Chlorpromazine hydrochloride has been shown to be effective in treating both the headache itself and the associated nausea and vomiting. Investigators have also shown that antiemetic drugs decrease the photophobia and phonophobia that may accompany the migraine headache. Adjuvant drugs do not necessarily prevent migraines or allow normal routines during a migraine. They may not hasten recovery from migraines.

4 of 20 A client is diagnosed with migraine headaches. Which class of medication would the nurse expect to be prescribed as treatment for the acute pain associated with migraine headaches? • selective serotonin agonists • anticonvulsants • beta blocker • calcium channel blockers

• selective serotonin agonists Explanation: Selective serotonin agonists are used to treat the acute pain associated with migraine headaches. Beta blockers are used for prophylactic migraine treatment. Calcium channel blockers are used for prophylactic migraine treatment. Anticonvulsants are used for prophylactic migraine treatment.

4 of 20 A nurse is caring for a client who has just been diagnosed and is suffering with migraine headaches. The nurse anticipates that the physician will order which type of drug to treat the pain? • ACE inhibitors • selective serotonin drugs • salicylates • NSAIDs

• selective serotonin drugs Explanation: The drugs of choice for relief of moderate to severe pain and inflammation related to migraine headaches are the selective serotonin drugs. The others are not prescribed treatments for migraine headaches.

16 of 20 A nurse who is providing health education for a client recently diagnosed with migraines should convey what point? • the importance of avoiding foods that may precipitate migraines • the role of herbal supplements in preventing migraines • the importance of limiting all forms of psychosocial stress • the need to maximize light exposure to prevent migraines

• the importance of avoiding foods that may precipitate migraines Explanation: Foods that precipitate migraine effects include aged cheeses, fermented foods, aspartame, monosodium glutamate, and chocolate. Stress is not a known salient causative factor. Herbal supplements and increased light exposure are unlikely to be of benefit.

8 of 20 The nurse caring for a client with a history of migraine headaches can expect this client to be on medications for which reason? • to prevent a coma • to treat pain • prophylactically to prevent spasms • to prevent another disease from developing

• to treat pain • prophylactically to prevent spasms Explanation: Drugs used to treat migraine headaches are given (1) prophylactically to prevent spasms or (2) to treat acute pain when a migraine occurs. Drugs are not given to prevent a coma or to prevent another disease.

8 of 20 The nurse caring for a client with a history of migraine headaches can expect this client to be on medications for which reason? SATA • to prevent a coma • to treat pain • prophylactically to prevent spasms • to prevent another disease from developing

• to treat pain • prophylactically to prevent spasms Explanation: Drugs used to treat migraine headaches are given (1) prophylactically to prevent spasms or (2) to treat acute pain when a migraine occurs. Drugs are not given to prevent a coma or to prevent another disease.

16 of 20 Estradiol has been prescribed for migraines associated with the menstrual cycle. What will be the preferred route of administration? • intramuscular • transcutaneous • sublingual • intravenous

• transcutaneous Explanation: Transcutaneous administration of estradiol increases the estrogen levels in the late luteal phase of the menstrual cycle that contribute to the development of menstrual migraine headaches. None of the other routes of administration would encourage the necessary protein synthesis.