NCLEX-RN PRACTICE QUESTION

NCLEX-RN PRACTICE QUESTION

1.  A patient is prescribed ibuprofen 800 mg every 4 hours for the treatment of rheumatoid arthritis (RA). Which of these clinical manifestations should the healthcare provider anticipate observing if the patient is developing an adverse effect from the medication?

Select all that apply.

Select all that apply.

• Patient report of epigastric pain
• Positive fecal occult blood test
• Decreased serum albumin
• Increased blood urea nitrogen (BUN)
• Increased serum hematocrit

HINTS:

1.  Recall the medication’s mechanism of action.

2.  NSAIDs like ibuprofen inhibit COX-1 and COX-2

3.  Inhibiting COX-1 and COX-2 results in decreased prostaglandins

4.  Pain is managed when COX-1 is inhibited.

5.  COX-2 is sometimes referred to as “good COX” (while COX-1 is sometimes called “bad COX), because when COX-2 is inhibited, prostaglandins that serve important normal functions are impaired. Prostaglandins are needed for the integrity of the peptic mucosal lining and maintenance of renal perfusion. Epigastric pain (peptic ulcer), blood in the stool (bleeding ulcer), and increased BUN (decreased renal perfusion and increased reabsorption of blood from the GI tract) are all indications that the patient may be experiencing a bleeding peptic ulcer.

ANSWER: 1, 2, 4