A 70-year-old man with a history of osteoarthritis has been taking Ibuprofen 600 mg three times daily for chronic knee pain. During a routine check-up, his blood pressure is found to be elevated at 160/95 mmHg, up from his usual 135/85 mmHg. Laboratory tests reveal an elevation in his kidney function tests and serum potassium level. Which of the following adverse effects of NSAIDS best explains these findings?

Cardiotoxicity

Nephrotoxicity

Neurotoxicity

Hepatotoxicity

Answer and Explanation

The Correct Answer is B

A. Cardiotoxicity: While NSAIDs can contribute to cardiovascular risks such as hypertension and fluid retention, nephrotoxicity is the more direct explanation for the elevated kidney function tests and potassium level. Cardiotoxicity typically presents with symptoms like heart failure or arrhythmias rather than kidney-related lab abnormalities.
B. Nephrotoxicity: NSAIDs inhibit prostaglandin synthesis, which plays a key role in maintaining renal blood flow, especially in older adults or those with preexisting renal impairment. Chronic NSAID use can reduce glomerular filtration, leading to elevated creatinine, hyperkalemia, and worsening blood pressure control, all of which are evident in this patient.
C. Neurotoxicity: Neurotoxic effects are not commonly associated with NSAID use. Symptoms of neurotoxicity include confusion or seizures, which are not relevant to the clinical findings in this scenario.
D. Hepatotoxicity: NSAID-induced liver injury is rare and would typically present with elevated liver enzymes (AST, ALT), not elevated creatinine or potassium. The current lab findings and blood pressure changes are more consistent with kidney involvement.

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Correct Answer is C

Explanation

A. Montelukast: This leukotriene receptor antagonist is used for long-term asthma control and prevention of exercise-induced bronchospasm. It is not effective for treating acute asthma attacks due to its delayed onset of action.
B. Salmeterol: This is a long-acting beta-2 agonist (LABA) used for maintenance therapy in asthma. It has a slower onset and should never be used for rapid symptom relief during an acute attack, as doing so can delay appropriate treatment.
C. Albuterol: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid bronchodilation and is the first-line rescue medication for aborting an acute asthma attack. It works within minutes to relieve bronchospasm and improve airflow.
D. Beclomethasone: This inhaled corticosteroid is used for long-term asthma management by reducing airway inflammation. It is not effective in acute situations because it does not provide immediate bronchodilation.

A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." C. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting." D. "I'll dial 911 when I have pain and then take the nitroglycerin tablets."

Correct Answer is C

Explanation

A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart.": While this reflects part of the correct sequence, waiting until all 3 doses are taken before seeking emergency help may delay life-saving treatment. Emergency services should be contacted sooner if the first dose is ineffective.
B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period.": This exceeds the recommended maximum of three sublingual nitroglycerin tablets within 15 minutes. Taking more than advised can increase the risk of hypotension and other complications.
C. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.": This is the correct protocol. If chest pain persists after the first dose, the patient should immediately call 911 and may continue with up to two additional doses, each 5 minutes apart, while waiting for emergency responders.
D. "I'll dial 911 when I have pain and then take the nitroglycerin tablets.": Calling 911 immediately without trying the medication first may lead to unnecessary emergency activation. The recommended approach is to take the first dose, then call if pain persists after 5 minutes.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a new diagnosis of asthma. Which of the following medications should the nurse instruct the client to use to abort an acute asthma attack?

Correct Answer is C

Explanation

A nurse is providing teaching to a client who has angina and a new prescription for Nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

A nurse is preparing to administer a triptan medication to a patient experiencing an acute migraine. Which of the following statements about triptan administration is correct?

A nurse is reviewing the concept of therapeutic index for medications. Which of the following statements best describes a drug with a narrow therapeutic index?

A nurse is providing teaching for a client who has anemia and a new prescription for Ferrous Sulfate liquid. Which of the following instructions should the nurse provide?

Order: Citalopram 20 mg PO q24hr Available: Refer to the med label below How many milliliters will you administer per dose? (Insert the numerical value only)

A nurse is educating a patient who is starting a new antidepressant medication. Which statement by the nurse is most accurate regarding the risk of suicidal thoughts and behaviors associated with antidepressant use?

4.5 cups =____ounces (Fill in the blank with the numerical value only)

A nurse is administering a medication with a half-life of 6 hours. If the initial dose is 800 mg, how much of the medication will remain in the patient's system after 18 hours?