A 55-year-old client with hypertension and a history of GERD is starting ibuprofen 600 mg three times daily for shoulder bursitis. Which client statement indicates correct understanding of safe NSAID use?

Nonselective NSAIDs such as ibuprofen, naproxen, and ketorolac inhibit COX-1 and COX-2 to reduce prostaglandin-mediated inflammation, pain, and fever, but at the cost of GI mucosal injury, renal vasoconstriction, fluid retention, hypertension, and increased cardiovascular risk. Standard teaching: (1) take with food, milk, or a full glass of water to limit GI upset; (2) GI bleeding signs — melena, hematemesis or coffee-ground emesis, epigastric pain, anemia, and unexplained fatigue — warrant immediate evaluation; risk is amplified by age over 60, prior ulcer, anticoagulants, corticosteroids, alcohol, and dual NSAIDs; (3) monitor BP because NSAIDs raise BP and blunt antihypertensive effect; (4) renal warnings — decreased urine output, ankle edema, weight gain, or rising creatinine require holding the drug; (5) cardiovascular warning class label about MI and stroke; (6) do not combine NSAIDs with each other, with corticosteroids, with anticoagulants without prescriber oversight; (7) if low-dose aspirin is also prescribed, take aspirin at least 30 to 60 minutes before ibuprofen and separate by 8 hours after, otherwise ibuprofen blocks the antiplatelet effect; (8) avoid in third-trimester pregnancy because of premature ductus closure. Empty stomach, ibuprofen plus aspirin daily, and ibuprofen plus prednisone are all incorrect.

Take with food, watch GI bleed signs, monitor BP and renal output, separate from aspirin if needed, avoid alcohol and combo. The food-plus-bleeding-watch-plus-aspirin-spacing rule is the NCLEX core for ibuprofen.