# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375132&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

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?

## Option

1. I will take it on an empty stomach so it works faster.
2. I will take it with food or milk, watch for black tarry stools or coffee-ground vomiting, monitor my blood pressure and avoid combining it with aspirin or alcohol, and report any new ankle swelling or decreased urine output. **✔ Correct answer**
3. I will combine it with aspirin every day to get extra cardiac protection.
4. I can take it with my prednisone for stronger effect.

**Correct answer: 2**

## Explanation

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.

## In-depth explanation

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.

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