# Situation: The nurse works in an outpatient clinic that manages clients with gastritis and peptic ulcer disease. Four clients have taken ibuprofen daily for 3 months. Which client has the HIGHEST risk of an ulcer induced by a nonsteroidal anti-inflammatory drug (NSAID)?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630373  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: The nurse works in an outpatient clinic that manages clients with gastritis and peptic ulcer disease.

Four clients have taken ibuprofen daily for 3 months. Which client has the HIGHEST risk of an ulcer induced by a nonsteroidal anti-inflammatory drug (NSAID)?

## 보기

1. A 72-year-old who also takes paracetamol for back pain
2. A 40-year-old who smokes about 10 cigarettes a day
3. A 40-year-old who eats spicy food and has a stressful job
4. A 72-year-old who also takes prednisone for arthritis **✔ 정답**

**정답: 4**

## 해설

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause ulcers by blocking protective prostaglandins. The risk rises sharply with older age and when NSAIDs are combined with corticosteroids, anticoagulants, antiplatelet drugs, or selective serotonin reuptake inhibitors. The 72-year-old taking prednisone has two added risk factors.

## 심화 해설

The client with the highest risk
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause ulcers mainly by inhibiting cyclooxygenase and blocking the prostaglandins that protect the gastric mucosa. The risk of an NSAID ulcer rises sharply with older age and when NSAIDs are combined with corticosteroids, anticoagulants, antiplatelet drugs, or selective serotonin reuptake inhibitors. The 72-year-old who also takes prednisone has two added risk factors and therefore the highest risk.

Why age and corticosteroids add risk
With aging, mucosal defenses weaken, blood flow to the mucosa decreases, and older adults often take more medicines and have more comorbidities. Prednisone impairs mucosal healing and, combined with an NSAID, markedly raises the risk of ulcer and bleeding. Ulcers in older adults may also cause few symptoms until a complication such as bleeding or perforation occurs.

| Client | Added factor | Effect on NSAID ulcer risk |
| --- | --- | --- |
| 72-year-old taking paracetamol | Age only | Paracetamol does not injure the gastric mucosa |
| 40-year-old smoker | Smoking | Delays healing; no age or corticosteroid risk |
| 40-year-old with spicy food and stress | Diet and stress | May worsen symptoms but do not cause ulcers |
| 72-year-old taking prednisone | Age plus corticosteroid | Highest risk |

Why the other clients are at lower risk
Paracetamol (acetaminophen) relieves pain without significant effects on gastric prostaglandins, so it does not add to ulcer risk; only age applies to that client. Smoking delays ulcer healing and increases recurrence, but the 40-year-old smoker has no age or corticosteroid factor. Watch out! Spicy food and stress are popular explanations for ulcers, but they do not cause them. They may aggravate symptoms in some people, but the main causes of peptic ulcer are Helicobacter pylori and NSAIDs.

Preventive nursing actions
For high-risk clients who must continue NSAIDs, the prescriber may use the lowest effective dose for the shortest time, consider alternatives such as paracetamol, and add gastroprotection such as a proton pump inhibitor. The nurse teaches clients to take NSAIDs with food, to avoid combining them with other over-the-counter NSAIDs, and to report black or tarry stools, vomiting of blood or coffee-ground material, dizziness, or new epigastric pain.

Exam takeaway
Key point! NSAID ulcer risk increases with older age and with corticosteroids, anticoagulants, antiplatelet drugs, or SSRIs. Spicy food and stress do not cause ulcers, and paracetamol does not injure the gastric mucosa.

## 임상 시나리오

NSAID Ulcer Risk FactorsFinding the highest-risk client
NSAIDs block protective prostaglandins. Risk rises sharply with older age and with corticosteroids, anticoagulants, antiplatelet drugs, or SSRIs.

The 72-year-old taking prednisone has two added risk factors and the highest risk.

Paracetamol does not injure the gastric mucosa. Smoking delays healing. Spicy food and stress may worsen symptoms but do not cause ulcers.

CautionOlder adults may have silent ulcers until bleeding occurs. Teach them to report black stools, vomiting of blood, or dizziness at once.

## 핵심 개념

- **NSAID** — Nonsteroidal anti-inflammatory drug that relieves pain and inflammation by blocking cyclooxygenase.
- **Prostaglandins** — Lipid mediators that protect the gastric mucosa by promoting mucus and bicarbonate secretion.
- **Corticosteroid** — An anti-inflammatory hormone drug such as prednisone that increases NSAID ulcer risk.
- **Paracetamol** — A pain reliever and antipyretic (acetaminophen) that does not injure the gastric mucosa.
- **Gastroprotection** — Use of drugs such as proton pump inhibitors to reduce NSAID-related ulcer risk.

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