Exam 5 Questions Pharm

A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast cancer. the nurse should tell the client that which of the following are adverse effects of this medication (SATA) 1. deepening voice 2.weight gain 3. low blood pressure 4. dry mouth 5. facial hair

1, 2, 5. development of adult male characteristics can be an adverse effect, edema and weight gain are adverse effects and facial hair

a nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. the nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives (SATA) 1. thickening the cervical mucus 2.inducing maturation of ovarian follicle 3. increasing development of the corpus luteum 4.altering the endometrial lining 5.inhibiting ovulation

1, 4,5.

a nurse is caring for a client who is in labor and is receiving oxytocin. the nurse should monitor the client for which of the following as complications of oxytocin? (SATA) 1. uterine rupture 2. uterine tachysystole 3.placental abruption 4.hyponatremia 5. placenta previa

1,2, 3, 4

a nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. which of the following actions should the nurse take (SATA) 1. use an infusion pump for administration 2. obtain vitals frequently and with every dosage 3. stop infusion if uterine contractions occur every 4 min and last 45 seconds 4. increase medication infusion rate rapidly 5. monitor fetal heart rate continuously

1,2,5. ensure precise dosage, monitor for hypertension, and assess for fetal distress

5. A nurse should anticipate the administration of vita-min K (AquaMEPHYTON) for which of the following patients? (Select all that apply.) 1. A newborn infant 2. The patient with visual disturbances 3. The patient who received an overdose of certain oral anticoagulants 4. The patient with hypothyroidism 5. A teenager with chronic acne

1. A newborn infant 3. The patient who received an overdose of certain oral anticoagulants Vitamin K is routinely given to newborn infants to prevent bleeding post delivery. Vitamin K decreases the anticoagulant effects of the drug warfarin

The nurse is teaching a 25-year-old patient about the administration of ciprofloxacin with hydrocortisone (Cipro) for otitis. In which order will the nurse instruct the patient to use the drug? 1. Gently massage the area in front of the ear. 2. Pull the earlobe upward and back. 3. Allow the drop to fall into the ear canal flowing down the side. 4. Remain with the treated ear in an uppermost position for 5 minutes.

2, 3,1, 4 The ear should be pulled gently upward and back and the drop instilled, allowing it to flow down the side of the canal.

a nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil to treat erectile dysfunction. which of the following medications is contraindicated with sildenafil? 1. aspirin 2.isosorbide 3.clopidogrel 4.atorvastatin

2. organic nitrate that manages pain from angina. concurrent use of it is contraindication d/t fatal hypotension can occur

3- a nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy (SATA) 12 year old child who has iron deficiency anemia 24 year old female who has no health problems 44 year old male who has hypertension 55 year old female who has alcohol use disorder 35 year old male who has type 2 diabetes mellitus

24 year old female who has no health problems 55 year old female who has alcohol use disorder Childbearing age should take folic acid to prevent neural tube defects in the fetus Excess alcohol consumption leads to poor dietary intake of folic acid and injury to the liver

The nurse has received a telephone call from an anx-ious mother of an 18-month-old child. In a panicked voice, the mother states, "I just discovered that my baby has swallowed an unknown amount of house-hold cleanser." Which instruction would be appropriate for the nurse to give? 1. "Consult the package instructions for information concerning poisoning." 2. "Force your child to vomit using a mixture of warm water and raw eggs." 3. "Call 911 to take your child immediately to the nearest emergency department or healthcare agency." 4. "If your child develops seizures or difficulty breathing, call the healthcare provider."

3. "Call 911 to take your child immediately to the nearest emergency department or healthcare agency." Time is a critical factor in acute poisonings. The emergency should be called into 911 and the rescue squad should should transport the child to the nearest healthcare facility immediately

Activated charcoal is ordered for a patient who unin-tentionally overdosed on prescription medications. The nurse would question the order for activated charcoal for the patient with which condition? 1. Acute hepatitis and cirrhosis 2. Chronic kidney disease 3. Decreased level of consciousness 4. Anxiety and nervousness

3. Decreased level of consciousness Patients with decreased sensorium are at high risk for pulmonary aspiration. Activated charcoal should be given to these patients only if the airway is maintained with an endotracheal tube

A nurse is reviewing the health care record of a client who is asking about conjugated quine estrogens. The nurse should inform the client this medication is contraindication in which of the following conditions? 1.atrophic vaginitis 2. dysfunctional uterine bleeding 3.osteoporosis 4. thrombophlebitis

4, estrogen increases the risk of thrombolytic events. estrogen use is contraindicated for a client who has a history of thrombophlebitis

The nurse is teaching a patient about a new eye drop prescription for timolol (Timoptic) for treatment of open-angle glaucoma. The patient has a history of seasonal allergies and hypertension. What is an important administration technique to stress for this patient? 1. Take any eye drops for allergies 5 minutes before administering the timolol drops. 2. Do not use the timolol drops while concurrently taking allergy medication. 3. The timolol drops may temporarily worsen seasonal allergies. 4. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

4. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop. Timolol is a beta-adrenergic blocker. To prevent swallowing and systemic absorption, pressure is to be applied to the inner canthus of the eye for 1 minute after instilling the drop

1- a nurse is teaching a client who has anemia and a new prescription for a liquid iron supplement. Which of the following information should the nurse include in the teaching? (SATA) Add food that are high in fiber to your diet Rinse you vermouth after taking the medication Expect stools to be green or balck in color Take the medication with a glass of milk Add red meat to your diet

Add food that are high in fiber to your diet Rinse you vermouth after taking the medication Expect stools to be green or black in color Add red meat to your diet Can prevent constipation, which can occur when taking iron supplements Can stain teeth when taken in a liquid form. The client should rinse orally after taking the medication Dark green or black stools can occur when taking iron supplements. The client should anticipate this effect High in iron and recommended for a client to improve anemia when taken concurrently with iron supplements

3. Ondansetron (Zofran) has been ordered prior to che-motherapy for a patient receiving treatment for lym-phoma. Prior to administering this drug, the nurse will review the patient's past medical history for what condition? 1. Allergy to soy or soy products 2. History of chronic constipation 3. Glaucoma 4. Cardiac dysrhythmias

Answer: 4 Rationale: Ondansetron is known to prolong the QT interval and may cause cardiac dysrhythmias.

. Pyridoxine (vitamin B6) may cause antagonistic drug effects for the patient taking: 1. Isoniazid (INH). 2. Oral contraceptives. 3. Hydralazine (Apresoline). 4. Antiparkinsonism drugs.

Antiparkinsonism drugs. Pyridoxine may reverse or antagonize the effects of antiparkinsonism drugs

6. Which of the following measures is used to assess the presence of obesity? (Select all that apply.) 1. Body weight 2. Body mass index 3. Waist circumference 4. Treadmill test 5. Buoyancy analysis

Body weight Body mass index Waist circumference All indicators of obesity levels

1. A patient is prescribed lorcaserin (Belviq) for the treatment of obesity and is concerned about the risks involved with the drug. Which of the following should the nurse include when teaching this patient? 1. If less than a 5% weight loss has been achieved after 3 months, a different weight loss regimen may be needed. 2. There is no need to worry about any long-term effects if they do not occur when the drug is taken. 3. Begin to see a cardiologist monthly until any cardiovascular risk has been ruled out. 4. Contact the drug company about follow-up programs.

If less than a 5% weight loss has been achieved after 3 months, a different weight loss regimen may be needed. It is recommended that the drug should be discontinues and other options be considered

6. The nurse would suspect a calcium deficiency in the patient exhibiting: 1. Night blindness. 2. Anemia. 3. Muscle cramping and spasms. 4. Bleeding abnormalities.

Muscle cramping and spasms. Muscle cramping and spasms may be early signs of hypocalcemia

.2. A patient asks the provider about a prescription for phentermine (Adipex-P) for obesity. Which of the following would be considered a contraindication for the use of this drug? 1. Extreme obesity 2. A history of type 2 diabetes managed with oral antidiabetic drugs 3. A history of hypertension managed with beta blockers 4. Pregnancy

Pregnancy Phentermine is a pregnancy category X drug and should not be used if the patient is pregnant or there is possibility of pregnancy

5-a nurse is teaching a client about probiotic supplements. Which of the following information should the nurse include (SATA) Probiotics are microorganisms that are normally found in the GI tract Probiotics are used to treat C.diff Probiotics are used to tx benign prostatic hyperplasia You can experience bloating while taking probiotic supplements

Probiotics are microorganisms that are normally found in the GI tract Probiotics are used to treat C.diff - Tx IBS, diarrhea, ulcerative colitis You can experience bloating while taking probiotic supplements - Flatulence and bloating

The nurse is teaching the patient about the need for adequate intake of zinc in the diet. The nurse will teach the patient to increase consumption of: 1. Protein foods such as beans, lentils, and nuts. 2. Vegetables such as leafy greens, carrots, and squash. 3. Citrus such as grapefruit, oranges, and lemons. 4. Cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts.

Protein foods such as beans, lentils, and nuts. Zinc is found in protein foods such as beans, lentils, nuts, meats and dairy

1. To meet his nutritional goals, the patient is placed on enteral feedings via a nasogastric (NG) tube. Which intervention should the nurse perform in order to ensure that the patient is maintaining a proper fluid balance? 1. Weigh the patient every other day. 2. Maintain a strict record of intake and output, and flush the nasogastric tube once a day. 3. Provide additional free water in addition to that used for irrigating the tube. 4. Assess the skin around the tube insertion site for any drainage or irritation.

Provide additional free water in addition to that used for irrigating the tube. A patient receiving enteral feedings can be at risk for dehydration caused by inadequate intake of free water. Important to irrigate the tube with water as ordered or per protocol and to include additional free water throughout the day unless contraindicated

The patient is suspected of having been exposed to ionizing radiation. Which nursing intervention would have the greatest priority? 1. Provide supportive care for nausea, vomiting, and diarrhea. 2. Limit the patient's exposure to ultraviolet light. 3. Avoid contamination of self through limited exposure to the patient. 4. Administer anti radiation medications as indicated.

Provide supportive care for nausea, vomiting, and diarrhea. No antidote or specific treatment exists for radiation poisoning. Supportive therapy for the associated symptoms is the only treatment available

The nurse knows that the mechanism of action for chelating therapy is: 1. Removal of positively charged metals. 2. Deactivation of chemical reaction. 3. Increased liver metabolism. 4. Decreased glomerular filtration.

Removal of positively charged metals. Chelating drugs capture the toxic metal through a bonding process. The kidneys removed both the chelator and the metal bound to it from the body

A nurse is teaching a client who has a new prescription for brimonidine ophthalmic drops and wears soft contact lenses. Which of the following instructions should the nurse include in the teaching? This medication can stain your contacts This medication can cause your pupils to constrict This medication can absorb into your contacts This medication can slow you heart rate

This medication can absorb into your contacts Can absorb into soft contact lenses. Client should remove them and wait 15 minutes before putting contacts back in

A nurse is teaching a client about preventing otitis externa. Which of the following instructions should the nurse include? Clean the ear with a cotton-tipped swab daily Place earplugs in the ears when sleeping at night Use a cool water irrigation solution to remove earwax Tip the head to the side to remove water from the ears after showering

Tip the head to the side to remove water from the ears after showering Client should remove water from the ear after showering or swimming to reduce the risk for otitis externa

Which of the preadministration assessment parame-ters would the nurse consider before administering edetate calcium disodium (Calcium EDTA) to a patient? 1. Bowel sounds 2. Urinary output 3. Visual acuity 4. Skin turgor

Urinary output Edetate calcium disodium may produce renal damage that may be reduced by ensuring adequate diuresis before therapy begins

2. Vitamin C (ascorbic acid) may cause a false-negative result in ______________ if taken within 48 to 72 hours of testing.

Vitamin C may cause a false negative result in occult blood if taken within 48-72 hours of testing

a nurse is teaching a client about terbutaline. which of the following statements by the client indicates understanding of the teaching? 1. this medication will stop my contractions 2. this medication will prevent vaginal bleeding 3. this medication will promote blood flow to my baby 4. this medication will increase my prostaglandin production

1. blocks beta2 adrenergic receptors which causes uterine smooth muscle relaxation

3. The nurse is making rounds at the beginning of the shift and notes that the patient's total parenteral nutrition bag is empty. Which solution should the nurse hang until the total parenteral nutrition solution can be properly prepared and delivered to the nursing unit? 1. 5% dextrose in water (D5W) 2. 5% dextrose in Ringer's lactate (D5RL) 3. 5% dextrose in 0.9% sodium chloride (D5NS) 4. 10% dextrose in water (D10W)

10% dextrose in water (D10W) Contains the highest concentration of glucose and should be hung until the new TPN bag is available. The solution selected should minimize the risk of hypoglycemia

2. The patient who is taking sulfasalazine (Azulfidine) develops a sore throat, bruising, and severe fatigue. The nurse determines that the patient is most likely experiencing drug-induced: 1. Stevens-Johnson syndrome. 2. Blood dyscrasias. 3. Idiosyncratic reaction. 4. Hypersensitivity response.

Answer: 2 Rationale: One adverse effect of sulfasalazine is blood dyscrasias, which may include anemia, leukopenia, and thrombocytopenia. Fever, an increase in bruising, and sore throat are all possible symptoms of these decreased cell counts.

4. A nurse should question the order for pancrelipase (Pancreaze) for which patient? 1. The patient with allergy to pork products 2. The patient with hypertension 3. The patient with coronary artery disease 4. The patient with hypersensitivity to iodine products.

Answer: 1 Rationale: The enzymes in pancrelipase come from pork. If the patient is allergic to or has religious restrictions on pork, the drug is contraindicated.

1. An adult patient has been receiving testosterone (Testoderm) for the treatment of primary hypogo-nadism. Which laboratory test would the nurse monitor to determine that this drug therapy is effective? 1. Red blood cell count 2. Sperm count 3. FSH 4. LH

Answer: 2 Rationale: Primary hypogonadism results in patients with normal pituitary function and testes that are either diseased or unresponsive to FSH and LH. A primary goal of ther-apy would be an increased sperm count with an increase in male masculinization.

5. A healthcare provider orders magnesium hydroxide (Milk of Magnesia) for a patient with constipation, secondary to postoperative opioid use. Before admin-istering the drug, the nurse would assess: 1. Blood pressure. 2. Dosage of the opioid drug prescribed. 3. The patient's ability to ambulate to the bathroom. 4. Bowel sounds.

Answer: 4 Rationale: Because magnesium hydroxide will stimulate peristalsis, it is important for the nurse to assess for bowel sounds before giving the drug. If blockage or an ileus is suspected, the drug should be held and the provider notified.

a nurse in a provider's office is instructing a guardian of a toddler how to administer ear drops. Which of the following instructions should the nurse include (SATA) Place the child on the unaffected side when you are ready to administer the medication Warm the medication by gently rolling it between your hands for a few minutes Gently shake medication that is in suspension form Keep the child on their side for 5 minutes after instillation of the ear drops Tightly pack the ear with cotton after instillation of the ear drops

Place the child on the unaffected side when you are ready to administer the medication Warm the medication by gently rolling it between your hands for a few minutes Gently shake medication that is in suspension form Keep the child on their side for 5 minutes after instillation of the ear drops

The patient has been discharged home on total parenteral nutrition therapy. When making the home visits, which assessments should the home care nurse closely monitor? 1. Temperature and blood pressure 2. Temperature and weight 3. Pulse and blood pressure 4. Pulse and weight

Temperature and weight The patient's temperature should be monitored for signs of infection and subsequent sepsis, which are complications of TPN therapy. The weight is monitored to assess the nutritional effectiveness of the TPN and to detect signs of fluid overload

6. The patient who is receiving enteral nutrition via a PEG tube suddenly spikes a fever of 38.6°C (101.5°F). The nurse notifies the healthcare provider who orders the solution and tubing to be changed immediately. Preventive measures to limit the risk of infection from enteral feedings include which of the following? (Select all that apply.) 1. Refrigerate unused portions of feeding. 2. Hang a feeding solution no longer than 4 hours. 3. Wash feeding bags and tubes before reusing. 4. Use plain water to irrigate the tube between feedings. 5. Maintain sterile technique whenever initiating a new feeding solution.

Refrigerate unused portions of feeding. Hang a feeding solution no longer than 4 hours. Refrigerating unused enteral feeding solutions and limiting the length of time the solution is not refrigerated will prevent the growth of pathogens

a nurse in an emergency department is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. Which of the following findings are indicative of this condition? Insidious onset of painless loss of vision Gradual reduction in peripheral vision Severe pain around eyes Intraocular pressure 12mmHg

Severe pain around eyes Radiates over the face is a manifestation of acute angle-closure glaucoma

a nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client to avoid which of the following laxatives? Sodium phosphate Psyllium Bisacodyl Polyethylene glycol

Sodium phosphate Causes fluid retention which can exacerbate heart failure

4. While taking orlistat (Alli), the nurse would instruct the patient to do which of the following? 1. Drink at least 2 to 3 liters of diet soda per day. 2. Always wear sunscreen when outdoors or when exposed to direct sunlight 3. Rise slowly from a sitting or supine position. 4. Take a daily vitamin supplement containing fat-soluble vitamins.

Take a daily vitamin supplement containing fat-soluble vitamins. Intake of the proper amount and type of vitamins and nutrients is important in a healthy weight loss program. Interferes with lipid absorption, the patient should be taught to supplement the diet with a product that contains all the essential fat-soluble vitamins. The supplement should be taken at least 2 hours before or after the orlistat

a nurse is reviewing a new prescription for terbutaline with a client who has a history of preterm labor. which of the following client statements indicates understanding of the teaching? 1. i can increase my activity now 2. i will increase my daily fluid intake to 3 quarts 3. i will report increasing intensity of contractions to my doctor 4. i am glad this will prevent preterm labor

3. client should report increasing intensity, frequency or duration of contractions to the provider. manifestations of preterm labor

a nurse is providing teaching to a client who will start alfuzosin for treatment of BPH. the nurse should instruct the client that which of the following is an adverse effect of this medication? 1.bradycardia 2.edema 3.hypotension 4.tremor

3. relaxes muscle tone in veins and cardiac output decreases, which leads to hypotension. client taking this medication are advised to rise slowly from sitting or lying position

2. The patient who is taking estradiol and drospirenone (Yasmin) informs the nurse that she forgot to take her pills for the past 2 days. Which response by the nurse would be best when addressing this concern? 1. "Take two pills today and tomorrow then resume your normal dosage." 2. "Take one pill now and resume your normal dosage time tomorrow." 3. "Skip another day and then resume the normal medication schedule." 4. "Stop taking the pills and have a pregnancy test performed as soon as possible."

Answer: 1 Rationale: If two consecutive days are missed, the patient should take two pills on the day it is discovered, two pills the following day, then resume the normal one pill per day routine. A second method of contraception should be used for 7 days after resuming the pills.

2. The patient with erectile dysfunction is being evalu-ated for pharmacotherapy. Which question should the nurse ask prior to initiating therapy with sildenafil (Viagra)? 1. "Are you currently taking medications for angina?" 2. "Do you have a history of diabetes?" 3. "Have you ever had an allergic reaction to penicillin products?" 4. "Have you ever been treated for gastric ulcers?"

Answer: 1 Rationale: The use of nitrates is contraindicated with sildenafil because dangerous hypotension may result

5. A patient has been diagnosed with H. pylori as the causative factor for a gastric ulcer. Which of the fol-lowing drug orders would be considered first-line therapy? (Select all that apply.) 1. Omeprazole 2. Metronidazole 3. Sucralfate 4. Bismuth subsalicylate 5. Fluconazole

Answer: 1, 2, 4 Rationale: First-line therapy for H. pylori includes a combination of a PPI such as omeprazole; antibiotics such as metronidazole, clarithromycin, or amoxicillin; and bis-muth subsalicylate.

The patient has developed severe diarrhea following 4 days of self-administered antacid preparation. The nurse suspects that the diarrhea may be caused by which type of antacid? 1. Aluminum compounds 2. Magnesium compounds 3. Calcium compounds 4. Sodium compounds

Answer: 2 Rationale: Magnesium compounds, especially in higher doses, often cause diarrhea.

6. Rank the following contraceptive methods in order of effectiveness from most to least effective: 1. Depo-Provera 2. Spermicides 3. Calendar rhythm 4. Oral contraceptives 5. Transdermal (Ortho-Evra)

Answer: 5, 1, 4, 3, 2 1. Depo-Provera: 94% effective 2. Oral contraceptives: 91% effective 3. Transdermal (Ortho-Evra): 91% effective 4. Calendar rhythm: 76% effective 5. Spermicides: 72% effective

The nurse is providing health teaching to a patient who has been prescribed latanoprost (Xalatan) for open-angle glaucoma. While harmless, the nurse would caution the patient about which potential nonocular effects of the drug? (Select all that apply.) 1. Darkening and thickening of the upper eyelid 2. Darkening and thickening of eyelashes 3. A lightening of iris color and a slight darkening of the sclera 4. A slight darkening of the iris color 5. A permanent bluish tint to the conjunctiva

1. Darkening and thickening of the upper eyelid 2. Darkening and thickening of eyelashes 4. A slight darkening of the iris color May cause thickening and darkening of the eyelashes and upper eyelid and may cause darkening of the iris, especially noticeable in patients with light eye colors

a nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate IV continuous infusion. which of the following findings should the nurse report to the provider? 1. 2+ deep tendon reflexes 2. 2+ pedal edema 3. 24 mL/hr urinary output 4. respirations 12/min

3. urine output less than 25 to 30 mL/hr is associated with magnesium sulfate toxicity and should be reported

The nurse is instilling drops of phenylephrine (Neo-Synephrine) into the patient's eye before cataract sur-gery. Phenylephrine is used prior to cataract surgery because it causes ________________, allowing visual-ization of the operative area.

Phenylephrine causes mydriasis, allowing better visualization of the area of the lens during cataract surgery

5. The nurse is teaching the patient about the use of fin-asteride (Proscar). What patient teaching related to this medication is needed? (Select all that apply.) 1. Finasteride promotes shrinkage of an enlarged prostate and helps restore urinary function. 2. The drug should not be handled by women who may be pregnant. 3. Finasteride affects both near and far vision in older adult men. 4. Six to 12 months may be required before the benefits of finasteride are achieved. 5. The drug may cause significant dizziness, which can be avoided by making position changes slowly

Answer: 1, 2, 4 Rationale: Finasteride promotes shrinkage of enlarged prostates and subsequently helps restore urinary function. Women should avoid handling crushed medication because it may be absorbed through the skin and have terato-genic effects. Maximum benefit may take 6 to 12 months to be achieved.

2. Omeprazole (Prilosec) is prescribed for a patient with gastroesophageal reflux disease. The nurse would monitor a reduction in which symptom to determine if the drug therapy is effective? (Select all that apply.) 1. Dysphagia 2. Dyspepsia 3. Appetite 4. Nausea 5. Belching

Answer: 1, 2, 4, 5 Rationale: Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain.

6. A patient asks the nurse about giving an over-the-counter drug, bismuth subsalicylate (Pepto-Bismol), to treat a daughter's diarrhea. On which of the following will the nurse base the recommendation? (Select all that apply.) 1. Cause of diarrhea 2. Normal activity level 3. Age 4. Weight 5. School schedule

Answer: 1, 3 Rationale: The nurse should explore possible causes for the diarrhea with the mother before making a recom-mendation because if diarrhea is caused by infections, slowing motility may allow the infection to increase. Salicylates, including bismuth subsalicylate, are contraindicated in children under the age of 19 because of an increased risk for Reye's syndrome.

4. A patient who has duodenal ulcers is receiving long-term therapy with ranitidine (Zantac). The nurse includes in the care plan that the patient should be monitored for which adverse effects? 1. Photophobia and skin irritations 2. Neutropenia and thrombocytopenia 3. Dyspnea and productive coughing 4. Urinary hesitation and fluid retention

Answer: 2 Rationale: Blood dyscrasias have been reported, especially neutropenia and thrombocytopenia, with long-term use. Periodic blood counts should be performed.

4. The nurse is counseling a patient about the goal of therapy with sildenafil (Viagra). What will the nurse teach the patient about the drug's effects? 1. It should always result in a penile erection within 10 minutes. 2. It is not effective if sexual dysfunction is psychologic in nature. 3. It will result in less intense feelings with prolonged use. 4. It may heighten sexual response in female partners

Answer: 2 Rationale: For sildenafil to be effective, the ED must be physiologic in nature. It is not effective if the dysfunction has solely psychologic origins and therefore does not always cause an erection.

5. The nurse is providing health education about contra-ceptive methods to a group of young adults. Which of the following statements is correct about the use of spermicides? 1. They are extremely effective in preventing pregnancy. 2. They have relatively low levels of effectiveness when used alone. 3. They are the main causes of HIV and pelvic inflammatory disease. 4. They can prevent ectopic pregnancy

Answer: 2 Rationale: Patients should be informed that sper-micidal agents have relatively low levels of efficacy when used alone and should therefore be used only in conjunction with bar-rier methods such as condoms and diaphragms.

5. The patient informs the healthcare provider that she has been trying to become pregnant for more than 2 years and has not used any form of contraception. The healthcare provider prescribes clomiphene (Clomid) 50 mg/day for 5 days. The nurse should instruct the patient to begin taking the drug on the: 1. First day of the menstrual cycle. 2. Fifth day of the menstrual cycle. 3. Fifth day after ovulation. 4. Last day of the menstrual cycle.

Answer: 2 Rationale: The standard treatment with clomi-phene is to begin with a low dose for 5 days beginning on the fifth day of the menstrual cycle.

1. A 52-year-old patient experiencing symptoms of menopause is interested in taking hormone replacement therapy (HRT) with conjugated estrogen (Premarin). Which conditions may be a contraindication for HRT for this patient? (Select all that apply.) 1. History of type 2 diabetes mellitus 2. History of deep vein thrombosis 3. History of breast cancer with "lumpectomy" treatment 4. History of hyperlipidemia, controlled by drug therapy 5. History of two cesarean births

Answer: 2, 3, 4 Rationale: A history of thromboembolic con-ditions, breast cancer, or hyperlipidemia may be contraindications for the use of HRT for this patient and will require further assess-ment by the healthcare provider before prescribing conjugated estrogen

3. The nurse is teaching a patient who has received a prescription testosterone gel (AndroGel) for treatment of symptoms related to low androgen levels. What instructions should the nurse give the patient? (Select all that apply.) 1. "Apply the gel to the scrotal and perineal area daily." 2. "Avoid exposing women to the gel or to areas of skin where gel has been applied." 3. "Report any weight gain over 2 kilograms (5 pounds) in 1 week's time." 4. "Avoid showering or swimming for at least 12 to 14 hours after applying the gel." 5. "Maintain a low-fat diet and return periodically for blood lipid laboratory studies."

Answer: 2, 3, 5 Rationale: Women and children should avoid skin contact with areas where testosterone gels or creams have been applied to avoid drug absorption. Testosterones may trigger sodium and water retention and a weight gain of 2 kg (5 lb) or more per week should be reported to the provider. They may also increase blood lipid levels. Therefore, the patient should follow a low-fat diet and have periodic blood lipid level assessments

6. The nurse who is caring for a patient with gastro-esophageal reflux disease should question the order for which drug? 1. H2-receptor antagonists 2. Proton pump inhibitors 3. Antibiotics 4. Antacids

Answer: 3 Rationale: Antibiotics have no role in the treat-ment of GERD although certain antibiotics are used in treating PUD to eradicate the H. pylori organism.

1. The patient is taking diphenoxylate with atropine (Lomotil). What does the nurse assess when monitor-ing for therapeutic effects? 1. Reduction of abdominal cramping 2. Minimal passage of flatus 3. Decrease in loose, watery stools 4. Increased bowel sounds

Answer: 3 Rationale: Diphenoxylate with atropine is given for diarrhea. The patient should report a decrease in the number of loose, watery stools after administration.

4. A 48-year-old patient has received a prescription for medroxyprogesterone (Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, the nurse will teach the patient to monitor and report which symptoms? 1. Insomnia or difficulty falling asleep 2. Excessive mouth, eye, or vaginal dryness 3. Joint pain or pain on ambulation 4. Breakthrough spotting between menstrual periods

Answer: 3 Rationale: Medroxyprogesterone is known to decrease bone density over time. The patient should be taught to report any bone, joint, or musculoskeletal pain and to report any difficulty or pain with movement or ambulation.

2. The nurse is evaluating the effect of an oxytocin infu-sion in a laboring woman. Which of the following indicates that the drug is exerting therapeutic effects? 1. Hemorrhage is controlled. 2. Contractions are sustained at 60 seconds long. 3. Contractions are occurring every 4 minutes and lasting 20 seconds. 4. Milk letdown has begun in preparation for breastfeeding.

Answer: 3 Rationale: Regular contractions increasing in occurrence indicate that the oxytocin is exerting a therapeutic effect.

4. The nurse is teaching the patient who has received a prescription for mifepristone (Mifeprex) and misopro-stol to terminate a pregnancy. When should the patient be instructed to take the misoprostol? 1. Take it after taking one additional dose of mifepristone (Mifeprex). 2. Take it 1 week after taking the mifepristone (Mifeprex). 3. Take it 24 to 48 hours after taking mifepristone. 4. Take it only if she is still bleeding in 3 days.

Answer: 3 Rationale: The patient takes misoprostol 24 to 48 hours after taking the mifepristone.

3. The nurse is scheduling the patient's daily medica-tion. When would be the most appropriate time for the patient to receive proton pump inhibitors? 1. At night 2. After fasting at least 2 hours 3. About 1/2 hour before a meal 4. About 2 to 3 hours after eating

Answer: 3 Rationale: The proton pump is activated by food intake. Thus, administering it about 20 to 30 minutes before the first major meal of the day allows peak serum levels to coincide with when the maximum levels of pumps are activated, allowing maximum efficiency of the PPI.

1. Estradiol-norethindrone (Ortho-Novum) is pre-scribed for each of the following patients. Which patients would the nurse consider at highest risk for an adverse response to this therapy? (Select all that apply.) 1. A 38-year-old with a body mass index classified as overweight 2. A 16-year-old athlete with asthma 3. A 22-year-old who smokes two packs of cigarettes per day 4. An 18-year-old with a history of chronic clinical depression 5. A 42-year-old who has delivered four healthy children

Answer: 3, 4 Rationale: Smokers have a significantly increased risk of serious thromboembolic events when taking OCs. Mood disorders, including depression, may worsen in patients taking OCs, and additional monitoring may be advised.

3. Which instruction about clomiphene (Clomid) will the nurse provide to a woman with infertility? 1. "The drug will be taken for a year and then reevaluated for an increased dose." 2. "The drug will be continued for the first 3 months of pregnancy to guard against miscarriage." 3. "You may stay on this indefinitely until pregnancy occurs. There are few adverse effects." 4. "If pregnancy does not occur within six cycles, other options for treatment will be explored."

Answer: 4 Rationale: Clomiphene is given over six ovulatory-menstrual cycles in increasing doses with HCG added as needed. If no pregnancy has occurred after six cycles, other treatment options will be considered.

6. A patient who has taken finasteride (Proscar) for the past 8 months reports a sudden increase in urinary hes-itancy, urinary retention, and slowing of the urinary stream. What will the nurse teach this patient to do? 1. Continue to take the drug to achieve full effects. 2. Decrease the intake of coffee, tea, and alcohol. 3. Discuss the use of a low-dose diuretic with the healthcare provider. 4. Return to the healthcare provider for a prostate exam.

Answer: 4 Rationale: Full effects of finasteride are realized within 6 to 12 months of therapy. Because the symptoms of dysuria have suddenly increased, the patient should be assessed for possible prostate cancer.

3. The patient is interested in taking levonorgestrel-estradiol (Seasonique) and asks how to take it. Which would be the correct response provided by the nurse? 1. "Seasonique is taken one pill per day for 3 weeks, then 1 week of 'dummy pills' with inert ingredients." 2. "Seasonique is taken year-round without a break and without a period." 3. "Seasonique is taken for 2 months then off for 1 month using regular oral contraceptives." 4. "Seasonique is taken for 84 days followed by 7 days of a lower dose that comes with the pack."

Answer: 4 Rationale: Levonorgestrel-estradiol is taken for 84 days followed by a lower dose of estrogen included in the pill package for 7 days.

6. A patient in preterm labor is receiving magnesium sulfate by IV infusion. Which early sign of magne-sium toxicity would prompt the nurse to stop the infusion and notify the provider? 1. Hyperactive patellar reflexes 2. Chest congestion and coughing 3. Seizure activity 4. Sedation and intense thirst

Answer: 4 Rationale: Sedation, intense thirst, flushing of the skin, confusion, and muscle weakness are early symptoms of magnesium toxicity and should be immediately reported to the provider

2- a nurse is assessing a client who is receiving magnesium sulfate and notes the client has decreased deep tendon reflexes. The nurse should expect to administer which of the following medications? Potassium chloride Folic acid Calcium gluconate Cyanocobalamin

Calcium gluconate Experiencing magnesium toxicity as evidenced by decreased/absent tendon reflexes

A nurse is caring for a client who received prochlorperazine 4 hr ago. The client reports spasms of the face. The nurse should expect a prescription for which of the following medications? Fomepizole Naloxone Phytonadione Diphenhydramine

Diphenhydramine Adverse effect. Acute dystonia. Suppresses EPS effects

the patient is exhibiting the symptoms of Yersinia pestis exposure. Which pharmacologic therapy would most likely be used in the treatment of this patient? 1. Doxycycline 2. Trivalent botulinum antitoxin 3. Ribavirin 4. Atropine sulfate

Doxycycline The preferred drug for Y pestis exposure is doxycycline

5- a nurse is caring for a client who is receiving IV potassium. The nurse should monitor the client for which of the following manifestations as an indication of hyperkalemia? Tachycardia Dyspnea Lethargy Increased thirst

Dyspnea Monitor the client for dyspnea as a manifestation of hyperkalemia

2. Before hanging a bag of total parenteral nutrition, the nurse checks the various components of the solution. Which elements would the nurse expect to see on the solution label? (Select all that apply.) 1. Electrolytes 2. Diuretic 3. Trace minerals 4. Isophane (NPH) insulin 5. Multivitamins

Electrolytes Trace minerals Multivitamins In addition to the base solution, TPN contains electrolytes, trace minerals and multivitamins

5. A nurse is instructing a patient taking orlistat (Xeni-cal) about adverse effects of the medication. Which symptoms indicate the presence of an expected adverse effect? 1. Flatus with discharge and oily stool 2. Heartburn and dyspepsia 3. Constipation with fecal impaction 4. Nausea with projectile vomiting

Flatus with discharge and oily stool Flatus and oily stools are adverse effects that are often troubling to the patient. The nurse should inform that this can happen while taking this medication

- a nurse is planning to administer ondansetron to a client. For which of the following adverse effects of ondansetron should the nurse monitor (SATA) Headache Diarrhea Shortened PR interval Hyperglycemia Prolonged QT interval

Headache Diarrhea Prolonged QT interval Lead to torsades de pointes, serious dysrhythmia

The nurse is teaching a patient with otitis about a prescription for polymyxin B, neomycin, with hydrocor-tisone (Cortisporin). The patient should be instructed to immediately report which symptom? 1. Mild itching in the outer ear canal 2. Gradually decreasing pain 3. Slight dizziness after instilling the eardrop 4. Increasing pain, particularly in the area around the ear

Increasing pain, particularly in the area around the ear Particularly around the ear area, may indicate worsening infection or mastoiditis and should be immediately reported

a nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take? (SATA) Infuse medication through a large-bore needle Monitor urine output to ensure at least 20mL/hr Administer medication via direct IV bolus Implement cardiac monitoring Administer the infusion using an IV pump

Infuse medication through a large-bore needle Implement cardiac monitoring Administer the infusion using an IV pump Prevent vein irritation, phlebitis, and filtration To detect cardiac dysrhythmias in a client receiving IV potassium Using an infusion pump to prevent fatal hyperkalemia due to rapid infusion rate

3. The patient has been started on orlistat (Xenical). The nurse would teach this patient to take this medication: 1. Once in the morning. 2. When a feeling of hunger is noticed. 3. Before daily exercise. 4. Just prior to each meal containing fats.

Just prior to each meal containing fats. Typically orlistat is taken just prior to meals containing fats so the the drug can inhibit lipase and thus the absorption of lipids in the meal

4- a nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should expect a prescription for which of the following medications? Lubiprostone Metoclopramide Bisacodyl Loperamide

Metoclopramide - Dopamine antagonist that is used to treat nausea and also increases gastric motility it can relieve the bloating and nausea of diabetic gastroparesis

Pilocarpine (Isopto Carpine) has been ordered for a patient with closed-angle glaucoma who has not responded well to other drugs. Pilocarpine causes __________________________, which stretches the trabecular meshwork, allowing a greater outflow of aqueous humor and lowering intraocular pressure.

Miosis which stretches the trabecular meshwork, allowing greater outflow of aqueous humor and decreasing the IOP

a nurse is instructing a client who has a new prescription for timolol how to insert eye drops. The nurse should instruct the client to press on which of the following areas to prevent systemic absorption of the medication? Bony orbit Nasolacrimal duct Conjunctival sac Outer canthus

Nasolacrimal duct Pressing on this area blocks the lacrimal punctum and prevents systemic absorption

5. The nurse is preparing to hang a lipid solution and notes that fat globules are visible at the top of the bag. Which action should be taken? 1. Roll the solution container gently. 2. Shake the solution container vigorously. 3. Run the solution container under warm water. 4. Obtain a different container of solution.

Obtain a different container of solution. The nurse should not hang the lipids if separation of the emulsion or fat globules is visible in the solution. Should be returned to pharmacy

1. A healthcare provider has ordered oral vitamin A (Aquasol A) supplements for a patient. The level of vitamin A may be increased if the patient is also taking: 1. Vitamins D and E. 2. Oral contraceptives. 3. Mineral oil. 4. Antibiotics.

Oral contraceptives. Can increases the levels of vitamin A