Pharm 1 exam 4 end of chapter questions

The nurse is caring for a patient with gastroesophageal reflux disease and would question an order for which of the following? Amoxicillin (Amoxil) Ranitidine (Zantac) Pantoprazole (Protonix) Calcium carbonate (Tums)

1 Rationale: Antibiotics such as amoxicillin (Amoxil) are used in the treatment of PUD caused by H. pylori. They are not indicated for the treatment of GERD. Options 2, 3, and 4 are incorrect. Antacids, H2 blockers, and PPIs are used in the treatment of GERD. Calcium carbonate, ranitidine, and pantoprazole would be appropriate drugs to use. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has started taking clomiphene (Clomid, Serophene) after an infertility workup and asks the nurse why she is not having in-vitro fertilization. Which statement would be most helpful in explaining the use of clomiphene to the patient? The patient's diagnostic workup suggested that infrequent ovulation may be the cause for her infertility, and clomiphene increases ovulation. In-vitro fertilization is expensive and because clomiphene is less expensive, it is always tried first. There is less risk of multiple births with clomiphene. The patient's past history of oral contraceptive use has prevented her from ovulating. Clomiphene is given to stimulate ovulation again in these conditions.

1 Rationale: Infertility may result from physical obstruction, pelvic infections, or endocrine-related reasons resulting in lack of ovulation. If a fertility workup suggests that infrequent or lack of ovulation is a primary cause, clomiphene may be tried to increase ovulation and is approximately 80% effective for patients with ovulatory-related infertility. Options 2, 3, and 4 are incorrect. Clomiphene will not be therapeutic if the causes of infertility are other than lack of ovulation. The risk of multiple births is higher with ovulatory stimulants with approximately 5% resulting in twins. Contraceptives do not continue to suppress ovulation after they have been discontinued. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administration. What would be the most appropriate time for this patient to take her lansoprazole (Prevacid)? About 30 minutes before her morning meal At night before bed After fasting at least 2 hours 30 minutes after each meal

1 Rationale: PPIs such as lansoprazole (Prevacid) should be taken before the first meal of the day. The proton pump is activated by food intake. The administration of a PPI 20 to 30 minutes before the first major meal of the day will allow peak serum levels to coincide with the occurrence of maximum acidity from the proton pump activity. Options 2, 3, and 4 are incorrect. PPIs should be taken before the first major meal of the day, not at night or after meals. Fasting is not required for this drug. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

Pancrelipase (Pancreaze) granules are ordered for a patient. Which action will the nurse complete before administering the drug? (Select all that apply.) Sprinkle the granules on a nonacidic food. Give the granules with or just before a meal. Mix the granules with orange or grapefruit juice. Ask the patient about an allergy to pork or pork products. Administer the granules followed by an antacid.

1, 2, 4 Rationale: Before administering pancrelipase (Pancreaze) the nurse should assess for an allergy to pork or pork products. The granules may be sprinkled on nonacidic foods and should be given 30 minutes before a meal or with meals. Options 3 and 5 are incorrect. Pancrelipase should not be given with acidic foods or beverages because the drug will be inactivated. It should not be taken with an antacid because the effect of the pancrelipase will be decreased. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which patients would have a higher risk for adverse effects from estradiol and norethindrone (Ortho-Novum)? (Select all that apply.) An 18-year-old with a history of depression A 16-year-old with chronic acne A 33-year-old with obesity per her body mass index (BMI) A 24-year-old who smokes one pack of cigarettes per day A 41-year-old who has delivered two healthy children

1, 4 Rationale: A previous history of depression is a relative contraindication because OCs may worsen depression in some women. The use of OCs should be evaluated by the healthcare provider in this situation. Women who smoke have a greater risk of adverse cardiovascular effects and the FDA has issued a black box warning about these effects. Options 2, 3, and 5 are incorrect. OCs are sometimes prescribed as an off-label treatment for acne. Obesity alone is not a contraindication for OCs, nor is age. A 41-year-old who has delivered two healthy children is not at risk. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

A young woman calls the triage nurse in her mother's healthcare provider's office with questions concerning her mother's medication. The mother, age 76, has been taking alendronate (Fosamax) after a bone density study revealed a decrease in bone mass. The daughter is worried that her mother may not be taking the drug correctly and asks for information to minimize the potential for drug adverse effects. What information should the triage nurse incorporate in a teaching plan regarding the oral administration of alendronate? A 36-year-old man comes to the emergency department complaining of severe pain in the first joint of his right big toe. The triage nurse inspects the toe and notes that the joint is red, swollen, and extremely tender. Recognizing this as a typical presentation for acute gouty arthritis, what historical data should the nurse obtain relevant to this disease process?

1. Alendronate (Fosamax) is poorly absorbed after oral administration and can produce significant GI irritation. It is important that the patient or patient's daughter be educated regarding several elements of drug administration. To promote absorption, the drug should be taken first thing in the morning with 8 oz of water 30 minutes before food or beverages are ingested or any other medications are taken. It has been shown that certain beverages, such as orange juice and coffee, interfere with drug absorption. By delaying eating for 30 minutes or more, the patient is promoting absorption of the drug. Additionally, the patient should be taught to sit upright after taking the drug to reduce the risk of esophageal irritation. Alendronate must be used carefully in patients with esophagitis or gastric ulcer. If the patient misses a dose, she should be told to skip it and not to double the next dose. Alendronate has a long half-life, and missing an occasional dose will do little to interfere with the therapeutic effect of the drug. 2. The triage nurse should obtain information about the onset of symptoms, degree of discomfort, and frequency of attacks. A familial history of gout can be predictive because primary gout is inherited as an X-linked trait. A past medical history of renal calculi may also be predictive of acute gouty arthritis. The nurse should ask the patient questions about his diet and fluid intake. An attack of gout can be precipitated by alcohol intake (particularly beer and wine), starvation diets, and insufficient fluid intake. In addition, the nurse should obtain information about prescribed drugs and the use of OTC drugs containing salicylates. Thiazide diuretics and salicylates can precipitate an attack. The nurse should also ask about recent lifestyle events. Stress, illness, trauma, or strenuous exercise can precipitate an attack of gouty arthritis.

Which teaching point will the nurse provide to a patient with a new prescription for alendronate (Fosamax)? Take the medication with a full glass of water 30 minutes before breakfast. Take the medication with a small snack or meal containing dairy. Take the medication immediately before bed. Take the medication with a calcium supplement.

1. Answer: 1 Rationale: Alendronate (Fosamax) should be taken on an empty stomach with a full glass of water, and the patient should remain upright for a minimum of 30 minutes to prevent esophageal irritation. Options 2, 3, and 4 are incorrect. The drug should not be taken with food and should be taken early in the day. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which of the following nursing assessments would be appropriate for the patient who is receiving testosterone? (Select all that apply.) Monitor for a decrease in hematocrit. Assess for signs of fluid retention. Assess for increased muscle mass and strength. Check for blood dyscrasias. Assess for muscle wasting.

1. Answer: 2, 3 Rationale: A side effect of testosterone therapy is fluid retention. Testosterone is also used to increase muscle mass and strength. Options 1, 4, and 5 are incorrect. The hematocrit may increase with the use of testosterone because it promotes the synthesis of erythropoietin. Muscle wasting should not occur, and blood dyscrasias are not common with the use of testosterone. Cognitive Level: Analyzing. Nursing Process: Assessment.

Yolanda Clerik is 22 years old and has been taking estradiol and norethindrone (Ortho-Novum) for contraception. She has been seen by her healthcare provider today for a recurrent throat infection and has been given a prescription for penicillin. As the nurse, what instructions will you give Yolanda about her new prescription and the effect it may have on her estradiol and norethindrone (Ortho-Novum)? While Yolanda is in the office, what additional education will you give her to minimize the risk of adverse effects from her estradiol and norethindrone (Ortho-Novum)?

1. Broad-spectrum antibiotics such as tetracyclines and penicillin can alter the effectiveness of OCs, resulting in an increased risk of pregnancy. The patient should not stop using Ortho-Novum but should use additional precautions during intercourse, such as condoms and spermicidal agents, until she starts her next monthly cycle of pills. 2. Each patient encounter provides the opportunity for a nurse to provide or reinforce education. As the nurse, you would evaluate Yolanda's understanding of her OC, assess for smoking, and provide education about smoking cessation programs if needed. You would also reinforce the need for her to immediately report any signs of thromboembolic conditions, such as dyspnea, chest pain, or blood in sputum (possible pulmonary embolism); a sensation of heaviness in the chest or chest pain, or overwhelming fatigue or weakness accompanied by nausea and diaphoresis (possible MI); sudden, severe headache, especially if associated with dizziness; difficulty with speech, numbness in the arm or leg, difficulty with vision (possible stroke); or warmth, redness, swelling, or tenderness in the calf or pain on walking (possible thrombophlebitis).

A 28-year-old woman has tried for over a year to become pregnant. Her husband has a 4-year-old child from a previous marriage and a physical workup suggests that clomiphene (Clomid) may be useful in promoting pregnancy. What information should be included in a teaching plan for a patient who is receiving this drug? A 22-year-old patient has been taking ethinyl estradiol with drospirenone (Yasmin) but has just started penicillin for a recurrent throat infection. She asks the nurse if she should stop taking the Yasmin. What instructions should the nurse give to this patient? A nurse is assessing a 32-year-old postpartum patient and notes [&2|plus|&] pitting edema of the ankles and pretibial area. The patient denies having "swelling" prior to delivery. The nurse reviews the patient's chart and notes that she was induced with oxytocin (Pitocin) over a 23-hour period. What is the relationship between this drug regimen and the patient's current presentation? What additional assessments should be made?

1. Clomiphene (Clomid) is used when lack of ovulation is a potential cause for infertility after mechanical causes have been ruled out (e.g., obstruction of the Fallopian tubes or pelvic inflammatory disease). Before administration of clomiphene the nurse would complete a medical history and physical examination. The pregnancy rate of persons taking this drug is about 80% and twins occur in about 5% of treated patients. She should discontinue the drug immediately if pregnancy is suspected. 2. Broad-spectrum antibiotics such as tetracyclines and penicillin can alter the effectiveness of OCs, resulting in an increased risk of pregnancy. The patient should not stop her use of Yasmin but should use additional precautions during intercourse such as condoms and spermicidal agents until she starts her next monthly cycle of pills. 3. Oxytocin exerts an antidiuretic effect when administered in doses of 20 milliunits/min or greater. Urine output decreases, and fluid retention increases. Most patients begin to have a postpartum diuresis and are able to balance fluid volumes relatively quickly. However, the nurse should evaluate the patient for signs of excess fluid volume, which include drowsiness, listlessness, headache, and oliguria. The patient's breath sounds, blood pressure, and pulse should be carefully monitored for adverse effects related to excess fluid volume.

Jerry Nobal is a 59-year-old manager at a local golf center. He has been prescribed diphenoxylate with atropine (Lomotil) for continual diarrhea for the past 3 days. He has taken the drug consistently, but he returns to his provider stating that he has had diarrhea 5 times today. What is a possible rationale for Jerry's continuing diarrhea? What is the key priority for nursing care? What are additional needs that Jerry may have?

1. Diphenoxylate with atropine is a combination drug that includes an opiate (diphenoxylate) and anticholinergic (atropine) that slows intestinal motility. If Jerry's diarrhea has continued despite drug therapy, he may have an infectious process that is causing the diarrhea, and additional treatment is needed to treat his infection. 2. A key priority is to assess the potential for dehydration. Signs and symptoms include hypotension, tachycardia, increased temperature, dry mucous membranes, and poor skin turgor. Because Jerry's diarrhea has continued over multiple days, the skin around the anus and perineal area may be excoriated and require treatment. As the nurse, you would also want to obtain a diet history and note any correlation between improvement or worsening of his symptoms. A dietary consultation may be needed.

Michael Galvin is a 68-year-old who has been diagnosed with BPH. He has been given a prescription for finasteride (Proscar), but he says that he has been hearing about the benefits of saw palmetto and is curious about it. What is the action of finasteride (Proscar), and how will it be beneficial in treating Mr. Galvin's BPH? How do the effects of saw palmetto compare to finasteride?

1. Finasteride (Proscar), an androgen inhibitor, is used to shrink the prostate and relieve symptoms associated with BPH. Finasteride inhibits 5-alpha reductase, an enzyme that converts testosterone to the potent androgen 5-alpha dihydrotestosterone (DHT). The prostate gland depends on this androgen for its development, but excessive levels can cause prostate cells to increase in size and divide. A regimen of 6 to 12 months may be necessary to determine Mr. Galvin's response. 2. Saw palmetto is an herbal preparation derived from a shrub-like palm tree that is native to the southeastern United States. This herbal medication compares pharmacologically with finasteride in that it is an antiandrogen. The mechanism of action is virtually the same in these two agents. There have been no serious adverse effects noted with saw palmetto extract and no known drug-drug interactions. Just as with finasteride, long-term use is required.

Lorcaserin (Belviq) has been prescribed to aid in a patient's weight loss regimen. What education, both general and drug-specific, will the nurse provide for the patient? A patient complains of a constant headache for the past several days. The only supplements the patient has been taking are megadoses of vitamins A, C, and E. What would be a priority for the nurse with this patient?

1. Lorcaserin seems to aid in weight-loss regimens by causing a feeling of fullness or satiety. It is combined with a healthy diet and regular exercise as part of the weight loss program. While it is generally well tolerated, it may cause headaches and upper respiratory tract infection. 2. Vitamin A may cause increased intracranial pressure, which could be the cause of the headaches. The nurse should perform a neurologic assessment and note any deficits. The healthcare provider should be notified and the patient should discuss the use and appropriate doses of the vitamins with the provider. Fat-soluble vitamins such as A and E accumulate in the body and may lead to toxicities.

A woman calls the healthcare provider's office, worried about her 82-year-old mother, Basanthi Singh. Mrs. Singh had a stroke 6 years ago and requires help with most ADLs. Since her husband's death 18 months ago, she rarely leaves home. She has lost 11 kg (25 lb) because she "just can't get interested" in her meals. She has never liked milk and now refuses to drink milk or eat dairy products. Mrs. Singh's daughter has been prescribed bisphosphonates, and wonders if her mother should also be on them. What risk factors does Mrs. Singh have for osteoporosis and hypocalcemia? What other factors should be considered before making a recommendation for an appointment to discuss a bisphosphonate prescription?

1. Mrs. Singh is a frail older patient who is postmenopausal and with, potentially, a significantly limited calcium intake. Her diet may lack sufficient quantities of vitamin D, and she has decreased physical activity and lack of exposure to sunshine. Her daughter reports that Mrs. Singh is uninterested in eating, has physical limitations, and is not able to get out of the house into the sunshine without assistance. 2. As the nurse, you would want to take a thorough dietary history, including whether any calcium and vitamin D supplements are used. You would also consider the physical limitations that Mrs. Singh has as a result of her stroke: Is she able to prepare her own meals, or does she have to rely on her daughter and others? Does she have favorite foods that are rich in the nutrients necessary? You may also consult with the healthcare provider about the need for depression screening for Mrs. Singh. Her lack of interest in her meals and remaining at home since her husband's death may indicate depression that is interfering with ADLs and nutrition. Mrs. Singh should be evaluated by the provider. Bisphosphonates may be required, but if other risk factors such as depression are present, additional treatment may be needed.

Reginald Foxe, 68 years old, has had chronic hyperacidity of the stomach and takes calcium carbonate (Tums) multiple times daily. He comes to the clinic with complaints of fatigue, increasing weakness, and headaches. When taking his medication history, Mr. Foxe tells the nurse that he takes two Tums tablets (1000 mg calcium carbonate) every 4 hours, and sometimes as frequently as every 2 hours. What may be the cause of Mr. Foxe's symptoms of fatigue, weakness, and headaches? As the nurse, what will you recommend to Mr. Foxe? What additional teaching is necessary?

1. Regular use of calcium-containing antacids, especially along with milk products, may cause milk-alkali syndrome. Early symptoms are similar to those of hypercalcemia and include headache, urinary frequency, anorexia, nausea, and fatigue. 2. As the nurse, you should instruct Mr. Foxe to stop taking the antacid and to discuss more appropriate therapy for the hyperacidity with the healthcare provider. 3. If Mr. Foxe's symptoms continue, he may need to be evaluated for H. pylori infection. General lifestyle changes such as quitting smoking, avoiding alcohol or caffeine, elevating the head of the bed, losing weight, and managing stress may also help to eliminate his symptoms.

An older adult patient has been ordered prochlorperazine (Compazine) for treatment of nausea and vomiting associated with a bowel obstruction, pending planned surgery. The nurse is preparing the plan of care for this patient. What should be included in the plan? A patient comes to the clinic complaining of no bowel movement for 4 days (other than small amounts of liquid stool). The patient has been taking psyllium (Metamucil) for his constipation and wants to know why it is not working. What is the nurse's response?

1. The nurse should plan to assess for signs of dehydration and plan for IV fluid replacement. Prochlorperazine (Compazine) may cause anticholinergic side effects, such as dry mouth, sedation, constipation, orthostatic hypotension, and tachycardia. The nurse will assess the patient for adverse effects and be particularly careful when helping the patient out of bed or with ambulation. If the drug is used for a prolonged period, EPS resembling those of Parkinson's disease are a serious concern, especially in older patients, and the nurse would assess for any motor-related symptoms. 2. Bulk-forming laxatives promote bowel regularity but they take several days or longer for best effects. The liquid stool the patient is experiencing is a concern and may be a result of fecal impaction, in which only liquid seeps out around the impacted area. The nurse should assess the abdomen for bowel sounds and, if hypoactive or absent, or if abdominal pain is present, should report the findings immediately to the healthcare provider. If the bowel sounds are normal, the nurse should educate the patient about the need to drink plenty of fluids when taking bulk-forming laxatives.

A 78-year-old widower has come to see his healthcare provider. The nurse practitioner interviews the patient about his past medical history and current health concerns. The patient states that he is planning to marry "a very nice lady" but is concerned about his sexual performance. He asks about a prescription for sildenafil (Viagra). What additional assessment data does the nurse need to collect given this patient's age? A 16-year-old adolescent tries out for the football team. He is immediately impressed with the size of several junior and senior linemen. One older student offers to "hook him up" with a source for androstenedione (Andro). From a developmental perspective, explain why this young man may be susceptible to anabolic steroid abuse. Can anabolic steroid abuse affect his stature?

1. This patient's age puts him at risk for a variety of health problems. Conditions such as kidney dysfunction may alter the manner in which sildenafil (Viagra) is metabolized or excreted, increasing the risk of adverse effects. The nurse should ensure that the history includes the following data: sexual dysfunction, cardiovascular disease and use of organic nitrates, severe hypotension, kidney or liver impairment, sexual history, and history of sexually transmitted infections. 2. At this age, peer groups are often more important than the family, and fitting in is important to many adolescents. This young man's desire to be accepted as an athlete and a team member may produce a willingness to do what it takes to fit in. In addition, the young man may have aspirations of a career in sports and recognize the need to be in optimal physical condition. He may not be aware that testosterone can produce premature epiphyseal closure, potentially affecting his adult height. Other risks include hypertension and long-term organ damage. He should be referred to his healthcare provider for a discussion on appropriate options to help build muscle mass such as moderate weight-lifting.

A patient with terminal cancer is receiving naloxegol (Movantik) for control of opioid-induced constipation. Because this drug is an opioid-antagonist, what effects on the patient's pain should the nurse anticipate? The pain may worsen and additional adjunctive drugs may be required There should be no effects on the patient's level of pain The pain may decrease, requiring less of the opioid drug The patient's pain level may decrease, but respiratory depression may occur

2 Rationale: Naloxegol (Movantik) is an opioid-antagonist that works on opioid receptors in the large intestine, thus decreasing chronic constipation. It is not absorbed through the blood-brain barrier. Options 1, 3, and 4 are incorrect. Because the drug is not absorbed through the blood-brain barrier, there is little effect on pain control. Cognitive Level: Applying. Nursing Process: Assessment. Client Need: Physiological Integrity.

A 24-year-old patient has been taking sulfasalazine (Azulfidine) for irritable bowel syndrome and complains to the nurse that he wants to stop taking the drug because of the nausea, headaches, and abdominal pain it causes. What would the nurse's best recommendation be for this patient? The drug is absolutely necessary, even with the adverse effects. Talk to the healthcare provider about dividing the doses throughout the day. Stop taking the drug and see if the symptoms of the irritable bowel syndrome have resolved. Take an antidiarrheal drug such as loperamide (Imodium) along with the sulfasalazine.

2 Rationale: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and headache are common adverse effects of sulfasalazine (Azulfidine). Dividing the total daily dose evenly throughout the day and using the enteric-coated tablets may improve adherence. Options 1, 3, and 4 are incorrect. Patients who experience significant adverse effects of drug therapy are unlikely to adhere to a drug regimen if the effects are severe. Suggesting that the patient take an antidiarrheal drug or that he stop drug therapy is not within the scope of a nurse's practice and should be items that he discusses with his healthcare provider. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient is interested in taking levonorgestrel and estradiol (Seasonique) and asks how it is taken. Which explanation by the nurse is correct? "Seasonique is taken year-round without a break and without a period." "Seasonique is taken for 84 days and then followed by 7 days of a lower dose contained in the same package." "Seasonique is a vaginal ring that is inserted monthly." "Seasonique is taken for 2 months then off for 1 month using regular oral contraceptives."

2 Rationale: Seasonique is taken for 84 consecutive days, followed by 7 days of a lower dose that is contained in the same pill pack. Options 1, 3, and 4 are incorrect. None of these explanations are correct for Seasonique. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient has been discharged home on total parenteral nutrition therapy. When making a home visit, which are the most important assessments that should be monitored by the family and the home care nurse? Temperature and blood pressure Temperature and weight Pulse and blood pressure Pulse and weight

2 Rationale: The patient's temperature should be monitored to detect early signs of infection, which is a complication of total parenteral nutrition. Daily weight will be monitored to assist in determining the effectiveness of the nutrition and to detect signs of fluid overload. Options 1, 3, and 4 are incorrect. Pulse and blood pressure are important parameters and will be monitored on the visit, but they are of less priority in determining the patient's status and safety while on the nutrition. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for ondansetron (Zofran). When should the nurse administer the ondansetron? Every time the patient complains of nausea Just prior to starting the chemotherapy Only if the patient complains of nausea When the patient begins to experience vomiting during the chemotherapy

2 Rationale: To be most effective, ondansetron (Zofran) or other antiemetics should be administered just prior to initiating the chemotherapy drugs. Options 1, 3, and 4 are incorrect. Almost all chemotherapy drugs have emetic potential and the nurse should not wait until the patient complains of nausea or experiences vomiting before giving the drug. The patient may complain of nausea more frequently than is possible to give the drug. Other nondrug relief strategies such as diversion techniques or ginger ale should also be tried. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A 62-year-old female has received a prescription for alendronate (Fosamax) for treatment of osteoporosis. The nurse would be concerned about this order if the patient reported which condition? (Select all that apply.) She enjoys milk, yogurt, and other dairy products and tries to consume some with each meal. She is unable to sit upright for prolonged periods because of severe back pain. She is lactose intolerant and rarely consumes dairy products. She has had trouble swallowing and has been told she has "problems with her esophagus." She has a cup of green tea every night before bed.

2, 3, 4 Rationale: Bisphosphonates such as alendronate require the patient to take the drug on an empty stomach and remain upright for 30 minutes to 1 hour. Adequate serum calcium levels should be confirmed before starting bisphosphonates, and adequate calcium and vitamin D intake should be encouraged while on drug therapy. Any narrowing of the esophagus may place the patient at risk of increased adverse esophageal effects from the drug. Options 1 and 5 are incorrect. Adequate calcium intake is advised while on bisphosphonates to maintain normal serum calcium levels. The use of green tea is not a contraindication to the use of bisphosphonates. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

A 35-year-old man has been prescribed omeprazole (Prilosec) for treatment of gastroesophageal reflux disease. Which assessment findings would assist the nurse to determine whether drug therapy has been effective? (Select all that apply.) Decreased "gnawing" upper abdominal pain on an empty stomach Decreased belching Decreased appetite Decreased nausea Decreased dysphagia

2, 4, 5 Rationale: Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, and chest pain. Therapeutic effects of omeprazole (Prilosec) would include relief of these symptoms. Options 1 and 3 are incorrect. Gnawing or burning upper abdominal pain is symptomatic of PUD, not GERD. A decreased appetite should not occur with omeprazole. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

The nurse is teaching a patient who has a new prescription for testosterone gel. Which instruction should the nurse give to this patient? "Avoid exposing women to the gel or to areas of skin where the gel has been applied." "Report any weight gain over 2 kg (5 lb) in 1 month." "Avoid showering or swimming for at least 12 hours after applying the gel." "Apply the gel to the scrotal and perineal areas daily."

2. Answer: 1 Rationale: Women and children should avoid contact with the gel or areas of the skin where gel has been applied to avoid drug absorption. Options 2, 3, and 4 are incorrect. Whereas weight gain of 2 kg (5 lb) in 1 week should be reported, the same gain over 1 month may not be significant. The gel should be applied to the chest or upper torso, not to the scrotal or perineal areas. Showering or swimming should be avoided for several hours after gel application to allow for adequate absorption, but there is no need to wait a full 12 hours before these activities. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

Which assessment findings in a patient who is receiving calcitriol (Calcijex, Rocaltrol) should the nurse immediately report to the healthcare provider? Muscle aches, fever, dry mouth Tremor, abdominal cramping, hyperactive bowel sounds Bone pain, lethargy, anorexia Muscle twitching, numbness, and tingling of the extremities

2. Answer: 3 Rationale: Toxicity from calcitriol (Calcijex, Rocaltrol) includes symptoms of hypercalcemia and bone pain, anorexia, nausea and vomiting, increased urination, hallucinations, and dysrhythmias. Options 1, 2, and 4 are incorrect. Muscle aches, fever, and dry mouth are not related to calcitriol toxicity, and other causes, including infection, should be investigated. Tremor, abdominal cramping, hyperactive bowel sounds, muscle twitching, numbness, and tingling of the extremities are signs of hypocalcemia. Calcitriol may cause symptoms of hypercalcemia. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, what will the nurse expect to find? Increased bowel sounds Decreased belching and flatus Decrease in loose, watery stools Decreased abdominal cramping

3 Rationale: A decrease in the number and consistency of stools is a therapeutic effect of diphenoxylate with atropine (Lomotil). Options 1, 2, and 4 are incorrect. A decrease in bowel sounds rather than an increase would be noted if the drug is having therapeutic effects. The drug has no direct effect on the causes of belching or flatus. Although reduction in abdominal cramping may occur due to decreased peristalsis, it is not the therapeutic indication for the drug. Cognitive Level: Applying. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A woman consults the nurse about Plan B (levonorgestrel) after unprotected intercourse that occurred 2 days earlier. Which instruction will the nurse give to this patient? "You must wait 7 days before taking the pills for Plan B to be effective." "Plan B is effective only within 24 hours of unprotected intercourse." "You will take one pill of Plan B at first, followed by another pill 12 hours later." "You will need to obtain a prescription for Plan B."

3 Rationale: Plan B (levonorgestrel) is administered by taking one pill, followed by another pill 12 hours later. Options 1, 2, and 4 are incorrect. Plan B should be taken within 120 hours after unprotected intercourse. After 7 days it is ineffective in preventing pregnancy. It is available OTC to women older than 17 after age verification by a pharmacist, and a prescription is not required. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The patient who is receiving allopurinol (Lopurin) for treatment of gout asks why he should avoid the consumption of alcohol. The nurse's response is based on the knowledge that the use of alcohol along with allopurinol may result in which of the following? It significantly increases the drug levels of allopurinol. It interferes with the absorption of antigout medications. It raises uric acid levels. It causes the urine to become more alkaline.

3. Answer: 3 Rationale: Gout is a metabolic disorder characterized by the accumulation of uric acid in the bloodstream or joint cavities. Alcohol increases uric acid levels. Options 1, 2, and 4 are incorrect. Alcohol does not cause a significant increase in drug levels of allopurinol, does not affect the absorption of antigout medications, and increases urine acidity. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse is teaching a patient about the use of tadalafil (Cialis). What will the nurse teach him about the effects of tadalafil? It should always result in a penile erection within 10 minutes. It may heighten female sexual response. It is not effective if sexual dysfunction is caused by psychologic conditions. It will result in less intense sensation with prolonged use.

3. Answer: 3 Rationale: Tadalafil (Cialis) and other similar drugs are not effective if the ED is psychologic in nature. Options 1, 2, and 4 are incorrect. Tadalafil will not heighten sexual response in women. It does not cause decreased sensations over time and it enhances, rather than causes, an erection. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A 43-year-old patient is receiving medroxyprogesterone (Depo-Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, which condition may indicate a potential adverse effect? Breakthrough bleeding between periods Insomnia or difficulty falling asleep Eye, mouth, or vaginal dryness Joint pain or pain on ambulation

4 Rationale: Medroxyprogesterone (Depo-Provera) carries a black box warning about the risk of decreased bone density that may occur over time. Joint or bone pain, or pain on ambulation, should be assessed as a sign of this potential adverse effect. Options 1, 2, and 3 are incorrect. Medroxyprogesterone may cause spotting between menstrual periods but is usually not an adverse effect of concern unless it increases. Insomnia or dryness of the eyes, mouth, or vagina are not effects associated with medroxyprogesterone. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient has been prescribed orlistat (Xenical). What will the nurse teach this patient? Take the drug once in the morning. Take the drug only when feeling hungry. Take the drug before exercising daily but no more than 3 times per day. Take the drug with or just before a meal containing fats.

4 Rationale: Orlistat (Xenical) should be taken with, or right before, meals containing fats. Options 1, 2, and 3 are incorrect. Orlistat is taken throughout the day with meals and does not decrease appetite. Exercise is an important part of a healthy lifestyle but the drug does not need to be administered before exercise. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

An older adult has been diagnosed with pernicious anemia, and replacement therapy is ordered. The nurse will anticipate administering which vitamin and by what technique? B6, orally in liquid form K, via intramuscular injection D, by light-box therapy or increased sun exposure B12, by intramuscular injection

4 Rationale: Pernicious anemia results in the inability to absorb vitamin B12 due to the lack of intrinsic factor in the gut. Replacement therapy must be administered via IM injection or by intranasal spray because oral supplementation will not be absorbed. Options 1, 2, and 3 are incorrect. Pernicious anemia affects vitamin B12 absorption. Replacement with vitamins B6 K, or D will not correct the disorder. Cognitive Level: Applying. Nursing Process: Planning. Client Need: Physiological Integrity.

A patient with constipation is prescribed psyllium (Metamucil) by his healthcare provider. What essential teaching will the nurse give to the patient? Take the drug with meals and at bedtime. Take the drug with minimal water so that it will not be diluted in the GI tract. Avoid caffeine and chocolate while taking this drug. Mix the product in a full glass of water and drink another glassful after taking the drug.

4 Rationale: To avoid esophageal or gastric obstruction, psyllium (Metamucil) should be mixed with a full glass of water or juice and followed by another full glass of liquid. Options 1, 2, and 3 are incorrect. The drug should not be taken directly with meals because nutrients in the food may be bound into the psyllium and not absorbed. Psyllium should not be taken dry and should be taken with plenty of fluids. Caffeine and chocolate do not need to be avoided while on this medication. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

The patient with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which question should the nurse ask before initiating therapy with sildenafil? "Are you currently taking medications for angina?" "Do you have a history of diabetes?" "Have you ever had an allergic reaction to dairy products?" "Have you ever been treated for migraines?"

4. Answer: 1 Rationale: Life-threatening hypotension is an adverse effect in patients who are taking sildenafil (Viagra) along with organic nitrates for angina. Options 2, 3, and 4 are incorrect. Diabetes, allergies to dairy, or migraines are not contraindications for sildenafil. Cognitive Level: Applying. Nursing Process: Assessment. Client Needs: Physiological Integrity.

A patient with a history of benign prostatic hyperplasia is complaining of feeling like he "cannot empty his bladder." He has been taking finasteride (Proscar) for the past 9 months. What should the nurse advise this patient to do? Continue to take the drug to achieve full therapeutic effects. Discuss the use of a low-dose diuretic with the healthcare provider. Decrease the intake of coffee, tea, and alcohol. Return to the healthcare provider for laboratory studies and a prostate exam.

5. Answer: 4 Rationale: Finasteride promotes shrinking of enlarged prostates and helps restore urinary function with full therapeutic effects obtained within 6 to 12 months. Because this patient reports a sudden increase in urinary symptoms after taking the drug for 9 months, he should be evaluated by the healthcare provider for prostate cancer screening. Options 1, 2, and 3 are incorrect. Continuing to take the dose, or a low-dose diuretic, with the onset of new symptoms would not be appropriate. Decreasing bladder irritants, such as coffee, tea, and alcohol, may help overall but does not explain the sudden increase in symptoms. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient is given a prescription for finasteride (Proscar) for treatment of benign prostatic hyperplasia. Essential teaching for this patient includes which of the following? (Select all that apply.) Full therapeutic effects may take 3 to 6 months. Hair loss or male-pattern baldness may be an adverse effect. The drug should not be handled by pregnant women, especially if it is crushed. Blood donation should not occur while taking this drug. Report any weight gain of over 2 kg (5 lb) in 1 week.

6. Answer: 1, 3, 4 Rationale: Enlarged prostatic tissue will decrease over a period of 3 to 6 months. The drug is teratogenic and should not be handled by pregnant women. Blood donation should not occur while taking finasteride because the blood may be given to a woman. Options 2 and 5 are incorrect. Finasteride in lower doses is given under the trade name "Propecia" for treatment of male pattern baldness. There is a concern for edema and weight gain when alpha-adrenergic antagonists are used to treat BPH, but finasteride (Proscar) is a 5-alpha reductase inhibitor, not an alpha-adrenergic antagonist, and edema and weight gain are not associated with its use. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

Simethicone (Gas-X, Mylicon) may be added to some medications or given plain for what therapeutic effect? Decrease the amount of gas associated with GI disorders. Increase the acid-fighting ability of some medications. Prevent constipation associated with gastrointestinal drugs. Prevent diarrhea associated with gastrointestinal drugs.

: 1 Rationale: Simethicone is used along with other GI drugs or alone to decrease the amount of gas bubbles that accumulate with GI disorders or indigestion. Options 2, 3, and 4 are incorrect. Simethicone will not affect the acid-fighting ability of medications or prevent constipation or diarrhea from developing. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

The patient on home-based enteral nutrition via a gastric tube has a temperature of 38.6°C (101.5°F). After assessing the patient, the nurse uses the opportunity to talk with the family about which preventive measure to decrease the risk of infection related to the enteral nutrition? Hang a feeding solution no longer than 2 hours. Refrigerate any unused portions of feeding. Use plain water to irrigate the tube between feedings. Maintain sterile technique whenever initiating a new feeding solution.

: 2 Rationale: Refrigerating unused portions of feeding solutions will help to decrease bacterial growth, reducing the risk of infection. Options 1, 3, and 4 are incorrect. Feedings may generally hang up to 4 hours unless otherwise ordered by the healthcare provider. Flushing with plain water is an acceptable technique because the water enters the GI tract; however, it does not reduce the risk of infections. Maintaining sterile technique for enteral feedings is not required to administer the solution; the solution enters the GI tract. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

The nurse completes an assessment of a patient in labor who is receiving an intravenous infusion of oxytocin. Which assessment indicates the need for prompt intervention? There is no vaginal bleeding noted. The patient is managing her pain through breathing techniques. Fetal heart rate remains at baseline parameters. Contractions are sustained for 2 minutes in duration.

: 4 Rationale: Sustained contractions increase the risk of uterine rupture and adverse effects to the fetus. They should be reported immediately and prompt and appropriate intervention started, including stopping the oxytocin drip and starting oxygen therapy for the patient. Options 1, 2, and 3 are incorrect. The absence of vaginal bleeding during labor, appropriate pain management, and fetal heart rate continuing at baseline parameters are appropriate findings during oxytocin administration. Cognitive Level: Analyzing. Nursing Process: Evaluation. Client Need: Physiological Integrity.

A patient with rheumatoid arthritis will begin treatment with adalimumab (Humira). Which statement related to this therapy is correct? Select all that apply. Adlimumab: May lower immune response and increase the risk of infections and malignancies. Is associated with osteoporosis and baseline and periodic DXA scans should be conducted. May reactivate latent TB. May cause local injection-site irritations such as pain and bruising. Must be taken daily for up to 6 months.

Answer: 1, 3, 4 Rationale: DMARDs modify immune and inflammatory responses but may increase the risk of infections and malignancies, and may reactivate latent TB. Injection site reactions such as pain, swelling, and bruising are common adverse effects. Options 2 and 5 are incorrect. Adalimumab has not been associated with an increased risk of osteoporosis and is given subcutaneously, every other week. Cognitive Level: Applying; Nursing Process: Evaluation; Client Need: Physiological Integrity.

The nurse would anticipate administering vitamin K (Aquamephyton) to which patients? (Select all that apply.) A newborn infant A patient with hearing impairment secondary to antibiotic use A teenager with severe acne A patient who has taken an overdose of the oral anticoagulant warfarin (Coumadin) A patient with newly diagnosed type 1 diabetes

Answer: 1, 4 Rationale: Vitamin K (Aquamephyton) is given routinely to newborn infants to prevent bleeding postdelivery. Vitamin K decreases the anticoagulant effects of warfarin (Coumadin). Options 2, 3, and 5 are incorrect. Vitamin K is not indicated as a therapeutic treatment for hearing impairment, acne, or diabetes. Cognitive Level: Analyzing. Nursing Process: Planning. Client Need: Physiological Integrity.

The nurse is preparing to administer magnesium sulfate intravenously to a patient. The nurse should assess for which early signs of magnesium toxicity? (Select all that apply.) Skin flushing Anxiety or excitement Complete heart block Muscle weakness Intense thirst

Answer: 1, 4, 5 Rationale: Flushing of the skin, sedation, intense thirst, muscle weakness, and confusion are all early signs of magnesium toxicity. Options 2 and 3 are incorrect. Circulatory collapse, complete heart block, and respiratory failure are all later signs that complete neuromuscular blockade has occurred due to the toxicity. Sedation rather than anxiety or nervousness occurs. Cognitive Level: Analyzing. Nursing Process: Assessment. Client Need: Physiological Integrity.

A postmenopausal woman is started on raloxifene (Evista) for prevention of osteoporosis. Because of the black box warning, what condition, noted in the patient's history, may indicate that this drug should not be given, or given with extreme caution? A history of depression A history of coronary artery disease or thrombophlebitis A history of osteoarthritis A history of using black cohosh to treat menopausal symptoms

Answer: 2 Rationale: Raloxifene carries a black box warning that the drug increases the risk of venous thromboembolism and death from strokes, especially in women with coronary artery disease. With a previous history, the drug may not be given, or the healthcare provider will evaluate risk-versus-benefit before beginning this drug. Options 1, 3, and 4 are incorrect. Raloxifene may cause depression in some patients, but it is an adverse effect, not a contraindication. A history of osteoarthritis is not a contraindication for this drug. Black cohosh may interfere with the effectiveness of raloxifene if taken concurrently, but a history of using the herbal product does not present a contraindication now. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

A woman reports using OTC aluminum hydroxide (AlternaGEL) for relief of gastric upset. She is on renal dialysis three times a week. What should the nurse teach this patient? Continue using the antacids but if she needs to continue them beyond a few months, she should consult the healthcare provider about different therapies. Take the antacid no longer than for 2 weeks; if it has not worked by then, it will not be effective. Consult with the healthcare provider about the appropriate amount and type of antacid. Continue to take the antacid; it is OTC and safe.

Answer: 3 Rationale: Antacids are generally combinations of aluminum hydroxide, calcium, and/or magnesium hydroxide. Hypermagnesemia, hypercalcemia, or hypophosphatemia can develop with use of OTC antacids. Because this patient is on renal dialysis, her kidneys are unable to adequately control the excretion of electrolytes. The nephrologist should be contacted about whether an antacid is appropriate for this patient. Options 1, 2, and 4 are incorrect. Because of concerns about electrolyte imbalance, taking the antacid for limited periods may not be advisable. A drug's availability OTC does not guarantee its safety, and it may produce adverse effects in patients. Cognitive Level: Analyzing. Nursing Process: Implementation. Client Need: Physiological Integrity.

A patient who is on ranitidine (Zantac) for PUD smokes and drinks alcohol daily. What education will the nurse provide to this patient?

This patient has a history of PUD, and alcohol and smoking exacerbate the condition. Avoiding these substances as well as caffeinated beverages and foods known to trigger abdominal pain should be included as part of the antiulcer regimen. This patient is on ranitidine (Zantac), and smoking decreases the effectiveness of the medication.

Jackson Shoewalter is a 66-year-old man with a history of type 1 diabetes. He has been on insulin for over 20 years. During the past few months, Mr. Shoewalter has had increasing difficulty eating. At first he noticed that he felt full almost immediately and then nausea began in waves, eventually resulting in vomiting. He began to lose weight and have trouble controlling his blood glucose levels, experiencing more frequent bouts of hypoglycemia. After seeing his provider and having follow-up testing, he was diagnosed with gastroparesis diabeticorum. His provider has told him that it is most likely due to his diabetes and may be temporary. He has been started on several prokinetic drugs that encourage gastric emptying (e.g., metoclopramide and erythromycin). A jejunostomy tube is inserted for feedings until the outcomes of drug therapy can be determined. Mr. Shoewalter has returned for his first postoperative visit to the provider's office and will need teaching about his feeding tube. Mr. Shoewalter wants to know if he can still eat foods "normally." Give a rationale for your answer. He does not know how to take care of his tube and wants to know if any special care is required. As the nurse, what would you teach him? Create a list of potential complications to which Mr. Shoewalter and his family should be alerted.

It may be possible for Mr. Shoewalter to continue to eat small amounts of food or to drink beverages but he should check with his provider first. If the gastroparesis has resulted in complete stasis of foods and fluid in the stomach, he may need to wait until the results of the prokinetic drugs have been determined. He may also be able to sip small amounts of water, which may be absorbed more quickly. Eating or drinking when gastric emptying is not occurring may increase the risk of regurgitation and aspiration. 2. Mr. Shoewalter should be taught to inspect the area around the tube insertion site daily for redness, "streaking," swelling, drainage, or tenderness. If the tube is sutured in place, he should also inspect the suture sites. 3. The list should include symptoms such as fever, redness or tenderness at the insertion site, or drainage from the site. Diarrhea or constipation may occur, and after tube feedings are started, clogging of the tube may also occur. Fluctuations in Mr. Shoewalter's blood sugar may occur. He should be provided with a written list of instructions on what to assess for and when to call his provider.

A 37-year-old man has been taking NSAIDs for a shoulder injury. He develops abdominal pain that is worse when his stomach is empty. After trying several OTC remedies, he schedules a visit with his healthcare provider. A breath test confirms the presence of H. pylori and a diagnosis of PUD is made. The patient is started on omeprazole (Prilosec), clarithromycin (Biaxin), and amoxicillin (Amoxil). He asks about the purpose of the drugs. How should the nurse respond?

The antibiotics clarithromycin (Biaxin) and amoxicillin (Amoxil) are used to treat the infection with H. pylori. Two or more antibiotics are given concurrently to increase the effectiveness of therapy and to lower the potential for bacterial resistance. Omeprazole (Prilosec) or other PPIs are used to control gastric acidity, decreasing the irritation to the ulcer site.

In taking a new patient's history, the nurse notices that he has been taking omeprazole (Prilosec) consistently over the past 6 months for treatment of epigastric pain. Which recommendation would be the best for the nurse to give this patient? Try switching to a different form of the drug. Try a drug like cimetidine (Tagamet) or famotidine (Pepcid). Try taking the drug after meals instead of before meals. Check with his healthcare provider about his continued discomfort.

nswer: 4 Rationale: PPIs such as omeprazole (Prilosec) are recommended for short-term therapy, approximately 4 to 8 weeks in length. If symptoms of epigastric pain and discomfort continue, other therapies and screening for H. pylori may be indicated. Options 1, 2, and 3 are incorrect. Switching to another PPI still exceeds the recommended time of use for this category of drugs. H2-receptor antagonists such as cimetidine (Tagamet) and famotidine (Pepcid) may be indicated but their use should be evaluated by a healthcare provider because more definitive treatment (e.g., for H. pylori) may be required. PPIs should be taken 30 minutes before meals. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.