340 test two pharm quiz

A patient is to be started on adalimumab (Humira) for management of rheumatoid arthritis. Which of the following statements by the patient demonstrates accurate knowledge about the drug? "My husband will be giving me intramuscular injections of the medication in the sides of my thighs." "I have been taught how to administer the medication to myself in the fatty tissues of the top of thighs and abdomen." "The drug must be stored in a warm place like my bathroom medicine cabinet." "The drug is more likely to cause allergic reactions when administered orally."

"I have been taught how to administer the medication to myself in the fatty tissues of the top of thighs and abdomen." Adalimumab (Humira) is administered subcutaneously in the anterior thighs or abdomen by the nurse, patient, or caregiver. Adalimumab is for subcutaneous administration only. It should be stored cold at 36° to 46° F (2° to 8° C). Adalimumab is not available for oral administration. See Lehne p. 925-926

The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "I would rather wait until my joint problems are worse before beginning any drugs." What will the nurse tell the patient? "Tell the doctor how you feel so the two of you can make a decision together." "Starting drug therapy as soon as possible can decrease future joint damage." "Methotrexate will be less expensive than other possible drugs." "Your disease can be controlled with corticosteroids and NSAIDs."

"Starting drug therapy as soon as possible can decrease future joint damage." The patient's statement indicates a lack of understanding about the progression of RA. Because joint degeneration occurs within the first year, disease-modifying anti-rheumatic drugs (DMARDs) are prescribed in the first months of diagnosis to delay this process. If, after an explanation, the patient continues to decline the medication, referral to the physician would be appropriate. Methotrexate is less expensive than biologic DMARDs, but the patient's statement reflects a desire to not take any drugs rather than a financial concern about their cost. The use of corticosteroids and NSAIDs is for short-term management of flare-ups or until the DMARD becomes effective. The most important point for the patient to understand is the importance of starting DMARDs as quickly as possible. See Lewis pp. 1653; Lehne pg. 920

The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse expects the prescriber to order that the drug be administered at what time? 0800 1200 1600 2100

0800 Early morning administration mimics the burst of glucocorticoids normally released by the adrenal glands at dawn (circadian rhythm). Patients on alternate-day therapy or who take one daily dose should receive this medication before 0900. Therefore, 0800 is the only time listed that matches this criterion. See Lehne p. 915 last paragraph

The nurse is administering mitoxantrone (Novantrone) to a patient with multiple sclerosis who was unresponsive to immunomodulators. The nurse teaches the patient to hold the drug and call the physician for which symptoms? diaphoresis and hypoglycemia dizziness and orthostatic hypotension headache and elevated blood pressure 3 lb. weight gain in 1 day and shortness of breath

3 lb. weight gain in 1 day and shortness of breath Mitoxantrone is cytotoxic and can produce irreversible side effects such as cardiotoxicity months to years after the drug is discontinued. The effects on the heart are manifested as reduced left ventricular ejection fraction and/or heart failure. A rapid weight gain should be quickly followed up on by the health care provider because it is a sign of heart failure. See Lehne, pg 219.

The health care provider left an order to discontinue prednisone. What will the nurse do next? Ask the health care provider for instructions to taper the prednisone dose. Explain to the patient that the drug should be immediately stopped. Advise the patient to consult a local pharmacist for tapering instructions. Inform the patient to gradually reduce the dosage over the next week.

Ask the health care provider for instructions to taper the prednisone dose. Prednisone must be tapered according to physician order to avoid adrenal insufficiency. Dosage adjustments are not within the pharmacist's or nurse's scope of practice unless there is a standing protocol or order. See Lehne pg 914-915.

A patient with systemic lupus erythematosus (SLE) asks the rheumatology nurse about belimumab (Benlysta), a new drug for SLE. How does the nurse respond? Belimumab has modest benefits and may contribute to mortality. This drug was effective for a large number of patients in clinical trials. Research shows that Benlysta can replace all your other SLE drugs. Physicians now consider Benlysta to be the first-line therapy for SLE.

Belimumab has modest benefits and may contribute to mortality. Benlysta, while promising, demonstrated only modest benefits to a limited population of patients with SLE. It has significant side effects and, in clinical trials, there was a slightly higher mortality rate with this drug than with the placebo. See Lehne, pg 1366-1367.

UESTION 20 The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine (Imuran). Which laboratory test result should be monitored periodically? Microscopic urine examination Complete blood count (CBC) with differential Immunoglobulin survey Serum albumin

CBC The nurse should monitor the CBC, because neutropenia is a major adverse effect of azathioprine (Imuran). Another major adverse effect is pancreatitis. Microscopic urinalysis is not indicated. The immunoglobulin and serum albumin levels do not require monitoring in relation to this drug. See Lehne p. 878 & 1020

The nurse understands that a COX-2 inhibitor (celecoxib [Celebrex]) should be avoided in patients with existing cardiac disease. What is the reason for excluding celecoxib in these patients? Celecoxib allows ongoing platelet aggregation and causes vasoconstriction. Antihypertensive medications interact with COX-2 inhibitors to increase blood pressure. COX-2 inhibitors interact with diuretics and cause increased risk of bleeding. A COX-2 inhibitor such as celcoxib contributes to vasodilation and arrhythmias.

Celecoxib allows ongoing platelet aggregation and causes vasoconstriction. COX-2 inhibitor drugs should be used with caution in patients with cardiovascular risk factors such as hypertension. Vasoconstriction from COX-2 inhibition can cause increased blood pressure. Like other NSAIDs, COX-2 inhibitors can lead to renal impairment which can contribute to increased risk for patients with cardiovascular diseases such as heart failure or hypertension. Also, normal platelet aggregation continues in a narrowed vessel. This places the patient at increased risk for thrombosis and myocardial events such as myocardial infarction (MI) and stroke. See Lehne, pg. 901

A patient is being treated with immunomodulators for relapsing-remitting multiple sclerosis. Which information about this drug will the nurse include in patient education? This drug should always be taken by mouth. Take this drug only if attacks last more than 1 week. Continue this drug indefinitely unless otherwise ordered. Use this drug only when you are having a relapse.

Continue this drug indefinitely unless otherwise ordered. Treatment should begin as soon as possible after diagnosis and continue indefinitely. If therapy is stopped, symptom progression will return to pre-treatment rate. Immunomodulators are typically injectable with only fingolimod available in an oral form. See Lehne pg 214

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. When the patient has a follow-up visit 1 month later, how will the nurse evaluate the effectiveness of the treatment? blood glucose testing liver function tests serum electrolyte levels C-reactive protein level

Creactive protein Glucocorticoids are strong anti-inflammatory drugs. C-reactive protein is a non-specific marker for inflammation and a decrease would indicate that inflammation is decreasing; therefore the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will be monitored to check for side effects of prednisone. Liver function is not routinely monitored for patients receiving steroids. See Lewis p. 1652 & 1654; Lehne p. 909-910

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication? a recent 5-pound weight loss increased erythrocyte sedimentation rate (ESR) DEXA scan that indicates osteoporosis no improvement in symptoms

DEXA scan Osteoporosis is an adverse effect of corticosteroid use. Weight gain, not weight loss, is seen with corticosteroid use. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication. See Lewis p. 1635.

The following information was included in the change of shift report on a patient who is prescribed aspirin for its anticoagulant effects. Which patient symptom would be the first priority for the nurse to report to the attending physician? nauseous symptoms dark tarry stools heartburn when recumbent two liquid stools in past 24 hours

Dark tarry stools Dark tarry stools suggest slow upper GI bleeding which would be the priority symptom to report to the physician. Nausea and heartburn, particularly when the patient is recumbent, are symptoms that can be remedied by taking aspirin with food or a full glass of water. Liquid stools are not an adverse effect of aspirin and would likely be a symptom of some other problem. See Lehne pg 893

The nurse is administering high-dose intravenous methylprednisolone to a patient who is experiencing an acute relapse of multiple sclerosis. Which chronic condition, if present, could be negatively affected by this treatment? Asthma Diabetes mellitus Rheumatoid arthritis Inflammatory bowel disease

Diabetes High-dose glucocorticoids interfere with glucose metabolism and require careful use with patients who have diabetes. Each of the other diseases can be treated with glucocorticoids.

The nurse is preparing to administer medication to a patient taking betamethasone. Which additional drug, when administered concurrently with betamethasone, would put the patient at risk for cardiotoxicity? ibuprofen live vaccine digoxin (Lanoxin) insulin

Dig Glucocorticoids can increase the loss of potassium through the urine leading to hypokalemia. Hypokalemia is cardiotoxic and can cause digoxin-induced cardiac dysrhythmias. Concurrent use of NSAIDs may increase the risk for gastric ulceration, not cardiotoxicity. Administration of a live vaccine while a patient is taking glucocorticoids increases the risk for acquiring viral disease. Glucose levels may be affected by glucocorticoids, but this would require adjustments to hypoglycemic medications not treatment for cardiotoxicity. See Lehne p. 914

A patient on long-term glucocorticoid therapy has a complete blood cell count drawn. What result does the nurse anticipate for this blood test? Decreased hematocrit Increased red blood cells Increased monocytes Increased lymphocytes

Increase RBC Glucocorticoids increase the number of circulating red blood cells and polymorphonuclear leukocytes. Glucocorticoids reduce the numbers of lymphocytes, eosinophils, basophils, and monocytes. Hematocrit is the percentage of blood cells to serum; because there are increased numbers of RBCs, the hematocrit would go up. See Lehne p. 909

The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for the patient. This medication places the patient at greatest risk for which nursing diagnosis? disturbed sensory perception, auditory. infection. fluid volume deficit. inflammation.

Infection Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the susceptibility to infection by suppressing host defenses. Glucocorticoids do not disturb sensory perception. Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid volume retention. Glucocorticoids can be used to treat inflammation; they don't put the patient at greater risk for inflammation. See Lehne p. 913

The nurse teaches a patient to self-administer etanercept (Enbrel). The patient should be instructed about which common adverse effect associated with administration of this drug? Nausea and vomiting for first 3 days Itching and erythema at injection site Urine color changes to an orange tinge Diarrhea following meal with fatty foods

Itching and erythema at injection site

A patient is prescribed hydroxychloroquine (Plaquenil) for rheumatoid arthritis. The nurse will need to emphasize the importance of follow-up care with which inter-professional discipline? endocrinoterm-1logist rheumatologist pharmacist ophthalmologist

Ophthalmology Although rare, retinal damage is the most serious toxic side effect of hydroxychloroquine (Plaquenil). The patient on this drug should have an ophthalmological examination prior to starting treatment and regularly thereafter (think baseline and trends). Retinopathy has occurred in some patients after treatment has been completed. The patient would already be seeing the rheumatologist for treatment; although follow-up care is very important, the rheumatologist won't be able to assess for all adverse effects from the drug. The pharmacist would provide counseling about the drug. Since RA is not an endocrine disease, an endocrinologist would not be needed. See Lehne pg 923 & Lewis pg 1653.

A patient with rheumatoid arthritis is on long-term treatment with hydroxychloroquine sulfate (Plaquenil). Which patient condition would the nurse would be most concerned in this patient? presence of visual disturbances decreased range of motion and crepitation upper abdominal discomfort poor skin turgor and increased urine specific gravity

Presence of visual disturbances Visual disturbances may be indicative of irreversible retinal damage that can occur even after the drug has been discontinued. Other side effects of immediate concern are related to signs and symptoms of infection because Plaquenil can cause decreased WBCs. Decreased range of motion would indicate the medication is no longer effective in treatment of RA. Plaquenil can cause GI problems, but this is a common side effect that can be alleviated by taking the medication with food. Plaquenil does not cause dehydration. See Lewis pg 1653 & Lehne pg 923

The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the action of sulfasalazine? "Azulfidine treats associated infections." reduces the inflammation." enhances the immune response." increases the reabsorption of fluid."

Redices inflammation Sulfasalazine reduces the inflammation associated with ulcerative colitis; this statement indicates understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed. Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed. See Lehne p. 1019

The nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex). Which information is most important to communicate to the health care provider? platelet count is 149,500/mm3 white blood cell count (WBC) is 1500 mm3 blood glucose is 110 mg/dL serum potassium is 5.1 mEq/L.

WCB The highest priority is the very low WBC count. Bone marrow suppression is a possible side effect of methotrexate, and the patient's resulting low WBC count places the patient at high risk for infection. The low platelet count is close to normal, and will need to be addressed because the patient is on methotrexate. However, the WBC count is a higher priority. The other laboratory values are also abnormal but are not far from normal values and would not have any immediate serious consequences. See Lewis pg. 1653, Lehne pg. 922

Medication education for a patient receiving glucocorticoids should include the preferred use of which medication for management of mild pain? Aspirin Acetaminophen Ibuprofen Naproxen sodium

acetaminophen Rationale: The nurse should counsel the patient to use acetaminophen for mild pain, because it does not cause gastric upset, as do nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium. Because glucocorticoids can also cause gastric distress, concurrent use of glucocorticoids with NSAIDs can lead to gastric ulceration. See Lehne p. 914

A mother brings her 17-year-old daughter to the emergency department. She states that the daughter took 40 extended-release acetaminophen tablets 8 hours ago. Which order would the nurse expect to implement? administer activated charcoal through an NG tube give high doses of antacids over the next 8 hours administer IV acetylcysteine (Mucomyst). arrange for temporary hemodialysis

administer IV acetylcysteine (Mucomyst). Liver damage can be minimized by giving acetylcysteine (Mucomyst), a specific antidote to acetaminophen. Acetylcysteine, the specific antidote, prevents injury when given within 8 to 10 hours, but is still effective if given within 24 hours of overdose. Antacids, even in high doses, work in the stomach and will not prevent liver damage, the primary risk associated with acute acetaminophen toxicity. Since overdose of acetaminophen is toxic to the liver, not the kidneys, hemodialysis is not indicated. See Lehne pg. 903.

The nurse is preparing to administer an initial dose of aspirin and obtains a brief health history. Based on an understanding of the therapeutic effects of this drug, the nurse would anticipate the patient to have which medical diagnosis? ulcerative colitis asthma arthritis chronic renal disease

arthritis Rationale: The nurse should anticipate that the initial dose of aspirin will begin to reduce inflammation; therefore, the nurse would expect the patient to be experiencing an inflammatory disorder, such as arthritis. Aspirin would be inappropriate for patients with ulcerative colitis, because these patients are already at risk for bleeding, and the use of aspirin could potentiate further bleeding. Aspirin can exacerbate asthma and should not be used with these patients. Aspirin can impair renal function; it is not given to treat renal disease. See Lehne pg 893-894.

The nurse is caring for a patient who is to be discharged from the hospital on etanercept (Enbrel). Which of the following instructions should the nurse include in the patient teaching? Take with food to enhance drug absorption. Avoid live vaccines. Avoid all forms of alcohol. Practice passive range-of-motion exercises daily.

avoid live vaccines The nurse should tell the patient to avoid live vaccines. The drug may increase the patient's risk of acquiring or transmitting infection if the person is vaccinated with a live vaccine. Because etanercept is administered subcutaneously, absorption of the medication is not affected by diet. Alcohol is not contraindicated with etanercept therapy. The patient should be encouraged to perform active, not passive, range-of-motion exercises. See Lehne p. 924-925, 929

The nurse is providing education to a patient for whom a COX-2 inhibitor has been prescribed. Patient teaching has been effective if the patient agrees to take celecoxib (Celebrex) for the shortest time possible to decrease the risk of which complication? peptic ulcer disease liver toxicity acid-base imbalance cardiovascular events

cardiovascular COX-2 inhibitors increase the risk of myocardial infarction and stroke. To decrease this risk, celecoxib should be taken in the smallest effective dose and for the shortest time possible. The incidence of peptic ulcer disease is lower with COX-2 inhibitors than with COX-1 inhibitors. In regular doses, COX-2 inhibitors are not toxic to the liver. COX-2 inhibitors in regular doses do not affect acid-base balance. See Lehne, pg. 901

A patient asks the nurse about the metabolic effects of glucocorticoids. Which statement best describes the effects? "Glucocorticoids prevent the body's metabolism of fatty acids for fuel." change carbohydrate metabolism by blocking the synthesis of glucose." cause elevated blood glucose levels by changing carbohydrate metabolism." increase muscle mass, bone mass, and improve the condition of skin."

cause elevated blood glucose levels by changing carbohydrate metabolism." Rationale: "The principle effect on carbohydrate metabolism is elevation of blood glucose levels." Glucocorticoids promote, not block, synthesis of glucose from amino acids. The most consistent effect of glucocorticoids on fat metabolism is not inhibition but stimulation of lipolysis (fat breakdown). Adverse effects of glucocorticoids are seen in decreased muscle and bone mass and in thinning of the skin. See Lehne p. 909

A patient wants to use medication rather than surgery for gall stones. The nurse explains that drugs used to dissolve gallstones are most effective for which gall stones? consist of cholesterol are located within the bile duct are located within the gallbladder can be seen on an X-ray

consist of cholesterol Chenodiol and Ursodiol, bile acids used to dissolve gallstones in carefully selected patients, promote dissolution of stones that are composed of cholesterol rather than those composed mainly of calcium. Gallstones composed of calcium are radiopaque and show up on X-ray. Those composed of cholesterol are radiolucent, so are not visible on X-ray. See Lehne p 1023

A patient has been started on analgesic therapy with a nonsteroidal anti-inflammatory drug. Because of the risk for significant drug interactions, which medication order would the nurse question? opioid analgesic glucocorticoid antimicrobial agent bulk laxative

glucocorticoids Drug interactions associated with NSAIDs include anticoagulants, glucocorticoids, alcohol, aspirin, ACE inhibitors, and angiotensin II receptor blockers (ARBs). An NSAID combined with an anticoagulant could lead to increased risk for hemorrhage. See Lehne, pg 907-908.

The patient has an order for administration of a glucocorticoid. The nurse would question this order if the patient also has which condition? systemic lupus erythematosus rheumatoid arthritis systemic fungal infections asthma

systemic fungal infections Rationale: The nurse should question administration of a glucocorticoid to a patient with any type of infection, because the drug suppresses immune responses that would normally allow the body to fight infection. Glucocorticoids are absolutely contraindicated for patients with systemic fungal infections. The use of glucocorticoids in a patient with asthma, systemic lupus erythematosus or RA is expected, because these are autoimmune, inflammatory disorders that would respond to glucocorticoid intervention. See Lehne pgs. 911-912 & 914