Pharm Quiz 3

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?

Change products at the beginning of her next cycle.

The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my:

thighs and calves

Which are contraindications for taking sildenafil [Viagra]?

1) Patients who are taking nitroglycerin for angina pectoris 2) Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye 3) Patients with BPH who are taking alpha1 -adrenergic antagonists

Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient?

1. Make sure you tell your prescriber if you might be pregnant. 2. If you experience any tingling or numbness, stop taking the drug and call the clinic immediately. 3. Headaches and drowsiness can occur and are mild side effects 4. Your urine may have a brown tinge while you are taking this drug."

A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what?

1.Intrauterine devices (IUDs), 2. Intramuscular medroxyprogesterone acetate 3. Etonogestrel subdermal implants 4. Male or female sterilization

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?

A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

An 18-year-old woman with multiple sexual partners

A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he doesn't want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient?

Avanafil [Stendra] Avanafil is used to treat ED and, unlike the other agents, has a shorter onset of action, with effects occurring in 15 minutes after taking the drug and may be taken 30 minutes prior to intercourse. The other agents must be taken 2 hours prior to intercourse.

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider?

DMPA (Depo-Provera) and condoms

According to studies of estrogen/progestin therapy (EPT), what are its known benefits?

Decreased osteoporosis risk, Glycemic control, Improved wound healing

A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?

Discuss an oral contraceptive with increased estrogen.

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem?

Elevated blood urea nitrogen and creatinine

A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient?

He should talk to his provider about daily dosing of tadalafil. Tadalafil is approved for daily dosing and can be given daily for men who anticipate sexual activity twice a week or more. Tadalafil has longer effects—up to 36 hours—than sildenafil, and adverse effects take longer to resolve. There is no increased risk of priapism associated with an increase in sexual activity. Because tadalafil has longer effects, dosing and sexual activity do not have to be closely timed.

A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient?

Medications for ED have no effect on erections in healthy men.

A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn't want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about:

Premarin vaginal.

A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching?

Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss.

A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do?

Schedule an appointment for her to receive the injection in 3 weeks.

A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?

She should discard the inert pills and start a new pack during the honeymoon.

The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient?

Stroke, Deep vein thrombosis, Ovarian cancer

A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?

The patient should request an OC containing less estrogen.

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?

The patient should discuss an alternate method of birth control prior to surgery.

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?

This agent is not effective against infections of the upper urinary tract.

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?

Tingling of the fingers

A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?

Uncomplicated lower urinary tract infection treatable with short-course

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct?

When hormone therapy is discontinued, bone mass is quickly lost

A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this patient?

You should not take sildenafil if you are taking silodosin [Rapaflo]. Sildenafil should not be taken with alpha1 -adrenergic antagonists, such as silodosin, because of the risk of severe decreases in blood pressure. Finasteride is not an alpha1-adrenergic antagonist and may be taken with sildenafil. Not all medications for BPH are safe to take with sildenafil. Invasive treatments for BPH are used when symptoms are severe.

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?

You will need to take a low dose of medication for 6 months to prevent infections.

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?

Your child may need tests to assess for urinary tract abnormalities.

A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect:

adverse effects. The principal adverse effects of terazosin and doxazosin are hypotension, fainting, dizziness, somnolence, and nasal congestion. No evidence indicates priapism, sinus infection, or an allergic reaction.

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:

begin a 2-week course of antibiotics.

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:

begin antibiotic therapy after urine culture and sensitivity results are available.

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:

clean the ring with warm water, reinsert it, and use condoms for 7 days.

A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to:

decrease her risk of endometrial cancer.

A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:

increased transmission of the human immunodeficiency virus (HIV).

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:

methenamine [Hiprex].

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has:

prostatitis

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:

reassure the patient that this is normal with this form of contraception.

A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him to:

start with one tablet about 1 hour before anticipated sexual activity. Patients older than 65 years should start with a low dose of 25 mg and may take the drug 1 hour before anticipated sexual activity. Sildenafil is taken when needed and not on a routine basis. Dosing at 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity is the standard recommendation for men younger than 65 years. Two tablets is a high dose; consumption of a high-fat meal would interfere with absorption of sildenafil.

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to:

take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that:

transdermal preparations have fewer side effects.

A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:

within 7 weeks of conception.

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home?

Acute cystitis, Acute urethritis, Recurrent UTI

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?

An older adult man with a low-grade fever, flank pain, and an indwelling catheter

A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching?

I should take the lowest effective dose for the shortest time needed.

Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]?

I should take this medication no more than once a day.

A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?

I will need to use backup contraception if I miss a pill.

A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching?

If my erection lasts longer than 4 hours, I should contact my provider. Priapism can occur and can cause tissue damage to the penis, so an erection lasting longer than 4 hours should be reported. Patients who use nitroglycerin should not use sildenafil within 24 hours of taking this drug. Patients should be advised to take sildenafil 30 minutes to 4 hours before anticipated sexual activity. Sildenafil does not cause an erection without sexual stimuli.

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern?

Occasional use of nitroglycerin Patients taking nitroglycerin should not take sildenafil. Having BPH is not a contraindication. Mild hypertension requires caution but is not a contraindication. Patients with BPH taking finasteride may take sildenafil.

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?

Use another form of contraception for the next month.

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication?

Vasomotor symptoms are a common side effect of this drug.

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring:

the day the last pill is taken and use backup contraception for 7 days.

A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order:

doxazosin [Cardura]. Nonselective alpha1-adrenergic antagonists do not commonly affect sexual function and are useful in patients with mild to moderate symptoms, so doxazosin would be a drug of choice for this patient. Finasteride is a 5-alpha-reductase inhibitor and is used for patients with more severe enlargement of the prostate; it also reduces ejaculate volume and libido. Silodosin is a selective alpha1 -adrenergic antagonist and can cause abnormal ejaculation. Transurethral prostatectomy is reserved for patients with more severe enlargement of the prostate.

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:

pyelonephritis The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms but not by severe flank pain.