Pharmacology Ch. 48

The client's calcium level is low. What will be the nurse's primary concern? 1. Seizures 2. Bone fractures 3. Hypoglycemia 4. Depression

Correct Answer: 1 Rationale 1: A low calcium level puts the client at risk for seizures. Rationale 2: A consistently low calcium level will result in bone fractures, but this is not the immediate concern. Rationale 3: A low calcium level will not result in hypoglycemia. Rationale 4: A low calcium level will not result in depression.

The nurse teaches a class for college students about osteoporosis. What is the best information to include? 1. Prevention of osteoporosis begins in early adulthood. 2. Medication is the primary treatment to prevent and halt bone loss. 3. Osteoporosis is an inevitable part of aging. 4. Men do not need to be concerned about osteoporosis.

Correct Answer: 1 Rationale 1: Prevention of osteoporosis should begin in early adulthood. Rationale 2: Lifestyle changes such as diet, exercise, and calcium are also needed as well as medication. Rationale 3: .Osteoporosis is not an inevitable part of aging. Rationale 4: Men are also at risk for osteoporosis.

A patient has been prescribed a bisphosphonate for treatment of osteoporosis. The nurse prioritizes teaching about immediately reporting which finding? 1. New onset thigh pain 2. Nausea 3. Headache 4. Dry, itchy skin

Correct Answer: 1 Rationale 1: There is an increased incidence of atypical fractures associated with bisphosphonate use. Thigh or groin pain has been noted to occur prior to fracture. Rationale 2: Nausea may occur if the patient is on a vitamin D supplement, but this is not the priority. Rationale 3: Headache may occur if the patient is on a vitamin D supplement, but this is not the priority. Rationale 4: Skin eruptions are not an effect of bisphosphonate use

During a medication history, the client states, "I take the calcium supplement called calcitriol." How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Calcitriol is a vitamin D supplement." 2. "What other medications do you take?" 3. "You don't understand the medications you are taking." 4. "Do you also take a vitamin D supplement?" 5. "Do you take the prescription strength or over-the-counter?"

Correct Answer: 1,2 Rationale 1: Calcitriol is a vitamin D supplement. Rationale 2: Calcitriol is often taken with calcium supplementation, and the client may have medication names confused. Rationale 3: This may be the truth, but this is not a therapeutic statement. Rationale 4: Calcitriol is a vitamin D supplement. Rationale 5: The nurse should correct the client's mistake.

A patient has been prescribed a bisphosphonate for treatment of osteoporosis. The nurse evaluates that additional teaching is required if the patient makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It will take at least 5 years for the maximum effect of this drug to happen." 2. "If I stop taking this drug, all of the bone density improvement will rapidly disappear." 3. "I still need to eat foods high in calcium." 4. "I should spend 15 to 20 minutes in the sun on most days." 5. "The medication I took to correct my vitamin D deficiency was in preparation for this new treatment."

Correct Answer: 1,2 Rationale 1: Maximum results of therapy will occur in 2-3 years. Additional teaching is necessary. Rationale 2: After discontinuation of therapy, bone density will remain increased for up to a year. Additional teaching is necessary. Rationale 3: The patient must have an adequate intake of calcium. Additional teaching is not necessary. Rationale 4: Vitamin D level is supported by 15-20 minutes of sun exposure each day. Additional teaching is not necessary. Rationale 5: Any deficiency in vitamin D should be corrected before therapy is initiated. Additional teaching is not necessary.

A client has been prescribed denosumab (Prolia). What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I will give your medication in the form of an injection." 2. "You may feel more fatigued than usual when taking this drug." 3. "Be certain to keep your appointments for follow-up." 4. "Do not take any kind of calcium supplement or vitamin D supplement while taking this drug." 5. "We must monitor your cholesterol while you are taking this drug."

Correct Answer: 1,2,3,5 Rationale 1: Denosumab is given subcutaneously. Rationale 2: An adverse reaction of this drug is fatigue. Rationale 3: This drug can cause severe hypocalcemia, so it is important to monitor lab values. Rationale 4: Calcium and vitamin D supplementation may be necessary to keep serum calcium at normal level. Rationale 5: This drug may result in hypercholesterolemia.

The client has gout and receives allopurinol (Zyloprim). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It may take a few days or weeks for me to get the full effect of this medication." 2. "I should not drink alcohol while taking this drug." 3. "If I develop a skin rash, I should contact the prescriber." 4. "I should not crush this medication." 5. "I should take this medication with food."

Correct Answer: 1,2,3,5 Rationale 1: It may take 1-3 weeks for blood levels of uric acid to return to normal range. Rationale 2: Alcohol may inhibit the renal excretion of uric acid. Rationale 3: Skin rash is a possible adverse reaction of allopurinol and can be serious. Rationale 4: Allopurinol tablets may be crushed for administration. Rationale 5: Allopurinol should be taken with or after meals.

A client who has osteoporosis says, "I am exercising more. I go to the gym once a week." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "What kind of exercises are you doing?" 2. "You should try to exercise three to five times a week." 3. "That is not enough." 4. "Is there somewhere that you can walk on the days you don't go to the gym?" 5. "Exercise will not improve your osteoporosis."

Correct Answer: 1,2,4 Rationale 1: In order to affect osteoporosis, exercise must be weight-bearing. Rationale 2: To affect osteoporosis, exercise should be done three to five times weekly. Rationale 3: This is a true statement but is not therapeutic. The nurse should encourage this client's efforts at exercise. Rationale 4: This client should exercise more frequently, and walking is a good form of exercise for those with osteoporosis. Rationale 5: Weight-bearing exercise has been shown to slow or improve effects of osteoporosis.

A client states, "I stopped taking my medications for osteoporosis. I couldn't see how they were helping me any." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The results from these medications are hard for you to see." 2. "It takes about 6 months to see any results." 3. "When did you stop taking the medications?" 4. "Were there any other reasons that you decided to discontinue the medications?" 5. "You are not helping us help you when you don't follow directions."

Correct Answer: 1,3,4 Rationale 1: The changes from taking medications for osteoporosis are difficult for the client to measure. Rationale 2: Therapeutic response may take 1 to 3 months. Rationale 3: The nurse should determine how long it has been since therapy was discontinued. Rationale 4: The nurse should determine if other reasons, such as adverse side effects or cost of medication, were factors in the client's decision. Rationale 5: This is not a therapeutic approach to this client's statement.

The client receives alendronate (Fosamax) as treatment for osteoporosis. The nurse has completed medication education and evaluates learning has occurred when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I cannot lie down for at least 30 minutes after taking the medication." 2. "Milk will help with the absorption of this medication." 3. "I should call my doctor if I experience heartburn." 4. "I must take this with a full glass of water." 5. "The medication can be taken with or without food."

Correct Answer: 1,3,4 Rationale 1: The client must stay upright for at least 30 minutes to prevent GI upset. Rationale 2: Milk will interfere with the absorption of alendronate (Fosamax); it should be taken on an empty stomach. Rationale 3: Alendronate (Fosamax) is irritating to the esophagus; the client must contact the physician if heartburn occurs. Rationale 4: Alendronate (Fosamax) must be taken on an empty stomach with a full glass of water to ensure absorption. Rationale 5: Food will interfere with the absorption of alendronate (Fosamax); it should be taken on an empty stomach.

A client is receiving therapy for gout. Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You should not drink alcohol." 2. "You should increase intake of fatty fish like salmon and sardines." 3. "Take a vitamin C supplement while on your medication for gout." 4. "Increase your fluid intake to 2 to 4 liters each day." 5. "If your joint pain does not improve, let us know."

Correct Answer: 1,4,5 Rationale 1: Limiting or eliminating alcohol consumption is standard treatment for gout. Rationale 2: Salmon and sardines should be eliminated from the diet. Rationale 3: Vitamin C may acidify the urine and lead to formation of uric acid stones. Rationale 4: Increasing fluid intake increases uric acid excretion. Rationale 5: The client should be taught to report worsening or continued inflammation or pain.

The symptoms of gout are due to 1. an increase in the excretion of uric acid. 2. buildup of uric acid in the blood. 3. cartilage loss in the joints. 4. a decrease in uric acid in the blood.

Correct Answer: 2 Rationale 1: An increase in excretion would not cause gout. Rationale 2: Gout is due to buildup of uric acid in blood or joints. Rationale 3: Cartilage loss is characterized by osteoarthritis. Rationale 4: A decrease in uric acid would not cause gout.

The client takes calcium supplements. What is the best instruction by the nurse? 1. "This drug may cause insomnia." 2. "Take your calcium with a meal." 3. "It does not matter if vitamin D is added." 4. "Take them on an empty stomach."

Correct Answer: 2 Rationale 1: Insomnia is not an adverse effect of calcium ingestion. Rationale 2: Calcium is best absorbed if taken with a meal. Rationale 3: Vitamin D facilitates absorption of calcium. Rationale 4: Calcium should be taken with food for best absorption. Global Rationale: Calcium is best absorbed if taken with a meal. Insomnia is not an adverse effect of calcium ingestion. Vitamin D facilitates absorption of calcium.

The nurse assesses the client might be experiencing toxicity from colchicine. Which statement by the client would most likely confirm the nurse's suspicion? 1. "My joints hurt more." 2. "I have nausea, vomiting, and abdominal pain every day." 3. "I don't see as well as I used to, and my taste has changed." 4. "I wake up at night with muscle cramps."

Correct Answer: 2 Rationale 1: Joint pain is not a sign of colchicine toxicity. Rationale 2: Nausea, vomiting, and abdominal pain are signs of colchicine toxicity. Rationale 3: Vision and taste changes are not signs of colchicine toxicity. Rationale 4: Muscle cramps are not a sign of colchicine toxicity.

The client receives hydroxychloroquine sulfate (Plaquenil). Which test does the nurse tell the client should be done on a regular basis? 1. Serum potassium 2. Eye exams 3. Serum glucose 4. Blood pressure

Correct Answer: 2 Rationale 1: Serum potassium monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil). Rationale 2: Blurred vision, inability to read, and visual field disturbances can occur when receiving hydroxychloroquine sulfate (Plaquenil) so the client must have regular eye exams. Rationale 3: Serum glucose monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil). Rationale 4: Blood pressure monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil

The nurse administers calcium intravenously (IV) to the client. What will a key assessment by the nurse include? 1. Assess the serum glucose levels. 2. Assess the intravenous (IV) site. 3. Assess the serum potassium levels. 4. Assess for peripheral edema.

Correct Answer: 2 Rationale 1: The client's glucose levels will not be affected when receiving intravenous (IV) calcium. Rationale 2: The intravenous (IV) site must be assessed, as extravasation may lead to necrosis of tissue at the insertion site. Rationale 3: The client's serum potassium levels should not be affected when receiving intravenous (IV) calcium. Rationale 4: The client should not develop peripheral edema when receiving intravenous (IV) calcium

A nurse is presenting community education for a group of patients with osteoarthritis. The nurse gives which information regarding the goals of pharmacotherapy for osteoarthritis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Medications for osteoarthritis help to prevent development of rheumatoid arthritis." 2. "Medications are given to help reduce the pain of osteoarthritis." 3. "Some of the medications for osteoarthritis focus on reducing inflammation." 4. "We can give medications to prevent the development of osteoarthritis." 5. "Antibiotics are given to treat common infections caused by osteoarthritis."

Correct Answer: 2,3 Rationale 1: Osteoarthritis does not become rheumatoid arthritis. Rationale 2: Pain relief is a major goal of treatment for osteoarthritis. Rationale 3: Inflammation is not as common in osteoarthritis as it is in rheumatoid arthritis, but it does occur. Medications are given to treat the inflammation. Rationale 4: There are no medications that prevent osteoarthritis. Rationale 5: Infections are not caused by osteoarthritis.

A patient reports having "arthritis." The nurse would determine that the patient's arthritis is rheumatoid arthritis if which findings are reported by history? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Joint pain 2. Frequent fever 3. Pulmonary disease 4. Pericarditis 5. Inflammation in joints

Correct Answer: 2,3,4 Rationale 1: Joint pain is common to both diseases. Rationale 2: Frequent fever is associated with rheumatoid arthritis. Rationale 3: Pulmonary disease is associated with rheumatoid arthritis. Rationale 4: Pericarditis is associated with rheumatoid arthritis. Rationale 5: Inflammation in the joints can occur in both diseases.

The nurse has taught the client with osteoporosis about how to manage the illness. Which statement by the client indicates that additional teaching is necessary? 1. "I will avoid drinking alcohol." 2. "I will walk for 30 minutes every day." 3. "I will take my calcium at bedtime." 4. "I will drink milk regularly."

Correct Answer: 3 Rationale 1: Avoiding alcohol will help with osteoporosis. Rationale 2: Walking will help with osteoporosis. Rationale 3: Calcium should be taken with meals, not at bedtime. Rationale 4: Drinking milk will help with osteoporosis.

A child has rickets and is being treated at the clinic. In addition to taking vitamin D as prescribed, what is the best information the nurse can provide? 1. Avoid dairy products while taking vitamin D. 2. Be sure to take brand name, not generic, vitamin D. 3. Spend at least 20 minutes/day in the sunlight. 4. Take your vitamin D on an empty stomach.

Correct Answer: 3 Rationale 1: Dairy products are good sources of vitamin D and should be consumed. Rationale 2: Generic vitamin D is fine to take. Rationale 3: Twenty minutes/day in the sun will provide all the vitamin D that is required. Rationale 4: Vitamin D should be taken with food, not on an empty stomach

The client has arthritis and has just learned that she is pregnant. What is the best instruction by the nurse? 1. Avoid using heat on the joint. 2. Hydroxychloroquine (Plaquenil) is the best medication for you. 3. You could try splinting for discomfort. 4. Glucocorticoids are considered safe during pregnancy.

Correct Answer: 3 Rationale 1: Heat will relieve arthritic pain. Rationale 2: Hydroxychloroquine (Plaquenil) is a Pregnancy Category C drug and should be avoided. Rationale 3: Splinting is an appropriate nonpharmacologic method for arthritic pain during pregnancy. Rationale 4: Glucocorticoids are Pregnancy Category C drugs and should be avoided

A patient calls the clinic to report severe exacerbation of gout. The patient says, "My probenecid (Probalan) is not helping." The nurse would consider which information before responding? 1. The patient is confused on the drug name as probenecid (Probalan) is administered intravenously. 2. The patient will not have relief of pain until probenecid (Probalan) levels are increased, which takes at least 48 hours. 3. Probenecid (Probalan) is not used to treat acute attacks of gout. 4. The patient should take the probenecid (Prolan) with an acidic drink like orange juice.

Correct Answer: 3 Rationale 1: Probenecid (Probalan) is taken orally. Rationale 2: There is no need to wait 48 hours for pain relief. Rationale 3: Probenecid (Probalan) is not used for relief of gouty arthritis because it has no anti-inflammatory properties. Rationale 4: There is no need to take this medication with an acidic drink.

The client takes a bisphosphonate for osteoporosis. Which assessment is best in determining the effectiveness of the medication? 1. Normal serum calcium levels 2. Absence of fractures 3. Bone density scan 4. Absence of bone pain

Correct Answer: 3 Rationale 1: The bone density scan, not the levels of serum calcium, is the best assessment measure to determine the effectiveness of bisphosphonates. Rationale 2: The bone density scan, not the absence of fractures, is the best assessment measure to determine the effectiveness of bisphosphonates. Rationale 3: The bone density scan is the best assessment tool to determine the effectiveness of bisphosphonates. Rationale 4: The bone density scan, not the absence of bone pain, is the best assessment measure to determine the effectiveness of bisphosphonates.

The nurse is teaching about the need for vitamin D in the body. The nurse would put these steps of vitamin D activation and action in which order? 1. Calcium absorption is increased in the small intestine 2. Calcifediol is formed 3. Dietary products are consumed 4. Calcitriol is formed 5. Cholecalciferol is synthesized

Correct Answer: 3,5,2,4,1

Which sign is common with hypocalcemia? 1. Bruising 2. Hypertension 3. Muscle wasting 4. Muscle spasms

Correct Answer: 4 Rationale 1: Bruising is not a sign of hypocalcemia. Rationale 2: Hypertension is not a sign of hypocalcemia. Rationale 3: Muscle wasting is not a sign of hypocalcemia. Rationale 4: Signs and symptoms of hypocalcemia are nerve and muscle excitability. Muscle spasms, tremors, or cramping can be evident. Numbness and tingling of the extremities can occur, and convulsions are possible

A client takes calcium three times a day in the form of supplements. The nurse will advise the client to take the drug 1. with tea or coffee. 2. on an empty stomach. 3. with zinc supplements. 4. with food.

Correct Answer: 4 Rationale 1: Caffeine may slow absorption. Rationale 2: Taking the calcium on an empty stomach can increase gastric upset. Rationale 3: Zinc can interact with calcium and decrease effectiveness. Rationale 4: Food helps to absorb the calcium.

An important function of calcium is to 1. regulate acid-base balance. 2. improve glucose absorption. 3. increase energy. 4. regulate nerve transmission.

Correct Answer: 4 Rationale 1: Calcium does not regulate acid-base balance. Rationale 2: Calcium does not improve glucose absorption. Rationale 3: Calcium does not increase energy level as do carbohydrates. Rationale 4: Adequate calcium levels help to transmit nerve impulses.

The client has osteomalacia, and the physician has ordered a treatment to restore calcium balance. What will the nurse plan to administer to the client? 1. Calcium supplements and dark green, leafy vegetables 2. Calcium supplements and milk products 3. Calcium supplements and potassium 4. Calcium supplements and vitamin D

Correct Answer: 4 Rationale 1: Dark green, leafy vegetables are not the best of the sources of calcium listed. Rationale 2: Calcium supplements and milk products are good choices, but the client must also have vitamin D. Rationale 3: Potassium is not necessary with this illness. Rationale 4: Calcium supplements and vitamin D are considered the most effective treatments for osteomalacia

The client receives alendronate (Fosamax) as treatment for osteoporosis. Which symptoms, caused by an adverse effect of the medication, does the nurse teach should be reported to the physician? 1. Ringing of the ears 2. Hot and dry skin 3. Vision changes and photophobia 4. Muscle spasms and facial twitching

Correct Answer: 4 Rationale 1: Ringing of the ears is not associated with alendronate (Fosamax). Rationale 2: Hot and dry skin is not an adverse effect of alendronate (Fosamax). Rationale 3: Vision changes and photophobia are not adverse effects of alendronate (Fosamax). Rationale 4: Muscle spasms and facial twitching indicate a low calcium level, which can be caused by alendronate (Fosamax), and should be reported immediately before the client has seizures.

The mechanism of action of selective estrogen receptor modulators (SERMs), such as raloxifene (Evista), is to 1. increase calcium levels in the bone. 2. slow bone resorption. 3. inhibit synthesis of microtubules. 4. increase bone mass and density.

correct Answer: 4 Rationale 1: Calcium supplements increase calcium levels. Rationale 2: Bisphosphonates slow bone resorption. Rationale 3: Selective estrogen receptor modulators do not inhibit synthesis of microtubules. Rationale 4: Selective estrogen receptor modulators increase bone mass and density through the estrogen receptor.