Reproductive Drug Questions (Book, Practice, Evolve and Study Guide)
6 A patient calls the clinic because she realized she missed one dose of an oral contraceptive. Which statement from the nurse is appropriate? (Select all that apply.) a "Go ahead and take the missed dose now, along with today's dose." b "Don't worry, you are still protected from pregnancy." c "Please come to the clinic for a reevaluation of your therapy." d "Wait 7 days, and then start a new pack of pills." e "You will need to use a backup form of contraception concurrently for 7 days."
A,E
The nurse would question the order for estrogen replacement therapy in a patient with a history of which condition? 1)Deep vein thrombosis 2)Vaginal bleeding 3)Weight loss 4)Dysmenorrhea
1 Increased coagulation and risk of deep vein thrombosis are side effects of hormone replacement therapy.
A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives? 1)"Use an alternative method of birth control this month during antibiotic use." 2)"The urinary tract infection can be passed to your partner, so he should be screened." 3)"Be sure to complete the full course of antibiotics." 4)"There is no interaction of oral contraceptives and antibiotics."
1 When a patient takes oral contraceptives and is prescribed an antibiotic, the oral contraceptive effectiveness can be decreased and an alternative method of birth control should be used for the month.
Patients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)? 1)nitroglycerin 2)aspirin 3)acetaminophen 4)Anticoagulants
1 When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension unresponsive to treatment.
Which is most important for the nurse to monitor in a patient receiving an antifungal medication? Select all that apply. 1 Daily weights 2Mental status 3Intake and output 4Blood urea nitrogen (BUN) 5Creatinine
1,3,4,5 Nursing assessments appropriate to patients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all patients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.
A female patient arrives in the clinic for counseling on potential hormone replacement therapy. When taking the patient history, which finding would the nurse consider as a contraindication to use of hormone replacement therapy for the patient? 1)High cholesterol 2)History of thromboembolic events 3)Early menstrual onset 4)High number of pregnancies
2 A contraindication for estrogen administration is any history of thromboembolic disorder.
Which is a pharmacodynamic effect of exogenous androgens? 1)Decreased erythropoiesis 2)Increased protein synthesis 3)Increased nitrogen excretion 4)Decreased sperm production
2 Androgens retard the breakdown of amino acids, contributing to an increased synthesis of body proteins, which aids in the formation and maintenance of muscle tissue. Additionally, they stimulate the production of erythropoietin by the kidney, resulting in enhanced erythropoiesis (red blood cell synthesis); increase the retention of nitrogen; and may suppress sperm production when given in large doses as a result of the feedback inhibition of pituitary follicle-stimulating hormone (FSH).
A patient prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that he experienced when previously taking erythromycin. What is the nurse's best response? 1 "I will call the doctor and ask for a different antibiotic." 2"This drug is like erythromycin with less severe gastrointestinal side effects." 3"You need this medication and will just have to deal with the nausea." 4"I will ask the doctor for a prescription for an antiemetic in case this drug makes you sick as well."
2 Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin.
The addition of continuous administration of progestin to an estrogen regimen reduces the risk of which cancer? 1)Ovarian cancer 2)Endometrial cancer 3)Breast cancer 4)Vaginal cancer
2 Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia.
Which laboratory test would the nurse expect to be ordered to monitor a patient for adverse effects related to progestin medications? 1)Cardiac enzymes 2)Liver function tests 3)BUN and creatinine 4)Complete blood count
2 One of the most serious undesirable adverse effects of progestins is liver dysfunction, which would be assessed by monitoring liver enzymes.
Which is the most common drug used for induction of labor in pregnant women and to promote ejection of milk during lactation? 1)clomiphene 2)oxytocin 3)misoprostol 4)mifepristone
2 Oxytocin is a naturally occurring hormone that can be given in synthetic form for induction of labor.
During a postpartum assessment, the nurse notes a boggy uterus and increased vaginal bleeding. Based upon this assessment and standing physician orders, the nurse prepares to administer which medication? 1)prostaglandin E 2)oxytocin (Pitocin) 3)terbutaline (Brethine) 4)clomiphene (Clomid)
2 Oxytocin is a uterine stimulant that causes uterine contractions, which would decrease the vaginal bleeding
An elderly woman being treated for osteoporosis with a selective estrogen receptor modulator (SERM) should be alerted to the potential for an increased risk of which condition? 1)Elevated blood pressure 2)Venous thromboembolism 3)Hypercalcemia 4)Skin color changes
2 Postmenopausal women taking SERMs are at an increased risk of development of thromboembolic events.
The nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medications have the longest therapeutic effect when taken orally? Select all that apply. 1) sildenafil (Viagra) 2)vardenafil (Levitra) 3)tadalafil (Cialis) 4)alprostadil (Caverject)
2,3 Phosphodiesterase inhibitors are used in the treatment of erectile dysfunction. Sildenafil (Viagra) was the first oral drug approved for the treatment of erectile dysfunction. Two drugs that are similar but have a longer duration of action are vardenafil (Levitra) and tadalafil (Cialis). Collectively, these drugs are referred to as erectile dysfunction drugs. A second type of drug used to treat erectile dysfunction is the prostaglandin alprostadil (Caverject). This drug must be given by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra.
Which statement, made by the patient, indicates an understanding of discharge teaching regarding alendronate (Fosamax)? 1)"I need to decrease my intake of dairy products so as to prevent hypercalcemia." 2)"I need to take this medication with food to prevent damage to my esophagus." 3)"I will take the medication first thing in the morning with 8 ounces of water and remain upright for 30 minutes." 4)"This medication will help relieve the bone pain I have from my osteoporosis."
3 Alendronate can cause erosive esophagitis. To prevent this side effect, it is important to take the medication first thing in the morning on an empty stomach without any other medications and maintain an upright position for 30 minutes. These actions facilitate rapid absorption and prevent reflux into the esophagus.
When educating a patient about the use of oral contraceptives, the nurse provides what explanation for the pills having different colors each week? 1)"They help you remember which week you are taking." 2)"There isn't a reason for the color, just the choice of the drug company." 3)"The different color pills are due to different amounts of hormones in each week." 4)"They are color coded for the weeks of the month."
3 Oral contraceptive pills can be monophasic, biphasic, or triphasic. If the pills are different colors, they have different amounts of hormones and are likely the triphasic type of contraceptive.
The nurse would question the administration of testosterone to a patient with which condition? 1)Hypocalcemia 2)Hyponatremia 3)Hyperkalemia 4)Hypovolemia
3 Testosterone can cause increased serum potassium levels.
When teaching a patient regarding proper application of a Testoderm transdermal patch, the nurse will instruct the patient to perform which action? 1)Replace the patch every 72 hours. 2)Replace the patch every 36 hours. 3)Place the patch on clean, dry, shaved scrotal skin. 4)Place the patch on the back, abdomen, upper arms, or thigh.
3 testoderm transdermal patches should be placed on clean, dry scrotal skin that has been shaved for optimal skin contact. A patch should be replaced every 24 hours.
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? 1nystatin (Mycostatin) 2caspofungin (Cancidas) 3voriconazole (Vfend) 4fluconazole (Diflucan)
4 Fluconazole is an antifungal drug that does not cause the severe side effects of amphotericin when given intravenously. It also has almost 100% bioavailability and therefore a single dose is often sufficient to treat vaginal yeast infections.
4 The nurse has provided patient education regarding therapy with the SERM raloxifene (Evista). Which statement from the patient reflects a good understanding of the instruction? a "When I take that long flight to Asia, I will need to stop taking this drug at least 3 days before I travel." b "I can continue this drug even when traveling as long as I take it with a full glass of water each time." c "After I take this drug, I must sit upright for at least 30 minutes." d "One advantage of this drug is that it will reduce my hot flashes."
A
1. The nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.) a. cephalexin (Keflex) b. guaifenesin (Robitussin) c. warfarin (Coumadin) d. ibuprofen (Motrin) e. theophylline (Uniphyl)
ANS: A, C, E Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of the following drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 551 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
1. The nurse notes in a patient's medication history that the patient is taking the synthetic androgen danazol (Danocrine). Indications for danazol include which conditions? (Select all that apply.) a. Endometriosis b. Decreased sexual libido c. Postpartum breast engorgement d. Fibrocystic breast disease in women e. Hereditary angioedema f. Metastatic breast cancer
ANS: A, D, E Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 565 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is providing patient teaching about the oral bisphosphonate alendronate (Fosamax). Which statement by the patient indicates a good understanding of when this drug should be taken? a. "I will take it in the evening just before bedtime." b. "I will take it in the morning with an 8-ounce glass of water." c. "I will take it with the first bite of the morning meal." d. "I will take it between meals on an empty stomach."
ANS: B Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 560 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
16. The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate? a. Subcutaneous b. Intramuscular c. Vaginal d. Transdermal
ANS: B Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 552 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
. 3. During the administration of finasteride (Proscar), the nurse must remember which important precaution? a. It must be taken on an empty stomach. b. It must not be handled by pregnant women. c. It is given by deep intramuscular injection to avoid tissue irritation. d. The patient needs to be warned that alopecia is a common adverse effect.
ANS: B Finasteride must not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 568 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil
ANS: B In patients with preexisting cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 568 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
1. The nurse is assessing a patient who is about to receive antifungal drug therapy. Which condition, if found in the patient, would be of most concern? a. Diabetes mellitus b. Liver disease c. Pulmonary disease d. Bleeding disorders
ANS: B Liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs. The other options are not contraindications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 685 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
19. The nurse is administering oxytocin (Pitocin). Which situation is an indication for the use of oxytocin? a. Decreased fetal heart rate and movements b. Stimulation of contractions in prolonged labor c. Cervical ripening near term in pregnant patients d. To reverse premature onset of labor
ANS: B Oxytocin is used to induce labor at or near full-term gestation and to enhance labor when uterine contractions are weak and ineffective. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 556 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased a. incidence of nausea. b. risk for thrombosis. c. levels of triglycerides. d. tendency to bleed during menstruation.
ANS: B Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 547 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
2. If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? a. Reduced action of oral anticoagulants, resulting in decreased prothrombin time/international normalized ratio (PT/INR) b. Increased effects of oral anticoagulants, resulting in increased PT/INR c. Increased change in renal impairment caused by the antifungal drug d. Decreased effectiveness of the antifungal drug
ANS: B Some antifungal drugs, including fluconazole and itraconazole, increase the effects of oral anticoagulants, which manifest as increases in PT/INR. As a result, increased bleeding may occur. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 686 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time? a. She will continue to take the alendronate with water. b. She cannot take the alendronate until she can sit up for 30 minutes. c. She can take the medication with breakfast. d. She will stop taking the medication 72 hours before her surgery.
ANS: B The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 553 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
6. The nurse is reviewing the use of uterine tocolytics, such as indomethacin (Indocin). Which statement best describes the indication for these drugs? a. Prevention of preterm labor in the 15th week of pregnancy b. Prevention of preterm labor in the 22nd week of pregnancy c. Stimulation of contractions in prolonged labor d. Stimulation of ovulation as part of infertility treatments
ANS: B Tocolytics relax uterine smooth muscles and stop the uterus from contracting and are used along with nonpharmacologic measures to prevent preterm labor between 20 and 37 weeks of pregnancy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 557 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
1. The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. phenytoin (Dilantin) f. warfarin (Coumadin)
ANS: B, C, E, F Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 615 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
4. A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to do this for 2 weeks!" Which is a possibility in this situation? a. A single dose of a vaginal antifungal cream b. A one-time infusion of amphotericin B c. A single dose of a fluconazole (Diflucan) oral tablet d. There is no better alternative to the suppositories.
ANS: C A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 687 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
20. An elderly female patient is receiving the progestin drug megestrol (Megace). Which is the most likely reason megestrol is ordered for this patient? a. Migraine headaches b. Osteoporosis c. Appetite stimulant d. Reduction of hot flashes
ANS: C Megestrol can cause appetite stimulation and weight gain, and therefore is used in the management of anorexia, cachexia, or unexplained substantial weight loss in patients with acquired immunodeficiency syndrome (AIDS) and in patients with cancer. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 550 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
17. When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of which condition? a. Severe weight gain b. Irregular menses c. Multiple pregnancy d. Alopecia
ANS: C Multiple births are a possible consequence of treatment for infertility with ovulation-inducing drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 559 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? a. Giving magnesium sulfate along with the oxytocin b. Administering the medication in an intravenous bolus c. Administering the medication with an IV infusion pump d. Monitoring fetal heart rate and maternal vital signs every 6 hours
ANS: C Oxytocin is infused via an infusion pump, not via an intravenous bolus. Magnesium sulfate is not administered with oxytocin. Fetal heart rate and maternal vital signs should be monitored continuously. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 561 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
1. The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? a. "If you miss a dose, double-up on the next dose." b. "There's no need to be concerned about breast lumps or bumps that occur." c. "Be sure to report any weight gain of 5 pounds or more per week." d. "Take the medication on an empty stomach to enhance absorption."
ANS: C Patients taking oral estrogen therapy should report weight gain of 5 pounds or more per week to a physician. The other statements are not true for estrogen replacement therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 562 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
15. While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse's best response? a. "Estrogen patches are still the first choice for osteoporosis prevention." b. "Estrogen patches are often used as long-term therapy for osteoporosis prevention." c. "Estrogen patches are not the first choice for osteoporosis prevention because they are associated with a high risk for cardiovascular problems." d. "Estrogen patches can be prescribed if you prefer patches to oral medications."
ANS: C Studies performed as part of the Women's Health Initiative have indicated that because of a high incidence of cardiovascular problems, estrogen therapy is not considered the first choice for osteoporosis prevention. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 548 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines
ANS: C Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 615 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? a. Monophasic b. Biphasic c. Triphasic d. Short-acting
ANS: C The triphasic drugs most closely duplicate the normal hormonal levels of the female menstrual cycle. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 550 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. The nurse recognizes that use of estrogen drugs is contraindicated in which patient? a. A patient who has atrophic vaginitis b. A patient who has inoperable prostate cancer c. A woman who has just given birth and wants to prevent postpartum lactation d. A woman with a history of thrombophlebitis
ANS: D Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 547 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? a. "The medication can be stopped when your symptoms are relieved." b. "Discontinue this medication if menstruation begins." c. "Daily douching is part of the treatment for vaginal fungal infections." d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."
ANS: D Female patients taking antifungal medications for the treatment of vaginal infections need to abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication needs to be taken for as long as prescribed. Instruct patients to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 690 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem? a. methylergonovine (Methergine) b. estradiol transdermal (Estraderm) c. raloxifene (Evista) d. medroxyprogesterone (Provera)
ANS: D Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea. Secondary amenorrhea is not an indication for the other drugs listed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 549 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse notes in a female patient's history that she has an order for the androgen methyltestosterone (Android). Based on this finding, the nurse interprets that the patient has which disorder? a. Fibrocystic breast disease b. Hereditary angioedema c. Hypertension d. Inoperable breast cancer
ANS: D Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 569 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."
ANS: D Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 630 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? a. Complete blood count b. Serum potassium level c. Vaginal cultures d. Pregnancy test
ANS: D Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
7. A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition? a. Hypocalcemia b. Breast cancer c. Stress fractures d. Venous thromboembolism
ANS: D SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 553 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
6. The nurse is instructing a male patient about application of transdermal testosterone (Testoderm) patches. Which body location is preferred for this specific patch? a. Back b. Chest c. Thigh d. Scrotum
ANS: D Testoderm patches are applied to the scrotal skin. Other forms (e.g., Androderm) may be applied to the back, abdomen, upper arms, or thighs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 569 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14 A patient will be receiving a one-dose treatment for vaginal candidiasis. The nurse expects to administer which drug? a. ketoconazole (Nizoral) b. fluconazole (Diflucan) c. griseofulvin d. terbinafine (Lamisil)
B
2 When teaching a patient who is taking oral contraceptive therapy for the first time, the nurse relates that adverse effects may include which of the following? a Dizziness b Nausea c Tingling in the extremities d Polyuria
B
1. When reviewing the health history of a patient who wants to begin taking oral contraceptives, the nurse recalls that which conditions are contraindications to this drug therapy? (Select all that apply.) a. Multiple sclerosis b. Pregnancy c. Thrombophlebitic disorders d. Hypothyroidism e. Estrogen-dependent cancers (Lilley, 122012)
B,c,e
12. A woman who lives in New York City is preparing to take a plane trip to China. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient? a. She needs to stop taking the drug at least 72 hours before the trip. b. She must remember to take this drug with a full glass of water each morning. c. She will not take the drug while traveling on the plane. d. No change in how the drug is taken will be needed.
ANS: A A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 560 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
2. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the antiinfective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.
ANS: A Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 618 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is reviewing the medication list of a patient who will be starting androgen therapy. Which drug classes, if taken with androgens, may have an interaction with them? a. Oral anticoagulants b. Nitrates c. Beta blockers d. Proton pump inhibitors
ANS: A Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 568 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
1. The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."
ANS: A Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 627 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
1. When a male patient is receiving androgen therapy, the nurse will monitor for signs of excessive androgens such as a. fluid retention. b. dehydration. c. restlessness. d. visual changes.
ANS: A Fluid retention is an undesirable effect of androgens. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 567 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? a. Headache b. Drowsiness c. Dysmenorrhea d. Hypertension
ANS: A Headache is one of the possible adverse effects of the fertility drugs. They may also cause vomiting, restlessness, and urticaria. See Table 34-5 for other adverse effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 555 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
18. A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for which potential drug interaction? a. Thyroid replacement therapy b. Oral anticoagulant therapy c. Nonsteroidal antiinflammatory drugs d. Beta blockers
ANS: A Orally administered soy may interfere with thyroid hormone absorption, so concurrent use must be avoided. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 547 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. The nurse recognizes that the risk of osteoporosis is higher in an individual with which risk factor? a. White or Asian race b. African-American race c. History of participation in active sports d. Obesity
ANS: A Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 551 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
1 A patient has been taking finasteride (Proscar) for almost a year. The nurse knows that which is most important to evaluate at this time? a Complete blood count b PSA levels c Blood pressure d Fluid retention
C
1 The nurse is assessing a patient who is to receive dinoprostone (Prostin E2). Which condition would be a contraindication to the use of this drug? a Pregnancy at 15 weeks' gestation b GI upset or ulcer disease c Ectopic pregnancy d Incomplete abortion
C
5 The nurse is discussing therapy with clomiphene (Clomid) with a husband and wife who are considering trying this drug as part of treatment for infertility. It is important that they be informed of which possible effect of this drug? a Increased menstrual flow b Increased menstrual cramping c Multiple pregnancy (twins or more) d Sedation
C
3 The nurse is reviewing the use of obstetric drugs. Which situation is an indication for an oxytocin (Pitocin) infusion? a Termination of a pregnancy at 12 weeks b Hypertonic uterus c Cervical stenosis in a patient who is in labor d Induction of labor at full term
D
2. When the nurse is teaching patients about postmenopausal estrogen replacement therapy, which statement is correct? a. "The smallest dose that is effective will be prescribed." b. "Oral forms should be taken on an empty stomach for best absorption." c. "Estrogen therapy should be long-term to prevent menopausal symptoms." d. "If estrogen is taken, supplemental calcium will not be needed."
a
3. When combination oral contraceptives are given to provide postcoital emergency contraception, the nurse must remember which fact? a. They are not effective if the woman is already pregnant. b. They should be taken within 12 hours of unprotected intercourse. c. They are given in one dose. d. They are intended to terminate pregnancy.
a
7. A patient is beginning a new prescription of raloxifene (Evista). The nurse will teach the patient to expect which potential adverse effects? (Select all that apply.) a. Leg cramps b. Loss of appetite c. Diarrhea d. Hot flashes e. Drowsiness (Lilley, 122012)
a,d
1 The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a Endocrine disease b Hepatic disease c Cardiac disease d Pulmonary disease
b
2. When instructing a patient on how to use miconazole (Monistat) vaginal cream for vaginal yeast infections, the nurse will keep in mind that this medication will be given in which manner? a. Insert once every other day at bedtime for 1 week. b. Insert once daily at bedtime for 7 consecutive days. c. A one-time dose is administered in the morning. d. Insert every night at bedtime until symptoms stop. (Lilley, 122012)
b
4. When reviewing an order for dinoprostone cervical gel (Prepidil), the nurse recalls that this drug is used for which purpose? a. To induce abortion during the third trimester b. To improve cervical ripening near term for labor induction c. To soften the cervix in women who are experiencing infertility problems d. To reduce postpartum uterine atony and hemorrhage
b
5. A pregnant woman is experiencing contractions. The nurse remembers that pharmacologic measures to stop contractions are used during which timeframe? a. Before the 20th week of gestation b. Between the 20th and 37th weeks c. After the 37th week d. At any time during the pregnancy if delivery is not desired
b
2. In which situations would androgens be prescribed for a woman? (Select all that apply.) a. Development of secondary sex characteristics b. Fibrocystic breast disease c. Ovarian cancer d. Treatment of endometriosis e. Postmenopausal osteoporosis prevention f. Inoperable breast cancer (Lilley, 122012)
b,d,f
6 When the Testoderm form of testosterone is ordered to treat hypogonadism in a teenage boy, which instructions by the nurse are correct? (Select all that apply.) a Place the patch on clean, dry skin on the back, upper arms, abdomen, or thighs. b Place the patch on clean, dry scrotal skin that has been shaved. c Place the patch on clean, dry scrotal skin, but do not shave the skin first. d Place the patch on any clean, dry, nonhairy area of the body. e Remove the old patch before applying a new patch.
b,e
2 A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a When the acne clears up, the medication may be discontinued. b This medication needs to be taken with antacids to reduce GI upset. c The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d The teeth should be observed closely for signs of mottling or other color changes.
c
2 The nurse is performing an assessment of a patient who is asking for a prescription for sildenafil (Viagra). Which finding would be a contraindication to its use? a Age of 65 years b History of thyroid disease c Medication list that includes nitrates d Medication list that includes saw palmetto
c
5 A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects that a this is an expected response to antibiotic therapy. b the UTI has become worse instead of better. c a superinfection has developed. d the UTI is resistant to the antibiotic.
c
6. What patient teaching is appropriate for a patient taking alendronate (Fosamax)? (Select all that apply.) a. Take with food. b. Take at night just before going to bed. c. Take with an 8-oz glass of water. d. Take with a sip of water. e. Take first thing in the morning upon arising. f. Do not lie down for at least 30 minutes after taking.
c,e,f
13 A patient calls the gynecologic clinic because she has begun to menstruate while taking vaginal cream for a vaginal infection. She asks the nurse, "What should I do about taking this vaginal medicine right now?" Which is the nurse's best response? a. "You need to stop the medication until the men- strual flow has stopped." b. "Just take the medication at night only." c. "You should stop the medication for 3 days, then start it again." d. "It's okay to continue to take the medication."
d
3 When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a history of cardiac disease. b history of gallbladder surgery. c ethnic background. d cytochrome P-450 enzyme system.
d
4 The nurse is teaching a patient about the possible adverse effect of priapism, which may occur when taking erectile dysfunction drugs. The nurse emphasizes that, if this occurs, the most important action is to a stay in bed until the erection ceases. b apply an ice pack for 30 minutes. c turn toward his left side and rest. d seek medical attention immediately.
d
4. Before a patient begins therapy with finasteride (Proscar), the nurse should make sure that which laboratory test has been performed? a. Blood glucose level b. Complete blood count c. Urinalysis d. Prostate-specific antigen (PSA) level (Lilley, 122012)
d
7. A patient has asked for a new prescription for silde- nafil (Viagra), an erectile dysfunction drug. As the nurse reviews his current medications, which drug, if taken by the patient, would cause a significant interaction? a. warfarin (Coumadin), an oral anticoagulant b. amoxicillin (Amoxil), an antibiotic c. esomeprazole (Nexium), a proton pump inhibitor d. isosorbide dinitrate (Isordil), a nitrate (Lilley, 122012)
d