Pharm 2: Exam 3 Questions

A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information? a."By reducing inflammation, this drug will slow the progression of your disease." b."Glucocorticoids are used as adjunctive therapy during acute flare-ups." c."Oral glucocorticoids cause less toxicity than intra-articular injections." d."You may resume running when the pain and swelling improve."

"Glucocorticoids are used as adjunctive therapy during acute flare-ups."

A 14-year-old male patient has not begun puberty. His parents tell the nurse that their son does not want to go to school, because he gets teased. The nurse learns that the boy's father did not begin puberty until age 16 years. Laboratory tests on this child do not reveal true hypogonadism. What will the nurse tell these parents when they ask what can be done for their son? a. "A limited course of androgen therapy may be prescribed, but it is not necessary." b. "He will eventually begin puberty, so this is nothing to worry about." c. "He will probably have to receive injections of androgens for 3 to 4 years." Ad. "The risk of accelerated growth plate closure is too great to warrant androgen therapy."

A

A clinic nurse is assessing an adolescent male patient who has been receiving androgen therapy for hypogonadism via a transdermal patch. The patient's last clinic visit was 4 weeks earlier. Which part of the interval history is of most concern to the nurse? a. Five-pound weight gain b. Increased growth of pubic hair c. Rash at the site of the patch d. Presence of acne

A

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: a. Take 1 pill ASAP and continue with active pills in the pack; skip placebo pills and go straight to a new pack once all the active pills have been taken b. take a pill immediately, continue the pack, and use an additional form of contraception for 1 month. c. not to worry, because up to 7 days can be missed without an increased risk of pregnancy. d. continue the pack, skip the inert pills, and use an additional form of contraception for 7 days.

A

A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a. Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] b. Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] c. Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] d. Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid]

A

A postpartum patient is receiving ergonovine maleate (Ergotrate) to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do? a. Continue to monitor and tell the patient to report increased cramping. b. Notify the provider of possible uterine hypertonicity. c. Notify the provider of the patient's blood pressure. d. Request an order to administer the Ergotrate intravenously.

A

A pregnant patient is 1 week post-term and will receive intravenous oxytocin. Which will the nurse evaluate before starting the infusion? (Select all that apply.) a. Cervical ripening b. Fetal monitoring c. Renal function d. Respiratory function e. Uterine activity

A, B, E

The nurse identifies which as an approved condition for induction of labor? A.Preeclampsia or eclampsia B.Transverse fetal position C.Previous cesarean delivery D.Placenta previa

A. Preeclampsia is a maternal condition that outways the risk that may occur with delivery and can be cured by delivering fetus. Transverse fetal position, Previous C-section and placenta previa are all contraindications of Labor induction

A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? a.Antihistamines should be avoided unless absolutely necessary. b.Second-generation antihistamines are safer than first-generation antihistamines. c.Antihistamines should not be taken during pregnancy but may be taken when breast-feeding. d.The margin of safety for antihistamines is clearly understood for pregnant patients.

ANS: A Rationale: Antihistamines are pregnancy Category C, with debate currently occurring regarding degree of effects on the fetus. They should be avoided unless absolutely necessary. All antihistamines have adverse effects on the fetus. Antihistamines can be excreted in breast milk. The margin of safety of antihistamines in pregnancy is not clear, so these agents should be avoided unless a clear benefit of treatment outweighs any risks.

A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug? a."Angioedema and hypersensitivity may occur, but they are usually self-limiting andmild." b."I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed." c."I will administer an antihistamine and acetaminophen before beginning the infusion." d."I will monitor this patient's blood pressure, respiratory rate, and oxygen saturationclosely."

ANS: A Rationale: Rituximab can cause severe infusion-related hypersensitivity reactions. Nurses should be prepared to administer epinephrine, steroids, and O2 if needed. Antihistamines and acetaminophen are given before infusion. Close monitoring of vital signs and oxygenation are indicated.

A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say? a."Allergy symptoms that are severe are caused by mediators other than histamine." b."H1 blockers do not prevent the release of histamine from mast cells and basophils." c."Second-generation H1 blockers contain less active drug and do not work in severe reactions." d."Severe allergic reactions occur through actions on muscarinic receptors."

ANS: A Rationale: Severe allergic reactions with symptoms of anaphylaxis are caused by mediators other than histamine, so the benefits of antihistamines are limited. H1 blockers do not block the release of histamine, but this is not why they are not effective in anaphylaxis. Second-generation agents are as effective as first-generation agents in allergic reactions mediated by histamine; neither is effective for treating anaphylaxis.

A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? a.Combination oral contraceptives are effective for improving fertility. b.Gonadotropin-releasing hormone agonists are used for long-term treatment. c.Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. d.Pharmacologic agents used to treat endometriosis do not enhance fertility.

ANS: A Rationale: When treatment with clomiphene has failed to produce ovulation after two courses, hCG is used to promote ovulation after follicular maturation has occurred. Cabergoline is used to treat hyperprolactinemia when excessive prolactin secretion occurs. Ovarian and pituitary function should be evaluated before a patient begins treatment with clomiphene. If ovulation had occurred, another cycle of clomiphene would be indicated.

An infertile patient has received two 5-day courses of clomiphene [Clomid] to help her conceive. An ultrasound 1 week after the last dose reveals that follicular maturation has occurred without ovulation. The nurse expects the next step for this patient to be: a.administration of human chorionic gonadotropin (hCG). b.an order for cabergoline to be given twice weekly. c.evaluation of ovarian and pituitary function. d.repeating clomiphene once daily for 5 days.

ANS: A Rationale: When treatment with clomiphene has failed to produce ovulation after two courses, hCG is used to promote ovulation after follicular maturation has occurred. Cabergoline is used to treat hyperprolactinemia when excessive prolactin secretion occurs. Ovarian and pituitary function should be evaluated before a patient begins treatment with clomiphene. If ovulation had occurred, another cycle of clomiphene would be indicated.

An otherwise healthy child receives a varicella virus vaccine. Three weeks later the parent calls to report that the child has a mild case of chickenpox and wonders how this could happen after the vaccination. What will the nurse tell the parent? a. "A varicella-like rash can occur after the vaccine is given." b. "The vaccine was probably ineffective." c. "This represents a serious vaccine side effect." d. "Give the child aspirin to treat any fever that may occur."

ANS: A Rationale:Children who receive the varicella vaccine may sometimes develop a mild, local varicella-like rash within a month of receiving the vaccine. This rash does not indicate that the vaccine was ineffective, and it is not a serious side effect. Because of the association with Reye's syndrome, children should not take aspirin or other salicylates for 6 weeks after receiving the vaccine.

patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient? a.That an eye exam is necessary at the beginning of therapy with this drug b.That the dose of NSAIDs may be decreased when beginning hydroxychloroquine c.To obtain tests of renal and hepatic function while taking this drug d.To stop taking methotrexate when starting hydroxychloroquine

ANS: A Ratoinale: Hydroxychloroquine can cause retinal damage so an eye exam is necessary at the onset of treatment as well as every 6 months during treatment. Patients taking other drugs should continue to take those when beginning treatment with hydroxychloroquine since full therapeutic effects take months to develop. Renal and hepatic toxicity are not concerns. The drug is usually combined with methotrexate.

A -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine [Varivax]; the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child? a. All four school immunizations b. DTaP and IPV only c. DTaP, OPV, and Varivax only d. DTaP and IPV, along with immunoglobulins

ANS: B Rationale: Children who are immunocompromised should not receive live virus vaccines, including the MMR vaccine and Varivax. Children taking high-dose systemic glucocorticoids are immunocompromised and should not receive the vaccine until therapy is stopped and normal glucocorticoid production returns. The oral polio vaccine (OPV) contains live virus and is contraindicated. Immunoglobulins are not indicated unless children are exposed to the diseases themselves.

A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain ands welling have been well controlled with the other medications. The nurse will tell the patient that: a.a methotrexate regimen can reduce overall costs and side effects of treatment. b.starting methotrexate early can help delay joint degeneration. c.starting methotrexate now will help increase life expectancy. d.with methotrexate, doses of NSAIDs can be reduced to less toxic levels.

ANS: B Rationale: Current guidelines for treatment of RA recommend starting a disease-modifyingantirheumatic drug (DMARD) early—within 3 months of diagnosis for most patients—inorder to delay joint degeneration. Methotrexate may take up to 3 to 6 weeks to be attherapeutic levels, so NSAIDs and glucocorticoids should be continued until this occurs.Methotrexate is expensive and has more toxic side effects. Patients taking methotrexatehave been shown in some data to have decreased life expectancy. Patients may eventuallybe able to stop taking NSAIDs altogether.

A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms? a.Desloratadine [Clarinex] b.Dimenhydrinate [Dramamine] c.Hydroxyzine [Vistaril] d.Promethazine [Phenergan]

ANS: B rationale: Some antihistamines, including dimenhydrinate and promethazine, are labeled for use in motion sickness. Promethazine, however, is contraindicated in children under age 2 years and should be used with caution in children older than 2 years because of the risks for severe respiratory depression. Desloratadine and hydroxyzine are not used for motion sickness.

he parents of an infant who will be attending day care tell the nurse that they do not want their child vaccinated against rotavirus because an older cousin developed intussusception after receiving this vaccine. Which response by the nurse is correct? a. "Intussusception is much less serious than getting the disease." b. "It was probably just a coincidental reaction to the vaccine." c. "The newer vaccines for rotavirus are not associated with intussusception." d. "Your child will have herd immunity and won't need the vaccine."

ANS: C Rataionale: The rotavirus vaccine product RotaShield was withdrawn because of the high rate of intussusception associated with it. The two products currently on the market—RotaTeq and Rotarix—do not carry a risk for intussusception. Intussusception can be life threatening, so telling parents it is less serious than the disease is incorrect. Intussusception was not merely a coincidental reaction. Herd immunity is not guaranteed.

A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will thenurse include when teaching the child's family about this drug? a.That abatacept and methotrexate must both be taken to be effective b.To continue getting vaccinations during therapy with abatacept c.That signs of infection may warrant immediate discontinuation of abatacept d.That a tumor necrosis factor (TNF) antagonist may be added if this therapy is noteffective

ANS: C Rationale: Abatacept suppresses immune function and can increase the risk of serious infection.Parents should report any signs of infection, which may warrant discontinuation of abatacept. Abatacept may be taken alone. Abatacept may blunt the effectiveness of vaccines, and vaccines should be up-to-date prior to therapy and may need to be delayed until 3 months after therapy. Live vaccines should be avoided. Abatacept should not begiven with TNF antagonists because of the increased risk of serious infections.

A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug? a.The drug will reduce redness and itching but not edema. b.This antihistamine is not likely to cause sedation .c.The patient should avoid drinking alcohol while taking the drug. d.The patient should report shortness of breath while taking the drug.

ANS: C Rationale: Hydroxyzine is a first-generation antihistamine and has sedative effects, so patients should be cautioned not to consume alcohol while taking the drug. In capillary beds, antihistamines reduce edema, itching, and redness. This antihistamine causes sedation. It is not associated with respiratory depression at therapeutic doses.

An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a.Give the medication as ordered. b.Monitor the child for bronchoconstriction. c.Question the order. d.Request an order to give the drug orally.

ANS: C Rationale: Promethazine can cause severe respiratory depression, especially in very young patients; it is contraindicated in children younger than 2 years. The medication should not be given as ordered. It is not safe to give the drug and then monitor for bronchoconstriction. The drug is not safe in this age group when given orally.

A 1-year-old child receives the MMR vaccine. The next day the child's parent calls the nurse to report that the child has a temperature of 103°F. What will the nurse do? a. File an adverse event report with the Vaccine Adverse Event Reporting System (VAERS). b. Notify the child's provider that thrombocytopenia is likely to occur. c. Reassure the parent that fever can occur with the MMR vaccine. d. Tell the parent to take the child to the emergency department.

ANS: C Rationale: The MMR vaccine can have several adverse effects, including fever up to 103°F; this is not considered a serious effect and does not warrant filing an adverse event report with VAERS. Thrombocytopenia is a rare but serious side effect of the MMR vaccine but is not associated with fever. There is no need to have the parent take the child to the emergency department.

Which parenteral antihistamines have sedative effects that are classified as low to none? (Select all that apply.) a.Cetirizine [Zyrtec] b.Clemastine [Tavist Allergy] c.Desloratadine [Clarinex] d.Fexofenadine [Allegra] e.Loratadine [Claritin]

ANS: C, D, E Rationale: Desloratadine, fexofenadine, and loratadine all have sedative effects classified as low to none. Cetirizine and clemastine have moderate sedative effects.

A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to: a.begin taking antituberculosis drugs at the beginning of treatment with etanercept. b.have periodic chest radiographs during treatment with etanercept. c.have regular monitoring of symptoms to detect active tuberculosis. d.undergo tuberculosis treatment prior to beginning etanercept treatment.

ANS: D Rationale: Since tuberculosis (TB) in a patient taking etanercept is often extrapulmonary anddisseminated, it is important to test all patients for TB. Those who test positive for latentTB should be treated for TB before etanercept treatment is begun. It is not correct tobegin TB treatment concurrently with etanercept treatment. Latent TB must be treatedand not monitored.

A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching? a."Clomiphene will help induce ovulation but will not treat the other symptoms of polycystic ovarian disease." b."If I lose weight, my infertility and irregular periods could resolve without medications." c."Metformin improves insulin sensitivity and reduces male hormone levels." d."Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

ANS: D Rationale: Spironolactone is antiandrogenic; it can reduce hirsutism and acne, but it also can harm the fetus and should not be used in patients trying to conceive. Clomiphene helps induce ovulation but does not treat symptoms of PCOS. Patients who lose weight might experience a reversal of symptoms without medications, although weight loss may be difficult to achieve. Metformin reduces serum insulin levels by increasing insulin sensitivity and indirectly lowers androgen levels

An immigrant child is in the clinic for MMR vaccination. The nurse learns that the child has recently received an immune globulin injection for a viral infection, currently has an upper respiratory infection with a temperature of 100°F, and has a recent history of thrombocytopenia, which has resolved. What does the nurse tell the child's parents? a. "The vaccine is contraindicated in this child because of the history of thrombocytopenia." b. "The child should be brought back for the vaccine when the temperature is back to normal." c. "The child is at increased risk of developing autism from this vaccine." d. "The vaccine must be postponed for 3 months after administration of the immune globulin."

ANS: D Rationale: The MMR vaccine should be postponed in children who have received immunoglobulins, because the immunoglobulin contains antibodies against the viruses in the vaccine. Thrombocytopenia is not a contraindication to the MMR vaccine. A low-grade temperature is not a contraindication. There is no link between receiving the MMR vaccine and the development of autism.

The parent of a child who attends day care questions the need for Varivax. What will the nurse tell the parent? a. "Chickenpox is not as contagious as other communicable diseases." b. "The child will be protected by herd immunity and does not need the vaccine." c. "Varicella is an uncomfortable disease, but it is not that serious." d. "Varicella in adults can have serious consequences."

ANS: D Rationale: Varicella tends to cause more severe symptoms in adults than in children; adults have a 10-fold greater likelihood of hospitalization and a 20-fold increase in deaths. Chickenpox is highly contagious. Even with herd immunity, because of the degree of contagiousness, spread is likely. Varicella can be serious, even in children.

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of: a. having routine renal and hepatic function tests. b. limiting folic acid consumption. c. reporting alopecia and rash. d. taking the medication on a daily basis.

Answer A: Rationale: methotrexate is associated with renal and hepatic issues so levels must be monitored. Folic acid is needed when taking methotrexate. Alopecia and rashes are a common AE of methotrexate that subside after stopping the medication.

A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin (Pitocin). The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs? a. Contractions occur every 2 to 3 minutes. b. Individual contractions last 2 minutes. c. Mild to moderate pain occurs with uterine contractions. d. Resting intrauterine pressure is greater than 10 to 15 mm Hg.

Answer B Rationale: this indicates hyperstimulation. all the other answers are normal.

A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen? a. It has minimal effects at peripheral sites. b. It is more similar to opioids than to nonsteroidal anti-inflammatory drugs (NSAIDs). c. It does not inhibit cyclooxygenase d. It is selective for cyclooxygenase-2.

Answer: 2 Rationale: Tylenol selectively blocks COX-2 receptors in the CNS so it has minimal peripheral effects

The parent of a 2-month-old infant who has just received the first dose of DTaP asks the nurse about expected reactions to the vaccine. The nurse will respond by saying that: a. "Mild reactions, including a low-grade fever, are common." b. "Seizures are common and may require anticonvulsant medication." c. "The most common reaction is a rash that develops into itchy vesicles." d. "Most children do not experience any reaction."

Answer: A

The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine. Which instruction should the nurse give the patient about taking the medications? a. "Take the antacid 1 hour after the ranitidine." b. "The antacid and ranitidine should be taken at the same time for better effect." c. "Take the antacid 15 minutes before the ranitidine." d. "Take the antacid 30 minutes after the ranitidine."

Answer: A Rationale: Antacids decrease the absorption of ranitidine

The nurse instructs a patient about the therapeutic effect of clomiphene [Clomid]. Which statement, made by the patient, indicates that teaching was effective? A."The drug causes the follicle to mature." B."The drug prevents premature ovulation." C."The drug increases estrogen in the blood." D."The drug acts directly on the ovary."

Answer: A Rationale: Clomiphene blocks estrogen receptors in the hypothalamus and pituitary and thereby causes a compensatory increase in the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which then act on the ovary to promote follicular maturation and possibly ovulation.

A patient has chronic idiopathic urticaria. Which medication would be appropriate for the nurse to administer for this condition? A.Fexofenadine [Allegra] B.Loratadine [Claritin] C.Azelastine [Astelin] D.Diphenhydramine [Benadryl]

Answer: A Rationale: Fexofenadine is a 2nd generation H1 antagonist used to treat seasonal rhinitis and chronic idiopathic urticaria. The other 3 medications are not used for this purpose

The nurse identifies which female patient has the least risk for developing complications when hormone therapy is prescribed? A.A 45-year-old patient who takes estrogen after a hysterectomy B.A 55-year-old patient who takes estrogen combined with progestin C.A 58-year-old patient with osteopenia who takes hormone therapy D.A 60-year-old patient with a family history of breast cancer

Answer: A Rationale: For women younger than 60 years who have undergone hysterectomy, hormone therapy may be safer than for any other group; women who no longer have a uterus are treated with estrogen alone, which is somewhat safer than estrogen combined with a progestin. The risks of estrogen therapy are lower for younger women than for older women. Specifically, compared with older women, younger women have a lower risk of estrogen-induced breast cancer.

The nurse instructs a patient in the use of combination oral contraceptives for birth control. The nurse determines that teaching is successful if the patient makes which statement? A."I'll avoid herbal products such as St. John's wort." B."Birth control pills don't have serious side effects." C."I can continue taking birth control before elective surgeries." D."I should take the pill with food to prevent an upset stomach."

Answer: A Rationale: Products that induce hepatic cytochrome P450 (for example, St. John's wort) can accelerate oral contraceptive (OC) metabolism and can thereby reduce OC effects. Combination OCs have several adverse effects (for example, thrombotic disorders, hypertension, abnormal uterine bleeding, glucose intolerance, stroke, hyperkalemia). Women who are scheduled for elective surgeries that will result in immobilization (and increased risk of thrombosis) should stop OCs before surgery. OCs do not cause gastrointestinal upset. OCs should be taken at the same time every day.

The nurse should instruct a patient prescribed sildenafil [Viagra] to avoid taking this medication with what? A. Grapefruit juice B. Milk C. Crackers D. Eggs

Answer: A Rationale: Sildenafil blood levels are increased by PY450 inhibitors such as Grapefruit, ketoconazole, erythromycin, Itraconazole, Cimetidine, and Ritonavir. Milk, crackers, and eggs have no effect on the elimination of Sildenafil

A patient is prescribed sirolimus [Rapamune] and cyclosporine [Sandimmune] after renal transplantation. It is most important for the nurse to closely monitor which value? A.Serum creatinine B.Aspartate aminotransferase C.Serum potassium D.Partial thromboplastin time

Answer: A Rationale: Sirolimus combined with cyclosporine poses a significant risk of renal injury. Renal function (serum creatinine, serum blood urea nitrogen, and urinary creatinine clearance) should be monitored. Although both drugs do have issues with hepatotoxicity the incidence of nephrotoxicity is much higher in these drugs and effects worsen when sirolimus and cyclosporine are combined.

A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics: a. help delay delivery while glucocorticoids are given. b. are used to help the fetal lungs mature. c. help treat the infections that cause preterm labor. d. are given until term to reduce fetal mortality.

Answer: A Rationale: tocolytics are used to delay delivery by 48 hours. Glucocorticoids are the drug used to help fetal lung maturity. Antibiotics are used against infections causing preterm delivery

A patient has been prescribed dinoprostone for cervical ripening. Which statement about dinoprostone does the nurse identify as being true? A.Dinoprostone is the most widely used agent for cervical ripening. B.The drug is a synthetic estrogen. C.Dinoprostone is administered subcutaneously. D.The drug increases the duration of labor.

Answer: A the drug is a synthetic prostaglandin. Dinoprostone is administered intravaginally or as gel on cervix. Dinoprostone decreases the duration of labor by increasing contractions

A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient? a. "Do not take more than 2 gm of acetaminophen a day." b. "Do not take more than 3 gm of acetaminophen a day." c. "Do not take more than 4 gm of acetaminophen a day." d. "Do not take a fixed-dose preparation with opioid analgesics."

Answer: A Rationale: those who drink 3 times a day are advised to take no more than 2 gm a day to prevent hepatotoxicity. Those who are fasting are recommended no more than 3. And healthy individuals should take no more than 4. Tylenol is a COX inhibitor NOT an opioid analgesic

Which are contraindications for taking sildenafil [Viagra]? (Select all that apply.) a. Patients who are taking nitroglycerin for angina pectoris b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye c. Patients with BPH who are taking alpha1-adrenergic antagonists d. Patients with a blood pressure of 100/60 mm Hg e. Patients with a history of myocardial infarction (MI) in the past 6 months

Answer: A, B, C Rationale: Men who take nitroglycerin should not take sildenafil, because at least 24 hours should elapse between taking nitroglycerin and taking sildenafil. Because sildenafil is associated with the development of NAION, patients with that disorder in one eye should not take sildenafil. Patients with low blood pressure should use caution in taking sildenafil, but it is not contraindicated. Patients who have had an MI in the past 6 months should use caution in taking sildenafil.

Which are indications for early induction of labor? (Select all that apply.) a. Abruptio placentae b. Active genital herpes infection c. Gestational hypertension d. Premature rupture of the membranes e. Umbilical cord prolapse

Answer: A, C, D Rationale: A, C, and D are all indications for induction while B and E are CI's for induction

A patient with rheumatoid arthritis is prescribed methotrexate [Rheumatrex]. The nurse will expect to observe therapeutic effects with this drug in which time period? A.3 to 7 days B.3 to 6 weeks C.3 to 4 months D.1 to 2 years

Answer: B

Which medication will reduce the effect of oral contraceptives? a. NSAID b. St. John's wort c. Insulin d. Tetracycline

Answer: B

A patient is diagnosed with infertility related to hyperprolactinemia. Which medication would the nurse anticipate being prescribed for this patient? A.Choriogonadotropin alpha [Ovidrel] B.Cabergoline [Dostinex] C.Leuprolide [Lupron Depot] D.Cetrorelix [Cetrotide]

Answer: B Rationale: Cabergoline, formerly available as Dostinex, is used to correct amenorrhea and infertility associated with excessive prolactin secretion. Leuprolide is a gonadotropin-releasing hormone (GnRH) analog used to treat endometriosis, uterine fibroids, central precocious puberty, and advanced prostate cancer. Choriogonadotropin alpha is given to trigger ovulation in women who are infertile owing to anovulation or to promote late follicular maturation and early luteinization in women undergoing assisted reproductive technology. Cetrorelix blocks GnRH receptors and thereby prevents GnRH from promoting the production and release of luteinizing hormone from the pituitary.

A patient is being treated for infertility. An examination reveals cervical mucus that is scant, thick,and sticky. The nurse suspects that the patient has been taking which medication? a. Progesterone b. Ethinyl estradiol c. Metformin d. Clomiphene

Answer: B Rationale: Estrogen is used as a treatment for unfavorable mucus causing infertility. Although this mucus pattern can manifest with progesterone, progesterone is not a treatment used for infertility. metformin is used to treat hyperglycemia related to PCOS cause of infertility. Clomiphene is used to induce follicle maturation in anovulation cause of infertility.

Which statement about enteracept does the nurse identify as true? A.The patient should stop taking the drug if redness appears at the injection site. B.Enteracept can cause liver injury. C.Live vaccines can be administered with enteracept. D. Enteracept is used to treat CNS demyelinating disorders

Answer: B Rationale: Etanercept has been related to cases of hepatotoxicity. Slight redness after injection is a minor SE of Etanercept and is not a reason to stop administration of the Drug. Etanercept has a high risk of serious infections such as fungus and opportunistic diseases so live vaccines should be avoided at all costs. Etanercept has a risk of CAUSING CNS issues such as multiple sclerosis, myelitis and retinal neuropathy as a result of demyelination

A patient is taking finasteride [Proscar] for benign prostatic hyperplasia (BPH). The nurse should explain that this medication has what effect? A.Decreases the size of the prostate gland. B.Relaxes smooth muscle of the prostate gland. C.Reduces the risk of prostate cancer. D.Improves sexual performance during intercourse.

Answer: B Rationale: Finasteride is a 5-alpha-reducatase inhibitor which is used to shrink the size of the prostate and relieve mechanical urethral obstruction. Alpha1-Adrenergic blockers like Doxazosin, Terazosin, Afluzosin, Silodosin relax the smooth muscle of prostate. Finasteride decreases the level of PSA and if this does not happen it is a sign of prostate cancer. Finasteride results in decreased libido and abnormal ejaculation

The nurse teaches a group of postmenopausal women about hormone therapy (HT). Which information should the nurse include in the teaching plan? A.The most frequent adverse effect of HT is headache. B.HT increases the risk of stroke and venous thromboembolism. C.Blood levels of estrogen are more consistent with oral HT. D.HT may cause a harmless yellow discoloration of the skin.

Answer: B Rationale: In postmenopausal women, estrogen, used alone or combined with a progestin, increases the risk of venous thromboembolism (VTE) and stroke. Nausea is the most frequent undesired response to the estrogens. Compared with oral formulations, the transdermal formulations cause fewer fluctuations of estrogen in the blood. Estrogens have been associated with jaundice r/t liver injury(yellow discoloration of the skin), which may develop in women with preexisting liver dysfunction.

A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about: a. reducing the patient's dose. b. using every other day dosing. c. increasing the patient's dose. d. tapering the dose.

Answer: C

A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: a. tolerance to sedation will occur in a few weeks. b. with renal impairment, this drug should be taken every other day. c. should not drink fruit juices within 4 hours before dosing or 1 to 2 hours after dosing. d. fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms.

Answer: C

A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? a. "I can take this medication long term." b. "I should not take this drug if I have diverticulitis." c. "I should take each dose with a full glass of water." d. "This drug can cause severe diarrhea."

Answer: C

An adult male patient will begin androgen therapy for testicular failure. Which statement by thepatient indicates understanding of the treatment regimen? a. "This will restore fertility, so I can have a child." b. "Taking this drug may lead to the development of prostate cancer." c. "My libido may improve while I am taking this medication." d. "I will need to have x-rays of my hands and feet every 6 months."

Answer: C

A nurse is discussing Sirolimus [Rapamune] with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "This medication can be used to prevent rejection after lung, liver, and renal transplant." b. " The patients who is taking this medication can receive live vaccination." c. " About 50% of patients who is taking this medication required treatment with lipid-lowering drugs." d. " This medication does not increase the risk of severe infection."

Answer: C Rationale: A big AE of Sirolimus is an increase in cholesterol and triglycerides. Sirolimus is only used for kidney transplant. Patients taking Sirolimus are at risk of infection and cannot receive any live vaccines.

nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching? a. "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase." b. " Unlike ASA, NSAIDs do not provide protective benefits against myocardial infarction and stroke." c. "Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions." d. "Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation."

Answer: C Rationale: All the other statements are true. However, ALL NSAIDS have a risk of hypersensitivity reactions

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: a. silodosin [Rapaflo] b. a transurethral prostatectomy c. doxazosin [Cardura] d. finasteride [Proscar]

Answer: C Rationale: Doxazosin is a Alpha 1 antagonist used to treat BPH. its AE's consists of hypotension, dizziness and h/a. Silosin is an Alpha 1 antagonist used to treat BPH that has AE's r/t difficulty ejaculating and reaching an orgasm. a transurethral prostatectomy is extreme and may cause sexual dysfunction. Finasteride is used to treat BPH but it may result in decreased libido

Which patient would be at greatest risk of developing a venous thromboembolism (VTE) if a combination oral contraceptive were prescribed? A.A 25-year-old patient who drinks 3 to 4 alcoholic drinks a day B.A 45-year-old patient who has a family history of stroke C.A 22-year-old patient who smokes 2 packs of cigarettes a day D.A 29-year-old patient who has used birth control pills for 9 years

Answer: C Rationale: Major factors that increase the risk of thromboembolism for women who take combination oral contraceptives are heavy smoking, a history of thromboembolism, and thrombophilias (genetic disorders that predispose to thrombosis). Additional risk factors include diabetes, hypertension, cerebral vascular disease, coronary artery disease, and surgery in which immobilization increases the risk of postoperative thrombosis

Which child should not receive the measles, mumps, and rubella (MMR) virus vaccine? a. A child who is allergic to penicillin and milk b. A child with a fever of 100.6º F (tympanic) c. A child with acute lymphocytic leukemia d. A child with asymptomatic HIV infection

Answer: C Rationale: Measles, mumps, rubella (MMR) is contraindicated in children with severe immunodeficiency conditions, such as leukemia, and these children should not be vaccinated. Children with mild upper respiratory infection and mild fever or asymptomatic HIV infection may be vaccinated. Children who are allergic to eggs, gelatin, or neomycin should not be vaccinated.

The nurse cares for a patient who is scheduled to receive menotropin [Repronex]. What should the nurse plan to teach this patient? A.Estrogen will be given to stimulate ovulation. B.The medication will be given intravenously. C.Frequent ultrasounds will be performed. D.Multiple births are relatively uncommon.

Answer: C Rationale: Ovarian response to menotropin is monitored by ultrasonography of the developing follicles and by measuring the serum estrogen. Menotropin causes follicular maturation; human chorionic gonadotropin is administered to stimulate ovulation. Menotropin [Repronex] is administered intramuscularly. Multiple births are relatively common in menotropin-facilitated pregnancies

A patient has been prescribed sildenafil [Viagra] for erectile dysfunction. Which instruction should the nurse include in the teaching plan? A.Take the medication on an empty stomach. B.Drink plenty of fluids to prevent priapism. C.Avoid taking nitroglycerin with this drug. D.Constipation is a common adverse effect.

Answer: C Rationale: The combination of PDE5 inhibitors with any drugs from nitrate class can result in fatal hypotension and is contraindicated. Sildenafil can be given with or without food and only need to be avoided with fatty foods that decrease its absorption. Fluids can increase priapism because of increased blood volume. Constipation is not an AE of Sildenafil.

A patient who is scheduled to receive human chorionic gonadotropin (hCG) complains of abdominal bloating and severe pain. Which action should the nurse take first? A.Administer a narcotic analgesic for the pain. B.Tell the patient that the symptoms are expected. C.Hold the hCG injection and contact the prescriber. D.Assess the patient for injection-site pain.

Answer: C Rationale: The most serious adverse response to hCG therapy is ovarian hyperstimulation syndrome, a condition characterized by sudden enlargement of the ovaries. Ovarian enlargement occurs rapidly and may be accompanied by ascites, pleural effusion, and considerable pain. If this manifestation of ovarian stimulation occurs, hCG should be withdrawn and the patient hospitalized. Treatment is usually supportive (bed rest, analgesics, fluid and electrolyte replacement). Paracentesis can be used to remove some excess ascitic fluid. If rupture of an ovarian cyst occurs, surgery may be required to stop the bleeding.

A patient is taking estrogen daily. Which instruction by the nurse should be included to reduce the risk of a cardiovascular event, such as stroke or myocardial infarction? A.Reduce aerobic activities. B.Increase dietary intake of trans fat. C.Stop smoking. D.Take the medication with food.

Answer: C Rationale: To reduce cardiovascular risk, patients should avoid smoking, perform regular exercise, and reduce their intake of saturated fats. Although taking estrogen with meals decreases nausea, this intervention does not reduce the cardiovascular risk.

A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Prepare to provide respiratory support, because the patient shows signs ofoverdose. b. Increase the aspirin dose to treat the patient's headache. c. Withhold the aspirin until the patient's symptoms have subsided. d. Notify the provider of possible renal toxicity.

Answer: C Rationale: the s/s are representative of Salicylate toxicity which indicates that the dosing limit of aspirin has been reached. Increasing the aspirin would be CI. these are not signs of renal toxicity

A nurse is providing medication teaching to a 12-year-old male patient with hypogonadism. Which statement, made by the patient, indicates an understanding of the prescribed medication, testosterone enanthate? A."I will grow significantly taller while taking this medication." B."Sexual changes in my body will occur within 4 to 6 months." C."I will come to the clinic every 4 weeks for shots of testosterone." D."If the medication causes stomach upset, I can take it with food."

Answer: C Rationale: Testosterone enanthate is administered intramuscularly (IM) as a long-acting testosterone and is administered every 2 to 4 weeks for 3 to 4 years. Height may be stunted because of accelerated bone maturation. Sexual changes will develop slowly over a period of years.

A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. The nurse understands that which vaccine should not be administered to this child? A. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine B. Polio injection C. Varicella virus vaccine D. Haemophilus influenzae type b (Hib) vaccine

Answer: C Rationale: Varicella along with measles mumps, rubella, rotavirus and intranasal influenza are all live vaccine and CI in immunocompromised patients. The other 3 vaccines are not live and do not have this issue

A patient with rheumatoid arthritis has been taking high-dose aspirin and complains of gastric upset and pain. What does the nurse anticipate will be prescribed for this patient? A.Taking a lower dose of aspirin B.Biweekly injections of methotrexate [Rheumatrex] C.Obtaining a prescription for celecoxib [Celebrex] D.Daily drug therapy with prednisone

Answer: C. Rationale: Celecoxib is a 2nd generation NSAID that only inhibits COX-1, it is not associate with the gastric effects and bleeding associated with 1st generation NSAIDS such as Aspirin and ibuprofen which inhibit both COX-1 and COX-2 resulting in decreased protective GI effects of prostaglandins . Methotrexate is DMARD that is not suggested unless other less harmful measures have been taken. Glucocorticoids are only used short-term to treat Rheumatoid Arthritis and are not the safest option.

After receiving an allograft liver transplant, a patient is prescribed cyclosporine [Sandimmune] oral solution. What is the most critical component of patient teaching that the nurse should stress? A.The medication will help prevent transplant rejection. B.The oral solution can be mixed with orange juice. C.The medication will be taken every day for life. D.The medication causes reversible increase of hair growth.

Answer: C. The medication will be taken every day for life. Rationale: Allograft recipients must take immunosuppressants for life to prevent transplant rejection. Although the other concepts are true and important to teach the patient, they are not as high a priority.

A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines? a. "First-generation antihistamines are more selective than second-generation antihistamines." b. "Antihistamines block release of histamine from mast cells and basophils." c. "H1 antagonists can bind to H1 receptors, H2 receptors, and muscarinic receptors." d. "Antihistamines block H1 receptors to prevent actions of histamine at these sites."

Answer: D

A patient who takes over-the counter diphenhydramine [Benadryl] for seasonal allergy symptoms complains of drowsiness. What should the nurse do? A.Instruct the patient to drink caffeinated beverages. B.Recommend taking the medication with meals. C.Ask the patient's healthcare provider to prescribe hydroxyzine [Vistaril]. D.Tell the patient to take Fexofenadine [Allegra] instead of diphenhydramine.

Answer: D Rationale: A good replacement of Diphenhydramine is another H1 antagonist such as Fexofenadine which is a second generation H1 antagonist less likely to cause sedation because it cannot pass the BBB. Caffeinated beverages are not generally recommended. Taking diphenhydramine is not advised unless in the case of GI upset because it decreases absorption. Hydroxyzine is another 1st generation H1 angonist like Diphenhydramine so it will pose the same issue with drowsiness,

A nurse is teaching a group of nursing students about the mechanism of Cyclosporine. Which of the following is correct? a. Inhibit mammalian target of rapamycin (mTOR) enzyme to supress T-cell and B-cell proliferation b. Suppresses the production of IL-2, interferon gamma, and other cytokines c. Cause lysis of antigen-activated lymphocytes, suppression of lymphocyte proliferation, and sequestration of lymphocytes at extravascular locations. d. Suppress immune response by killing B and T lymphocytes undergoing proliferation

Answer: D Rationale: A is the action of Mtor inhibitors such as sirolimus and everolimus. C is the functions of glucocorticoids. D is the action of Cytotoxic drugs

A male patient is prescribed a transdermal testosterone gel [AndroGel]. It is most appropriate for the nurse to teach the patient to do what? A.Apply the gel to the genital area every morning. B.Leave the patch in contact with the skin for 24 hours. C.Avoid showering or swimming after gel application. D.Keep the treated area covered with clothing.

Answer: D Rationale: AndroGel should be applied once daily to the shoulders, upper arms, or abdomen, but not the genitalia. AndroGel is not a patch, but rather a gel that is rubbed into the skin. Showering or swimming is allowed 5 to 6 hours after application. The treated area should be covered with clothing

The nurse teaches a patient about Camila. Which statement by the patient requires an intervention by the nurse? A."I might have irregular bleeding while taking this pill." B."These pills do not usually cause blood clots." C."I should take this pill at the same time every day." D."This pill works primarily by preventing ovulation."

Answer: D Rationale: Camila is a progestin-only contraceptive; contraceptive effects of Camila result largely from altering cervical glands to produce a thick, sticky mucus that acts as a barrier to penetration by sperm. Progestins also modify the endometrium, making it less favorable for nidation. Compared with combination oral contraceptives, Camila is a weak inhibitor of ovulation; therefore, this mechanism contributes little to their effects. Camila does not contain estrogen and will not cause thromboembolic disorders. Camila is more likely to cause irregular bleeding than combination oral contraceptives. Camila is taken every day and should be taken at the same time each day.

A nurse is preparing to administer vaccines to a 1-year-old child. The parents ask the nurse to give the child acetaminophen before administering the vaccine to reduce the pain. Which response by the nurse is correct? a. "Children don't remember pain, so it isn't necessary to give acetaminophen." b. "The small needles used to inject the vaccines cause hardly any discomfort." c. "You can apply a topical anesthetic when you get home to reduce pain from the injection." d. "Your child's immune response may not be as effective if I give acetaminophen before the vaccine."

Answer: D Rationale: Giving analgesic/antipyretic medications before or shortly after vaccines can reduce the immune response, so giving them to prevent pain or fever is not recommended. Children do remember pain, and it is important to provide other comfort measures and to give the injections rapidly. Small needles cause less discomfort, and it is important to reassure the parents about this; however, it is more important to explain why acetaminophen is not recommended. Topical anesthetics are useful before giving the injections, not afterwards.

A female patient who swims competitively admits to using 17-alpha-alkylated compounds to increase her musclemass and improve her performance. What will the nurse tell this patient? a. Voice changes and facial hair will reverse when she stops the drug. b. Anabolic steroids may actually regulate her periods. c. Breast size may increase as a result of this drug use. d. The risk of liver disease will increase.

Answer: D Rationale: One of the biggest AE's found with 17-alpha alkylated compounds specifically is that they pose a very high risk of hepatotoxicity.

A patient contacts a clinic nurse to determine the proper action after she forgot to take her oral contraceptive [Ortho Tri-Cyclen] for the past 2 days during the first week of a 28-day regimen. Which response by the nurse is most appropriate? A."Take the omitted two doses together with the next dose." B."Take two doses per day on the following 2 days." C."Stop taking the oral contraceptive until menstruation occurs." D."Take a dose now and continue with the scheduled doses."

Answer: D Rationale: Ortho Tri-Cyclen is a combination of estrogen and progestin (on a 28-day-cycle). If 1 or more pills are missed in the first week, the patient should be advised to take 1 pill as soon as possible and then continue with the pack; the patient should also be instructed to use an additional form of contraception for 7 days.

A nurse provides teaching for a female patient with anemia who has had cancer chemotherapy and who will begin treatment with testosterone. Which statement by the patient indicates understanding of the teaching? a. "Facial hair may develop with this drug but will go away over time." b. "I may experience an increase in breast size while taking this drug." c. "Testosterone may increase my high-density lipoprotein (HDL) cholesterol and reduce my low-density lipoprotein (LDL) cholesterol." d. "Testosterone treats anemia by stimulating the synthesis of a renal hormone"

Answer: D Rationale: Testosterone increases erythropoietin that is used to produce RBC;s Facial hair growth may be an irreversible SE of testosterone. Increased breast size occurs with estrogen/progestin. Testosterone increases LDL and Decreases HDL, increasing risk for atherosclerosis.

The parent of a 6-month-old baby asks about the recommended childhood schedule for varicella vaccine. The nurse should inform the parent that the infant may receive the vaccine at which age? a. 6 months b. 8 months c. 10 months d. 12 months

Answer: D Rationale: The Centers for Disease Control and Prevention (CDC) recommends varicella vaccination between 12 and 18 months of age.

Which vaccine has been identified as the safest, the one for which no adverse effects have been reported? a. MMR b. Varicella c. Hepatitis B d. Haemophilus influenzae type b

Answer: D Rationale: The Haemophilus influenzae type b conjugate (Hib) vaccine is one of our safest vaccines. No serious adverse events have been reported.

When caring for a 21-year-old female patient, post kidney transplantation, who is taking cyclosporine [Sandimmune] and repaglinide [Prandin], what should the nurse do? A.Administer the medication with grapefruit juice. B.Monitor the patient for hyperglycemia. C.Encourage the patient to take an oral contraceptive. D.Assess the patient for signs and symptoms of infection.

Answer: D Rationale: one of greatest post-op assessment for transplant would be for s/s of infection which may indication transplant rejection. Cyclosporine should NEVER be taken with grapefruit juice as it is a strong metabolic inhibitor and will raise cyclosporine levels. Repaglinide is a Hypoglycemic drug who's effects are amplifies by cyclosporine leading to hypOglycemia not hypErglycemia. Oral contraceptives can cause hyperglycemia. Oral contraceptives are related to hypOglycemia and will cause severe hypoglucemia when combined with repaglinide.

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? a. "This drug may cause me to have an erection when I don't want one." b. "I can take this drug with grapefruit juices." c. "I should not use nitroglycerin within 12 hours of using sildenafil." d. "If my erection lasts longer than 4 hours, I should contact my provider."

Answer: D Rationale: one of the AE's of Sildenafil is priapism so if an erection lasts more than 4 hours the PCP should be contacted. In order to get an erection with sildenafil there must be an external stimulator (seeing/feeling something). Grapefruit juice can greatly increase levels of sildenafil. Nitroglycerines should never be used along with sildenafil

An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier.The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss FIRST: a. adding an antihypertensive medication b. obtaining serum electrolytes. c. ordering a potassium-sparing diuretic. d. withdrawing the aspirin.

Answer: D Rationale: the patient is exhibiting signs of nephrotoxicity related to aspirin so the medication should be stopped ASAP.

A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? a. Pharmacologic agents used to treat endometriosis can enhance fertility b. Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. c. Gonadotropin-releasing hormone agonists are used for long-term treatment. d. Nonsteroidal anti-inflammatory drugs (NSAIDs) and combination oral contraceptives can relief the symptoms

Answer: D Rationale: NSAIDS and OC's are a 1st line therapy treatment for Endometriosis

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? a. Avanafil [Stendra] b. Sildenafil [Viagra] c. Tadalafil [Cialis] d. Vardenafil [Levitra]

Answer: a. Avanafil [Stendra] Rationale: 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.

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? a. Benign prostatic hypertrophy b. Mild hypertension c. Occasional use of nitroglycerin d. Taking finasteride

Answer: c. Occasional use of nitroglycerin Rationale: 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.

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]? a. "I can take this up to 2 times a day, just before intercourse." b. "I have a little renal trouble, so I should take a higher dose." c. "I should take this medication with food." d. "I should take this medication no more than once a day."

Answer: d. "I should take this medication no more than once a day." Rationale: Tadalafil should be taken no more than once a day and without regard to meals. Tadalafil has a half-life of 17.5 hours and should not be taken twice a day. Men with moderate renal or hepatic insufficiency should take a reduced dosage. This patient may be confusing the actions of tadalafil and prazosin.

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? a. "Sildenafil is not safe to take in conjunction with finasteride [Proscar]." b. "Sildenafil is safe with any medication for benign prostatic hyperplasia." c. "To be safe, you should have a transurethral resection before starting sildenafil." d. "You should not take sildenafil if you are taking silodosin [Rapaflo]."

Answer: d. "You should not take sildenafil if you are taking silodosin [Rapaflo]." Rationale: 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 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? a. Adverse effects of tadalafil resolve more quickly than those of sildenafil. b. There is an increased risk of priapism with frequent sexual activity. c. He should take tadalafil 30 to 60 minutes before sexual activity. d. He should talk to his provider about daily dosing of tadalafil.

Answer: d. He should talk to his provider about daily dosing of tadalafil. Rationale: 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 patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she cannot 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: a. prevent deep vein thrombosis (DVT). b. decrease her risk of endometrial cancer c. lower her risk of myocardial infarction (MI). d. increase bone resorption to prevent fractures.

B

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? a. "It treats the infection that triggers the condition." b. "It reduces the inflammation." c. "It enhances the immune response." d. "It increases the reabsorption of fluid."

B.

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? a."Because I am not at risk for uterine cancer, I can take hormones indefinitely." b."I can take estrogen to reduce my risk of cardiovascular disease. " c."I should take the lowest effective dose for the shortest time needed." d."I will need a progestin/estrogen combination since I have had a hysterectomy.

C

A nurse provides teaching to a woman who is taking tranexamic acid (Lysteda) for menorrhagia. Which statement by the patient indicates a need for further teaching? a. "I may experience back pain or muscle cramps while taking this drug." b. "I may take two tablets 3 times daily for up to 5 days with each period." c. "I should take an oral contraceptive to prevent pregnancy while taking this drug." d. "I should take this medication with food to improve absorption of the drug."

C

A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron[Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a. Contact the provider to discuss increasing the dose of ondansetron. b. Suggest giving prolonged doses of dexamethasone. c. Suggest adding aprepitant [Emend] to the medication regimen. d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.

C

A patient is started on an oxytocin infusion to promote uterine contractions during labor. The patient's intrauterine pressure is 25 mm Hg. Which nursing action is appropriate? A.Prepare for immediate cesarean section. B.Assess the fetal heart tones for 2 minutes. C.Stop the infusion immediately. D.Continue to monitor the patient.

C. The infusion of Oxytocin is stopped when 1. elevation of uterine pressure by 15-20 , 2. contractions lasting more than 1 minute, 3. Contractions occurring more often than every 2-3 minutes and 4. Pronounced alterations in fetal heart rate and rhythm

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: a.an estrogen-progesterone product will reduce side effects. b.an intravaginal preparation may be best for her. c.side effects of ET are uncommon among women her age. d.transdermal preparations have fewer side effects.

D

A nurse is providing education to a patient who is beginning therapy with AndroGel testosterone gel. What statement made by the patient demonstrates a need for further teaching? a. "I should not shower or swim for at least 5 to 6 hours after application." b. "I should avoid direct skin-to-skin contact with my spouse where the medication was applied." c. "I should have my blood drawn for laboratory tests in 14 days." d. "I should apply the medication to my genitals for best results."

D

A nurse provides teaching to a group of nursing students about the risks and benefits of hormonetherapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT).Which statement by a student indicates understanding of the teaching? a. "In women with established coronary heart disease, EPT can protect against myocardial infarction." b. "ET can provide protection against coronary heart disease and reverse osteoporosis." c. "EPT is generally safer than ET, especially in women who have undergone hysterectomies." d. "Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss."

D

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? a.Raloxifene reduces the risk of thromboembolism. b.The drug is associated with an increased risk of breast cancer. c.Use of this drug increases the risk of endometrial carcinoma. d.Vasomotor symptoms are a common side effect of this drug.

D

A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do? a. Reduce the amount of fluid given with the laxative to prevent fluid retention. b. Suggest that the patient reduce the dietary sodium intake. c. Suggest using a suppository laxative instead. d. Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead.

D

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? a."Estrogen can help reverse bone loss." b."Hormone therapy increases bone resorption." c."Hormone therapy does not decrease fracture risk." d."When hormone therapy is discontinued, bone mass is quickly lost."

D