Pharm II exam 2

A nurse is planning caring for for a client who has a new prescription for fortorsemide. The nurse should for should plan to monitor which of the following adverse reactions of this medications? (Select all that apply) A. Respiratory acidosis B. Hypokalemia C. Hypotension D. Ototoxicity E. Ventricular dysrhythmias

ANS: B. Hypokalemia C. Hypotension D. Ototoxicity E. Ventricular dysrhythmias

A nurse is assessing a client during transfusion of a unit of whole blood The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine (Adrenalin) B. Lorazepam (Ativan) C. Furosemide (Lasix) D. Diphenhydramine (Benadryl) C. Furosemide (Lasix)

ANS: C) Furosemide ( Lasix ) - A loop diuretic may be prescribed to relieve manifestations of circulatory overload.

A patient has anemia and is being given Ferrous. Which of the following is a therapeutic action for this drug? A) decrease respiration B) decreased blood pressure C) increased exercise tolerance D) increase urination

ANS: C) increased exercise tolerance

A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which the following finding should the nurse report to the provider? A. Blood glucose 150 mg/dL B. Urine output 40 mL/hr C. Dyspnea D. Bilateral equal pupil size

ANS: C. Dyspnea

A nurse is monitoring a client who is receiving spironolactone. Which ofthe following findings should the nurse report to the provider. A. Serum sodium 144 mEq/L B. Urine output 120 m L in 4 h C. Serum potassium 5.2 mEq/l D. Blood pressure 140/90 mm Hg

ANS: C. Serum potassium 5.2 mEq/l

A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. Assess for tinnitus b. Report urine output 50 mL/hr. c. Monitor serum potassium levels. d. Elevate the head of the bed slowly before ambulation e. recommend eating a banana daily

ANS: a. Assess for tinnitus c. Monitor serum potassium levels. d. Elevate the head of the bed slowly before ambulation e. recommend eating a banana daily

A nurse is providing information to client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A. Take the medication with food B. Plan to take the medication at bedtime. C. Expect increased swelling of the ankles D. Fluid intake should be limited in the morning.

ANS:A. Take the medication with food

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply? A) Potassium losses are lower with spironolactone. B) Potassium losses are greater with spironolactone. C) Water losses are greater with spironolactone. D) Sodium losses are greater with spironolactone.

Ans: A Feedback: Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone.

The nurse is developing a nursing plan of care for a patient who will receive a fast-acting abortifacient. What nursing diagnosis would apply to care provided shortly after administering the medication? A) Acute pain related to uterine contractions or headache B) Ineffective coping related to abortion or fetal death C) Risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis D) Deficient knowledge regarding drug therapy.

Ans: A Feedback: The rapid-acting abortifacients work within 10 to 15 minutes , so shortly after administration of the drug, the patient will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur. Deficient knowledge regarding drug therapy should have been addressed before administering the medication. Ineffective coping usually occurs after acute symptoms subside and the patient begins to cope with the decision.

A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed? A) Acetazolamide (Diamox) B) Spironolactone (Aldactone) C) Chlorthalidone (Hygroton) D) Bendroflumethiazide (Naturetin)

Ans: A Feedback: Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is a thiazide-like diuretic and bendroflumethiazide, a thiazide diuretic, are used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension

A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed? A) Acetazolamide (Diamox) B) Spironolactone (Aldactone) C) Chlorthalidone (Hygroton) D) Bendroflumethiazide (Naturetin)

Ans: A Feedback: Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is a thiazide-like diuretic and bendroflumethiazide, a thiazide diuretic, are used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension.

A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse? A) Smoking a pack of cigarettes a day B) Gaining 10 pounds in the last 3 months C) Craving sugar D) Spending less time exercising

Ans: A Feedback: All these options are poor health habits and will impact the patient's health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 pounds, a craving for sugar, and a decrease in exercise would not be as immediate a concern although the nurse should address these issues.

What is the priority assessment for the 23-year-old female patient who is on estrogen therapy? A) Monitor liver function periodically for the patient on long-term therapy. B) Assess for contraindications to drug therapy. C) Help plan a diet rich in calcium and vitamin D. D) Provide patient teaching for diet therapy to prevent osteomyelitis.

Ans: A Feedback: Assessing liver function is important for the patient on long-term estrogen therapy. Teaching is an intervention and not an assessment. The patient should be assessed for contraindications before administering the medication initially

A child in renal failure is taking androgens to promote red blood cell production and is seen in the clinic every other month. What adverse drug effect would the nurse monitor for with this child? A) Epiphyseal closure B) Acne C) Skin color D) Weight gain

Ans: A Feedback: Because of the effects of androgens on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. The other options are also adverse effects and require monitoring but are not as serious as premature epiphyseal closure.

What statement by the 62-year-old patient indicates that the patient understand the nurse's teaching about diuretics? A) I will weigh myself daily and report significant changes. B) I will have to limit my high sugar foods. C) If my leg gets swollen again, I'll take an additional pill. D) I will take my medication before bedtime on an empty stomach.

Ans: A Feedback: Daily weights and blood pressures should be monitored at home in a patient taking diuretics. Options B, C, and D would indicate that further teaching is needed.

What statement by the 62-year-old patient indicates that the patient understand the nurse's teaching about diuretics? A) ​I will weigh myself daily and report significant changes.​ B) ​I will have to limit my high sugar foods.​ C) ​If my leg gets swollen again, I'll take an additional pill.​ D) ​I will take my medication before bedtime on an empty stomach.​

Ans: A Feedback: Daily weights and blood pressures should be monitored at home in a patient taking diuretics. Options B, C, and D would indicate that further teaching is needed

A patient is being treated for benign prostatic hyperplasia (BPH). The patient asks the nurse how the medicine used to treat BPH is supposed to work. The nurse explains that the drug therapy is designed to relieve the symptoms associated with this condition by doing what? A) Shrinking the gland and/or relaxing the sphincter of the bladder B) Increasing testosterone levels to improve sexual functioning C) Increasing blood pressure, which will increase blood flow to the area D) Activate nitric acid, which will dilate blood vessels in the area to relieve pressure

Ans: A Feedback: Drugs given to treat BPH will block sympathetic activity to allow relaxation of the sphincter of the bladder or will decrease testosterone effects to shrink the gland and relieve symptoms. They do not increase testosterone levels or blood pressure. Dilating blood vessels would further congest the gland and increase symptoms

A businesswoman who is leaving on a business trip the next day tells the nurse she knows she has cystitis and does not want to have to mess with medicine while she is gone. What drug would be a good choice for this patient? A) Fosfomycin (Monurol) B) Methenamine (Hiprex) C) Nitrofurantoin (Furadantin) D) Norfloxacin (Noroxin)

Ans: A Feedback: Fosfomycin would be a good choice for this patient because it has the convenience of a single dose. Methenamine is taken either twice a day or up to four times a day. This drug could interfere with the patient's busy schedule. Nitrofurantoin is also prescribed four times a day and would also be inconvenient for the patient. Norfloxacin is taken every 12 hours and could be inconvenient as well.

The nurse attributes what assessment finding to the use of androgens by the male patient? A) Testicular atrophy B) Increased fertility C) Increased urination D) Hoarseness

Ans: A Feedback: In adult men, adverse effects include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido. Increased fertility, increased urination, and hoarseness would not be expected assessment findings

The nurse admits a 26-year-old patient with sickle cell anemia. What drug does the nurse anticipate administering? A) Hydroxyurea B) Methoxy polyethylene glycol-epoetin beta C) Vitamin B12 D) Leucovorin

Ans: A Feedback: Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult patients with sickle cell anemia. Other options would not be used to treat a patient with sickle cell anemia.

The nurse is caring for a child who is prescribed supplemental iron therapy in liquid form. What is the priority parent teaching to be provided by the nurse? A) The iron should be taken through a straw. B) Positive results from treatment will be seen in 1 to 2 weeks. C) Results will be evaluated through the child's appearance. D) Dosages are determined by serum iron levels.

Ans: A Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the child should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed; it may take 4 to 6 months of oral therapy to reverse an iron deficiency. Remember that iron can be toxic to children, so that iron supplements should be kept out of their reach and administration monitored

A 16-year-old boy is diagnosed with delayed onset of puberty and the physician has ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the patient? A) Discuss changes that will occur in his body. B) Have patient fast before injection. C) Have patient reduce protein intake. D) Decrease exercise while on this hormonal treatment.

Ans: A Feedback: It is important for this patient to understand what will happen and the changes he will see to reduce the anxiety that could occur if he didn't understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the patient fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.

For what purpose would the nurse administer postoperative epoetin alfa to the patient who is a Jehovah's Witness? A) Reduce the need for allogenic blood transfusion B) Treatment of anemia associated with chronic renal failure C) Treatment of HIV infection D) To prevent the need for chemotherapy

Ans: A Feedback: Jehovah's Witnesses often refuse allogenic blood transfusions because of their religious beliefs. Indications for the use of epoetin alfa include treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer patients, to reduce the need for allogenic blood transfusions in surgical patients. There is no indication in this question that the patient has chronic renal failure, HIV, or need for chemotherapy.

A 72-year-old man is being treated with doxazosin (Cardura) for his BPH. What nursing diagnosis would be important to include in this patient's plan of care? A) Sexual dysfunction B) Chronic pain C) Disturbed sensory perception D) Risk of impaired urinary elimination

Ans: A Feedback: Nursing diagnoses related to drug therapy might include sexual dysfunction related to drug effects, acute pain related to headache, central nervous system (CNS) effects, and GI effects of the drug, risk for injury related to blockage of alpha receptors, and deficient knowledge regarding drug therapy. The nursing diagnosis of risk of impaired urinary elimination would not be appropriate because the effect of the drug is to improve urinary elimination issues.

A 69-year-old man is prescribed testosterone. The patient is found to have hypertension and a history of congestive failure after assessment by the nurse. What is this patient at increased risk for? A) Fluid retention B) Impotence C) Liver failure D) Kidney failure

Ans: A Feedback: Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but since that is not indicated by the question, this would be a lower risk than fluid retention.

A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat? A) Peaches B) Apples C) Pears D) Pineapple

Ans: A Feedback: Peaches, as well as bananas, oranges, raisins, and other fruits, spices, and vegetables are high in potassium and consuming them should be encouraged when taking furosemide. Apples, pears, and pineapple, however, do not replace potassium in the body.

The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The patient is on a low-residue diet for colitis. What factor in the patient's history may contraindicate the use of birth control pills? A) Migraine headaches B) Age C) Asthma D) Colitis

Ans: A Feedback: Progestins should be used with caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives

When providing patient teaching for a 30-year-old primigravida diagnosed with sickle cell anemia, but not currently in crisis, the priority teaching point is what? A) Avoidance of infection B) Constipation prevention C) Control of pain D) Iron-rich foods

Ans: A Feedback: Severe, acute episodes of sickling with blood vessel occlusion may be associated with acute infections and the body's reactions to the immune and inflammatory responses. Avoidance of infection is, then, a priority teaching point. Pain would be a concern only if the patient is in crisis. Constipation prevention and iron-rich foods would not be the priority at this time.

For what reason might the nurse administer sildenafil to a woman? A) Pulmonary arterial hypertension B) Sexual dysfunction C) Breast cancer D) Endometriosis

Ans: A Feedback: Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply? A) Potassium losses are lower with spironolactone. B) Potassium losses are greater with spironolactone. C) Water losses are greater with spironolactone. D) Sodium losses are greater with spironolactone.

Ans: A Feedback: Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone

A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient? Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 842 A) Are you taking a salicylate? B) Are you taking acetaminophen? C) Are you taking ibuprofen? D) Are you using a lot of salt?

Ans: A Feedback: The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased sodium intake.

The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)? A) Allergy to sulfa drugs B) Allergy to codeine C) BP 160/96 D) Blood glucose level of 140 mg/dL

Ans: A Feedback: Thiazide and thiazide-like diuretics are contraindicated with allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. The other options are not correct

A 50-year-old patient with pernicious anemia asks why she can't just take a vitamin B12 pill instead of getting an injection. What is the nurse's best response to her question? A) "Pernicious anemia is caused by the body's inability to absorb vitamin B12 . B) Oral ingestion of vitamin B12 irritates the GI tract and bleeding could occur. C) Pernicious anemia alters mucous membrane lining of the bowel and impairs absorption. D) With severe deficiencies like yours, oral vitamin B12 does not work fast enough.

Ans: A Feedback: Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the patient to absorb vitamin B12 due to low levels of intrinsic factor. Other options are incorrect.

The nurse, working in a women's health center, is reviewing the patient's medical record and recognizes the patient with what medical history should not receive an abortifacient? (Select all that apply.) A) Active pelvic inflammatory disease (PID) B) Pulmonary disease C) Cardiovascular disease D) Hypertension E) Adrenal disease

Ans: A, B, C Feedback: Abortifacients should not be used with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Caution should be used with any history of asthma, hypertension, or adrenal disease

For what purpose might the nurse administer folic acid to the patient? (Select all that apply.) A) Nutritional deficiency B) Megaloblastic anemia C) Pregnancy or preparation for pregnancy D) Sickle cell anemia E) Renal failure

Ans: A, B, C Feedback: Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure.

A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Select all that apply.) A) Paresthesia B) Confusion C) Drowsiness D) Vomiting E) Hyperkalemia

Ans: A, B, C Feedback: Metabolic acidosis is a relatively common and potentially dangerous adverse effect that occurs when bicarbonate is lost. Hypokalemia is also common. Patients also complain of paresthesias of the extremities, confusion, and drowsiness. Vomiting and hyperkalemia are not common adverse effects

A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Select all that apply.) A) Paresthesia B) Confusion C) Drowsiness D) Vomiting E) Hyperkalemia

Ans: A, B, C Feedback: Metabolic acidosis is a relatively common and potentially dangerous adverse effect that occurs when bicarbonate is lost. Hypokalemia is also common. Patients also complain of paresthesias of the extremities, confusion, and drowsiness. Vomiting and hyperkalemia are not common adverse effects

The nurse is caring for a patient with a bladder infection. What symptoms are most common with this type of infection? (Select all that apply.) A) Frequency B) Urgency C) Dysuria D) Flank pain E) Temperature elevation over 102°F .

Ans: A, B, C Feedback: Patients with bladder infection most commonly experience urinary frequency, urgency, and burning on urination (dysuria). Patients with pyelonephritis also experience flank pain and temperature elevation

The nurse is caring for a patient with a bladder infection. What symptoms are most common with this type of infection? (Select all that apply.) A) Frequency B) Urgency C) Dysuria D) Flank pain E) Temperature elevation over 102°F

Ans: A, B, C Feedback: Patients with bladder infection most commonly experience urinary frequency, urgency, and burning on urination (dysuria). Patients with pyelonephritis also experience flank pain and temperature elevation

The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance his performance. What findings would the nurse associate with this practice? (Select all that apply.) A) Personality changes B) Sexual dysfunction C) Increased serum lipid levels D) Cardiomyopathy E) Weight loss

Ans: A, B, C, D Feedback: Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off-label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss.

The nurse is caring for a patient with edema who has just begun taking a diuretic. What will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.) A) Daily weight B) Decrease in edema C) Increase in blood pressure D) Increase in urinary output E) Increase in pulse

Ans: A, B, D Feedback: Responsiveness to the use of a diuretic can be measured by daily weights, increased urinary output, decrease in edema, decrease in blood pressure and pulse rate. Options C and E are not correct.

A patient has just begun therapy with furosemide (Lasix), and the nurse is instructing the patient about the need to include foods high in potassium in the diet. Which foods would be appropriate for this patient to choose? (Select all that apply.) A) Prunes B) Apples C) Watermelon D) Lima beans E) Rice

Ans: A, C, D Feedback: Foods high in potassium include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, sunflower seeds, spinach, tomatoes, and watermelon. Apples and rice are not potassium-rich foods.

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics? A) Hyperkalemia B) Alkalosis C) Hypertension D) Hypercalcemia

Ans: B Feedback: Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct.

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics? A) Hyperkalemia B) Alkalosis C) Hypertension D) Hypercalcemia

Ans: B Feedback: Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct.

The nurse is caring for a patient in end-stage renal failure and anemia. What is the cause of this patient's anemia? A) Low serum iron levels B) Low erythropoietin levels C) Inadequate oxygenation of tissue D) Lack of B12 and folic acid intake

Ans: B Feedback: Anemia can occur if erythropoietin levels are low. This is seen in association with renal failure, when the kidneys are no longer able to produce erythropoietin. Low iron levels, hypoxia, and vitamin deficiency are not likely to be the primary cause of anemia in a patient with kidney failure.

The 63-year-old male patient receives a prescription for androgens. The nurse evaluates that the patient understood drug teaching when he makes what statement? A) If I experience acne, I will contact my physician immediately. B) If I experience flushing, sweating, nervousness, or emotional lability I'll know it's the drug. C) I will report any difficulty urinating such as trouble starting my flow. D) These pills may make my skin turn yellow but it will go away when the drug is stopped.

Ans: B Feedback: Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. Nurses should teach these men the signs and symptoms of prostatic enlargement and the importance of reporting these manifestations immediately to prevent worsening of symptoms. Acne need not be reported immediately. Flushing, sweating, nervousness, and emotional lability are more usually experienced by women. Yellowing of the skin may be an indication of liver disease, which should be reported immediately.

When the nurse administers an endogenous estrogen, what systemic effects does the nurse expect the drug will have? A) Causes proliferation of endometrial lining B) Provides protection of heart from atherosclerosis C) Retains calcium in the bloodstream D) Inhibits ovulation

Ans: B Feedback: Estrogens produce a wide variety of systemic effects, including protecting the heart from atherosclerosis, retaining calcium in the bones, not the bloodstream, and maintaining the secondary female sex characteristics. Proliferation of endometrial lining and inhibiting ovulation are effects of estrogen but are not systemic effects

Before administering an iron preparation, what should the nurse assess? A) Red blood cell count (RBC) B) Hematocrit and hemoglobin C) Aspartate aminotransferase levels D) Serum creatinine levels

Ans: B Feedback: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Counting RBCs would indicate the number of blood cells per cubic millimeter but not iron or oxygen content. Aspartate aminotransferase levels are associated with liver function and serum creatinine levels are associated with renal function.

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include? A) Measuring intake and output of urine B) To weigh themselves on the same scale, at the same time of day, in the same clothing C) Restrict fluids to 500 mL/d to limit the need to urinate D) Decrease exercise to conserve energy

Ans: B Feedback: Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated.

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include? A) Measuring intake and output of urine B) To weigh themselves on the same scale, at the same time of day, in the same clothing C) Restrict fluids to 500 mL/d to limit the need to urinate D) Decrease exercise to conserve energy

Ans: B Feedback: Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated.

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Penile implant C) Hypotension D) Lung cancer

Ans: B Feedback: Patients with a penile implant should not take tadalafil. Patients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects

The nurse is caring for a patient diagnosed with pernicious anemia and anticipates this patient will require supplemental what? A) Iron B) Vitamin B12 C) Erythropoietin D) Oxygen .

Ans: B Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Other options are incorrect

A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color? A) Bluish-green B) Reddish-orange C) Brown D) Black

Ans: B Feedback: Phenazopyridine turns urine reddish-orange, which may be mistaken for blood. It does not cause the urine to appear bluish-green, brown, or black

The nurse is preparing to administer an infusion of oxytocin (Pitocin) to the pregnant patient. What is the priority assessment before beginning the infusion? A) Cervical dilation B) Cephalopelvic proportions C) Electrocardiogram readings D) Respiratory excursion

Ans: B Feedback: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated so this is not a priority assessment, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting condition.

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element? A) Calcium B) Potassium C) Glucose D) Magnesium

Ans: B Feedback: Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important.

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element? A) Calcium B) Potassium C) Glucose D) Magnesium

Ans: B Feedback: Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important.

A patient with benign prostatic hyperplasia has been self-treating with an herbal called saw palmetto. The nurse would know which drug is contraindicated in this patient? A) Tamsulosin (Flomax) B) Finasteride (Proscar) C) Alfuzosin (Uroxatral) D) Terazosin (Hytrin)

Ans: B Feedback: Saw palmetto is an herbal therapy that has been used very successfully for the relief of symptoms associated with benign prostatic hyperplasia (BPH). Patients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur. There is no contraindication in the use of tamsulosin, alfuzosin, and terazosin, which are alpha-adrenergic blockers. Finasteride is a testosterone blocking agent.

The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration? A) Weight of patient B) Blood pressure of patient C) Pulse of patient D) Respiratory rate of patient

Ans: B Feedback: Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 845 The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels. Mannitol peaks 1 hour after administration, therefore, it would be most important to monitor blood pressure. Weight is the best indicator over time but would not be as effective in indicating a dangerous fluid drop as the blood pressure. Respiratory and pulse rates would also not be as effective as blood pressure in evaluating dangerous fluid drops.

A patient has been prescribed sildenafil citrate. What should the nurse teach the patient about this medication? A) Take the medication with a glass of grapefruit juice. B) The drug should be taken 1 hour before attempting intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) A dose exceeding 80 mg will result in a change of vision, making everything appear blue.

Ans: B Feedback: The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. The blue haze that occurs with the 100-mg dosage is transient (it lasts about 1 hour). Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion.

A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse's priority response? A) The effect of oral contraceptives containing progestin is reduced by phenytoin. B) The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin. C) The effect of oral contraceptives containing estrogen is reduced by phenytoin. D) You will need to increase the dosage of your phenytoin once you start contraceptives. .

Ans: B Feedback: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin

A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication? A) Hypokalemia B) Hyperkalemia C) Gastric irritation D) Hypertension

Ans: B Feedback: The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Hypokalemia, gastric irritation, and hypertension are not recognized as adverse effects of spironolactone.

A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin alfa therapy for iron replacement. What will the nurse assess before initiating therapy? A) Weight B) Last menstrual period C) Intake and output (I & O) for a 24-hour period D) Blood type

Ans: B Feedback: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the patient is not pregnant before drug therapy has started so the nurse would assess when the patient last menstruated. The patient's weight, I & O, and blood type are not important factors in determining whether the drug can be used.

A 62-year-old female patient is started on vitamin B12 for pernicious anemia. When the nurse develops the plan of care, what expected outcome will the nurse include? A) Decreased bleeding B) Increased hemoglobin C) Decreased joint pain D) Less fatigue

Ans: B Feedback: Vitamin B12 is essential for normal functioning of red blood cells (RBCs) so the drug would be evaluated as successful in treating the disorder if the patient's hemoglobin and RBC count increased after administration. Expected outcomes do not include decreased bleeding, decreased joint pain, or less fatigue.

A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this patient experience while taking this medication? (Select all that apply.) A) Constipation B) Dizziness C) Polyphagia D) Nocturia E) Muscle cramps

Ans: B, D, E Feedback: The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The patient would not experience polyphagia (great hunger) and constipation.

A nurse is taking care of a woman receiving an abortifacient. The nurse is aware that the most serious adverse effect is what? A) Vomiting B) Nausea C) Uterine rupture D) Diarrhea

Ans: C Feedback: All these options are adverse effects of abortifacients. However, the most serious adverse effect would be uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken.

The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician? A) Indomethacin (Indocin) B) Colestipol (Colestid) C) Lithium (Eskalith) D) Ibuprofen (Motrin)

Ans: C Feedback: An increase in the excretion of lithium can occur when taken with acetazolamide, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-to-drug interactions when given with acetazolamide.

The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician? A) Indomethacin (Indocin) B) Colestipol (Colestid) C) Lithium (Eskalith) D) Ibuprofen (Motrin)

Ans: C Feedback: An increase in the excretion of lithium can occur when taken with acetazolamide, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-to-drug interactions when given with acetazolamide

A patient has been prescribed epoetin alfa. The nurse determines the drug is contraindicated as a result of what finding in the patient history? A) Asthma B) Irritable bowel syndrome C) Hypertension D) Shortness of breath

Ans: C Feedback: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis- stimulating agents for patients with asthma, irritable bowel syndrome, or shortness of breath.

The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication? A) Reduced risk of endometriosis B) Reduced risk of dysfunctional uterine bleeding C) Reduced risk of osteoporosis D) Reduced risk of uterine cancer

Ans: C Feedback: Estrogen slows the bone loss seen with osteoporosis so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer and screening for cancer should be performed before prescribing this drug.

The nurse has been conducting patient teaching for a 16-year-old who is starting oral contraception. What statement indicates that she needs additional teaching? A) I will monitor my weight and have my blood pressure checked monthly. B) I will see my woman's health provider and have a Pap smear done on a yearly basis. C) If I forget to take my pill for 2 consecutive days I will take three pills to catch up. D) I will take the pill every day at the same time and never miss a pill.

Ans: C Feedback: If one tablet is missed, take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the patient understood the nurse's teaching.

The patient has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the patient's lab results and finds indications of severe anemia and cytopenias. What order will the nurse anticipate receiving? A) Increase the dosage of Epogen. B) Change the patient to another erythropoiesis-stimulating agent. C) Discontinue Epogen. D) Begin administering Epogen IV instead of subcutaneously.

Ans: C Feedback: In patients treated with Epogen or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to patient's development of neutralizing antibodies. Increasing the dosage will not help and changing the route of administration will not reverse the process after antibodies have formed.

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic? A) Spironolactone (Aldactone) B) Bumetanide (Bumex) C) Mannitol (Osmitrol) D) Ethacrynic (Edecrin) .

Ans: C Feedback: Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic? A) Spironolactone (Aldactone) B) Bumetanide (Bumex) C) Mannitol (Osmitrol) D) Ethacrynic (Edecrin)

Ans: C Feedback: Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

What would be an appropriate nursing intervention for a patient on a urinary tract antispasmodic? A) Monitor for patient use of hot showers. B) Advise patient about change in color of sclera. C) Offer sugarless hard candy. D) Teach proper personal hygiene.

Ans: C Feedback: Offer frequent sips of water or use of sugarless hard candy to alleviate dry mouth because antispasmodics have anticholinergic effects that cause dry mouth. The use of hot water for showers will not cause the patient any danger. Urinary antispasmodics do not cause changes in the sclera. This patient has an issue with bladder spasms and not a urinary tract infection

A patient will begin taking sildenafil (Viagra) for penile erectile dysfunction (ED). What is the nurse's priority teaching point about this drug? A) He will have an erection exactly 1 hour after taking the drug. B) The drug should not be taken with a penile implant or any anatomic penile obstruction. C) Avoid drinking grapefruit juice for 2 days before and after taking the drug. D) It is important to know the cause of ED because sildenafil does not treat all causes.

Ans: C Feedback: Patients who are using sildenafil need to be advised to avoid drinking grapefruit juice while using the drug. Grapefruit juice can cause a decrease in the metabolism of the PDE5 inhibitor, leading to increased serum levels and a risk of toxicity. They need to know that it takes 48 hours for grapefruit juice to be processed by the body, so they need to avoid it for several days before and after taking the drug. The patient should be screened for penile implants, anatomic penile obstruction, and the cause of ED before the drug is prescribed. Sildenafil has a median onset of 27 minutes and duration of 4 hours so the patient may have an erection as early as 27 minutes after taking it

After assessing the patient receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? A) Constipation B) Hypotension C) Edema D) Depression

Ans: C Feedback: Potential adverse effects of an erythropoietin are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Options A, B, and D are not associated with these drugs.

The nurse is caring for a patient taking raloxifene. What manifestation reported by the patient would raise the highest level of concern from the nurse? A) Headache B) Weight loss C) Calf pain D) Edema

Ans: C Feedback: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes. Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation. However, these are not symptoms.

The nurse instructs a patient taking oral iron preparations about which potential adverse effect? A) Clay-colored stools B) Hypotension C) Constipation D) Frequent flatus

Ans: C Feedback: The most common adverse effects associated with oral iron supplements are related to direct GI irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Oral iron supplements do not cause hypotension, clay-colored stools, or frequent flatus

The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient? A) Skin condition B) Cardiac arrhythmia C) Vision changes D) Mental status

Ans: C Feedback: The nurse should assess for vision changes and recommend an ophthalmologic examination during treatment to evaluate drug effects on intraocular pressure so that the drug can be stopped if intraocular pressure increases. A rash and changes in cardiac rhythm and rate are possible adverse effects. Also, disorientation (mental status) could be a concern. However, these effects can be treated and may not necessitate stopping the medication

A 28-year-old female patient is taking danazol (Danocrine) as treatment for endometriosis. The patient is upset about increased facial hair, a weight gain of 15 pounds, and a change in her voice; she discusses her concerns with the nurse. What nursing diagnoses would be most appropriate for this patient? A) Acute pain related to need for injections B) Deficient knowledge regarding drug therapy C) Disturbed body image related to drug therapy D) Sexual dysfunction related to androgenic effects

Ans: C Feedback: The patient is concerned about the way she looks and the sound of her voice. The most appropriate nursing diagnosis would be disturbed body image. Danazol is not administered by injections; therefore, acute pain would not be applicable. Sexual dysfunction and deficient knowledge would be possible nursing diagnoses for this patient, but the concerns expressed by the patient fail to support these diagnoses.

The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics? A) Loop diuretics B) Carbonic anhydrous inhibitors C) Thiazide and thiazide-like diuretics D) potassium-sparing diuretics

Ans: C Feedback: Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective.

An older male patient, who has difficulty swallowing pills and tablets, will begin taking an androgen. What drug would the nurse identify as a good choice for this patient? A) Danazol (Danocrine) B) Fluoxymesterone (Androxy) C) Methyltestosterone (Testred) D) Testosterone (Androderm)

Ans: D Feedback: A good choice for this patient would be testosterone because the drug can be administered in long- acting depository forms and by dermatologic patch. These forms would eliminate the need for the patient to swallow a pill or tablet. The other options shown here are available only in oral form

An adolescent patient asks the nurse, What should I do if I forget to take my birth control pill? What should the nurse reply? A) Abstain from intercourse for 7 days. B) It's okay to miss a day or two, as long as you don't go over 5 days. C) Just wait until your next dose, then take double the dose. D) Take the dose as soon as you discover your oversight.

Ans: D Feedback: A missed pill should be taken as soon as the error is noticed. Telling the patient to abstain from intercourse would be inappropriate but if the patient misses three tablets they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken the better contraceptive protection provided, so patients should not wait until the next dose and then double it

What anemia does the nurse classify as a type of hemolytic anemia? A) Iron deficiency anemia B) Megaloblastic anemia C) Pernicious anemia D) Sickle cell anemia

Ans: D Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia

A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? A) Liver function test (LFT) B) Cholesterol level C) Vision D) Hand and wrist radiographs

Ans: D Feedback: Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision.

A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)? A) To decrease the action of the reninangiotensin cycle B) To make more concentrated plasma C) To dilute the urine D) To avoid rebound edema

Ans: D Feedback: Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a patient stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The decreased volume is sensed by the nephrons, which activate the renin-angiotensin cycle. When concentrated blood is sensed by the osmotic center in the brain, antidiuretic hormone (ADH) is released to retain water and dilute the blood. The result can be rebound edema as fluid is retained. Drinking 8 to 10 glasses of water will not decrease the action of the renin-angiotensin cycle, or make plasma more concentrated. It may produce urine that is dilute but that is not the reason it is recommended

The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs? A) Decreased appetite B) Dehydration C) Occasional headaches D) History of deep vein thrombosis

Ans: D Feedback: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. A loss of appetite would not contraindicate oral contraceptives but would require further assessment to determine the cause. Dehydration would require fluid administration to correct but is not a contraindication to oral contraceptives. Occasional headaches are not uncommon and would not contraindicate contraceptive use.

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor? A) Sodium levels B) Bone narrow function C) Calcium levels D) Potassium levels

Ans: D Feedback: Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor? A) Sodium levels B) Bone narrow function C) Calcium levels D) Potassium levels

Ans: D Feedback: Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

The nurse develops a care plan for a patient who has been prescribed a folic acid derivative that includes what priority nursing diagnosis? A) Deficient knowledge regarding drug therapy B) Monitor possibility of hypersensitivity reactions C) Acute pain related to injection or nasal irritation D) Risk for fluid volume imbalance related to cardiovascular effects

Ans: D Feedback: Nursing diagnoses related to drug therapy might include: Risk for fluid volume imbalance related to cardiovascular effects. Deficient knowledge and acute pain might apply to this patient, but the priority nursing diagnosis this patient, but the priority nursing diagnosis for this patient is the risk for fluid imbalance related to cardiovascular effects. Monitoring for hypersensitivity is not a nursing diagnosis.

When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered? A) Long-term B) Short-term C) Continuous D) Intermittent

Ans: D Feedback: Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy

When caring for a patient on estrogen therapy, what is the nurse's priority assessment? A) Blood sugar levels B) Bowel sounds C) Weight D) Therapeutic and adverse drug effects

Ans: D Feedback: Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. Bowel sounds, weight, and blood sugar may be part of the assessment, but it is most important to assess for therapeutic and adverse effects of the medication

What is the drug of choice in a patient with renal impairment who is being treated for a urinary tract infection (UTI)? A) Salazopyrin B) Silver sulfadiazine C) Declomycin D) Fosfomycin

Ans: D Feedback: The dosage of fosfomycin, given orally, does not need to be changed in cases of renal impairment. It is the only medication listed here that is used in the treatment of urinary tract infections. Declomycin may be used to inhibit antidiuretic hormone in the treatment of chronic inappropriate antidiuretic hormone secretion. Salazopyrin is used in ulcerative colitis. Silver sulfadiazine is used topically to treat Pseudomonas infections.

The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has? A) Cystitis B) Kidney stones C) Neurogenic bladder D) Pyelonephritis

Ans: D Feedback: The fever and chills indicate an inflammatory process. Flank pain and left-sided tenderness indicate kidney swelling within the capsule. These symptoms indicate pyelonephritis. Kidney stones cause intense pain; fever and chills would not be present. Cystitis and neurogenic bladder present with bladder-related symptoms such as frequency, urgency, burning, and bloating

The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has? A) Cystitis B) Kidney stones C) Neurogenic bladder D) Pyelonephritis .

Ans: D Feedback: The fever and chills indicate an inflammatory process. Flank pain and left-sided tenderness indicate kidney swelling within the capsule. These symptoms indicate pyelonephritis. Kidney stones cause intense pain; fever and chills would not be present. Cystitis and neurogenic bladder present with bladder-related symptoms such as frequency, urgency, burning, and bloating

The nurse is talking with a menopausal woman about the use of hormone replacement therapy (HRT). What statement, if made by the nurse, would be accurate and appropriate to share with the patient? A) Symptoms of menopause are short-term and minor so HRT is not necessary. B) The newer drugs used in HRT cause cardiovascular events even when taken short-term. C) The risk for osteoporosis is much higher in women who take HRT. D) There is a possible increased risk of breast and cervical cancer when taking HRT.

Ans: D Feedback: The use of HRT can decrease the discomforts associated with menopause, although various forms of HRT have been associated with increased risks of breast and cervical cancer, heart disease, and stroke. The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use, they are associated with an increased risk of cardiovascular events. The risk for osteoporosis declines with HRT because of the bone saving effects of the drugs. It would be inappropriate and judgmental for the nurse to say symptoms of menopause are minor because some women experience more severe symptoms that can negatively impact their day-to- day life.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? A) Carbonic anhydrase inhibitors B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics

Ans: D Feedback: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? A) Carbonic anhydrase inhibitors B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics

Ans: D Feedback: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.

A patient is taking phenazopyridine (Azo-Standard) and ciprofloxacin (Cipro) for a urinary tract infection. What is the most important instruction the nurse needs to provide to the patient concerning this drug combination? A) Do not be alarmed if your urine is a reddish-brown color. B) Be sure to take your medication with food if you have GI irritation. C) Increase your fluid intake. Drink lots of water. D) If you notice yellowing of your eyes or skin, contact your health care provider immediately.

Ans: D Feedback: Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatic (liver) toxicity. Phenazopyridine should not be used more than 2 days, especially if taken, as here, with an antibacterial agent (ciprofloxacin). The other suggested options are important and should be included in the instructions given the patient. However, the possibility of toxicity is the most important.

A nurse is reviewing the health care record of a client who is asking about conjugated equine estrogens. The nurse should inform the client this medication is contraindicated in which of the following conditions? A. Atrophic vaginitis B. Dysfunctional uterine bleeding C. Osteoporosis D. Thrombophlebitis

D. CORRECT: Estrogen increases the risk of thrombolytic events. Estrogen use is contraindicated for a client who has a history of thrombophlebitis