exam 4

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

a. An 18-year-old woman with multiple sexual partners Response Feedback: Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD.

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?

a. Color vision and visual acuity Response Feedback: Optic neuritis is a dose-related adverse effect of ethambutol. Patients receiving this drug should have color vision and visual acuity testing before therapy starts and periodically thereafter. A CBC, hearing evaluations, and hepatic function testing are not recommended.

What are the effects of prolactin secretion in males? (Select all that apply.)

a. Decreased libido b. Delayed puberty d. Galactorrhea Response Feedback: Prolactin can cause decreased libido, delayed puberty, and galactorrhea in males, but it does not cause breast development or infertility.

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

a. Discuss an oral contraceptive with increased estrogen. Response Feedback: Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symptom may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing the dose of carbamazepine is not correct. Discontinuing the OC immediately is not correct.

A patient arrives in the emergency department after a bicycle-automobile accident with multiple dirty abrasions. Which product might be used initially to cleanse this patient's wounds?

a. Hydrogen peroxide Response Feedback: Hydrogen peroxide does not have good antiseptic properties, because the antimicrobial component is destroyed by catalase in tissues. It is useful initially because the frothing that occurs when catalase liberates oxygen loosens debris and facilitates cleansing of a dirty wound. Isopropanol is irritating to the skin. Povidone iodine is used on intact skin. Soap and water can be used, but hard scrubbing is necessary on a dirty abrasion and can be painful.

The nurse asks a graduate nurse, "When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?" The graduate nurse would be correct to respond with which conditions? (Select all that apply.)

a. Myalgia d. Lymphadenopathy e. Fever Response Feedback: Fever, myalgia, and lymphadenopathy are early signs associated with HIV infection. Respiratory distress and insomnia are not consistent findings in the initial phase of HIV infection.

A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient?

a. The medication will probably be stopped, and the patient should come into the clinic for further evaluation. Response Feedback: The patient has early signs and symptoms of neuropathy, which may resolve if the drug is stopped. The patient should be taught early in treatment to report these symptoms immediately. Numbness is not an expected side effect and these symptoms may diminish once the drug is withdrawn. The patient should never be advised to cut the dose in half unless instructed to do so by a prescriber. Taking the medication on a full stomach will not affect the amount of medication absorbed.

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. Vasomotor symptoms are a common side effect of this drug. Response Feedback: Raloxifene can induce hot flashes in patients taking the drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.

A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine [Synthroid]. The child comes to the clinic for a well-child checkup. The nurse will expect the provider to:

a. change the dose of levothyroxine to 6 mcg/kg/day. Response Feedback: In the treatment of cretinism, thyroid dosing decreases with age. For infants 6 to 12 months of age, the dose is 6 mcg/kg/day. At 1 year of age, the dose is reduced to 5 to 6 mcg/kg/day. For all children, treatment should continue for 3 years. It is incorrect to increase the dose with age. After 3 years of therapy, the patient undergoes a trial of 4 weeks without the drug, followed by assessment of the TSH and T4 levels, to determine whether the drug may be discontinued.

A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:

a. reassure the patient that this is not considered a positive test result. Response Feedback: This patient has a moderate risk of tuberculosis; the area of induration would have to be 10 mm or greater to be considered a positive skin test result. Without other clinical signs, there is no indication to treat this patient or to perform diagnostic testing, so a chest x-ray or sputum cultures are not recommended.

A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for:

a. recent serum electrolyte levels. Response Feedback: Moxifloxacin prolongs the QT interval and poses a risk of serious dysrhythmias. Patients with hypokalemia have an increased risk, so serum electrolyte levels should be monitored. Having a history of asthma is not significant. Moxifloxacin does not alter digoxin or warfarin levels.

A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct?

b. "Azoles have lower toxicity than amphotericin B." Response Feedback: The azoles class of antifungals is less toxic than amphotericin B. Amphotericin B may only be given parenterally. The azoles, not amphotericin B, inhibit hepatic P450 drug-metabolizing enzymes, so they increase the levels of many other drugs. Both classes are broad-spectrum antifungal agents.

A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct?

b. "Resistance is common with this medication." Response Feedback: The development of resistance during flucytosine therapy is common and is a serious clinical problem. Flucytosine has a narrow antifungal spectrum. Neutropenia and thrombocytopenia may occur but are reversible. Severe hepatic injury is rare; mild and reversible hepatic dysfunction is common.

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

b. "This agent is not effective against infections of the upper urinary tract." Response Feedback: Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys, so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems.

A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic?:

b. Daptomycin [Cubicin] Response Feedback: Daptomycin is active against MRSA. Levofloxacin and norfloxacin are not approved to treat MRSA. Ciprofloxacin is a poor choice for staphylococcal infections, including MRSA.

A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs?

b. Isoniazid and rifabutin Response Feedback: Rifabutin is used off-label as an alternative to rifampin to treat TB in patients with HIV, because it has less impact on the metabolism of protease inhibitors. The effects of rifapentine on protease inhibitors is similar to those of rifampin. Pyrazinamide is not indicated.

A patient with Cushing's syndrome has undergone surgery and radiation treatment. The nurse will expect to teach the patient about which medication?

b. Ketoconazole [Nizoral] Response Feedback: The role of drugs in the treatment of Cushing's syndrome is limited; drugs are used only as adjuncts to surgery and radiation therapy. The most effective agent is ketoconazole, which suppresses steroid synthesis. Cosyntropin is used to diagnose adrenal insufficiency. Dexamethasone is a glucocorticoid used for replacement therapy and to diagnose Cushing's syndrome. Fludrocortisone is used for chronic mineralocorticoid replacement.

A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct?

b. Request an order for a different antifungal medication . Response Feedback: Because of the risk of serious and potentially fatal hepatic necrosis with oral ketoconazole, it is not recommended for use in treating superficial fungal infections. Another antifungal medication should be ordered.

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

b. The patient should discuss an alternate method of birth control prior to surgery. Response Feedback: Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient?

b. This is an acceptable practice. Response Feedback: NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

A nurse is caring for a patient with an infection caused by Bacillus anthracis. What action is most important for reducing the transmission of this disease?

b. Using antibacterial hand soap when washing the hands Response Feedback: All of these measures are appropriate for this patient; however, using an antibacterial hand soap is the most important, because only an antimicrobial soap is effective against a spore-forming bacterium, such as B. anthracis.

A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for:

b. ibuprofen. Response Feedback: Polyarthralgias occur in 40% of patients during the initial phase of treatment with pyrazinamide and can be managed with a nonsteroidal anti-inflammatory drug (NSAID). Renal function tests and uric acid levels are not indicated. Unless the pain cannot be managed with NSAIDs, there is no need to reduce the dose of pyrazinamide.

A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:

b. is administered less frequently than interferon. Response Feedback: Pegylated interferon alfa preparations are preferred because of their convenience and superior efficacy. These preparations may be given once weekly instead of three or more times per week like the regular interferon. Using pegylated interferons does not decrease the need for additional medications. Pegylated interferons have similar adverse effects. Pegylated interferons are not given orally.

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

b. methenamine [Hiprex]. Response Feedback: Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross-reactivity with amoxicillin.

The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with:

b. modified diet and exercise. Response Feedback: All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancrease is not indicated to lower triglycerides and cholesterol.

A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:

b. propylthiouracil (PTU). Response Feedback: Propylthiouracil is used for patients experiencing thyroid storm, and this patient is showing signs of that condition. Levothyroxine is given IV for hypothyroidism. 131I is used in patients over age 30 who have not responded to other therapies. Methimazole is used long term to treat hyperthyroidism, but PTU is more useful for emergency treatment.

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

b. prostatitis. Response Feedback: The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria.

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

b. reassure the patient that this is normal with this form of contraception. Response Feedback: Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception.

A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin [Pitressin]. Which statement by the student indicates a need for further teaching?

c. "Desmopressin has a shorter duration of action than vasopressin." Response Feedback: Desmopressin has a long duration of action, which is the reason it is preferred for the treatment of diabetes insipidus. It can be administered intranasally, so it is easier to administer than vasopressin. Vasopressin has hemodynamic effects that can be beneficial during cardiac resuscitation but that also can cause serious adverse cardiovascular effects.

The nurse is providing patient education to a patient who will begin taking fludrocortisone [Florinef] as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching?

c. "I should report any swelling of my hands and feet." Response Feedback: Fludrocortisone is a mineralocorticoid that regulates sodium, potassium, and water balance. Water and sodium retention is a particular concern, so the patient should be taught to report any signs of fluid retention, such as swelling of the hands and feet. Fludrocortisone elevates the blood pressure, so hypotension is not a concern. Because fluid retention causes weight gain, patients should be taught to report any increase in weight. Patients should report decreased urine output.

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

c. "I will need to use backup contraception if I miss a pill." Response Feedback: When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience. The mini-pill is slightly safer than combination OCs but not as effective. The mini-pill is a weak inhibitor of ovulation.

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

c. "When hormone therapy is discontinued, bone mass is quickly lost." Response Feedback: Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount.

A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition?

c. Diabetes insipidus Response Feedback: Deficiency of antidiuretic hormone (ADH) produces hypothalamic diabetes insipidus, in which large volumes of dilute urine are produced. Head trauma can cause the hypothalamus to stop producing ADH. Diabetes mellitus is an endocrine disorder of the pancreas that causes the production of large volumes of nondilute urine. SIADH is a condition in which too much ADH is produced, causing oliguria. Water intoxication occurs with SIADH.

A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient?

c. Fluconazole [Diflucan] Response Feedback: Fluconazole is a drug of choice for treating systemic candidal infections. Amphotericin is nephrotoxic and should not be used in patients with existing renal disease. Itraconazole is a possible alternative agent for treating candidiasis but has serious cardiac side effects. Voriconazole is a drug of first choice for treating aspergillosis but not for candidiasis.

Which compound can be used to treat localized skin infections and to irrigate wounds?

c. Oxychlorosene sodium (Clorpactin WCS90) Response Feedback: Oxychlorosene sodium can be used to treat localized infections caused by drug-resistant microbes and to irrigate wounds. Benzalkonium chloride can cause severe local injury, so it is not widely used. Hexachlorophene has central nervous system (CNS) effects when absorbed through the skin and is not used in open areas such as wounds. Sodium hypochlorite is too irritating for application to the skin.

A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider.

c. another birth control method Response Feedback: Rifampin induces cytochrome P450 enzymes and can accelerate the metabolism of many drugs, including oral contraceptive pills (OCPs). Women taking OCPs should consider a nonhormonal form of birth control. Reducing the dose of rifampin or isoniazid is not indicated. Increasing the OCP dose is not recommended.

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:

c. help delay delivery while glucocorticoids are given. Response Feedback: Tocolytic agents are used to postpone premature labor and, on average, for only 48 hours. During this time, glucocorticoids are given to help the fetal lungs mature. Tocolytic agents do not suppress labor long term. They do not directly help the fetal lungs to mature; they help by allowing time for glucocorticoids to be given. They do not treat infection.

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?

d. "I may have a deficiency of vitamin B6." Response Feedback: A deficiency of vitamin B12, not vitamin B6, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.

A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin [Humatrope]. Which statement by the patient indicates understanding of the teaching?

d. "I will need to monitor my blood pressure frequently while taking this drug." Response Feedback: Growth hormone in adults causes an increase in systolic blood pressure, so patients should be taught to monitor blood pressure while taking the drug. Subcutaneous dosing is as effective as IM dosing and is preferred, because it is less painful. Although muscle mass will increase, strength and height will not. Growth hormone is diabetogenic but causes significant problems in patients with preexisting diabetes.

A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement?

d. "Your child will need to take this oral medication for 6 to 8 weeks." Response Feedback: Tinea capitis is difficult to treat with topical medications; oral griseofulvin, taken for 6 to 8 weeks, is standard therapy. Itching, burning, and erythema are side effects of topical agents. Patients treating tinea corporis, tinea cruris, or tinea pedis are taught to apply medication until 7 days after the rash disappears. Antifungal shampoos are not effective for treating tinea capitis.

A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis?

d. Posaconazole [Noxafil] Response Feedback: Posaconazole is used as prophylaxis for invasive Aspergillus and Candida infections in immunocompromised patients. Fluconazole, ketoconazole, and voriconazole are not used prophylactically.

A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to:

d. add metronidazole [Flagyl]. Response Feedback: C. difficile is resistant to fluoroquinolones; metronidazole is the drug of choice to treat this infection. Metronidazole is lethal only to anaerobic organisms, so the ciprofloxacin should be continued to treat the pneumonia. Increasing the dose of ciprofloxacin is not indicated, because C. difficile is resistant to ciprofloxacin. Gemifloxacin is approved for use in respiratory infections.

A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to:

d. administer hydrocortisone 50 mg IV before surgery. Response Feedback: Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal. For surgeries that cause moderate stress, such as a cholecystectomy, patients should be given 50 mg of hydrocortisone intravenously the day of the procedure, followed by a taper over 1 to 2 days to the usual replacement dose. Giving the usual dose or giving an increased oral dose is not indicated.

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

d. begin a 2-week course of antibiotics. Response Feedback: Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy, followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors, an evaluation for structural abnormalities may be warranted. Unless the infections are severe or are complicated, intravenous antibiotics are not indicated.

A patient with infertility will begin taking menotropins [Repronex]. The nurse will evaluate this patient's history to determine whether the:

d. patient's ovaries are capable of responding to gonadotropins. Response Feedback: Menotropins are used when gonadotropin secretion by the pituitary is insufficient to provide adequate ovarian stimulation. Candidates must have ovaries capable of responding to FSH and LH. Metformin is used for hyperinsulinemia. Women with excessive prolactin secretion are treated with cabergoline. Menotropins contain equal amounts of LH and FSH and act directly on the ovaries, so the pituitary's inability to produce these hormones is not a factor for beginning treatment with this drug.

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis?

b. "Women with asymptomatic Chlamydia trachomatis infections can become sterile." Response Feedback: Chlamydial infections are frequently asymptomatic in women and may be asymptomatic in men; they can cause sterility in women. C. trachomatis conjunctivitis in newborns does not result in blindness. The Centers for Disease Control and Prevention (CDC) recommends routine screening for sexually active women under age 25 and for those over age 25 with new partners or multiple partners. Treatment should begin when infections are identified, regardless of whether they are symptomatic.

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

c. "Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss." Response Feedback: ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease.

An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen?

d. "My libido may improve while I am taking this medication." Response Feedback: Treatment with androgen replacement therapy in patients with testicular failure helps to restore libido. A side effect of androgens is premature epiphyseal closure; this is not a concern in adults, so radiographs to evaluate this are not indicated. Androgens can promote the growth of prostate cancer when it occurs, but they do not cause it. Androgens do not restore fertility.

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused byChlamydia trachomatis. The nurse will expect the provider to order which drug?

d. Azithromycin Response Feedback: The preferred treatment for C. trachomatis during pregnancy is either azithromycin or amoxicillin. Doxycycline can be used for nonpregnant patients. Erythromycin is used for infants. Sulfisoxazole is not recommended for pregnant woman near term, because it can cause kernicterus in the infant.

A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him?

d. Boceprevir is contraindicated in males whose partners are pregnant. Response Feedback: The triple combination is dangerous for pregnant women whose partners are using it, so it is contraindicated for any man whose partner is pregnant. Barrier contraceptives should be used by couples to prevent pregnancy when either partner is taking the triple combination therapy. Ribavirin is teratogenic and is not safe when a partner is pregnant. This combination is not safe for pregnant women whose partners are taking these drugs.