Pharm exam 4

Answer: B: Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require the above dosing to achieve a full 24 hours of basal coverage.

1. A patient is prescribed insulin glargine [Lantus]. Which statement should the nurse include in the discharge instructions? A. The insulin will have a cloudy appearance in the vial. B. Once daily at bedtime. C. The patient should mix Lantus with the intermediate-acting insulin. D. The patient will have less risk of hypoglycemic reactions with this insulin.

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

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

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

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

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

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

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

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

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

14. A nurse is providing medication teaching to a 12-year-old male patient with hypogonadism. Which statement, made by the patient, indicates an understanding of the prescribed medication, testosterone enanthate? A. "I will grow significantly taller while taking this medication." B. "Sexual changes in my body will occur within 4 to 6 months." C. "I will come to the clinic every 2 weeks for shots of testosterone." D. "If the medication causes stomach upset, I can take it with food."

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

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

Answer: C: Taking nitrates with sildenafil may result in severe hypotension. Sildenafil can be taken with or without food. Patients who experience priapism (an erection lasting longer than 4 hours) should contact their health care provider immediately

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

Answer: A: Finasteride [Proscar] promotes the regression of prostate epithelial tissue and decreases the size of the mechanical obstruction.

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

Answer: D: Second-generation antihistamines, such as cetirizine, cross the blood-brain barrier poorly and hence produce much less sedation than first-generation antihistamines.

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

Answer: D: When used in older adults, antihistamines can cause sedation; smaller doses should be used initially and titrated up if needed. Also, these medications can worsen glaucoma or benign prostatic hyperplasia.

19. Which statement regarding antihistamine administration to older adults does the nurse identify as true? A. Antihistamines cause CNS excitation in older adults. B. Larger doses of antihistamines are needed for older adults. C. Antihistamines can be used to reduce intraocular pressure. D. Older men with benign prostatic hypertrophy can experience worse symptoms when taking antihistamines.

Answer: A: NPH insulins are supplied as cloudy suspensions. The onset of action of NPH insulin is delayed, and the duration of action is extended. NPH insulin is the only one suitable for mixing with short-acting insulins. Allergic reactions are possible with NPH insulins.

2. A patient is prescribed NPH insulin. Which statement should the nurse include in the discharge instructions? A. The insulin will have a cloudy appearance in the vial. B. The onset of action is rapid. C. The patient should not mix Lantus with short-acting insulin. D. The patient will have no risk of allergic reactions with this insulin.

Answer: C: Patients should be taught to wait at least 1 minute between puffs. Extra doses should not be taken unless prescribed by the health care provider. Glucocorticoid inhalation requires oral rinses to prevent the development of dysphonia and oropharyngeal candidiasis. Patients should take adequate amounts of calcium and vitamin D with glucocorticoid therapy.

20. A patient with asthma is prescribed albuterol [Proventil], 2 puffs every 4 hours as needed. The nurse should teach the patient to do what? A. Rinse the mouth after taking the prescribed dose. B. Take an extra dose if breathing is compromised. C. Wait 1 minute between puffs from the inhaler. D. Take adequate amounts of calcium and vitamin D.

Answer: C: Inhaled glucocorticoids are generally very safe. Their principal side effects are oropharyngeal candidiasis and dysphonia, which can be minimized by using a spacer device during administration and by rinsing the mouth and gargling after use.

21. Which information should the nurse include when teaching a patient about inhaled glucocorticoids? A. Inhaled glucocorticoids have many significant adverse effects. B. The principal side effects of inhaled glucocorticoids include hypertension and weight gain. C. Use of a spacer can minimize side effects. D. Patients should rinse the mouth and gargle before administering inhaled glucocorticoids.

Answer: C: Serious adverse effects include adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.

22. Which of the following is NOT a serious adverse effect of long-term oral glucocorticoid therapy? A. Adrenal suppression B. Osteoporosis C. Hypoglycemia D. Peptic ulcer disease

Answer: C: Glucocorticoids (fluticasone [Flonase]) are the most effective agents used to treat allergic rhinitis.

23. A patient asks what medication would be most effective in the treatment of seasonal hay fever. The nurse will teach the patient about the use of which drug? A. Azelastine [Astelin] B. Chlorpheniramine [Chlor-Trimeton] C. Fluticasone [Flonase] D. Pseudoephedrine [Sudafed]

Answer: A: Codeine is an opioid that can suppress respiration.

24. A patient is prescribed codeine as an antitussive. Which symptom will the nurse observe for as an adverse effect of this medication? A. Respiratory depression B. Increased heart rate C. Productive cough D. Restlessness

Answer: B: Metformin decreases absorption of vitamin B12 and folic acid and thereby can cause deficiencies of both. Metformin is considered a "weight-neutral" antidiabetic drug, in contrast with several other antidiabetic drugs that tend to increase weight ("weight-positive"). Metformin and other biguanides inhibit mitochondrial oxidation of lactic acid and can thereby cause lactic acidosis.

3. A patient is prescribed metformin. Which statement about metformin does the nurse identify as true? A. Metformin increases absorption of vitamin B12. B. Metformin can delay the development of type 2 diabetes in high-risk individuals. C. Metformin causes patients to gain weight. D. Metformin use predisposes patients to alkalosis.

Answer: B: Levothyroxine overdose may produce the following symptoms: tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, and sweating; the patient should contact the prescriber if these symptoms are noted. Levothyroxine should be taken in the morning on an empty stomach 30 minutes before a meal. Levothyroxine should not be taken with antacids, which reduce the absorption of levothyroxine.

4. The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective? A. "To prevent an upset stomach, I will take the drug with food." B. "If I have chest pain or insomnia, I should call my doctor." C. "This medication can be taken with an antacid." D. "The drug should be taken before I go to bed at night."

Answer: D: Fever and sore throat are signs of infection, which concerning for agranulocytosis, is a serious condition characterized by a dramatic reduction in circulating granulocytes, a type of WBC needed to fight infection

5. A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects? A. Gingival hyperplasia and dysphagia B. Dyspnea and a dry cough C. Blurred vision and nystagmus D. Fever and sore throat

Answer: B: Serum thyroid-stimulating hormone (TSH) is the preferred laboratory test for monitoring replacement therapy in patients with hypothyroidism.

6. A patient takes levothyroxine [Synthroid] 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed? A. Thyrotropin-releasing hormone (TRH) B. Thyroid-stimulating hormone (TSH) C. Serum free T4 test D. Serum iodine level

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

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

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

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

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

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