Pharm

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? A. Aspirin [Bayer] B. Acetaminophen [Tylenol] C. Ibuprofen [Advil] D. Naproxen sodium [Aleve]

B. Acetaminophen [Tylenol] The risk of gastrointestinal irritation and ulceration for a patient taking glucocorticoids is increased by concurrent use of other medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) A. Blood urea nitrogen B. Complete blood count C. Hemoglobin A1c D. Alkaline phosphatase E. Immunoglobulin G levels

B. Complete blood count D. Alkaline phosphatase When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? A. Hives B. Hematemesis C. Dysmenorrhea D. Jaundice

B. Hematemesis Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

A nurse is monitoring a patient who is receiving an intravenous infusion of rituximab [Rituxan] for severe rheumatoid arthritis. Which finding is a complication of this treatment that would require the nurse to stop the infusion? A. Nosebleed B. Hypotension C. Seizure activity D. Hypoglycemia

B. Hypotension Rituximab can cause infusion-related hypersensitivity reactions within 30 minutes of initiation. Symptoms include hypotension, bronchospasm, hypoxia, and cardiogenic shock. Nosebleeds, seizure activity, and hypoglycemia are not associated with infusion reactions of rituximab.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? A. An imbalance of dopamine and acetylcholine in the central nervous system B. Inflammation and myelin destruction in the central nervous system C. An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone D. High-frequency discharge of neurons from a specific focus area of the brain

B. Inflammation and myelin destruction in the central nervous system The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? A. Interferon beta-1a [Avonex] IM B. Methylprednisolone [Solu-Medrol] IV C. Glatiramer acetate [Copaxone] subQ D. Natalizumab [Tysabri] IV infusion

B. Methylprednisolone [Solu-Medrol] IV During an acute relapse episode of MS, the treatment of choice is a high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. The other agents are disease-modifying drugs that are used in the long-term management of MS.

Which medication used for the management of multiple sclerosis cannot be self-administered? A. Fingolimod [Gilenya] B. Natalizumab [Tysabri] C. Glatiramer acetate [Copaxone] D. Interferon beta-1b [Betaseron]

B. Natalizumab [Tysabri] Natalizumab [Tysabri] is administered by intravenous infusion over 1 hour. The patient must be observed during the infusion and also must be monitored for 1 hour after the infusion is complete. Before this medication can be prescribed and administered, everyone involved with the drug—patients, physicians, pharmacists, infusion nurses, and infusion centers—must be registered with the TOUCH Prescribing Program. The other medications can be self-administered: fingolimod (oral), glatiramer acetate, and interferon beta-1b (subcutaneous injection).

What assessment is essential before treatment with hydroxychloroquine [Plaquenil] is started for a patient with rheumatoid arthritis (RA)? A. T3, T4, TSH B. Ophthalmic examination C. PPD and chest x-ray D. BUN and creatinine

B. Ophthalmic examination Patients with RA should have a thorough ophthalmic examination before treatment with hydroxychloroquine is started and also every 6 months thereafter because the drug poses a risk of retinal damage. The medication should be discontinued at the first sign of retinal injury. The remaining options are not indicated before initiating treatment with hydroxychloroquine.

A nurse teaches a patient who is to start taking infliximab [Remicade] for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of the treatment? A. Calf pain B. Pedal edema C. Cool, pale toes D. Clubbed fingernails

B. Pedal edema Infliximab is a tumor necrosis factor (TNF) blocker used for the treatment of rheumatoid arthritis. It should not be used in patients who have heart failure, and it may cause new-onset heart failure in some individuals. Pedal edema is a sign of heart failure, and the patient should report it to the healthcare provider. Cool, pale toes; calf pain; and clubbed fingers are not symptoms related to heart failure.

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? A. Hypothyroidism B. Recent heart bypass surgery C. Positive tuberculin skin test result D. Allergy to penicillin

B. Recent heart bypass surgery Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? A. Relapsing-remitting B. Secondary progressive C. Primary progressive D. Progressive-relapsing

B. Secondary progressive Relapsing-remitting MS is marked by defined episodes of neurologic dysfunction separated by periods of partial or full recovery. In secondary progressive MS, the patient with the relapsing-remitting subtype experiences declining function with or without occasional recovery of function. Primary progressive MS presents with progressive decline of function from the onset. Progressive-relapsing MS is rare and is similar to primary progressive but has acute episodes in addition to the progressively worsening dysfunction.

A nurse is monitoring a patient who takes etanercept [Enbrel] for rheumatoid arthritis. The nurse should obtain the results of which laboratory test when evaluating for adverse effects? A. Arterial blood gases (ABGs) B. Skin test for tuberculosis C. Electrocardiogram (ECG) D. 24-hour urine collection for creatinine clearance

B. Skin test for tuberculosis Etanercept increases the risk for serious bacterial and fungal infections, as well as tuberculosis. Patients who develop new infections should be monitored frequently. If tuberculosis develops, it often is extrapulmonary. Patients should be tested for latent tuberculosis, and if the test result is positive, they should be treated for TB before starting etanercept. It is not necessary to obtain ABGs, an ECG, or urine for creatinine clearance when a patient is taking etanercept.

Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (Select all that apply.) A. Warming blankets are routinely used to raise the patient's temperature. B. Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. C. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. D. Activated charcoal is contraindicated in the treatment of aspirin poisoning. E. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.

C. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. E. Hemodialysis or peritoneal dialysis can accelerate salicylate removal. Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? A. Hair loss B. Backache C. Dizziness and fatigue D. Blue-green tint to the skin

C. Dizziness and fatigue Fingolimod slows the heart rate and can cause bradycardia. Dizziness and fatigue may be consequences of bradycardia. Backache is an adverse effect that occurs in 12% of patients taking the medication, but it does not require prompt attention. Reversible hair loss and a blue-green tint to the skin are adverse effects of mitoxantrone [Novantrone].

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? A. "I need to rotate my injection sites, so I'll need to keep a record of them." B. "I will apply hydrocortisone ointment to the injection site if it is itchy." C. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." D. "I can take over-the-counter Benadryl if the injection site itches and is red."

C. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." Brief application of ice rather than warm compress application is indicated prior to injection. Warm compresses may be helpful following the injection. Injections sites should be rotated to decrease discomfort. Itching and erythema can be reduced by topical application of hydrocortisone or oral diphenhydramine.

Which statement by a patient indicates understanding of teaching about leflunomide [ARAVA]? A. "I'll need to learn how to give myself injections." B. "Constipation is a common side effect, so I'll need to take a stool softener." C. "I'll need to be extremely conscientious about taking my birth control pills." D. "I'll need to have routine eye examinations to make sure I'm not having any side effects of the medication."

C. "I'll need to be extremely conscientious about taking my birth control pills." Leflunomide is contraindicated during pregnancy and has been classified by the U.S. Food and Drug Administration (FDA) as Pregnancy Risk Category X. Women of child-bearing age must use a reliable form of contraception. Leflunomide is administered orally, not by injection. Diarrhea, not constipation, is a common adverse effect. Eye examinations are not essential.

A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information? A. "My tongue may become discolored and my taste altered." B. "I may have constipation, so I'll increase my fluid intake." C. "I'll report any fatigue or sore throat and fever to my doctor." D. "I'll immediately report any chest pain or shortness of breath."

C. "I'll report any fatigue or sore throat and fever to my doctor." Sulfasalazine is used to treat ulcerative colitis by suppressing inflammation. It has the adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic anemia. Patients should report any signs of infection and/or fatigue. Altered taste, tongue discoloration, constipation, chest pain, and shortness of breath are not effects associated with sulfasalazine.

When administering prednisone to a patient, the nurse will do what? A. Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. B. Instruct the patient to stop taking the prednisone immediately if diarrhea develops. C. Ensure that meals are at bedside so that administration with food reduces gastric irritation. D. Avoid intravenous delivery to prevent adverse effects.

C. Ensure that meals are at bedside so that administration with food reduces gastric irritation. Glucocorticoids given in larger pharmacologic doses for nonendocrine causes produce many adverse effects, including gastric irritation and ulcers. They should be given with food. Doses should be administered before 9:00 AM to maximize endocrine function. Prednisone should not be stopped abruptly; the patient should contact the healthcare provider before discontinuing the medication. The drug may be administered by many routes, including the parenteral route.

Which medication requires screening for tuberculosis before treatment is started? A. Celecoxib [Celebrex] B. Minocycline [Minocin] C. Leflunomide [ARAVA] D. Sulfasalazine [Azulfidine]

C. Leflunomide [ARAVA] Screening for tuberculosis is necessary before treatment with leflunomide is started, because this medication can increase the risk for severe infection, including tuberculosis. The other medications do not require tuberculosis screening.

The nurse is screening a patient before administering a live virus vaccine. The patient is currently taking a glucocorticoid medication. Which action should the nurse take? A. Continue screening and give the vaccine if appropriate. B. Note the contraindication but give the vaccine anyway. C. Note the contraindication and clarify the order with the healthcare provider. D. Hold the vaccine and notify the department of health.

C. Note the contraindication and clarify the order with the healthcare provider. The nurse should note the contraindication and clarify the order with the provider. Because of their immunosuppressant actions, glucocorticoids can decrease antibody responses to vaccines. Accordingly, immunization should not be attempted while glucocorticoids are in use. Furthermore, if a live virus vaccine is employed, there is an increased risk of developing viral disease. There is no need to contact the health department.

The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) A. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." B. "The most common side effect of treatment with the drug is kidney failure." C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." E. "Use of this drug can prevent heart attack and stroke."

C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? A. "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." B. "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." C. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." D. "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

C. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpesvirus 6, and Chlamydia pneumonia.

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? A. Docusate sodium [Colace] B. Ascorbic acid (vitamin C) C. Pantoprazole [Protonix] D. Furosemide [Lasix]

C. Pantoprazole [Protonix] Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole [Protonix]. It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide [Lasix] with aspirin.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? A. Congestive heart failure B. Liver toxicity C. Renal failure D. Hemorrhage

C. Renal failure High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

A transplant recipient is receiving cyclosporine [Sandimmune]. Which response should a nurse expect if the medication is having the desired effect? A. Increased antibody response B. Increased natural killer (NK) cellular activity C. Suppression of T lymphocytes D. Suppression of hepatic metabolism of steroids

C. Suppression of T lymphocytes Immunosuppressants inhibit T-lymphocyte synthesis through inhibition of calcineurin, thus reducing the immune response to organ transplants. Increased antibody response, increased NK cellular activity, and suppression of hepatic metabolism of steroids are not actions of cyclosporine.

The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching? A. "I volunteer at a local day care center once a week." B. "I drink grapefruit juice with breakfast each morning." C. "I enjoy walking and outdoor activities in the sun." D. "I understand this drug may cause my urine to turn blue."

A. "I volunteer at a local day care center once a week." Mitoxantrone can cause myelosuppression. Patients taking this drug should be advised to avoid contact with people who have infections, such as children in day care centers. The other statements are appropriate for patients taking this drug.

The nurse is teaching a patient with rheumatoid arthritis who is scheduled to start a treatment regimen that includes nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and glucocorticoids. Which statement by the nurse is correct? A. "It will take at least 3 to 5 months for the DMARD to produce effects." B. "In large doses, the NSAIDs will stop most of the disease process." C. "Remission is achieved quickly, and usually the medications can be stopped." D. "The glucocorticoid will need to be taken for at least 2 years."

A. "It will take at least 3 to 5 months for the DMARD to produce effects." The treatment for rheumatoid arthritis includes NSAIDs, glucocorticoids, and DMARDs; it is chronic because of the progressive nature of rheumatoid arthritis. A DMARD is started very soon after diagnosis to delay joint destruction. However, effects from the DMARD take months to develop. An NSAID provides quick pain relief but does not prevent joint damage; it is given until the DMARD has had time to take effect. Glucocorticoids are reserved for short-term disease management, not long-term control.

After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? A. Absence of jaundice B. Clear breath sounds C. Increased bowel sounds D. Palpable pedal pulses

A. Absence of jaundice Acetylcysteine [Mucomyst] substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen [Tylenol] (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen [Tylenol] poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine [Mucomyst] for the treatment of acetaminophen overdose.

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) A. Adrenal insufficiency B. Osteoporosis C. Hypoglycemia D. Hyperkalemia E. Cataracts

A. Adrenal insufficiency B. Osteoporosis E. Cataracts Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia, and cataracts.

A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? A. Alcoholic drinks B. Leafy green foods C. Bananas D. Dairy products

A. Alcoholic drinks Through several mechanisms, regular alcohol consumption while taking acetaminophen [Tylenol] increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen [Tylenol] may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen [Tylenol] labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen [Tylenol] can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for a history of what? A. Allergy to sulfonamides B. History of hepatitis C C. Hypothyroidism D. Diabetes mellitus

A. Allergy to sulfonamides Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. The other conditions listed should be part of the nurse's assessment but are not the most important.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Continue as planned, because the level is within normal limits. The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

When assessing a patient for adverse effects of cyclosporine [Sandimmune], it is most important for the nurse to review which laboratory findings? (Select all that apply.) A. Creatinine level B. Hemoglobin level C. Platelet count D. Bilirubin level E. White blood cell (WBC)

A. Creatinine level D. Bilirubin level E. White blood cell (WBC) Cyclosporine is an immunosuppressant medication used to prevent organ rejection. Adverse effects include significant neurotoxicity, renal toxicity, hepatotoxicity, and infection risk. The hemoglobin level and the platelet count are not adversely affected by cyclosporine.

Which drug would not be included in the pretreatment plan for a patient who is to receive an infusion of infliximab [Remicade]? A. Epinephrine B. Acetaminophen C. Diphenhydramine D. Methylprednisolone

A. Epinephrine Infusion reactions are common with infliximab and manifest themselves as flulike symptoms—headache, fever, chills, dyspnea, hypotension, skin reactions, and gastrointestinal (GI) disturbances. These symptoms can be reduced by pretreatment with antihistamines (diphenhydramine), acetaminophen, and glucocorticoids (methylprednisolone). Epinephrine is administered for anaphylaxis, which is rare with infliximab.

In addition to local joint pain and limited range of motion, a nurse should recognize which findings as systemic manifestations of rheumatoid arthritis? (Select all that apply.) A. Fatigue B. Hyperglycemia C. Osteoporosis D. Vasculitis E. Corneal ulcers

A. Fatigue D. Vasculitis E. Corneal ulcers Rheumatoid arthritis is manifested by joint stiffness and pain secondary to an autoimmune disorder in which damaging compounds attack the articular cartilage. In addition, systemic manifestations of fatigue, corneal ulcers, and vasculitis may occur.

A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? A. Ibuprofen [Motrin] B. Zolpidem [Ambien] C. Loratadine [Claritin] D. Diphenhydramine [Benadryl]

A. Ibuprofen [Motrin] Ibuprofen [Motrin] can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen [Motrin]. It is not necessary to avoid taking zolpidem [Ambien], loratadine [Claritin], or diphenhydramine [Benadryl] while taking aspirin.

What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.) A. Impaired carbohydrate and glucose tolerance B. Increased production of glucocorticoids from the adrenals C. Predisposition to gastrointestinal ulceration D. Decrease in serum sodium and glucose levels E. Increase in plaque development in coronary arteries

A. Impaired carbohydrate and glucose tolerance C. Predisposition to gastrointestinal ulceration Adverse effects of glucocorticoids occur in response to pharmacologic doses; they include suppression of adrenal glucocorticoids; glucose and carbohydrate intolerance, elevated blood glucose level; water and sodium retention; and increased gastric acid secretion. Plaque development in arteries is not affected.

A nurse monitors a patient who takes azathioprine [Imuran] for which adverse effects? (Select all that apply.) A. Leukopenia B. Thrombocytopenia C. Alopecia D. Nephrotoxicity E. Red urine color

A. Leukopenia B. Thrombocytopenia C. Alopecia Azathioprine is a cytotoxic medication used to suppress the immune response. It is toxic to all proliferating cells. Cytotoxic medications usually are reserved for patients who have not responded to safer immunosuppressants. Nephrotoxicity and red-colored urine are not adverse reactions associated with azathioprine.

Which medication can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) A. Modafinil [Provigil] B. Clonazepam [Klonopin] C. Amantadine [Symmetrel] D. Carbamazepine [Tegretol] E. Dalfampridine [Ampyra]

A. Modafinil [Provigil] C. Amantadine [Symmetrel] Fatigue develops in about 90% of patients with multiple sclerosis, and the drugs most commonly used to manage this symptom include modafinil and amantadine. Clonazepam may be useful for alleviating tremor and ataxia associated with the disease. Carbamazepine, an antiepileptic drug, may be helpful for alleviating neuropathic pain. Dalfampridine may be given to improve walking.

Which assessment is essential before a patient receives a second dose of mitoxantrone [Novantrone]? (Select all that apply.) A. Pregnancy test B. Echocardiogram C. Complete blood count D. T3, T4, and TSH levels E. Ophthalmic examination F. Magnetic resonance imaging (MRI)

A. Pregnancy test B. Echocardiogram C. Complete blood count Mitoxantrone [Novantrone] can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.

A nurse should teach a patient to observe for which side effects when taking ampicillin? A. Skin rash and loose stools B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae

A. Skin rash and loose stools Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

The nurse should question an order for glucocorticoids in the treatment of a patient with what? A. Systemic fungal infection B. Diabetes mellitus C. Myasthenia gravis D. Glaucoma

A. Systemic fungal infection Glucocorticoids are contraindicated in the treatment of a patient with a systemic fungal infection or in patients receiving live vaccines. Glucocorticoids should be used with caution in patients with diabetes mellitus, myasthenia gravis, and glaucoma.

After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A. The patient takes antacids on a daily basis. B. The medication was stored in a cool, dry area. C. The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. D. The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.

A. The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.) A. Ibuprofen [Advil] B. Naproxen [Aleve] C. Aspirin [Bayer] D. Acetaminophen [Tylenol] E. Indomethacin [Indocin]

D. Acetaminophen [Tylenol] The use of NSAIDs, which include ibuprofen [Advil], naproxen [Aleve], indomethacin [Indocin], and especially aspirin [Bayer], by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen [Tylenol] may be used safely to reduce fever in children with influenza.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (Select all that apply.) A. Routine dental cleaning B. Removal of a skin mole C. Cataract surgery D. Cholecystectomy E. Hysterectomy

D. Cholecystectomy E. Hysterectomy Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.

The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included? A. Increases daily intake of sodium for vascular expansion B. Tapers blood pressure medications to avoid hypotension C. Obtains periodic ultrasound scans of adrenal glands D. Increases or supplements dosage of glucocorticoid at times of stress

D. Increases or supplements dosage of glucocorticoid at times of stress Exogenous steroids inhibit the synthesis and release of endogenous steroids by the adrenals, and recovery is variable, taking from days to a year. Failure to increase or supplement doses at times of stress may be life-threatening. Increasing sodium intake and tapering blood pressure medications could cause harm. Adrenal gland ultrasound scans are not a valid way to minimize adrenal insufficiency.

The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? A. Flulike symptoms with fever B. Decreased neutrophil count C. Jaundice and elevated bilirubin D. Injection site pain and redness

D. Injection site pain and redness Injection site reactions, such as pain, erythema, pruritus, and induration, are the most common adverse effects of glatiramer. Unlike interferon, glatiramer does not cause flulike symptoms, myelosuppression, or hepatotoxicity, which would be indicated in the other responses.

Which clinical manifestation in a patient taking etanercept [Enbrel] requires a prompt call by the nurse to the prescriber? A. Swollen, tender joints B. Itching and erythema at the injection sites C. Tenting of the skin and dry mucous membranes D. New onset of an S3 heart sound and crackles in the lower third of the lungs

D. New onset of an S3 heart sound and crackles in the lower third of the lungs Etanercept may pose a risk for the development or worsening of heart failure. A new-onset S3 heart sound and crackles are consistent with heart failure and should be reported immediately. Etanercept is administered to relieve swollen, tender joints associated with rheumatoid arthritis. Itching and erythema are associated with injections and usually subside in a few days. Tenting of the skin and dry mucous membranes are a consequence of dehydration, which is not associated with this medication.

A patient takes glucocorticoids and digoxin [Lanoxin]. It is most important for the nurse to monitor which electrolyte? A. Calcium B. Magnesium C. Sodium D. Potassium

D. Potassium Because of the mineralocorticoid activity of sodium and water retention and potassium loss, glucocorticoids can increase the risk of toxicity from digoxin. They also can exacerbate hypokalemia caused by thiazide and loop diuretics. Calcium, magnesium, and sodium do not require more frequent monitoring as a result of digoxin and glucocorticoid use.

Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? A. Increased risk of sudden cardiac death B. Documented reports of necrotizing colitis C. Increased risk of Stevens-Johnson syndrome D. Rare cases of dangerous brain infections

D. Rare cases of dangerous brain infections Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug now is available only through a specialized, carefully controlled prescribing program.

A patient is taking methotrexate [Rheumatrex] for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect? A. Selective inhibition of cyclooxygenase B. Neutralization of tumor necrosis factor C. Inhibition of T-cell activation D. Suppression of T and B lymphocytes

D. Suppression of T and B lymphocytes Methotrexate is a nonbiologic DMARD that suppresses the immune system by reducing the activity of B and T lymphocytes. It is highly effective and considered a first-choice medication. Inhibition of cyclooxygenase, neutralization of tumor necrosis factor, and inhibition of T-cell activation are not actions of methotrexate.

A patient with a chronic illness is on daily glucocorticoids. He is brought to the hospital following a severe motor vehicle accident. He is wearing a medical alert bracelet stating his home medications. Noting that the patient takes glucocorticoids daily, the nurse knows which of the following to be true? A. The patient will need lower doses of glucocorticoids following the trauma. B. The patient will have to stop all glucocorticoids immediately. C. The patient will need the same dose of glucocorticoids he used at home. D. The patient will need higher doses of glucocorticoids following a trauma.

D. The patient will need higher doses of glucocorticoids following a trauma. During times of stress, the adrenal glands normally secrete large amounts of glucocorticoids. If the stress is sufficiently severe (eg, trauma, surgery), these glucocorticoids are essential for supporting life. Accordingly, because of adrenal suppression, it is imperative that patients receiving long-term glucocorticoid therapy be given increased doses at times of stress.