Pharmacology II Exam 4 Chapter 29, 41, 42, 45

A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?

the risks of stroke and breast cancer are unacceptably high in women taking HRT

The nurse is providing client education prior to administering propylthiouracil. During teaching, the nurse should inform the client about the need for what form of follow-up?

Routine liver function testing

The nurse is preparing to administer a scheduled dose of levothyroxine to a client. What assessment should the nurse perform prior to giving the drug?

heart rate

A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should be the instructor's response?

"Succinylcholine is not broken down instantly."

An adult client is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this client about the appropriate use of corticosteroids, the nurse should include what teaching point?

"You will likely gain some weight after you start taking this drug."

Levothyroxine is classified in which pregnancy category?

A

A client is prescribed probenecid. When assessing the client's medical record, the nurse will question administering this drug if the client is currently taking which additional drug(s)? Select all that apply. A) Phenobarbital B) Valproic acid C) Diazepam D) Diclofenac E) Acyclovir

Acyclovir Answer: A, C, D, E Rationale: Probenecid increases the serum levels of the following medications, placing the client at risk for toxicity: penicillin, cephalosporins, acyclovir, rifampin, sulfonamides, barbiturates (phenobarbital), benzodiazepines (diazepam), and NSAIDs (diclofenac). Antiepileptics (valproic acid) should be administered to clients with renal impairment

A nurse is preparing to administer goserelin to a client with prostate cancer. Which assessment findings should the nurse prioritize on the ongoing assessment? A) Breast atrophy, sexual dysfunction B) Pharyngitis, asthenia C) Breast tenderness, edema D) Hyperglycemia, leukocytosis

Answer: A Rationale: Breast atrophy and sexual dysfunction may be seen as adverse reactions of goserelin therapy. Pharyngitis and asthenia are seen with the use of anastrozole. Breast tenderness and edema are seen with drugs such as estramustine. Hyperglycemia and leukocytosis are seen as adverse reactions of mitotane.

The nurse is teaching a client about the ACTH which has been prescribed. The nurse determines the session is successful when the client correctly points out they will need to avoid which medication? A) Live vaccines B) Thyroid hormones C) NSAIDs D) Cold preparations

Answer: A Rationale: Clients taking ACTH should avoid any vaccination with live virus as it may increase any adverse reaction to the vaccine, and decrease the client's antibody response to the vaccine. Clients with hypothyroidism should use glucocorticoids cautiously. The use of NSAIDs and cold preparations are not contraindicated with the use of ACTH; however, the nurse should evaluate each client individually to ensure there are no other reasons to avoid these medications.

A nurse is caring for a client who is receiving cyclobenzaprine. The nurse would expect to assess which finding as indicating the therapeutic effect of the drug? A) Reduction of muscle spasm B) Prevention of seizure C) Relief from anxiety D) Relief from nervous disorder

Answer: A Rationale: Cyclobenzaprine, a skeletal muscle relaxant, affects muscle tone, thereby causing reduction of muscle spasm. Antiepileptics are used to prevent seizures. Benzodiazepines are used for anxiety. There are a variety of nervous disorders, and they can be treated with amphetamines, analeptics, anorexiants, cholinesterase inhibitors, adrenergics, adrenergic blocking agents, cholinergics, cholinergic blocking agents, anti-Parkinson, and antiepileptics.

A health care provider has prescribed a medication for a client who is diagnosed with euthyroid goiter. The nurse would expect to administer which drug? A) Levothyroxine B) Methimazole C) Propylthiouracil D) Sodium iodide

Answer: A Rationale: Euthyroid goiter is treated with thyroid hormones, such as levothyroxine. Methimazole, propylthiouracil, and sodium iodide are used to treat hyperthyroidism.

A client is receiving alendronate for osteoporosis. The client has informed the nurse that they have also been taking aspirin. Which interaction should the nurse monitor for in this client? A) Increased risk of GI bleeding B) Decreased effects of bisphosphonate C) Increased level of sedation D) Increased risk of rash

Answer: A Rationale: Interaction of aspirin with a bisphosphonate drug causes increased risk of GI bleeding, which requires monitoring. Interaction of a uric acid inhibitor with barbiturates and benzodiazepines causes an increased level of sedation. Interaction of a uric acid inhibitor with ampicillin causes increased risk of rash. Interaction of calcium supplements or antacids with bisphosphonates decreases the effects of bisphosphonates.

A nurse is providing care for a client diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client? A) Iodine 131 B) Methimazole C) Propylthiouracil D) Liothyronine

Answer: A Rationale: Radioactive iodine (131I) is used for the treatment of hyperthyroidism and cancer of the thyroid. Methimazole and propylthiouracil are used to manage hyperthyroidism. Liothyronine is used to treat hypothyroidism.

A client diagnosed with hyperthyroidism has been prescribed propylthiouracil. After administering the drug, which assessment finding should the nurse prioritize? A) Skin rash B) Tachycardia C) Nervousness D) Constipation

Answer: A Rationale: The adverse reactions to propylthiouracil include paresthesias, numbness, headache, skin rash, nausea, vomiting, and agranulocytosis. Tachycardia, nervousness, and vomiting are the adverse reactions associated with the thyroid hormone levothyroxine sodium (T4).

A nurse has administered levothyroxine to a client for hypothyroidism. The nurse determines the client is responding appropriately to the therapy based on which assessment finding? A) Increased appetite B) Swollen neck C) Excessive sweating D) Flushing

Answer: A Rationale: The nurse should assess for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. Swollen neck, sore throat, and cough may occur after 2-3 days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.

A client with a musculoskeletal disorder is unable to ambulate due to significant pain and immobility issues. Which care should the nurse prioritize for this client? A) Changing the client's position every 2 hours B) Changing the bed linens every 2 hours C) Encouraging the client to walk with assistance D) Encouraging the client to exercise with assistance

Answer: A Rationale: The nurse should change the client's position every 2 hours and inspect pressure sites for skin breakdown. The nurse need not change linens every 2 hours unless they are soiled. Once the client's condition improves, then encouraging ambulation with assistance and exercises would be appropriate

A client with nocturnal enuresis is prescribed desmopressin acetate. Which assessment finding should the nurse prioritize for this client? A) Nasal congestion B) Breast tenderness C) Fluid retention D) Gynecomastia

Answer: A Rationale: The nurse should monitor for nasal congestion, abdominal cramps, headache, and nausea in the client as the adverse reactions to desmopressin acetate. When the client is administered gonadotropin, the nurse needs to monitor for fluid retention and gynecomastia as the adverse reactions to the drug. When choriogonadotropin alfa is administered to the client, the nurse should monitor for breast tenderness, ovarian overstimulation, and vasomotor flushes as the adverse reactions to the drug.

A client with thyrotoxicosis is prescribed levothyroxine. The nurse would prioritize which finding on assessment? A) Tachycardia B) Agranulocytosis C) Loss of hair D) Skin rash

Answer: A Rationale: The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering levothyroxine to a client with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to levothyroxine; they are adverse reactions found in a client receiving methimazole.

A client is receiving corticosteroids and digoxin. The nurse will carefully monitor the client for which potential adverse reaction? A) Increased risk for toxicity B) Decreased muscle function C) Increased risk of hyperkalemia D) Decreased serum corticosteroid levels

Answer: A Rationale: The nurse should observe for an increased risk for digitalis toxicity when corticosteroids are given with digoxin. Musculoskeletal disturbances are a potential adverse reaction to glucocorticoids. Hypokalemia, not hyperkalemia, is a recognized adverse reaction to the use of fludrocortisone. It can also occur when corticosteroids and digoxin and potassium-depleting diuretics are used together. The effects of corticosteroids may be decreased when administered with hydantoins, rifampin, and theophyllines.

A nurse is preparing to administer oxybutynin to a client and discovers the client is also prescribed haloperidol. The nurse predicts the client has the increased risk of which reaction related to the concomitant use of both drugs? A) Decreased effect of haloperidol B) Increased risk for bleeding C) Lowered plasma concentrations D) Increased effect of oxybutynin

Answer: A Rationale: The nurse should observe for decreased effectiveness of the antipsychotic drug (haloperidol) in the client as the effect of the interaction of the antispasmodic drug (oxybutynin) and haloperidol. Increased risk for bleeding results from the interaction of oral anticoagulants with anti-infective drugs. Increased effect of the antispasmodic drug occurs with the interaction of an antispasmodic drug with a tricyclic antidepressant. Plasma concentrations are lowered due to the interaction of fosfomycin, which is an anti-infective, with metoclopramide, which is used to relieve gastric upset.

The client with systemic lupus erythematosus, who is prescribed prednisone, presents to the clinic for a routine health care visit. Which instruction should the nurse prioritize after noting the client now has acne on the assessment? A) Use water-based cosmetics or creams. B) Do not receive live virus vaccines. C) Avoid the use of alcohol while taking the drug. D) Avoid exposure to infections.

Answer: A Rationale: The use of glucocorticoids can result in the adverse effect of cushingoid syndrome. Some of the signs and symptoms include a buffalo hump, moon face, oily skin and acne, osteoporosis, purple striae on the abdomen and hips, altered skin pigmentation, and weight gain. The nurse should instruct the client with acne to keep the affected areas clean and use over-the-counter acne drugs and water-based cosmetics or creams. When the client is undergoing long-term or high-dose glucocorticoid therapy, the nurse should inform the client in the preadministration teaching to avoid receiving live virus vaccines and avoid exposure to infections if possible. If the client is undergoing vasopressin therapy, the nurse needs to instruct the client to avoid the use of alcohol while taking the drug.

A client has been prescribed glucocorticoids for the treatment of congenital adrenal hyperplasia. Which should the nurse prioritize on the ongoing assessment for the client? A) Take and record vital signs every 4 to 8 hours. B) Test the serum electrolyte levels. C) Auscultate the abdomen and record the findings. D) Observe for signs of blanching of the skin.

Answer: A Rationale: When glucocorticoids are administered to the client, the nurse should take and record vital signs every 4 to 8 hours if the client is not continuously monitored. The nurse need not perform assessments related to serum electrolyte levels, abdominal auscultation, or skin blanching. These are appropriate for a client receiving vasopressin therapy.

A client is receiving allopurinol. Which instruction would be most important for the nurse to include in the client's plan of care? A) Liberal fluid intake B) Moderate exercise C) Use of a brace or corset D) Avoidance of direct sunlight

Answer: A Rationale: When using uric acid inhibitors, such as allopurinol, the nurse should encourage liberal fluid intake and measure the client's intake and output. The client does not need to exercise or use braces or corsets; clients with osteoporosis may require a brace or corset when out of bed. The client need not avoid sunlight as uric acid inhibitors do not cause photosensitivity.

The nursing instructor is leading a class discussion about drug therapy for rheumatoid arthritis. The instructor determines the session is successful when the students correctly choose which drug(s) as an example of a DMARD? Select all that apply. A) Infliximab B) Etanercept C) Ibandronate D) Zoledronic acid E) Carisoprodol

Answer: A, B Rationale: Infliximab and etanercept are examples of DMARDs. Ibandronate and zoledronic acid are examples of bone resorption inhibitors (bisphosphonates). Carisoprodol is a skeletal muscle relaxant

After teaching a client who is prescribed methimazole, the nurse determines that the teaching was effective when the client states which point(s)? Select all that apply. A) "I need to take the drug around the clock." B) "I should call my primary health care provider if I have a fever." C) "I can use any over-the-counter medications if I need to." D) "I might have some tenderness and swelling of my neck." E) "I don't need to monitor my weight like I did before."

Answer: A, B Rationale: The client taking methimazole should take the drug as prescribed around the clock and call the primary health care provider if they develop fever, sore throat, cough, easy bleeding or bruising, headache, or a general feeling of malaise. The client also needs to check with the prescriber before using any nonprescription drugs and monitor their weight twice a week, notifying the primary health care provider if there is any sudden weight gain or loss. Tenderness and swelling would be noted if the client received radioactive iodine for a procedure

A nurse is completing discharge teaching for a client taking vasopressin. The nurse determines the session is successful when the client points out the health care provider should be notified if which reactions occur? Select all that apply. A) Changes in urine output B) Abdominal cramps C) Skin blanching D) Diarrhea E) Cough

Answer: A, B, C Rationale: A client taking vasopressin should be taught to notify the health care provider if any of the following occur: a significant increase or decrease in urine output, abdominal cramps, skin blanching, nausea, confusion, headache, drowsiness, or signs of inflammation or infection at the injection sites. Diarrhea is a potential trigger for the pituitary to secrete more vasopressin. Diarrhea is a reason to contact the health care provider if a client is taking glucocorticoid. A cough is not considered an adverse reaction to vasopressin.

A nurse is assessing a client who is receiving desmopressin therapy and suspects that the client is experiencing water intoxication. Which findings on assessment would support the nurse's suspicions? Select all that apply. A) Drowsiness B) Headache C) Confusion D) Abdominal pain E) Diarrhea

Answer: A, B, C Rationale: Symptoms of water intoxication include drowsiness, listlessness, confusion, and headache (which may precede convulsions and coma). Abdominal pain and diarrhea are not associated with water intoxication.

A client receiving gonadotropin therapy comes to the clinic with reports of not feeling well. Which assessment findings would the nurse immediately report to the primary health care provider? Select all that apply. A) Ascites B) Abdominal distention C) Abdominal pain D) Weight gain E) Irritability

Answer: A, B, C Rationale: The client is at risk for ovarian enlargement manifested by abdominal distention, pain, and ascites (with serious cases). The nurse would immediately notify the primary health care provider and the drug would be discontinued at the first sign of ovarian stimulation or enlargement. Weight gain and irritability would not need to be reported immediately.

The nurse is caring for a client who was administered radioactive iodine (131I). Which assessment finding(s) should the nurse prioritize on the ongoing assessment? Select all that apply. A) Agranulocytosis B) Exfoliative dermatitis C) Hypoprothrombinemia D) Seizures E) Stroke

Answer: A, B, C Rationale: The nurse should monitor a client receiving radioactive iodine (131I) for severe reactions including agranulocytosis, exfoliative dermatitis, hypoprothrombinemia, granulocytopenia, and drug-induced hepatitis. Seizures and stroke are not recognized as a severe reaction to radioactive iodine.

The nurse is performing the ongoing assessment of a client taking levothyroxine. The nurse predicts the client is experiencing a therapeutic response based on which assessment finding(s)? Select all that apply. A) Weight loss B) Mild diuresis C) Increased appetite D) Increased mental activity E) Decreased pulse rate

Answer: A, B, C, D Rationale: Signs of therapeutic response to levothyroxine include weight loss; mild diuresis; increased appetite; increased (not decreased) pulse rate; decreased puffiness of face, hands, and feet; and client report of increased mental activity and increased sense of well-being.

The nurse is completing a health history on a client experiencing menopause. What assessment finding(s) indicates menopause? Select all that apply. A) Hot flashes B) Mood changes C) Sleep problems D) Painful intercourse E) Increased heart rate

Answer: A, B, C, D Rationale: With the onset of menopause, symptoms such as hot flashes, night sweats, vaginal dryness, painful intercourse, mood changes, and sleep problems may occur. An increase in the heart rate is not associated with menopause.

While conducting a health promotion presentation for a local group of women who are in their 30s and 40s, one of the women asks the nurse, "I've heard horror stories about menopause. Are there any herbal products that can help?" Which herb(s) would the nurse point out in the response? Select all that apply. A) Black cohosh B) Sage C) Calendula D) Saw palmetto E) Dandelion

Answer: A, B, C, E Rationale: Black cohosh, sage, dandelion, evening primrose oil, and calendula are herbs that may be used to address menopausal symptoms. Saw palmetto is used to relieve the symptoms of benign prostatic hypertrophy.

A nurse is preparing to administer estrogen to a client with menopause. By which route(s) can estrogen be administered? Select all that apply. A) PO B) IV C) IM D) SQ E) Transdermally

Answer: A, B, C, E Rationale: Estrogen may be given transdermally, intramuscularly, intravenously, and by mouth. Estrogen is not administered SQ.

The nurse is preparing to teach a client with prostate cancer about the various drug therapies that may be used. Which drug(s) will the nurse point out is actually a hormone but is effective in the treatment of prostate cancer? Select all that apply. A) Testolactone B) Leuprolide C) Megestrol D) Bicalutamide E) Goserelin

Answer: A, B, C, E Rationale: Testolactone, leuprolide, megestrol, bicalutamide, and goserelin are hormones used as antineoplastic drugs. Bicalutamide is also used for prostate cancer; however, it is an antiandrogen.

A health care provider has ordered an iodine procedure for a client with thyroid dysfunction. What should the nurse prioritize in the preadministration assessment for the client? Select all that apply. A) Allergy history B) Weight C) Pulse D) Blood glucose E) Temperature

Answer: A, B, C, E Rationale: The nurse's preadministration assessment for the client should include vital signs (blood pressure, respiratory rate, pulse, and temperature), allergy history, weight, and notation regarding the outward symptoms of the hyperthyroidism. The blood glucose is not necessary for this situation.

A client is prescribed flavoxate. When preforming the preadministration assessment, which symptom(s) will the nurse expect the client to report? Select all that apply. A) Dysuria B) Nocturia C) Leakage D) Suprapubic pain E) Inability to void

Answer: A, B, D Rationale: Flavoxate, an antispasmodic, is used to relieve symptoms of dysuria, urinary urgency, nocturia, suprapubic pain, and frequency and urge incontinence. Other antispasmodics are used to treat bladder instability, such as leakage caused by a neurogenic bladder. The drug is not used to treat an inability to void.

A nursing instructor is teaching a class on pituitary gland hormones. The instructor determines the class is successful when the students correctly choose which hormones as being secreted by the anterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Answer: A, B, D Rationale: Prolactin, adrenocorticotropic hormone, growth hormone, luteinizing hormone, follicle-stimulating hormone, and thyroid-stimulating hormone are secreted by the anterior pituitary gland. Vasopressin and oxytocin are secreted by the posterior pituitary gland.

The nurse is teaching a client about the prescribed fludrocortisone. The nurse determines the session is successful when the client correctly chooses which potential adverse reactions to notify the health care provider about if they happen? Select all that apply. A) Muscle weakness B) Weight gain C) Otic irritation D) Edema E) Diarrhea

Answer: A, B, D Rationale: The nurse instructs a client receiving fludrocortisone (a mineralocorticoid) to report any of the following adverse reactions to the health care provider: edema, muscle weakness, weight gain, anorexia, swelling of the extremities, dizziness, severe headache, or shortness of breath.

A nurse is preparing to administer oxybutynin to a client. The nurse should question this order if which disorder(s) is noted in the client's medical record? Select all that apply. A) Myasthenia gravis B) Urinary tract blockage C) Diabetes D) Intestinal blockage E) Hypertriglyceridemia

Answer: A, B, D Rationale: The use of oxybutynin is contraindicated in clients with the following: known hypersensitivity; glaucoma; myasthenia gravis; abdominal bleeding; and intestinal, gastric, or urinary tract blockages. Diabetes is a potential cause of erectile dysfunction. Women with diabetes and hypertriglyceridemia should use the transdermal delivery method of estrogens as it has been found to be the safest method.

A client who is receiving warfarin has been prescribed medication for a thyroid issue. The nurse will monitor for potential signs of bleeding if which drug(s) is initiated? Select all that apply. A) Propylthiouracil B) Desiccated thyroid C) Sodium iodine D) Methimazole E) Liothyronine

Answer: A, B, D, E Rationale: All of the thyroid hormone replacements such as levothyroxine, liothyronine, liotrix, and desiccated thyroid and antithyroid preparations such as methimazole and propylthiouracil can increase the risk for bleeding when clients are also administered warfarin.

The nurse is caring for a client diagnosed with gout. The client is prescribed colchicine and allopurinol. The nurse should perform which assessment(s)? Select all that apply. A) During acute gout attack, assess every hour before administering colchicine for improvement of affected joints. B) Assess intake and output to ensure at least 2 L of noncaffeinated fluid intake and at least 3 L of urine output in 24 hours. C) Assess that the client takes allopurinol on an empty stomach while upright for at least 30 minutes. D) Assess for development of a red rash, hold allopurinol, and report it immediately to primary care provider for further orders. E) Assess for pain in back, abdomen, or groin; hematuria, and pain upon urination; and presence of fever.

Answer: A, B, D, E Rationale: During an acute attack of gout, the nurse administers colchicine every hour until the client's gout pain and joint redness and edema has resolved, or adverse gastrointestinal symptoms or bone marrow suppression has occurred with thrombocytopenia and leukopenia, as noted in complete blood count. The nurse needs to assess intake and output to ensure 2 L of noncaffeinated fluids have been drank over a 24-hour period and there is at least 2 L of urine. It is necessary to flush the kidneys with ample fluids to get rid of uric acid and prevent the formation of uric acid kidney stones. The client should take medications with food, but does not have to remain upright. If a red rash develops while the client is taking allopurinol, the nurse should hold the medication and call the primary care provider immediately because this could be an early manifestation of Stevens-Johnson Syndrome. The nurse should assess for symptoms of a kidney stone, including flank, abdominal, or groin pain, or pain with urination and presence of blood in urine.

A nurse is teaching a client and caregivers about vasopressin for the treatment of diabetes insipidus. The nurse determines the session is successful when the client and caregiver correctly choose which instructions to ensure safe use of vasopressin? Select all that apply. A) Wear a medical alert bracelet. B) Monitor the daily intake of fluids. C) Avoid sun exposure while using the drug. D) Carry extra doses with the client at all times. E) Carry liquids with the client at all times.

Answer: A, B, D, E Rationale: In addition to administration instructions, the nurse should include the following: wear a medical alert bracelet, monitor the daily intake and output of fluids, avoid the use of alcohol, and carry extra doses and liquids with the client at all times. Vasopressin does not have photophobia reactions so there is no need to avoid sun exposure when using the drug.

After teaching a client receiving leflunomide, the nurse determines the teaching was successful when the client correctly chooses which as a possible adverse reaction(s)? Select all that apply. A) Alopecia B) Hypotension C) Diarrhea D) Nystagmus E) Hematuria

Answer: A, C Rationale: Adverse reactions to leflunomide include hypertension, alopecia, rash, nausea, and diarrhea. Hypotension is a potential adverse reaction to baclofen and zoledronic acid. There is also an increased risk of hypotension if tizanidine is mixed with antihypertensive medications. Nystagmus is a possible adverse reaction to antiepileptics. It is also a sign of toxicity when using phenytoin. Hematuria is a possible adverse reaction to sulfasalazine.

The nurse is conducting the preadministration assessment on a client with abdominal distention who is prescribed DDAVP. Which assessments should the nurse prioritize? Select all that apply. A) Abdominal girth B) Weight C) Pulse D) Respiratory rate E) Blood glucose

Answer: A, C, D Rationale: Blood pressure, pulse, respiratory rate, and abdominal girth should be included in the nurse's preadministration assessment of a client receiving desmopressin (DDAVP) for relief of abdominal distention. The weight and respiratory rate would be obtained but are not a priority when assessing for abdominal distention.

The nurse is preparing to administer colchicine to a client. The nurse should seek clarification from the health care provider if which disorder(s) is noted in the client's medical record? Select all that apply. A) Gastrointestinal disorders B) Pulmonary disorders C) Cardiac disorders D) Blood disorders E) Central nervous system disorders

Answer: A, C, D Rationale: Colchicine is contraindicated in clients with serious GI, renal, hepatic, or cardiac disorders and those with blood dyscrasias. Clients taking etanercept, adalimumab, or infliximab should be screened for preexisting tuberculosis, as the combination may increase the risk of opportunistic infections. The mix of skeletal muscle relaxants and CNS depressants can increase the CNS depressant effect.

A nursing instructor is teaching a group of students about estrogens and their use. The instructor determines that the teaching was successful when the students correctly choose which statement(s) as true concerning estrogen? Select all that apply. A) Changes in lipids levels occur with the use of estrogens. B) Progestin use is recommended when estrogen is used after a hysterectomy. C) Estrogen replacement therapy (ERT) helps to lessen the changes to the aging tissues. D) Estrogens increase a woman's risk for gallbladder disease. E) The use of estrogens is associated with relatively few adverse reactions.

Answer: A, C, D Rationale: Estrogens can relieve symptoms of menopause but can lead to blood pressure and lipid changes. ERT can help lessen the changes to aging tissues, but the estrogen does increase a woman's risk for gallbladder disease. The addition of progestin is recommended when estrogen is used to treat menopausal symptoms in a woman with an intact uterus. Estrogen alone may be used for estrogen replacement therapy after a hysterectomy. The administration of estrogen by any route may result in many adverse reactions, although these reactions vary in incidence and intensity.

A nurse would monitor a client closely for increased CNS depressant effects when a skeletal muscle relaxant is used concomitantly with which additional drug(s)? Select all that apply. A) Antihistamine B) Oral contraceptives C) Alcohol D) Opiates E) Antidiabetic medications

Answer: A, C, D Rationale: The concomitant use of skeletal muscle relaxants and antihistamines, alcohol, opiates, or sedatives can result in increased CNS depressant effects. The use of a skeletal muscle relaxant and oral contraceptives may result in decreased effectiveness of the contraceptive. It is recommended that a barrier contraceptive be used to prevent transfer of the drug to the sperm and ensure effectiveness of the contraceptive. Skeletal muscle relaxants should be used cautiously by individuals using antidiabetic medication.

A nurse is talking to a client about estrogen, which has been prescribed after a hysterectomy. Which is an adverse effect(s) that the nurse should include in the teaching plan? Select all that apply. A) Headache B) Diarrhea C) Breast pain D) Depression E) Abdominal cramps

Answer: A, C, D, E Rationale: Client education would center on adverse effects of headache, breast pain, depression, abdominal cramps, and breakthrough bleeding or changes in menstrual flow. The client would not have diarrhea.

A nursing instructor is teaching a session on the functions of adrenocortical hormone drugs. The instructor determines the class is successful when the students correctly choose which drugs as influencing glucose, fat, and protein metabolism? Select all that apply. A) Betamethasone B) Fludrocortisone C) Budesonide D) Hydrocortisone E) Dexamethasone

Answer: A, C, D, E Rationale: Glucocorticoids, like betamethasone, budesonide, hydrocortisone, and dexamethasone, influence or regulate functions such as the immune response; glucose, fat, and protein metabolism; and anti-inflammatory response. Fludrocortisone is a mineralocorticoid drug which is important in controlling salt and water balance. Even though this drug has both mineralocorticoid and glucocorticoid activity, it is used only for its mineralocorticoid effects.

The nurse is prepared to administer a skeletal muscle relaxant cautiously to clients with which disorder(s)? Select all that apply. A) Cerebrovascular accident B) Diabetes C) Epilepsy D) Pregnancy E) Parkinsonism

Answer: A, C, D, E Rationale: Skeletal muscle relaxants are used with caution in clients with a history of cerebrovascular accident, cerebral palsy, parkinsonism, or epilepsy and during pregnancy and lactation. Clients with diabetes should use DMARDs cautiously.

A nurse is preparing to administer methotrexate to a client. The nurse determines close monitoring is warranted if the client is also administered which drug(s)? Select all that apply. A) Aspirin B) Cephalexin C) Sulfamethoxazole/trimethoprim D) Ibuprofen E) Diclofenac

Answer: A, C, D, E Rationale: The nurse should closely monitor the client for methotrexate toxicity when methotrexate is given with aspirin, sulfa antibiotics, and NSAIDs. Cephalosporins should be used cautiously with probenecid as it can increase the serum level of anti-infective

A nurse is assessing a client who received desmopressin (DDAVP). Which findings should the nurse prioritize on assessment? Select all that apply. A) Tremor B) Hypotension C) Diaphoresis D) Dehydration E) Nausea

Answer: A, C, E Rationale: A nurse should monitor a client taking desmopressin (DDAVP) for the following adverse reactions: tremor, diaphoresis (not dehydration), vertigo, nasal congestion, nausea, vomiting, abdominal cramps, and water intoxication. Hypotension is a potential adverse reaction to glucocorticoids related to an electrolyte disturbance.

A nurse is preparing to teach a client about the estrogen therapy that has been prescribed. The nurse will point out which adverse reaction(s) to the client that will need to be reported to the health care provider? Select all that apply. A) Migraines B) Decreased bleeding C) Changes in libido D) Constipation E) Breast tenderness

Answer: A, C, E Rationale: Adverse reactions associated with estrogens include headache, including migraines; breakthrough bleeding (not decreased), spotting, or changes in menstrual flow; changes in libido; weight gain or loss; breast pain, enlargement, and tenderness; and nausea and vomiting but not constipation.

A client is prescribed finasteride to treat symptoms of BPH. When teaching the client about this drug, the nurse should point out the potential for which adverse reaction(s)? Select all that apply. A) Erectile dysfunction B) Dry mouth C) Constipation D) Decreased libido E) Weight gain

Answer: A, D Rationale: Androgen hormone inhibitors such as finasteride have been associated with the adverse reaction of erectile dysfunction and decreased libido. Dry mouth and constipation are associated with antispasmodics. Weight gain is associated with alpha-adrenergic blockers.

The nurse is preparing to administer dexamethasone to a client diagnosed with aspiration pneumonia. Which assessments should the nurse prioritize on the preadministration assessment? Select all that apply. A) Lung auscultation B) Mental status assessment C) Height D) Pulse E) Skin integrity assessment

Answer: A, D Rationale: Assessments for glucocorticoids (dexamethasone) depend on the client's condition and diagnosis. The physical assessment should include the area of disease involved, such as the lungs for pneumonia. Vital signs are always assessed and recorded to establish a baseline from which to monitor response to the medication. Mental status, height, and skin integrity assessment would be part of the whole assessment; however, not a priority to provide a baseline from which to evaluate effectiveness of dexamethasone on further assessments.

A nurse is preparing to teach a client and caregivers about levothyroxine. Which instruction(s) should the nurse prioritize giving the client? Select all that apply. A) Therapy is lifelong. B) Drug is taken in the evening. C) Neck swelling and tenderness is expected after initiating therapy. D) Do not skip a dose unless advised to do so. E) Changing brands of the drug is okay

Answer: A, D, E Rationale: A nurse educating a client and their family about levothyroxine includes the following: therapy is lifelong, dose is taken in the morning before breakfast, and the client should not change brands of the drug without consulting the health care provider. The client should also notify the health care provider if headache, nervousness, palpitations, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, or any unusual physical change or event occurs. Twice weekly weights are required if the client is taking methimazole or propylthiouracil. Tenderness and swelling of the neck, sore throat, and cough may occur in 2-3 days after the nuclear medicine department administers radioactive iodine to a client.

The nurse is preparing to administer cyclobenzaprine to a client. The nurse should question this order if which disorder(s) is noted in the past history? Select all that apply. A) Recent myocardial infarction B) Diabetes C) Hepatic disease D) Hypertension E) Hyperthyroidism

Answer: A, E Rationale: The use of cyclobenzaprine is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, hyperthyroidism, and known hypersensitivity to the drug and within 14 days of the administration of an MAOI. Individuals with diabetes should use DMARDS cautiously. Hepatic disease is a contraindication for clients to be administered oral dantrolene and colchicine. Hypertension is a potential adverse reaction to leflunomide.

Administration of estrogen is different in women who have an intact uterus or a hysterectomy. Which statement is correct? A) Estrogen is used alone with an intact uterus. B) Estrogen is administered alone after a hysterectomy. C) Estrogen and progestin are prescribed after a hysterectomy. D) Estrogen and gonadotropin are administered with an intact uterus

Answer: B Rationale: After a hysterectomy, estrogen alone is prescribed because there is no fear of the effect on the endometrium when it has been removed. When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, concurrent use of progestin is recommended to decrease the risk of endometrial cancer

After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students correctly choose which drug as being used to treat osteoporosis? A) DMARDs B) Bone resorption inhibitors C) Skeletal muscle relaxants D) Uric acid inhibitors

Answer: B Rationale: Bone resorption inhibitors are used to treat osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are used to treat rheumatoid arthritis. Uric acid inhibitors are used to treat gout. Skeletal muscle relaxants are used to alleviate muscle spasms and cramping.

An elderly client with diabetes insipidus has been prescribed vasopressin. Which nursing action should the nurse prioritize for this client? A) Measuring the amount of fluid loss every 24 hours B) Refilling the water container at frequent intervals C) Giving four glasses of water immediately after the client takes the drug D) Examining the client's abdomen every 15 to 30 minutes

Answer: B Rationale: Clients with diabetes insipidus are continually thirsty. Elderly individuals often have limited ambulatory abilities. Therefore, the nurse should be careful to refill the water container at frequent intervals to ensure the availability of enough drinking water at hand for the client. The nurse need not be careful to measure the amount of fluid loss every 24 hours, give four glasses of water immediately after the client takes the drug, or examine the client's abdomen every 15 to 30 minutes. The nurse instructs the client to measure the amount of urine excreted at each voiding and then total the amount for each 24-hour period. The nurse should instruct the client to drink one or two glasses of water immediately before taking the drug. The nurse need not auscultate the abdomen every 15 to 30 minutes in a client with diabetes insipidus. The nurse auscultates the abdomen every 15 to 30 minutes in a client with abdominal distention.

The health care provider has ordered a variety of laboratory assessments on a client who will need estrogen replacement. The follow laboratory tests are ordered: blood urea nitrogen (BUN), creatinine, and liver function tests (LFTs). What is the nurse's best statement explaining to a client the need to draw the laboratory tests? A) "Medication adjustments are based on baseline laboratory values." B) "The laboratory tests will identify your body's ability to filter and excrete medications." C) "I will get the prescriber to talk to you about the laboratory assessments ordered." D) "Additional laboratory tests will be ordered if these values indicate problems with your body."

Answer: B Rationale: Estrogens are used cautiously in a variety of disease processes including liver impairment. The liver filters or metabolizes medications. The kidneys are the main organ that excrete medications. The nurse is providing a rationale to the client about drawing laboratory assessments. The statement that medication adjustments are based on baseline laboratory values does not explain why laboratory tests are needed currently. The health care provider or the nurse can discuss the laboratory assessments when they are completed. Additional laboratory tests may be ordered on a future date, but teaching is focused on the need for laboratory tests currently.

The nurse has administered gonadotropin to a client. Which assessment finding should the nurse prioritize? A) Abdominal pain B) Visual disturbances C) Auditory disturbances D) Ascites

Answer: B Rationale: If the client reports visual disturbances, the drug therapy is discontinued and the primary health care provider notified. An examination by an ophthalmologist is usually indicated. Abdominal pain and ascites are adverse reactions that may or may not require discontinuation of the drug. Auditory disturbances are not associated with this drug.

A client is beginning therapy with terazosin. Based on the action of this drug, which nursing diagnosis should the nurse prioritize? A) Acute pain B) Injury risk C) Impaired oral mucous membranes D) Knowledge deficiency

Answer: B Rationale: Terazosin, an antiadrenergic drug, can cause a hypotensive reaction. Thus, the client may experience an immediate lowering of blood pressure when first starting this drug and be at risk for injury. Acute pain would be more appropriate for a client experiencing priapism from erectile dysfunction drugs. Impaired oral mucous membranes would be appropriate for the client receiving antispasmodics. Knowledge deficiency could apply to any client receiving medication.

A nurse is preparing to administer levothyroxine to a client who is also prescribed citalopram. The nurse predicts which assessment finding may occur in this client? A) Prolonged bleeding B) Decreased effectiveness of the thyroid drug C) Increased risk of paresthesias D) Increased risk of hypoglycemia

Answer: B Rationale: The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction with selective serotonin reuptake inhibitors (SSRIs) such as citalopram. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.

A health care provider has prescribed methimazole for an elderly client with hyperthyroidism who lives alone. Which potential nursing diagnosis should the nurse prioritize for this client? A) Disturbed thought processes related to adverse drug reactions B) Risk for ineffective health management C) Risk for infection related to adverse drug reactions D) Risk for impaired skin integrity related to adverse reactions

Answer: B Rationale: The nurse should prioritize risk for ineffective health management for this client. The client with hyperthyroidism may be concerned with the results of medical treatment and with the problem of taking the drug at regular intervals around the clock. Risk for infection related to adverse drug reactions and risk for impaired skin integrity related to adverse reactions could also be appropriate for this client receiving antithyroid drugs; however, not the priority. Disturbed thought processes may apply for a client receiving ACTH.

What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen? A) Diabetes mellitus B) Endometrial cancer C) Parkinson disease D) Cardiac valve dysfunction

Answer: B Rationale: Warnings associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, and thromboembolic disease, and hypercalcemia in those with breast cancer and bone metastases.

A nurse is monitoring a client who is prescribed short-term high-dose methylprednisolone. Which assessment findings should the nurse prioritize? Select all that apply. A) Weight loss B) Moon face C) Buffalo hump D) Dry skin E) Hypotension

Answer: B, C Rationale: A nurse should monitor a client taking short-term high-dose methylprednisolone for signs and symptoms of Cushing syndrome, which include buffalo hump, moon face, oily skin (not dry skin), acne, osteoporosis, purple striae on the abdomen and hips, altered skin pigmentation, and weight gain (not weight loss). Hypotension is a potential adverse reaction related to a fluid or electrolyte disturbance which can occur with the use of glucocorticoids. It is not related to cushingoid effects.

The nursing instructor is teaching a class on the various hormones in the body. The instructor determines the class is successful when the students correctly choose which hormones as products of the adrenal gland? Select all that apply. A) Growth hormone B) Mineralocorticoids C) Glucocorticoids D) Prolactin E) Oxytocin

Answer: B, C Rationale: Glucocorticoids and mineralocorticoids (also referred to as adrenocortical hormones and collectively as corticosteroids) are secreted by the adrenal cortex. Growth hormone, prolactin, and oxytocin are secreted by the pituitary gland.

The nurse is preparing a teaching session for a client who is prescribed alendronate. Which instruction(s) will the nurse include in this session? Select all that apply. A) Take the medication in the evening. B) Take the medication with 6-8 ounces of water. C) Remain upright for at least 30 minutes after administration. D) Wait 30 minutes before taking any other food or drink. E) Take a calcium supplement at the same time with the medication.

Answer: B, C, D Rationale: A nurse should include the following administration instructions to a client being discharged with a prescription for alendronate: take the medication in the morning (not evening) with 6-8 ounces of water, remain upright for at least 30 minutes after administration, and do not take any other food, drink, medication, or supplement until at least 30 minutes after administration of the medication.

The health care provider has prescribed somatropin for a client. As the nurse conducts the preadministration assessment, which assessments should the nurse prioritize? Select all that apply. A) Muscle strength B) Weight C) Blood pressure D) Pulse E) Complete blood count

Answer: B, C, D Rationale: Blood pressure, pulse, respiratory rate, temperature, height, and weight should be included in the nurse's preadministration assessment of a client about to receive somatropin. Muscle strength and a complete blood count would not be a priority, but could be included on the general assessment before a child is accepted into a GH program.

A nurse is teaching a client about the prescribed tolterodine. The nurse determines the session is successful when the client correctly chooses which potential adverse reaction(s) to report to the health care provider? Select all that apply. A) Anorexia B) Xerostomia C) Decreased lacrimation D) Blurred vision E) Diarrhea

Answer: B, C, D Rationale: Common adverse reactions seen with the use of tolterodine include xerostomia, constipation, headache, and dizziness. Anorexia is a potential adverse reaction to testolactone. Diarrhea is a potential adverse reaction to mirabegron, silodosin, bicalutamide, enzalutamide, flutamide, and estramustine.

A nurse is preparing to administer levothyroxine to a client. Which sign(s) or symptom(s) would the nurse expect to document on the preadministration assessment? Select all that apply. A) Nervousness B) Anorexia C) Coarse hair D) Cold intolerance E) Tachycardia

Answer: B, C, D Rationale: Levothyroxine is used to treat hypothyroidism manifested by anorexia, coarse hair, cold intolerance, lethargy, and bradycardia (not tachycardia). Nervousness and tachycardia are possible adverse reactions to levothyroxine and would be evident on the ongoing assessment after therapy had started.

A nurse is preparing to administer adalimumab to a client. The nurse determines caution is warranted after noting which disorders in the client's history? Select all that apply. A) Hepatitis A B) Diabetes C) Obesity D) Hepatitis B E) Hepatitis C

Answer: B, C, D, E Rationale: Adalimumab is used with caution in clients with obesity, diabetes, and hepatitis B or C. It is not recognized to cause any adverse reactions in individuals with hepatitis A.

. A nurse is providing care to a client with hyperthyroidism. Which treatment modalit(ies) would the nurse anticipate being used? Select all that apply. A) Levothyroxine B) Methimazole C) Radioactive iodine D) Propylthiouracil E) Subtotal thyroidectomy

Answer: B, C, D, E Rationale: Methimazole, propylthiouracil, radioactive iodine, and subtotal thyroidectomy are treatment modalities used in the treatment of clients with hyperthyroidism. Levothyroxine is used for hypothyroidism, and this client will likely be prescribed it if the thyroid tissue is eradicated by either the radioactive iodine or subtotal thyroidectomy.

When teaching a client about the prescribed levothyroxine therapy, the nurse determines that the teaching was successful when the client states that they will contact the primary health care provider if which symptom(s) occurs? Select all that apply. A) Constipation B) Palpitations C) Excessive diaphoresis D) Significant weight changes E) Chest pain

Answer: B, C, D, E Rationale: The client taking levothyroxine should contact the primary health care provider if any of the following occur: headache, nervousness, palpitations, diarrhea (not constipation), excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event

A nurse is preparing to administer vasopressin to a client. The nurse will exercise caution if which disorder is noted in the client's medical history? Select all that apply. A) Sleep apnea B) Migraine headaches C) Asthma D) Seizure disorders E) Angina

Answer: B, C, D, E Rationale: Vasopressin is used cautiously in clients with a history of seizure disorder, migraine headaches, asthma, congestive heart failure, or vascular disease (angina and myocardial infarction). Sleep apnea is not recognized as a disorder for which cautious use is recommended. The nurse would need to evaluate the rest of the history.

A nurse is completing an assessment on a 70-year-old client suspected of having a thyroid dysfunction. The nurse will question which finding(s) as an indication before starting any thyroid treatment? Select all that apply. A) Constipation B) Confusion C) Unsteady gait D) Decreased visual acuity E) Cold intolerance

Answer: B, C, E Rationale: Hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait. These symptoms should be thoroughly evaluated before thyroid treatment is started. Constipation and decreased visual acuity are not related to hypothyroidism.

A client presents to the clinic for a routine visit. The nurse suspects the client is experiencing hypothyroidism based on which assessment finding(s)? Select all that apply. A) Elevated body temperature B) Weight gain C) Bradycardia D) Hypertension E) Sleepiness

Answer: B, C, E Rationale: The signs and symptoms of hypothyroidism include decreased metabolism; cold intolerance; low body temperature (not elevated); weight gain; bradycardia; hypotension (not hypertension); lethargy; sleepiness; pale, cool, dry skin; face appearing puffy; coarse hair; thick, hard nails; heavy menses; fertility problems; and low sperm count.

A client prescribed treatment for atrial fibrillation is now prescribed levothyroxine for hypothyroidism. The nurse prepares to monitor the client for increased cardiac dysfunction if the client is prescribed which current medication(s)? Select all that apply. A) Lisinopril B) Digoxin C) Diltiazem D) Metoprolol E) Warfarin

Answer: B, D Rationale: A client with a heart condition controlled on digoxin and metoprolol must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated due to decrease effectiveness of digoxin and β-blockers (metoprolol). There are no recognized reactions when lisinopril (ACE inhibitor) or diltiazem (calcium channel blocker) are used with thyroid replacements. The use of warfarin (anticoagulant) with levothyroxine may result in prolonged bleeding.

A nursing instructor is teaching a session on the drugs used to treat benign prostatic hypertrophy. The instructor determines the session is successful when the students correctly choose which drug(s) that exerts its effect by preventing testosterone conversion into an androgen? Select all that apply. A) Terazosin B) Finasteride C) Tamsulosin D) Dutasteride E) Doxazosin

Answer: B, D Rationale: Finasteride and dutasteride inhibit the conversion of testosterone into the androgen 5-alpha-dihydrotestosterone (DHT), which results in a decrease in prostate gland size, making them useful in the treatment of benign prostatic hypertrophy. Antiadrenergic drugs, such as terazosin, tamsulosin, and doxazosin, exert their effect by blocking norepinephrine, causing the muscles to relax, and allow urine to flow from the bladder.

A nurse is preparing to teach a client about levothyroxine. The nurse will point out which factor(s) about this drug to the client during the teaching session? Select all that apply. A) Equivalent to all other thyroid hormone replacement drugs B) More uniform potency than other thyroid hormone replacement drugs C) Twice-daily dosing necessary D) Relatively inexpensive E) Less frequent laboratory monitoring required

Answer: B, D Rationale: Levothyroxine is the drug of choice for hypothyroidism. It is relatively inexpensive, requires once-daily dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Laboratory monitoring will remain the same for all thyroid therapies to ensure adequate response to therapy.

A nurse is preparing to teach a client about vasopressin. Which factors would the nurse integrate into the teaching? Select all that apply. A) Secreted by the adrenal gland. B) Secreted when body fluids must be conserved. C) Exhibits its greatest activity in the bladder. D) Regulates the reabsorption of water from the kidney. E) Used to treat diabetes mellitus.

Answer: B, D Rationale: The following is true of the hormone vasopressin: it is secreted by the posterior pituitary gland (not adrenal gland), is secreted when body fluids must be conserved, exhibits its greatest activity on the renal tubular epithelium (not the bladder), regulates the reabsorption of water from the kidney, and is used to treat diabetes insipidus (not diabetes mellitus).

After teaching a client how to use an estradiol transdermal system, the nurse determines that the teaching was successful when the client makes which statement(s)? Select all that apply. A) "I can put the patch on my breasts." B) "I should rotate the sites, staying away from the same site for about a week." C) "When I apply it, I should rub the patch vigorously for about 10 seconds." D) "I apply the patch immediately after I open the pouch." E) "If the area is oily or irritated, I need to avoid that area."

Answer: B, D Rationale: When using a transdermal system, the client should apply the system immediately after opening the pouch with the adhesive side down, applying it to the clean, dry skin of the buttocks, trunk, abdomen, upper inner thigh, or upper arm. The system should not be applied to the breasts, waistline, or a site exposed to sunlight. The area should not be oily or irritated. Once the patch is applied, the client should press on it firmly with the palm of the hand for about 10 seconds. The application site is rotated with at least 1-week intervals between applications to a particular site.

The nursing instructor is teaching a group of nursing students about the various androgen drugs. The instructor determines the session is successful when the students correctly choose which drug(s) that needs to be handled with extreme caution especially by pregnant women? Select all that apply. A) Abiraterone B) Finasteride C) Nilutamide D) Dutasteride E) Enzalutamide

Answer: B, D Rationale: Women of childbearing age should not handle androgen hormone inhibitors, such as finasteride or dutasteride tablets, if they are crushed or broken due to the drugs' substantial risk of abnormal growth to a male fetus. Abiraterone, nilutamide, and enzalutamide are antiandrogens used in the treatment of prostate cancer and do not carry this caution.

A young couple has come to a fertility clinic seeking assistance. Which medication does the nurse anticipate the health care provider will prescribe to help increase the chances of the woman becoming pregnant? Select all that apply. A) Vasopressin B) Clomiphene C) Octreotide D) Cetrorelix E) Gonadotropin

Answer: B, D, E Rationale: A nurse might administer clomiphene, cetrorelix, or gonadotropin to a female client with fertility problems to help increase her chances of becoming pregnant. Vasopressin is prescribed for individuals with diabetes insipidus. Octreotide is used to reduce the production of GH in acromegaly and in the treatment of certain tumors and bleeding esophageal varices.

The nurse is preparing to administer methotrexate to a client. The nurse should question this order if which disorder(s) is noted in the medical record? Select all that apply. A) Hypertension B) Folate deficiency C) Vitamin B12 deficiency D) Diabetes E) Liver disease

Answer: B, E Rationale: The use of methotrexate is contraindicated in clients with known hypersensitivity to the drug and clients with renal insufficiency, liver disease, alcohol abuse, pancytopenia, or folate deficiency. Hypertension is a potential adverse reaction to leflunomide. Vitamin B12 deficiency can be seen with the use of proton pump inhibitors or metformin. Individuals with diabetes should use these medications cautiously.

. A nurse is preparing to administer gonadotropin to a client. The nurse would question this order if which disorder is documented in the client's medical history? A) Sensitivity to benzyl alcohol B) Epiphyseal closure C) Adrenal dysfunction D) Epilepsy

Answer: C Rationale: Gonadotropins are contraindicated in clients with adrenal dysfunction, high gonadotropin levels, thyroid dysfunction, liver disease, abnormal bleeding, ovarian cysts, sex-hormone-dependent tumors, or organic intracranial lesions (pituitary tumors). Gonadotropins should be used cautiously in clients with epilepsy. Somatropin growth hormones are contraindicated in clients with sensitivity to benzyl alcohol, epiphyseal closure, and underlying cranial lesions

The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route? A) Orally B) Intramuscularly C) Subcutaneously D) Intravenously

Answer: C Rationale: Adalimumab, a DMARD, is administered by subcutaneous injection. Abatacept and infliximab are examples of DMARDs that are administered IV. Methotrexate, sulfasalazine, and leflunomide are examples of DMARDs that can be given orally.

A health care provider has prescribed vasopressin to the client. Which assessment should the nurse perform on the ongoing assessment? A) Observe for and report any evidence of edema, such as dyspnea. B) Measure and record the client's abdominal girth every hour. C) Observe the client for blanching of the skin, abdominal cramps, and nausea. D) Weigh the client every day to obtain a baseline weight.

Answer: C Rationale: After vasopressin is administered to the client, the nurse should observe the client every 10 to 15 minutes for signs of an excessive dosage, which include blanching of the skin, abdominal cramps, and nausea. After corticotropin is administered to the client, the nurse needs to observe for and report any evidence of edema, such as weight gain, rales, increased pulse or dyspnea, or swollen extremities. If the client is receiving vasopressin for abdominal distention, the nurse needs to auscultate the abdomen every 15 to 30 minutes and measure abdominal girth hourly. The nurse needs to weigh the client to obtain a baseline weight for future comparison before administering vasopressin to the client.

A health care provider has prescribed vasopressin to the client. Which assessment should the nurse perform on the ongoing assessment? A) Observe for and report any evidence of edema, such as dyspnea. B) Measure and record the client's abdominal girth every hour. C) Observe the client for blanching of the skin, abdominal cramps, and nausea. D) Weigh the client every day to obtain a baseline weight.

Answer: C Rationale: After vasopressin is administered to the client, the nurse should observe the client every 10 to 15 minutes for signs of an excessive dosage, which include blanching of the skin, abdominal cramps, and nausea. After corticotropin is administered to the client, the nurse needs to observe for and report any evidence of edema, such as weight gain, rales, increased pulse or dyspnea, or swollen extremities. If the client is receiving vasopressin for abdominal distention, the nurse needs to auscultate the abdomen every 15 to 30 minutes and measure abdominal girth hourly. The nurse needs to weigh the client to obtain a baseline weight for future comparison before administering vasopressin to the client.

A client alerts the nurse that they have been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective? A) "There is an increase in the gonadotropins." B) "The menstrual cycle becomes irregular." C) "Estrogen and progesterone diminish." D) "Hot flashes and night sweats are prominent."

Answer: C Rationale: During menopause, estrogen and progesterone diminish causing the menstrual cycle to become more irregular and then stop altogether. Symptoms of the decrease in estrogen and progesterone are hot flashes, night sweats, vaginal dryness, and sleep problems. There is not an increase of gonadotropins during menopause.

A health care provider has prescribed growth hormone for a client. Which periodic tests would the nurse anticipate monitoring at different intervals during the treatment? A) Carbohydrate tolerance B) Serum electrolyte levels C) Glucose tolerance D) pH level of the blood

Answer: C Rationale: Periodic testing of growth hormone levels, glucose tolerance, and thyroid functioning are required during growth hormone treatment for the client. The pH level of blood and carbohydrate tolerance testing are not required. Testing serum electrolyte levels is needed when a client is undergoing vasopressin therapy.

A client comes to the emergency department and reports extreme pain. Physical assessment reveals a 6-hour erection. When obtaining the client's medication history, which drug would the nurse expect the client to report using? A) Tamsulosin B) Terazosin C) Tadalafil D) Tolterodine

Answer: C Rationale: Priapism (an erection lasting more than 4-6 hours) occurs with the use of phosphodiesterase type 5 inhibitors, such as tadalafil. It is not associated with use of antiadrenergic drugs or antispasmodics.

A client has been prescribed a transdermal patch of estrogen. Which adverse effect should be included in the teaching plan about the medication? A) Pain at the injection site B) Irritation of the oral pharynx C) Redness at the application site D) Edema and rhinitis of the nose

Answer: C Rationale: Redness and irritation at the application site is an adverse reaction with the transdermal system. The client is receiving a transdermal patch, not an injection. Irritation of the oral pharynx would occur with an oral medication. Edema and rhinitis of the nose can occur with nasal medications or rhinitis.

A client reports taking the prescribed medication immediately upon arising each morning and sits for 30 minutes before eating or drinking. The nurse anticipates discovering the client is taking which medication? A) Methotrexate B) Allopurinol C) Risedronate D) Baclofen

Answer: C Rationale: The client is taking a bisphosphonate, which requires that it be taken upon arising in the morning with 6-8 ounces of water, with the client remaining in an upright position. Methotrexate (a DMARD), allopurinol (uric acid inhibitor), and baclofen (skeletal muscle relaxant) are taken with or immediately after meals to minimize gastric distress.

A nurse is caring for a female client who states she has a 28-day cycle. Which two hormones are influential in the female fertility cycle? A) Prolactin and cortisol B) Gonadotropin and insulin C) Estrogen and progesterone D) Testosterone and growth hormone

Answer: C Rationale: The female fertility cycle is under the influence of estrogen and progesterone. Estrogen is a hormone that thickens the lining of the uterus in preparation for egg, assists the body to process calcium to maintain bone structure, helps keep cholesterol levels in balance, and maintains vaginal health. Progesterone regulates the menstrual cycle and maintains pregnancy. Gonadotropin, testosterone, and growth hormone are hormones secreted by the pituitary gland. Insulin is a hormone secreted by the pancreas.

The nurse is preparing to administer colchicine to a client who is in the initial phase of gout. Which disorder will the nurse be prepared to monitor the client for? A) Stomatitis B) Stevens-Johnson syndrome C) Bone marrow depression D) Exfoliative dermatitis

Answer: C Rationale: The nurse needs to closely monitor the client for bone marrow depression, an adverse reaction of colchicine. Stomatitis, Stevens-Johnson syndrome, and exfoliative dermatitis are not adverse reactions of colchicine. Stomatitis is an adverse reaction of immunosuppressive drugs. Stevens-Johnson syndrome and exfoliative dermatitis are adverse reactions of allopurinol.

The nurse provides client teaching for a client diagnosed with rheumatoid arthritis (RA) about the prescribed methotrexate. Which client statements determines the need for further teaching? A) "I will take methotrexate the same time every Monday and set a reminder in my calendar." B) "I will wash my hands thoroughly with soap and water to decrease risk for infection." C) "I will have labs to monitor for possible bad effects of methotrexate drawn every 6 months." D) "It may take several weeks to see improvement of my rheumatoid arthritis symptoms."

Answer: C Rationale: The nurse needs to provide further teaching about how often the client needs to have liver, renal, and complete blood count laboratory tests, which is usually every month when the client begins therapy and gradually may be increased to every 3 months. The client demonstrates an adequate understanding about the importance of taking the medication the same time once a week. Methotrexate is an immunosuppressant so the client needs to perform correct handwashing and stay away from persons known to have a contagious infection. The client is also correct that the medication will take several weeks before noting improvement in the RA symptoms.

A client with benign prostatic hypertrophy is questioning the nurse about saw palmetto. Which is the best response from the nurse related to the use of this herb? A) Take the herb as tea, prepared in hot water. B) Improvement can be seen within 2-3 weeks. C) Need to be reevaluated after 6 months of use. D) Stop the herb after 3 months of intake.

Answer: C Rationale: The nurse should inform the client that saw palmetto might help relief the symptoms of benign prostatic hypertrophy. The active components are not water soluble and should not be taken as a tea. Improvement can be seen after 1- 3 months of taking the herb, and not within 2-3 weeks. The herb intake should not be stopped after 3 months but should be continued for 6 months, followed by evaluation by the health care provider.

The nursing instructor is teaching a group of students about drugs used for muscle spasms and cramping. The instructor determines the session is successful when the students correctly choose which instruction as relevant to skeletal muscle relaxants? A) Take the drug with food. B) Stay upright for 30 minutes after taking the drugs. C) Avoid alcohol or other CNS depressants. D) Take the drug with 6-8 ounces of water.

Answer: C Rationale: The nurse should instruct the client to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct clients taking drugs for osteoporosis to take them with 6-8 ounces of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct clients with gout to take drugs for treating gout with food.

The nurse is teaching a client about the medication they are receiving as treatment for gout. The nurse determines the session is successful when the client correctly chooses which instruction as most important? A) Taking drug on an empty stomach B) Using protection against sunlight C) Reporting any skin rash D) Wearing a brace to get out of bed

Answer: C Rationale: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks.

A client with hyperthyroidism, who is prescribed methimazole, reports a skin rash to the nurse. Which instruction should the nurse prioritize when assessing the client? A) Offer suggestions to alter the drug schedule. B) Instruct the client to avoid applying lubricants. C) Instruct the client to use soap sparingly. D) Check if discoloration of the hair occurs.

Answer: C Rationale: The nurse should instruct the client to use soap sparingly, if at all, and apply soothing creams or lubricants until the rash subsides. The dosing may need to be changed and the rash should be reported immediately to the health care provider. The nurse need not offer suggestions to alter the drug schedule, instruct the client to avoid applying lubricants, or check if discoloration of hair occurs.

The nurse is administering a bisphosphonate to a client with Paget disease. Which finding on assessment should the nurse prioritize? A) Altered renal function B) Increased skin rashes C) Serum calcium levels D) Hematology function

Answer: C Rationale: The nurse should monitor the serum levels of calcium before, during, and after bisphosphonate therapy because bisphosphonates act primarily on the bone by inhibiting normal and abnormal bone resorption. These drugs are used cautiously in clients with renal function impairment but do not alter renal function. The nurse should monitor the client's renal function when allopurinol is administered and hematology function when methotrexate is administered

A nurse has administered estrogen and phenytoin to a client. Which reaction should the nurse plan to monitor the client carefully for? A) Potential for blood clots B) Increased risk for infection C) Possibility of breakthrough bleeding D) Increased risk for seizures

Answer: C Rationale: When estrogen is given with phenytoin, a hydantoin, the client is at increased risk for breakthrough bleeding not seizures. Blood clots can be an adverse reaction with estrogen therapy alone. There is no increased risk for infection. When given together, these drugs do not increase the risk for seizures.

After teaching a group of nursing students about drugs used to treat genitourinary problems in the older adult, the instructor determines that the teaching was successful when the students correctly choose which drug(s) as an alpha-adrenergic blocker used to treat BPH? Select all that apply. A) Darifenacin B) Oxybutynin C) Alfuzosin D) Tamsulosin E) Raloxifene

Answer: C, D Rationale: Alpha-adrenergic drugs used to treat BPH include alfuzosin and tamsulosin. Darifenacin and oxybutynin are antispasmodics. Raloxifene is a miscellaneous agent used to prevent and treat osteoporosis.

A client presents to the health care provider's office with reports of worsening hypothyroidism symptoms in spite of taking the prescribed levothyroxine. When questioned about medication changes, the client tells the nurse that they were recently prescribed an antidepressant by another health care provider. Which antidepressant(s) does the nurse suspect the client has started? Select all that apply. A) Amitriptyline B) Quetiapine C) Sertraline D) Fluoxetine E) Topiramate

Answer: C, D Rationale: Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and fluoxetine, can decrease the effectiveness of levothyroxine, leading to the reappearance of hypothyroidism symptoms in clients previously controlled on a dose of levothyroxine. Other categories of antidepressants such as amitriptyline (tricyclic antidepressant) will increase the effectiveness of the thyroid drug. There are no apparent interactions between levothyroxine and quetiapine (antipsychotic) or topiramate (anticonvulsant)

The nurse is assessing the client's past medical history in preparation to administer dantrolene. The nurse will question this order if which condition(s) are noted in the medical record? Select all that apply. A) Hypertension B) Atrial fibrillation C) Hepatic disease D) Diabetes E) Lactation

Answer: C, E Rationale: The use of dantrolene is contraindicated during lactation and in clients with active hepatic disease and muscle spasm caused by rheumatic disorders. Hypertension is a potential adverse reaction to leflunomide. Cyclobenzaprine is contraindicated for clients with atrial fibrillation. Individuals with diabetes should use DMARDs cautiously.

The nursing instructor is teaching a session on the thyroid and its hormones. The instructor determines the class is successful when the students correctly choose which hormone(s) as originating in the thyroid gland? Select all that apply. A) Thyroid-stimulating hormone B) Adrenocorticotropic hormone C) Thyroxine D) Prolactin E) Triiodothyronine

Answer: C, E Rationale: Thyroxine and triiodothyronine are hormones secreted by the thyroid gland. The anterior pituitary secretes thyroid-stimulating hormone. Prolactin and adrenocorticotropic hormone are secreted by the pituitary gland.

A group of nursing students are preparing a presentation depicting the various hormones necessary for proper functioning of the human body. The students should point out which hormones are secreted by the posterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Answer: C, E Rationale: Vasopressin and oxytocin are secreted by the posterior pituitary gland. Growth hormone, adrenocorticotropic hormone, and prolactin are secreted by the anterior pituitary gland.

A nurse is caring for a client who is receiving corticosteroid therapy. Which nursing diagnosis would the nurse be least likely to prioritize for this client? A) Risk for Infection B) Disturbed Body Image C) Risk for Injury D) Deficient Fluid Volume

Answer: D Rationale: A client who is receiving corticosteroid therapy would be least likely to have a nursing diagnosis of Deficient Fluid Volume. Rather, Excess Fluid Volume would be more appropriate. Risk for Infection related to immunosuppression, Disturbed Body Image related to cushingoid effects, and Risk for Injury related to muscle atrophy and osteoporosis would be appropriate. Individuals prescribed vasopressin are more likely to be given the diagnosis of deficient fluid volume.

A nurse is teaching a client with gout the importance of getting adequate fluids. The nurse determines the session is successful when the client correctly plans to drink at least how much fluid each day? A) 1000 mL B) 1500 mL C) 2000 mL D) 3000 mL

Answer: D Rationale: A client with gout is encouraged to drink at least 3000 mL of fluid per day to promote uric acid excretion.

The nurse has administered anakinra to a client. Which assessment finding should the nurse prioritize? A) Constipation B) Abdominal pain C) Retinal changes D) Pancytopenia

Answer: D Rationale: Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes. Constipation is a potential adverse reaction to cyclobenzaprine. Retinal changes are potential adverse reactions to hydroxychloroquine. Pancytopenia is a potential adverse reaction to sulfasalazine, alendronate, ibandronate, risedronate, allopurinol, and colchicine.

After teaching a group of nursing students about corticosteroids, the instructor determines that the teaching was successful when the students correctly choose which drug as a mineralocorticoid? A) Hydrocortisone B) Betamethasone C) Triamcinolone D) Fludrocortisone

Answer: D Rationale: Fludrocortisone is a mineralocorticoid. Hydrocortisone, betamethasone, and triamcinolone are glucocorticoids.

A client presents to the emergency department with an apparent reaction to recently started thyroid therapy. Which assessment finding would lead the nurse to question that this client is experiencing a thyroid storm? A) Memory impairment B) Cold intolerance C) Constipation D) Altered mental status

Answer: D Rationale: Some clients will experience an increase in hyperthyroidism rather than decrease during therapy. When these symptoms occur rapidly, it is termed a thyrotoxic crisis or thyroid storm. It is characterized by high fever, extreme tachycardia, and altered mental status. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe form of hypothyroidism.

A client is prescribed tamsulosin and atenolol. Which assessment would the nurse prioritize when conducting the ongoing assessment? A) Intake and output B) Pulse rate C) Respiratory rate D) Blood pressure

Answer: D Rationale: Tamsulosin, an alpha-adrenergic blocker, when given with a beta-blocker such as atenolol can cause an increase in hypotension. Therefore, assessment of the client's blood pressure would be most important. Individuals with BPH may experience a variety of urinary symptoms such as frequency, reduced flow, nocturia, and dysuria; however, monitoring the intake and output would not be the priority in this situation.

A client is receiving hydroxychloroquine for a musculoskeletal disorder. Which adverse reactions are irreversible and needs to be reported immediately? A) Easy bruising B) Skin rash C) Fever D) Visual changes

Answer: D Rationale: The nurse needs to report visual changes in a client receiving hydroxychloroquine because irreversible retinal damage may occur. Although easy bruising, skin rash, and fever are adverse reactions of the drug, they are not irreversible

A nurse is preparing to administer liothyronine to a client with chronic thyroiditis. The nurse determines the drug needs to be administered cautiously after noting which disorder in the client's medical history? A) Upper respiratory tract infection B) Diabetes C) Elevated body temperature D) Cardiac disease

Answer: D Rationale: The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic thyroiditis. The nurse need not be cautious about administering liothyronine to clients with an upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should be cautious about clients contracting an upper respiratory tract infection on administrating antithyroid drugs. A client with diabetes may experience an increase in diabetes while undergoing thyroid hormone replacement therapy. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.

A nurse is teaching a client about the thyroid hormone replacement therapy which has been prescribed. The nurse determines the teaching session is successful when the client indicates which time to take the drug? A) Before bedtime B) Just before dinner C) After lunch D) Before breakfast

Answer: D Rationale: The nurse should inform the client undergoing thyroid hormone replacement therapy to take the drug in the morning before breakfast. These drugs should be taken on an empty stomach to ensure proper absorption.

A nurse is preparing discharge teaching for a client who is prescribed glucocorticoid therapy. Which instructions should the nurse point out in the teaching plan for the client and caregivers? A) Report any symptoms of sore throat or fever immediately. B) Notify the primary health care provider if glucose appears in the urine. C) Measure the amount of fluids taken each day. D) Take the oral drug with meals or snacks.

Answer: D Rationale: The nurse should instruct the client to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the client and caregivers. Reporting any symptoms of sore throat or fever immediately and notifying the primary health care provider if glucose appears in the urine should be included in the teaching plan for a client undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the client to measure the amount of fluids taken each day in the teaching plan for the client receiving vasopressin.

A client with gout is prescribed pegloticase after not responding to the usual medications. Which nursing diagnosis would the nurse determine to be most appropriate in this case? A) Risk for injury B) Acute pain C) Impaired comfort: gastric distress D) Risk for allergic response

Answer: D Rationale: When first-line treatments for gout are not successful, sometimes drugs that are more toxic may be prescribed, such as the pegloticase infusion. During the infusion, the client is closely monitored for the development of adverse reactions, in particular anaphylaxis. Should an anaphylactic reaction occur, the infusion center staff members are prepared to start resuscitative measures as emergency personnel are notified. Risk for injury would be appropriate if the client is drowsy as well as pain and deformity may contribute to the risk of falling and suffering an injury. Acute pain is not a recognized nursing diagnosis for this medication. Impaired comfort: gastric discomfort may be appropriate if the client experiences GI upset, which is possible.

A client diagnosed with hypothyroidism admits knowing the term "thyroid gland" but not knowing its function. The nurse should explain the fact that thyroid hormone is responsible for which action?

Controlling the rate of cell metabolism throughout the body

The nurse would expect to administer tiludronate to a client with which condition?

Paget disease

The nurse knows that a male client with benign prostatic hypertrophy should not take saw palmetto if he had which other condition?

Peptic ulcer

It has been determined that a 33-year-old male client would likely benefit from treatment with testosterone. What aspect of the client's medical history could contraindicate this treatment?

The client has been diagnosed with hepatitis C

A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication?

The importance of ensuring safety related to possible sedation

Gonadotropins are classified in which pregnancy category?

X

Which classification of medication is used to treat overactive bladder syndrome?

antispasmodics

A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms?

cardiac arrhythmias

An older adult with intractable back pain is scheduled to begin taking a centrally acting skeletal muscle relaxant. What medication is most likely to balance risks and benefits to the client?

carisprodol

A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication?

decreased muscle spasms

A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms?

extreme tachycardia

A client has been prescribed a corticosteroid for the treatment of chronic adrenocortical insufficiency. The nurse's instructions for administration should include taking the medication under what condition?

in the morning