Test 5 practice questions

An adult patient has developed renal failure secondary to an overdose of a nephrotoxic drug. Which of the following assessment findings would the nurse recognize as being most suggestive of impaired erythropoiesis? A) Frequent infections and low neutrophil levels B) Fatigue and increased heart rate C) Agitation and changes in cognition D) Increased blood pressure and peripheral edema

Ans: B Feedback: As RBCs decrease, conditions related to inadequate hematopoiesis develop. Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. A compensatory increase in heart rate and cardiac output initially increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood.

A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician? A) Aminocaproic acid (Amicar) B) Platelets C) Protamine sulfate D) Vitamin K

Ans: D Feedback: Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

A patient with chronic renal failure is prescribed filgrastim (Neupogen). What is the major effect of filgrastim (Neupogen)? A) Decreases neutropenia related to chemotherapy B) Decreases white blood cells related to infection C) Decreases growth of blood vessels due to ischemia D) Decreases platelet count related to bleeding

Ans: A Feedback: Filgrastim (Neupogen) is used to stimulate blood cell production by the bone marrow in places with bone marrow transplantation or chemotherapy-induced neutropenia. Filgrastim does not decrease white blood cells in response to infection. Filgrastim increases growth of blood vessels related to ischemic heart disease. Filgrastim does not decrease platelet count related to bleeding.

A patient with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents? A) The use of three agents decreases the development of cell resistance. B) The use of three agents increases adherence to treatment. C) The use of three agents increases the serum levels of one of the agents. D) The use of three agents decreases the total adverse effects.

Ans: A Feedback: Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance.

A patient will begin taking atorvastatin (Lipitor), and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of A) muscle pain. B) dry mouth. C) pruritus (itching). D) increased thirst.

Ans: A Feedback: Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.

An adult male patient is postoperative day 2 following a kidney transplant, and his regimen of antirejection drugs began just prior to surgery. What nursing action should be integrated into this patient's plan of care? A) Place the patient in a single, positive-pressure room. B) Arrange for the patient to receive a raw-food, organic diet. C) Wash the patient's skin with chlorhexidine twice daily. D) Have the patient wear a gown and gloves when outside his room.

Ans: A Feedback: Patients receiving antirejection therapy are at a greatly heightened risk of infection; protective isolation is warranted. Raw foods are normally contraindicated, and the use of a gown and gloves does not protect the patient sufficiently from infectious microorganisms. It is not necessary to perform twice-daily antiseptic washes.

A male patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important? A) Call his physician if he develops muscle pain. B) It is unacceptable to eat dietary fats. C) Decrease the dose if lethargy occurs. D) Eat two eggs per day to increase protein stores.

Ans: A Feedback: Patients should be advised to notify their health care provider if unexplained muscle pain or tenderness occurs. The patient should avoid saturated fats when taking statins but should not entirely eliminate fats from his diet. The patient should not decrease the dose of statins without the physician's knowledge. The patient should not increase the intake of eggs due to the increase in cholesterol.

Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies? A) Soy B) Ginkgo biloba C) Green tea D) Garlic

Ans: A Feedback: Soy is used as a food source and has been researched extensively to lower cholesterol. Ginkgo biloba, green tea, and garlic do not have extensive scientific research to support the lowering of cholesterol.

A patient has been placed on tacrolimus, and the route will be changed from IV to oral prior to discharge home from the hospital. How will this change in administration route affect the patient's plan of care? A) The patient's dose of tacrolimus will have to be increased. B) The patient will receive the drug QID rather than BID C) The patient will have to be monitored more closely for adverse effects. D) The patient will have to take tacrolimus concurrently with an antiemetic.

Ans: A Feedback: Tacrolimus, like cyclosporine, is not well absorbed orally, so it is necessary to give higher oral doses than IV doses to obtain similar blood levels. Increased frequency is not necessarily required. Concurrent dosing with an antiemetic is not required. Regardless of the route by which the drug is provided, the patient needs to be closely monitored for adverse effects.

A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant? A) Graft-versus-host disease B) Hepatotoxicity C) Acute kidney injury D) Sepsis

Ans: A Feedback: The goal after bone marrow transplantation is to provide adequate immunosuppression. If immunosuppression is inadequate, graft-versus-host disease will occur with bone marrow transplantation. The patient will not suffer from hepatic or renal failure. Inadequate immunosuppression will not place the patient at risk for serious infection.

A patient is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the patient's hemostatic function? A) The patient's platelet count will decline. B) The patient will be at increased risk of deep vein thrombosis. C) The patient will require prophylactic heparin. D) The patient will likely experience thrombocytosis.

Ans: A Feedback: Thrombocytopenia is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.

A patient has been administered methotrexate, which is a purine antagonist used to treat a rapidly growing tumor. The patient develops stomatitis. What is the priority nursing diagnosis for a patient suffering from stomatitis? A) Impaired skin integrity B) Activity intolerance C) Self-care deficit: hygiene D) Risk for disuse syndrome

Ans: A Feedback: Toxic effects of methotrexate include stomatitis, which is an alteration in skin integrity. Disuse syndrome, lack of hygiene, and activity intolerance are less directly related to stomatitis.

A patient has been diagnosed with chronic renal failure. Which of the following agents will assist in raising the patient's hemoglobin levels? A) Epoetin alfa (Epogen, Procrit) B) Pentoxifylline (Pentoxil) C) Estazolam (ProSom) D) Dextromethorphan hydrobromide

Ans: A Feedback: Uses of epoetin include the prevention and treatment of anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.

A patient has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The patient develops heparin-induced thrombocytopenia. Which of the following medications will be administered? A) Argatroban (Acova) B) Vitamin K C) Calcium gluconate D) Aminocaproic acid (Amicar)

Ans: A Feedback: Heparin-induced thrombocytopenia may occur in 1% to 3% of those receiving heparin and is a very serious side effect of heparin. In this patient, all heparin administration must be discontinued and anticoagulation managed with a direct thrombin inhibitor, such as argatroban. The patient is not administered vitamin K, calcium gluconate, or aminocaproic acid.

A patient is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin? A) "LMWH is associated with less thrombocytopenia than standard heparin." B) "LMWH is associated with stronger anticoagulant effects than standard heparin." C) "LMWH is given to patients who have a history of blood dyscrasia." D) "LMWH is more effective than standard heparin for patients with hypertension."

Ans: A Feedback: Low molecular weight heparins are associated with less thrombocytopenia than standard heparin. Low molecular weight heparin is not stronger than standard heparin. Low molecular weight heparin is administered cautiously in patients with blood dyscrasia and hypertension.

A patient is admitted with thrombophlebitis and sent home on enoxaparin (Lovenox). Which statement indicates a good understanding of why enoxaparin is being administered? A) Enoxaparin inhibits the formation of additional clots. B) Enoxaparin eliminates certain clotting factors. C) Enoxaparin decreases the viscosity of blood. D) Enoxaparin will dissolve the existing clots.

Ans: A Feedback: Low molecular weight heparins prevent the development of additional clots. They do not eliminate clotting factors. LMWHs do not dissolve the clot or decrease the viscosity of blood.

A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors? A) Vitamin K B) Vitamin E C) Protamine sulfate D) Acetylsalicylic acid (Aspirin)

Ans: A Feedback: Vitamin K is the antidote for warfarin overdosage. In this case, the patient may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low molecular-weight heparin. Acetylsalicylic acid (Aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

A patient who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of her incision sites. During the process of clot formation, plasminogen will become part of a clot by which of the following means? A) By binding with fibrin B) By binding with platelets C) By activating plasmin D) By activating factor VII

Ans: A Feedback: When a blood clot is being formed, plasminogen, an inactive protein present in many body tissues and fluids, is bound to fibrin and becomes a component of the clot. Plasminogen does not bind to platelets, activate plasmin, or active factor VII.

A patient who is undergoing chemotherapy for the treatment of non-Hodgkin's lymphoma will soon begin treatment with epoetin alfa (Epogen). The nurse should be aware that this drug may be administered by which of the following routes? Select all that apply. A) Subcutaneous B) Intramuscular C) Oral D) Buccal E) Intravenous

Ans: A, E Feedback: Epogen is administered by either IV or sub-Q routes.

A hospital patient's complex medical history includes a recent diagnosis of kidney cancer. Which of the following medications is used to treat metastatic kidney cancer? A) Filgrastim (Neupogen) B) Aldesleukin (Proleukin) C) Interferon alfa-2b (Intron A) D) Darbepoetin alfa (Aranesp)

Ans: B Feedback: Aldesleukin (Proleukin) is used to treat metastatic kidney cancer but is contraindicated in patients with serious pulmonary impairment. Filgrastim is a colony-stimulating factor that is not used for the treatment of kidney cancer. Darbepoetin alfa is a hormone that stimulates the production of red blood cells by the bone marrow. Interferon alfa-2b (Intron A) is normally used to treat leukemia.

Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which of the following? A) Heart failure and bleeding problems B) Changes in cognition and personality changes C) Ischemic heart disease D) Bronchoconstriction and pulmonary edema

Ans: B Feedback: Although some adverse effects of monoclonal antibodies are rare, they are serious (e.g., heart failure, bleeding problems, electrolyte imbalances) and vary with a particular drug.

Following a successful kidney transplant in 1999, a 59-year-old woman has presented to the clinic for one of her regularly scheduled follow-up appointments. The nurse at the clinic should assess the patient in the knowledge that long-term use of antirejection drugs has been associated with A) early onset of dementia. B) increased risk of malignancy. C) atherosclerosis. D) increased risk of venous thromboembolism.

Ans: B Feedback: As a consequence of long-term survival and chronic immunosuppression, patients on long-term immunosuppressants have an increased risk of developing a malignancy. These drugs have not been linked to dementia, VTE, or atherosclerosis.

A patient is being administered chemotherapeutic agents for the treatment of cancer. Which of the following blood cells will be stimulated by the colony-stimulating factors in response to the effects of the chemotherapy? A) White blood cells B) Red blood cells C) Phagocytes D) Myocardial cells

Ans: B Feedback: Chemotherapeutic agents have the potential to decrease red blood cells and will result in the colony-stimulating factors stimulating the production of red blood cells. The colony-stimulating factors do not affect the white blood cell production, phagocytes, or cardiac cells.

A patient is ordered to receive cyclosporine intravenously, and the nurse has explained the need for frequent blood work. This blood work is required because cyclosporine A) decreases erythropoiesis. B) has a narrow therapeutic range. C) has been linked to spontaneous hemolysis. D) can precipitate a thyroid storm.

Ans: B Feedback: Cyclosporine has a very narrow therapeutic index; therefore, prescribers use serum drug levels to regulate cyclosporine dosing, and close monitoring is necessary. Cyclosporine does not have a significant bearing on RBC production and has not been closely linked to thyroid function of hemolysis.

A patient is prescribed fenofibrate (TriCor). When providing patient teaching, which of the following accurately describes the action of fenofibrate? A) It binds to bile acids in the intestinal lumen. B) It increases oxidation of fatty acids in the liver. C) It inhibits an enzyme required for hepatic synthesis. D) It inhibits mobilization of free fatty acids from peripheral tissues.

Ans: B Feedback: Fibrates increase oxidation of fatty acids in the liver. Bile acid sequestrants bind to bile acids in the intestinal lumen. HMG-CoA reductase inhibitors inhibit an enzyme required for hepatic synthesis. Niacin inhibits mobilization of free fatty acids from peripheral tissues.

A patient is administered a granulocyte colony-stimulating factor (G-CSF). What is the expected outcome of a G-CSF? A) Red blood cell count of 3000 mm3 B) Decreased number of infections C) Decreased fatigue and increased energy D) White blood cell count of 20,000 mm3

Ans: B Feedback: G-CSFs help to prevent infection by reducing the incidence, severity, and duration of neutropenia associated with several chemotherapy regimens. The administration of a G-CSF should not lower red blood cell count or raise white blood cell count. They assist in the prevention of infection but do not necessarily resolve fatigue.

An oncology nurse is providing for an adult patient who is currently immunocompromised. The nurse is aware of the physiology involved in hematopoiesis and immune function, including the salient role of cytokines. What is the primary role of cytokines in maintaining homeostasis? A) Cytokines perform phagocytosis in response to bacterial and protozoal infection. B) Cytokines perform a regulatory role in the development of diverse blood cells. C) Cytokines can be considered to be the basic "building blocks" of all blood cells. D) Cytokines are formed in response to the presence of antibodies.

Ans: B Feedback: Hematopoietic cytokines are diverse substances produced mainly by bone marrow and white blood cells (WBCs). They regulate many cellular activities by acting as chemical messengers among cells and as growth factors for blood cells. Blood cells are not made up of cytokines, and they do not perform phagocytosis. The presence of antigens, not antibodies, can prompt the expression of certain cytokines.

The nurse's medication reconciliation performed on a patient who is newly admitted to the hospital reveals that he regularly takes infliximab (Remicade), a humanized IgG monoclonal antibody. The nurse is justified in suspecting that this patient may have a history of which of the following? A) Osteoporosis B) Crohn's disease C) Organ transplant D) Severe seasonal allergies

Ans: B Feedback: Infliximab (Remicade) is a humanized IgG monoclonal antibody used to treat rheumatoid arthritis and Crohn's disease.

A 49-year-old patient is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? A) Cancerous cells do not require an energy source in order to proliferate. B) Cancerous cells grow in an uncontrollable fashion. C) Cancerous cells have a theoretically infinite lifespan. D) Cancerous cells are not responsive to the presence of drugs.

Ans: B Feedback: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. They grow in an uncontrolled fashion without regard to growth regulation signals (e.g., contact with other cells) that stop the growth of normal cells. Cancerous cells, like all cells, have a finite lifespan and need energy. Cancerous cells are responsive to drugs; this is the rationale for treatment with antineoplastics.

An obese patient who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by her primary care physician. What do these data suggest in this patient? A) The development of arthritic syndrome B) The development of metabolic syndrome C) The development of Reye's syndrome D) The development of Tay-Sachs disease

Ans: B Feedback: Metabolic syndrome is noted when the patient has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride level and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome. Reye's syndrome is marked by acute encephalopathy and seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurological deterioration in the first year of life.

A patient's current medical condition is suggestive of impaired erythropoiesis. Which of the following laboratory studies would be most clinically relevant in diagnosing this health problem? A) White blood cell count with differential B) RBC, hemoglobin, and hematocrit C) INR and aPTT D) d-dimer and C-reactive protein

Ans: B Feedback: Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration and hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.

A patient is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim (Neupogen) may aid in achieving what desired outcome? A) Resolution of mucositis B) Increased leukocytes C) Increased platelet levels D) Prevention of hemorrhagic cystitis

Ans: B Feedback: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the patient's risk for bleeding.

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen (Nolvadex). The nurse is justified in concluding that the woman has a history of what malignancy? A) Ovarian cancer B) Breast cancer C) Malignant melanoma D) Cervical cancer

Ans: B Feedback: Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor-positive disease.

An adult patient has recently begun cancer treatment with methotrexate (MTX). The nurse is aware of the importance of monitoring the patient closely for adverse effects of treatment. When reviewing this patient's laboratory work, the nurse should consequently prioritize assessment of which of the following? A) Sodium and potassium B) BUN and creatinine C) Calcium and magnesium D) Arterial blood gases

Ans: B Feedback: The antimetabolites may also be nephrotoxic. MTX use in patients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the patient's renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.

Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure? A) Risk for infection related to decreased erythropoiesis B) Activity intolerance related to decreased oxygen-carrying capacity C) Powerlessness-related sequelae of renal failure D) Ineffective breathing pattern related to inadequate erythropoietin synthesis

Ans: B Feedback: The impaired erythropoiesis that accompanies renal failure results in fatigue and decreased stamina, symptoms that can be addressed with the administration of epoetin alfa. Decreased erythropoiesis does not constitute a risk for infection, and the patient may or may not experience feelings of powerlessness. Inadequate erythropoietin synthesis causes impaired oxygenation, but this does not normally manifest as breathing problems.

An adult male patient is being administered immunosuppressant agents on a long-term basis. Which of the following assessments should be made routinely with the use of long-term immunosuppressant therapy? A) Yearly bronchoscopy B) Yearly skin assessment C) Yearly bladder biopsy D) Yearly prostate examination

Ans: B Feedback: The most common malignancies among transplant recipients are skin cancers and lymphomas. The patient should be assessed annually for skin cancer. The patient will not require a yearly bronchoscopy. The patient will not require a yearly bladder biopsy. The male patient should have a yearly prostate examination, but this examination is not required for immunosuppressant therapy.

A patient is being treated with cyclophosphamide (Cytoxan). Which of the following laboratory values should the nurse follow most closely? A) D-dimer B) Complete blood count C) C-reactive protein level D) Arterial blood gases

Ans: B Feedback: The patient's complete blood count should be assessed frequently because of the adverse effect of bone marrow depression. The other listed lab values may be important to assess at different points but are not normally as critical as the CBC.

A patient has an elevated total serum cholesterol of 260 mg/dL. Which of the following aspects of patient teaching of lifestyle changes is most important for the patient? A) Eat organic foods. B) Stop smoking. C) Increase rest periods. D) Drink whole milk.

Ans: B Feedback: Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smoking cessation, change in diet, and drug therapy, are recommended to lower serum cholesterol. The patient with an elevated serum cholesterol should increase exercise and not increase rest periods. The patient should consume low-fat dairy products and avoid whole milk. Organic foods are not specifically recommended.

A patient asks the nurse what dose of acetylsalicylic acid (Aspirin) is needed each day for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation? A) 10 mg B) 30 mg C) 625 mg D) 1000 mg

Ans: B Feedback: A single dose of 300 to 600 mg or multiple doses of 30 mg inhibit cyclooxygenase in circulating platelets almost completely. The dose of 10 mg is too small. The doses of 625 mg and 1000 mg are too large.

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? A) Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. B) Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. C) Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation. D) Antiplatelet agents have fewer adverse effects than anticoagulants.

Ans: B Feedback: Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for DVT prophylaxis? A) The man is morbidly obese. B) The man has a diagnosis of ulcerative colitis. C) The man had a myocardial infarction 18 months ago. D) The man has a diagnosis of type 2 diabetes mellitus.

Ans: B Feedback: GI ulcerations contraindicate the use of heparin. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which of the following statements indicates successful patient teaching? A) "If I miss a dose, I will take two doses." B) "I will avoid herbal remedies." C) "I will eat spinach or broccoli daily." D) "I will discontinue my other medications."

Ans: B Feedback: Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The patient should never double up on dosing related to a missed dose. The patient should avoid green leafy vegetables due to vitamin K. The patient should not discontinue his or her medications.

A patient has a history of clot formation. She is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? A) Acetylsalicylic acid (Aspirin) B) Heparin C) Warfarin (Coumadin) D) Streptokinase (Streptase)

Ans: B Feedback: Prophylactically, low doses of heparin are given to prevent thrombus formation in patients having major abdominal surgery. Acetylsalicylic acid is not used to prevent thrombus in patients having major abdominal surgery. Warfarin takes several days for therapeutic effects to occur; thus it is not used prophylactically to prevent thrombus in a patient with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

A patient has experienced the formation of clots and has bruising. It is determined that there is a depletion of the patient's coagulation factors and widespread bleeding. Which of the following medications will be administered? A) Aminocaproic acid (Amicar) B) Heparin C) Warfarin (Coumadin) D) Protamine sulfate

Ans: B Feedback: The development of clots and widespread bleeding is indicative of disseminated intravascular coagulation. The patient should be administered heparin to slow the formation of clots. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting factors to replenish and control hemorrhage. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Warfarin is administered orally to decrease clot formation. Protamine sulfate would not be administered.

A patient is receiving omalizumab (Xolair) to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab? A) Administer high-flow oxygen prior to administration. B) Avoid high-fat foods during the course of treatment. C) Have epinephrine available during administration. D) Administer a corticosteroid prior to administration.

Ans: C Feedback: Because of the risk of anaphylaxis, the FDA has issued a black box warning for omalizumab. Administration should occur only in a health care setting under direct medical supervision by provider who can initiate treatment of life-threatening anaphylaxis. The patient will not require oxygen therapy with every dose administration. The patient will not need to avoid high-fat foods. The patient will not receive corticosteroid agents.

A patient is administered bevacizumab (Avastin) to treat tumor growth in a breast tumor. What is the action of a monoclonal antibody such as bevacizumab (Avastin)? A) It changes the RNA of the tumor cell to a normal form. B) It binds to the 30S ribosome. C) It prevents the activation of intracellular growth factors. D) It blocks the cell wall synthesis.

Ans: C Feedback: Bevacizumab (Avastin) binds to growth factor receptors found on blood vessels to prevent intracellular growth factors from becoming activated and stimulating cell growth. Bevacizumab does not change the RNA of the tumor cell. Bevacizumab does not bind to the 30S ribosome or block cell wall synthesis.

A transplant nurse is aware of the need to closely monitor a patient's serum levels of cyclosporine. In order to do this, the nurse should ensure that blood is drawn at what time? A) 30 minutes before a scheduled dose B) Simultaneous to the administration of a dose C) 2 hours after a dose D) At the halfway point between two scheduled doses

Ans: C Feedback: Cyclosporine has a very narrow therapeutic index; therefore, prescribers use serum drug levels to regulate cyclosporine dosing, and close monitoring is necessary. They use blood levels measured 2 hours after a dose for dosage adjustments.

A patient is administered methotrexate for the treatment of severe rheumatoid arthritis. Administration of this drug should be performed with particular care because of the associated high risk of A) intracapsular bleeding. B) thrombophlebitis. C) hepatotoxicity. D) myocardial infarction or CVA.

Ans: C Feedback: Even in the low doses used in rheumatoid arthritis and psoriasis, methotrexate may cause hepatotoxicity. Consequently, many clinicians recommend serial liver biopsies for patients on long-term, low-dose methotrexate. This drug is not closely associated with bleeding disorders, MI, or stroke.

A patient is diagnosed with ischemic heart disease. She is prescribed filgrastim (Neupogen). What effect will this medication provide in the treatment of ischemic heart disease? A) Increase platelets B) Decrease platelets C) Promote angiogenesis D) Prevent thrombus formation

Ans: C Feedback: Experts believe that filgrastim promotes the growth of arterioles around blocked areas in coronary arteries. Filgrastim does not increase or decrease platelets. Filgrastim does not prevent thrombus formation.

A patient is scheduled to have her serum triglyceride level assessed. How long should the patient be without food or fluids prior to the serum triglyceride test? A) 6 hours B) 8 to 10 hours C) 12 hours D) 24 hours

Ans: C Feedback: For accurate interpretation of a patient's lipid profile, blood samples for laboratory testing of triglycerides should be drawn after the patient has fasted for 12 hours.

Which of the following is the most likely indication for the use of immunosuppressant agents? A) Intractable seizure disorders B) Increased intracranial pressure C) Organ transplantation D) HIV/AIDS with multiple drug resistance

Ans: C Feedback: Immunosuppressant agents are used for inflammatory autoimmune disorders or to prevent or treat tissue rejection reactions in organ transplantation. Immunosuppressant agents are not administered for seizure disorders, increased intracranial pressure, or HIV/AIDS.

A 69-year-old female patient has been diagnosed with malignant melanoma. The care team has collaborated with the patient and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the patient may develop which of the following adverse effects? A) Profound diaphoresis B) Decreased level of consciousness C) Flu-like symptoms D) Cyanosis and pallor

Ans: C Feedback: In the majority of patients, flu-like symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.

A 32-year-old female patient is being treated with a cytotoxic antineoplastic agent. Which of the following is the most important instruction related to the potential for teratogenicity? A) The medication will be completely eliminated 24 hours after the administration. B) The patient should protect herself from infections and take Bactrim. C) The patient should not become pregnant for several months. D) The patient will not get pregnant due to the elimination of ova.

Ans: C Feedback: Most cytotoxic antineoplastic drugs are potentially teratogenic, and pregnancy should be avoided during and for several months after drug therapy is stopped. The medication is not completely eliminated in 24 hours. The patient should be protected from infection, but this characteristic is not related to pregnancy. The patient can get pregnant after the medication is administered.

A patient has chosen to receive palliative care after his lung cancer metastasized to his bones and liver. Which of the following is most appropriate during palliative cancer care? A) Abrupt cessation of chemotherapy immediately prior to entering palliative care B) Aggressive chemotherapy to reduce malignant cell proliferation C) The use of chemotherapy to reduce pain D) The replacement of chemotherapy with complementary and alternative treatments

Ans: C Feedback: Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context.

Sirolimus and cyclosporine are being used to prevent renal transplant rejection in an adult patient. What principle should guide the nurse's administration of these two drugs? A) Sirolimus should be given orally; cyclosporine should be administered IV. B) The two drugs should be administered together to potentiate their effects. C) The two drugs should be given at least 4 hours apart. D) The drugs should be administered in a single intramuscular injection.

Ans: C Feedback: Sirolimus may have synergistic effects with cyclosporine because it has a different mechanism of action, and prescribers may order both drugs in combination. However, because the two drugs are metabolized by the same liver CYP3A4 enzymes, cyclosporine can increase blood levels of sirolimus, potentially to toxic levels. Consequently, it is essential that the drugs not be given at the same time; patients should take sirolimus 4 hours after a dose of cyclosporine.

A patient has developed a decubitus ulcer on the coccyx. What defense mechanism is most affected by this homeostatic change? A) The mucous membrane is affected. B) The respiratory tract is affected. C) The skin is affected. D) The gastrointestinal tract is affected.

Ans: C Feedback: The body's primary external defense mechanism is intact skin. The development of a decubitus ulcer allows for entry of microbial growth. The mucous membranes, respiratory tract, and gastrointestinal tract are not affected primarily.

A patient is administered mycophenolate (CellCept) to prevent rejection of his transplanted heart. It is recommended that he have a CBC drawn weekly. He asks the nurse the reason for the weekly CBC. Which of the following is the nurse's best response? A) "The weekly CBC is routine and ordered for all patients." B) "The weekly CBC assesses for the development of bleeding." C) "The weekly CBC assesses for the development of infection." D) "The weekly CBC assesses for changes in your blood's oxygen carrying capacity."

Ans: C Feedback: The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia. Stating to the patient that the CBC is routine is a belittling response that does not provide patient education. The weekly CBC is not indicated to assess for bleeding or a decrease in erythrocytes.

A patient is receiving epoetin alfa (Epogen) for anemia. Which of the following adjunctive therapies is imperative with epoetin alfa? A) Potassium supplements B) Sodium restriction C) Iron supplement D) Renal dialysis

Ans: C Feedback: When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness and an iron supplement is usually necessary. It is not necessary to provide the patient with potassium supplements, restrict sodium, or place the patient on renal dialysis.

A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen). Frequent assessment of which of the following laboratory values should be prioritized before and during treatment? A) AST B) C-reactive protein C) CBC D) ALT

Ans: C Feedback: With the use of hematopoietic and immunostimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is less imperative to monitor liver enzymes or CRP levels.

A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) "After a certain period of time, you must start warfarin and heparin together." B) "You will need both warfarin and heparin for several days." C) "Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin." D) "Warfarin cannot be given without heparin due to the amount of clotting you need."

Ans: C Feedback: Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statement "After a certain period of time, you must start warfarin and heparin together" does not explain clearly the reason for the two medications concurrently. The statement "You will need both warfarin and heparin for several days" does not explain clearly the reason for the two medications. The statement "Warfarin cannot be given without heparin due to the amount of clotting you need" is not accurate.

A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored? A) RBC B) aPTT C) PT and INR D) Platelet count

Ans: C Feedback: The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

A patient has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the patient has been prescribed cholestyramine (Prevalite, Questran). What change in this patient's lipid profile will the nurse identify as the most likely goal of therapy? A) Reduction in triglycerides B) Reduction in total serum cholesterol levels C) Increase in HDL levels D) Reduction in LDL cholesterol levels

Ans: D Feedback: Cholestyramine (Prevalite, Questran), the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

A patient with colorectal cancer is being treated with oxaliplatin (Eloxatin). Which of the following potential adverse effects should the nurse explain to the patient? A) Dysuria B) Diarrhea C) Insomnia D) Cold-induced neuropathy

Ans: D Feedback: Cold-induced neuropathy is an adverse effect of oxaliplatin. Dysuria, diarrhea, and insomnia are not closely associated with Eloxatin.

An oncology nurse is reviewing the medication administration record of a patient being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the patient has been ordered a cytoprotective agent. The goal of this agent is to A) buffer the cytotoxins that result from the metabolism of chemotherapeutic agents. B) protect the patient from pathophysiological effects of his malignancy. C) potentiate the beneficial effects of chemotherapy. D) reduce the incidence or severity of adverse drug effects.

Ans: D Feedback: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the patient from the effects of cancer, or buffer cytotoxins.

Mr. Burris is a 66-year-old man who leads a sedentary lifestyle and who has recently been diagnosed with dyslipidemia. Mr. Burris is disappointed to learn of this apparent deterioration in his health, stating, "First it was the diabetes and then the arthritis, now this." The nurse has performed health education with Mr. Burris and has described metabolic syndrome. In addition to his elevated cholesterol levels, what aspect of Mr. Burris' health is congruent with a diagnosis of metabolic syndrome? A) Sedentary lifestyle B) Age over 65 coupled with male gender C) Arthritis D) Diabetes mellitus

Ans: D Feedback: Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascular risk factors linked with obesity: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Age, gender, and joint disorders are not among these criteria.

A patient with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will administered by the patient at home. Which of the following statements indicates that the nurse's initial health education has been successful? A) "I'll make sure to take my Epogen pill on a strict schedule and make sure I never miss a dose." B) "I'm glad that Epogen can help to protect me from getting an infection." C) "I'm excited that there's a medication that can help my kidneys work better." D) "I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn."

Ans: D Feedback: Epogen is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epogen does not enhance immune function.

A patient with a diagnosis of cardiovascular disease is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a patient taking atorvastatin calcium (Lipitor)? A) 100 to 115 mg/dL B) 75 to 85 mg/dL C) Less than 60 mg/dL D) Less than 100 mg/dL

Ans: D Feedback: In patients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 100 mg/dL.

Which of the following patients would likely be the most appropriate candidate for treatment with filgrastim (Neupogen)? A) A patient who has undergone a mastectomy for the treatment of breast cancer B) A patient with acquired immune deficiency syndrome (AIDS) who has been diagnosed with Kaposi's sarcoma C) A patient who developed acute renal failure secondary to rhabdomyolysis D) A patient whose acute myelogenous leukemia necessitated a bone marrow transplant

Ans: D Feedback: Indications for filgrastim include preventing infection in patients with neutropenia induced by cancer chemotherapy or bone marrow transplantation. Surgical patients, patients with AIDS, and patients with renal failure are not typically treated with G-CSFs.

A 50-year-old man has just been diagnosed with liver cancer, and the care team is finalizing the chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which of the following? A) An intramuscular depot B) A peripheral IV in the nondominant forearm C) Peripheral intravenous access in the antecubital fossa D) A central venous catheter

Ans: D Feedback: Insertion of an indwelling central venous catheter is often appropriate for patients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. Overall, a CVC is preferable to peripheral access. IM administration is uncommon.

A patient is exposed to a viral infection. What role will interferon most likely play during this exposure? A) It will stimulate B-lymphocyte activity. B) It will interfere with stem cell multiplication. C) It will stimulate growth of lymphoid cells. D) It will interfere with virus replication.

Ans: D Feedback: Interferons interfere with the ability of viruses in infected cells to replicate and spread to uninfected cells. Interferons will not stimulate B-lymphocyte activity, stem cell multiplication, or growth of lymphoid cells.

A patient is receiving immunosuppressant therapy and is preparing for discharge. For which of the following should the patient be educated? A) The importance of a high-protein diet B) The need to maximize fluid intake C) The need for regular physical activity D) The importance of keeping the home clean

Ans: D Feedback: Meticulous environmental cleansing and personal and hand hygiene will protect from the development of serious infection. The importance of this infection control measure is greater than that of dietary or exercise guidelines.

A patient's chemotherapy regimen has been deemed successful, but the patient is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? A) Acute pain B) Adult failure to thrive C) Ineffective therapeutic regimen management D) Imbalanced nutrition: less than body requirements

Ans: D Feedback: Nausea and vomiting are major threats to the patient's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this patient is not maintaining the necessary regimen.

A patient is undergoing a bone marrow transplant. Which of the following medications is most effective in stimulating the production of granulocytes and macrophages? A) Bacillus Calmette-Guérin (BCG) B) Epoetin alfa (Epogen) C) Aldesleukin (Proleukin) D) Sargramostim (Leukine)

Ans: D Feedback: Sargramostim (Leukine) is a formulation of granulocyte colony-stimulating factor (GCSF) and granulocyte macrophage colony-stimulating factor (GM-CSF). Bacillus Calmette-Guérin is a vaccine used to treat bladder cancer. Epoetin alfa stimulates bone marrow production of red blood cells. Aldesleukin (Proleukin) is a recombinant DNA version of interleukin-2. It activates cellular immunity.

A patient develops tumor lysis syndrome during the administration of chemotherapy agents. Which of the following treatments is implemented to resolve this health problem? A) Administration of potassium IV B) Administration of anti-inflammatory agents C) Limiting of fluid intake and reduction in IV fluid rate D) Administration of IV normal saline and sodium bicarbonate

Ans: D Feedback: The patient experiencing lysis syndrome should receive regular insulin and IV sodium bicarbonate. The patient suffers from hyperkalemia and should not be administered potassium. The patient would not be administered anti-inflammatory agents. The patient should be aggressively hydrated and thus should not have fluids limited or decreased.

A patient has been discharged from the hospital after a kidney transplant. Which of the following nursing interventions is the first line of defense against the immunosuppressed patient developing an infection? A) Ensure visitors do not come to the home. B) Teach the patient to wear a mask consistently. C) Administer prophylactic antibiotics. D) Teach the patient the importance of personal hygiene.

Ans: D Feedback: With patients who are taking immunosuppressant drugs, a major role of the home care nurse is to assess the environment for potential sources of infection, assist patients and other members of the household to understand the patient's susceptibility to infection, and teach ways to decrease risks of infection. Meticulous environmental cleansing as well as personal and hand hygiene are required. Visitors do not necessarily need to be wholly barred from the home, and a mask is not always required. Prophylactic antibiotics are not normally used.

A patient has undergone an aggressive chemotherapeutic regimen to treat leukemia. The patient develops gastrointestinal upset, hypertension, and paresthesias. What syndrome is the patient developing? A) Fröhlich's syndrome B) Epidermal nevus syndrome C) Irritable bowel syndrome D) Tumor lysis syndrome

Ans: D Feedback: With the treatment of leukemias and lymphomas, a serious, life-threatening adverse effect called tumor lysis syndrome may occur. This syndrome occurs when large numbers of cancer cells are killed or damaged, releasing their contents into the blood stream. The patient may have metabolic imbalances, which include gastrointestinal upset, hypertension, and paresthesias. Fröhlich's syndrome is noted in adolescent boys who have an increase in fat and atrophy of the genitals. Epidermal nevus syndrome is associated with multiple nevi. Irritable bowel syndrome is marked by abdominal pain and disturbances of evacuation.

A patient is prescribed eptifibatide (Integrilin), which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which of the following syndromes are treated with eptifibatide? A) Blocked carotid arteries B) Intermittent claudication C) Hypertension D) Unstable angina

Ans: D Feedback: Eptifibatide (Integrilin) inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Eptifibatide is used for acute coronary syndromes, including unstable angina, myocardial infarction, and non-Q wave MI. Blocked carotid arteries, intermittent claudication, and hypertension are not treated with eptifibatide.

A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel (Plavix). The nurse is most justified is suspecting that this man has a history of A) hemorrhagic cerebrovascular accident. B) hemophilia A. C) idiopathic thrombocytopenic purpura (ITP). D) myocardial infarction.

Ans: D Feedback: Indications for use of Plavix include reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet? A) Eggs B) Dairy products C) Apples D) Spinach

Ans: D Feedback: Spinach is a green leafy vegetable that is high in vitamin K and will interact to prevent adequate levels of anticoagulant therapy. Eggs, dairy products, and apples are not contraindicated with warfarin.

A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain? A) Joint thrombosis B) Torn medial meniscus C) Degenerative joint disease caused by her medication D) Bleeding

Ans: D Feedback: The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

A 71-year-old woman has experienced a sharp decline in her mobility and quality of life due to severe rheumatoid arthritis. As a result, her care provider has recently prescribed abatacept (Orencia). This fusion protein inhibitor will achieve a therapeutic effect by what means? A) Preventing the activation of T cells B) Increasing antibody production by B cells C) Antagonizing histamine receptors D) Inhibiting the production of mast cells

Ans: A Feedback: Abatacept (Orencia) is a fusion protein inhibitor synthesized from an IgG antibody fused to a cell protein that binds to antigen-presenting molecules. This action prevents the activation of T lymphocytes and the production of inflammatory cytokines. Abatacept does not increase antibody production, antagonize histamine receptors, or inhibit mast cell production.

A patient is to begin treatment for rheumatoid arthritis with infliximab (Remicade). What potential risk should the nurse identify as being associated with this drug? A) Risk for infection B) Risk for decreased level of consciousness C) Risk for nephrotoxicity D) Risk for hepatotoxicity

Ans: A Feedback: All TNF-alpha blockers carry a risk for infection. This risk supersedes the risks of kidney or liver damage. Changes in LOC are not typically noted.

An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which of the following measures best protects the nurse from harm related to the chemotherapy? A) Wearing protective equipment B) Performing thorough hand hygiene C) Mixing medication in a 1000-mL bag D) Administering medication intramuscularly whenever possible

Ans: A Feedback: Because of the drugs' toxicity, nurses who administer IV cytotoxic chemotherapy should be specially trained to administer the medications safely and use protective equipment when handling the medication. Hand hygiene is important during care but will only minimally protect from harm. The medication is mixed in a variety of solutions and amounts. The medication is not normally administered intramuscularly.

Which single drug class is known to be most effective in reducing the major types of dyslipidemia? A) Statins B) Bile acid sequestrants C) Fibrates D) Niacin

Ans: A Feedback: For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

A patient has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the patient that cancer is essentially a result of the disruption of the A) cell cycle. B) cell wall. C) lymphatic system. D) immune system.

Ans: A Feedback: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. In essence, the cell cycle has been pathologically disrupted.

A patient has been reading about the use of flax seed to lower cholesterol. What should the patient be taught about the use of flax seed and cholestyramine (Questran)? A) Cholestyramine absorption will be increased with flax seed. B) Cholestyramine absorption will be decreased with flax seed. C) Bleeding will be increased with flax seed and cholestyramine. D) Hypoglycemia will result from flax seed and cholestyramine.

Ans: B Feedback: Absorption of cholestyramine is decreased with flax seed. Bleeding is not increased with flax seed and cholestyramine. Hypoglycemia will not result from flax seed and cholestyramine.

A 66-year-old woman's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The woman is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin (Lipitor). The nurse should anticipate what order? A) "Lipitor 150 mg PO BID" B) "Lipitor 10 mg PO OD" C) "Lipitor 50 mg PO TID with meals" D) "Lipitor 75 mg PO BID"

Ans: B Feedback: Lipitor is normally administered PO 10 to 80 mg daily in a single dose.

A patient is administered cyclosporine (Sandimmune, Neoral) to prevent rejection of a kidney transplant. Which of the following is a major adverse effect of cyclosporine? A) Congestive heart failure B) Nephrotoxicity C) Anaphylaxis D) Respiratory arrest

Ans: B Feedback: The major adverse effect of cyclosporine is nephrotoxicity. Congestive heart failure is not noted as an adverse effect of cyclosporine. Anaphylaxis and respiratory arrest are not common adverse effects of cyclosporine.

A patient who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medication regimen? A) Digoxin (Lanoxin) B) Vitamin D C) Cholestyramine (Questran) D) Calcium carbonate

Ans: C Feedback: Cholestyramine is administered to patients to reduce LDL cholesterol in patients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.

A 74-year-old male patient is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The patient's wife has been participating actively in his care and performs much of his feeding and hygiene. This evening, the patient's wife has brought in a number of healthy snacks to keep at his bedside. Knowing that the patient's medication regimen includes simvastatin, the nurse would remove which of the following items? A) Purple grapes B) Cranberry cocktail C) Grapefruit juice D) Trail mix (salted nuts and seeds)

Ans: C Feedback: It is important to avoid taking simvastatin with grapefruit juice. None of the other listed foods is contraindicated.

A 50-year-old male is admitted to the emergency room with a head injury after a motorcycle crash. He is unconscious with one eye dilated and one constricted. He has a widened pulse pressure. What corticosteroid will most likely be administered parenterally? A) Cortisone B) Prednisone C) Dexamethasone (Decadron) D) Fluticasone (Flonase)

Ans: C Feedback: Dexamethasone is considered the corticosteroid of cerebral edema. It is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluid. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Fluticasone (Flonase) is administered by oral inhalation.

An adult patient has been taking oral prednisone for the treatment of an acute dermatological condition. When teaching this patient about this course of treatment, what teaching point should the nurse emphasize? A) The need to supplement prednisone with high doses of vitamin D B) The need to avoid drinking grapefruit juice for the duration of treatment C) The importance of gradually reducing rather than abruptly stopping the drug D) The importance of matching each day's dose to the severity of symptoms

Ans: C Feedback: Gradually tapering the dose is necessary for any systemic corticosteroid. It is not imperative to avoid grapefruit juice or take vitamin D supplements. Daily doses are not normally adjusted on the basis of short-term symptoms.

A patient is in the admission department prior to outpatient surgery, and she states that she is exceptionally nervous. Which of the following actions increases this patient's stress-related release of cortisol? A) Negative feedback mechanism B) Stimulation of the hypothalamus C) Release of epinephrine and norepinephrine D) Atrophy of the adrenal cortex

Ans: C Feedback: The stress response activates the sympathetic nervous system to produce more epinephrine and norepinephrine and the adrenal cortex to produce as much as 10 times the normal amount of cortisol. The negative feedback mechanism does not accelerate the stress response. Cortisol production is not based on the stimulation of the hypothalamus. The stress response will not cause atrophy of the adrenal cortex.

A patient is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this patient? A) The two medications should be taken together. B) The ezetimibe inhibits cholesterol in the liver. C) The cholestyramine (Questran) is administered 1 hour after ezetimibe. D) The administration of ezetimibe (Zetia) is 2 hours before cholestyramine.

Ans: D Feedback: Ezetimibe (Zetia) should be taken 2 hours before or 4 hours after a bile acid sequestrant. The two medications should not be taken together. Ezetimibe acts in the small intestine to inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol in the liver. They do not inhibit the absorption of cholesterol. Cholestyramine should not be administered 1 hour after ezetimibe.

A patient with Crohn's disease is given a corticosteroid to decrease inflammation. Which of the following effects will occur with the use of corticosteroids? A) Increased joint pain B) Increased C-reactive protein levels C) Increased T-cell counts D) Decreased antibody production

Ans: D Feedback: The administration of corticosteroids will decrease T-cell and antibody production. Corticosteroids do not cause joint pain or increase a patient's C-reactive protein levels.

A 79-year-old woman has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the STAT administration of what drug? A) Low molecular weight heparin B) Vitamin K C) Clopidogrel (Plavix) D) Alteplase (Activase)

Ans: D Feedback: Alteplase (Activase) is used as first-line therapy for the treatment of acute ischemic stroke in selected people. Vitamin K would exacerbate the woman's symptoms, and LMWH and Plavix would be ineffective.

A patient is admitted to a neurological unit with a confirmed cerebrovascular bleed. Which of the following medications used to treat inflammation is contraindicated in this patient? A) Furosemide (Lasix) B) Hydrochlorothiazide with triamterene C) Digoxin (Lanoxin) D) Ketorolac (Toradol)

Ans: D Feedback: Ketorolac (Toradol) should not be administered to a patient with a suspected or confirmed cerebrovascular bleed. Furosemide (Lasix) is administered to reduce fluid volume and is not administered to treat inflammation. Hydrochlorothiazide with triamterene is administered to reduce fluid volume and is not administered to treat inflammation. Digoxin (Lanoxin) is administered to increase cardiac output, not to treat inflammation.

A male patient has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply. A) Statins are nephrotoxic. B) Statins are expensive. C) Statins are contraindicated in patients with a history of myocardial infarction. D) Statins require regularly scheduled blood work. E) Statins have an immunosuppressive effect.

15. A male patient has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply. A) Statins are nephrotoxic. B) Statins are expensive. C) Statins are contraindicated in patients with a history of myocardial infarction. D) Statins require regularly scheduled blood work. E) Statins have an immunosuppressive effect.

An elderly patient with dyslipidemia has had fenofibrate (TriCor) added to her existing medication regimen. In addition to having her lipid profile drawn on a regular basis, the nurse should educate the patient about the need for what ongoing laboratory testing during therapy? A) Complete blood count (CBC) B) Liver panel C) INR and aPTT D) Reticulocyte count

20. An elderly patient with dyslipidemia has had fenofibrate (TriCor) added to her existing medication regimen. In addition to having her lipid profile drawn on a regular basis, the nurse should educate the patient about the need for what ongoing laboratory testing during therapy? A) Complete blood count (CBC) B) Liver panel C) INR and aPTT D) Reticulocyte count

A patient is to be administered antithymocyte globulin (ATG) to treat renal transplant rejection. What skin test should be assessed prior to the administration of the first dose of medication? A) Allergy to horse serum B) Allergy to ragweed C) Allergy to dust mites D) Tuberculosis

Ans: A Feedback: Antithymocyte globulin is obtained from horse serum, and, prior to administration, the patient should be tested for allergy to horse serum. The patient will not need to be assessed for allergy to ragweed. The patient will not be assessed for an allergy to dust mites. The patient will not be assessed for tuberculosis.

A patient is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse? A) Give the next two doses at the same time. B) Give the dose and chart the patient response. C) Check the patient's vital signs and give the dose. D) Hold the dose and call the aPTT result to the physician's attention.

Ans: D Feedback: The normal control value is 25 to 35 seconds; therefore, therapeutic values are 45 to 70 seconds, approximately. A result of 92 seconds is a risk for bleeding, and the dose should be held until approval to administer is provided by the physician. The nurse should not give the next two doses at the same time. The nurse should not give the dose and document the patient's response. The nurse should not check the patient's vital signs and give the dose.

A patient is taking cholestyramine (Questran) to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which of the following medications? A) Digoxin (Lanoxin) B) Ibuprofen (Motrin) C) Aspirin D) Acetaminophen (Tylenol)

Ans: A Feedback: Bile acid sequestrants may decrease absorption of digoxin (Lanoxin). Cholestyramine will not decrease the ibuprofen, aspirin, or acetaminophen.

A patient has begun taking cholestyramine. Which of the following are noted as the most common adverse effects? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Fatigue and mental disorientation D) Hiccups, nasal congestion, and dizziness

Ans: A Feedback: Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem.

A patient has a low erythrocyte count. How may a colony-stimulating factor affect the patient's erythrocyte count? A) It stimulates growth of red blood cells. B) It suppresses T-cell production. C) It inhibits protein synthesis. D) It stimulates antibody production.

Ans: A Feedback: Colony-stimulating factors stimulate the production of red blood cells, platelets, granulocytes, granulocyte-macrophages, and monocyte-macrophages. Colony-stimulating factors will not suppress the T-cell production, inhibit protein production, or stimulate antibody production.

Which of the following is the antidote for acetaminophen (Tylenol) poisoning? A) Acetylcysteine (Mucomyst) B) Allopurinol (Zyloprim) C) Diclofenac sodium (Voltaren) D) Ketorolac (Toradol)

Ans: A Feedback: A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.

A patient is to be discharged on prednisone to be administered every other day at 9:00 AM. When implementing discharge teaching, what should the nurse explain as the rationale for giving the medication every other day? A) It reduces adverse effects. B) It prolongs therapeutic effects. C) It prevents steroid tolerance. D) It increases effectiveness.

Ans: A Feedback: Alternate-day therapy allows rest periods so that adverse effects are decreased. Alternative-day therapy will not prolong the therapeutic effects, prevent steroid tolerance, or increase effectiveness.

An adult patient is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this patient about the appropriate use of corticosteroids, the nurse should include what teaching point? A) "You will likely gain some weight after you start taking this drug." B) "Try to eat as many organic and natural foods as possible while taking this drug." C) "You might have some slight bleeding in your stool after you start this drug." D) "Ensure that you vary the times that you take your drug in order to maximize effectiveness."

Ans: A Feedback: An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected.

A patient is administered acetylsalicylic acid (aspirin) for fever and headache. What is the action of acetylsalicylic acid (aspirin)? A) Inhibiting prostaglandin synthesis in the central and peripheral nervous system B) Providing selective action by inhibiting prostaglandin synthesis in the CNS C) Inhibiting the release of norepinephrine to increase blood pressure D) Suppressing the function of the hypothalamus to decrease inflammation

Ans: A Feedback: Aspirin inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation.

A 12-year-old boy was recently diagnosed with asthma, and his primary care provider has prescribed a corticosteroid to be administered by metered-dose inhaler. This drug achieves a therapeutic effect by which of the following means? A) By increasing the number of beta-adrenergic receptors B) By increasing the muscle tone in the smooth muscle of the trachea C) By increasing the permeability of the alveolar membrane D) By increasing the number of binding sites on erythrocytes

Ans: A Feedback: Corticosteroids increase the number of beta-adrenergic receptors and increase or restore responsiveness of beta receptors to beta-adrenergic bronchodilating drugs. They do not influence the permeability of alveoli, muscle tone, or the structure of red blood cells.

A patient is being treated with corticosteroids for chronic adrenocortical insufficiency. When should the patient be instructed to take the medication? A) Between 06:00 and 09:00 B) 12:00 C) Between 13:00 and 14:00 D) 21:00

Ans: A Feedback: Daily administration of corticosteroids is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00 AM. This schedule stimulates normal endogenous corticosteroid secretion.

A patient is seen in the primary care provider's office with complaints of polydipsia and polyuria without polyphagia. He has very edematous ankles, and his blood pressure is elevated. From which disorder of the adrenal cortex is the patient suffering? A) Hyperaldosteronism B) Adrenocortical hyperfunction C) Androgen-producing tumors D) Adrenal hyperplasia

Ans: A Feedback: Hyperaldosteronism is characterized by hypokalemia, hypernatremia, hypertension, thirst, and polyuria. Adrenocortical hyperfunction causes the secretion of several corticosteroids. Androgen-producing tumors of the adrenal cortex, which are usually benign, produce masculinizing effects. Adrenal hyperplasia results from deficiencies in one or more enzymes required for cortisol production.

A child is prescribed therapy with glucocorticoids. The child is placed on alternate-day therapy. What is the advantage of alternate-day therapy in this child? A) The child will have less chance of infection. B) It will protect the child from hyperglycemia. C) The child will have less chance of hypertension. D) Adherence will be increased.

Ans: A Feedback: Intermediate-acting glucocorticoids are the drugs of choice for alternate-day therapy and will decrease the susceptibility of infection. Alternative-day therapy will not protect from hyperglycemia. Alternate-day therapy will not affect blood pressure. Alternate-day therapy is not used as a strategy for improving adherence

A patient suffers from gouty arthritis. Why is probenecid (Benemid) administered? A) To increase urinary excretion of uric acid B) To decrease the level of liver enzymes C) To diminish the temperature D) To increase protein metabolism

Ans: A Feedback: Probenecid (Benemid) increases the urinary excretion of uric acid. Probenecid (Benemid) will not decrease the level of liver enzymes, diminish temperature, or increase protein metabolism.

A perinatal nurse is preparing a dose of IV indomethacin for administration to a neonate. What is the most plausible indication for this treatment? A) Patent ductus arteriosus B) Tetralogy of Fallot C) Patent foramen ovale D) Cardiomyopathy

Ans: A Feedback: The FDA has approved IV indomethacin for treatment of patent ductus arteriosus in premature infants.

A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees and elbows with pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process? A) Prostaglandin inhibition is limited to the central nervous system. B) Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. C) Acetaminophen has an antiplatelet effect to decrease edema. D) Prostaglandins decrease the gastric acid secretion.

Ans: A Feedback: The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

A patient with a diagnosis of breast cancer is administered a corticosteroid in addition to chemotherapy agents. What effect will the corticosteroids have on this patient's course of recovery? A) The corticosteroid will decrease signs and symptoms of cancer. B) The corticosteroid will alter the action of the chemotherapy agent. C) The corticosteroid will decrease metastasis to distant sites. D) The corticosteroid will decrease hepatic effects of the chemotherapy.

Ans: A Feedback: The administration of corticosteroid agents in cancer will assist in decreasing symptoms associated with cancer. The administration of the corticosteroid will not alter the action of the chemotherapy agent. The corticosteroid will not affect metastasis. The corticosteroid will not decrease hepatic effects.

A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A) 80 mg B) 180 mg C) 325 mg D) 650 mg

Ans: A Feedback: The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 80 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.

A 71-year-old woman with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) has begun tapering off of prednisone. The nurse should prioritize which of the following assessments during this phase of the woman's care? A) Daily weights B) Level of consciousness assessment C) Nonstress cardiac testing D) Positional blood pressure measurement

Ans: A Feedback: When caring for a patient with COPD and a history of heart failure who takes a tapering dose of prednisone, it is necessary to instruct the patient to check his or her weight daily. The patient should also assess his or her extremities for edema. If the patient's weight increases, edema is evident, and shortness of breath develops, the patient should notify the primary health provider. This potential alteration in fluid balance is more likely than blood pressure changes, decreased LOC, or acute cardiac changes.

A nurse is conducting a medication reconciliation for a 79-year-old man who has just relocated to the long-term care facility. The nurse notes that the man has been taking colchicine (Colcrys) on a regular basis. This aspect of the man's medication regimen should signal the nurse to the possibility that he has a diagnosis of A) osteoarthritis. B) gout. C) inflammatory bowel disease. D) bursitis or tendonitis.

Ans: B Feedback: Colchicine (Colcrys), the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medication. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis.

A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)? A) Nephrotoxicity B) Hepatotoxicity C) Pulmonary insufficiency D) Pancreatitis

Ans: B Feedback: In acute or chronic overdose of acetaminophen (Tylenol), the patient can develop hepatotoxicity. Nephrotoxicity is not an adverse effect associated with Tylenol overdose. Pulmonary insufficiency is not an adverse effect associated with Tylenol overdose. Pancreatitis is not an adverse effect associated with Tylenol overdose.

A child has symptoms of influenza, including a fever. Which of the following medications should not be administered to the child because of the risk of Reye's syndrome? A) Acetaminophen (Tylenol) B) Acetylsalicylic acid (aspirin) C) Ibuprofen (Motrin) D) Ascorbic Acid (vitamin C)

Ans: B Feedback: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen (Tylenol) and ibuprofen (Motrin) are safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children but is not used to reduce fever or pain.

A patient is allergic to acetylsalicylic acid (aspirin). Which of the following medications is contraindicated due to cross-hypersensitivity reactions? A) Acetaminophen (Tylenol) B) Naproxen sodium (Naprosyn) C) Morphine sulfate (MS Contin) D) Naloxone (Narcan)

Ans: B Feedback: In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. Acetaminophen (Tylenol) does not have cross-sensitivity with acetylsalicylic acid (aspirin) because it is not an NSAID. Morphine sulfate (MS Contin) does not have a cross-sensitivity to aspirin because it is an opioid, not an NSAID. Naloxone (Narcan) is an opioid antagonist and does not have cross-sensitivity with aspirin.

A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of salicylate overdose? A) Intravenous meperidine (Demerol) B) Intravenous sodium bicarbonate C) Intravenous furosemide (Lasix) D) Inhaled acetylcysteine (Mucomyst)

Ans: B Feedback: Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted in patients with salicylism.

A patient is taking ibuprofen (Motrin) for knee pain. The patient is admitted to the hospital with abdominal pain. Which of the following assessments should the nurse prioritize? A) Assessment for diarrhea B) Assessment for occult blood in the patient's stool C) Assessment of the patient's urine for hematuria D) Assessment for hemoptysis

Ans: B Feedback: Nonsteroidal anti-inflammatory agents that block COX-1 and COX-2 place the patient at risk for gastrointestinal bleed. Patients who have symptoms of abdominal pain and are taking NSAIDs should be assessed for signs and symptoms of gastrointestinal bleed. Assessing the patient for diarrhea is not related to ibuprofen (Motrin) administration. Assessing the patient for hematuria or hemoptysis is not a priority.

A patient suffers from pain in the elbow related to inflammation. What are the chemical mediators of inflammation? A) Insulin, thyroid hormone, and calcitonin B) Bradykinin, histamine, and leukotrienes C) Phospholipids, arachidonic acid, and platelets D) Red blood cells, lymph, and serosa

Ans: B Feedback: Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes. Insulin, thyroid hormone, and calcitonin are not chemical mediators of inflammation. Phospholipids, arachidonic acid, and platelets are not chemical mediators of inflammation. Red blood cells, lymph, and serosa are not chemical mediators of inflammation.

A patient enters the emergency room with complaints of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to which of the following? A) Acute acetaminophen toxicity B) Salicylism C) Ibuprofen overdose D) Caffeine overdose

Ans: B Feedback: Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.

A patient is admitted with an acute asthma attack. He has been using inhaled corticosteroids two times daily. Based on this information in the patient's history, what should you anticipate will be required in his care? A) The patient will require an antibiotic to treat infection. B) The patient will require high doses of systemic drugs. C) The patient will need to be treated with an oral opioid. D) The patient will have diminished tidal volume after treatment.

Ans: B Feedback: The patient who has taken inhaled steroids will require high doses of systemic drugs during acute attacks because aerosols are not effective. The patient will only require antibiotics in the presence of infection. The patient's tidal volume should be increased with the administration of systemic corticosteroids. Opioids are not likely indicated.

A patient has a tumor of the spinal cord and is administered a corticosteroid. What statement by the patient demonstrates an accurate understanding of this treatment? A) "This drug will cause my tumor to be more susceptible to treatment." B) "This drug will decrease my chance of infection and meningitis." C) "This drug won't cure my cancer, but it may help me feel much better." D) "This drug will stop my cancer cells from growing further."

Ans: C Feedback: Patients tend to feel better when taking corticosteroids, although the basic disease process may be unchanged. The corticosteroid will not allow the tumor to be more susceptible to treatment. The corticosteroid will not prevent meningitis.

A patient is diagnosed with an adrenal tumor. With which of the following abnormalities of the adrenal gland will the patient most likely be diagnosed? A) Primary adrenocortical insufficiency B) Secondary adrenocortical insufficiency C) Adrenocortical hyperfunction D) Hyperaldosteronism

Ans: C Feedback: Adrenocortical hyperfunction (Cushing's disease) may be a result of a primary adrenal tumor. Primary adrenocortical insufficiency is associated with destruction of the adrenal cortex by disorders such as tuberculosis, cancer, or hemorrhage. Secondary adrenocortical insufficiency is produced by inadequate secretion of corticotropin. Hyperaldosteronism is a rare disorder caused by adenoma or hyperplasia of the adrenal cortex cells that produce aldosterone.

A patient has long-standing pain in her right hip, and the orthopedic surgeon has prepared an intra-articular injection. How long will it take for the patient to see improvement in her pain and mobility? A) Approximately 10 days B) 1 to 3 weeks C) 2 to 8 weeks D) 1 to 4 months

Ans: C Feedback: An intra-articular injection of corticosteroid provides decreased pain and improved movement in 2 to 8 weeks.

A patient is suffering from bursitis in the right elbow. Which of the following orally administered medications is most likely to diminish inflammation and assist in relieving pain? A) Acetaminophen (Tylenol) B) Morphine sulfate C) Acetylsalicylic acid (aspirin) D) Codeine

Ans: C Feedback: Aspirin is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders. Aspirin is administered orally. Acetaminophen (Tylenol) will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation.

A patient is diagnosed with familial adenomatous polyposis. Which of the following nonsteroidal anti-inflammatory agents has the potential to reduce the number of polyps and decrease the risk of colon cancer? A) Ibuprofen (Motrin) B) Nabumetone (Relafen) C) Celecoxib (Celebrex) D) Probenecid (Benemid)

Ans: C Feedback: Celecoxib (Celebrex), a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen (Motrin) and nabumetone (Relafen) are not recommended for use in preventing familial adenomatous polyposis. Probenecid (Benemid) is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.

A patient with osteoarthritis has been prescribed meloxicam (Mobic). Which of the following instructions should the patient be given? A) Take the medication with orange juice. B) Crush enteric-coated tablets to aid swallowing. C) Take the medication with food. D) Take the medication at bedtime.

Ans: C Feedback: Meloxicam should be taken with food. Enteric-coated tablets are never crushed, and it is not always necessary to take this medication at bedtime. Orange juice is not of particular benefit.

An elderly patient has taken ibuprofen (Motrin) 800 mg two times per day for the past 3 years. Which of the following laboratory tests is the priority assessment? A) Renin and aldosterone levels B) 24-hour urine for microalbumin C) Blood urea nitrogen and serum creatinine D) Complete blood count

Ans: C Feedback: Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The patient should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen. A complete blood count may not be necessary.

A patient has questioned why she cannot stop taking her prescribed corticosteroid as soon as she achieves relief of her symptoms. The nurse should explain the rationale for the patient's regimen based on which of the following? A) The serum half-life of many corticosteroids can exceed 3 months. B) Corticosteroids are sequestered in hepatocytes and released over several weeks. C) The HPA axis does not normally resume full function for several months. D) Abrupt cessation of corticosteroid therapy can cause nephrotoxicity.

Ans: C Feedback: When steroids are given for purposes other than replacement and then discontinued, the HPA axis usually recovers within several weeks to months, but recovery may take a year. The necessity for tapering is not based on the half-life of the drugs, storage in the liver, or the potential for nephrotoxicity.

When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A) Inflammation is relieved. B) Core body temperature is reduced. C) Pain is relieved. D) Platelet aggregation is inhibited.

Ans: D Feedback: At low doses, aspirin blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet.

A patient is receiving hydrocortisone 40 mg PO daily for treatment of severe autoimmune inflammation. Which of the following nursing interventions is most important to implement? A) Increase dietary sodium. B) Limit dietary protein. C) Assess BUN and creatinine regularly. D) Implement infection control measures.

Ans: D Feedback: Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the patient should limit dietary sodium due to fluid retention. The patient should maintain a diet high in protein. The patient should not alter fluid intake unless the patient shows signs of fluid volume overload. Renal function may or may not be an assessment priority.

A patient who is receiving chemotherapy is administered a corticosteroid agent. What is the mostly likely intended effect of this drug administration? A) Increased pulmonary function B) Decreased diarrhea C) Decreased infection susceptibility D) Decreased nausea

Ans: D Feedback: Corticosteroids have strong antiemetic effects; the mechanism is unknown. Corticosteroids diminish pulmonary inflammation, but this reaction is not related to chemotherapy administration. The administration of corticosteroids will decrease gastric inflammation but will not decrease diarrhea. The administration of corticosteroids will diminish the patient's ability to fight infection.

A male patient has been on chronic corticosteroid therapy for several years and has been scheduled for a colonoscopy. How should the patient's corticosteroid therapy be altered to accommodate this impending stressful event? A) The patient should stop taking the corticosteroid 7 days prior to the procedure. B) The patient should continue taking the regular dose of his corticosteroid. C) The patient should temporarily change to IV administration of his corticosteroid. D) The patient should temporarily take a higher dose of his corticosteroid.

Ans: D Feedback: For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. Some common sources of stress for most people include surgery and anesthesia, infections, anxiety, and extremes of temperature.

A 22-year-old male patient has been living with Crohn's disease for several years and is experiencing an exacerbation of symptoms. The nurse should anticipate the use of what corticosteroid? A) Oral fludrocortisone (Florinef) B) Topical hydrocortisone C) Oral dexamethasone (Decadron) D) Oral prednisone

Ans: D Feedback: In moderate Crohn's disease, oral prednisone, 40 mg daily, is usually given until symptoms subside. The other listed corticosteroids are not normally used in the treatment of IBD.