D116 Comprehensive assessment with explanations
A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse Practitioner?
"I may continue to have a glass of wine with dinner." Feedback: Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose
A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects?
"I need to take it every day to reduce the frequency of migraines." Feedback: When taken prophylactically, medications such as beta blockers can reduce the frequency of migraine attacks. They do not provide complete relief from migraines. They do not reduce the duration of migraines. They are not effective for treating a migraine once the migraine has begun
A nurse Practitioner is teaching a patient who will begin taking methimazole [Tapazole] for Graves disease about the medication. Which statement by the patient indicates understanding of the teaching?
"I should report a sore throat or fever to my provider if either occurs." Feedback: Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection, such as a sore throat or fever. Liver toxicity is not a side effect, so liver function tests are not indicated. Because agranulocytosis often develops rapidly, periodic blood counts do not guarantee early detection. Methimazole is contraindicated in the first trimester of pregnancy
The FNP has recommended a bulk-forming laxative for occasional constipation.Which statement by the patient indicates understanding of the teaching about this agent?
"I should take each dose with a full glass of water." Feedback: Bulk-forming laxatives provide insoluble substances that swell in water to both soften and increase the size of the fecal mass. Patients should be taught to take the dose with a full glass of water. Laxatives in general are not recommended for long-term use. Bulk-forming laxatives are safe for patients with diverticulitis. They are often used to treat diarrhea, because they help form the fecal mass
A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer disease. Which statement by a student indicates understanding of the teaching?
"Memantine modulates the effects of glutamate to alter calcium influx into neurons." Feedback: Memantine modulates the effects of glutamate, which is involved in calcium influx into neuronal cells. Memantine is used for patients with moderate to severe AD. Memantine does not prevent calcium from leaving cells; it only affects the influx of calcium. In studies, although the effects of memantine and donepezil appear to be synergistic or may confer independent benefits, they only demonstrate improvement in cognitive function and not a stop in disease progression
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
"The glucocorticoid is used as prophylaxis to prevent exacerbations." Feedback: Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta2- adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation
The Nurse practitioner teaches a patient about bethanechol (Urecholine). Which statement by the patient requires an intervention by the NP?
"The medication should be taken with meals" Feedback: Bethanechol should be taken 1 hour before or 2 hours after meals; nausea and vomiting and gastric upset may occur if bethanechol is taken with meals.
A patient will begin taking a cholinesterase inhibitor for early Alzheimer disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?
"This drug significantly slows the progression of the disease." Feedback: Cholinesterase inhibitors produce modest improvements in cognition, behavior, and function and may slightly delay disease progression; they do not have a major impact on delaying progression of the disease. Gastrointestinal symptoms are common side effects. Drugs that block cholinergic receptors, including antihistamines, can reduce therapeutic effects and should be avoided. Cholinesterase inhibitors do not affect neurons already damaged, but they do improve function in those not yet affected
Apatient has begun taking anHMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate?
"You should come into the clinic for liver enzymes in 1 month." Feedback: Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months. A recent study demonstrated protection against influenza morbidity in patients because of a decrease in proinflammatory cytokine release. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods
Consider the potential risk of muscle injury when simvastatin is taken with colchicine when prescribing Feedback: Colchicine can cause rhabdomyolysis, and this risk is increased in patients who also take simvastatin or other statin drugs. Amoxicillin does not interact with colchicine. The side effects of digoxin are not increased by concurrent use with colchicine. NSAIDs can safely be taken with colchicine.
"You will take both drugs initially and then stop taking the colchicine." Feedback: Colchicine is used for prophylaxis when urate-lowering drugs, such as allopurinol, are initiated, because gouty episodes have a tendency to increase during this time. Patients start with both drugs, and ultimately the colchicine is withdrawn. Allopurinol does not affect the GI side effects caused by colchicine. Allopurinol may precipitate an acute gouty attack when treatment is begun; colchicine is given to prevent a gouty episode. Colchicine does not enhance the effects of allopurinol.
A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should this medication be taken so the patient will have the maximum benefit of this medication?
1 hour before the patient eats (1100) Feedback: Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.
A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend?
400 to 800 mg of folic acid per day Feedback: The current recommendation is that all women of childbearing age receive folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant. Vitamin B12 supplements are not recommended
Which patients are at increased risk for adverse drug events? Select all that apply
A 2-month-old infant taking a medication for gastroesophageal reflux disease A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications A 7-year-old female receiving insulin for diabetes An 80-year-old male taking medications for COPD Feedback: Patients at increased risk for adverse drug events include the very young, the very old, and those who have serious illnesses. Females, children, and young adults taking single medications do not have increased risk for adverse events.
An NP student asks the instructor what an accurate description of a drug agonist is. What is the instructors best response?
A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drug enzyme interactions interfere with the enzyme systems that stimulate various chemical reactions
A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist Feedback: LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available
A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?
ACE inhibitors Feedback: ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse Practitionerlearns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse Practitioner will prescribe which drugs?
Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] Feedback: The regimen recommended for the treatment of PUD includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation. Patients taking metronidazole cannot consume alcohol, as this would precipitate a disulfiram-like reaction. The last option does not include two antibiotics
A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action should be taken first?
Ask the patient about the number and frequency of tablets taken Feedback: using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and how often helps the nurse determine compliance. Assessing current pain does not yield information about how well the medication is working unless the patient is currently taking it. The nurse should gather as much information about compliance, symptoms, and drug effectiveness as possible before contacting the prescriber. Biofeedback may be an effective adjunct to treatment, but it should not be recommended without complete information about drug effectiveness
The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? Select all that apply
Binding of one or both agents will be reduced Plasma levels of free drug will rise The increase in free drug will intensify effects Feedback: When two drugs bind to the same site on plasma albumin, coadministration of those drugs produces competition for binding. As a result, binding of one or both agents is reduced, causing plasma levels of free drug to rise. The increase in free drug can intensify the effect, but it usually undergoes rapid elimination. The increase in plasma levels of free drug is rarely sustained.
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis?
Calcium and vitamin D supplements Feedback: Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A baseline vitamin D level is not recommended. Estrogen therapy can help in postmenopausal women, but its risks outweigh its benefits. Patients should undergo evaluation of the bone mineral density of the lower spine, not skeletal x-rays
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment bythe nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?
Check the patient for other symptoms of digitalis toxicity. Feedback: Yellow halos around lights indicate digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level. The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level. No evidence indicates that the patient is in worsening heart failure. Documentation of findings is secondary to further assessment and prevention of digoxin toxicity.
A patient test reveals the philadelphia chromosome. What disease is this chromosome most commonly associated with?
Chronic myelogenous leukemia (CML) Feedback: The truncated chromosome 22 that results from the reciprocal translocation t(9;22)(q34;q11) is known as the Philadelphia chromosome (Ph) and is a hallmark of chronic myeloid leukemia (CML). In leukemia cells, Ph not only impairs the physiological signaling pathways but also disrupts genomic stability.
A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse Practitioner do?
Consider the potential risk of muscle injury when simvastatin is taken with colchicine when prescribing Feedback: Colchicine can cause rhabdomyolysis, and this risk is increased in patients who also take simvastatin or other statin drugs. Amoxicillin does not interact with colchicine. The side effects of digoxin are not increased by concurrent use with colchicine. NSAIDs can safely be taken with colchicine.
A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient?
Continuing the memantine as ordered Feedback: Patients with severe renal impairment may require a dosage reduction. Adding sodium bicarbonate would alkalinize the urine and increase memantine levels, causing toxicity. It is not necessary to discontinue or decrease the dose of the memantine with mild or moderate renal impairment.
A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effects of ACE inhibitors will not occur with an ARB medication (select all that apply)?
Cough Feedback: ARBs do not produce clinically significant hyperkalemia. Angioedema may occur with ARBs, but the incidence is lower than with ACE inhibitors. They do not promote the accumulation of bradykinin in the lungs and produce a lower incidence of cough. An increased risk of cancer may be a concern with ARBs but is not a concern with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney Hyperkalemia Feedback: ARBs do not produce clinically significant hyperkalemia. Angioedema may occur with ARBs, but the incidence is lower than with ACE inhibitors. They do not promote the accumulation of bradykinin in the lungs and produce a lower incidence of cough. An increased risk of cancer may be a concern with ARBs but is not a concern with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney
A 4½-year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine [Varivax]; the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child?
DTaP and IPV only Feedback: Children who are immunocompromised should not receive live virus vaccines, including the MMR vaccine and Varivax. Children taking high-dose systemic glucocorticoids are immunocompromised and should not receive the vaccine until therapy is stopped and normal glucocorticoid production returns. The oral polio vaccine (OPV) contains live virus and is contraindicated. Immunoglobulins are not indicated unless children are exposed to the diseases themselves.
An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient'sfamily?
End-of-life care Feedback: Patients in Stage D heart failure have advanced structural heart disease. For eligible patients, the best long-term solution is heart transplantation, but this patient probably is not eligible, given his advanced age. End-of-life care should be discussed. Antidysrhythmic medications are not indicated and may make symptoms worse. An implantable mechanical assist device is used in patients awaiting heart transplantation
What is a commonly used antibiotic for the treatment of Crohn's disease?
Flagyl (Metronidazole) Feedback: Metronidazole is used to treat Crohn's disease, abscesses, bacterial overgrowth in the intestine and pouchitis. It has antimicrobial activity (kills bacteria and parasites) as well as anti-inflammatory and immunosuppressive properties.
A patient who is malnourished has scaling, cracked skin on the arms and face. The patient is irritable, anxious, and has difficulty sleeping. The patient complains of soreness of the tongue and mouth. Whenteaching this patient about vitamin therapy for this disorder, the nurse will tell the patient to report which side effects?
Flushing, dizziness, and nausea Feedback: This patient shows signs of niacin deficiency. Side effects of niacin deficiency include flushing, dizziness, and nausea secondary to vasodilation. Abdominal cramps, diarrhea, migraines, and numbness of extremities are not side effects of niacin deficiency
A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action?
Giving an anticholinergic medication Feedback: The patient is showing signs of parkinsonism, an extrapyramidal effect associated with antipsychotic medications. Anticholinergic medications are indicated. A direct dopamine antagonist would counter the effects of the antipsychotic and remove any beneficial effect it has. Increasing the dose of the antipsychotic medication would only worsen the extrapyramidal symptoms. A second-generation antipsychotic medication may be used if parkinsonism is severe, since the risk of parkinsonism is lower than with the FGA. This patient is exhibiting mild symptoms, so this is not necessary at this point.
Which finding would indicate that terazosin has been effective for a patient with BPH?
Improved urinary hesitation Feedback: Terazosin is an alpha1-adrenergic antagonist. These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement.
Which factors could be attributed to limited prescriptive authority for APRNs?Select all that apply.
Inaccessibility of patient care Feedback: Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible patient care. It may also lead to poor collaboration among providers and higher health care costs. It would not directly impact patient's health literacy. Higher health care costs Feedback: Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible patient care. It may also lead to poor collaboration among providers and higher health care costs. It would not directly impact patient's health literacy.
A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?
Instruct the patient not to get up without assistance. Feedback: Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor.
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid. Feedback: LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.
The nurse Practitioner is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the NP she does not want to take medications while she is pregnant. What will the NPexplain to this patient?
Neuropsychologic deficits in the fetus can occur if the condition is not treated Feedback: Maternal hypothyroidism can result in permanent neuropsychologic deficits in the child. Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because the thyroid does not fully develop until the second trimester. Early identification is essential. Symptoms often are vague. Treatment should begin as soon as possible, or mental retardation and other developmental problems may occur
Insulin glargine is prescribed for a patient who has diabetes. When will the patient administer this drug?
Once daily at bedtime Feedback: Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The NP assesses the patient and notes a respiratory rate of 18 breaths/minute, a heart rate of 96 beats/minute, and an oxygen saturation of 95%. The nurse Practitionerauscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?
Question the patient about how much albuterol has been used Feedback: To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted
A 1-year-old child receives the MMR vaccine. The next day, the child's parent calls the nurse Practitionerto report that the child has a temperature of 103°F. What will the NP do?
Reassure the parent that fever can occur with the MMR vaccine. Feedback: The MMR vaccine can have several adverse effects, including fever up to 103°F; this is not considered a serious effect and does not warrant filing an adverse event report with VAERS. Thrombocytopenia is a rare but serious side effect of the MMR vaccine but is not associated with fever. There is no need to have the parent take the child to the emergency department.
A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse Practitionerperforming an assessment notes that the patient's tongue is black. What will the NP do?
Reassure the patient that this is an expected side effect of this drug. Feedback: Bismuth subsalicylate can cause blackening of the tongue and stools, an expected side effect. This finding does not indicate GI bleeding, hepatotoxicity, or drug overdose
An 18 month old has developed a rash and urticaria and the NP orders promethazine (Phenergan). What should be considered before finalizing this prescription?
Reconsider order due potential respiratory depression in children Feedback: Promethazine can cause severe respiratory depression, especially in very young patients; it is contraindicated in children younger than 2 years. The medication should not be given as ordered. It is not safe to give the drug and then monitor for bronchoconstriction. The drug is not safe in this age group when given orally or IV
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The NP should:
Reduce the Theophylliine dose Feedback: Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.
A client is started on cyclobenzaprine for muscle spasms. Which potential side effects should the NP be aware of?
Risk for injury Feedback: Muscle spasms without skeletal injury do not pose a risk for infection. Bladder spasms are treated with a different medication. There is generally no risk for tissue perfusion in muscle spasms unless the client is immobile and not turned appropriately. The client should be protected from injury related to falls due to excessive drowsiness.
Which medication should be used for asthma patients as part of step 1 management?
Short-acting beta2 agonists Feedback: Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management
A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as?
Stage 4 Feedback: his is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows: Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more); Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min; Stage 4: Severe loss renal function GFR 15-29 mL/min; Stage 5: End stage renal disease GRF less 15 mL/min
The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?
Take the antacid 1 hour after the ranitidine." Feedback: Because antacids raise the gastric pH, they can affect the dissolution and absorption of ranitidine; therefore, 1 hour should separate administration of antacids and ranitidine. Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced. One hour should separate administration of antacids and ranitidine; intervals of 15 minutes and 30 minutes are not long enough
A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated bythis patient inthe past. Which could be a probable cause of the test result?
The patient is taking another medication that binds to serum albumin Feedback: Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount ofa drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than the drug half-life will likely be at subtherapeutic levels and not at toxic levels
A patient in her twenties with Graves disease who takes methimazole [Tapazole] tells a nurse Practitionerthat she is trying to conceive and asks about disease management during pregnancy. What will the NP tell her?
The patient should discuss changing to propylthiouracil from now until her second trimester Feedback: Methimazole is not safe during the first trimester of pregnancy, because it is associated with neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third trimesters. Propylthiouracil is recommended for pregnant patients only in the first trimester and during lactation only if a thionamide is absolutely necessary. Iodine-131 is used in women older than 30 years who have not responded to medication therapy and is contraindicated during pregnancy
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?
The patient should stop taking the medication and contact her provider immediately Feedback: ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors.
A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient?
To change the patch every week Feedback: Transdermal patches are to be changed every 7 days. Medication administered by patch has the same therapeutic effect and adverse effects asthat given by other routes, except that localized skin reactions may occur and are common with clonidine patches. The patch should be applied to intact, hairless skin on the upper arm or torso
A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. The nurse understands which vaccine should not be administered to this child?
Varicella virus vaccine Feedback: The varicella vaccine should be avoided by individuals who are immunocompromised, which includes those infected with the human immunodeficiency virus (HIV) and those who have a congenital immunodeficiency. The DTaP vaccine, Hib vaccine, and polio injection may be administered to immunocompromised individuals, because these are not live vaccines
A patient has had blood pressures of 150/95 mmHg and 148/90 mmHg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:
a thiazide diuretic. Feedback: This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not firstline drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists
A 25-year-old patient has been newly diagnosed with Parkinson disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:
any history of alcohol abuse or compulsive behaviors Feedback: Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.
A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe?
ceftriaxone Feedback: Ceftriaxone is a third-generation cephalosporin with antibacterial and pharmacokinetic characteristics that make it an excellent choice for the treatment of gonococcal infection and chancroid. Adverse effects are unusual. Clinical efficacy in all reported studies has been excellent.
A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of:
changes in the brain as a result of prolonged drug exposure Feedback: It is thought that beneficial responses to central nervous system (CNS) drugs are delayed because they result from adaptive changes as the CNS modifies itself in response to prolonged drug exposure, and that the responses are not the result of the direct effects of the drugs on synaptic functions. The blood-brain barrier prevents protein-bound and highly ionized drugs from crossing into the CNS, but it does not slow the effects of drugs that can cross the barrier. Tolerance is a decreased response to a drug after prolonged use
You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition?
cholinesterase medications Feedback: These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.
A nurse is caring for an older adult patient who has Alzheimer disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?
lowed heart rate and lightheadedness Feedback: Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Dizziness, headache, nausea, vomiting, and diarrhea are all expected adverse effects, and although uncomfortable, they do not present an increased risk to the patient.
A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's:
metabolism of drugs Feedback: The most common source of genetic variation in drug response is related to alterations in drug metabolism and is determined by genetic codes for various drug-metabolizing isoenzymes. There are known genetic differences in codes for drug target sites, but these are not as numerous asthose for metabolic isoenzymes. Hypersensitivity potential is also genetically determined, but variations produce differences in adverse reactions to drugs and not in drug effectiveness. Psychosocial responses vary for many less measurable reasons, such as individual personalities and variations in cultures
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply.)
polyuria muscle weakness Feedback: B. CORRECT: Polyuria is an early indication of lithium toxicity D. CORRECT: Muscle weakness is an early indication of lithium toxicity.
A patient reports taking an oral bisacodyl laxative [Dulcolax] for several years. The FNPhas suggested discontinuing the laxative, but the patient is unsure how to do this. The FNP will tell the patient to:
stop taking the laxative immediately and expect no stool for several days. Feedback: The first step in breaking the laxative habit is abrupt cessation of laxative use. Bowel movements will be absent for several days after laxative withdrawal. Using a suppository, a bulk-forming laxative, or tapering the laxative only prolongs the habit and prevents normal function from returning
A patient with hyperlipidemia has been told by the NP to take extra niacin. The NP will tell the patient to:
take nicotinic acid supplements Feedback: Nicotinic acid is given in high doses to treat hyperlipidemia. Increasing dietary niacin is not sufficient to treat hyperlipidemia. Nicotinamide does not affect plasma lipoproteins. Dietary tryptophan is converted by the body into nicotinic acid, but not in sufficient amounts to treat hyperlipidemia.
