N2532 Exam 3 (renal/reproductive)

Ortho Evra

-transdermal contraceptive patch -applied once a week for 3 weeks followed by 1 week off -A/E: breast discomfort, headache, local irritation, nausea, menstrual cramps

Uterine Relaxants (Tocolytics)

-drugs used to delay delivery

RAAS (renin-angiotensin-aldosterone system)

-helps regulate BP in the presence of hemorrhage, dehydration, or sodium depletion -causes vasoCONSTRICTION and sodium & water RETENTION

follicular maturation

Clomiphene therapeutic response?

TMP/SMZ and nitrofurantoin

Frequently the treatment of choice for oral therapy of UTIs?

timolol

HR 48, what med to hold and contact HCP?

2

Patients should remain supine for at least ___ hours after dinoprostone pouch insertion. Pouch is removed when active labor occurs or when 12 hours have elapsed, whichever comes first.

b. Angiotensin II

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? a. Angiotensin I b. Angiotensin II c. Angiotensin III d. Renin

c. Ejaculatory dysfunction

When assessing a patient who takes finasteride [Proscar], a nurse should monitor for which adverse effect? a. Hair loss b. Increased libido c. Ejaculatory dysfunction d. Muscle weakness

HCTZ (hydrochlorothiazide)

-most widely used thiazide diuretic -Indications: essential HTN, edema, DI -can be combined with ototoxic agents without increased risk of hearing loss

Raloxifene (Evista)

-SERM -does not activate estrogen -protects against breast cancer and osteoporosis -promotes thromboembolism and hot flashes

to stop increasing drug resistance

Gonorrhea- why give 2 drugs?

ACE inhibitors

-"-pril" -Indications: HTN, HF, MI -A/E: *first dose hypotension*, cough, fetal injury, angioedema, hyperkalemia, neutropenia -all are administered PO (except enalaprilat)

ARBs (angiotensin II receptor blockers)

-"-sartan" -reduce excretion of potassium and increase excretion of sodium and water -Indications: HTN, HF, MI, patients unable to use ACE inhibitors -may prevent diabetic retinopathy -A/E: angioedema, fetal injury, renal failure, cough (lower incidence than ACE)

Finasteride (Proscar)

-5-alpha reductase inhibitor -used in tx of BPH -A/E: decreases ejaculate volume and libido, gynecomastia, decreased levels of prostate-specific antigen

progestin-only oral contraceptives

-Camila, Errin, Heather, Jolivette, Ortho Micronor, Nor-QD, and Nora-BE -Do not cause thromboembolic disorders, headaches, or nausea -Less effective -More likely to cause irregular bleeding

loop diuretics

-Furosemide, Bumetanide [Bumex], Torsemide [Demadex] -All can cause: Ototoxicity, hypovolemia, hypotension, hypokalemia, hyperuricemia, hyperglycemia, and disruption of lipid metabolism

hydroxyprogesterone caproate

-Indicated only for women with a singleton pregnancy and a history of at least one preterm birth -Most common adverse effects: Injection-site reactions (pain, swelling, itching), hives, nausea, and diarrhea

sildenafil (viagra)

-Phosphodiesterase-5 enzyme inhibitor -Tx of erectile dysfunction -*avoid concurrent use with nitrates (vasodilators) and alpha blockers* -A/E: hypotension, headache, dizziness, sudden hearing loss -Use with caution: hx of MI, stroke, hypotension, HTN, HR, unstable angina

acute bacterial prostatitis

-inflammation of the prostate caused by local bacterial infection -S/S: high fever, chills, malaise, myalgia, localized pain, dysuria, nocturia, urinary urgency, urinary frequency, urinary retention -frequently associated with indwelling urethral catheter, urethral instrumentation, transurethral prostatic resection -TX: *antimicrobials*

Cervadil (Dinoprostone)

-most widely used agent for cervical ripening -Have patient lie supine during gel administration and for at least 30 minutes after -Uterine activity and fetal heart rate should be monitored continuously -Major adverse effect: Uterine tachysystole -Systemic absorption: Nausea, vomiting, diarrhea, and fever

androgens

-produced by testes, ovaries, and adrenal cortex -promote expression of male sex characteristics -used to tx management of androgen deficiency in males -A/E: virilization, hepatotoxicity

nitroglycerin

-tocolytic administered via transdermal patch -A/E: hypotension, headache

magnesium sulfate

-tocolytic to suppress uterine contractions -Increases infant mortality -monitor for edema, toxicity, *antidote Calcium Gluconate*

Oxytocin (Pitocin)

-uterine stimulant used to facilitate labor -increases the force, frequency, and duration of uterine contractions -A/E: water intoxication/retention -avoid in women with active genital herpes

5

1 tsp = ____ mL

c. Estrogen

A patient reports unfavorable mucus. The healthcare provider would be expected to prescribe which medication to restore cervical mucus to its proper volume and consistency? a. hCG b. Progestin c. Estrogen d. Clomiphene [Clomid]

c, e

A nurse monitors for which adverse cardiovascular effects in a male patient taking testosterone [Androderm]? (Select all that apply.) a. Postural hypotension b. Atrial fibrillation c. Pedal edema and weight gain d. Prolonged QT interval e. Decrease in high-density lipoprotein (HDL) levels

b, c, d

A nurse should recognize that which therapies would be beneficial to a patient with BPH? (Select all that apply.) a. Saw palmetto b. Botulinum [Botox] c. Tolterodine [Detrol] d. Alfuzosin [Uroxatral] e. Sildenafil [Viagra]

b. Ascites and weight gain

A nurse should report which finding of ovarian hyperstimulation in a woman receiving menotropins? a. Hirsutism and acne b. Ascites and weight gain c. Engorgement of breasts d. Scant and viscous cervical mucus

d. Indomethacin

A nurse states that there is concern that the ductus arteriosus will close in utero after giving a drug to a pregnant patient. Which drug did the nurse administer? a. Nifedipine b. Terbutaline c. Nitroglycerin d. Indomethacin

a, b, c

A nurse who is assessing a patient with polycystic ovary syndrome (PCOS) would expect to observe which findings? (Select all that apply.) a. High blood glucose levels b. Infertility c. Absence of menstrual cycles d. Weight loss e. Hypothyroidism

d. Candesartan [Atacand]

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? a. Quinapril [Accupril] b. Aliskiren [Tekturna] c. Eplerenone [Inspra] d. Candesartan [Atacand]

a. Angina

A patient is scheduled to start taking sildenafil [Viagra]. A nurse should recognize that the patient is at risk for developing an adverse cardiac event if the patient's history reveals which of these conditions? a. Angina b. Hypertension c. Varicose veins d. Prosthetic mitral valve

d. "Seek emergency help, because permanent damage can occur."

A patient taking sildenafil [Viagra] asks a nurse what action to take if priapism occurs. Which response should the nurse make? a. "Take an additional half-strength dose of sildenafil." b. "The condition usually resolves in 12 hours or less." c. "Wait until the following day and notify the doctor." d. "Seek emergency help, because permanent damage can occur."

a. Follicular maturation

A patient who is infertile is taking clomiphene [Clomid]. A nurse should expect the patient to have which therapeutic response? a. Follicular maturation b. Ovarian hyperstimulation c. Regression of endometriosis d. Lower androgen levels

B. Gentamicin [Garamycin] (High-ceiling loop diuretics may cause hearing impairment; furosemide may result in deafness that is transient. Because of the risk of hearing loss, caution is needed when high-ceiling diuretics are used in combination with other ototoxic drugs (eg, aminoglycoside antibiotics). Gentamicin is an aminoglycoside.)

A patient with heart failure who takes furosemide [Lasix] is diagnosed with bacterial pneumonia. Which medication, if ordered by the physician, should the nurse question? A. Ciprofloxacin [Cipro] B. Gentamicin [Garamycin] C. Amoxicillin [Amoxcil] D. Erythromycin [E-Mycin]

angiotensin II bradykinin

ACE inhibitors reduce levels of ____ and increase levels of _____.

b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once

An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)? a. Azithromycin [Zithromax], 1 gm PO once, and doxycycline [Vibramycin], 100 mg PO twice daily for 7 days b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once c. Ceftriaxone [Rocephin], 125 mg IM once d. Doxycycline [Vibramycin], 100 mg IV twice daily for 12 days

b, c, d

According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.) a. Cardiovascular protection in older patients b. Decreased osteoporosis risk c. Glycemic control d. Improved wound healing e. Prevention of colorectal cancer

a. Elevated creatinine clearance

An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol

d. prostatitis.

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

b. Promoting synthesis of erythropoietin

Androgens are prescribed for a patient with anemia. The nurse is aware that the action of the androgen in this patient is what? a. Iron replacement b. Promoting synthesis of erythropoietin c. Prevention of blood loss d. Increase in bone formation

a, b, e

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis

a. Azithromycin

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? a. Azithromycin b. Doxycycline c. Erythromycin ethylsuccinate d. Sulfisoxazole

c. Proliferation of the endometrium

During the follicular phase of the menstrual cycle, estrogen has which effects on the female reproductive organs? a. Maturation of a corpus luteum b. Ripening of an ovarian follicle c. Proliferation of the endometrium d. Monthly menstrual bleeding

antibiotics

In women with bacterial vaginosis, _____ can reduce the incidence of preterm labor.

Loop, osmotic, Thiazide, Potassium Sparing, Carbonic Anhydrase

List the 5 categories of diuretics.

heart disease and Alzheimer's disease

Name the 2 diseases in which hormone therapy is inappropriate.

Rifampin, ritonavir, antiepileptic drugs, St. John's wort

Name the drugs/herbs that reduce the effectiveness of oral contraceptives. (4)

a, b, c, e

Progestins may be used to treat which conditions? (Select all that apply.) a. Endometrial hyperplasia b. Dysfunctional uterine bleeding c. Endometriosis d. Breast cancer e. Amenorrhea

hypotension

Pt taking captopril. What would you monitor for?

lower

Recurrent UTI's d/t reinfection usually involve the ____ urinary tract and may be related to sexual intercourse.

allopurinol

Renal calculi w/ hyperuricemia, what drug to prevent reoccurrence?

d. Hold the Lasix and notify the physician.

The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? a. Administer Lasix as ordered. b. Place the patient on a cardiac monitor. c. Begin a 24-hour urine collection. d. Hold the Lasix and notify the physician.

a. Monitor blood pressure.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? a. Monitor blood pressure. b. Check the heart rate. c. Auscultate lung sounds. d. Draw a potassium level.

a, b

The nurse is aware that which treatments are used in nonpregnant women to treat bacterial vaginosis? (Select all that apply.) a. Oral metronidazole b. Vaginal metronidazole c. Penicillin G d. Tetracycline e. Azithromycin

c. It inhibits the conversion of angiotensinogen into angiotensin I.

The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? a. It blocks the conversion of angiotensin I to angiotensin II. b. It prevents angiotensin II from binding to its receptors. c. It inhibits the conversion of angiotensinogen into angiotensin I. d. It selectively blocks aldosterone receptors in the kidneys.

b. Lithium level

The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? a. Potassium level b. Lithium level c. Creatinine level d. Blood pressure

azithromycin and doxycycline

Tx of chlamydia?

cephalosporins

Tx of gonorrhea?

penicillin G

Tx of syphillis?

d. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

When evaluating the effects of leuprolide [Lupron] in a patient who has endometriosis, a nurse should monitor the laboratory results for which hormone or hormones? a. Testosterone b. Human chorionic gonadotropin (hCG) c. Prolactin d. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

a. Edema

Which adverse effect is associated with daily testosterone therapy? a. Edema b. Confusion c. Dry mouth d. Incontinence

a, c, d

Which beneficial metabolic effects does estrogen have in nonreproductive tissues? (Select all that apply.) a. It promotes and suppresses coagulation. b. It improves glomerular filtration rates. c. It reduces low-density lipoproteins (LDLs). d. It suppresses bone resorption. e. It reduces fat deposits in the liver.

c. Nitrofurantoin

Which drug does the nurse identify as a urinary tract antiseptic? a. Ciprofloxacin b. Ceftriaxone c. Nitrofurantoin d. Ceftazidime

c. Follicle-stimulating hormone (FSH)

Which hormone is responsible for initiating activity in the ovary? a. Luteotropic hormone b. Luteinizing hormone (LH) c. Follicle-stimulating hormone (FSH) d. Interstitial cell-stimulating hormone

b. Obtaining deep tendon reflexes

Which nursing action is the priority for a patient in preterm labor who is receiving magnesium sulfate? a. Documenting body temperature b. Obtaining deep tendon reflexes c. Measuring intake and output d. Monitoring the intensity of contractions

a, b, d

Which of the following statements about mannitol [Osmitrol] are correct? (Select all that apply.) a. Mannitol cannot be given orally. b. Mannitol can cause edema. c. Mannitol can cause renal failure. d. Diuresis begins in 30 to 60 minutes after administration. e. Mannitol is a loop diuretic.

b. To suppress endometrial proliferation

Which therapeutic effect is the purpose of a progestin medication in menopausal hormone therapy (HT)? a. To reduce urogenital atrophy b. To suppress endometrial proliferation c. To relieve vasomotor symptoms d. To prevent adverse cardiac events

oxytocin and misoprostol

drug combination used to stop postpartum hemorrhage resulting from uterine atony

proximal tubule

site of action of diuretics that produces the greatest diuresis

taldalafil

used in tx of ED effects lasts up to 36 hrs

avanafil

used in tx of ED fastest onset of action

vardenafil

used in tx of ED prolongs QT interval

ergot alkaloids

uterine stimulant not used to induce risk of severe hypertension used to control postpartum bleeding

Methenamine

-antiseptic used to tx lower UTI's -decomposes into ammonia and formaldehyde -contraindicated in renal and liver failure -Drug interactions: urinary alkalinizers, sulfonamides

aliskiren (Tekturna)

-direct renin inhibitor -A/E: angioedema, cough, GI effects, hyperkalemia, fetal injury, and death

potassium-sparing diuretics

-diuretic with modest increase in urine production and substantial decrease in potassium excretion -rarely used alone for therapy -2 types

Cabergoline

-dopamine agonist -used to correct amenorrhea and infertility -A/E: nausea, headache, dizziness, orthostatic hypotension

thiazide diuretics

-effects similar to loop diuretics -Increase renal excretion of sodium, chloride, potassium, and water -Elevate levels of uric acid and glucose -*not effective when urine flow is scant*

Menotropins (Repronex, Menopur)

-fertility drug used in conjunction with hCG to promote follicular maturation and ovulation in anovulatory patients -A/E: ovarian hyperstimulation syndrome, multiple births

Clomiphene (Clomid)

-fertility drug used to promote follicular maturation and ovulation by blocking receptors for estrogen -A/E: hot flashes, nausea, bloating, blurred vision, multiple births, breast engorgement

Triamterene

-nonaldosterone antagonist potassium sparing diuretic -decreases sodium reuptake -Indications: HTN, edema -A/E: *hyper*kalemia, leg cramps, n/v, diarrhea, blood dyscrasias

Amiloride (Midamor)

-nonaldosterone antagonist potassium sparing diuretic -used to counteract potassium loss caused by more powerful diuretics -A/E: *hyperkalemia* -Drug interactions: *ACE inhibitors*

estrogens

-hormones found more abundantly in females than males -have positive effect on bone mass and cholesterol levels -A/E: endometrial hyperplasia and carcinoma, ovarian cancer, cardiovascular events, nausea, gallbladder disease

progestins

-hormones produced by ovaries and placenta -A/E: teratogenic, breast cancer, breast tenderness, depression, bloating

acute cystitis

-inflammation of the bladder; most common site of UTI -s/s: dysuria, urinary urgency, urinary frequency, suprapubic discomfort, pyuria, bacteriuria (subclinical pyelonephritis)

SERMs (selective estrogen receptor modulators)

-mimics estrogen beneficial bone sparing properties without affecting the uterus or breasts -tamoxifen, toremifene, and raloxifene

blockade of sodium and chloride reabsorption

What is the mechanism of action of diuretics?

Leuprolide (Lupron)

-GnRH agonist -Suppresses ovarian hormone production -Therapeutic uses: endometriosis, uterine fibroids, advanced prostate cancer -A/E: hot flashes, vaginal dryness, decreased libido, bone loss, mood changes

furosemide (Lasix)

-Loop diuretic -Block Na and Cl reabsorption in ascending loop -rapid onset (5 min-60 min) -Indications: pulmonary edema, HTN -A/E: hypotension, ototoxicity, hypokalemia, hyponatremia, hypochloremia, dehydration, hyperglycemia -CAN be used in pregnancy -Drug interactions: digoxin, potassium-sparing diuretics, NSAIDs, lithium

Tamoxifen (Nolvadex)

-SERM -activates estrogen -Breast cancer treatment: Inhibits cell growth in the breast -protects against osteoporosis -produces hot flashes -risk for endometrial cancer and *thromboembolism*

Nifedipine (Procardia)

-Tocolytic. -Side effects: hypotension, fatigue, nausea, flushing, uteroplacental perfusion complications. -Monitor BP, avoid concurrent use with magnesium sulfate, monitor contractions and FHT, prevent complication with hypotension.

Nitrofurantoin [Macrobid]

-UTI antiseptic -Indications: lower UTIs, prophylaxis, recurrent lower UTIs -A/E: pulmonary reactions, GI effects, hepatotoxicity, peripheral neuropathy, birth defects

Nexplanon (Implanon)

-a plastic capsule inserted in a woman's upper arm that releases a low dose of progestin to prevent pregnancy -one of the most effective contraceptives available -A/E: irregular bleeding

Choriogonadotropin alfa

-administered to trigger ovulation in women who are infertile owing to anovulation -major adverse effects: Ovarian hyperstimulation syndrome, rupture of ovarian cysts, and multiple births

Eplerenone (Inspra)

-aldosterone antagonist -Indications: HTN, HF -A/E: *hyperkalemia* -Use with caution when combined with lithium

Spironolactone (Aldactone)

-aldosterone antagonist -potassium-sparing causing retention of potassium and excretion of sodium -Indications: HTN, edema, HF, PMS, PCOS, acne in young women -A/E: hyperkalemia, tumors, gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of the voice -Drug interactions: thiazide and loop diuretics, drugs that raise potassium levels

Mannitol (Osmitrol)

-osmotic diuretic -Indications: prophylaxis of renal failure, reduction of ICP, reduction of IOP -*must be given parenterally* -A/E: edema, headache, n/v, fluid and electrolyte imbalance -preparations should be observed for crystals before use. Preparations that contain crystals should be warmed and then cooled to body temperature for administration. -*use filter needles*

hCG (human chorionic gonadotropin)

-polypeptide hormone produced by the placenta -Therapeutic use" promotes follicular maturation and ovulation and spermatogenesis -A/E: ovarian hyperstimulation syndrome, edema, CNS disturbances, headache, fatigue

Indomethacin (Indocin)

-second-line tocolytic -reserved for women who go into labor extremely early -higher risk for neonatal complications -prolonged renal insufficiency, bronchopulmonary dysplasia, necrotizing enterocolitis, and periventricular leukomalacia

acute uncomplicated pyelonephritis

-sudden development of kidney inflammation -common in young children, older adults, and women of childbearing age -E.coli (cause 90% of time) -Mild: tx at home with PO antibiotics -Severe: hospitalizations with IV antibiotics

Terbutaline (Brethine)

-tocolytic (treatment of preterm labor) -Beta2-selective adrenergic agonist -Risks: pulmonary edema, hypotension, and hyperglycemia in the mother, and tachycardia in both the mother and fetus -can be used to *suppress* preterm labor but not to prevent preterm labor

a. Furosemide [Lasix]

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone]

C. Salt substitutes

A patient is prescribed spironolactone [Aldactone] for treatment of hypertension. Which foods should the nurse teach the patient to avoid? A. Baked fish B. Low-fat milk C. Salt substitutes D. Green beans

c. "You will need to take a low dose of medication for 6 months to prevent infections."

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

a. Male partners should always be treated, even if they are asymptomatic.

A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient? a. Male partners should always be treated, even if they are asymptomatic. b. The applicator for the vaginal gel should be washed after each application. c. The infection is not completely eliminated with the medication. d. The medication should be taken twice daily for 2 weeks.

d. "When hormone therapy is discontinued, bone mass is quickly lost."

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? a. "Estrogen can help reverse bone loss." b. "Hormone therapy increases bone resorption." c. "Hormone therapy does not decrease fracture risk." d. "When hormone therapy is discontinued, bone mass is quickly lost."

d. "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching? a. "Clomiphene will help induce ovulation but will not treat the other symptoms of polycystic ovarian disease." b. "If I lose weight, my infertility and irregular periods could resolve without medications." c. "Metformin improves insulin sensitivity and reduces male hormone levels." d. "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

a. Gonorrhea

An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a. Gonorrhea b. Herpes simplex c. Nongonococcal urethritis d. Syphilis

dig toxicity

Giving hydrochlorothiazide and digoxin. What do you monitor for?

D. Schedule the medication to be given at 0800 and 1400. (The nurse should administer oral bumetanide with twice-a-day dosing at 0800 and 1400 to minimize nocturia. Daily weights should be obtained in the morning before eating. Patients receiving IV bumetanide are more likely to need hourly monitoring of urine output with a urinary catheter. Bumetanide may cause hypokalemia; signs and symptoms of hypokalemia include irregular heartbeat, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, and confusion.)

The nurse cares for a patient who is prescribed oral bumetanide twice daily. It is most important for the nurse to take which action? A. Monitor the patient for signs and symptoms of hyperkalemia. B. Insert a urinary catheter and assess the hourly urine output. C. Weigh the patient before administering each dose. D. Schedule the medication to be given at 0800 and 1400.

a. "I use NoSalt instead of salt to season foods."

The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? a. "I use NoSalt instead of salt to season foods." b. "I eat sweet potatoes once or twice a week." c. "I drink 4 ounces of prune juice each morning." d. "I like asparagus because it's high in vitamin K."

a. Oranges, spinach, and potatoes (Furosemide may have the adverse effect of hypokalemia. Hypokalemia can be reduced by consuming foods that are high in potassium, such as nuts, dried fruits, spinach, citrus fruits, potatoes, and bananas.)

When providing discharge teaching for a patient who has been prescribed furosemide [Lasix], it is most important for the nurse to include which dietary items to prevent adverse effects of furosemide [Lasix] therapy? a. Oranges, spinach, and potatoes b. Baked fish, chicken, and cauliflower c. Tomato juice, skim milk, and cottage cheese d. Oatmeal, cabbage, and bran flakes

a, b, c, d, e

Which infections may be acquired through nonsexual transmission? (Select all that apply.) a. Chlamydia trachomatis b. Gardnerella vaginalis c. Herpes simplex d. Neisseria gonorrhea e. Treponema pallidum

c. A female patient with recurring acute urinary tract infections

Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? a. A female patient with acute pyelonephritis b. A male patient with acute prostatitis c. A female patient with recurring acute urinary tract infections d. A male patient with acute cystitis

d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

b. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain

Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? a. A patient with an uncomplicated urinary tract infection caused by Escherichia coli b. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain c. A patient with acute cystitis who complains of dysuria, frequency, and urgency d. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia

Isosorbide

pt is asking about Sildenafil for erectile dysfunction but has angina, what med is contraindicated?

furosemide

pt w/ chronic renal failure, what diuretic can you give?

a. Cleansing and maintenance of extracellular fluid volume

The nurse knows that diuretics mostly affect which function of the kidneys? a. Cleansing and maintenance of extracellular fluid volume b. Maintenance of acid-base balance c. Excretion of metabolic waste d. Elimination of foreign substances

c. "Your baby will need to be treated with oral erythromycin."

A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? a. "The erythromycin ointment will prevent your baby from developing conjunctivitis." b. "Without additional treatment, your baby could develop blindness." c. "Your baby will need to be treated with oral erythromycin." d. "Your baby will need to take doxycycline [Vibramycin] for 10 days."

b. "Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation."

A nurse is explaining to a nursing student how clomiphene [Clomid] works to improve fertility. Which statement by the student indicates a need for further teaching? a. "Clomiphene blocks estrogen receptors to cause increased secretion of gonadotropins." b. "Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation." c. "If follicular maturation is the only result of clomiphene therapy, human chorionic gonadotropin may be given." d. "If the pituitary gland cannot produce LH and FSH, clomiphene will not be effective."

d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? a. "C. trachomatis conjunctivitis in newborns can result in blindness." b. "The CDC recommends screening for chlamydial infections in all sexually active men." c. "Treatment for C. trachomatis should be initiated when infections are symptomatic." d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

d. Request an order for furosemide [Lasix].

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to request an order for serum electrolytes. d. Request an order for furosemide [Lasix].

c. "I should take the lowest effective dose for the shortest time needed."

A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching? a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely." b. "I can take estrogen to reduce my risk of cardiovascular disease." c. "I should take the lowest effective dose for the shortest time needed." d. "I will need a progestin/estrogen combination since I have had a hysterectomy."

a. Acyclovir [Zovirax]

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax]

c. Spironolactone [Aldactone]

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]

a. Clomiphene [Clomid]

A patient is being treated for infertility. An examination reveals cervical mucus that is scant, thick, and sticky. The nurse suspects that the patient has been taking which medication? a. Clomiphene [Clomid] b. Estrogen c. Follicle-stimulating hormone (FSH) d. Progesterone

c. Ringing in the ears

A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention

c. pyelonephritis.

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

d. Pharmacologic agents used to treat endometriosis do not enhance fertility.

A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? a. Combination oral contraceptives are effective for improving fertility. b. Gonadotropin-releasing hormone agonists are used for long-term treatment. c. Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. d. Pharmacologic agents used to treat endometriosis do not enhance fertility.

d. Vasomotor symptoms are a common side effect of this drug.

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication? a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug.

B. Itraconazole [Sporanox] (Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity. Weak inhibitors (for example, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels. Strong inhibitors (for example, ketoconazole, itraconazole) can increase levels fivefold. If eplerenone is combined with a weak inhibitor, the eplerenone dosage should be reduced. Eplerenone should not be combined with a strong inhibitor.)

A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? A. Ciprofloxacin [Cipro] B. Itraconazole [Sporanox] C. Tetracycline [Sumycin] D. Ampicillin [Principen]

c. Potassium level of 3.5 mEq/L

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c. Potassium level of 3.5 mEq/L d. Sodium level of 140 mEq/L

C. Administer the medications as scheduled. (These medications may be administered together without serious drug interactions.)

A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? A. Assess for symptoms of hyperkalemia. B. Observe for a hypertensive crisis. C. Administer the medications as scheduled. D. Evaluate for first-dose hypotension.

a. reduce intracranial pressure.

A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: a. reduce intracranial pressure. b. reduce renal perfusion. c. reduce peripheral edema. d. restore extracellular fluid.

a. decrease her risk of endometrial cancer.

A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to: a. decrease her risk of endometrial cancer. b. increase bone resorption to prevent fractures. c. lower her risk of myocardial infarction (MI). d. prevent deep vein thrombosis (DVT).

d. "I will take Benadryl for any itching caused by a local reaction to the patch."

A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching? a. "I can use sugar-free gum for dry mouth." b. "I may need laxatives for constipation." c. "I should keep the site covered to prevent other people from getting the medicine." d. "I will take Benadryl for any itching caused by a local reaction to the patch."

a. begin antibiotic therapy after urine culture and sensitivity results are available.

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization.

b. "I need to stop taking potassium supplements."

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration."

c. "I may have menopausal-like symptoms when taking this medication."

A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching? a. "I can continue to take the medication if I get pregnant." b. "I can expect the medication to cure my symptoms." c. "I may have menopausal-like symptoms when taking this medication." d. "I will need to take the medication for several years."

d. Spironolactone [Aldactone]

A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide [Bumex] b. Chlorothiazide [Diuril] c. Hydrochlorothiazide [HydroDIURIL] d. Spironolactone [Aldactone]

c. Decreased blood pressure

The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? a. Decreased pulse b. Decreased temperature c. Decreased blood pressure d. Decreased respiratory rate

d. Decreased vaginal bleeding

When evaluating the effects of ergonovine [Ergotrate], the nurse expects which assessment finding? a. Suppressed milk reflex b. Decreased blood pressure c. Decreased uterine tone d. Decreased vaginal bleeding

c. Spironolactone [Aldactone] (Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.)

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Spironolactone [Aldactone] d. Mannitol [Osmitrol]

c. Serum creatinine level of 2.3 mg/dL (Patients with bilateral renal artery stenosis are at increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia, hyperglycemia, or hyperuricemia.)

The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? a. Potassium level of 3.2 mEq/L b. Blood glucose level of 180 mg/dL c. Serum creatinine level of 2.3 mg/dL d. Uric acid level of 10 mg/dL

a, b, c

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a. Acute cystitis b. Acute urethritis c. Recurrent UTI d. Severe pyelonephritis e. Acute bacterial prostatitis

b, c, d

The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.) a. Increased colon cancer b. Stroke c. Deep vein thrombosis d. Ovarian cancer e. Decreased bone density

b. "I understand that the combination product should help protect me from the side effects of the estrogen."

The nurse is providing teaching regarding Duavee (conjugated estrogens/bazedoxifene). Which statement by the patient indicates that the teaching was effective? a. "I know I am at an additional risk for increased growth of my uterus lining." b. "I understand that the combination product should help protect me from the side effects of the estrogen." c. "I will have to set an alarm to take my medication four times per day." d. "I am prepared to take this medication for the rest of my life."

c, d, e

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) a. Take the medication with food. b. Expect a sore throat and fever. c. Avoid potassium salt substitutes. d. A persistent dry cough may occur. e. Report difficulty in breathing immediately.

a. Fosfomycin

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? a. Fosfomycin b. Amoxicillin c. Cephalexin d. Trimethoprim

b. Hypertension

Which of these findings, if identified in a patient receiving ergonovine [Ergotrate], should a nurse report to a physician immediately? a. Tremors b. Hypertension c. Uterine cramping d. Hypoglycemia

b. "Have intercourse every other day for 5 to 10 days after the last dose of this medication."

Which of these instructions should a nurse give a patient who is to start taking clomiphene [Clomid]? a. "You'll need an injection of this medication 2 days before ovulation." b. "Have intercourse every other day for 5 to 10 days after the last dose of this medication." c. "It is necessary to have weekly blood draws to monitor the effects on your liver." d. "You'll have to have a bone density test periodically, because osteoporosis is more likely."

a, c, d

Which outcomes should a nurse establish when planning care for a patient taking methenamine [Mandelamine]? (Select all that apply.) a. Maintains a urine pH of 5.5 or lower. b. Consumes 3000 mL of liquid daily. c. Uses an enteric-coated formulation. d. Avoids sulfonamide medications. e. No elevation in liver enzymes.