Pharm: 54 Sexually Transmitted Infections, 53: Men's Health , 5: Pediatric Considerations, 52 Women's Health (Test 1)

Which side effect occurs due to excess progestin? 1 Acne 2 Dyspareunia 3 Amenorrhea 4 Atrophic vaginitis

1 Progestin is synthetic progesterone, which in excess causes acne as a side effect. Dyspareunia is a physiologic effect caused by estrogen deficiency. Amenorrhea is caused by deficiency of progestin. Atrophic vaginitis is caused by deficiency of estrogen. p 770

What is an adverse effect associated with estrogen therapy? 1 Nausea 2 Dry skin 3 Weight loss 4 Higher-pitched voice

1 The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma, not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy. p 784

Which term describes the study of the time course of drug absorption, distribution, metabolism, and excretion? 1 Pharmacokinetics 2 Pharmacogenetics 3 Pharmacodynamics 4 Pharmacotherapeutics

1 Pharmacokinetics describes the study of the time course of drug absorption, distribution, metabolism, and excretion. Pharmacogenetics is the study of the effect of genetic factors on reactions to drugs. Pharmacodynamics refers to the mechanisms of action and effects of a drug on the body and includes the onset, peak, and duration of effect of a drug. Pharmacotherapeutics is the study of the therapeutic uses and effects of drugs. p 44

A patient is prescribed tamsulosin. What are the possible side effects of this medication? Select all that apply. 1 Rhinitis 2 Headache 3 Fatigue 4 Dyspnea 5 Gynecomastia 6 Postural hypotension

1, 2, 3, 4, 6 Side effects of tamsulosin include rhinitis, headache, fatigue, dyspnea, and postural hypotension. Gynecomastia is a side effect of 5-alpha-reductase inhibitors like finasteride and dutasteride. p 798

Which sexually transmitted infections (STIs) can be treated with antibiotics? Select all that apply. 1 Gonorrhea 2 Hepatitis C 3 Klebsiella granulomatis 4 Chlamydia trachomatis 5 Molluscum contagiousum

1, 3, 4 Gonorrhea, K. granulomatis, and C. trachomatis can be treated with antibiotics. Hepatitis C and M. contagiousum are viruses. p 804

What is the minimum number of patient identification methods the nurse must use prior to drug administration? 1 1 2 2 3 3 4 4

2 The nurse should use at least two methods of patient identification prior to drug administration. The nurse should follow the organization's protocol, but generally, one method is not enough, and three and four are more than necessary. p 50

A patient taking clomiphene citrate to increase ovulation becomes pregnant. What potential side effect might she experience? 1 Gestational diabetes 2 Breast tenderness 3 Multiple gestation 4 Subsequent infertility

3 Clomiphene citrate causes an increase in ovulation, which then increases the chances that the woman will have more than one fertilized egg, resulting in a multiple gestation/birth. Gestational diabetes is not known to be an adverse effect of this drug. Breast tenderness is more likely to occur because of pregnancy than the drug. The use of clomiphene is not associated with subsequent infertility. p 779

What effect does the neonate's high gastric pH have on drug absorption? 1 Increases drug absorption 2 Decreases drug absorption 3 Increases absorption of basic drug formulations 4 Increases absorption of acidic drug formulations

3 The neonate's high pH creates an alkaline environment that favors basic drug formulations, increasing their absorption. Differences in pH may increase or decrease drug absorption depending on the formulation. A low pH, or acidic environment, would increase absorption of acidic drug formulations. p 44

Individualization of drug dosage is most relevant in which pediatric population? 1 Child 2 Infant 3 Neonate 4 Adolescent

4 Adolescents of similar ages are of very different sizes, height-to-weight proportions, timing of secondary sex characteristics, and other indicators of physical maturity. These differences may warrant individualization of drug dosage. Individualization is less relevant for the child, infant, and neonate, who are closer in size and stages of physical development. p 48

In the pediatric population, differentiating between the chronologic age and what other age is important for its impact on the child's response to drug administration? 1 Social 2 Behavioral 3 Psychological 4 Developmental

4 It is important for the nurse to differentiate the child's developmental age from chronologic age, because this difference has an impact on the child's response to drug administration. Social, behavioral, and psychological are not quantifiable ages relevant to drug administration. p 46

A patient who has been exposed to hepatitis C virus (HCV) asks the nurse, "Now that I have been exposed to this, how can I prevent contracting it?" What is the nurse's best response? 1 "I am going to administer a prophylactic immune globulin." 2 "I am going to administer an immune globulin and a vaccine." 3 "I will give you a vaccination to prevent you from contracting the virus." 4 "There is nothing available to prevent you from contracting HCV after exposure."

4 The nurse's best response is, "There is nothing available to prevent you from contracting HCV after exposure." Prophylactic immune globulin is not effective in preventing HCV after exposure and there is no vaccine for HCV. p 803

Which medications increase protein synthesis within cells, resulting in the buildup of cellular tissue? 1 Anabolic steroids 2 Antiandrogens 3 Anticholinergics 4 Phosphodiesterase-5 inhibitors

1 Anabolic steroids increase protein synthesis within cells resulting in buildup of cellular tissue. Antiandrogens block the synthesis or action of androgens. Anticholinergics block the action of acetylcholine. Phosphodiesterase-5 inhibitors cause vasodilation in the penis and lung by blocking the breakdown of cyclic guanosine monophosphate. p 793

The nurse informs a male patient about which potential adverse effect of testosterone therapy? 1 Prostate cancer 2 Bladder cancer 3 Kidney cancer 4 Intestine cancer

1 Testosterone plays a role in the development of prostate cancer, but the extent to which supplemental testosterone therapy increases cancer risk is unclear. Testosterone does not affect the bladder, kidney, or intestine in a direct way. p 793

Gastric emptying and gastrointestinal (GI) motility are unpredictable in neonates and infants; however, these processes approach that of adults by what age? 1 6 to 8 months 2 8 to 10 months 3 10 to 12 months 4 12 to 14 months

1 Gastric emptying and GI motility are unpredictable in neonates and infants, but they approach that of adults by 6 to 8 months of age. The processes become similar to those in adults before 8 to 10 months, 10 to 12 months, and 12 to 14 months of age p 44

The primary health care provider prescribes a cough syrup for an infant who has a cold. Which method of administration does the nurse expect to be safe and effective? 1 Administering the medication through an oral syringe 2 Administering the medication through the intravenous route 3 Administering the medication by mixing it with the child's formula or milk 4 Administering the medication by placing the dropper at the back of the child's mouth

1 The oral route is a safe administration route for syrups. The nurse should administer the medication through an oral syringe because it is easy to use and ensures exact dosing. Syrups are viscous, have thick consistency, and may cause hemolysis. The nurse should not administer them intravenously. The nurse should not mix medications with child's formula or milk; administering the medication mixed with formula or milk may change the taste of the formula and may cause the infant to reject the formula or milk. The nurse should avoid administering the medication by placing the dropper at the back of the child's mouth, which can cause gagging and choking. p 47

A woman with a category B pregnancy has large amounts of homogenous, thin, white vaginal discharge. The nurse detects a fishy odor from the discharge. On further assessment, the nurse learns that the patient has a habit of using mouthwash regularly. What would be the ideal course of treatment if the patient is in her first trimester? 1 Clindamycin 300 mg PO bid for 7 days 2 Metronidazole 750 mg tab PO for 7 days 3 Tinidazole 2 g/d for 2 days or 1 g/d for 5 days 4 Clotrimazole 1% cream 5 g intravaginally for 7-14 days

1 The patient displays the symptoms of bacterial vaginosis. Clindamycin may be used to treat the infection in the patient, because this medication is not contraindicated in the first trimester. Oral intake of metronidazole and tinidazole is prohibited in the first trimester of pregnancy. Moreover, the patient is habituated to mouthwash, which is an alcohol-based product. These medications will be rendered ineffective due to the use of regular mouthwash. Clotrimazole is used to treat vulvovaginal candidiasis. p 804

What dual drug treatment is recommended for a patient with an uncomplicated urogenital gonorrheal infection? 1 Ceftriaxone 250 mg IM, azithromycin 1 g PO 2 Azithromycin 1 g IM, ceftriaxone 250 mg PO 3 Azithromycin 1 g IM, ceftriaxone 250 mg IM 4 Azithromycin 1 g PO, ceftriaxone 250 mg PO

1 The recommended treatment for an uncomplicated urogenital gonorrheal infection is ceftriaxone 250 mg IM and azithromycin 1 g PO. The dual drug treatment is necessary due to the organism's development of resistance to medication treatment. Ceftriaxone is not available by mouth, and azithromycin is not administered intramuscularly. p 805

Limited pediatric pharmacologic research results in drugs being used in the pediatric population despite lacking federally approved indications for use in children. What term describes the use of drugs in this manner? 1 Off label 2 Anecdotal 3 Research equity 4 Informed consent

1 Only half of all drugs carry federally approved indications for use in children. This means many drugs prescribed for children are being prescribed "off label," which means the drug is being used for some purpose for which it has not been approved. Anecdotal evidence may provide a basis for this use in lieu of scientific research. Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. p 44

What statement made by the nurse about erythromycin ointment administration for the newborn is correct? 1 "Erythromycin ointment prevents blindness caused by chlamydia." 2 "Erythromycin ointment prevents blindness caused by syphilis." 3 "Erythromycin ointment can be administered within 2 hours after birth." 4 "The antibiotic administered in labor crosses the placenta, so erythromycin is unnecessary."

1) The statement, "Erythromycin ointment prevents blindness caused by exposure to chlamydia" is correct. It is also used to treat gonorrhea, which can also cause blindness in the newborn. The transmission of syphilis occurs through the placenta from the infected mother to the baby during the pregnancy. Maternal syphilis is treated with penicillin. Erythromycin is administered within the first hour after birth. Antibiotics are not routinely used for laboring patients. If a laboring patient receives antibiotics, the antibiotics cross the placenta but are not effective in preventing blindness that can be caused by chlamydia and gonorrhea. p 802

Which patient complaints could be adverse reactions to amyl nitrate? Select all that apply. 1 "It feels like an elephant is sitting on my chest." 2 "I feel like I am being smothered." 3 "My skin has looked blue for the past few hours." 4 "I feel like I have to urinate all the time." 5 "It burns when I urinate."

1, 2, 3 Amyl nitrate can be used for erectile dysfunction, but sudden death, myocardial infarction, and methemoglobinemia have been reported with its use. The patient statements, "It feels like an elephant is sitting on my chest" and "I feel like I am being smothered" are concerning because these symptoms are complaints associated with pre-infarction angina. Methemoglobinemia has been reported with use of amyl nitrate, and a symptom of this complication is a bluish skin color change. Urinary symptoms are not common with amyl nitrate. p 797

Which are contraindications to androgen therapy? Select all that apply. 1 Hypercalcemia 2 Primary hypogonadism 3 Nephrosis 4 Cirrhosis 5 Breast cancer palliation 6 Benign prostatic hyperplasia (BPH)

1, 3, 4, 6 Contraindications to androgen therapy includes hypercalcemia, nephrosis, cirrhosis, and BPH since these conditions may be exacerbated with the use of androgens. Androgen therapy is sometimes used for medical management of primary hypogonadism and breast cancer palliation. p 792

Which side effects are associated with the use of testosterone (Delatestryl)? Select all that apply. 1 Insomnia 2 Depression 3 Gynecomastia 4 Aggressive behavior 5 Postural hypotension

1, 4 Patients on testosterone (Delatestryl) therapy experience insomnia and frequently demonstrate aggressive behavior. Depression and gynecomastia are adverse reactions associated with the use of testosterone (Delatestryl). Postural hypotension is a side effect of tamsulosin (Flomax), an alpha-adrenergic blocking agent. p 791

blank A pediatric patient weighing 66 pounds is to receive intravenous (IV) ceftriaxone for treatment of gonorrhea. What is maximum dosage the patient can receive? ______ mg

1500 mg The safe dosage range for a pediatric patient weighing less than 45 kg is 25-50 mg/kg intravenously. The nurse divides 66 lb by 2.2 kg to determine the patient weighs 30 kg. Knowing the maximum dose is 50 mg/kg, the nurse multiplies this number by 30 kg to determine that the maximum dose is 1500 mg for this patient. p 805

At what age does hepatic blood flow match that of an adult? 1 6 months 2 12 months 3 18 months 4 24 months

2 By 12 months of age, hepatic blood flow has reached that of an adult. It does not match that of an adult by age 6 months, but it does before 18 months or 24 months. p 45

Which prescription for a patient taking sildenafil (Viagra) will the nurse question to prevent adverse effects? 1 Dietary nitrites 2 Organic nitrates 3 Organophosphates 4 Nitrogen mustard

2 The only contraindication for sildenafil (Viagra) is the concomitant administration of an organic nitrate, because it may lead to severe hypotension in the patient. Dietary nitrites and organophosphates are not prescribed. Dietary nitrites increase the risk for gastrointestinal cancer and organophosphate is an insecticide. Nitrogen mustard is usually used as a chemotherapy agent. p 797

Which are combined hormonal contraception (CHC) products? Select all that apply. 1 Minipill 2 Biphasic pills 3 Triphasic pills 4 Monophasic pills 5 Ethinyl estradiol and norelgestromin (Ortho-Evra)

2, 3, 4 Monophasic combined hormonal contraception (CHC) pills deliver estrogen and progestin in a fixed ratio throughout the menstrual cycle. Biphasic COC pills deliver estrogen in a fixed amount; however, the amount of progestin varies. With triphasic COC pills, the amount of either estrogen or progestin varies throughout the menstrual cycle. Ortho-Evra is not a COC pill, but a transdermal patch. The minipill is a progestin-only oral contraception pill (POP).

A patient is prescribed tadalafil. Concomitant therapy should be avoided with tadalafil and which medications? Select all that apply. 1 Salicylic acid 2 Thioridazine 3 Verapamil 4 Fluconazole 5 Isosorbide

2, 3, 4, 5 A patient that is taking tadalafil should not take thioridazine, verapamil, fluconazole, or isosorbide at the same time. Cardiac drugs such as thioridazine or verapamil may cause alterations in heart rate and blood pressure when taken with tadalafil. Antiinfective agents such as fluconazole may alter drug effectiveness. Organic nitrates such as isosorbide taken with tadalafil may cause a significant decrease in blood pressure. Salicylic acid is safe to take while on tadalafil. p 797

Which parameters should be considered while prescribing medications to an adolescent? Select all that apply. 1 Physical activity 2 Lean-to-fat body mass 3 Cognitive development 4 Presence of growth spurts 5 Appetite and food consumption

2, 3, 4, 5 When prescribing medication to an adolescent, the primary health care provider considers the patient's lean-to-fat body mass. It helps to determine the amount of fat in the body and its effects on the concentration of a fat-soluble drug. Because puberty occurs during adolescence, it results in a change in hormone levels and alters the pharmacokinetic parameters of the drug. The primary health care provider should consider the appearance of a growth spurt. Appetite and food consumption help determine the response of the medication in the adolescent and eliminate food-drug interactions. They also help determine the scheduling of the medication. Physical activity and cognitive ability do not alter the pharmacokinetics of the drug and need not be considered when prescribing medications to an adolescent. p 48

The nurse is responsible for dispensing medications to children. Which characteristics of pediatric children have significant impact on dosage of drugs? Select all that apply. 1 Risk of excessive hydration 2 Lack of acid in stomach 3 Thin skin with reduced permeability 4 Immature liver and kidney function

2, 4 Pediatric patients lack acid production in the stomach, and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not get metabolized or dissolved in the stomach. Pediatric patients have immature liver and kidneys, which impair drug metabolism and excretion. Pediatric patients are at risk of dehydration due to a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily. p 44-45

Which points of inoculation should be included in a physical examination for sexually transmitted infections (STIs)? Select all that apply. 1 Larynx 2 Oropharynx 3 Nasopharynx 4 Genitalia 5 Mouth

2, 4, 5 The physical examination for STIs will include the oropharynx, genitalia, and mouth. The larynx and nasopharynx are not points of inoculation and cannot be visually inspected. p 808

The nurse is assessing a female patient who has osteoporosis. The nurse finds that the patient is prescribed bisphosphonate instead of calcitonin. What is the possible reason for this prescription? 1 The patient has breast cancer. 2 The patient smokes frequently. 3 The patient is allergic to salmon. 4 The patient experiences joint pain.

3 Calcitonin is derived from salmon; hence the drug is not prescribed for patients who are allergic to salmon. Medications for breast cancer would not interact with calcitonin; hence breast cancer is not a reason to prescribe bisphosphonate. Joint pain is an adverse effect of bisphosphonate; the drug needs to be changed in case there are adverse effects of calcitonin. Smoking is harmful if the patient is taking estrogen therapy, because the combination leads to thrombosis. p 787

Which statement by a student nurse about breakthrough bleeding (BTB) indicates effective learning? 1 "Breakthrough bleeding occurs as a side effect of seasonale (Jolessa)." 2 "Breakthrough bleeding occurs when a patient does not take a contraceptive regularly." 3 "Breakthrough bleeding occurs with the use of combined oral contraception (COC) products." 4 "Breakthrough bleeding occurs because of a lack of estrogen in combined hormone contraception (CHC) products."

3 Breakthrough bleeding (BTB) refers to a bleeding episode that occurs during the active pill cycle of the combined oral contraception (COC) products. A lack of progestational activity in CHC products is likely to cause BTB as a side effect. Seasonale (Jolessa) is a continuous dosing combined hormone contraception (CHC) pill that reduces the incidence of BTB. Irregular use of contraceptives does not cause BTB, but increases the risk for pregnancy. p 763

Which medication is contraindicated with tadalafil? 1 Acetaminophen 2 Furosemide 3 Nitroglycerin 4 Heparin

3 Patients taking nitrates (e.g., nitroglycerine) should not be prescribed tadalafil. The combination of nitroglycerin and tadalafil may trigger an unsafe drop in blood pressure. There are no contraindications for concomitant use of tadalafil with acetaminophen, furosemide, or heparin. p 798

A patient with coronary artery disease (CAD) is taking isosorbide 10 mg by mouth every 12 hours. Which order by the physician should the nurse question? 1 Famotidine 2 Furosemide 3 Sildenafil 4 Ketoconazole

3 The nurse should question sildenafil ordered for a patient with CAD receiving isosorbide as this can cause an unsafe fall in blood pressure and myocardial infarction. A patient taking isosorbide can safely take famotidine, furosemide, and ketoconazole. p 797

A patient diagnosed with gonorrhea has an allergy to penicillin and cephalosporins. What is the safest treatment option for the patient? 1 PO cefixime 400 mg, PO azithromycin 1 gm 2 IM ceftriaxone 250 mg, PO azithromycin 1 gm 3 PO gemifloxacin 320 mg, PO azithromycin 2 gm 4 IM gentamycin 240 mg, PO erythromycin 400 mg

3 The patient diagnosed with gonorrhea who is allergic to penicillin and cephalosporins will be treated with PO gemifloxacin 320 mg and azithromycin 2 gm. Gemifloxacin is a fluoroquinolone and azithromycin is a macrolide antibiotic, so they are safe for this patient. Cefixime and ceftriaxone are cephalosporins. Erythromycin is not used in the treatment of gonorrhea. p 805

What information will the nurse include when teaching about cancer risks in postmenopausal women? 1 Estrogen monotherapy increases the risk of breast cancer. 2 Monotherapy with a progestin increases breast cancer risk. 3 Unopposed estrogen increases the risk of endometrial cancer. 4 Estradiol with progestin increases the risk of endometrial cancer.

3 The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. Estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes. p 783

A 5-year-old child with diarrhea has been prescribed 0.2 mg/kg of loperamide (Imotil). The child's weight is 15 kg. What dose of medication should the nurse administer to the child to ensure safety? Record your answer using a whole number. _______ mg

3 mg In order to prevent overdose and toxic medication effects, the primary health care provider prescribes the medication dosage based on the child's body weight in kilograms. The nurse should check the child's weight and calculate the dosage appropriately before administering the medication. Here, the child's weight is 15 kg and the dosage prescribed is 0.2 mg/kg; therefore, the daily dose of loperamide (Imotil) that the nurse should administer to the child to ensure safety is 3 mg (0.2 mg × 15 kg = 3 mg). p 45

The nurse is caring for an adolescent child with appendicitis. The child tells the nurse, "Some of my school friends drink alcohol and pressure me to drink with them." What should the nurse do in this situation? 1 Advise the child to avoid interacting with these friends. 2 Inform the child's parents of the child's concern. 3 Explain the adverse effects of alcohol to the child. 4 Suggest the child spend as much time as possible at home for few days.

3) Children may exhibit high-risk behavior during adolescence and may drink alcohol. An adolescent child has concrete and abstract reasoning; therefore, the nurse should explain the adverse effects of alcohol and suggest that the child refrain from consuming it. However, the child may feel rejected and isolated if the nurse advises that he or she avoid interacting with friends who drink. An adolescent will have proper cognition and would be able to understand the situation. The nurse should explain the adverse effects of alcohol consumption directly to the child rather than informing his or her parents about the child's concern. Moreover, suggesting that the child spend more time at home may not prevent high-risk behaviors and may alter the child's social interactions. p 48-49

Which sexually transmitted infection (STI) is vertically transmitted from the mother to the neonate? 1 Scabies 2 Bacterial vaginosis (BV) 3 Herpes simplex virus 2 (HSV-2) 4 Pediculosis pubis

3) HSV-2 is vertically transmitted from the mother to the neonate. Transmission of HSV-2 requires contact by the infant with the microorganisms in the birth canal. Scabies is a skin disease caused by a mite. BV is not considered an STI. Pediculosis pubis is a parasitic infection. p 802

Which statement indicates that the patient understands the benefit of continuous administration of progestin with an estrogen regimen? 1 "This regimen prevents ovarian cancer." 2 "This regimen will prevent breast cancer." 3 "Vaginal cancer is prevented with this regimen." 4 "Endometrial cancer risk can be reduced with this regimen."

4 Endometrial cancer risk is decreased with this regimen. Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia. It does not prevent ovarian, vaginal or breast cancer from occurring. p 765

The nurse is assessing a patient who is prescribed estrogen replacement therapy. A history of which medical condition would be a contraindication to this therapy? 1 Weight loss 2 Dysmenorrhea 3 Vaginal bleeding 4 Deep vein thrombosis

4 Increased coagulation and risk of deep vein thrombosis are side effects of estrogen hormone replacement therapy. A previous history would put the patient at increased risk for more clot formation. Vaginal bleeding, weight loss and dysmenorrhea are not contraindications for this therapy. p 769

A patient newly diagnosed with hepatitis A (HAV) states, "I have been in a monogamous relationship, and I don't understand how I contracted this." What is the nurse's best response? 1 "Have you been using condoms during sex?" 2 "Do you wash your hands after using the bathroom?" 3 "How many partners have you had in the past year?" 4 "Hepatitis A infection can be contracted in different ways."

4 The nurse's best response is, "Hepatitis A infection can be contracted in different ways." HAV is primarily transmitted by the fecal-oral route in which the patient ingests food or water contaminated by feces. HAV can also be spread through anal-oral or anal intercourse. Asking the patient about condom use, hand washing, and the number of sexual partners does not answer the patient's question. p 803

A female patient using contraceptives complains of headaches. Which contraceptive is the patient most likely using? 1 Cervical cap with spermicidal jelly 2 Male condom with spermicidal jelly 3 Medroxyprogesterone (Depo-Provera) 4 Norethindrone and ethinyl estradiol (Necon)

4 The patient has headaches, which are common side effects of estrogens. The cervical cap, male condom, and progestin are reasonable alternatives for the prevention of pregnancy in this patient. p 763

The cerebral spinal fluid (CSF) analysis in a patient with tertiary syphilis reveals neurosyphilis. What pharmacological treatment does the nurse anticipate will be ordered? 1 Cephalexin 2 Doxycycline 3 Benzathine penicillin G 4 Aqueous crystalline penicillin G

4 The pharmacological treatment for a neurosyphilis is aqueous crystalline penicillin G.Cephalexin is a cephalosporin and is not used to treat syphilis. Doxycycline is not used to treat the tertiary stage of syphilis. Patients with syphilis but normal CSF should receive benzathine penicillin G. p 806

Which inadequacy in neonates results in reduced absorption of lipid-soluble drugs? 1 Water and electrolytes 2 Cholesterol and triglycerides 3 Gastric acid and intrinsic factor 4 Bile salts and pancreatic enzymes

4 Immature enzyme function may affect drug absorption; neonates have inadequate production of bile salts and pancreatic enzymes, which leads to reduced absorption of lipid-soluble drugs. Reduced absorption of lipid-soluble drugs in the neonate is not a result of inadequate water and electrolytes, cholesterol and triglycerides, or gastric acid and intrinsic factor. p 44

A 28-year-old male is diagnosed with testicular cancer. What treatment should the patient expect? 1 Chemotherapy 2 Radiation and chemotherapy 3 Surgical excision, radiation, and chemotherapy 4 Dependent on the type and stage of the tumor

4 Testicular tumors peak in early adulthood. They include malignant germinal cell tumors and benign Leydig or Sertoli cell tumors. Treatment depends on the type and stage of the tumor. Surgical excision, radiation therapy, and chemotherapy are used alone or in combination but all depend on the type and stage of the tumor. p 799

At what age does intestinal surface area match that of adults? 1 20 days 2 20 years 3 20 weeks 4 20 months

2 Intestinal surface area in neonates reaches that of adults at about 20 weeks. Prior to this, the reduced surface area leads to reduced drug absorption. It is not reached yet at 20 days, but it matches that of adults before 20 years or 20 months. p 44

A patient receiving finasteride (Proscar) has improvements in urinary flow. What is the nurse's priority action? 1 Hold the medication. 2 Call the health care provider. 3 Continue to assess. 4 Measure testosterone levels.

3 Improvement in urinary flow is a therapeutic effect of this medication. The nurse should continue to assess. It is not necessary to hold the medication or notify the provider. Because it is a therapeutic effect, drug levels do not need to be tested. p 795

Which statement should the nurse use to inform a patient about the benefit of taking loestrin Fe 1.5/30 (norethindrone acetate and ethinyl estradiol and ferrous sulfate)? 1 "This pill will increase the period of withdrawal bleeding." 2 "This pill will provide high estrogen levels for ovarian suppression." 3 "This pill will prevent iron-deficiency anemia associated with menstruation." 4 "This pill will prevent the occurrence of headaches during the menstrual cycle."

3 Loestrin Fe 1.5/30 contains ferrous fumarate, an iron compound that provides iron supplementation during the period of withdrawal bleeding. As a result, loestrin Fe helps prevent menstrual-associated iron-deficiency anemia in a patient who is on birth control; therefore, the nurse should inform the patient of the benefit of taking this pill. Ovarian suppression occurs because of low estrogen levels, which is unlikely in this case, because this pill does not provide high estrogen levels. Loestrin Fe 1.5/30 is an estrogen-progestin combination pill that will reduce the period of withdrawal bleeding. Mircette (Desogestrel), not loestrin Fe 1.5/30, helps prevent the occurrence of headaches during menstruation. p 765

Which drug will be ordered for a patient who presents with erectile dysfunction? 1 Testosterone (Axiron) 2 Fluoxymesterone (Halotestin) 3 Finasteride (Proscar) 4 Alprostadil (Caverject)

4 Alprostadil is used in the treatment of erectile dysfunction. The intracavernous injection is also used as a single injection in the diagnosis of erectile dysfunction. Testosterone and fluoxymesterone are used to treat male hypogonadism. Finasteride is used to treat benign prostatic hyperplasia. p 796

Which antiviral drug is used to treat herpes simplex virus 2 (HSV-2)? 1 Salicylic acid 2 Azithromycin 3 Ofloxacin 4 Famciclovir

4 Famciclovir is used to treat HSV-2. Salicylic acid is used to treat Molluscum contagiosum. Azithromycin is used to treat chancroid. Ofloxacin is an alternative treatment for chlamydia. p 806

The nurse is reviewing the patient's current medication and nutritional supplement intake. Which nutritional supplement is most likely to affect absorption of an orally administered drug by altering gut motility? 1 Probiotic 2 Thiamine 3 Vitamin D 4 Magnesium

4 Magnesium can have a laxative effect, altering the patient's gut motility, which impacts drug absorption. A probiotic, thiamine supplement, and vitamin D are less likely to alter gut motility. p 44

Which benefit of synthetic androgens can be seen in a patient? 1 Enhancement of the male libido 2 Relief from fluid retention 3 Prolonged erection 4 Increased hair growth

1 Synthetic androgens, administered through androgen-replacement therapy, helps treat testicular failure in a male patient. They help improve the performance of the male libido. Fluid retention and prolonged erection are adverse effects of androgens. Finasteride (Proscar) causes increased hair growth. pp 791-792

The half-life of which drug is higher in the infant than in the adult? 1 Caffeine 2 Diazepam 3 Phenytoin 4 Phenobarbital

1 The half-life of caffeine is higher in the infant (seven hours) than in the adult (four hours). The half-lives of diazepam, phenytoin, and phenobarbital are higher in the adult than in the infant. p 46

What assessment findings are expected in a patient in the latent stage of syphilis? 1 The patient is asymptomatic. 2 The patient has a genital chancre sore. 3 The patient has a fever, fatigue, and mucocutaneous lesions. 4 The patient has a rash on both the hands and soles of the feet.

1 The patient in the latent stage of syphilis is asymptomatic. The latent stage occurs during secondary syphilis. A genital chancre sore develops in primary syphilis. Characteristics of the second stage of syphilis are fever, fatigue, mucocutaneous lesions, and a rash on the hands and the soles of the feet. p 805

Knowing that albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity? 1 Decrease the amount of drug given. 2 Increase the amount of drug given. 3 Shorten the time interval between doses. 4 Administer the medication intravenously.

1 A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. All of the other options would increase the risk for toxicity for neonates and infants. p 45

Knowing that the proteins in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity? 1 A decrease in the dosage of drug given 2 An increase in the dosage of drug given 3 A shorter time interval between doses 4 Intravenous administration of the drug

1 A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action. p 45

A patient who is 24 weeks gestation reports "a large amount vaginal discharge" described as having a "fishy odor." The patient is diagnosed with Gardnerella vaginalis. What does this mean for the patient? 1 The patient is at risk for preterm delivery. 2 The patient's baby is at risk for malformation. 3 The patient will require treatment during labor. 4 G. vaginalis crosses the placenta and increases the risk of fetal infection.

1 A patient diagnosed with G. vaginalis at 24 weeks gestation is at risk for preterm delivery. G. vaginalis does not cause fetal malformation. The patient will be treated immediately, not waiting until labor. G. vaginalis does not cross the placenta. p 808

A patient receiving androgen therapy has an elevated serum calcium level. What assessment should the nurse make? 1 Presence of chest pain 2 Renal dysfunction 3 Hypotension 4 Nausea and vomiting

1 A patient receiving androgen therapy with an elevated serum calcium level is at risk for cardiac arrest, so the nurse should assess the patient for the presence of chest pain. Renal dysfunction such as difficulty urinating or priapism require prompt attention; however, chest pain is a more urgent concern. Hypertension, not hypotension, may occur with androgen therapy due to possible fluid retention. Nausea and vomiting are likely unrelated to androgen therapy and hypercalcemia. p 794

The nurse is reviewing the patient's current medication and nutritional supplement intake. Which nutritional supplement is most likely to affect absorption of an orally administered drug by altering the gut microbiome? 1 Probiotic 2 Thiamine 3 Vitamin D 4 Magnesium

1 A probiotic supplement will alter the patient's gut microbiome, which impacts drug absorption. Thiamine supplement, vitamin D, and magnesium are less likely to have this effect. p 44

The laboratory reports of an infant with jaundice indicate high serum bilirubin levels. The primary health care provider prescribes a medication that that is highly bound to albumin. Which intervention helps provide safe and effective treatment to the infant? 1 Administering a low dose of the drug to the infant 2 Administering the medication by the rectal route 3 Increasing the frequency of the drug administration 4 Assessing the hydration status of the infant

1 An infant with jaundice may have high serum bilirubin levels. These high bilirubin levels reduce the availability of protein-binding sites to the drug. This increases the availability of free drugs in the blood, which may lead to toxicity. A low dose of the drug is therefore administered to prevent toxicity in the infant. Administering the medication by the rectal route decreases the drug absorption and delays the therapeutic action of the drug. Increasing the frequency of drug administration increases the concentration of the drug in the blood, resulting in drug toxicity. Assessing the hydration status of the infant helps to enhance the elimination of the drug metabolites. It does not decrease the concentration of the drug in the blood. p 45

The parent of an 8-month-old infant tells the nurse, "While administering the medication to my child, I add a small amount of honey to mask the bitter taste." For which condition is this infant at risk due to this method of medication administration? 1 Botulism 2 Diabetes 3 Hypothermia 4 Hypertension

1 An infant's immune system is not well developed; honey is associated with an increased risk of botulism. Honey does not impair pancreatic functioning or elevate glucose; there will not be any increased risk for diabetes. Honey does not affect thermoregulation; therefore, it would not lead to hypothermia. Honey does not cause vasoconstriction; therefore, it would not cause hypertension. p 45

A patient being treated for bacterial vaginosis (BV) asks the nurse, "Why am I at an increased risk for contracting a sexually transmitted infection (STI)?" Which response by the nurse is correct? 1 "BV causes an imbalance in vaginal bacteria." 2 "BV enhances the growth of the Candida albicans." 3 "BV causes the vaginal secretions to become acidic." 4 "BV kills the lactobacilli and replaces it with aerobic bacteria."

1 BV can increase a woman's risk of getting an STI due to the imbalance in vaginal bacteria. C. albicans is an opportunistic fungus, not an STI. BV can cause the pH of the vaginal secretions to become alkalotic, not acidic. BV kills the lactobacilli and replaces it with anaerobic, not aerobic, bacteria. p 802

A patient in the clinic is diagnosed with Haemophilus ducreyi (chancroid). Which statement will the nurse include in the patient's teaching? 1 "You have a high risk factor for contracting and transmitting human immunodeficiency virus (HIV)." 2 "We can offer you an immunoglobulin to prevent further infection." 3 "You will be getting a vaccine to prevent any further transmission of the virus." 4 "Any partners you have had sex with at least 30 days prior to your symptoms should be treated."

1 Chancroid is a high risk factor for contracting and transmitting human immunodeficiency virus. An immunoglobulin is not effective in a patient with chancroid because it is caused by bacteria. Immediate treatment is necessary to cure the infection, prevent transmission, and resolve the clinical symptoms; a vaccine is not a cure. Any partner with whom sexual contact has occurred 10 days preceding the patient's should be examined and treated. p 803

A patient with vulvar lesions is diagnosed with Molluscum contagiosum. What treatment does the nurse anticipate for the patient? 1 Cryotherapy 2 Oral cimetidine 3 Nothing; the infection is self-limiting 4 Topical therapeutic cream

1 Cryotherapy is used to treat M. contagiosum manifesting as lesions in the genital area. There is a risk for reinfection if all lesions are not eradicated. Treatment with oral cimetidine is recommended as an alternative for small children. M. contagiosum is self-limiting, but treatment is necessary if there are lesions in the genital area. Treatment with a therapeutic cream is reliable as a home therapy for men, not women. p 804

A patient has been taking sildenafil (Viagra) for erectile dysfunction. The patient reports episodes of dizziness and fainting spells after using this drug. Which other drug should the nurse assess for while taking the drug history of the patient? 1 Nitrates 2 α agonist 3 Antibiotic drugs 4 Anticoagulants

1 Dizziness and fainting spells are signs associated with low blood pressure. Sildenafil (Viagra) decreases blood pressure by releasing nitric oxide. Nitrates also decrease the workload of the heart by reducing the blood pressure. Administration of both drugs may cause severe hypotension in the patient. Thus, the nurse should determine whether the patient is taking nitrate drugs. α agonist drugs will cause hypertension, whereas sildenafil (Viagra) will be helpful in reducing blood pressure in patients taking an α agonist. Antibiotic drugs and anticoagulants do not interact with sildenafil (Viagra). Antibiotics such as erythromycin (E-Mycin) and clarithromycin (Biaxin) increase the concentration of tamsulosin (Flomax) in the blood. Anticoagulants interact with androgens, thereby causing increased or decreased activity of oral anticoagulant drugs. p 797

A female patient with nongonococcal urethritis is prescribed doxycycline (Vibramycin). Which assessment finding would be a contraindication for the use of this medication? 1 The patient is pregnant. 2 The patient engages in unprotected sex. 3 The patient experiences pain during intercourse. 4 The patient's partner has nongonococcal urethritis.

1 Doxycycline (Vibramycin) is an antibiotic that belongs to the tetracycline class. The use of this drug is unsafe for the fetus and not recommended during pregnancy. Nongonococcal urethritis is a sexually transmitted infection. Therefore, it is likely that the patient either engages in unprotected sex or the patient's partner is infected. A patient with nongonococcal urethritis is likely to experience pain during intercourse. p 805

What is important for the nurse to understand when caring for a patient receiving episodic treatment for herpes simplex virus 2 (HSV-2)? 1 Treatment should begin in the prodrome phase. 2 Treatment should begin with the onset of the lesion. 3 If a lesion is present, the treatment is still effective. 4 If a lesion is present, suppressive therapy is initiated.

1 Episodic treatment for HSV-2 should begin in the prodrome phase that occurs anywhere from 30 minutes to a couple of days before some outbreaks. Episodic treatment is most effective prior to the onset of the lesion. If a lesion is present, the prescribed medication therapy may be of little benefit. Suppressive therapy is not intended for episodic treatment, but it will help reduce the frequency of genital herpes in patients that have frequent reoccurrences. p 806

Which treatment for dysfunctional uterine bleeding (DUB) is always used in combination with other drugs? 1 Estrogen 2 Progestin 3 Nonsteroidal antiinflammatory drugs (NSAIDs) 4 Gonadotropin-releasing hormone (GnRH) agonists

1 Estrogen is never used alone to treat DUB because the risk of endometrial cancer rises dramatically. Progestin is often used alone, especially in low-dose birth control pills. NSAIDs treat the pain associated with cramping that accompanies DUB but do not treat the underlying cause of the bleeding. GnRH agonists may be used specifically to treat endometriosis, not DUB. p 776

The nurse observes a patient who is taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia. What adverse effect is expected in the patient? 1 Decreased libido 2 Increased amount of ejaculate 3 Prolonged erection 4 Fluid retention

1 Finasteride (Proscar) causes libido loss in men. It does not increase ejaculate, but causes ejaculatory dysfunction and erection loss. Prolonged erection is a side effect of erectile dysfunction drugs. Fluid retention is an undesirable effect of androgens. p 798

While reviewing the medical records of a patient, the nurse learns that the patient has taken finasteride (Proscar) in the past. The patient does not have a history of difficulty with urination. What is the probable reason for administering finasteride (Proscar) to this patient? 1 Baldness 2 Infertility 3 Hypertension 4 Benign prostate hyperplasia (BPH)

1 Finasteride (Proscar) is a 5-alpha reductase inhibitor drug that is also known to stimulate the hair follicles and stimulate hair growth. Thus, it is recommended for treating male-pattern baldness. Sperm production is not affected by finasteride (Proscar). Thus, finasteride (Proscar) is not recommended for treating infertility in males. Unlike other drugs for BPH, such as doxazosin (Cardura), finasteride (Proscar) does not act on the blood vessels by stimulating the α receptors. Therefore, it may not result in hypertension. Because the patient had not reported any difficulty in urination in the past, it is unlikely that the patient ever had BPH. p 795

While assessing a patient who is pregnant, the nurse finds that the patient is taking finasteride (Proscar) for hair growth, which was prescribed for her spouse. What will the nurse suggest to the patient to avoid complications during pregnancy? 1 Discontinue taking this medication or drug. 2 Wear gloves while taking this medication. 3 Drink excess water with this medication. 4 Reduce salt intake while taking this medication

1 Finasteride (Proscar) is used for the treatment of baldness in men. It is not prescribed for women of any age, because it has teratogenic effects. Therefore, the nurse should suggest that the patient avoid taking the medication to prevent fetal detects. Taking the medication while wearing gloves will not help to prevent the systemic effects of the drug. Drinking excess water will not help to prevent the teratogenic effects of the drug. Reducing salt intake will help to prevent hypertension, but it will not help to prevent the adverse effect of the medication. p 795

Which action of finasteride (Proscar) helps in the treatment of benign prostatic hypertrophy? 1 It inhibits the conversion of testosterone. 2 It increases the penile blood flow. 3 It relieves male urine retention. 4 It relaxes the prostatic sphincter.

1 Finasteride promotes the regression of prostate epithelial tissues, resulting in decreased mechanical obstruction of the urethra through the inhibition of 5-alpha-reductase which blocks the conversion of testosterone to DHT. Finasteride has no effect on penile perfusion or urinary stasis. The prostatic sphincter does not exist. p 795

The primary health care provider prescribes an intravenous, water-soluble medication to a 2-year-old child. What is the priority nursing intervention in this situation? 1 Identify whether the dosage is appropriate 2 Evaluate the patency of the site 3 Assess for adverse reactions 4 Check the time of administration

1 In neonates and young infants, the proportion of water in the body is 75%. Due to the increased body fluid proportion, the distribution of medication decreases the concentration of the drug in the body. Therefore, children up to 2-years of age require higher doses of water-soluble medications to achieve the desired therapeutic levels. The priority nursing intervention in this situation is to check for the dosage. The nurse should check for the patency of the site when the parenteral route of administration is prescribed. The nurse should monitor for adverse reactions after administering the medication to ensure the child's safety. The nurse can also check for the time of administration, but this can be done after checking the dosage. p 45

Which adverse effect is the nurse alert for while providing care for a patient taking finasteride (Proscar)? 1 Loss of libido 2 Peliosis of the liver 3 Hypotension 4 Depression

1 Loss of libido is seen in patients taking finasteride (Proscar). Peliosis of the liver and depression are adverse effects of androgenic steroids. The concurrent use of erectile dysfunction drugs and nitrates may cause severe hypotension. pp 798

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? 1 Male condom 2 Spermicidal agent 3 Intrauterine device 4 Cervical diaphragm

1 Male condoms are most likely to prevent the transmission of a sexually transmitted disease because they provide the most barrier protection. A spermicidal agent kills sperm. An intrauterine device is placed in the uterus. A cervical diaphragm is not as effective as condoms. p 772

Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol (Ortho-Novum)? 1 Rifampin (Rifadin) 2 Furosemide (Lasix) 3 Acetaminophen (Tylenol) 4 Calcium citrate (Citracal)

1 Rifampin (Rifadin) decreases the estrogenic effects of oral contraceptives. Furosemide (Lasix) is used for the treatment of edema. Acetaminophen (Tylenol) is used to relieve pain and fever. Calcium citrate (Citracal) is a calcium supplement used for preventing osteoporosis. p 764, 784

A patient with a history of coronary artery disease (CAD) presents to the emergency room with complaints of severe chest pain, dizziness, nausea, and vomiting. The patient is hypotensive and diaphoretic. Which statement made by the patient indicates the most likely cause of these symptoms? 1 "I started taking sildenafil for erectile dysfunction." 2 "I started taking an antidepressant recently." 3 "I use a testosterone patch." 4 "I was just finishing my daily walk."

1 Sildenafil is contraindicated for patients with significant cardiovascular disease as this could result in myocardial infarction. The patient's chest pain, dizziness, nausea, and vomiting are consistent with myocardial ischemia and infarction. Antidepressants are more likely to cause sexual dysfunction. Testosterone patches can cause skin irritation, diarrhea, insomnia, and aggression. While vigorous exercise may cause some of these symptoms, it is unlikely mild exercise like walking will do so. p 797

The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis? 1 The patient smokes cigarettes. 2 The patient's fluid intake is low. 3 The patient takes herbal supplements. 4 The patient takes tricyclic antidepressants.

1 Smoking causes thrombosis in patients who undergo estrogen therapy. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. Thrombosis is not caused by a decrease in fluids. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant. p 783

The student nurse is teaching a patient about safe use of doxazosin. Which statement by the patient indicates teaching was successful? 1 "I should take this medication at bedtime." 2 "I should take this medication on an empty stomach." 3 "I may feel increased energy while taking this medication." 4 "I can stop this medication when I feel better."

1 Teaching is successful when the patient states, "I should take this medication at bedtime." Doxazosin is an alpha-adrenergic blocking agent that can cause postural hypotension. Taking it at bedtime will decrease the incidence of hypotension. Dietary intake is not an issue with this medication. Fatigue, not increased energy may be experienced by the patient receiving doxazosin. The patient should continue the medication even if feeling better. p 798

A patient is sterile due to low testosterone levels. Which other complication will the nurse suspect to find in the patient? 1 Anemia 2 Hypoglycemia 3 Hyperacidity 4 Fatty liver

1 Testosterone is a hormone that plays an important role in erythropoiesis. It helps in the formation of red blood cells. Reduced levels of testosterone cause reduced production of red blood cells, which in turn causes anemia due to reduced hemoglobin. Testosterone does not affect the function of the pancreas. Therefore, it does not cause hypoglycemia. Testosterone does not affect the function of the proton pump in the stomach, and hence, it does not cause hyperacidity. Unlike alcohol consumption, low levels of testosterone do not cause fatty liver. p 792

A teenage patient is asking the nurse to explain how birth control pills work. What is the nurse's best response? 1 "Estrogen in the pills keeps you from ovulating." 2 "Just take the pills, or you'll get pregnant." 3 "The pills keep you from having a period." 4 "The pills kill sperm."

1 The basis for oral contraceptive mode of action is that estrogen inhibits ovulation, thereby drastically reducing the risk of pregnancy. Telling the patient to just take the pills does not educate the patient. Most birth control pills still allow for the woman to have periods, though the characteristics of that period may vary. Oral contraceptives have no effect on sperm viability. p 762

A patient is diagnosed with a deep vein thrombosis (DVT) and is taking enoxaparin injections. She requests birth control. What is the most appropriate contraceptive method for this patient? 1 Condom 2 Progestin-only pill 3 Triphasic pill 4 Withdrawal method

1 The condom is the safest option for women who cannot take oral contraceptives. In this case, both progestin-only and triphasic pills are contraindicated because of the patient's DVT history. The withdrawal method won't compromise the patient's health, but it is an unreliable method of contraception. p 769

Which organ is primarily involved in the metabolism of medications? 1 Liver 2 Lungs 3 Kidneys 4 Pancreas

1 The liver is primarily involved in the metabolism of medications. The enzymes present in the liver convert complex drug molecules into a simple form. The lungs are mainly involved in the excretion of water-soluble medications. The kidneys eliminate drug molecules along with urine. The pancreas is a mixed gland that secretes insulin in the body and promotes glucose metabolism, but is not involved in the metabolism and excretion of drugs. p 45

What information does the nurse include when teaching a patient diagnosed with acute hepatitis B (HBV) about hepatitis B immune globulin (HBIG)? 1 Treatment of HBV is supportive only. 2 HBIG is recommended. 3 The HBV vaccination is the preferred treatment. 4 There is no immune globulin available for HBV.

1 The nurse can tell the patient is that treatment of hepatitis B is supportive only. HBIG is for post-exposure prophylaxis, and the HBV is for the prevention of hepatitis B. Immune globulin does exist but it is not used for an acute drug. p 803

What does the nurse include in the assessment of a pregnant patient with syphilis? 1 Allergy to penicillin 2 History of drug abuse 3 Presence of anaerobes 4 The Jarisch-Herxheimer reaction

1 The nurse needs to assess if the patient is allergic to penicillin because benzathine penicillin G is the treatment of choice for syphilis. The Jarisch-Herxheimer reaction most commonly occurs after a patient with syphilis is administered benzathine penicillin G. Therefore, the reaction will not be seen in the patient during the assessment. The nurse need not assess for a history of drug abuse in this case because syphilis is a sexually transmitted infection; it does not occur due to drug abuse. Anaerobes are an indication of pelvic inflammatory disease, not syphilis. p 805-806

A patient diagnosed with bacterial vaginosis (BV) is prescribed PO metronidazole 500 mg twice a day for 7 days. What medication instruction should the nurse include in the patient's teaching? 1 Take the medication with food. 2 The medication should be taken at bedtime. 3 Drink only small amounts of alcohol during treatment. 4 Use a condom during intercourse.

1 The nurse should teach the patient to take the medication with food. Metronidazole can cause an upset stomach and should be taken with food or a full glass of water or milk. The oral dose of medication does not have to be taken at bedtime. Alcohol causes severe vomiting and nausea and should be avoided entirely during and for 48 hours after the treatment. BV is not considered a sexually transmitted infection (STI), but intercourse is not recommended during treatment. p 804

A patient who uses a vaginal ring tells the nurse, "My vaginal ring had dislodged, but I reinserted it within 6 hours. I also took a backup oral contraceptive pill for 2 days." What can the nurse conclude from this information? 1 The patient is at a risk for pregnancy. 2 The patient may develop an infection. 3 The patient cannot use the vaginal ring. 4 The patient will not have withdrawal menses.

1 The vaginal ring should be reinserted within 3 hours, not 6; therefore, in this case, the patient would be at risk of pregnancy and should use a backup contraception for 7 days. Vaginal infection is a side effect of the vaginal ring and does not occur if the vaginal ring is dislodged. A patient uses a vaginal ring for three weeks and has withdrawal menses in the fourth week. If a patient can reinsert the vaginal ring after dislodgment, it indicates that the patient is able to use the vaginal ring effectively. p 766

A patient who has been taking sildenafil (Viagra) has developed angina. The health care provider has ordered isosorbide mononitrate (Imdur). What is the nurse's primary intervention? 1 Advise the patient not to take the sildenafil. 2 Tell the patient to take the Imdur before the sildenafil. 3 Instruct the patient to take the medications on opposite days. 4 Take the patient's blood pressure.

1 When taken in conjunction with nitrates, sildenafil (Viagra) can cause severe hypotension unresponsive to treatment. The patient should not take these medications together. The other interventions are not correct. p 797

Which precautions should the nurse take while administering Depot medroxyprogesterone acetate (Depo-Provera) injection to a patient? Select all that apply. 1 Use the ventrogluteal or deltoid muscle to administer the medication. 2 Provide a personalized calendar to the patient for subsequent doses. 3 Avoid massaging the injection site after administering the medication. 4 Administer a pregnancy test if the patient takes the next dose after 13 days. 5 Avoid shaking the Depot medroxyprogesterone acetate vial before administration.

1, 2, 3 The nurse should use a patient's ventrogluteal or deltoid muscle to administer Depot medroxyprogesterone acetate (Depo-Provera) injection for effective absorption. The nurse should not massage the injection site after administering the medication to prevent irritation at the injection site. The nurse should provide a personalized calendar to a patient for subsequent doses to ensure that the patient does not miss a dose. The nurse should shake the vial before administering the medication to obtain a uniform medication suspension. Depot medroxyprogesterone acetate is a long-acting injectable progestin that is taken every 11 to 13 weeks, not 13 days. p 767

Which nonpharmacologic methods of pain and anxiety control are appropriate for the nurse to use with pediatric patients when administering drugs? Select all that apply. 1 Diversion 2 Relaxation 3 Distraction 4 Creative imagery 5 Administration during sleep

1, 2, 3, 4 Based on the cognitive level of the child, nonpharmacologic methods of pain and anxiety control such as diversion, relaxation, distraction, and creative imagery can be used to decrease the perception of pain. Medications should never be given to a sleeping child with the intent to surprise the child with a quick procedure. The child may subsequently experience a lack of trust and may be reluctant to sleep in the future. p 48

Which are preventative measures recommended by the Centers for Disease Control and Prevention (CDC) to prevent sexually transmitted infections (STIs)? Select all that apply. 1 Using condoms 2 Practicing abstinence 3 Having fewer partners 4 Talking to your partner about STIs 5 Getting tested annually for all STIs

1, 2, 3, 4) The measures recommended by the CDC to prevent STIs include using condoms, practicing abstinence, having fewer partners, and talking to your partner about STIs. The CDC does not endorse getting tested annually for all STIs; rather, there are specific recommendations for each STI depending on patient characteristics and lifestyles. p 802

Which are considered contributing factors to the increase in sexually transmitted infections (STIs) in adults over 50 years of age? Select all that apply. 1 High divorce rate 2 Low rate of condom use 3 Postmenopausal changes in women 4 Older adults' decreased immune response 5 The availability of drugs for erectile dysfunction

1, 2, 3, 5 Contributing factors to the increase in STIs in adults over 50 include a high divorce rate, low rate of condom use, postmenopausal changes in women, and the availability of drugs for erectile dysfunction. The high divorce rate has contributed to the increased number of adults dating. The low rate of condom use is due to a lack of need to prevent pregnancy. Postmenopausal changes in women, such as decreased vaginal lubrication, increase the risk for infection. The availability of drugs for erectile dysfunction makes sex more possible for an increased number of older men. Changes in the immune response that occur with age are not a factor in rising STI rates. p 808

Which factors increase the risk for contracting a sexually transmitted infection (STI)? Select all that apply. 1 Substance abuse 2 Sexual assault 3 Imprisonment 4 Mutual monogamy 5 Paid sexual activity

1, 2, 3, 5 Factors that increase the risk for contracting an STI include substance abuse, sexual assault, imprisonment, and paid sexual activity. Mutual monogamy decreases the risk for contracting an STI. p 808

What instructions for comfort are approved for a patient newly diagnosed with the Zika virus? Select all that apply 1 Get plenty of rest. 2 Take acetaminophen for fever. 3 Take aspirin for fever and pain. 4 Drink plenty of fluids. 5 Take ibuprofen for muscle pain.

1, 2, 4 Patient instructions for comfort includes getting plenty of rest, taking acetaminophen for fever, and drinking plenty of fluids. To reduce the risk of bleeding, aspirin and ibuprofen are contraindicated until dengue fever can be ruled out. p 804

The nurse is providing education to a patient prescribed a testosterone gel preparation. Which instructions should the nurse include regarding safe use of testosterone gel? Select all that apply. 1 Apply the gel to the clean, dry skin of the shoulders or upper arms. 2 Cover application areas with clothing to avoid secondary exposure. 3 Apply the gel liberally to the genital area. 4 Leave the application open to air for better absorption. 5 Wash the hands with soap and water after application. 6 Children should avoid contact with unwashed application sites.

1, 2, 5, 6 Patients on testosterone therapy should be taught to apply the gel to the clean, dry skin of the shoulders and upper arms. Patients should cover the areas with clothing to avoid secondary exposure. Patients should wash hands with soap and water after application to avoid secondary exposure. Children should avoid contact with unwashed application sites. Testosterone gel should not be applied to the genital area. The patient should not leave the testosterone gel application area exposed to open air since it does not improve drug absorption and increases the risk of secondary exposure. p 793

Health care providers may base pediatric dosing on which factors? Select all that apply. 1 Body weight 2 Lean body mass 3 Body surface area 4 Body fat percentage 5 Body water percentage

1, 3 Drugs for pediatric patients are ordered based on either the child's weight in kilograms (mg/kg) or body surface area (mg/m 2). Body surface is based on a percentage of adult surface area (1.73 m 2). It is not safe or practical to base pediatric dosing on lean body mass, body fat percentage, or body water percentage. p 45

A patient reports that the use of combined hormonal contraception (CHC) products has not been effective in preventing pregnancy. Which assessment finding is the most probable cause of the ineffectiveness of the CHC products? Select all that apply. 1 The patient has been ingesting St. John's wort. 2 The patient smokes and drinks alcohol regularly. 3 The patient has been taking antibiotics for an infection. 4 The patient experienced breakthrough bleeding (BTB). 5 The patient has been taking ascorbic acid (vitamin C) supplements.

1, 3 Herbs such as St. John's wort have the potential to interact with combined hormonal contraception (CHC) products and reduce their effectiveness. A patient who takes St. John's wort should use a backup method of birth control. Antibiotics interfere with the effectiveness of birth control pills; therefore, back up birth control methods should be used whenever an antibiotic is taken. Smoking and alcohol are associated with increased risks of teratogenic effects on the fetus and cardiovascular problems in the patient; however, there is no known interaction with COC products. BTB is a common side effect of COC products and is not related to pregnancy. The use of vitamin supplements, such as ascorbic acid, increases the effectiveness of COC products; therefore, pregnancy will not occur when such supplements are taken. p 763

Which factors impede the absorption of drugs delivered intramuscularly or subcutaneously? Select all that apply. 1 Dehydration 2 Low gut motility 3 Cold temperatures 4 Altered cardiac status 5 Reduced enzyme levels

1, 3, 4 Conditions that alter perfusion, like dehydration, cold temperatures, and alterations in cardiac status, may impede absorption of drugs in the tissues when delivered intramuscularly or subcutaneously. Gut motility and enzyme levels affect absorption of drugs administered via the oral route. p 44

Which practices put an individual at an increased risk for contracting sexually transmitted infections (STIs)? Select all that apply. 1 Anal intercourse 2 Open-mouth kissing 3 Hand-anal contact 4 Intercourse without a condom 5 Contact with menstrual blood during sexual activity

1, 3, 4, 5 Practices that place an individual at an increased risk for contracting STIs include anal intercourse, hand-anal contact, intercourse without a condom, and contact with menstrual blood during sexual activity. Sexual transmission of pathogens can occur through breaks in the skin and mucosa. Open-mouth kissing does not place an individual at an increased risk for contracting an STIs. p 801

Which medications are unaffected by food intake? Select all that apply. 1 Avanafil 2 Sildenafil 3 Warfarin 4 Tadalafil 5 Vardenafil

1, 4 The actions and effects of avanafil and tadalafil are unaffected by food. Sildenafil works best on an empty stomach. Warfarin has many food and drug interactions. Vardenafil is less effective when taken with a fatty meal. p 797

The nurse is caring for a patient receiving androgen therapy. The nurse understands that androgen therapy is indicated for which conditions? Select all that apply. 1 Delayed puberty 2 Hypergonadism 3 Priapism 4 Prostate cancer 5 Testicular failure

1, 5 Androgen therapy is indicated for the treatment of delayed puberty in adolescents, testicular failure in adult males, and hypogonadism. It is not indicated for hypergonadism, priapism, or prostate cancer. p 792

While assessing the cognitive skills of an adolescent patient, the nurse finds that the patient is in the concrete operational stage. Which action of the patient supports the nurse's conclusion? 1 The patient provides exact reasoning for taking medications. 2 The patient is unable to comprehend potential drug implications. 3 The patient comprehends complex information related to drug administration. 4 The patient takes extra precautions necessary to combat drug effects.

2 The adolescent patient who is in the concrete operational stage will not be able to understand potential drug implications. The patient has difficulty understanding concepts such as drug interactions, side effects, adverse reactions, and therapeutic levels. If the patient is able to provide exact reasoning for taking the medications, it indicates that the patient is in the abstract reasoning stage. If the patient is unable to demonstrate an understanding of complex information, it indicates that the patient remains in the concrete operational stage. If the patient avoids taking extra precautions that are necessary to combat drug effects, it indicates that the patient is in the concrete operational stage. p 48

A patient has been prescribed PO acyclovir 400 mg two times a day for herpes simplex virus 2 (HSV-2). What is the goal of treatment for this prescription? 1 The dosage will eradicate the the viral load. 2 The dosage prescribed is for suppressive therapy. 3 The dosage prescribed is for an initial HSV-2 infection. 4 The severity of recurrent episodes will be reduced when completing treatment.

2 Acyclovir 400 mg two times a day for HSV-2 is prescribed for suppressive therapy. The dosage will decrease the viral load but not eradicate it. The dosage for an initial HSV-2 infection is PO acyclovir 400 mg three times daily for 7 to 10 days. The dosage does not reduce the severity in recurrent episodes following drug discontinuation. p 806

A patient is taking a combined hormone contraception (CHC) product and ampicillin (Amoxil). The primary health care provider prescribes the patient with a higher dose of ethinyl estradiol than the CHC product contains. What is the purpose of this prescription? 1 To prevent pain 2 To prevent pregnancy 3 To enhance the effectiveness of ampicillin 4 To prevent ascorbic acid (vitamin C) deficiency

2 Ampicillin (Amoxil) is an antibiotic that interacts with combined hormone contraception (CHC) products and reduces its effectiveness; therefore, a patient needs to take a CHC with a higher dose of ethinyl estradiol to prevent pregnancy. A higher dose of ethinyl estradiol will not enhance the effectiveness of ampicillin, as it is not an antibiotic, but a contraceptive medication. The use of ethinyl estradiol does not increase the risk for a deficiency in ascorbic acid (vitamin C). A primary health care provider would not prescribe ethinyl estradiol for pain. p 768

A patient reports an inability to achieve or maintain an erection during sexual intercourse. Which medication does the nurse anticipate the primary health care provider will prescribe for this patient? 1 Oxandrolone (Oxandrin) 2 Phentolamine (Regitine) 3 Goserelin acetate (Zoladex) 4 Methyltestosterone (Methitest)

2 An inability to achieve or maintain an erection during sexual intercourse is erectile dysfunction, which may be caused by vascular insufficiency. Phentolamine (Regitine) is a vasodilator, which acts by dilating the blood vessels of the penis, thereby engorging the penis with blood and resulting in erection. Oxandrolone (Oxandrin) is an anabolic steroid used to treat cachexia, short stature, and osteoporotic pain. Goserelin acetate (Zoladex) belongs to the class of antiandrogens, which are effective in the treatment of benign prostatic hypertrophy, advanced prostatic cancer, and endometriosis. Methyltestosterone (Methitest) is a synthetic androgen used to treat breast carcinoma and androgen deficiency. p 796

A child with stunted growth is prescribed androgen therapy. What is the best way to monitor the effectiveness of the therapy? 1 Daily height and weight measurements 2 Hand and wrist x-rays every 6 months 3 Liver and thyroid function laboratory tests 4 Appraisal of expressive affect

2 Androgen therapy should be cautiously used in children and only by specialists aware of the adverse effects on bone maturation. Skeletal maturation must be monitored every 6 months by radiography of the hand and wrist. Daily height and weight measurements are excessive. The liver and thyroid panels should be monitored related to adverse reactions to androgen therapy, not to assess drug effectiveness. Appraisal of expressive affect should be routinely done during therapy but does not measure drug effectiveness. p 792

As children grow and develop, what generally happens to the absorption of drugs? 1 Becomes less effective throughout life 2 Becomes more effective but may slow in adolescence 3 Becomes less effective until adolescence, when it becomes more effective 4 Becomes more effective, peaking in adolescence and slowing in early adulthood

2 As children grow and develop, the absorption of drugs generally becomes more effective; therefore less developed absorption in neonates and infants must be considered in dosage and administration. However, poor nutritional habits, changes in physical maturity, and hormonal differences during the adolescent years may cause slowing of drug absorption. Absorption does not become less effective throughout life, more effective in adolescence, or peak in adolescence and slow in early adulthood. p 44

A female patient with strep throat is taking amoxicillin with clavulanate (Augmentin) to treat the infection. Because the patient also takes an oral contraceptive (OC), the nurse will instruct the patient to use a different method of birth control for how long? 1 During the entire period the patient is taking the antibiotic 2 For at least 1 month during and after starting the antibiotic 3 Until three throat cultures have been negative for the pathogen 4 For at least 6 weeks, starting at the end of the antibiotic regimen

2 Because antibiotics, especially penicillins and cephalosporins, can impair the action of OCs, the nurse instructs the patient to use another method of birth control for at least 1 month during and after starting the antibiotic. p 763, 769

What information regarding scabies should be included in the patient teaching to prevent further transmission? 1 All bedding and clothing should be discarded. 2 Bedding and clothing should be removed from body contact for at least 72 hours. 3 All bedding and clothing should be washed with bleach. 4 Anyone who has had close personal contact with the patient within 60 days preceding the infestation should seek treatment.

2 Bedding and clothing should be removed from body contact for at least 72 hours to prevent reinfestation. Scabies mites do not survive more than 2 to 3 days away from human skin, so it is not necessary to dispose of all bedding and clothing. Bedding and clothing can be machine washed and dried using the hottest cycle. Bleach does not have to be used; hot water will kill the mites. Anyone who has had close personal contact with the patient within a month preceding the scabies infestation should seek treatment. p 807

Which term describes therapeutic care that eliminates or minimizes the psychological and physical distress experienced by children and families? 1 Research equity 2 Atraumatic care 3 Informed consent 4 Age-appropriate dosing

2 Donna Wong's principle of atraumatic care is "the philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and families." Research equity describes efforts to require drug manufacturers to study pediatric drug use and offer incentives for pediatric pharmacology research. Informed consent is difficult to obtain in the pediatric population. Age-appropriate dosing involves taking into consideration the developmental and metabolic differences in the pediatric population. p 47

In what stage of syphilis do large sores inside the body occur? 1 Latent 2 Tertiary 3 Secondary 4 Primary

2 During the tertiary stage of syphilis, large sores occur inside the body or on the skin. During the latent stage, the patient is asymptomatic. Rash and mucocutaneous lesions are characteristic of the secondary stage of syphilis. A chancre appears in the primary stage of syphilis at the site where the infection entered the body. p 805

A 39-week gestation patient has begun treatment with ciprofloxacin for chancroid. She delivers the baby and plans on breastfeeding. What order from the health care provider is the most appropriate treatment during lactation? 1 Ciprofloxacin PO 500 mg for 3 days 2 Erythromycin PO 500 mg tid for 7 days 3 Ceftriaxone IM 250 mg single dose 4 Trimethoprim-sulfamethoxazole PO 160 mg/800 mg bid for 3 weeks

2 Erythromycin PO 500 mg tid for 7 days is the safest treatment during lactation. Ciprofloxacin presents a low risk to the fetus during pregnancy with a potential for toxicity during breastfeeding. Ceftriaxone is not recommended for treatment of chancroid during lactation. Trimethoprim-sulfamethoxazole is used for the treatment of Klebsiella infections. p 803

The nurse is teaching a student about the functions of estrogen. Which statement by the student indicates a need for additional teaching? 1 Estrogen produces viscous cervical secretions. 2 Estrogen decreases the amount and quality of cervical mucus. 3 Estrogen stimulates the pituitary gland to release luteinizing hormone. 4 Estrogen stimulates growth of the glandular surface of the endometrium.

2 Estrogen is responsible for stimulating growth of the glandular surface of the endometrium, stimulating the pituitary to release luteinizing hormone, and affecting the mucus glands of the cervix to produce more plentiful, viscous mucus. pp 765, 780

A patient has been diagnosed with benign prostatic hypertrophy (BPH). Why will the primary health care provider prescribe finasteride (Proscar)? 1 It helps relax urine retention. 2 It helps stop a growing prostate. 3 It helps increase penile blood flow. 4 It helps treat erectile dysfunction.

2 Finasteride (Proscar) focuses on the degeneration of the prostate epithelial tissue, which further helps reduce mechanical obstruction in the urethra. Finasteride inhibits 5-alpha reductase, responsible for converting testosterone to 5-dihydrotestosterone. Finasteride has no effect on urine retention. Sildenafil (Viagra) increases penile blood flow and helps treat erectile dysfunction. p 795

A 10-year-old is prescribed the antidepressant drug fluoxetine. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for this patient? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population

2 Fluoxetine is metabolized by the CYP2D6 isoenzyme. Activity of this enzyme is lower in the pediatric population until about 12 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug may be prescribed in appropriate doses in the pediatric population. p 46

Which classification of drugs may cause gynecomastia and priapism? 1 5-alpha-reductase inhibitors 2 Androgens 3 Antiandrogens 4 Alpha-adrenergic blocking agents

2 Gynecomastia and priapism are side effects of androgen therapy. Side effects of 5-alpha-reductase inhibitors include decreased libido, erective dysfunction, orthostatic hypotension, and gynecomastia, but not priapism. Antiandrogen side effects include abdominal symptoms, heartburn, blurry vision, dizziness, headache, and nasal congestion. Alpha-adrenergic blocking agent side effects include postural hypotension, dizziness, edema, dyspnea, palpitations, and polyuria. p 793

A 6-year-old is prescribed the antiepileptic drug lamotrigine. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 6-year-old patient? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population

2 Lamotrigine is metabolized by N-methyltransferases UGTs. Activity of this enzyme is lower in the pediatric population until about 7 to 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug may be safely prescribed in appropriate doses for the pediatric population. p 46

Which drug has abortificient properties and is avoided in pregnant women? 1 Sulindac (Clinoril) 2 Misoprostol (Cytotec) 3 Indomethacin (Indocin) 4 Diclofenac sodium (Voltaren)

2 Misoprostol is a synthetic prostaglandin E1 analogue and has abortificient properties. It is prescribed with nonsteroidal antiinflammatory drugs to prevent gastrointestinal ulcers. Sulindac, indomethacin, and diclofenac sodium are nonsteroidal antiinflammatory drugs. These are acetic acid derivatives and do not have abortifacient properties. p 774

A 9-year-old is prescribed omeprazole. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for this patient? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population

2 Omeprazole is a proton pump inhibitor metabolized by the CYP2C19 isoenzyme. Activity of this enzyme is lower in the pediatric population until about 10 years of age compared to adults. Therefore the dosage should be decreased. The dosage should not be increased or equivalent to the adult recommended dosage. This drug is safe to prescribe in appropriate doses in the pediatric population. p 46

A patient who is postmenopausal is planning to start oral estrogen-progestin therapy (EPT) for the relief of symptoms related to menopause. After further assessment of the patient, the nurse obtains a prescription for a transdermal skin patch. Which assessment finding supports the change in the prescription? 1 The patient has osteoporosis. 2 The patient has a history of peptic ulcers. 3 The patient is taking antibiotics for an infection. 4 The patient has an ascorbic acid (vitamin C) deficiency.

2 Oral estrogen-progestin therapy (EPT) increases the risk for gastrointestinal problems in patients; therefore, a patient who has a history of peptic ulcers is likely to experience the adverse effects of oral EPT. A transdermal patch bypasses the gastrointestinal tract and would be more effective for such patients. A deficiency in ascorbic acid (vitamin C) is not related to the intake of oral EPT. The use of antibiotics will indicate a need to increase the estrogen-progestin dose, but not the drug route. The use of EPT helps deliver estrogen to the patient, which will reduce the risk of osteoporosis; however, osteoporosis is not an indication to change the administration route. p 784

An older patient with a history of atrial fibrillation reports erectile dysfunction. The patient states, "I am on so many prescription drugs, I decided to try ginkgo biloba because I read it works." Which medication on the patient's medication administration record is a contraindication to ginkgo biloba? 1 Salicylic acid 2 Warfarin 3 Potassium chloride 4 Furosemide

2 Patients with atrial fibrillation are often prescribed warfarin to prevent blood clot formation. Ginkgo biloba taken with warfarin can result in uncontrolled bleeding or hemorrhage. Gingko biloba does not interact with salicylic acid, potassium chloride, or furosemide. p 797

What is the priority nursing intervention for a patient who is taking combined hormone contraception (CHC) pills with drospirenone (DSRP)? 1 Monitoring input and output (I&O) 2 Monitoring serum potassium levels 3 Reducing salt in the patient's diet 4 Assessing for gastrointestinal problems

2 Rationale The nurse should monitor the serum potassium levels in a patient who is taking hormone contraception (CHC) pills combined with drospirenone (DSRP). This is because DSRP contains spironolactone, a potassium-sparing diuretic hormone that can increase serum potassium levels in the patient. It is not necessary to monitor the patient's input and output (I&O), because fluid imbalances do not occur with CHC pills. A decrease in dietary salt is necessary if the patient's sodium levels are high. CHC pills may cause nausea and vomiting, but not gastrointestinal problems in the patient. p 764

Which human papillomavirus (HPV) vaccine prevents infection from the strain that causes the majority of all cervical cancers? 1 9-valent 2 Bivalent 3 Covalent 4 Quadrivalent

2 The bivalent vaccine prevents infection from the strain of HPV that causes the majority of all cervical cancers. The 9-valent prevents infection from some types of HPV. Covalent does not describe an HPV vaccine; it is a type of chemical bond. The quadrivalent HPV vaccine prevents infection from the majority of HPV types that cause genital warts. p 807

After administering an intravenous medication to a preschooler, the nurse places a decorative bandage at the site of injection. What is the rationale for this intervention? 1 To reduce pain 2 To relieve anxiety 3 To prevent infection 4 To enhance containment

2 The fear of injection is common among children. The preschooler may perceive that the insertion of the needle will cause his or her skin to open and blood to leak from the area. In order to prevent the fear of "leakage," the nurse should apply a colorful bandage at the site of the injection. This intervention helps reduce fear and anxiety in the child. Additionally, to reduce pain, the nurse should apply a local, topical anesthetic prior to administration at the selected site of administration. The nurse cleanses the site of injection with an antiseptic solution to prevent infection. The nurse applies a transparent dressing at the site of administration to enhance the containment of the drug. p 48

How many hours would it take for the lidocaine level in a child to reach 50% of the intake level? 1 2 to 3 hours 2 1 to 5 hours 3 1 to 2 hours 4 2 to 7 hours

2 The half-life for lidocaine in a child is 1 to 5 hours. Therefore the lidocaine level in a child would reach 50% of the intake level at 1 to 5 hours. The half-life range for lidocaine in a child is not 2 to 3, 1 to 2, or 2 to 7 hours. p 46

Which drug prescription does the nurse report to the primary health care provider if the patient is taking tadalafil (Cialis)? 1 Famotidine (Pepcid) 2 Nitroglycerin (Nitrobid) 3 Ibuprofen (Motrin) 4 Furosemide (Lasix)

2 The major contraindication to the use of tadalafil is concurrent nitrate therapy because this can result in severe hypotension. It includes the use of amyl nitrate, sublingual or topical nitroglycerine, and oral nitrate derivatives such as isosorbide mononitrates and dinitrates. Famotidine, ibuprofen, and furosemide are not contraindicated in patients taking tadalafil. p 797

When assessing a patient, the nurse learns that the patient has been abusing anabolic steroids to improve sports performance for the past 3 years. Which test will the nurse discuss with the provider? 1 Kidney function test 2 Liver function test 3 Complete blood picture 4 Chest x-ray

2 The most serious adverse effects associated with the long-term use of anabolic steroids are liver conditions such as peliosis, hepatic neoplasms (liver cancer), and cholestatic hepatitis. Therefore, the nurse should first refer the patient for a liver function test to check for the presence of any liver abnormality. Renal function is not affected by steroids; therefore, the nurse need not ask the patient to take a kidney function test. A complete blood picture in this patient would reveal mild elevation in the red blood cell levels, because these drugs facilitate erythropoiesis. Anabolic steroids are not known to cause any pulmonary problems. Therefore, the nurse need not refer the patient for a chest x-ray. p 793

The nurse is assessing a patient with symptoms of human papillomavirus (HPV). The patient states that she had a Gardasil vaccination at 11 years of age. Which further assessment data will the nurse obtain? 1 CD4 count 2 Pap test results 3 Allergy to penicillin 4 Tetanus booster vaccination information

2 The patient has had a Gardasil vaccination for the prevention of cervical cancer caused by HPV. However, because the patient is symptomatic, she will need to undergo routine cancer screening. The nurse will evaluate the Pap test results to determine if the cervical cells are abnormal. Tetanus booster vaccination is not related to HPV. Penicillin is not useful for the treatment of HPV. Therefore, it is not important to assess the patient for penicillin allergy. CD4 counts are useful in assessing HIV infections, not HPV. p 807

What instruction does the nurse provide to the patient prescribed intramuscular medication for the treatment of gonorrhea? 1 "You will also be given a cream to use until the lesions heal." 2 "Abstain from sexual activity for 7 days after treatment." 3 "Use a condom during treatment to prevent spreading the infection." 4 "All partners should be treated during the 30 days preceding the onset of symptoms."

2 The patient should be instructed to abstain from sexual activity for 7 days after treatment. Gonorrhea does not cause lesions. It is recommended the patient abstain from sexual activity during treatment. All partners should be treated during the 60 days preceding the onset of symptoms or diagnosis. p 805

What is the recommended therapy for a pregnant woman experiencing recurrent genital herpes? 1 Acyclovir 400 mg three times a day beginning at 24 weeks gestation 2 Valacyclovir PO 500 mg twice a day beginning at 36 weeks gestation 3 Acyclovir 400 mg three times a day beginning at 12 weeks gestation 4 Valacyclovir PO 500 mg twice a day beginning at 40 weeks gestation

2 The recommendation therapy for a pregnant woman experiencing recurrent genital herpes is valacyclovir PO 500 mg twice a day beginning at 36 weeks gestation. The treatment with acyclovir 400 mg three times a day beginning at 24 or 12 weeks gestation is too remote from delivery. Valacyclovir PO 500 mg twice a day beginning at 40 weeks gestation is too late in the pregnancy for the medication to be effective. p 806

A 1-year-old is prescribed the bronchodilator theophylline. Based on known isoenzyme activity at this age, how should the provider's recommended dosing change for the 1-year-old patient? 1 Increase dosage 2 Decrease dosage 3 Follow adult recommended dosage 4 Avoid prescribing this drug in the pediatric population

2 Theophylline is metabolized by the CYP1A2 isoenzyme. Activity of this enzyme is lower in the pediatric population until 2 years of age compared to adults. Therefore the dosage should be decreased. It is not safe for the dosage to be increased or equivalent to the adult recommended dosage. This drug may be prescribed in appropriate dosages in the pediatric population. p 46

A patient who is on vardenafil (Levitra) therapy reports a severe headache accompanied by flushing. Which action might have resulted in these symptoms? 1 Drinking milk 1 hour before taking the medication 2 Drinking grapefruit juice while taking the medication 3 Performing weightlifting exercise after taking the medication 4 Performing deep breathing exercises after taking the medication

2 Vardenafil (Levitra) belongs to the class of phosphodiesterase-5 (PDE-5) inhibitors. PDE-5 inhibitors interact with grapefruit juice and thereby result in an increased concentration of the drug in the blood. Elevated serum levels of vardenafil (Levitra) are associated with headache, flushing, dyspepsia, and nasal congestion. Vardenafil (Levitra) and milk have no known side effects. Performing exercises after taking the medication does not precipitate side effects. p 797

Which has the greatest potential to increase the risk of thromboembolic phenomena in a patient taking norethindrone and ethinyl estradiol (Loestrin)? 1 Sedentary lifestyle 2 Smoking heavily every day 3 Consumption of saturated fats 4 Increased body mass index (BMI)

2 Women taking oral contraceptives are at increased risk of thromboembolic events if they smoke heavily or have a history of thromboembolism; this higher risk is partially due to an increase in circulating levels of clotting factors. Consumption of saturated fats is likely to increase the risk of a thromboembolic event in a patient who takes an oral contraceptive, but not as much as smoking. Increased BMI and sedentary living elevate the risk of several health problems and can contribute to the development of thromboemboli, but that risk is secondary to the risk resulting from concurrent smoking and use of oral contraceptives. p 783

Which statement should the nurse use to instruct a patient who takes a progestin-only oral contraception pill (POP)? 1 "Take the pill within a 6-hour window." 2 "Take one pill daily at the same time of day." 3 "Do not take any pills during withdrawal bleeding." 4 "There is a risk for pregnancy when taking this pill."

2 patient misses a single dose because the progestin-only oral contraception pill (POP) does not suppress the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to a great degree. The nurse should instruct a patient to take the pill within a 3-hour window. If a patient takes the pill within a 6-hour window, the patient will need a backup contraceptive method for 48 hours. There is no risk for pregnancy if a patient takes one pill every day. A patient should take the pill continuously without break during withdrawal bleeding. p 768

Which factors affect the distribution of medications in the body? Select all that apply. 1 Hydration status 2 Body fluid composition 3 Body tissue composition 4 Gastrointestinal enzymes 5 Protein-binding capability

2, 3, 5 The distribution of medication is the reversible transfer of medication from one location to another in the body. The factors affecting the distribution of medications are: body fluid composition, body tissue composition, and protein-binding capability. The amount of medication distributed in body fluids and body tissues increases or decreases the therapeutic efficacy. The amount of medication bound to the proteins also alters the distribution and the therapeutic efficacy. Hydration status effects the excretion of the drug from the body. Gastrointestinal enzymes affect the drug absorption of lipid-soluble drugs in the body, but not the drug distribution. p 45

A male patient is taking Sildenafil (Viagra). What health problem does the nurse expect in the patient? 1 Decreased libido 2 Low sperm count 3 Erectile dysfunction 4 Gynecomastia

3 Sildenafil (Viagra) is one of the primary agents used for the treatment of erectile dysfunction for patients diagnosed with hypertension, renal disorders and diabetes. Finasteride is associated with decreased libido and gynecomastia. Testosterone is used for the treatment of oligospermia or fluctuating sperm count. p 797

The nurse has calculated the drug dosage for a child and finds the dosage to be higher than the safe range. What will the nurse do? 1 Administer the lowest dose of the safe range. 2 Administer the highest dose of the safe range. 3 Contact the primary health care provider. 4 Administer the calculated dose irrespective of the safe range.

3 The ideal nursing measure is to contact the primary health care provider or the prescriber immediately, because the dosage needs to be readjusted as per the weight and the safe range. Administering the lowest dose of the safe range may deprive the patient of the therapeutic effect. Administering the highest dose of the safe range and administering a calculated dose irrespective of the safe range is not ethically or professionally accepted because these may lead to adverse effects. p 45

The nurse is caring for a patient with vulvovaginal candidiasis who has been prescribed miconazole (Monistat). Which instruction will the nurse expect the primary health care provider to give? 1 "Apply 5 g of 2% powder once daily at bedtime for 7 days." 2 "Apply 2 g of 5% vaginal cream once daily at bedtime for 7 days." 3 "Insert a 200-mg vaginal suppository once daily at bedtime for 3 days." 4 "Insert one 100-mg vaginal suppository once daily at bedtime for 3 days."

3 "The medication applied to the affected area may be washed off after 8 hours" is the appropriate information to provide the patient. Telling the patient to apply the medication to the affected area does not provide all of the information in order for treatment to be effective. The affected area should be washed for hygiene and to prevent infection, just not right away. The medications that are applied and washed off after 10 minutes are permethrin 1% cream or pyrethrins with piperonyl butoxide. p 807

A 41-year-old patient informs the nurse that her menstrual cycle has changed and occurs every 25 days. The patient also informs the nurse that her mood changes abruptly and she often feels anxious. Which condition is the patient most probably experiencing? 1 Menopause 2 Postmenopause 3 Perimenopause 4 Pseudomenstruation

3 A normal menstrual cycle is 28 days. During perimenopause, the menstrual cycle frequently becomes shorter. Abrupt mood changes and increased irritability are noted in the perimenopausal period as well. Menopause refers to a permanent end of the menstrual cycle, which is not consistent with the patient's report. Postmenopause is a period when there is a new hormonal environment in the body; however, it occurs after the menstrual cycle ceases to occur. Pseudomenstruation refers to the withdrawal bleeding that occurs when combined oral contraception products are taken. p 782

The nurse is caring for an infant who has been prescribed ranitidine (Zantac) syrup. While administering the medication, the nurse avoids pointing the oral syringe directly towards the back of the infant's mouth. What is the rationale behind this intervention? 1 To prevent the risk of aspiration 2 To prevent damage to the taste buds 3 To prevent the risk of gagging or choking 4 To prevent damage to the oral mucosa

3 Administering medication directly into the back of the mouth may lead to direct dumping of the medication into the pharynx, possibly leading to gagging and choking in the infant. To prevent this, the nurse should avoid pointing the oral syringe directly toward the back of the infant's mouth. Aspiration can be prevented by placing the infant in the side-lying position while administering the medication. Pointing the oral syringe at the back of the mouth does not damage the taste buds or oral mucosa. p 47

The nurse is caring for a patient who has erectile dysfunction who has been prescribed alprostadil (Caverject). How will the nurse administer the medication to the patient? 1 Placing the medication under the patient's tongue. 2 Asking the patient to chew the medication thoroughly. 3 Placing the medication in the patient's urethra. 4 Asking the patient to take the medication with milk.

3 Alprostadil (Caverject) is a prostaglandin analogue that is used for the treatment of erectile dysfunction. It increases the blood flow into the penis by causing vasodilation. This medication is available as an intravenous injection and suppository. Therefore, the nurse can either insert the suppository by pushing it through the urethra, or the nurse may inject the medication into the erectile tissue of penis. The medication is not available as sublingual tablets or chewable tables. Therefore, the nurse should neither place the tablet under the patient's tongue nor ask the patient to chew the tablet thoroughly. The medication cannot be taken with milk, because this causes adverse effects. p 796

Which group of college students does the nurse need to include in a teaching session on the risks of androgen abuse? 1 Students who do not socialize well in school 2 Students who perform extraordinarily in class 3 Students who are on athletic teams 4 Students who are often tardy

3 Androgens are potent anabolic agents that stimulate the formation and maintenance of muscular and skeletal proteins. Athletes use androgens to increase weight, musculature, and muscle strength. Many major sporting events disqualify athletes who have documented use of such products. Psychotherapy is used to help children socialize well. Children who perform extraordinarily need not take any therapy. Tardy students need to be evaluated for developmental delays. p 793

A pregnant patient who has gonorrhea and chlamydia is prescribed ceftriaxone (Rocephin). Which other drug will be included in the patient's prescription? 1 Metronidazole (Flagyl) 2 g PO in a single dose 2 Acyclovir (Zovirax) 400 mg PO tid. for 7-10 days 3 Azithromycin (Zithromax) 1 g PO in a single dose 4 Doxycycline (Vibramycin) 100 mg PO bid for 21 days

3 Azithromycin (Zithromax) 1 g PO in a single dose is included in the patient's prescriptions, because it is an antibacterial drug that is used to treat sexually transmitted diseases like gonorrhea and chlamydia. Acyclovir (Zovirax) 400 mg PO tid for 7-10 days is an antiviral drug that is used in the treatment of genital herpes simplex. The primary health care provider prescribes doxycycline (Vibramycin) 100 mg PO bid for 7 days, not for 21 days. Metronidazole (Flagyl) 2 g PO in a single dose is effective for patients with trichomoniasis or for victims of sexual assault. p 805

What difference between breast-fed and formula-fed infants is relevant to drug administration? 1 Breast-fed infants have higher gastric pH than do formula-fed infants. 2 Breast-fed infants have lower enzyme function than do formula-fed infants. 3 Breast-fed infants have faster gastric emptying than do formula-fed infants. 4 Breast-fed infants have less intestinal surface area than do formula-fed infants.

3 Breast-fed infants have faster gastric emptying than formula-fed infants, which affects drug absorption. Gastric pH, enzyme function, and intestinal surface area reach adult levels in breast-fed and formula-fed infants at similar times. p 44

The nurse is caring for an adolescent child with appendicitis. The child tells the nurse, "Some of my school friends drink alcohol and pressure me to drink with them." What should the nurse do in this situation? 1 Advise the child to avoid interacting with these friends. 2 Inform the child's parents of the child's concern. 3 Explain the adverse effects of alcohol to the child. 4 Suggest the child spend as much time as possible at home for few days.

3 Children may exhibit high-risk behavior during adolescence and may drink alcohol. An adolescent child has concrete and abstract reasoning; therefore, the nurse should explain the adverse effects of alcohol and suggest that the child refrain from consuming it. However, the child may feel rejected and isolated if the nurse advises that he or she avoid interacting with friends who drink. An adolescent will have proper cognition and would be able to understand the situation. The nurse should explain the adverse effects of alcohol consumption directly to the child rather than informing his or her parents about the child's concern. Moreover, suggesting that the child spend more time at home may not prevent high-risk behaviors and may alter the child's social interactions. p 48-49

What is the most frequent clinical presentation of a Chlamydia trachomatis infection in a newborn who was exposed to the mother's infected cervix during delivery? 1 Pneumonia 2 Acute illness 3 Conjunctivitis 4 Erythema toxicum

3 Conjunctivitis is the most frequent clinical presentation in a newborn caused by exposure to C. trachomatis in the mother's infected cervix during delivery. C. trachomatis can cause pneumonia in infants between 1 and 3 months old, but it is less common. Gonorrhea presents as an acute illness in the newborn that develops 2 to 5 days after delivery. Erythema toxicum is a common newborn rash that may appear in the newborn and is self-limiting and unrelated to C. trachomatis. p 805

Which statement about emergency contraception is true? 1 It is an abortifacient. 2 It must be used within 12 hours of unprotected sex. 3 It is a combination of high doses of hormones and an antiemetic. 4 A prescription is required for all forms of emergency contraception.

3 Emergency contraception consists of higher than usual doses of hormones and an antiemetic (often an antihistamine) to prevent nausea. The regimen does not cause an abortion to occur; it prevents fertilization and implantation. The optimal time for using emergency contraception is 24 hours after unprotected sex, but it can be taken up to 72 hours after intercourse. Not all forms of emergency contraceptives are prescription; Plan B One-Step and Next Choice are sold over the counter. p 773

The nurse encounters a male patient who is taking finasteride (Proscar). Which condition does the nurse suspect in the patient? 1 Bladder cancer 2 Priapism 3 Benign prostatic hyperplasia 4 Testicular cancer

3 Finasteride (Proscar) is specifically administered for the treatment of benign prostatic hyperplasia (BPH), which leads to enlargement of the prostate. Finasteride (Proscar) helps lower the dihydrotestosterone (DHT) level. The medication is not directly related to bladder cancer, priapism, or testicular cancer. p 795

The nurse is assessing a patient who is taking fluoxymesterone (Halotestin) to treat reduced testosterone levels. The patient has gained weight 1 week after beginning the medication. What is the likely cause for weight gain in the patient? 1 Impaired lipid metabolism 2 Impaired thyroid activity 3 Increased fluid retention 4 Impaired liver function

3 Fluoxymesterone (Halotestin) is an androgenic drug that may cause fluid retention in some patients. Thus, in this patient, fluid retention would have been the most probable cause of weight gain. Impaired lipid metabolism is also a complication associated with androgens, due to which there are elevated cholesterol levels. However, weight gain due to high cholesterol levels takes place over a long period of time. Impaired thyroid activity may cause weight gain; however, androgenic drugs do not affect the thyroid activity. Impaired liver function is a complication associated with anabolic steroids and not fluoxymesterone (Halotestin). pp 792-793

The nurse is instructing a patient on the use of the contraceptive NuvaRing. What information will the nurse include in the patient's teaching plan? 1 The patient should eat a low-fiber diet to prevent diarrhea. 2 NuvaRing protects against sexually transmitted infections (STIs). 3 The patient should insert the ring during the first 5 days of the menstrual cycle. 4 Backup contraception is not needed during the first 7 days after the first ring is placed.

3 NuvaRing should be inserted during the first 5 days of the menstrual cycle. Backup contraception is recommended during the first 7 days after the first ring is placed, until hormones have had the opportunity to reach an appropriate level. NuvaRing does not cause diarrhea and does not protect against STIs, including human immunodeficiency virus. p 766

Which statement about progestin is accurate? 1 Progestin is only used for contraception. 2 All progesterones are synthetic. 3 Progestin is a derivative of testosterone. 4 There is only one type of progestin.

3 Progestins are derivatives of testosterone. As such, it is used for contraception but also to balance out the effects of estrogen. Progesterones can be both natural or synthetic. There are eight different types of progestin used in oral contraceptives. pg 762

A patient prescribed androgen therapy is experiencing edema. What advice can the nurse give to the patient? 1 Drink 2 L or more of fluid a day. 2 Stop androgen therapy immediately. 3 Restrict sodium from the diet. 4 Reduce the androgen dosage by half.

3 Rationale A patient receiving androgen therapy experiencing edema should be advised to restrict sodium in the diet. Drinking 2 L of fluid daily is appropriate if calcium levels are elevated, not for edema. Androgen therapy should not be stopped; rather, reducing sodium should be attempted first. Reducing androgen dosage by half will not improve edema or water retention alone; dietary considerations and patient activity must be considered. p 794

According to regulatory agencies, drug administration errors are more common in which patient population? 1 Male 2 Female 3 Pediatric 4 Older adult

3 Regulatory agencies caution that drug administration errors are more common in pediatric patients, which warrants increased precautions in drug administration. Regulatory agencies do not cite more errors among male, female, or older adult patients. p 43

The nurse is assessing a 38-year-old patient who uses a combined hormone contraception (CHC) product. The nurse finds that the patient is a frequent smoker. Which assessment parameter is of highest priority in this case? 1 Medical history 2 Occupational detail 3 Blood pressure readings 4 Use of dietary supplements

3 Smoking increases the risk for hypertension in patients who are over 35 years old and who take CHC products; therefore, the nurse should assess the patient's blood pressure in this case. Smoking also increases the risk of endothelial damage, which is a precursor to developing deep vein thrombosis. Assessing the patient's use of dietary supplements or medical history is not a priority in this case, because it is more important to understand the immediate risks to the patient. Assessing the patient's occupational details will help to understand stress factors, which are secondary in this case. pp 770-771

Which pharmacologic class is used to describe testosterone drugs? 1 Schedule I 2 Schedule II 3 Schedule III 4 Schedule IV

3 Testosterone, a naturally occurring androgenic hormone produced primarily by the testes, regulates male sexual development. Most androgens are classified as Schedule III drugs in the United States. They have less abuse potential than Schedule II drugs and a moderate dependence liability. Schedule I and II drugs have a high potential for abuse. Schedule IV drugs have less abuse potential than Schedule III drugs. p 792

Which is the most effective screening tool for early detection of human papillomavirus (HPV) in women? 1 HPV test 2 Visual examination for genital warts 3 Papanicolaou ("Pap") test 4 Rapid plasma reagin (RPR)

3 The Pap test is a screening tool for early detection of HPV in women. It can detect cervical dysplasia, which can be a precursor to cervical cancer if left untreated. An HPV test is a diagnostic tool that will be used if cervical dysplasia is detected. Visual examination for genital warts is diagnostic of HPV, but not diagnostic of the type of HPV, and it is not an early detector. An RPR is a nontreponemal antibody test for syphilis. p 807

What test is a nontreponemal antibody test that is one of the two types of serological tests used to diagnose syphilis? 1 Nucleic acid amplification (NAA) 2 T. palladium particle agglutination assay (TP-PA) 3 Venereal disease research laboratory (VDRL) 4 Fluorescent treponemal antibody absorption (FTA-ABS)

3 The VDRL is a nontreponemal antibody test that is one of the two types of serological testing used to diagnose syphilis. NAA is a method for testing gonorrhea. TP-PA and FTA-ABS are tests for antibodies that specifically target T. palladium, the bacteria that cause syphilis. p 805

The nurse is evaluating a student nurse's knowledge on the physiology of drug absorption in different age groups. Which statement by the student nurse indicates the need for further teaching? 1 "An adolescent will have slow absorption of a drug due to hormonal changes." 2 "A child who has a delay in gastric emptying will have a delay in drug absorption." 3 "A 1-year-old infant will have effective absorption of low-pH medications." 4 "A child who has a developed gastrointestinal tract will have effective absorption."

3 The absorption of medications depends on the age, health, and weight of the child. A 1-year-old infant will have an alkaline intestinal pH. Therefore, medications with higher pH are more easily absorbed. A low pH indicates that the medication has acidic pH and is effectively absorbed in the child who has an acidic gastrointestinal tract (GI) pH. Hormonal changes and nutritional habits affect the physical maturity of an adolescent, thereby decreasing the absorption of the medication. A delay in gastric emptying causes a delay in absorption because it reduces the peak serum concentration of the medication. Complete development of the GI tract will result in effective absorption of the medications because the GI tract will have intestinal flora, and proper pH and enzyme levels. p 44

Why is the dosage of medications prescribed for neonates lesser than adult dosages? 1 Neonates have high body fat 2 Neonates have highly acidic gastric pH 3 Neonates have low protein levels 4 Neonates have low bilirubin levels

3 The concentration of a drug in the body depends on its distribution. Neonates have decreased protein concentrations, resulting in decreased protein binding of the drug. This increases the systemic bioavailability of the drug. Reducing the dose of the medication helps prevent drug toxicity in neonates. A neonate will have low body fat, which results in lower distribution of fat-soluble medications and indicates the need to reduce the dose of the drug for neonates. The gastric pH of a neonate is less than that of an adult due to less gastric acid secretion, increasing the absorption of an alkaline drug. Neonates may have high bilirubin levels due to hemolysis, but it does not affect the dose of the drug. p 45

Which statement by the student nurse about tinidazole (Tindamax) therapy indicates a need for further learning? 1 "Tinidazole is used in the treatment of bacterial vaginosis." 2 "Tinidazole is contraindicated in the first trimester of pregnancy." 3 "Tinidazole should be taken in the morning on an empty stomach." 4 "Tinidazole will cause vomiting in a patient who uses mouthwash."

3 The nurse asks the patient to take tinidazole (Tindamax) with food to prevent gastrointestinal upset. Tinidazole is an antibacterial drug that can be used in the treatment of bacterial vaginosis. Tinidazole is contraindicated in the first trimester of pregnancy because it is unsafe for the fetus. Tinidazole interacts with alcohol, causing nausea and vomiting. p 804

Which statement should the nurse use to instruct a patient about the use of the Ortho-Evra transdermal patch? 1 "Use one patch for 3 weeks." 2 "Place the patch near the breasts." 3 "Rotate the placement site of the patch." 4 "Report the occurrence of withdrawal bleeding."

3 The nurse should instruct a patient to rotate the placement site of the Ortho-Evra transdermal patch to avoid skin irritation. The patch should be changed weekly for a period of 3 weeks, and then not worn for 1 week. The nurse should ask a patient to avoid placing the patch near the breasts, because the patch contains an estrogen component, which may increase the risk of breast cancer if the added supplementation of estrogen is in close proximity to the breasts. There is no need for a patient to report withdrawal bleeding, because it would be a normal finding. pp 788, 765

A patient is receiving one 400-mg dose of intramuscular androgen every 2 weeks. Which assessment finding should be reported to the physician immediately? 1 Blood pressure of 140/90 mm Hg 2 Irritation at the injection site 3 Bilateral icterus 4 Increased facial hair

3 The nurse should notify the physician immediately if bilateral icterus occurs. Adverse and life-threatening reactions to androgen therapy include hepatic necrosis, hepatitis, or hepatic tumors, which may present as icterus, or yellowing of the eyes. A blood pressure of 140/90 is slightly elevated, but this is not life-threatening and may not be related to androgen therapy. Irritation at the injection site is a common side effect of intramuscular therapy and can be relieved with nonpharmacologic interventions, such as application of ice. Increased facial hair is a secondary male sex characteristic that is expected with androgen therapy. p 791

The nurse is caring for a newborn with congenital syphilis. The mother asks, "How did my baby get this?" What is the nurse's best response? 1 "The infection was transmitted when you conceived the baby." 2 "The baby was exposed to the infection when your water broke." 3 "The infection occurred before your baby was born." 4 "The infection occurred when the baby was exposed to your blood."

3 The nurse's best response is, "The infection occurred before your baby was born." Syphilis is transmitted to the fetus through the placenta and membranes. The infection is not transmitted at conception because the embryo does not adhere to the uterine wall until 5 days after conception. Syphilis is not transmitted after rupture of membranes or upon exposure to maternal blood. p 802

Which condition will be treated with topical drugs from the azole drug classification? 1 Endometriosis 2 Secondary dysmenorrhea 3 Vulvovaginal candidiasis (VVC) 4 Severe premenstrual syndrome (PMS)

3 The overgrowth of Candida albicans in the vagina causes VVC. Topical drugs from the azole classification are antifungal agents that help with the treatment of VVC. Selective serotonin reuptake inhibitors (SSRIs) decrease irritability and mood swings that occur during PMS. Aromatase inhibitors, combined hormone contraception (CHC) products, gonadotropin-releasing hormone (Gn-RH) agonists, and progestins are used to treat endometriosis. NSAIDs block pain and are effective for the treatment of secondary dysmenorrhea. p 808

Which drug is a Schedule III drug? 1 Doxazosin (Cardura) 2 Goserelin (Zoladex) 3 Testosterone (Androderm) 4 Minoxidil (Rogaine)

3 The testosterone hormone is primarily produced in the testes, categorized under the broad heading of the androgens. Androgens are Schedule III drugs in the United States. Doxazosin is an alpha blocker used to treat hypertension. Goserelin is a hormone analogue, used to suppress the sex hormones. Minoxidil is a specifically peripheral vasodilator used for widening the blood vessels and relieve hypertension. pp 792

The nurse is preparing to intramuscularly administer a vaccine to an infant. Which nursing intervention ensures safe administration of the vaccine? 1 Administering medication at the abdomen 2 Administering medication at the dorsogluteal site 3 Administering medication at the ventrogluteal site 4 Administering medication at the leg or upper arm

3 The ventrogluteal muscle is well developed in infants and enhances the absorption of the drug. The nurse should administer the vaccine at the ventrogluteal site to ensure effective absorption of the medication. In the case of adults, subcutaneous medications should be administered in the abdomen because it contains a high amount of subcutaneous tissue. The nurse should not administer medication at the dorsogluteal site, which is not well developed in infants; administering the medication at the dorsogluteal site may cause sciatic nerve damage. When administering subcutaneous medication to an infant, the nurse should select the leg or upper arm, because they contain high amounts of subcutaneous tissue. p 48

The nurse is assessing a female patient who is seeking treatment for trichomoniasis. The patient is prescribed tinidazole (Tindamax) 2 g PO in a single dose. Which assessment finding would indicate a need to cancel the prescription? 1 The patient has chlamydia. 2 The patient is allergic to cephalosporins. 3 The patient is in the first trimester of pregnancy. 4 The patient experiences the Jarisch-Herxheimer reaction.

3 Tinidazole (Tindamax) therapy, which is used in the treatment of trichomoniasis, is unsafe for the fetus during the first trimester of the pregnancy. Therefore, the nurse should not administer the medication to the patient. The Jarisch-Herxheimer reaction occurs when a patient with syphilis is administered benzathine penicillin G. Tinidazoleis not a cephalosporin. At the same time, cephalosporins are not used in the treatment of trichomoniasis. A patient with trichomoniasis who is taking tinidazole (Tindamax) can be concurrently treated for chlamydia. p 804

What is the purpose of giving estrogen therapy cyclically or with progestins? 1 To treat breast cancer 2 To treat ovarian cancer 3 To prevent endometrial cancer 4 To reduce the chances of vaginal cancer

3 To reduce the risk of endometrial hyperplasia or cancer, the concurrent use of a progestin for 10 to 14 days of the cycle is recommended for women with an intact uterus. Estrogens are administered to prevent complications due to ovarian failure and not to treat ovarian cancer. Estrogen therapy raises recurrence risk if administered to patients with breast cancer. Vaginal cancer is treated with surgery or chemotherapy. p 776

A 57-year-old patient who has osteoporosis after menopause is prescribed 1500 mg of calcium per day and 2000 IU per day of vitamin D for 3 months. After these 3 months, the nurse finds little improvement in the patient's condition. Which assessment finding could be a cause of the patient's condition? 1 The patient takes sedatives at bedtime. 2 The patient performs low-impact aerobics. 3 The patient smokes and consumes alcohol. 4 The patient's intake of ascorbic acid (vitamin C) is low.

3 Smoking interferes with the absorption of vitamin D and alcohol consumption interferes with the absorption of calcium; therefore, a patient's condition will not improve if the patient smokes and drinks alcohol while taking calcium and vitamin supplements. Low-impact aerobics help increase muscle mass and strengthen the bones. An increase or decrease in the intake of ascorbic acid (vitamin C) will not affect a patient who has osteoporosis after menopause, because this supplement does not help restore bone health in the patient. The use of sedatives will increase a patient's risk for falls, but will not interfere with calcium and vitamin D absorption. p 786

What solid drug dosage forms are most appropriate for children ages 6 to 11 years? Select all that apply. 1 Syrups 2 Capsules 3 Oral films 4 Chewable tablets 5 Orally disintegrating tablets

3, 4, 5 Solid drug dosage forms most appropriate for children age 6 to 11 years include oral films, chewable tablets, and orally disintegrating tablets. Syrups are a liquid drug dosage form more appropriate for infants and children 2 to 5 years. Capsules are more appropriate for adults. p 47

What positions are recommended to the patient for insertion of a female condom? Select all that apply. 1 Prone 2 Standing 3 Squatting 4 Lying down 5 Placing one foot on a chair

3, 4, 5 The recommended positions for insertion of a female condom include squatting, lying down, or placing one foot on a chair. A prone or standing position may not allow proper placement of the condom. p 810

A primary health care provider has prescribed lindane (Kwell) lotion to a patient with scabies. The nurse teaches the patient about the prescribed treatment. Which instruction should the nurse include in the teaching? 1 "Avoid intake of yogurt and cheese while using this medication." 2 "Avoid contact with water for 24 hours after applying this medication." 3 "Vaccinate your pet dog regularly to prevent the spread of the infection." 4 "All of your family members should be examined and treated if necessary."

4 Scabies can be transmitted from the patient to other family members by direct physical contact and by shared personal items even before the symptoms appear. Therefore, the patient and his or her family members should be examined and treated if necessary. This helps to prevent transmission and recurrence and eradicates the disease. Unlike monoamine oxidase inhibitors (antidepressant medications), lindane (Kwell) lotion does not interact with foods containing tryptamine, such as cheese and yogurt. Human scabies does not spread by animals. Therefore, regularly vaccinating pet animals may not help to prevent the infection. Most of the lotion gets absorbed immediately and the patient can wash the medicated areas after 8 to 12 hours. p 807

In an assessment session, a patient tells the nurse that she became pregnant after using the contraceptive pills regularly. The nurse finds that the patient uses a Sunday start method for using contraception. Which other assessment finding could be a likely cause of the patient's pregnancy? 1 The patient is older than 35. 2 The patient smokes excessively. 3 The patient usually takes the pills an hour late. 4 The patient did not use a backup contraception method.

4 A backup method of contraception is needed when a patient uses a Sunday start method, which is when a patient begins taking a contraceptive on the Sunday after the first day of menstruation, because the patient can start the contraception later than the fifth day of the menstrual cycle. A second contraception method will ensure protection until the first method reaches its peak level of contraceptive effectiveness. Excessive smoking is likely to increase the risk for cardiovascular problems in a patient, but not pregnancy. Age does not affect the effectiveness of the contraception method. A patient should take the contraception daily within a 3-hour window each day for effectiveness. p 768

The nurse is assessing a female patient who has symptoms of venous thromboembolism (VTE). What might be a probable cause of the patient's condition? 1 The patient takes a minipill daily. 2 The patient is nearing menopause. 3 The patient engages in unsafe sex practices. 4 The patient is using the Ortho-Evra patch for contraception.

4 A patient who uses the Ortho-Evra patch for contraception is likely to develop venous thromboembolism (VTE) because the patch exposes the patient to high levels of estrogen. A patient who engages in unsafe sex practices is at a risk for pregnancy and sexually transmitted diseases, but not VTE. The use of the minipill is not associated with VTE, because it is a progestin-only oral contraception pill (POP). A patient who is nearing menopause will have low levels of estrogen, and is unlikely to develop VTE. p 763

A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents? 1 "Make sure that you give the medication at the same time every day." 2 "Make sure that the child likes the taste of the medication." 3 "Mix the medication with the child's favorite food or beverage." 4 "Observe the child for potential adverse effects of the medication."

4 Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate this symptom. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Medications should never be mixed with food or beverages because proper dosing may not be achieved if child does not consume all of the food or beverage. Depending on the dosage schedule, there may be some flexibility of administration times to fit with the child's normal routine. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good. p 45, 49-50

Which patient statement indicates to the nurse that the patient understands the discharge instructions regarding alendronate (Fosamax)? 1 "I need to decrease my intake of dairy products to prevent hypercalcemia." 2 "This medication will help relieve the bone pain I have from my osteoporosis." 3 "I need to take this medication with food to prevent damage to my esophagus." 4 "I will take the medication on an empty stomach and not lie down for 30 minutes."

4 Alendronate (Fosamax) can cause erosive esophagitis. To prevent this side effect, it is important to take the medication first thing in the morning on an empty stomach without any other medications and to maintain an upright position for 30 minutes. These actions facilitate rapid absorption and prevent reflux into the esophagus. Decreasing dairy intake is not indicated. The medication does not directly relieve bone pain caused by osteoporosis. p 786

The nurse is teaching a patient with benign prostatic hyperplasia (BPH) about doxazosin. What time of day should the nurse advise the patient to take the medication? 1 Early morning 2 Afternoon with lunch 3 Before evening meal 4 Bedtime

4 Alpha-adrenergic blocking agents may be used to control blood pressure or BPH. To avoid hypotensive episodes, the patient should be advised to take alpha-adrenergic blocking agents such as doxazosin at bedtime to mitigate the effects of postural hypotension. Early morning is not a good time to take alpha-adrenergic blocking agents due to blood pressure fluctuations. Tamsulosin and alfuzosin should be taken 30 minutes after meals. p 798

A patient taking the oral contraceptive Ortho Tri-Cyclen has developed an infection and is prescribed tetracycline. What information is essential for the nurse to teach the patient? 1 "Stop the Ortho Tri-Cyclen while on this medication." 2 "Do not drink grapefruit juice while on these medications." 3 "Take these two medications with milk to prevent stomach upset." 4 "Use an additional form of contraception while on these medications."

4 Antibiotics interact with oral contraceptives and decrease their effectiveness. An additional form of contraception is needed while taking tetracycline. p 769

Which medication is suitable therapy for oral contraception in women who cannot take estrogen? 1 Megestrol (Megace) 2 Estropipate (Ortho-Est) 3 Estrone (Estrone Aqueous) 4 Medroxyprogesterone (Provera)

4 Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers. Estropipate and Estrone are synthetic estrogens. p 776

The nurse is assessing a patient who may have a sexually transmitted infection. What is the first step in the nurse's assessment? 1 Culture vaginal secretions. 2 Ask about medication allergies. 3 Determine if the patient has a fever. 4 Ask the patient about sexual partners.

4 Before physical data are gathered, a history is elicited. The term partner is used when discussing sexual activity, rather than value-laden terms such as wife or boyfriend. Include the following questions for all patients, regardless of gender or sexual orientation: "Do you have sex with women?" and "Do you have sex with men?" p 808

A patient comes to the clinic complaining of itching in the vaginal area and is diagnosed as having candidiasis. Which intervention is a priority for this patient? 1 Have the patient soak in a warm bath. 2 Assist the patient with vaginal irrigations. 3 Administer intravenous (IV) erythromycin. 4 Insert a vaginal suppository of miconazole (Monistat) 100 mg.

4 Candidiasis is a fungal infection that is treated with the antifungal agent miconazole (Monistat), among others. The patient should not soak in a bath, and vaginal irrigations and IV erythromycin are not treatments for this disorder. p 808

Which problem in a patient's history would contraindicate the administration of estrogen? 1 Weight gain 2 Hypertension 3 Dysmenorrhea 4 Thrombophlebitis

4 Contraindications for estrogen administration include known drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or a history of such a disorder. It is not contraindicated in patients with hypertension, dysmenorrhea, or weight gain. p 784

An elderly patient is accompanied to the clinic by his 30-year-old daughter. The patient has benign prostatic hyperplasia and is prescribed finasteride. What is an important teaching point for safe use of finasteride? 1 Take finasteride on an empty stomach. 2 If a dose is missed, take 2 doses at once. 3 You may donate blood while taking finasteride. 4 Crushed or broken tablets must not be handled by pregnant women.

4 Crushed or broken finasteride tablets should not be handled by pregnant women or women of childbearing age as there is a risk for secondary absorption placing the male fetus at risk. Finasteride should be taken with food. If a dose is missed, it should be skipped and then the regular schedule should be resumed. Patients should not donate blood products while on finasteride therapy. p 798

The nurse notes that a patient is ordered to receive dutasteride (Avodart). Which condition does the nurse suspect in the patient? 1 Impotence 2 Testicular cancer 3 Hypogonadism 4 Benign prostatic hyperplasia (BPH)

4 Dutasteride (Avodart) is an alternative for finasteride (Proscar), indicated for the treatment of benign prostatic hyperplasia (BPH). The medicine is available in 0.5 mg doses. Dutasteride (Avodart) has no effect on impotence or testicular cancer. Testosterone is used for the treatment of hypogonadism. p 798

Which clinical manifestation does the nurse anticipate for a patient with pediculosis pubis? 1 A flu-like syndrome 2 A diffuse rash with crusted-over lesions 3 Generalized pruritus and erythema 4 Extreme pruritus in the affected area

4 Extreme pruritus in the affected area is a clinical manifestation of pediculosis pubis. This is caused by lice moving and laying egg cases. Flu-like syndrome is a symptom in patients with secondary syphilis, HIV, as well as other many other clinical conditions that are not sexually transmitted infections (STIs). A diffuse skin rash with crusted-over lesions may be a clinical finding of the herpes virus or other medical conditions. Generalized pruritus and erythema are not a clinical presentation of pediculosis pubis. p 807

A patient who is pregnant tells the nurse, "My husband is bald and I apply finasteride (Propecia) cream on his scalp daily." Which test should the nurse discuss with the patient's provider? 1 Lipid profile 2 Liver function test 3 Exercise tolerance test 4 Ultrasonography of the fetus

4 Finasteride (Propecia) is contraindicated in women of childbearing age, because this drug has teratogenic effects. The patient has been applying finasteride (Propecia) to her husband; this indicates that the drug would have been topically absorbed into the skin of the patient. Thus, the nurse should ask the patient to undergo an ultrasound scan of the fetus to check for fetal abnormalities. Unlike anabolic steroids, finasteride (Propecia) does not affect the lipid levels in the patient. Therefore, the nurse need not refer the patient for a lipid profile. Unlike anabolic steroids, finasteride (Propecia) does not affect liver function; therefore, the nurse need not refer the patient for a liver function test. Finasteride (Propecia) does not affect cardiac function. Moreover, an exercise tolerance test is contraindicated in pregnant women. pp 795, 798

A patient who is undergoing treatment for benign prostatic hyperplasia complains of a lack of sexual desire. Which medication might lead to this side effect? 1 Tadalafil (Cialis) 2 Terazosin (Hytrin) 3 Doxazosin (Cardura) 4 Finasteride (Proscar)

4 Finasteride (Proscar) is a 5-alpha reductase inhibitor that is used in the treatment of benign prostatic hyperplasia. This drug has the potential to precipitate impotence or decreased libido. Tadalafil (Cialis) is a phosphodiesterase-5 inhibitor and may increase the risk of hypotension if used along with alpha blockers. Its use does not affect sexual activity. Alpha adrenergic blocking agents such as terazosin (Hytrin) and doxazosin (Cardura) have the potential to reduce or stop the production of semen after orgasm. p 795, 798

When does gastrointestinal (GI) microbial colonization reach adult levels? 1 Birth 2 Infancy 3 Childhood 4 Adolescence

4 GI microbial colonization reaches adult levels in adolescence. Intestinal microbial colonization begins in the first few hours after birth. Adult levels are not yet reached in infancy or childhood. p 44

Which factor requires the pediatric patient until about 2 years of age to have higher doses of water-soluble drugs to achieve therapeutic levels? 1 Higher fat stores 2 Higher bilirubin levels 3 Lower protein concentrations 4 Higher proportion of body fluid

4 In neonates and infants, the body is about 75% water compared with 60% in adults. This increased body fluid proportion allows for a greater volume of fluid in which to distribute drugs, which results in a lower drug concentration. Therefore until about age 2 years, the pediatric patient requires higher doses of water-soluble drugs to achieve therapeutic levels. Higher fat stores alter the distribution of some lipid-soluble drugs. Higher bilirubin levels and lower protein concentrations may result in higher levels of unbound drug and an increased risk of drug toxicity. p 45

Individuals aged 28 days to 23 months fall under which pediatric age classification? 1 Children 2 Adolescent 3 Term neonate 4 Infant/toddler

4 Individuals aged 28 days to 23 months are classified as infant/toddler. Children are aged 24 months to 11 years. Adolescents are aged 12 years to 16 or 18 years depending on region. Term neonates are aged from birth at 38 or more weeks gestation to 27 days. p 44

The nurse is caring for a 2-year-old infant suffering from constipation. The nurse finds that the child has been prescribed a lipid-soluble medication. What factor does the nurse expect to alter the absorption of the medication? 1 Gastric PH 2 Gastric motility 3 Gastric emptying 4 Gastric enzyme levels

4 Infants have immature enzymatic functioning, which reduces drug absorption. Infants have low lipase levels, resulting in the reduced absorption of lipid-soluble medications. The nurse expects that gastric enzyme levels will decrease the drug's absorption. The nurse should consider that gastric PH affects the absorption of acidic or alkaline medications, but not lipid-soluble substances. Gastric motility and gastric emptying time are interrelated and help determine the amount of time spent by the drug in the stomach. Gastric motility and gastric emptying do not directly affect the absorption of a lipid-soluble drug. p 44-45

The student nurse is discussing pharmacokinetics in infants. Which statement of the student nurse indicates effective learning? 1 "Medications do not reach the brain in infants." 2 "The elimination rate of medications is high in infants." 3 "The distribution of fat-soluble medications is high in infants." 4 "The distribution of water-soluble medications is high in infants."

4 Infants have increased body fluids, resulting in the greater distribution of water-soluble drugs. The blood-brain barrier is not well developed in the infants; therefore, the medications may more easily cross the blood-brain barrier. Renal functions are not well developed in pediatric patients under 9 years of age; infants will not have a high rate of elimination. Infants have less adipose tissue, which will reduce the distribution of fat-soluble medications. p 45

What is the maximum dose of subcutaneous menotropin for treating hypogonadism? 1 300 international units once per week 2 300 international units once per month 3 300 international units twice per week 4 300 international units three times per week

4 One ampule of menotropin contains 75 international units (IU) of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) each. The initial dose is 75-150 IU subcutaneously or three times per week. Dosage adjustments according to individual response should not exceed 75-150 IU per adjustment; the maximum dose is 300 units three times per week. The dosages 300 IU per week, 300 IU per month, and 300 IU twice a week do not reach the maximum. p 796

The nurse is caring for a patient receiving testosterone therapy. For which assessment finding will the nurse intervene? 1 Abdominal pain 2 Nausea 3 Dizziness 4 Pitting edema

4 Pitting edema is a sign of sodium and water retention and is an adverse reaction of administration of testosterone. Abdominal pain, nausea, and dizziness are side effects but do not require immediate attention. p 791

While assessing a 14-year-old, the nurse finds decreased function of the pituitary gland. Which complication does the nurse suspect? 1 Impotence 2 Testicular atrophy 3 Loss of muscle tone 4 Lack of secondary sex characteristics

4 Pituitary gland dysfunction in young males may result in a lack of secondary sex characteristics. Inadequate pituitary gland function in adult men causes impotence, testicular atrophy, and loss of muscle tone. p. 792

How does the use of the hormone progestin help inhibit pregnancy? 1 It stabilizes the uterine endometrium. 2 It prevents changes in the endometrium. 3 It causes the surge of luteinizing hormone (LH). 4 It changes the quantity and viscosity of the cervical mucus.

4 Progestin thickens the cervical mucus, thereby making it hostile to sperm penetration, which helps inhibit pregnancy. An increase in estrogen levels would cause a luteinizing hormone (LH) surge, which would cause ovulation; however, progestin suppresses the LH surge. The estrogen component of combined hormone contraception (CHC) products, not progestin, stabilizes the uterine endometrium. Progestin changes the endometrium so that it is unfavorable for implantation of a fertilized ovum. p 763

The nurse is asked to administer medications to several patients. Which patient is prescribed a proper dose of the medication? 1 Sildenafil (Viagra) 50 mg injected into the penile shaft 2 Finasteride (Propecia) 5 mg/day by mouth for baldness 3 Transdermal testosterone (Testoderm) 2 mg/day applied to the back 4 Testosterone cypionate (Depo-Testosterone) 300 mg IM each month

4 The dosage range for testosterone cypionate is an intramuscular injection of 50 to 400 mg every second or fourth week. Sildenafil is taken 25-100 mg by mouth, one hour before intercourse; finasteride is administered in a dosage of 1 mg/day; and transdermal testosterone 4-6 mg/day must be applied to the scrotum. p 792, 795

How many hours would it take for caffeine levels in an infant to reach 50% of the intake level? 1 9 hours 2 33 hours 3 50 hours 4 95 hours

4 The half-life for caffeine in an infant is 95 hours. Therefore the caffeine level in an infant would reach 50% of the intake level at 95 hours. The level would remain higher than 50% at 9, 33, and 50 hours. p 46

The nurse is assessing a patient who is prescribed estrogen replacement therapy. A history of which medical condition would be a contraindication to this therapy? 1 Weight loss 2 Dysmenorrhea 3 Uterine bleeding 4 Deep vein thrombosis

4 The most serious adverse effects of the estrogens are thromboembolic events. A history would put the patient at increased risk. Uterine bleeding is an indication for estrogen therapy. p 769

Which guideline should be followed for time-released and enteric-coated drugs? 1 These drugs should be avoided in the pediatric population. 2 These drugs should be deposited close to the front of the mouth. 3 Parents and caregivers are unqualified to administer these drugs to children. 4 Nurses should avoid crushing or dissolving these drugs prior to administration.

4 The nurse should work closely with the pharmacist and in compliance with hospital policies to determine the advisability of crushing or dissolving a drug before administration; some drugs, particularly timed-release and enteric-coated drugs, should not be crushed or dissolved. These drugs may be appropriate in the pediatric population. Depositing a drug too close to the front of the mouth increases the likelihood that the child will spit it out. Parents and caregivers are qualified to administer these drugs to children with adequate guidance from the provider. p 47

A 35-week gestation patient is diagnosed with scabies and prescribed PO ivermectin 12,360 mcg to be given now and repeated in 1 week. The patient weighs 136 lb. What is the nurse's priority action? 1 Administer the prescribed medication. 2 Contact the prescriber; the dosage is incorrect. 3 Contact the prescriber; the medication is not used to treat scabies. 4 Contact the prescriber; the medication is not recommended during pregnancy.

4 The nurse's priority action is to contact the prescriber; the medication is not recommended during pregnancy. Permethrin or pyrethrins with piperonyl butoxide can be used safely during pregnancy. The dosage calculation is correct. The dosage for ivermectin is 200 mcg/kg. Ivermectin is used to treat scabies.

A patient presenting to the clinic at 20 weeks gestation tests positive for chlamydia. What is the most appropriate treatment option for the patient? 1 Doxycycline PO 100 mg bid for 21 days 2 Ceftriaxone IM 250 mg single dose 3 Ciprofloxacin PO 500 mg bid for 3 days 4 Erythromycin 500 mg qid for 21 days

4 The safest treatment for the treatment for a patient who is 20 weeks gestation with chlamydia is erythromycin 500 mg qid for 21 days. Doxycycline should be avoided in the second and third trimesters of pregnancy because of the risk of discoloration of teeth. Ceftriaxone is used to treat chancroid. Ciprofloxacin is used to treat chancroid and Klebsiella granulomatis. p 803

The nurse is teaching students about progestin-only oral contraceptives. Which statement by a student indicates effective learning? 1 "They are taken every week." 2 "They produce anovulatory cycles." 3 "They are taken after lunch and dinner." 4 "They may cause breakthrough bleeding."

4 The use of progestin-only formulations (often referred to as the "minipill") may cause breakthrough bleeding. They have a higher incidence of ovulatory cycles. They are taken daily. It is important for the patient to take this oral contraceptive at the same time every day to maintain effective hormone serum levels. p 763

The nurse is assessing an elderly patient who has angina pectoris who has been prescribed nitroglycerin (Nitrostat). After reviewing the patient's medical history, the nurse advises the patient to avoid vardenafil (Staxyn, Levitra). What is the reason for giving this advice to the patient? 1 Vardenafil (Staxyn, Levitra) is contraindicated for use in elderly patients. 2 Vardenafil (Staxyn, Levitra) reduces the efficacy of nitroglycerin (Nitrostat). 3 Vardenafil (Staxyn, Levitra) may cause erectile dysfunction in patients. 4 Vardenafil (Staxyn, Levitra) causes hypotension if taken with nitroglycerin (Nitrostat).

4 Vardenafil (Staxyn, Levitra) is a phosphodiesterase inhibitor. It is contraindicated in patients with cardiovascular disorders. This medication will be discontinued when nitrates such as nitroglycerin (Nitrostat) are prescribed for the patient, because it causes hypotension. This effect is seen due to synergistic action of the medications, which results in excessive vasodilation. Vardenafil (Staxyn, Levitra) is not contraindicated in elderly patients. It can be prescribed for them unless they have cardiovascular disorders. Vardenafil (Staxyn, Levitra) does not reduce the efficacy of nitroglycerin, because it does not interact with the drug. Vardenafil (Staxyn, Levitra) is prescribed for the treatment of erectile dysfunction. Therefore, it does not cause erectile dysfunction. p 797

The nurse is educating a patient about common vaginal infections and related treatment measures. Which information provided by the nurse is most important? 1 "Monistat, a medication used to treat VVC, is available in different forms." 2 "Metronidazole should never be used during the first trimester of pregnancy." 3 "Creams and suppositories used for treating vulvovaginal candidiasis (VVC) are inserted intravaginally." 4 "All ETOH products must be avoided during treatment and for 3 days after use of oral tinidazole therapy."

4 When receiving treatment with oral tinidazole, all ETOH products are contraindicated. Therefore, the nurse should provide teaching for the patient's future reference. Oral metronidazole should never be used during the first trimester of pregnancy. This information, though true, is not going to affect the treatment. Cream and suppositories used for treating VVC are inserted intravaginally. While this information is good to know, it is not imperative to treat the patient. Informing the patient that Monistat is available in different forms is not going to affect the treatment outcome. p 808

A patient diagnosed with vulvovaginal candidiasis (VVC) is prescribed butoconazole 2% cream. What will the nurse do when reviewing the plan of care with the patient? 1 Inform the patient that any sexual partners should be treated. 2 Inform the patient to abstain from intercourse until treatment is completed. 3 Review the systemic side effects of the medication with the patient. 4 Instruct the patient that local burning and irritation may occur with the use of the medication.

4 When reviewing the plan of care with the patient, the nurse should inform the patient that the medication prescribed may cause local burning and irritation. Uncomplicated VVC is not acquired through sexual intercourse, so treatment of a sexual partner is not necessary. It is not necessary to abstain from intercourse until treatment is completed. Intercourse does not interfere with the action of the medication, though it may be uncomfortable for the patient. Topical agents usually cause no systemic side effects. The effects that may occur are localized. p 807

Individuals aged 28 days to 23 months fall under which pediatric age classification? 1 Children 2 Adolescent 3 Term neonate 4 Infant/toddler

4) Individuals aged 28 days to 23 months are classified as infant/toddler. Children are aged 24 months to 11 years. Adolescents are aged 12 years to 16 or 18 years depending on region. Term neonates are aged from birth at 38 or more weeks gestation to 27 days. p 44

Which laboratory finding regarding plasma testosterone concentration is abnormal? 1 600 ng/dL 2 800 ng/dL 3 1000 ng/dL 4 1200 ng/dL

4) The normal range of plasma testosterone concentration is 250 to 1000 ng/dL. Therefore, a laboratory finding of 1200 ng/dL is high. Plasma testosterone concentrations of 600, 800, and 1000 ng/dL are normal findings. p 791

Which statements are true about men's reproductive health as a part of the aging process? Select all that apply. 1 The number of Leydig cells increases with age. 2 The rate of sperm production increases with age. 3 The production of testosterone increases with age. 4 The level of luteinizing hormone increases with age. 5 The level of follicle-stimulating hormone increases with age.

4, 5 The release of luteinizing hormone and follicle-stimulating hormone (FSH) and the production of testosterone are linked. As the testosterone level declines, FSH is released by the anterior pituitary gland, which then increases the production of testosterone. Testosterone production in men decreases with age. Therefore, as a negative feedback mechanism, luteinizing hormone and FSH levels tend to rise. With increasing age, the number of Leydig cells decreases and sperm production and testosterone production also decrease. p 791-792

Which statements are true about men's reproductive health as a part of the aging process? Select all that apply. 1 The number of Leydig cells increases with age. 2 The rate of sperm production increases with age. 3 The production of testosterone increases with age. 4 The level of luteinizing hormone increases with age. 5 The level of follicle-stimulating hormone increases with age.

4, 5) The release of luteinizing hormone and follicle-stimulating hormone (FSH) and the production of testosterone are linked. As the testosterone level declines, FSH is released by the anterior pituitary gland, which then increases the production of testosterone. Testosterone production in men decreases with age. Therefore, as a negative feedback mechanism, luteinizing hormone and FSH levels tend to rise. With increasing age, the number of Leydig cells decreases and sperm production and testosterone production also decrease. p 791-792

The nursing instructor is teaching students about safe administration of menotropin. Which statements made by the students indicate teaching was successful? Select all that apply. 1 "Menotropin should be stored in a well-lit area." 2 "Menotropin is administered intramuscularly." 3 "Following reconstitution, leftover menotropin may be refrigerated and used for the next dose." 4 "Menotropin is administered subcutaneously." 5 "One ampule of menotropin contains 300 international units." 6 "Menotropin should be administered immediately after reconstitution."

4, 6 Statements indicating teaching was successful include "menotropin is administered subcutaneously" and "menotropin should be administered immediately after reconstitution." Menotropin should be protected from light, not stored in a well-lit room. Menotropin is administered subcutaneously, not intramuscularly. Leftover menotropin should be discarded as it needs to be used immediately after reconstitution. One ampule of menotropin contains 75 IU. p 796

The employee health nurse will administer a hepatitis B immune globulin (HBIG) to a nurse that has sustained a needlestick injury. The nurse has no allergies and weighs 167 lb. How much HBIG will be administered? Record your answer using one decimal place. _____ mL

4.6 mL The recommended dose of HBIG is 0.06 mL/kg intramuscular (IM) x one dose for postexposure prophylaxis. The nurse divides 167 lb by 2.2 to determine the patient weighs 75.9 kg. The nurse multiplies 0.06 mL by 75.9 kg to determine that 4.6 mL of HBIG will be administered. p 703

The pediatric infection disease specialist orders intramuscular (IM) benzathine penicillin G for a child diagnosed with syphilis. The patient weighs 24 lb. How many units of benzathine penicillin G will be administered? Record your answer using a whole number. _______ units

545455 units The recommended dosage for benzathine penicillin G for a child is 50,000 units/kg IM. The nurse divides 24 lb by 2.2 to determine the patient weighs 10.9 kg. The nurse multiplies 10.9 kg by 50,000 units/kg to determine the patient will receive 545,455 units. p 805