Pharm Quiz 9

The nurse has provided education on minocycline (Minocin) to a patient with rheumatoid arthritis. Which statement by the patient best demonstrates understanding of the drug's adverse effects?

"I will call my prescriber if I develop a skin rash or dizziness."

A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?

"It is best to use single-agent medications to treat individual symptoms."

A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast (Singulair) to replace the glucocorticoid, because the child has frequent nosebleeds. When teaching this child's parents about montelukast, the nurse will include which statement?

"Montelukast may cause behavior changes in your child."

A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?

"Oral beta2 agonists are not useful for short-term treatment."

A patient who takes teriparatide (Forteo) administers it subcutaneously with a prefilled pen injector. The patient asks why she must use a new pen every 28 days when there are doses left in the syringe. Which is the correct response by the nurse?

"The drug may not be stable after 28 days."

A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate (Fosamax) to zoledronate (Reclast). Which statement by the patient indicates a need for further teaching?

"This drug is less likely to cause osteonecrosis of the jaw."

A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do?

Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine.

The nurse is preparing to administer abatacept (Orencia) to a patient with severe rheumatoid arthritis. Which of the following would represent an appropriate action by the nurse?

Obtain a low-protein-binding filter with a pore size of 0.2 to 1.2 micrometers.

The nurse is providing education for a patient starting therapy on hydroxychloroquine (Plaquenil). Before giving the first dose of medication, the nurse would expect to see which diagnostic test ordered?

Ophthalmological exam

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?

Participating in weight-bearing exercises on a regular basis

A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient uses an inhaled glucocorticoid, montelukast (Singulair), and a SABA via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?

Question the patient about how much albuterol has been used.

A child is receiving a combination albuterol/ipratropium (DuoNeb) inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?

Reassure the patient that these are expected side effects.

A patient admitted to the hospital has been using phenylephrine nasal spray (Neo-Synephrine), 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?

Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.

A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

the patient should wait 1 minute between puffs.

A patient who has developed postmenopausal osteoporosis will begin taking alendronate (Fosamax). The nurse will teach this patient to take the drug:

while sitting upright with plenty of water.

The nurse is caring for a patient who is to be discharged from the hospital on etanercept (Enbrel). Which of the following instructions should the nurse include in the patient teaching?

Avoid live vaccines.

A postmenopausal patient is at high risk for developing osteoporosis. The patient's prescriber orders raloxifene (Evista), and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching?

"I should walk as much as possible during long airline flights."

A nurse is discussing the role of vitamin D in calcium regulation with a nursing student. Which statement by the student indicates a need for further teaching?

"Adequate amounts of vitamin D occur naturally in the diet."

A parent asks a nurse about giving diphenhydramine (Benadryl) to a child to relieve cold symptoms. Which response by the nurse is correct?

"Because histamine doesn't cause cold symptoms, Benadryl would not be effective."

A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct?

"Decongestant drops are recommended instead of decongestant sprays."

A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?

"Dosing is titrated based on the serum theophylline levels."

A patient is to be started on adalimumab (Humira) for management of rheumatoid arthritis. Which of the following statements by the patient demonstrates accurate knowledge about the drug?

"I have been taught how to administer the medication to myself in the fatty tissues of my anterior thighs and abdomen."

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast (Singulair) to the child's regimen. Which statement by the child's parent indicates understanding of this medication?

"I may notice mood changes in my child."

A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching?

"I should clear secretions from my nose before using the glucocorticoid."

A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching?

"I should not take more than 600 mg of calcium at one time."

A patient has just received a prescription for fluticasone/salmeterol (Advair Diskus). What will the nurse include as part of the teaching for this patient about the use of this device?

"You do not need good hand-lung coordination to use this device."

A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?

"You should take oral antihistamines daily during each allergy season to get maximum effects."

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol (Zyloprim) and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?

"You will take both drugs initially and then stop taking the colchicine."

A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide (Forteo). What will the nurse expect to administer?

20 mcg once daily subQ

A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9.5 mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding _____ daily and _____ IU of vitamin D3 each day.

600 mg of calcium once; 10,000

What is ipratropium bromide (Atrovent)?

An anticholinergic used for allergic rhinitis and colds

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

Ask whether the patient is gargling after each dose of the glucocorticoid.

A patient has severe Paget's disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider?

Calcitonin-salmon (Miacalcin)

A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?

LABAs should be combined with an inhaled glucocorticoid

A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen?

Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed

A nurse is providing education to a patient who will begin taking alendronate (Fosamax). Which complication should the patient be instructed to report immediately?

Difficulty swallowing

A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient's medication record, administered concurrently, would require additional patient monitoring by the nurse?

Digoxin (Lanoxin)

A postmenopausal patient develops osteoporosis. The patient asks the nurse about medications to treat this condition. The nurse learns that the patient has a family history of breast cancer. The nurse will suggest discussing which medication with the provider?

Estrogen estradiol

A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?

Fluticasone propionate (Fluticasone)

A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?

Growth may be slowed, but eventual adult height will not be reduced.

A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone (Flovent HFA) 110 mcg twice daily and has used 2 puffs of albuterol (Proventil HFA), 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen

The nurse administers etanercept (Enbrel) to a patient who has just begun therapy. A couple of hours later, the patient complains of conditions that are common reactions associated with etanercept. Upon further investigation of the patient's complaints, what clinical manifestation would the nurse expect to find?

Itching and erythema

A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do?

Suggest delaying the probenecid therapy until the acute episode has subsided.

A child with seasonal rhinitis has used budesonide (Rhinocort Aqua) for several years. The parents are concerned that the child's rate of growth has slowed. What will the nurse do?

Suggest that the parents discuss using fluticasone (Flonase) with the provider.

A patient newly diagnosed with asthma receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

The glucocorticoid is used as prophylaxis to prevent exacerbations."

A patient taking risedronate IR (Actonel) for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient?

These are common side effects of this drug.

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?

Urate-lowering drugs

A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that the patient has a temperature of 101° F and a rash. What will the nurse do?

Withhold the allopurinol and notify the prescriber of the drug reaction.

A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine, and the prescriber orders pegloticase (Krystexxa). Before administering this drug, the nurse will expect to:

administer an antihistamine and a glucocorticoid.

A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine (Claritin-D) every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to:

discuss using an intranasal glucocorticoid and loratadine (Claritin).

A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:

helps stimulate the flow of secretions to increase cough productivity.

A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do?

hold medication and notify prescriber

A patient is taking alendronate (Fosamax) to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to:

prevent hyperparathyroidism.

A patient who takes theophylline (Theochron) twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:

reducing the theophylline dose.

A patient is being treated with warfarin (Coumadin) to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol (Zyloprim). The nurse will contact the provider to discuss _____ the _____ dose.

reducing; warfarin

Which medication should be used for asthma patients as part of step 1 management?

short acting beta 2 agonist

A patient reports experiencing weakness, fatigue, nausea, vomiting, constipation, and nocturia. A dipstick urinalysis shows a positive result for protein. When questioned, the patient reports taking vitamin D and calcium supplements. The nurse will counsel the patient to:

stop taking vitamin D, reduce the amount of calcium, and increase the fluid intake.

A female patient with rheumatoid arthritis has taken leflunomide (Arava) for 1 year. She telephones the clinic nurse and says that a home pregnancy test showed a positive result. The nurse should

tell her to stop the drug immediately and notify the prescriber.