• Question 1
A woman is receiving prolonged drug therapy during her complicated
1 out of 1 points
pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosag
...
• Question 1
A woman is receiving prolonged drug therapy during her complicated
1 out of 1 points
pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure
• Question 2
1 out of 1 points
After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from
• Question 3
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A patient is pregnant and is at 7 weeks' gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be
• Question 4
1 out of 1 points
A 51-year-old female patient has been receiving doxorubicin (Adriamycin)
for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient?
• Question 5
A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following?
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• Question 6
A nurse is working in a women's hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following?
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• Question 7
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On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate?
• Question 8
A female patient has been prescribed estrogen therapy. Which of the
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following will the nurse advise the patient is a common adverse effect of estrogen therapy?
• Question 9
A nurse is working with a 16-year-old pregnant teen and assessing for
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behavior that may put the baby at risk. The most important assessment the nurse can make is
• Question 10
A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug
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taking the drug at bedtime is not advisable.
• Question 11
A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient?
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• Question 12
A nurse is providing patient education to a 23-year-old woman who is starting the norelgestromin/ethinyl estradiol transdermal system (Ortho
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Evra). Because this is the patient's first time to use the birth control patch, the nurse will instruct her to apply the patch
Response Feedback:
The first time a woman uses the norelgestromin/ethinyl estradiol transdermal system, she should start it after her menstrual period begins. She can choose to apply the first patch either the day her period starts or the following Sunday. If she chooses the Sunday after the start of her period, she needs to use backup contraception for the first week of her first cycle.
• Question 13
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A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include
Response Feedback:
Adverse effects of oxytocin are dose related and take two forms
—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia.
• Question 14
1 out of 1 points
A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for which of the following?
Response Feedback:
Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.
• Question 15
A nurse is assigned to a patient who is at 32 weeks' gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor.
1 out of 1 points
Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus?
Response Feedback:
In a patient receiving terbutaline, the nurse should closely monitor the patient's pulse rate and blood pressure. In addition, to increase placental perfusion, the nurse should have the patient lie on her left side during the infusion. This will help minimize the risk for hypotension and promote circulation to the fetus. Palpitations are a common adverse effect of the drug and should be reported but are unrelated to hypotension and fetal circulation. The nurse should advise the patient to limit her fluid intake during the infusion because of possible fluid overload. However, this, too, is unrelated to hypotension and fetal circulation.
• Question 16
1 out of 1 points
A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug?
Response Feedback:
Nocturia is a characteristic symptom of BPH. Strong smelling urine that is cloudy is suggestive of a urinary tract infection. Finasteride is not used for the treatment of ED.
• Question 17
1 out of 1 points
A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize?
Response Feedback:
The primary goal of treatment with finasteride is to facilitate complete bladder emptying, resulting in less urgency and decreased frequency of voiding. Urethral pain, sexual side effects, and hematuria are possible but less commonly associated with BPH. Consequently, outcomes relating to bladder emptying would be prioritized.
• Question 18
A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because
1 out of 1 points
Response Feedback:
Drugs may compete with the hormones of pregnancy for albumin-binding sites, which may result in a larger amount of unbound (or free) drug in circulation, leaving the drug available to cross the placental membrane and enter the fetal circulation. A drug does not enter the fetal circulation as a direct result of increases in blood volume and heart rate or the occurrence of hemodilution.
• Question 19
1 out of 1 points
A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses?
Response Feedback:
Progesterone therapy carries risks of thrombotic events and vision loss. It is not associated with fluid loss, incontinence, or cognitive changes.
• Question 20
1 out of 1 points
A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following?
Response Feedback:
In a patient receiving warfarin concomitantly with etoposide, prothrombin time can become elevated and place the patient at an increased risk of bleeding. The heart rate, drug serum levels, and liver enzymes are not affected by concomitant use of warfarin.
• Question 21
1 out of 1 points
A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy?
Response Feedback:
Adverse effects are usually uncommon with finasteride therapy. However, there is a risk of sexual dysfunction related to the use of the drug. Excess fluid volume related to potential effects of
drug therapy and hypercalcemia related to drug therapy, immobility, and breast cancer are risks associated with testosterone therapy. Finasteride does not present a risk of neoplasms.
• Question 22
1 out of 1 points
A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group?
Response Feedback:
Vascular disease is the most common physical cause of erectile dysfunction. Atherosclerosis of the penile artery is the primary cause of erectile dysfunction in more than half of men over age
50. Men with diabetes are more prone to erectile dysfunction because of a combination of vascular disease and neuropathy. A decrease in testosterone levels is not a common cause of erectile dysfunction. Emotional stress is not a physical factor.
• Question 23
A patient has acquired primary hypogonadism and has been prescribed testosterone transdermal (Androderm) patches. When educating the patient on how to administer the drug, the nurse will instruct him to
1 out of 1 points
Response Feedback:
The patient should place the patch on the back, abdomen, upper arms, or thighs. He should not place it on the scrotum or on bony areas such as the shoulder or the hip. The skin area should not be oily, damaged, or irritated. The patch should stay in place for 7 days before replacement.
• Question 24
1 out of 1 points
A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following?
Response Feedback:
Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity.
Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider.
• Question 25
A man has a demonstrated history of androgen deficiency and the
1 out of 1 points
consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)?
Response Feedback:
Testosterone is used in treating erectile dysfunction and male climacteric symptoms when these conditions are secondary to androgen deficiency. PDE5 inhibitors do not address ED secondary to androgen deficiency. Tamsulosin is used to treat BPH.
• Question 26
A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication
1 out of 1 points
Response Feedback:
Oxybutynin is available as a transdermal patch and causes dry mouth approximately 60% of patients. The drug is not noted to cause palpitations or lightheadedness and it is not administered as an IM injection.
• Question 27
1 out of 1 points
Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects?
Response Feedback:
Vaginal burning, itching, or both can occur in the female partner of a man using intraurethral alprostadil. The nurse will advise the wife to be aware that this is a possibility. The pharmacodynamics of alprostadil may lead to hemodynamic changes such as low blood pressure and increased heart rate in the man. However, these changes are not clinically important and would not affect the female partner. The drug is not known to decrease sexual desire in either men or women.
• Question 28
A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to
1 out of 1 points
Response Feedback:
A teaching priority would be to tell the patient to use another form of birth control if she was taking an oral contraceptive. Fluconazole may decrease the effectiveness of oral contraceptives. Taking an antiemetic or antidiarrheal for adverse GI effects would be an appropriate instruction for this drug. The nurse should also instruct the patient to take aspirin instead of acetaminophen for relief of minor discomforts
because acetaminophen has the potential to damage the liver and kidneys. Taking the drug with food is recommended if the patient experiences GI distress. All of these instructions are important, but not as important as making sure that the patient does not inadvertently become pregnant while on the medication.
• Question 29
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A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as
Response Feedback:
Maternal adverse effects from magnesium sulfate toxicity are sweating, hypotension, flaccid paralysis, hypothermia, and cardiac depression. A serum level of 10 to 12 mg/dL is associated with toxicity (normal levels without infusion of magnesium sulfate are 1.8–3 mg/dL). Common adverse effects include headache, hyporeflexia, weakness, thirst, flushing, and burning at the infusion site. These manifestations do not indicate hypersensitivity or idiosyncratic reactions.
• Question 30
A 20-year-old woman has been prescribed estrogen. As with all women
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taking estrogen, the nurse will carefully monitor the patient for which of the following?
Response Feedback:
Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen.
Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen.
• Question 31
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The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during
Response Feedback:
The critical period of organogenesis, during which the major fetal organs form, is from implantation up to approximately day 58 to 60 after conception. If drugs that cause teratogenic effects are administered during this period, major malformations of fetal organ systems may result.
• Question 32
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A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?
Response Feedback:
Acetaminophen is the analgesic of choice during pregnancy.
• Question 33
1 out of 1 points
A nurse is working with a patient in the clinic who has erectile dysfunction. The patient has been prescribed sildenafil (Viagra). The patient wants to do everything he can to promote effectiveness of the drug. The nurse will instruct him to
Response Feedback:
Maximum plasma concentrations of sildenafil are reached within 30 to 120 minutes of oral dosing when taken on an empty stomach. The most frequent peak time is 60 minutes. However, when the drug is taken with a high-fat meal, absorption is slow and 60 extra minutes are needed to reach peak plasma levels. A high-fat meal reduces peak serum concentrations by 29%. Therefore, the patient should be advised to avoid high-fat meals when ingesting the drug.
Avoiding a high-protein meal or drinking fluids will not help achieve quick effects from the drug. It is not advisable to increase the dosage of the drug without consulting the prescriber.
• Question 34
1 out of 1 points
A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy?
Response Feedback:
The hemodynamic changes during pregnancy, such as increased blood volume and heart rate, increase the distribution of drugs. GFR and tidal volume both typically increase during pregnancy, resulting in increased excretion rates and increased absorption of inhaled drugs, respectively. Drug metabolism is not affected by pregnancy.
• Question 35
A 66-year-old man has made an appointment with his primary care
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provider to discuss his recent erectile dysfunction (ED) and has requested a prescription for tadalafil (Cialis) based on television commercials he has seen. What characteristic of this patient would most likely contraindicate
the use of tadalafil for his ED?
Response Feedback:
Like the other drugs in this class, tadalafil should not be taken within 48 hours of taking nitrates, such as nitroglycerin, because substantially lower blood pressure and possibly death may result. Nitroglycerin use is a contraindication for taking tadalafil, as it is for all drugs in this class. Allopurinol, ginseng, and low bone density do not contraindicate the use of tadalafil.
• Question 36
A male patient with a medical background tells the nurse that he is not
1 out of 1 points
satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse?
Response Feedback:
Natural testosterone undergoes a high first-pass effect and is therefore not used orally. The form of testosterone that is used orally is a synthetic androgen that is less extensively metabolized and has a longer half-life than natural testosterones. Natural testosterone does not pose a higher risk of gynecomastia.
• Question 37
A nurse is providing patient education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid which of the following drugs?
1 out of 1 points
Response Feedback:
Because MTX is secreted by the renal tubules, certain drugs that follow the same pathway, such as salicylates, sulfonamides, phenytoin, and penicillin, may compete with MTX excretion, resulting in accumulation and increased toxicity.
Therefore, if these drugs cannot be avoided, they should be discontinued 2 days before and restarted 2 days after MTX therapy. Acetaminophen, furosemide, and digoxin do not cause drug–drug interactions with MTX.
• Question 38
1 out of 1 points
A man is prescribed ciprofloxacin to treat a sexually transmitted infection. The nurse will instruct the patient to
Response Feedback:
To maximize the therapeutic effects of the drug, the nurse should encourage the patient to complete the entire drug therapy as prescribed. The dosage of ciprofloxacin is not reduced gradually but taken in the same dosage throughout the treatment period, and there is no indication that it is necessary for the patient to take the drug only at home. The prescriber
would be the only person who could change the form of the drug to be used, and subcutaneous injection is not an identified route of administration for ciprofloxacin.
• Question 39
1 out of 1 points
A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient to also
Response Feedback:
The patient should be encouraged to exercise and lift light weights as often as she can to increase bone density. It is also important to have adequate amounts of vitamin C in her diet, but it would not be directly related to this therapy. Drinking at least 6 to 8 oz of milk daily is a good idea, but she is already taking a calcium and vitamin D supplement. There is no identified adverse relationship between artificial sweeteners and alendronate therapy.
• Question 40
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A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend
Response Feedback:
Tylenol, which is acetaminophen, is the only analgesic recommended for use during pregnancy.
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