Pharmacology Exam 4Questions and Answers,100% CORRECT

Pharmacology Exam 4Questions and Answers CH 30-37 PPT Questions 1. Which effect does the nurse expect to see in a patient receiving hydrocortisone (Solu-Cortef) ? a. Increase in inflammatory leukocyte function b. R ...

Pharmacology Exam 4Questions and Answers CH 30-37 PPT Questions 1. Which effect does the nurse expect to see in a patient receiving hydrocortisone (Solu-Cortef) ? a. Increase in inflammatory leukocyte function b. Reduction of scar tissue formation c. Renal excretion of sodium d. Hypotension 2. When administering octreotide (Sandostatin) to a patient, it is most important for the nurse to assess which parameter? a. Urine output b. Blood sugar c. Liver function tests d. Electrocardiogram 3. A patient will be receiving somatropin. The nurse expects that the patient has which disorder? a. Adrenocortical insufficiency b. Hypopituitary dwarfism c. Esophageal varices d. Septic shock 4. A patient is in pulseless cardiac arrest. Which medication does the nurse anticipate administering? a. Vasopressin b. Desmopressin c. Cosyntropin d. Somatropin 5. A patient has been taking levothyroxine for 6 months. After this month’s laboratory work, the nurse practitioner tells the nurse that the patient is “euthyroid.” What does that term mean? a. The patient is experiencing hyperthyroidism. b. The patient is experiencing hypothyroidism. c. The patient’s thyroid hormone levels are within normal limits. d. The patient’s thyroid hormone levels are still fluctuating. 6. A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by a. Inadequate doses of the medication. b. Possible overdose of the medication. c. Worsening of the underlying disease. d. Drug interactions with another medication. 7. Which information will the nurse include when teaching a patient about thyroid replacement therapy? a. “Take the medication before bed.” b. “You will experience beneficial effects of the drug after one week of treatment.” c. “Stop taking the drug if you experience insomnia.” d. “Take the medication on an empty stomach.” 8. Which would be the best menu choice for a patient who is taking an antithyroid medication? a. A seafood platter b. Sushi c. Tofu burger d. Pasta with marinara sauce 9. A woman who has type II diabetes is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? a. She should continue the antidiabetic medication at the same dosage. b. The antidiabetic medication dosage will be increased gradually throughout her pregnancy. c. She will be switched to insulin therapy while she is pregnant. d. She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely. 10. The nurse has just administered the morning dose of a patient’s lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? a. Inform the patient of the delay. b. Check the patient’s blood glucose levels. c. Call the dietary department to send a tray immediately. d. Give the patient food, such as cereal and skim milk, and juice. 11. A patient with type 1 diabetes is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). He is placed on IVPB antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastrointestinal esophageal reflux disease (GERD). He takes a dose of glargine insulin every evening. That evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? a. The albuterol b. The antibiotics c. The proton pump inhibitor d. The corticosteroid 12. After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record (MAR) has not been signed by the nurse. The patient is confused and says “she thinks” the night nurse gave her the insulin. The patient’s blood glucose level is 142 mg/dL. What will the day shift nurse do? a. Give the insulin because it was not signed off. b. Hold the insulin because the patient thinks she received it and it is recorded in the machine. c. Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given. d. Report this to the nursing supervisor. 13. A male patient who has a history of type 2 diabetes mellitus is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about hemoglobin A1C. The nurse will inform the patient that hemoglobin A1C provides information regarding: a. Which type of diabetes the patient has. b. If he has an infection. c. Patient compliance with treatment regimen for several months previously. d. Current fasting blood glucose level. 14. The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin? a. Insulin glulisine (Apidra) b. Insulin isophane suspension (NPH) c. Insulin detemir (Levemir) d. Regular insulin (Humulin R) 15. The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient? a. Store the insulins in the refrigerator b. Shake the insulins for 1 full minute before use. c. Administer the injection at a 30-degree angle to your skin. d. Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe. 16. The nurse enters the patient’s room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. What is the most appropriate response by the nurse? a. Place a packet of table sugar in the patient’s mouth. b. Start CPR. c. Roll the patient to the side and administer the ordered glucagon. d. Have the patient drink orange juice. 17. The nurse should teach a patient taking an oral corticosteroid to take the medication at what time? a. 8:00 AM b. 12 noon c. 5:00 PM d. 8:00 PM 18. A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease [GERD]). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone? a. Furosemide b. Levothyroxine c. Proton pump inhibitor d. Antacid 19. When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor: a. Serum electrolytes. b. Cardiac enzymes. c. Liver enzymes. d. Arterial blood gases. 20. A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, the nurse’s priority should be to: a. Listen to the patient’s breath sounds. b. Have the patient rinse his mouth with warm water. c. Instruct the patient to cough and deep breathe. d. Take the patient’s apical pulse for 1 minute. 21. While taking a history of a 68-year-old female patient who is receiving estrogen therapy as part of palliative treatment for advanced breast cancer, which assessment finding would be of most concern to the nurse? a. The patient is on transdermal opioids for cancer pain. b. The patient smokes 1 pack of cigarettes a day. c. The patient drinks a glass of wine one evening a week. d. The patient has a history of osteoporosis. 22. A 60-year-old woman is taking a bisphosphonate. She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. The nurse will instruct her to: a. Take this medication with milk. b. Take this medication with breakfast. c. Remain upright in a sitting position for at least 10 minutes after taking this medication. d. Stop the medication and to come in for an evaluation. 23. A woman in labor is on an oxytocin infusion. The nurse notes that her contractions are close to 100 seconds apart and are lasting 1.25 seconds. The mother’s blood pressure has increased to 130/98, and the fetal heart rate decreases during the contractions. The woman states, “Wow, this medicine is sure hurrying things along!” The nurse’s next action(s) will be to: a. Continue to monitor the labor, which is progressing nicely. b. Offer comfort measures during the contractions. c. Stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately. d. Take the patient to the delivery area because delivery is imminent. 24. A woman has not taken her oral contraceptive since Monday. It is now Wednesday morning. What should she do now to prevent pregnancy? a. Take the two missing doses as soon as possible. b. Continue the drug as if no doses were missed. c. Start over with a new monthly pack of oral contraceptives. d. Resume the drug but also use a second form of birth control. 25. A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? a. Transdermal nitroglycerin b. Hydrochlorothiazide c. Potassium d. Multivitamin with iron 26. When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review? a. Hemoglobin A1C b. Triglycerides c. Potassium d. Lactate dehydrogenase (LDH) 27. A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? a. Calcium with vitamin D b. Acetaminophen (Tylenol) c. St. John’s wort d. Ibuprofen (Motrin) 28. The common cold is treated with empiric therapy, which means: a. The medications cure the cold. b. The medications only treat the symptoms. c. Herbal medications are useful to eliminate symptoms. d. It is prevented with careful use of medications. 29. Prior to administering an antihistamine to a patient, it is most important for the nurse to assess the patient for a history of which condition? a. Chronic urticaria b. Motion sickness c. Urinary retention d. Insomnia 30. A 94-year-old patient has a severe dry cough. He has coughed so hard that the muscles in his chest are hurting. He is unsteady on his feet and slightly confused. Which drug would be the best choice for this patient’s cough? a. Benzonatate (Tessalon Perles) capsules b. Dextromethorphan (Robitussin-DM) oral solution c. Codeine cough syrup d. Guaifenesin (Mucinex) 31. A patient with a tracheostomy developed pneumonia. It is very difficult for the patient to cough up the thick, dry secretions he has developed. The nurse identifies which drug as being most effective in helping this patient? a. Benzonatate (Tessalon Perles) capsules b. Dextromethorphan (Robitussin-DM) oral solution c. Codeine cough syrup d. Guaifenesin (Mucinex) 32. Which medication will the nurse teach a patient with asthma to use when experiencing an acute asthma attack? a. Albuterol (Ventolin) b. Salmeterol (Serevent) c. Theophylline (Theo-Dur) d. Montelukast (Singulair) 33. A patient with chronic bronchitis calls the office for a refill of his albuterol inhaler. He just had the prescription filled 2 weeks ago, but he says it is empty. When asked, he tells the nurse, “I use it whenever I need it, but now when I use it I feel so sick. I’ve been needing to use it more often.” What is the most appropriate action by the nurse? a. The nurse should confirm the pharmacy location for the needed refill. b. The nurse should ask the patient to come to the office for an evaluation of his respiratory status. c. The nurse should tell the patient not to use this drug too often. d. The nurse should consult the prescriber for a different inhaler prescription. 34. A patient is prescribed two different types of inhaled medications for treatment of chronic obstructive pulmonary disease (COPD). After administering the first medication, how long should the nurse wait to administer the second medication? a. One minute b. Five minutes c. Ten minutes d. Fifteen minutes 35. The nurse is providing teaching to a group of individuals with chronic obstructive pulmonary disease (COPD) at a community center. Which statement by one of the attendees indicates that further teaching is needed? a. “If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately.” b. “I will inform my prescriber of any weight gain of 2 pounds or more in 24 hours or 5 pounds or more in 1 week.” c. “I use omalizumab (Xolair) to control my asthma but not for an acute asthma attack.” d. “When taking theophylline (Theo-Dur), I will advise my prescriber if I experience epigastric pain.” 36. One of the attendees expressed concern regarding her granddaughter’s asthma. The attendee tells the nurse that she is afraid that she will not know which of her granddaughter's medications to give first in case of an asthma attack. Which medication should the nurse inform the attendee to administer first for an acute asthma attack? a. Ipratropium (Atrovent) b. Albuterol (Proventil) c. Budesonide (Pulmicort Turbuhaler) d. Montelukast (Singulair) 37. One of the attendees tells the nurse that he has asthma and is being treated with a short-acting inhaled beta2 agonist. The nurse identifies this treatment as which step of the stepwise therapy for the treatment of asthma? a. Step 1 b. Step 2 c. Step 3 d. Step 4 CH 30-35 PPT Answers 1. ANS: B a. Hydrocortisone is the drug form of the hormone cortisol. Cortisol has many antiinflammatory effects, including reduction of inflammatory leukocyte functions and scar tissue formation. Cortisol also promotes renal retention of sodium, which can result in edema and hypertension 2. ANS: B a. Octreotide (Sandostatin) may cause alterations in blood glucose levels; closely monitor blood glucose during drug therapy. 3. ANS: B a. Somatropin is human growth hormone that is used for the treatment of hypopituitary dwarfism. Cosyntropin is used for the diagnosis of adrenocortical insufficiency. Octreotide is used for esophageal varices. Vasopressin is indicated for septic shock 4. ANS: A a. Vasopressin is also a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). It is also used in the Advanced Cardiac Life Support (ACLS) guidelines for treatment of pulseless cardiac arrest. Desmopressin is useful in treating certain blood disorders. Cosyntropin is used in the diagnosis of adrenocortical insufficiency. Somatropin and somatrem are effective in stimulating skeletal growth in patients with an inadequate secretion of normal endogenous GH. 5. ANS: C a. The term euthyroid means that normal thyroid hormone levels have been achieved. 6. ANS: A a. A return of the symptoms of hypothyroidism indicates that the patient is receiving inadequate doses of the medication. 7. ANS: D a. Thyroid replacement drugs are best taken ½ to 1 hour before breakfast on an empty stomach to enhance their absorption orally, maintain constant hormone levels, and help prevent insomnia. These medications should never be abruptly discontinued, and lifelong therapy is usually the norm. Patients should be advised that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs 8. ANS: D a. The patient should avoid foods high in iodine, such as soy, tofu, and seafood. 9. ANS: C a. Oral antidiabetic medications are generally not recommended for pregnant patients because of a lack of firm safety data. Insulin therapy is the currently recommended drug therapy for pregnant women. 10. ANS: D a. Lispro insulin's onset of action is 15 minutes. It is essential that a diabetic patient eat a meal after injection. Otherwise profound hypoglycemia may result. 11. ANS: D a. Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. 12. ANS: C a. Never guess whether a drug was given. Taking the drug out of the machine does not mean it was given. The nurse should ask the night nurse what was done. 13. ANS: C a. Hemoglobin A1C is a good indicator of the patient's compliance with the therapy regimen for several months previously. 14. ANS: C a. The nurse should inform the patient that timing of meals with insulin and oral antidiabetic therapy is important to prevent hypoglycemia and to obtain the most optimal results from the antidiabetic therapy. Insulin detemir (Levemir) is a long-acting insulin while insulin glulisine (Apidra) is a rapid-acting insulin. Insulin isophane suspension (NPH) is an intermediate-acting insulin, and regular insulin (Humulin R) is a short-acting insulin. 15. ANS: D a. The rapid-acting (clear) then the intermediate-acting (cloudy) insulins should be mixed in the syringe after the appropriate amount of air has been injected. Insulin is stored at room temperature when it will be used within the month. The injection should be administered at a 90-degree angle for patients who have adequate body fat and at a 45-degree angle for patients who are very thin. Insulins should be rolled prior to administration and not shaken. 16. ANS: C a. Glucagon, a natural hormone secreted by the pancreas, is available as a subcutaneous injection to be given when a quick response to severe hypoglycemia is needed. Because glucagon injection may induce vomiting, roll an unconscious patient onto his or her side before injection. Glucagon is useful in the unconscious hypoglycemic patient without established intravenous access. The patient is at risk for aspiration so nothing should be administered by mouth. CPR is not indicated. 17. ANS: A a. Oral corticosteroids should be taken in the morning to minimize adrenal suppression. 18. ANS: A a. Coadministration of a loop diuretic with a corticosteroid may result in hypokalemia because of the potassium loss caused by both drugs. 19. ANS: C a. Aminoglutethimide therapy may cause hepatotoxicity, so it is important to monitor liver enzymes. 20. ANS: B a. The patient should rinse his mouth with water immediately after taking an inhaled corticosteroid to avoid oral fungal infections and other oral irritations. 21. ANS: B a. Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis. 22. ANS: D a. Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions 23. ANS: C a. These are signs of hyperstimulation of the uterus from the oxytocin. Fetal compromise may occur if the infusion is not stopped. 24. ANS: D a. Missed doses will reduce the effectiveness of the oral contraceptive, so another form of pregnancy prevention will be needed. 25. ANS: A a. Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes. 26. ANS: D a. Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life-threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice. 27. ANS: D a. The nurse should be most concerned about concurrent use of saw palmetto with the NSAID ibuprofen (Motrin) because of the potential for drug interactions 28. ANS: B a. There is no cure for the common cold, and the efficacy of herbal products is not proven. Treatment rendered can only treat the presenting clinical symptoms. 29. ANS: C a. The anticholinergic effects of antihistamines may cause difficulty urinating. The other answers are potential indications for an antihistamine. 30. ANS: B a. Dextromethorphan does not cause respiratory or central nervous system depression, and it is not an opioid. Guaifenesin is an expectorant that is used to thin excessive mucus, which this patient does not have. 31. ANS: D a. Expectorants such as guaifenesin aid in the expectoration (i.e., coughing up and spitting out) of excessive mucus that has accumulated in the respiratory tract by breaking down and thinning out the secretions. 32. ANS: A a. Albuterol (Ventolin) is a short-acting bronchodilator (SABA). Patients must be taught to use the SABAs as rescue treatment. Salmeterol (Serevent) is a long-acting bronchodilator. Because the LABAs have a longer onset of action, they must never be used for acute treatment . Because of their relatively slow onset of action, xanthines such as theophylline (Theo-Dur) are more often used for the prevention of asthmatic symptoms than for the relief of acute asthma attacks. Montelukast (Singulair) is an LTRA and is used primarily for oral prophylaxis and long-term treatment of asthma. 33. ANS: B a. While it is true that the patient should be reminded about the correct use of this inhaler, it is evident that he has used it too often and that his respiratory status should be evaluated to see if an adjustment in the prescription should be made. 34. ANS: B a. If a second puff of the same drug is ordered, instruct the patient to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is ordered, instruct the patient wait 2 to 5 minutes between the medications or to take as prescribed. Bronchodilators are usually administered first. 35. ANS: A a. Patients should be taught to not stop systemic corticosteroids abruptly. The patient should be educated about the possibility of Addisonian crisis, which may occur if a systemic corticosteroid is abruptly discontinued. These drugs require weaning prior to discontinuation of the medication. Patients should monitor their weight daily and report the increase stated. Omalizumab (Xolair) is used for the treatment of moderate to severe asthma and not for aborting acute asthma attacks. Adverse effects of theophylline (Theo-Dur) that should be reported immediately to the prescriber include epigastric pain. 36. ANS: B a. Albuterol (Proventil) is a short-acting beta2 agonist indicated for treatment of acute asthma attacks. Ipratropium (Atrovent) is an anticholinergic not indicated for treatment of acute asthma attacks. Budesonide (Pulmicort Turbuhaler) is an inhaled corticosteroid that should not be used in an acute asthma attack. Montelukast (Singulair) is a leukotriene receptor agonist used for long-term management of asthma, not for acute exacerbations. 37. ANS: A a. Step 1 includes use of a short-acting inhaled beta2 agonist as needed. CH 30 Questions 1. The nurse notes in a patient’s medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder? a. Diabetes mellitus b. Diabetes insipidus c. Adrenocortical insufficiency d. Carcinoid tumor 2. A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? a. He will need to stop participating in school physical education classes. b. The somatropin must be discontinued immediately. c. The somatropin dosage may be adjusted. d. His growth will be documented and monitored for changes. 3. When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output 4. An 8-year-old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome? a. Increased growth b. Decreased urinary output c. Increased muscle strength d. Increased height when the child reaches puberty 5. When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP), the nurse notes that a drug interaction will occur if which drug is taken with desmopressin? a. Aspirin b. Digoxin c. Lithium d. Penicillin 6. A patient’s medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition? a. Adrenocortical insufficiency b. Diabetes insipidus c. Myasthenia gravis d. Pituitary dwarfism 7. A patient is about to receive a dose of octreotide (Sandostatin). The nurse will assess for which contraindications or cautions? (Select all that apply.) a. Carcinoid crisis b. Diarrhea c. Type 1 diabetes mellitus d. Gallbladder disease e. Chronic renal failure f. Esophageal varices 8. A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instruction? a. "I will not stop the drug unless my doctor tells me to stop it." b. "I will call my doctor if I have a fever or sore throat." c. "I will have to stop drinking my nightly glass of wine." d. "I am looking forward to a cure for my condition with this hormone replacement." CH 30 Answers 1. ANS: B a. Desmopressin is used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus. The symptoms are caused by a deficiency of endogenous antidiuretic hormone. The other options are incorrect. 2. ANS: C a. Somatropin is to be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient’s growth will be measured and documented throughout therapy with somatropin. 3. ANS: D a. Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. The other options are incorrect. 4. ANS: A a. In patients for whom somatropin is indicated, increased growth is expected. The other options are incorrect. 5. ANS: C a. Lithium may cause a decreased therapeutic effect of desmopressin. The other options are incorrect. 6. ANS: A a. Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The other options are incorrect. 7. ANS: C, D, E a. Octreotide is used with caution in patients with diabetes (type 1 or 2), gallbladder impairment, or renal impairment. Carcinoid crisis, which may be associated with severe diarrhea and flushing, is an indication for octreotide; esophageal varices are also an indication. 8. ANS: D a. The medication does not lead to a cure but does help to alleviate the symptoms of the disease for which it is being given. The patient needs to avoid alcohol while taking any of the pituitary drugs. Instruct the patient not to discontinue this drug abruptly because of possible negative consequences to the patient and the levels of pituitary hormones. Any fever, sore throat, joint pain, or muscular pain needs to be reported to the prescriber immediately. CH 31 Questions 1. A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug? a. Infection b. Diabetes mellitus c. Liver disease d. Recent myocardial infarction 2. A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more “natural” forms of drugs. What will the nurse explain to him about the advantages of levothyroxine? a. It has a stronger effect than the natural forms. b. Levothyroxine is less expensive than the natural forms. c. The synthetic form has fewer adverse effects on the gastrointestinal tract. d. The half-life of levothyroxine is long enough to permit once-daily dosing. 3. The order reads, “Give levothyroxine (Synthroid), 200 mg, PO once every morning.” Which action by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200 mcg because that is what the prescriber meant. c. Hold the drug until the prescriber returns to see the patient. d. Question the order because the dose is higher than 200 mcg 4. During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions? a. Using iodized salt when cooking b. Avoiding foods containing iodine c. Restricting fluid intake to 2500 mL/day d. Increasing intake of sodium- and potassium-containing foods 5. A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate? a. It blocks the action of thyroid hormone. b. It slows down the formation of thyroid hormone. c. It destroys overactive cells in the thyroid gland. d. It inactivates already existing thyroid hormone in the bloodstream. 6. A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a. “It will probably require surgery for a cure to happen.” b. “The full therapeutic effects may not occur for 3 to 4 weeks.” c. “Is it possible that you did not take your medication as instructed?” d. “Let’s review your diet; it may be causing absorption problems.” 7. A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day? a. In the morning b. With the noon meal c. With the evening meal d. At bedtime 8. When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? a. Decreased glucose levels b. Decreased white blood cell count c. Increased red blood cell count d. Increased platelet count 9. A patient has been taking levothyroxine (Synthroid) for more than one decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse’s best advice? a. “This would be a great way to save money.” b. “There’s no difference in brands of this medication.” c. “This should never be done; once you start with a certain brand, you must stay with it.” d. “It’s better not to switch brands unless we check with your doctor.” 10. A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem? a. The hypothalamus is not secreting thyrotropin-releasing hormone (TRH); therefore, thyroid-stimulating hormone (TSH) is not released from the pituitary gland. b. The pituitary gland is dysfunctional and is not secreting TSH. c. The abnormality is in the thyroid gland itself. d. The abnormality is caused by an insufficient intake of iodine 11. A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct? a. “You can stop the medication if your symptoms have improved.” b. “You need to stay on the medication for at least 1 year before a decision about stopping it can be made.” c. “You need to stay on this medication until you become pregnant.” d. “Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication.” 12. Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient’s current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? (Select all that apply.) a. Phenytoin (Dilantin) b. Estrogens c. Beta blockers d. Warfarin (Coumadin) e. Penicillins f. Iron supplements 13. When monitoring a patient who is taking a thyroid replacement hormone, which adverse effect needs to be reported to the prescriber? a. Weakness b. Palpitations c. Constipation d. Drowsiness CH 31 Answers 1. ANS: D a. Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are incorrect. 2. ANS: D a. One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life. The other options are incorrect. 3. ANS: D a. Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred. The other options are incorrect. 4. ANS: B a. Patients on antithyroid therapy need to avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are incorrect. 5. ANS: B a. Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone. The other options are incorrect. 6. ANS: B a. Patients need to understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect. 7. ANS: A a. If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing. 8. ANS: B a. Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect. 9. ANS: D a. Switching brands of levothyroxine during treatment can destabilize the course of treatment. Thyroid function test results need to be monitored more carefully when switching products. 10. ANS: C a. Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs when the thyroid gland is not able to perform one of its many functions. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T3 and T4 stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid hormone levels. 11. ANS: D a. These medications must never be abruptly discontinued, and lifelong therapy is usually the norm. The other options are incorrect. 12. ANS: A, B, D, F a. Drug interactions with thyroid preparations include phenytoin, cholestyramine, antacids, calcium salts, iron products, estrogens, and warfarin (see Table 31-3). The other options are not correct. 13. ANS: B a. The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism. Instruct the patient to report immediately any of the following to the prescriber: chest pain, weight loss, palpitations, tremors, sweating, nervousness, shortness of breath, or insomnia. The other options are incorrect. CH 32 Questions 1. The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame? a. 15 minutes b. 1 to 2 hours c. 80 minutes d. 3 to 5 hours 2. When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including: a. hypothermia and seizures. b. nausea and diarrhea. c. confusion and sweating. d. fruity, acetone odor to the breath. 3. The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? a. Patients need to use the injection site that is the most accessible. b. If two different insulins are ordered, they need to be given in separate injections. c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first. 4. When monitoring a patient’s response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? a. Random blood glucose level of 180 mg/dL b. Blood glucose level of 50 mg/dL after meals c. Fasting blood glucose level between 92 mg/dL d. Evening blood glucose level below 80 mg/dL 5. A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse’s best response? a. “Take this medication in the morning, 30 minutes before breakfast.” b. “Take this medication in the evening with a snack.” c. “This medication needs to be taken after the midday meal.” d. “It does not matter what time of day you take this medication.” 6. A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? a. Administer half the original dose. b. Withhold all medications as ordered. c. Contact the prescriber for further orders. d. Give the medication with a sip of water. 7. The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, “What should you do if your fasting blood glucose is 47 mg/dL?” Which response by the patient reflects a correct understanding of insulin therapy? a. “I will call my doctor right away.” b. “I will give myself the regular insulin.” c. “I will take an oral form of glucose.” d. “I will rest until the symptoms pass.” 8. The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? a. Avoid the abdomen because absorption there is irregular. b. Choose a different site at random for each injection. c. Give the injection in the same area each time. d. Rotate sites within the same location for about 1 week before rotating to a new location. 9. Which action is most appropriate regarding the nurse’s administration of a rapid-acting insulin to a hospitalized patient? a. Give it within 15 minutes of mealtime. b. Give it after the meal has been completed. c. Administer it once daily at the time of the midday meal. d. Administer it with a snack before bedtime 10. After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient’s adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin level 11. A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse’s next action? a. Have the patient eat glucose tablets. b. Have the patient consume fruit juice, a nondiet soft drink, or crackers. c. Administer intravenous glucose (50% dextrose). d. Call the lab to order a fasting blood glucose level. 12. The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? a. Insulin is never given intravenously. b. Only regular insulin can be administered intravenously. c. Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction. d. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration. 13. A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? a. The antibiotics may cause an increase in glucose levels. b. The corticosteroids may cause an increase in glucose levels. c. His type 2 diabetes has converted to type 1. d. The hypoxia caused by the COPD causes an increased need for insulin. 14. The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? a. 30 minutes before breakfast b. With the first bite of each main meal c. 30 minutes after breakfast d. Once daily at bedtime 15. A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a. To increase the pancreatic secretion of insulin b. To decrease insulin resistance c. To increase blood glucose levels d. To decrease the pancreatic secretion of insulin 16. When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? a. Give the drug as ordered 30 minutes before breakfast. b. Hold the drug, and check the order with the prescriber. c. Give a reduced dose of the drug with breakfast. d. Give the drug, and monitor for adverse effects. 17. The nurse is reviewing a patient’s medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a. Glitazone b. Insulin c. Metformin (Glucophage) d. Sulfonylurea 18. The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? a. “Patients with type 2 diabetes will never need insulin.” b. “Oral antidiabetic drugs are safe for use during pregnancy.” c. “Pediatric patients cannot take insulin.” d. “Insulin therapy is possible during pregnancy if managed carefully.” 19. The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? a. “Basal dosing delivers a constant dose of insulin.” b. “With basal dosing, you can eat what you want and then give yourself a dose of insulin.” c. “Glargine insulin is given as a bolus with meals.” d. “Basal-bolus dosing is the traditional method of managing blood glucose levels.” 20. When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? a. “Take metformin if your blood glucose level is above 150 mg/dL.” b. “Take this 60 minutes after breakfast.” c. “Take the medication on an empty stomach 1 hour before meals.” d. “Take the medication with food to reduce gastrointestinal (GI) effects.” 21. The insulin order reads, “Give 10 units of NPH insulin and 5 units of regular insulin, subcut, every morning before breakfast.” Choose the proper syringe for this injection. 22. A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) a. Hypoglycemia b. Nausea c. Diarrhea d. Weight gain e. Peripheral edema CH 33 Questions 1. The nurse is administering adrenal drugs to a patient. Which action by the nurse is appropriate for this patient? a. Administering oral drugs on an empty stomach to maximize absorption b. Rinsing the oral cavity after using corticosteroid inhalers c. Administering the corticosteroids before bedtime to minimize adrenal suppression d. Discontinuing the medication immediately if weight gain of 5 pounds or more in 1 week occurs 2. A patient will be starting therapy with a corticosteroid. The nurse reviews the patient’s orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes? a. Nonsteroidal anti-inflammatory drugs b. Antibiotics c. Opioid analgesics d. Antidepressants 3. A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image? a. Weight loss b. Weight gain c. Pale skin color d. Hair loss 4. A patient is taking fludrocortisone (Florinef) for Addison’s disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information? a. It may cause severe postural hypotension. b. It needs to be taken with food or milk to minimize gastrointestinal upset. c. The medication needs to be stopped immediately if nausea or vomiting occurs. d. Weight gain of 5 pounds or more in 1 week is an expected adverse effect. 5. When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition? a. Dehydration b. Hypokalemia c. Hyponatremia d. Hypoglycemia 6. A glucocorticoid is prescribed for a patient. The nurse checks the patient’s medical history knowing that glucocorticoid therapy is contraindicated in which disorder? a. Cerebral edema b. Peptic ulcer disease c. Tuberculous meningitis d. Chronic obstructive pulmonary disease 7. A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient’s recovery? a. Hypotension b. Delayed wound healing c. Muscle weakness d. Osteoporosis 8. The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs? (Select all that apply.) a. Glaucoma b. Cerebral edema c. Chronic obstructive pulmonary disease and asthma d. Organ transplantation e. Varicella f. Septicemia 9. The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment? (Select all that apply.) a. Dehydration b. Weight loss c. Steroid psychosis d. Increased potassium levels e. Increased blood glucose levels f. Decreased serum sodium levels 10. The nurse notes in the patient's medication history that the patient is taking aminoglutethimide. Based on this finding, the nurse interprets that the patient has which disorder? a. Acute asthma b. Addison's disease c. Chronic obstructive pulmonary disease d. Cushing's syndrome CH 33 Answers 1. ANS: B a. After the patient has used the corticosteroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs need be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they need to be discontinued by weaning, not abruptly. 2. ANS: A a. The use of corticosteroids with aspirin, other NSAIDs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. The other options are incorrect. 3. ANS: B a. Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are possible body changes that may occur with long-term prednisone therapy. 4. ANS: B a. Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension. 5. ANS: B a. Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia. The other options are incorrect. 6. ANS: B a. Contraindications to the administration of glucocorticoids include drug allergy and may include cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The other options are indications for glucocorticoids. 7. ANS: B a. Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient’s recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy. 8. ANS: B, C, D a. Cerebral edema, chronic obstructive pulmonary disease, asthma, and organ transplantation are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. 9. ANS: A, B, D, F a. The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison’s disease, which is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. Steroid psychosis is an effect of glucocorticoid excess. 10. ANS: D a. Aminoglutethimide is an adrenal steroid inhibitor that is used in the treatment of Cushing's syndrome. The other options are incorrect. CH 32 Answers 1. ANS: A a. The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours. 2. ANS: C a. Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect. 3. ANS: D a. If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered. 4. ANS: C a. The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect. 5. ANS: A a. Glipizide is taken in the morning, 30 minutes before breakfast. When taken at this time, it has a longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day. 6. ANS: C a. When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect. 7. ANS: C a. Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more. 8. ANS: D a. Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least to 1 inch away from the previous site. 9. ANS: A a. Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient’s mealtime. The other options are incorrect. 10. ANS: B a. The hemoglobin A1C level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect. 11. ANS: C a. Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. 12. ANS: B a. Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes. 13. ANS: B a. Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect. 14. ANS: B a. When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented. 15. ANS: B a. Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect. 16. ANS: B a. There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified. 17. ANS: B a. Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin. 18. ANS: D a. Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses. 19. ANS: A a. Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented. 20. ANS: D a. The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect. 21. The proper syringe for insulin injection is the insulin syringe, which is marked in units. The other syringes listed are not correct for use with insulin because they are not marked in units. 22. ANS: A, B, D a. The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn. CH 34 Questions 1. The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? a. “If you miss a dose, double-up on the next dose.” b. “There’s no need to be concerned about breast lumps or bumps that occur.” c. “Be sure to report any weight gain of 5 pounds or more per week.” d. “Take the medication on an empty stomach to enhance absorption.” 2. The nurse recognizes that use of estrogen drugs is contraindicated in which patient? a. A patient who has atrophic vaginitis b. A patient who has inoperable prostate cancer c. A woman who has just given birth and wants to prevent postpartum lactation d. A woman with a history of thrombophlebitis 3. A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem? a. Methylergonovine (Methergine) b. Estradiol transdermal (Estraderm) c. Raloxifene (Evista) d. Medroxyprogesterone (Provera) 4. The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? a. Headache b. Drowsiness c. Dysmenorrhea d. Hypertension 5. A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? a. Giving magnesium sulfate along with the oxytocin b. Administering the medication in an intravenous (IV) bolus c. Administering the medication with an IV infusion pump d. Monitoring fetal heart rate and maternal vital signs every 6 hours 6. The nurse is reviewing the use of uterine tocolytics, such as indomethacin (Indocin). Which statement best describes the indication for these drugs? a. Prevention of preterm labor in the 15th week of pregnancy b. Prevention of preterm labor in the 22nd week of pregnancy c. Stimulation of contractions in prolonged labor d. Stimulation of ovulation as part of infertility treatments 7. A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition? a. Hypocalcemia b. Breast cancer c. Stress fractures d. Venous thromboembolism 8. During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased: a. incidence of nausea. b. risk for thrombosis. c. levels of triglycerides. d. tendency to bleed during menstruation. 9. When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? a. Monophasic b. Biphasic c. Triphasic d. Short acting 10. A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? a. Complete blood count b. Serum potassium level c. Vaginal cultures d. Pregnancy test 11. The nurse is providing patient teaching about the oral bisphosphonate alendronate (Fosamax). Which statement by the patient indicates a good understanding of when this drug should be taken? a. “I will take it in the evening just before bedtime.” b. “I will take it in the morning with an 8-ounce glass of water.” c. “I will take it with the first bite of the morning meal.” d. “I will take it between meals on an empty stomach.” 12. A woman who lives in Seattle is preparing to take a plane trip to London. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient? a. She needs to stop taking the drug at least 72 hours before the trip. b. She must remember to take this drug with a full glass of water each morning. c. She will not take the drug while traveling on the plane. d. No change in how the drug is taken will be needed. 13. The nurse recognizes that the risk of osteoporosis is higher in an individual with which risk factor? a. White or Asian race b. African-American race c. History of participation in active sports d. Obesity 14. A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time? a. She will continue to take the alendronate with water. b. She cannot take the alendronate until she can sit up for 30 minutes. c. She can take the medication with breakfast. d. She will stop taking the medication 72 hours before her surgery. 15. The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate? a. Subcutaneous b. Intramuscular c. Vaginal d. Transdermal 16. A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient’s medication history for which potential drug interaction? a. Thyroid replacement therapy b. Oral anticoagulant therapy c. Nonsteroidal anti-inflammatory drugs d. Beta blockers 17. The nurse is administering oxytocin (Pitocin). Which situation is an indication for the use of oxytocin? a. Decreased fetal heart rate and movements b. Stimulation of contractions during labor c. Cervical ripening near term in pregnant patients d. To reverse premature onset of labor 18. An older adult female patient is receiving the progestin drug megestrol (Megace). Which is the most likely reason megestrol is ordered for this patient? a. Migraine headaches b. Osteoporosis c. Appetite stimulant d. Reduction of hot flashes 19. The nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.) a. Cephalexin (Keflex) b. Guaifenesin (Robitussin) c. Warfarin (Coumadin) d. Ibuprofen (Motrin) e. Theophylline (Uniphyl) 20. While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse's best response? a. "Estrogen patches are still the first choice for osteoporosis prevention." b. "Estrogen patches are often used as long-term therapy for osteoporosis prevention." c. "Estrogen patches are not the first choice for osteoporosis prevention because they are associated with a high risk for cardiovascular problems." d. "Estrogen patches can be prescribed if you prefer patches to oral medications." 21. When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of which condition? a. Severe weight gain b. Irregular menses c. Multiple pregnancy d. Alopecia CH 34 Answers 1. ANS: C a. Patients taking oral estrogen therapy should report weight gain of 5 pounds or more per week to a physician. The other statements are not true for estrogen replacement therapy. 2. ANS: D a. Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation. 3. ANS: D a. Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea. Secondary amenorrhea is not an indication for the other drugs listed. 4. ANS: A a. Headache is one of the possible adverse effects of the fertility drugs. They may also cause vomiting, restlessness, and urticaria. Drowsiness, dysmenorrhea, and hyperten 5. ANS: C a. Oxytocin is infused via an infusion pump, not via an IV bolus. Magnesium sulfate is not administered with oxytocin. Fetal heart rate and maternal vital signs should be monitored continuously. 6. ANS: B a. Tocolytics relax uterine smooth muscles and stop the uterus from contracting and are used along with nonpharmacologic measures to prevent preterm labor between 20 and 37 weeks of pregnancy. 7. ANS: D a. SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders. The other options are incorrect. 8. ANS: B a. Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are incorrect. 9. ANS: C a. The triphasic drugs most closely duplicate the normal hormonal levels of the female menstrual cycle. The other options are incorrect. 10. ANS: D a. Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X. 11. ANS: B a. Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them. 12. ANS: A a. A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis. 13. ANS: A a. Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis. 14. ANS: B a. The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time. 15. ANS: B a. Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route. The other options are incorrect. 16. ANS: A a. Orally administered soy may interfere with thyroid hormone absorption, so concurrent use must be avoided. The other options are incorrect. 17. ANS: B a. Oxytocin is used to induce labor at or near full-term gestation and to enhance labor when uterine contractions are weak and ineffective. 18. ANS: C a. Megestrol can cause appetite stimulation and weight gain, and therefore is used in the management of anorexia, cachexia, or unexplained substantial weight loss in patients with acquired immunodeficiency syndrome (AIDS) and in patients with cancer. The other options are incorrect. 19. ANS: A, C, E a. Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives. 20. ANS: C a. Studies performed as part of the Women's Health Initiative have indicated that because of a high incidence of cardiovascular problems, estrogen therapy is not considered the first choice for osteoporosis prevention. 21. ANS: C a. Multiple births are a possible consequence of treatment for infertility with ovulation-inducing drugs. CH 35 Questions 1. A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, “Why am I getting a patch? Can’t I just take a pill?” Which response by the nurse is correct? a. “The patch reduces the incidence of side effects.” b. “If you don’t take the patch, you will have to have injections instead.” c. “The patch allows for better absorption of the medication.” d. “You will only have to change the patch weekly.” 2. When a male patient is receiving androgen therapy, the nurse will monitor for signs of excessive androgens such as: a. fluid retention. b. Dehydration. c. Restlessness. d. visual changes. 3. A patient is receiving finasteride (Proscar) for treatment of benign prostatic hyperplasia. The nurse will tell him that a possible effect of this medication is: a. Alopecia. b. increased hair growth. c. urinary retention. d. increased prostate size. 4. The nurse notes in a female patient’s history that she has an order for the androgen methyltestosterone (Android). Based on this finding, the nurse interprets that the patient has which disorder? a. Fibrocystic breast disease b. Hereditary angioedema c. Hypertension d. Inoperable breast cancer 5. A 21-year-old male athlete admits to using androgenic steroids. The nurse tells him that which of these is a possible adverse effect of these drugs? a. Liver damage b. Renal failure c. Heart failure d. Stevens-Johnson syndrome 6. During the administration of finasteride (Proscar), the nurse must remember which important precaution? a. It must be taken on an empty stomach. b. It must not be handled by pregnant women. c. It is given by deep intramuscular injection to avoid tissue irritation. d. The patient needs to be warned that alopecia is a common adverse effect. 7. A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil 8. The nurse is reviewing the medication list of a patient who will be starting androgen therapy. Which drug classes, if taken with androgens, may have an interaction with them? a. Oral anticoagulants b. Nitrates c. Beta blockers d. Proton pump inhibitors 9. A 63-year-old male patient is scheduled for a physical examination, and he tells the nurse that he wants to start taking a vitamin formula that includes saw palmetto for prostate health. Which is the nurse’s best response? a. “I’ve heard many good things about saw palmetto.” b. “It’s not a good idea to start herbal therapy at your age.” c. “There are very few adverse effects with saw palmetto therapy.” d. “The doctor will need to draw some blood and do a digital rectal exam first.” 10. The nurse notes in a patient’s medication history that the patient is taking the synthetic androgen danazol (Danocrine). Indications for danazol include which conditions? (Select all that apply.) a. Endometriosis b. Decreased sexual libido c. Postpartum breast engorgement d. Fibrocystic breast disease in women e. Hereditary angioedema f. Metastatic breast cancer 11. The nurse is instructing a male patient about application of transdermal testosterone gel (AndroGel). Which body location is preferred for this medication? (Select all that apply.) a. Back b. Chest c. Thigh d. Scrotum e. Abdomen f. Upper arms CH 35 Answers 1. ANS: C a. The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily. 2. ANS: A a. Fluid retention is an undesirable effect of androgens. The other options are incorrect. 3. ANS: B a. Finasteride is given to reduce prostate size in men with benign prostatic hyperplasia. It has been noted that men taking this medication experience increased hair growth. The other options are incorrect. 4. ANS: D a. Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are incorrect. 5. ANS: A a. Peliosis of the liver, the formation of blood-filled cavities, is a potential effect of androgenic anabolic steroid therapy and may be life threatening. Other serious hepatic effects are hepatic neoplasms (liver cancer), cholestatic hepatitis, jaundice, and abnormal liver function. The other options are incorrect. 6. ANS: B a. Finasteride must not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals. The other options are incorrect. 7. ANS: B a. In patients with pre-existing cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. The other options are incorrect. 8. ANS: A a. Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. The other options are incorrect. 9. ANS: D a. A prostatic-specific antigen test and digital rectal examination needs to be performed before initiation of treatment with saw palmetto for benign prostatic hyperplasia. Adverse effects may include gastrointestinal upset, headache, back pain, and dysuria. 10. ANS: A, D, E a. Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease. The other options are incorrect. 11. ANS: A, C, E, F a. AndroGel is applied to the skin of the back, abdomen, upper arms, or thighs. Testoderm patches are applied to the scrotal skin. CH 36 Questions 1. When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action? a. Causing depression of the central nervous system b. Anesthetizing the stretch receptors c. Having direct action on the cough center d. Decreasing the viscosity of the bronchial secretions 2. During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? a. Constipation b. Abdominal cramps c. Drowsiness d. Decreased libido 3. A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants? a. Immediate onset b. A more potent effect c. Lack of rebound congestion d. Shorter duration 4. A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? a. Force fluids to help loosen and liquefy secretions. b. Report clear-colored sputum to the prescriber. c. Avoid driving a car or operating heavy machinery because of the sedating effects. d. Report symptoms that last longer than 2 days. 5. The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? a. Heartburn b. Bradycardia c. Drowsiness d. Palpitations 6. A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? a. Guaifenesin (Humibid) b. Benzonatate (Tessalon Perles) c. Diphenhydramine (Benadryl) d. Dextromethorphan (Robitussin DM) 7. A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? a. “You won’t see effects for at least 1 week.” b. “Limit use of this spray to 3 to 5 days.” c. “Continue the spray until nasal stuffiness has resolved.” d. “Avoid use of this spray if a fever develops.” 8. A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? a. Memory enhancement b. Boosting the immune system c. Improving mood d. Promoting relaxation 9. When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.) a. “Antihistamines are generally safe to take with over-the-counter medications.” b. “Take the medication on an empty stomach to maximize absorption of the drug.” c. “Take the medication with food to minimize gastrointestinal distress.” d. “Drink extra fluids if possible.” e. “Antihistamines may cause restlessness and disturbed sleep.” f. “Avoid activities that require alertness until you know how adverse effects are tolerated.” 10. A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal? (Select all that apply.) a. Taking a proton-pump inhibitor b. Nasal congestion c. Hypothyroidism d. Hypertension e. Sinus infections f. Pregnancy 11. The nurse is reviewing the use of antitussive drugs. Antitussive drugs would be most appropriate for which patient? a. A patient who has pneumonia with a productive cough b. A patient who has a tracheostomy and thick mucus secretions c. A patient who has had a productive cough for 2 weeks d. A patient who has developed bronchitis 2 days after abdominal surgery CH 36 Answers 1. ANS: C a. Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect 2. ANS: C a. Drowsiness is usually the chief complaint of people who take antihistamines. 3. ANS: C a. Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms. 4. ANS: A a. Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient must also report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery. 5. ANS: D a. Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect. 6. ANS: A a. Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect. 7. ANS: B a. Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect. 8. ANS: B a. Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect. 9. ANS: C, D, F a. Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines. 10. ANS: A, D, F a. Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies. 11. ANS: D a. Although most of the time coughing is a beneficial response, there are times when it is not useful and may even be harmful (e.g., after a surgical procedure such as hernia repair or in cases of nonproductive, or dry, cough). Coughing would be beneficial in the other three situations. CH 37 Questions 1. A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? a. Increased sputum production b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing 2. A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives? a. Diarrhea b. Palpitations c. Bradycardia d. Drowsiness 3. A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent) 4. The prescriber has changed the patient’s medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? a. The proper technique for inhalation must be followed. b. The patient needs to keep it close by at all times to treat acute asthma attacks. c. It needs to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued 5. After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse’s best response? a. “This is an expected adverse effect. Let me take your pulse.” b. “The next scheduled nebulizer treatment will be skipped.” c. “I will notify the physician about this adverse effect.” d. “We will hold the treatment for 24 hours.” 6. A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? a. “Take the corticosteroid inhaler first.” b. “Take the bronchodilator inhaler first.” c. “Take these two drugs at least 2 hours apart.” d. “It does not matter which inhaler you use first.” 7. When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? a. Fatigue and depression b. Anxiety and palpitations c. Headache and rapid heart rate d. Oral candidiasis and dry mouth 8. The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be: a. below the therapeutic level. b. at a therapeutic level. c. above the therapeutic level. d. at a toxic level. 9. When evaluating a patient’s use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? a. Notify the doctor that the patient is unable to use the MDI. b. Obtain an order for a peak flow meter. c. Obtain an order for a spacer device. d. Ask the prescriber if the medication can be given orally. 10. The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? a. It is indicated for the treatment of acute bronchospasms. b. It needs to be used with a spacer for best results. c. Patients need to avoid drinking water for 1 hour after taking this drug. d. It is used for the prevention of bronchospasms. 11. The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) a. Salmeterol (Serevent) inhaler b. Albuterol (Proventil) nebulizer solution c. Epinephrine d. Montelukast (Singulair) e. Fluticasone (Flovent) Rotadisk inhaler 12. The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) a. “I will rinse my mouth with water after using the inhaler and then spit out the water.” b. “I will gargle after using the inhaler and then swallow.” c. “I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling.” d. “I will use this inhaler for asthma attacks.” e. “I will continue to use this inhaler, even if I am feeling better.” f. “I will use a peak flow meter to measure my response to therapy.” 13. A patient has a new order for an ipratropium (Atrovent) inhaler, an anticholinergic drug. The nurse knows to assess for an allergy to which food before giving this drug? a. Shellfish b. Soy products c. Peanuts d. Eggs 14. A patient has a metered-dose inhaler that contains 200 actuations (puffs), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, how many days will this inhaler last at the prescribed dose? CH 37 Answers 1. ANS: D a. The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect. 2. ANS: B a. The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects. 3. ANS: B a. The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation. 4. ANS: C a. These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally. 5. ANS: A a. Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses. 6. ANS: B a. An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug. 7. ANS: D a. Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect. 8. ANS: C a. Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL. 9. ANS: C a. The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions. 10. ANS: D a. Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect. 11. ANS: B, C a. Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis. 12. ANS: B, D a. The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient’s response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better. 13. ANS: C a. There have been reported cases of severe anaphylactic reactions to ipratropium inhalers in patients with allergies to peanuts, and such use must be avoided. 14. ANS: 50 days a. Note the number of doses in the canister, and then calculate the number of days that the canister will last. For this question, assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50; that is, the inhaler will last approximately 50 day