Which type of therapy will the nurse anticipate administering to a patient who has newly diagnosed Helicobacter?

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time?a. As needed, at the first sign of nauseab. At 0700, before leaving for the airportc. At 0830, just prior to boarding the plane

d. When seated, just prior to takeoff

ANS: C
Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

The nurse is performing a medication history on a patient who has glaucoma. The patient cannot remember the name of the drug prescribed but tells the nurse that the drug causes light sensitivity. The nurse knows that the drug is among which class of medications?a. Alpha-adrenergic agonistsb. Beta-adrenergic blockersc. Cholinergic agonists

d. Cholinesterase inhibitors

ANS: A
Alpha-adrenergic agonists cause mydriasis, which increases sensitivity to light. Beta-adrenergic blockers cause miosis, which impairs vision in the dark. Cholinergic agonists and cholinesterase inhibitors may cause myopia and will impair vision in the dark.

The nurse administers proparacaine HCl (Ophthaine) drops to a patient prior to an eye examination. What sign will the nurse look for to determine when the examination can begin?a. Absence of the blink reflexb. Blurred visionc. Drying of the corneal epithelium

d. Photophobia

ANS: A
Ophthaine is a topical anesthetic for the eye and causes loss of the blink reflex. Drying of the corneal epithelium is a side effect but occurs later as a result of the loss of the blink reflex. Blurred vision and photophobia result from mydriasis and miosis.

The nurse is administering timolol (Timoptic) eye drops to a patient who has glaucoma. To prevent bradycardia, the nurse will perform which action?a. Apply pressure to the lacrimal ducts.b. Have the patient sit up after instilling the drops.c. Prepare to administer an alpha-adrenergic agonist.

d. Wait 5 minutes between drops.

ANS: A
Bradycardia is a systemic side effect of timolol. Applying pressure to the lacrimal ducts prevents the medication from being systemically absorbed and causing systemic side effects such as bradycardia

A patient has an infection of the eyelash follicles and in the gland on the eyelid margin. The nurse recognizes these symptoms as being consistent with which condition?a. Blepharitisb. Chalazionc. Endophthalmitis

d. Hordeolum

ANS: D
Hordeolum is a local infection of eyelash follicles and glands on the eyelid margin. Blepharitis is an infection of the margins of the eyelid. Chalazion is an infection of the glands of the eyelids that may produce cysts. Endophthalmitis is an infection of the structures of the inner eye.

The nurse is preparing to administer atropine sulfate drops as a mydriatic agent. Which assessment would cause the nurse to withhold the drug and notify the provider?a. Blood pressure of 140/90 mm Hgb. Heart rate of 60 beats per minutec. Respiratory rate of 12 breaths per minute

d. Temperature of 37.9° C

ANS: A
Atropine sulfate can cause systemic cardiovascular side effects such as tachycardia and hypertension. An elevated blood pressure warrants holding the drug and notifying the provider.

The nurse is preparing to administer olopatadine (Patanol) eyedrops to a patient who has allergic conjunctivitis. The patient tells the nurse that the drops have caused burning and stinging. What action will the nurse take?a. Administer the drops and reassure the patient that this is a normal side effect.b. Offer an over-the-counter eye lubricant to minimize this adverse effect.c. Request an order for antibiotic eyedrops.

d. Withhold the medication and notify the provider.

ANS: A
Burning and stinging are the most common side effects of this class of drugs but do not warrant withholding the medication. An over-the-counter lubricant is not indicated. These symptoms are not an indication of infection.

The nurse is providing teaching for a patient who will begin using tobramycin ointment (Nebcin) 0.5 inches 3 times daily. The patient currently uses pilocarpine HCl (Isopto Carpine) drops to treat glaucoma. Which statement by the patient indicates a need for further teaching?a. “I should apply the third dose of tobramycin at bedtime each day.”b. “I should instill the drops in the conjunctival sac of the lower eyelid.”c. “I should not stop the medications without consulting my provider.”

d. “I should put the ointment on first and then instill the eyedrops.”

ANS: D
Patients using both drops and ointments should instill the drops prior to applying the ointment. Ointments should be applied at bedtime if possible. Drops should be instilled into the conjunctival sac of the lower lid. Patients should always consult with their provider before discontinuing any medication.

The nurse is counseling an adolescent patient who has recurrent otitis externa and who works as a lifeguard in the summer about preventing this condition. The nurse will teach this patient toa. avoid using ear plugs while swimming.b. request a prescription for prophylactic antibiotic eardrops.c. use a hair dryer to dry the ears after swimming.

d. wear a medical alert bracelet.

ANS: C
To help prevent otitis externa, patients should be counseled to use a portable hair dryer to dry the ears after swimming. Ear plugs are recommended. Prophylactic antibiotic eardrops are not indicated. A medical alert bracelet is not necessary.

The parent of a toddler asks the nurse what can be done to prevent otitis media. What will the nurse recommend?a. Administer diphenhydramine when the child has a runny nose.b. Give phenylephrine (Neo-Synephrine Ophthalmic) to prevent congestion.c. Keep the child’s immunizations up to date.

d. Remove cerumen with carbamide peroxide (Auro Ear Drops).

ANS: C
The pneumococcal conjugate vaccine (PCV) protects children against S. pneumoniae and should be administered to all children to prevent otitis media. Antihistamines and decongestants have been shown to be ineffective in preventing otitis media. Removing cerumen helps to prevent otitis externa.

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time?a. As needed, at the first sign of nauseab. At 0700, before leaving for the airportc. At 0830, just prior to boarding the plane

d. When seated, just prior to takeoff

ANS: C
Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications?a. Antibiotics and antiemeticsb. Intravenous fluids and electrolytesc. Nonprescription antiemetics

d. Prescription antiemetics

ANS: B
Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occur. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child?a. Administering an OTC antiemetic medication such as diphenhydramineb. Giving frequent, small amounts of Pedialytec. Keeping the child NPO until vomiting subsides

d. Taking the child to the emergency department for IV fluids

ANS: B
The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient?a. “Do not drive while taking this medication.”b. “Dry mouth is a sign of toxicity with this medication.”c. “Take the medication 1 to 2 hours prior to beginning the trip.”

d. “Take 100 mg up to 6 times daily for best effect.”

ANS: A
Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.

The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patient’s health history would be of concern?a. Asthmab. Diabetesc. GERD

d. Glaucoma

ANS: D
Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.

The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are givena. in smaller doses.b. less frequently.c. with anticholinergics.

d. with antihistamines.

ANS: A
Antipsychotic medications have antiemetic properties in smaller doses.

A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time?a. Before and after the chemotherapyb. During chemotherapyc. Immediately prior to chemotherapy

d. 24 hours prior to chemotherapy

ANS: A
Cannabinoids are given prior to chemotherapy and for 24 hours after chemotherapy

A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first?a. Contact the provider to discuss a possible need for intravenous fluids.b. Contact the provider to discuss a prescription antiemetic.c. Use nonpharmacologic measures such as saltines.

d. Take over-the-counter antiemetics such as diphenhydramine.

ANS: C
Pregnant women should avoid antiemetics during the first trimester of pregnancy because of possible teratogenic effects. The nurse should recommend nonpharmacologic measures such as saltines. If this is not effective, intravenous fluids may become necessary. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect?a. Excess sedationb. Extrapyramidal symptomsc. Paralytic ileus

d. Vertigo

ANS: B
Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.

The child who is a candidate for treatment with an emetic after ingestion of a toxic substance or overdose is the child who has ingested which substance?a. Acetaminophen elixirb. Chlorine bleachc. Kerosene

d. Toilet cleanser

ANS: A
An emetic, such as Ipecac, should not be given to patients who have ingested caustic substances or petroleum distillates since regurgitation carries a risk of aspiration. Acetaminophen is not a caustic substance or a petroleum distillate. Chlorine bleach and toilet cleanser are caustic substances. Kerosene is a petroleum distillate.

The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide?a. “Do not administer ipecac without consulting a poison control center.”b. “Expect the onset of emesis to be immediate.”c. “Give ipecac with a glass of milk to increase its emetic effect.”

d. “Use ipecac fluid extract and not ipecac syrup.”

ANS: A
Ipecac should not be used for caustic substances or petroleum distillates. Ipecac should be given only after determining whether it is safe. The onset of emesis is within 15 to 30 minutes. Ipecac should not be given with milk or carbonated beverages. Ipecac syrup should be used.

A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response will the nurse give?a. “Loperamide results in many central nervous system (CNS) side effects.”b. “Loperamide has no effect on infectious diarrhea.”c. “Loperamide is taken once daily.”

d. “Loperamide may prolong the symptoms.”

ANS: D
Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than other antidiarrheals. It is taken after each loose stool.

A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administeringa. activated charcoal.b. an anticholinergic antiemetic.c. gastric lavage.

d. syrup of ipecac.

ANS: A
Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.

A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added toa. decrease abdominal cramping.b. increase intestinal motility.c. minimize nausea and vomiting.

d. provide analgesia.

ANS: A
Atropine is added to decrease abdominal cramping and intestinal motility. It does not affect nausea and vomiting or pain.

The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe diarrhea. The nurse will monitor this patient closely for which effect?a. Bradycardiab. Fluid retentionc. Nervousness and tremors

d. Respiratory depression

ANS: D
Diphenoxylate is an opium agonist and can cause respiratory depression. Children and older adults are more susceptible to this effect. It contains atropine, so it will increase heart rate. It does not contribute to fluid retention. Lomotil causes central nervous system depression and will not cause nervousness and tremors.

A patient asks the nurse the best way to prevent traveler’s diarrhea. The nurse will provide which recommendation to the patient?a. “Ask your provider for prophylactic antibiotics.”b. “Drink bottled water and eat only well-cooked meats.”c. “Eat fresh, raw fruits and vegetables.”

d. “Take loperamide (Imodium) every day.”

ANS: B
Patients traveling to areas with potential traveler’s diarrhea should be taught to drink bottled water and eat meats that are well cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide can increase exposure to pathogens by slowing motility.

An appropriate goal when teaching a patient who has diarrhea is that the patienta. will have less frequent, more formed stools.b. will not have a stool for 1 to 2 days.c. will receive adequate intravenous fluids.

d. will receive appropriate antibiotic therapy.

ANS: A
An appropriate goal is that patients will have formed less frequent stools, not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions, not goals.

A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform which action?a. Recommend increased fluids and dietary fiber.b. Request an order for a laxative as needed.c. Request an order for a stool softener.

d. Suggest discussing chronic constipation with the provider.

ANS: A
This patient is having stools that are within the normal range for frequency. Nonpharmacologic measures should be used first to help soften stools.

The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient?a. The importance of consuming adequate amounts of waterb. The need to monitor for systemic side effectsc. The onset of action of 30 to 60 minutes after administration

d. The need to use the dry form of Metamucil to prevent cramping

ANS: A
Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract. Psyllium is not digestible, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. The dry form can cause cramping.

A 50-year-old male patient reports having decreased libido and testicular atrophy. The nurse will anticipate that the provider may order which medication to treat these symptoms?a. Testosterone (Androderm)b. Finasteride (Proscar)c. Gonadotropin-releasing hormone (Gn-RH)

d. Sildenafil (Viagra)

ANS: A
Testosterone is given patients who have low testosterone, evidenced by decreased libido and testicular atrophy in adult men. Finasteride is given to treat benign prostatic hypertrophy. Gn-RH is used to inhibit testosterone production. Sildenafil is used to treat erectile dysfunction.

The nurse is teaching the parents of a boy who has inadequate pituitary function and delayed puberty about testosterone enanthate injections. Which statement by the parents indicates a need for further teaching?a. “He will need x-rays of his hands every 6 months.”b. “Injections will be given deep into his gluteal muscles.”c. “Sexual development will occur in 1–2 years.”

d. “We should report urinary tract problems immediately.”

ANS: C
It takes 3–4 years for sexual development to occur with androgen therapy for hypogonadism, so parents should be reminded of this. X-rays are needed every 6 months to assess bone age. Injections are given deep intramuscularly into gluteal muscles. Urinary tract problems can occur and should be reported.

The nurse is instructing a patient about the buccal muco-adhesive testosterone system (Striant) to treat low testosterone. What information will the nurse include when teaching this patient about this drug?a. “If the product slides out of position more than 4 h before the next dose, replace it with a new system.”b. “Place the flattened surface against the gum and hold it firmly in place for 30 seconds.”c. “The product may be swallowed after it has been in place for at least 4 h.”

d. “To remove the product, slide it upwards away from the tooth until it releases.”

ANS: A
If the product falls off within the 12-h dosing interval or falls out of position within 4 h of the next dose, it should be discarded and a new product applied. The rounded surface should be placed against the gum. The product should not be swallowed. The product should be removed by sliding downwards toward the tooth.

The nurse provides teaching to a man who will begin using an Androderm testosterone patch. Which statement by the patient indicates understanding of the teaching?a. “I may stop using Androderm when my serum testosterone is normal.”b. “I should apply this to any skin other than the scrotum or bony areas.”c. “I will apply two skin patches every morning after a shower.”

d. “My serum testosterone will continue to rise with each day of use.”

ANS: B
Androderm should be applied to any intact skin other than the scrotum or over a bony area. When the medication is withdrawn, testosterone levels will drop. The patient should apply two patches every day at 10 PM. The first day of use results in serum testosterone levels in the normal range, and serum levels do not accumulate with continued use.

A man who has been using androgen therapy tells the nurse that he and his wife wish to conceive a pregnancy. The nurse will tell this patient thata. androgen therapy will not harm the fetus.b. he will need to increase his dose of testosterone to increase his sperm count.c. it may take 3 months after cessation of androgen therapy to conceive.

d. there should be no problems conceiving while using androgen therapy.

ANS: C
Androgens cause decreased sperm counts and usually takes 3 months after cessation of therapy to return sperm counts to normal. During pregnancy, androgens can cross the placenta and cause masculinization of the fetus. Virilization can occur in those secondarily exposed to testosterone gel and may cause teratogenic effects in fetuses. Increasing the testosterone will not increase the sperm count

The nurse is teaching an adult male patient about the use of testosterone gel. Which statement by the patient indicates understanding of the teaching?a. “A decreased urinary stream is an expected side effect.”b. “I should apply the gel to my forearms every day.”c. “I will have hand and wrist x-rays every 6 months.”

d. “I will need regular evaluation of serum lipid levels.”

ANS: D
Testosterone can increase lipid levels so these should be monitored regularly. A decreased urinary stream can indicate prostatic hypertrophy and should be reported. Patients should apply the gel where it is least likely to come in contact with other people. Only prepubertal males require bone age evaluation.

The oral antiandrogen drug flutamide (Eulexin) is used to treat which condition?a. Benign prostatic hypertrophy (BPH)b. Breast cancerc. Male-pattern baldness

d. Metastatic prostate cancer

ANS: D
This antiandrogen drug is used to treat metastatic prostate cancer. It is not effective to treat other hormonally dependent diseases such as breast cancer, male-pattern baldness, or BPH.

A patient will begin taking finasteride (Propecia) to treat benign prostatic hypertrophy (BPH) and asks the nurse how long the medication will be necessary. The nurse will tell the patient that he will need to take this medication for how long?a. 6 monthsb. 12 monthsc. Indefinitely

d. Until symptoms resolve

ANS: C
Continued treatment with finasteride is recommended in order to sustain results since reversal of effect usually occurs within 1 year after cessation of the drug.

A 14-year-old male is being evaluated for delayed puberty. Which finding indicates delayed puberty in this child?a. Androgen deficiencyb. Growth hormone deficiencyc. Height of 2.5 standard deviations below the mean

d. Lack of epiphyseal closure

ANS: A
Low androgen levels indicate delayed puberty. Patients who are short and who have not developed secondary sexual characteristics may have growth hormone deficiency, normal variations in development, or delayed puberty. Growth hormone deficiency may cause short stature.

A male patient wants to begin taking tadalafil (Cialis) to treat erectile dysfunction. Which aspect of this patient’s history would be of concern?a. Angina pectorisb. Asthmac. Benign prostatic hypertrophy

d. Color blindness

ANS: A
Patient with angina usually are treated with nitrates; phosphodiesterase inhibitors such as tadalafil are contraindicated in patients taking nitrates.

A patient will begin using sildenafil citrate (Viagra) to treat erectile dysfunction. The nurse will instruct the patient to take the medicationa. daily in the morning.b. just prior to sexual activity.c. 30 min-4 h before sexual activity.

d. twice daily.

ANS: C
Sildenafil should be taken at least 30 min and less than 4 h prior to sexual activity. It is not taken daily or twice daily. If taken just prior to sexual activity, it does not have time to take effect.

A woman is taking a combination oral contraceptive and asks the nurse why progestin is necessary. The nurse will explain that progestin helps prevent pregnancy by which method?a. Altering the quantity and viscosity of cervical mucusb. Inhibiting proliferative and secretory changes in the endometriumc. Increasing motility of muscles and cilia in the fallopian tubes

d. Stimulating a surge in luteinizing hormone (LH)

ANS: A
Progestin alters the quantity and viscosity of cervical mucus, making it thick and hostile to sperm penetration. Estrogen inhibits proliferative and secretory changes in the endometrium. Progestin decreases muscle and ciliary motility and decreases the LH surge.

A woman will begin taking a combination oral contraceptive (COC) that has a higher estrogenic activity than her previous COC. When teaching this woman about the new product, the nurse will explain that she may experience which effect(s)?a. Cyclic breast changes and chloasmab. Decreased dysmenorrhea and menorrhagiac. Decreased libido

d. Weight gain and fatigue

ANS: A
Increased estrogenic activity may include side effects such as cyclic breast changes and chloasma as well as increased dysmenorrhea and menorrhagia. Increased progestin causes decreased libido, weight gain, and fatigue.

A woman who has recently begun taking a combination oral contraceptive calls the clinic to report breakthrough bleeding. The nurse willa. advise her to use a back-up method of contraception.b. counsel her to continue taking the contraceptive as prescribed.c. recommend discussing an alternative contraceptive with her provider.

d. suggest that she perform a home pregnancy test to rule out pregnancy.

ANS: B
Breakthrough bleeding is more common at the start of COC use, and there is no evidence that an episode of bleeding is associated with a decrease in the COC’s effectiveness as long as the patient continues to take the pill as prescribed. She does not need to use back-up contraception. Unless the bleeding continues and is problematic, there is no need to change products. A pregnancy test is not indicated.

A young woman who is taking Ortho-Tri-Cyclen for contraception tells the nurse that her provider has told her it will help to treat her acne. The nurse explains that this is because this product isa. high in progestin.b. low in androgenic activity.c. low in estrogen.

d. triphasic.

ANS: B
Products with low androgenic activity help to reduce acne.

The nurse is caring for a woman who will begin taking ibuprofen to treat arthritis. The woman tells the nurse that she takes Yasmin for contraception. The nurse will perform which action?a. Counsel the patient to use a back-up method of contraception while taking ibuprofen.b. Notify the provider to discuss an alternate combination oral contraceptive.c. Suggest a COX-2 inhibitor instead of ibuprofen for arthritis pain.

d. Tell the patient to use a lower dose of ibuprofen to prevent adverse effects.

ANS: B
Yasmin contains drospirenone, which is derived from spironolactone. Drospirenone can alter water and electrolyte balances in women, and women taking this product should avoid NSAIDs to avoid compounding this effect. The provider may want to consider another COC product. It does not alter fertility.

A woman who is taking a combined oral contraceptive (COC) that contains 21 days of active pills and 7 days of inert pills reports having headaches accompanying withdrawal bleeding every month. The nurse willa. counsel her to take ibuprofen to counter these side effects.b. notify her provider to discuss these adverse effects.c. recommend a Loestrin Fe product.

d. suggest she ask her provider about Mircette.

ANS: D
Mircette provides 2 inert pills and 5 pills with 10 mcg of ethinyl estradiol during the counter phase, which helps to decrease withdrawal bleeding and headaches. Loestrin counters withdrawal bleeding but does not help with headaches.

A woman who is using a NuvaRing transvaginal contraceptive product calls to report that the ring has slipped out while sleeping. The nurse will instruct the patient to rinse the ring with lukewarm water, reinsert the ring, anda. abstain from sexual intercourse for 24 h.b. replace it with a new ring as soon as possible.c. take an oral contraceptive product for 2 weeks.

d. use a back-up method of contraception for 7 days.

ANS: D
If the NuvaRing slips out, it should be rinsed off and reinserted. If it has been out longer than 3 h, the woman should be counseled to use a back-up method of contraception.

A 35-year-old woman asks the nurse about oral contraceptives. The nurse learns that the patient smokes and has a family history of venous thromboembolism (VTE). The nurse will suggest that the patienta. discuss a progestin-only oral contraceptive with her provider.b. may want to consider having a tubal ligation.c. use a transdermal contraceptive product.

d. will not be a candidate for oral contraceptive products.

ANS: A
Patients who smoke or who have an increased risk of VTE may be candidates for progestin-only products. A 35-year-old woman may still want children in the future, so recommending a tubal ligation is not indicated. Transdermal products contain estrogen and carry the same risks as COCs.

A woman comes to the clinic for a Depo-Provera injection. The nurse reviews her medical record and notes that it has been 100 days since her last injection. What action will the nurse perform?a. Administer Depo-Provera 150 mg IMb. Give Depo-Provera 300 mg IMc. Perform a pregnancy test

d. Suggest she wait until she has had a period.

ANS: C
Women should receive Depo-Provera injections every 13 weeks. Patients who are late for injections (13 weeks plus 1 day) will need to rule out pregnancy before receiving the next injection. Patients who are eligible receive 150 mg IM. It is not correct to give a higher dose.

A 45-year-old woman reports cessation of menses for the past 6 months and asks the nurse if she needs to continue using contraception. The nurse will tell hera. that she may discontinue using contraception.b. that she most likely has premature ovarian failure.c. to begin hormone therapy to prevent menopausal symptoms.

d. to continue using contraception for at least 6 more months.

ANS: D
Women should use contraception until menstruation has ceased for 1 year if they do not wish to become pregnant. Premature ovarian failure occurs when menstruation stops before age 40 years. It is not necessary to treat menopausal symptoms until they occur

A 45-year-old woman who has not had a period for 15 months reports severe hot flashes and poor sleep. The nurse reviews information about hormone replacement therapy and tells this woman that hormone therapya. is very safe and may be used freely to treat menopausal symptoms.b. may be used indefinitely to treat menopausal symptoms.c. should be used at the lowest dose possible for less than 5 years.

d. will be necessary to prevent osteoporosis caused by estrogen depletion.

ANS: C
Women should use hormone therapy at the lowest dose possible for a period of less than 5 years. It carries risks for breast cancer and cardiovascular disease and cannot be used indefinitely. Hormone therapy can help slow osteoporosis, but it does not prevent osteoporosis and is not recommended for this use.

The parent of a 16-year-old female tells the nurse that the child has not had a menstrual period in spite of having breast and pubic hair development. The nurse recognizes this as characteristic of which condition?a. Dysmenorrheab. Hypothyroidismc. Primary amenorrhea

d. Secondary amenorrhea

ANS: C
Females who have never had a period have primary amenorrhea, which is defined as no menses by age 14 without secondary sex characteristics, or no menses by age 16 with secondary sex characteristics. Dysmenorrhea refers to painful cramping with periods. Hypothyroidism can contribute to secondary amenorrhea, which is characterized by cessation of periods for at least 6 months once menses have begun.

A young woman reports not having a period for 7 months. Which test will the provider likely order first to evaluate the cause of amenorrhea in this patient?a. Pelvic ultrasoundb. Pregnancy testc. Progestational challenge test

d. Serum insulin levels

ANS: B
When secondary amenorrhea occurs, pregnancy must be ruled out prior to performing other tests. A progestational challenge test will be performed if the patient is not pregnant. If polycystic ovarian syndrome is suspected, serum insulin levels and possibly a pelvic ultrasound will be performed.

A woman is diagnosed with polycystic ovarian disease (PCOS) after being unable to conceive. Her provider has ordered metformin (Glucophage) and clomiphene citrate (Clomid). The nurse will explain that metformin is given for which purpose?a. To increase androgen levelsb. To induce ovulationc. To promote a dominant follicle

d. To regulate menstrual periods

ANS: D
Metformin decreases androgen levels, which helps to regulate periods. It does not induce ovulation but increases the possibility of ovulation by its antiandrogenic effects. Clomiphene citrate promotes a dominant follicle.

A 30-year-old woman describes having periods every 30 days, lasting 8 days, with heavy bleeding. The nurse understands that these are signs of which condition?a. Menometrorrhagiab. Menorrhagiac. Menorrhea

d. Metrorrhagia

ANS: B
Menorrhagia is defined as regular uterine bleeding lasting more than 7 days with heavy bleeding. Metrorrhagia is irregular uterine bleeding lasting more than 7 days with heavy bleeding. Menorrhea is normal uterine bleeding. Menometrorrhagia is a combination of menorrhagia and metrorrhagia.

A woman who has menorrhagia is prescribed ibuprofen, and she asks the nurse how a pain medication can decrease uterine bleeding. The nurse will explain that this is most likely explained by ibuprofen’s effects ona. estrogen levels.b. platelet aggregation.c. prostaglandin production.

d. uterine endometrium.

ANS: C
Ibuprofen blocks prostaglandin production, which decreases uterine bleeding and cramps. Ibuprofen does not affect estrogen levels. Its effects on platelet aggregation would most likely increase bleeding. It does not have effects on the uterine endometrium.

A woman who is infertile has taken 50 mg of clomiphene citrate (Clomid) from days 5 through 9 of a cycle and has not ovulated. The nurse will anticipate that the provider will perform which action?a. Begin recombinant follicle-stimulating hormone therapy.b. Increase the dose to 100 mg on days 5 through 9 of her next cycle.c. Order clomiphene citrate to be given throughout her next cycle.

d. Repeat the 50 mg of clomiphene citrate for 2 more cycles.

ANS: B
If clomiphene is unsuccessful, the provider may increase the dose by 50 mg increments for 2 cycles up to 250 mg until ovulation occurs. Recombinant FSH may be used if this fails. It is not correct to administer the drug throughout the cycle or to continue with the initial dose.

The nurse performs a history on a woman who will begin taking clomiphene citrate (Clomid) to induce ovulation. Which aspect of this patient’s history is of concern?a. Anovulationb. Dysmenorrheac. Sexually transmitted infection

d. Uterine fibroids

ANS: D
Patients with a history of uterine fibroids should not take clomiphene. Anovulation is the indication for clomiphene. Dysmenorrhea and sexually transmitted infections are not contraindications

The nurse is caring for a woman who is in early labor. The woman wants to avoid pain medications as long as possible. What will the nurse tell her?a. “I can give you a sedative-hypnotic now to help you relax.”b. “I can teach you some simple breathing exercises to help lessen discomfort.”c. “If you take fentanyl (Sublimaze) now, it will be more effective than if you wait.”

d. “You may take ibuprofen, which won’t cause drowsiness.”

ANS: B
Breathing and relaxation techniques are often used as nonpharmacologic measures to control pain during labor. Sedatives are often used to decrease maternal anxiety during false labor, latent labor, or with ruptured membranes without true labor. Fentanyl is generally not given until active labor. Ibuprofen can cause premature closure of the ductus arteriosis.

The nurse administers meperidine (Demerol) to a woman who is in early labor. Immediately after the drug is given, the woman’s labor progresses quickly, and she delivers her infant. The nurse will monitor the infant closely for which condition?a. Opioid withdrawal syndromeb. Orthostatic hypotensionc. Respiratory depression

d. Tachycardia and poor perfusion

ANS: C
Narcotic analgesics cause respiratory depression in the infant if given shortly before delivery. The nurse should monitor the infant closely and prepare to give naloxone (Narcan) if this occurs. Opioid withdrawal occurs with prolonged exposure to opioids. Orthostatic hypotension and tachycardia are not common effects.

The nurse is caring for an infant who is 2 days postpartum and notes that the infant has a poor sucking response. The nurse reviews the delivery record and will likely note that which drug was given to the mother during labor?a. Butorphanol tartrate (Stadol)b. Fentanyl (Sublimaze)c. Nalbuphine (Nubain)

d. Secobarbital (Seconal)

ANS: D
Sedative-hypnotic drugs, such as secobarbital, can cause neonatal respiratory depression, hypotonia, and a poor sucking response up to 4 days. Butorphanol tartrate, fentanyl, and nalbuphine do not have prolonged effects.

The nurse is caring for a woman who is in active labor and wants to receive a drug for severe pain immediately. Her intravenous line has just infiltrated. The nurse will perform which action?a. Administer fentanyl intramuscularly.b. Contact the provider for an order for IM meperidine (Demerol).c. Give the woman promethazine (Phenergan)

d. Request an order for hydroxyzine (Vistaril).

ANS: B
Meperidine may be given IM and is the most commonly used opioid during labor. Fentanyl is best given intravenously. Promethazine is given in combination with opioids during active labor to potentiate the analgesic action of the opioids and minimize emesis. Hydroxyzine is given for nausea.

The nurse is caring for a woman who is in labor. The woman is anxious and reports increasing nausea after receiving an opioid analgesic medication. The nurse will contact the provider and request an order for which intravenous medication?a. Hydroxyzine HCl (Vistaril)b. Pentobarbital sodium (Nembutal)c. Promethazine (Phenergan)

d. Secobarbital sodium (Seconal)

ANS: C
Phenergan is used as an adjunct to narcotic analgesics to potentiate pain relief, control anxiety, and reduce nausea. Hydroxyzine may have similar effects but is not given intravenously. Pentobarbital and secobarbital are used for anxiety only.

The nurse is preparing a woman who is in labor for a lumbar epidural and explains that she will receive a continuous infusion of epidural anesthesia. She asks what will happen if that isn’t effective. What response by the nurse is correct?a. “Increasing the amount of anesthesia will increase the risk of postdural headache.”b. “You should tell the provider, and you may receive rescue doses of anesthesia if needed.”c. “You will receive opioid analgesics if the epidural anesthesia is ineffective.”

d. “The consistent level provided by the continuous anesthesia will be sufficient.”

ANS: B
Continuous epidural anesthesia provides a consistent drug level and more effective pain relief than with intermittent epidural anesthesia. Patients may have rescue doses as needed. Postdural headache occurs with accidental puncture of the dura with epidural anesthesia

The nurse is assisting with placement of epidural anesthesia for a woman who is in labor. To help prevent maternal hypotension, which is the nurse’s initial action?a. Administer 40–80 mcg of intravenous phenylephrine.b. Infuse a bolus of 500–1000 mL of IV crystalloid solution.c. Monitor the patient’s blood pressure closely during epidural placement.

d. Turn the patient onto her left side and give a rapid bolus of crystalloid solution.

ANS: B
To decrease maternal hypotension before epidural placement, an IV bolus of 500–1000 mL of crystalloid solution is given. When hypotension develops, the woman should be turned to her left side and administered a rapid bolus of crystalloid solution. Phenylephrine is given if hypotension does not improve. Blood pressure should be monitored throughout the procedure

The nurse examines a primipara woman who has received an epidural block. The woman’s cervix has been dilated at 5 cm for an hour after having shown steady progression earlier. The nurse will notify the provider and anticipate a need fora. caesarean section.b. forceps delivery.c. intravenous oxytocin.

d. vacuum extraction.

ANS: C
Regional anesthetics may slow labor, and therefore the patient may need to be administered a drug to enhance uterine contractions. Intravenous oxytocin is given to stimulate contractions. If oxytocin is not effective, the other measures may be necessary.

The nurse is caring for a patient after the third stage of labor, and the provider orders 20 units of oxytocin to be given intramuscularly. The nurse will explain to the patient that this drug for which purpose?a. To allow the cervix to closeb. To enhance milk letdownc. To prevent uterine atony

d. To suppress lactation

ANS: C
After delivery of the infant, oxytocin is given to help the uterus stay contracted and prevent uterine atony. It may be given intravenously or intramuscularly. It does not constrict the cervix. Intranasal oxytocin may be given later to enhance letdown of breast milk. Oxytocin does not suppress lactation.

The nurse is caring for a postpartum woman who has chosen not to breastfeed her infant. She asks why she cannot use drugs to suppress lactation. Which response by the nurse is correct?a. “Hormonal drugs are not as effective as complementary therapies.”b. “Hormonal drugs cause increased constipation.”c. “Hormonal drugs increase the risk of blood clots.”

d. “Hormonal drugs promote uterine atony.”

ANS: C
Estrogenic drug therapy is less common than in the past because of the increased risk of thrombophlebitis. They are more effective than complementary drugs. They do not increase constipation or promote uterine atony.

The nurse provides teaching for a postpartal woman who will take bisacodyl tablets to help with constipation. What information will the nurse include when teaching this patient about this medication?a. “Crush the tablet if it is difficult to swallow.”b. “Store this medication in a cool, dry place.”c. “Take the tablet with a carbonated beverage.”

d. “Take with milk if gastrointestinal upset occurs.”

ANS: B
Bisacodyl tablets should be stored in a cool, dry place. They should not be crushed. It is not necessary to give with a carbonated beverage. Bisacodyl tablets should not be taken within 1–2 h of milk or antacid.

When teaching a postpartal patient about the use of mineral oil as a laxative, the nurse will explain that mineral oila. does not have serious side effects.b. is safe to take with other laxatives.c. may be taken with food.

d. should be mixed with juice or soda.

ANS: D
Mineral oil should be given with fruit juice or soda to disguise the taste. It can be aspirated, causing aspiration pneumonia—a serious side effect. It should not be taken with food and should not be taken with other laxatives.

The nurse is caring for a postpartal patient who has just delivered her first baby by caesarean section. The mother’s blood type is Rh-negative, and the infant’s blood type is Rh-positive. The provider has ordered human D immune globulin (RhoGAM). The nurse understands that this patient will needa. less than the usual RhoGAM dose.b. more than the usual RhoGAM dose.c. no RhoGAM.

d. the usual RhoGAM dose.

ANS: B
For women with abruption, previa, caesarean births, or manual placental removal, more than 15 mL of fetal-maternal hemorrhage of Rh-positive red blood cells may have occurred, necessitating an increased dose of D immune globulin.

The nurse has just administered Rho(D) immune globulin (RhoGAM) to a postpartal woman. What information will the nurse include when teaching this patient?a. “Avoid live vaccines for 3 months.”b. “There are no adverse reactions to this injection.”c. “The immune globulin does not cross into breast milk.”

d. “You will not need to have the injection with future deliveries.”

ANS: A
Patients receiving Rho(D) immune globulin should be cautioned to avoid live vaccines for 3 months. Patients can experience hypersensitivity reactions to the immune globulin, and Rho(D) immune globulin crosses into breast milk. Women will need to have the immune globulin with future deliveries if the infant is Rh-positive.

The nurse is caring for a postpartal woman and reviews the following lab results in her medical record: HBsAg-negative, rubella titer less than 1:8/1:10, Rh-negative with Rh-positive infant. Which injections will the nurse expect to be ordered?a. Hepatitis B immune globulin and MMR todayb. MMR and Rho(D) immune globulin (RhoGAM) todayc. Rho(D) immune globulin (RhoGAM) and hepatitis B immune globulin today

d. Rho(D) immune globulin (RhoGAM) today and MMR in 3 months

ANS: D
The woman needs RhoGAM today and will need an MMR since her rubella titer is low. Because it is a live vaccine, the MMR should be given in 3 months. She does not need hepatitis B immune globulin.

A woman who is 2 months pregnant tells the nurse that she has never received the MMR vaccine and has not had these diseases. She has 3-year-old and 5-year-old children who have not been immunized. The nurse will counsel the patient to perform which action?a. Delay obtaining the vaccines for her children and herself until after her baby is born.b. Have her children vaccinated now and obtain the vaccine for herself after the baby is born.c. Obtain the MMR vaccine for her children and herself when she is in her third trimester of pregnancy.

d. Obtain the MMR vaccine for her children and herself within the next few weeks.

ANS: B
Pregnant women should not receive MMR vaccine because it is a live virus and there is risk to the fetus. Her children should be vaccinated so they do not contract rubella and pass it to her.

A pregnant woman asks the nurse about whether a medication is safe to take during pregnancy. The nurse notes that the drug has a low-molecular weight. Based on this drug characteristic, the nurse understands that this druga. can cause greater gastrointestinal distress and hyperemesis.b. has reduced renal elimination resulting in toxicity.c. is more sensitive to metabolism by circulating maternal hormones.

d. will be more likely to cross the placenta and affect the fetus.

ANS: D
Low–molecular-weight drugs are more likely to cross the placental barrier. This characteristic does not contribute to increased GI distress or toxicity because of reduced renal elimination. Drugs with low-molecular weight are not more sensitive to metabolism by maternal hormones.

A woman who is 4 weeks pregnant is worried that a medication she took until 3 weeks ago may cause birth defects. The nurse will tell her thata. drugs taken in the first week of pregnancy can cause CNS defects.b. medications have increased teratogenicity during the first week of pregnancy.c. she should have an ultrasound immediately.

d. teratogenic effects are rare in the first 2 weeks of pregnancy.

ANS: D
During the first 2 weeks, the embryo is not susceptible to teratogenesis. There is no need for an ultrasound.

Which statement by the nurse is accurate regarding iron supplementation during pregnancy?a. “All women should take iron supplements throughout their pregnancy.”b. “Iron supplements are given to supply the fetus.”c. “Iron supplements usually are not necessary until the second trimester.”

d. “The greatest iron demand is in the first trimester of pregnancy.”

ANS: C
Iron supplements generally are not necessary until the second trimester when the fetus begins to store iron. Iron supplements are given to prevent maternal iron deficiency, not to supply the fetus. The greatest demand occurs in the third trimester.

A patient who has just delivered her baby asks the nurse if she needs to continue taking her iron supplement. What instruction will the nurse provide to the patient?a. “Continue taking iron for 6 more weeks.”b. “Stop taking the iron supplement now.”c. “Take the iron supplement while nursing.”

d. “Take the iron only if your hemoglobin is low.”

ANS: A
Women should continue taking an iron supplement for 6 weeks after delivery. It is not necessary to take iron for the duration of nursing

The nurse is teaching a woman who is pregnant about iron supplementation. Which statement by the woman indicates understanding of the teaching?a. “I may take the iron with an antacid to reduce gastrointestinal upset.”b. “I should drink a glass of milk with iron to increase absorption.”c. “I should take the iron supplement with a glass of orange juice.”

d. “I will stop taking the iron if my stools turn black and tarry.”

ANS: C
Orange juice helps to improve absorption. Antacids and milk interfere with absorption. Black, tarry stools are an expected side effect and do not warrant stopping the supplement.

A young woman who is contemplating pregnancy asks the nurse what she can do to get healthy in preparation for pregnancy. The nurse will recommend which dietary supplement?a. 60 mg of elemental iron per dayb. 400 mcg of folic acid per dayc. 400 IU of vitamin D per day

d. 1200 mg of calcium per day

ANS: B
Folic acid can help prevent neural tube defects. All women of childbearing age should take folic acid supplements. The other supplements may be given during pregnancy but are not recommended prior to getting pregnant.

A pregnant woman who has morning sickness asks the nurse what she can do to decrease her symptoms. The nurse will counsel her to take which action?a. Avoid fatty foods.b. Drink fluids with meals.c. Eat a large lunch and dinner.

d. Take an iron supplement in the morning.

ANS: A
Avoiding fatty foods is a nonpharmacologic measure to reduce nausea and vomiting. Patients should drink fluids between and not with meals. Taking iron in the morning is not recommended. The pregnant woman should eat small, frequent meals.

A pregnant woman asks the nurse if she must give up caffeinated coffee while pregnant. How will the nurse advise the patient?a. “Two cups of coffee can increase your risk of spontaneous abortion.”b. “Drinking fewer than 6 cups of coffee per day is not harmful.”c. “You may consume coffee freely during your third trimester.”

d. “There is evidence that caffeine is teratogenic.”

ANS: A
Two cups of coffee per day increase epinephrine and decrease intervillous blood flow with a potential for spontaneous abortion. Although an amount greater than 6–8 cups per day is likely to be toxic to the embryo, there is no evidence that caffeine is teratogenic. The risk is consistent throughout the pregnancy.

The nurse is caring for a patient who is 6–7 weeks pregnant and has moderate to severe vomiting. The provider has ordered doxylamine (Unisom) and intravenous fluids. The patient reports a history of asthma and type 2 diabetes mellitus. The nurse will hold the drug and contact the provider because doxylamine should not be given to patients whoa. are pregnant.b. are in their first trimester.c. have asthma.

d. have diabetes.

ANS: C
Doxylamine is used for nausea and vomiting during pregnancy. It should not be given to patients who have asthma. It may be given to pregnant women in their first trimester. Diabetes is not a contraindication.

A woman who is pregnant tells the nurse she has frequent heartburn in spite of eating small meals slowly; avoiding greasy, gas-forming foods; and remaining upright for 30 min after eating. The nurse will recommend which over-the-counter product?a. Alka-Seltzerb. Magaldratec. Pepcid

d. TUMS

ANS: B
If a pregnant patient does not respond to nonpharmacologic therapy, antacids are first-line therapy, and patients should choose a nonsystemic low-sodium product such as hydroxymagnesium aluminate (Magaldrate). Alka-Seltzer contains baking soda and can be harmful during pregnancy. A histamine2 receptor antagonist, such as Pepcid, may be used, but only if recommended by the provider. TUMS contain calcium, which can be constipating during pregnancy.

A pregnant woman reports having constipation and has tried dietary changes without success. What will the nurse recommend?a. Bisacodyl (Dulcolax)b. Mineral oilc. Psyllium (Metamucil)

d. Senna (Senokot)

ANS: C
Bulk-forming laxatives, like psyllium, should be tried first because they are not systemically absorbed. Bisacodyl and senna have systemic effects. Mineral oil can reduce the absorption of fat-soluble vitamins.

A woman who is in her third trimester of pregnancy asks the nurse why she cannot take ibuprofen instead of acetaminophen for headaches. The nurse will explain that NSAIDsa. will affect her fetus.b. have renal toxicity.c. induce premature labor.

d. prolong labor.

ANS: A
Ibuprofen can cause premature closure of the ductus arteriosus in the fetus if taken late in the pregnancy. Aspirin can induce premature labor and prolong labor.

A woman who is experiencing premature labor is being given betamethasone (Celestone). She asks the nurse why this drug is being given. The nurse will explain that betamethasone is given for which reason?a. It lowers her blood pressure and prevents seizures.b. It prevents closure of the ductus arteriosus.c. It prevents respiratory distress in her infant.

d. It stops her contractions.

ANS: C
The medication is given to accelerate lung maturation and lung surfactant development in the fetus in utero. It does not lower maternal blood pressure, stop maternal contractions, or prevent closure of the fetal ductus arteriosus.

The nurse is caring for a woman who is experiencing premature labor. The provider has ordered intravenous terbutaline (Brethine) to be given. The nurse will explain that this medication will have which action?a. It will decrease uterine contractions.b. It will enhance fetal lung development.c. It will increase fetal blood supply.

d. It will lower her blood pressure.

ANS: A
Terbutaline is given to relax the smooth muscle of the uterus and decrease contractions in order to stop premature labor. It does not affect fetal lung development or fetal blood supply and does not lower maternal blood pressure.

The nurse is caring for a woman who is in labor and has a blood pressure of 180/98 mm Hg with proteinuria of 400 mg/24 h. The woman is receiving magnesium sulfate. The woman becomes lethargic with slurring of her speech and decreased muscle tone. Her serum magnesium sulfate level is 11 mEq/L. The nurse recognizes which condition in this patient?a. Abruptio placentab. Hypertensive crisisc. Impending eclampsia

d. Magnesium toxicity

ANS: D
Patients receiving magnesium sulfate can develop toxicity, evidenced by lethargy, slurred speech, and decreased muscle tone. A level greater than 10 mEq/L indicates toxicity. An elevated blood pressure and proteinuria are expected findings in a patient with pre-eclampsia. Patients with eclampsia will have marked elevation of blood pressure and seizures.

The nurse is caring for a woman who is in her third trimester of pregnancy. The patient has a blood pressure of 165/95 mm Hg with proteinuria of 350 mg/24 h and has been diagnosed with preeclampsia. The nurse recognizes which conditions as risk factors for this condition?a. African American, multigravida, and 40 years of ageb. Caucasian, multifetal gestation, and preexisting hypertensionc. Maternal infection, age 19, and preexisting renal disease

d. History of preeclampsia, obesity, and surrogacy

ANS: C
Maternal infection, age younger than 19 and older than 35 years, and preexisting renal disease are all predisposing factors for preeclampsia. Additional risk factors include African American, obesity; primigravida; history of preeclampsia; multifetal gestation; family history of preeclampsia, pregestational diabetes mellitus; and preexisting hypertension, vascular, or renal disease

A woman who is experiencing preeclampsia asks what changes she has to make to her routine to minimize the risk of worsening her condition. The nurse will explain that she shoulda. lie on her right side when sleeping.b. be hospitalized for the remainder of the pregnancy.c. restrict her fluids to 1000 mL/day.

d. maintain a low stimulating environment.

ANS: D
Nonpharmacologic treatments for preeclampsia include activity reduction, lying on left side, drinking six to eight 8-ounce glasses of water a day. There is no need for hospitalization if the condition can be controlled.

Which are physiologic changes during pregnancy that affect drug absorption, metabolism, distribution, and excretion? (Select all that apply.)a. Circulating steroid hormonesb. Decreased gastrointestinal motilityc. Decreased renal perfusiond. Increased maternal circulatory blood volumee. Poor sleep and fatigue

f. Rapid respiratory rate

ANS: A, B, D
Steroid hormones, decreased GI motility, and increased blood volume all affect maternal drug effectiveness. Renal perfusion is increased during pregnancy. Poor sleep does not alter drug effectiveness. Rapid respiratory rate does not necessarily occur.

The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common?a. Type 1 diabetes mellitusb. Type 2 diabetes mellitusc. Diabetes insipidus

d. Secondary diabetes

ANS: B
Type 2 diabetes mellitus is the most common type of diabetes.

A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetesa. is generally triggered by medications.b. is not as common as type 1 diabetes.c. is often related to heredity and obesity.

d. will not require insulin therapy.

ANS: C
Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulin-dependent.

A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition?a. Diabetes mellitusb. Hypoglycemiac. Normal blood levels

d. Prediabetes

ANS: D
Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic.

The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching?a. “I may use a chosen site daily for up to a week.”b. “I should give each injection a knuckle length away from a previous injection.”c. “I will not be concerned about a raised knot under my skin from injecting insulin.”

d. “Insulin is absorbed better from subcutaneous sites on my abdomen.

ANS: C
Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdominal areas.

The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulina. by pinching up the skin and injecting straight down.b. in the abdomen only with the needle at a 90-degree angle.c. subcutaneously with the needle at a 45- to 60-degree angle.

d. using the thigh and buttocks areas exclusively.

ANS: C
In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another.

The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action?a. Administer the dose as ordered.b. Clarify the insulin type and route.c. Give the drug subcutaneously.

d. Question the insulin dose.

ANS: B
Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider.

The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route?a. Intradermalb. Intramuscularc. Intravenous

d. Subcutaneous

ANS: D
Insulin is given by the subcutaneous route. Only regular insulin may be given IV.

The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient?a. “Draw up the medications in separate syringes.”b. “Draw up the NPH insulin first.”c. “Draw up the regular insulin first.”

d. “Draw up the medications after mixing them in a vial.”

ANS: C
Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.

A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time?a. 5 min before eatingb. 15 min after eatingc. 30 min before eating

d. 10 min after eating

ANS: A
Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 min before eating.

The parent of a junior high school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parenta. that strenuous exercise is not recommended for children with diabetes.b. that the child must be monitored for hyperglycemia while exercising.c. to administer an extra dose of regular insulin prior to exercise.

d. to send a snack with the child to eat just prior to exercise.

ANS: D
Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.

A patient has administered regular insulin 30 min prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurse’s first action?a. Administer glucagon.b. Give the patient orange juice.c. Notify the kitchen to deliver the tray.

d. Perform bedside glucose testing.

ANS: B
The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates

A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 70/20. The nurse will tell the patient that use of this producta. depends on individual insulin needs.b. is useful for patient with insulin resistance.c. means less rotation of injection sites.

d. requires refrigeration at all times.

ANS: A
Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.

The patient asks the nurse about storing insulin. Which response by the nurse is correct?a. “All insulin vials must be refrigerated.”b. “Insulin will last longer if kept in the freezer.”c. “Opened vials of insulin must be discarded.”

d. “Some combination pens do not require refrigeration.”

ANS: D
Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months.

A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need toa. decrease the glucocorticoid dose.b. decrease the insulin dose.c. increase the glucocorticoid dose.

d. increase the insulin dose.

ANS: D
Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects.

Which statement by a patient who will begin using an external insulin pump indicates understanding of this device?a. “I will have an increased risk for hypoglycemia.”b. “I will leave this on when bathing or swimming.”c. “I will not need to count carbohydrates anymore.”

d. “I will still need to monitor serum glucose.”

ANS: D
Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.

A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administera. cardiopulmonary resuscitation (CPR).b. glucagon.c. insulin.

d. orange juice.

ANS: B
This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia.

A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizidea. has a longer duration of action.b. has fewer gastrointestinal side effects.c. may be taken on an as-needed basis.

d. results in less hypoglycemic potential.

ANS: A
Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics.

A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition?a. Hypoglycemiab. Hyperglycemiac. Renal failure

d. Respiratory distress

ANS: C
Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress.

A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patient’s fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agentsa. cannot be used if the patient is overweight.b. cannot be used once a patient requires insulin.c. may be used since this patient meets criteria.

d. may not be used since this patient’s fasting blood glucose is too high.

ANS: C
Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication.

The nurse is providing teaching for an adolescent who has acne vulgaris. In addition to teaching about correct administration of the prescribed medications, the nurse will instruct this patient toa. apply topical vitamin D3.b. cleanse the skin gently several times a day.c. cleanse the affected skin vigorously twice daily.

d. take supplemental vitamin A.

ANS: B
Gentle cleansing is one of the chief nonpharmacologic treatments of acne. Vigorous scrubbing should be avoided. Topical vitamin D is sometimes used to treat psoriasis

A patient reports using benzoyl peroxide 2.5% for acne but doesn’t feel that it is working. The nurse notes papules and nodules on the patient’s face, neck, and back, consistent with moderate acne vulgaris. The nurse will counsel this patient to ask the provider abouta. adding isotretinoin (Amnesteem) to the treatment regimen.b. increasing the benzoyl peroxide to a 5% solution.c. taking systemic antibiotics until symptoms improve.

d. using benzoyl peroxide 10% and a topical antibiotic.

ANS: D
Moderate acne requires a stronger concentration of benzoyl peroxide (10%) and possibly topical antibiotics. Isotretinoin is used for severe cystic acne. Systemic antibiotics are given for severe acne.

The nurse is teaching a female patient who will begin taking isotretinoin (Amnesteem) to treat severe cystic acne. Which statement by the patient indicates understanding of the teaching?a. “I may get a 3-month supply of the medication with each refill.”b. “I must abstain from intercourse while taking this drug.”c. “I should avoid strenuous exercise when I am taking this medication.”

d. “I should take a vitamin A supplement while I am taking the medication.”

ANS: C
Serious muscle damage may occur while taking this medication, so patients should avoid strenuous activity which can compound this effect. Patients must get monthly refills and must take a pregnancy test before each refill. Patients should use two reliable forms of birth control, but abstinence is not required. Vitamin A can compound the adverse effects of this medication.

A patient who has psoriasis is taking methoxsalen (Oxsoralen) to treat the condition along with receiving therapeutic ultraviolet A. The nurse notes burning and blistering of the patient’s skin. Which action will the nurse take?a. Ask the patient about any recent exposure to sunlight.b. Explain to the patient that these signs mean the treatment is working.c. Report spread of the psoriasis to the patient’s provider.

d. Tell the patient to take the methoxsalen after the ultraviolet A treatment.

ANS: A
Patients taking methoxsalen can develop burning and blistering with exposure to sunlight. These signs do not indicate efficacy of the treatment and do not mean the psoriasis is worsening. There is no indication for taking the drug after the UVA exposure.

A patient who has psoriasis will begin taking etanercept (Enbrel). The nurse will ensure that which laboratory test is performed prior to initiating treatment with this drug?a. Complete blood count (CBC) with differentialb. CD4 and T-cell countc. Serum pregnancy test

d. Tuberculin test

ANS: D
Enbrel can worsen infections, and patients taking this drug must have a tuberculin skin test prior to initiation of treatment. CBC, CD4, and T-cell counts are monitored during therapy with alefacept. A serum pregnancy test is not indicated.

The nurse assists the provider to treat a patient who has warts with cantharidin (Cantharone). After the cantharidin is applied to the warts, the nurse willa. apply gauze dressings to the warts and secure them with tape.b. cover the warts with nonporous tape when the solution dries.c. prepare to assist the provider with cryotherapy to complete the procedure.

d. treat the warts with Burrow’s soaks and apply a wet-to-dry dressing.

ANS: B
To prevent damage to the surrounding skin, the wart should be covered with nonporous tape after the application of cantharidin is allowed to dry. This procedure can be repeated in 1 to 2 weeks. Gauze dressings are porous and would allow the solution to come in contact with intact skin. Cryotherapy is a separate procedure and not done after treatment with cantharidin. Burrow’s soaks are not indicated.

A patient reports localized itching after contact with a new brand of laundry detergent. The nurse will suggest that the patient contact the provider to discuss treatment with which product?a. Calamine lotionb. Systemic glucocorticoidc. Topical diphenhydramine

d. Topical glucocorticoid

ANS: D
This patient has contact dermatitis related to contact with a chemical. Topical glucocorticoids may be used for the itching. Calamine lotion may contain diphenhydramine and is used mainly for contact with plant irritants. A topical diphenhydramine is not recommended because of an increased risk of allergic reaction to systemic diphenhydramine. Systemic glucocorticoids are used for more severe reactions.

A patient who works outdoors has frequent contact dermatitis flares secondary to exposure to plant irritants. The patient asks the nurse how to minimize these episodes. The nurse will counsel this patient to perform which action?a. Apply topical glucocorticoid medication prior to exposure.b. Cleanse the skin immediately after any contact with plants.c. Take systemic diphenhydramine (Benadryl) after being outdoors.

d. Use calamine lotion prior to working outdoors.

ANS: B
Cleansing is one of the chief methods to decrease the irritation that has been caused by contact dermatitis.

A female patient has begun using 2% minoxidil (Rogaine) to treat thinning of her hair. After several weeks of treatment, she reports minimal effectiveness but has noticed some improvement. The nurse will counsel her to perform which action?a. Continue to use the 2% minoxidil.b. Change to finasteride (Propecia).c. Discontinue the minoxidil.

d. Increase to 5% minoxidil.

ANS: A
The patient has shown some improvement, so she should keep using the product if she wants to maintain the results, since stopping treatment will result in hair loss in a few months. Finasteride and 5% minoxidil are not approved for women.

The nurse is teaching a group of adolescents about sun protection. What information will the nurse include when teaching this group?a. Effective sunscreens guard against melanoma and basal cell carcinoma.b. SPF numbers indicate UVB protection, and UVA protection is assumed for all products.c. SPF ratings are proportional to the amount of UVB radiation that they block.

d. Sunscreen products of all SPF ratings will protect for 2 hours if not exposed to moisture.

ANS: D
Sunscreen will protect about 2 hours if not exposed to moisture, such as swimming or sweating. Sunscreens do not guard against melanoma or basal cell carcinoma. UVA protection is not in all products. SPF ratings are not proportional.

An adolescent patient is preparing to take a summer job as a landscaper and asks the nurse about insect repellents and sunscreens. Which statement by the nurse is correct?a. Apply sunscreen prior to applying insect repellents containing DEET.b. Apply sunscreen containing PABA 30 minutes prior to sun exposure.c. Most sunscreens block both UVB and UVA radiation.

d. Reapply sunscreen every 2 hours if sweating occurs.

ANS: D
Sunscreen should be reapplied if exposed to moisture as through sweating. Sunscreen should be applied after using repellents containing DEET. Sunscreens with PABA should be applied at least 2 hours prior to exposure. Not all sunscreens block UVA radiation

A patient who has extensive second- and third-degree burns will use mafenide acetate (Sulfamylon) to treat the burns. What is an important aspect of care for this patient?a. Assess for fluid overload.b. Explain that this medication will decrease pain.c. Monitor the patient’s electrolytes.

d. Teach the patient how to use sterile technique at home.

ANS: C
Mafenide acetate can cause electrolyte imbalances. Fluid overload is not likely. This medication does not decrease pain. Patients should be taught to use clean technique.

A patient has second- and third-degree burns, and the nurse is applying silver sulfadiazine (Silvadene) to the burns with each dressing change. The patient reports a burning sensation. The nurse understands that this isa. a hypersensitivity reaction to the medication.b. an expected adverse reaction to the medication.c. a sign of localized tissue infection.

d. a sign of skin necrosis.

ANS: B
A common adverse reaction to silver sulfadiazine is a burning sensation. It does not indicate a hypersensitivity reaction, localized tissue infection, or skin necrosis.

The parents of an 11-year-old boy ask about growth hormone therapy for their child, who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormonea. does not affect other hormones when given.b. is available as an oral tablet to be taken once daily.c. is given after tests prove that it is necessary.

d. may be given until the child’s desired height is reached.

ANS: C
Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. It cannot be given after the epiphyses are fused.

The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor daily?a. Complete blood countb. Height and weightc. Renal function

d. Serum glucose

ANS: D
Growth hormone antagonizes insulin secretion, so serum glucose should be monitored

The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve muscle strength. What will the nurse tell the parents?a. “Growth hormone may be used to improve strength in young athletes.”b. “If the epiphyses are not fused, growth hormone may be an option.”c. “Small doses of growth hormone may be used indefinitely for this purpose.”

d. “Using growth hormone to build muscle mass is not recommended.”

ANS: D
Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar and other side effects.

Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child?a. Asthmab. Dwarfismc. Enuresis

d. Prader-Willi syndrome

ANS: D
Fatalities associated with risks of taking growth hormone with Prader-Willi syndrome have been reported, so it is contraindicated in patients with this syndrome. It is not contraindicated in patients with asthma or enuresis. Dwarfism is an indication for hormone therapy.

A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication will most likely be used to treat this child?a. Bromocriptine mesylate (Parlodel)b. Octreotide acetate (Sandostatin)c. Somatrem (Protropin)

d. Somatropin (Genotropin)

ANS: A
Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone deficiency and would make acromegaly worse

The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and secondary hypothyroidism, the nurse will expect the provider to order which drug?a. Liothyronine sodium (Cytomel)b. Liotrix (Thyrolar)c. Methimazole (Tapazole)

d. Thyrotropin (Thytropar)

ANS: D
Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Liothyronine and liotrix are thyroid replacement drugs. Methimazole is used to decrease thyroid hormone secretion

The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 min later shows no change in serum cortisol levels from prior to the dose. What is the nurse’s first action?a. Notify the provider to discuss a possible non-functioning adrenal gland.b. Recognize the need for an increased dose to treat pituitary insufficiency.c. Request an order for a second dose of corticotropin to treat cortisone deficiency.

d. Request an order to repeat the serum cortisol level in 1–2 h.

ANS: A
Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30–60 min if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30–60 min, there is no need to repeat the test in 1–2 h.

The nurse provides teaching for a patient who is receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs?a. Bruisingb. Constipationc. Myalgia

d. Nausea

ANS: A
Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are known side effects but are not serious. Myalgia is not common.

The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering which medication?a. Calcifediol (Calderol)b. Corticotropin (Acthar)c. Prednisolone (AK-Pred)

d. Vasopressin (Pitressin)

ANS: D
The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin). When there is a deficiency of ADH, sometimes caused by head trauma, patients excrete large amounts of dilute urine. ADH replacement is necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone do not prevent diuresis.

The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas. The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order fora. a different antibiotic.b. blood glucose monitoring.c. cardiac monitoring.

d. serum electrolytes.

ANS: D
Corticotropin can interact with piperacillin to cause hypokalemia, so serum electrolytes should be monitored. It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated.

The nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient?a. Blood pressure and serum potassiumb. Heart rate and serum calciumc. Lung sounds and serum magnesium

d. Urine output and serum sodium

ANS: D
Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels. Side effects and adverse reactions include hyponatremia, cephalgia, dyspepsia, diarrhea, nausea, and vomiting.

A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition?a. Cretinismb. Early menopausec. Hyperthyroidism

d. Myxedema

ANS: D
Myxedema is severe hypothyroidism characterized by this woman’s symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.

A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication?a. Levothyroxine sodium (Synthroid)b. Liothyronine (Cytomel)c. Liotrix (Thyrolar)

d. Thyroid desiccated (Armour Thyroid)

ANS: B
Liothyronine has a short t1/2 and rapid onset of action and is not recommended for maintenance therapy but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy. Liotrix is a second-line drug. Thyroid desiccated is used for hypothyroidism to reduce goiter size.

A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient?a. Decreased digoxin and decreased warfarinb. Decreased digoxin and increased warfarinc. Increased digoxin and decreased warfarin

d. Increased digoxin and increased warfarin

ANS: C
Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased.

A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor fora. hyperglycemia.b. hypoglycemia.c. hyperkalemia.

d. hypokalemia.

ANS: A
Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.

A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)?a. Fava beansb. Foods high in purinec. Grapefruit

d. Shellfish

ANS: D
Patients should be advised about the effects of iodine and its presence in foods such as shellfish. There is no need to avoid fava beans, purine, or grapefruit.

The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action?a. Assess serum glucose to evaluate possible hypoglycemia.b. Check the patient’s heart rate to assess for tachycardia.c. Perform an assessment of hydration status.

d. Take the patient’s temperature to evaluate for infection.

ANS: B
The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection.

A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels?a. Liotrix (Thyrolar)b. Propranolol (Inderal)c. Propylthiouracil (PTU)

d. Thyroid (Thyro-Tab)

ANS: C
Propylthiouracil is a potent antithyroid drug used in preparation for a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with hyperthyroidism.

A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse anticipate giving to this patient?a. Calcitoninb. Calcitriolc. Calcium

d. Vitamin D

ANS: B
Calcitriol is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is used to treat hyperparathyroidism. Calcium and vitamin D are not useful in parathyroid deficiency.

A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition?a. Acromegalyb. Adrenocortical insufficiencyc. Hypertensive crisis

d. Thyroid storm

ANS: B
Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth hormone hypersecretion. Hypertensive crisis and thyroid storm are associated with thyroid replacement

A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a dieta. high in carbohydrates.b. high in fat.c. high in protein.

d. low in potassium.

ANS: C
Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet.

A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform?a. Observe the patient for hypoglycemia.b. Monitor closely for increased urine output.c. Observe the patient for hypotension.

d. Request an order for enteric-coated aspirin.

ANS: D
Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hypoglycemia, fluid retention, and hypertension.

A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient?a. Take a laxative if constipation occurs.b. Take 60 minutes after meals and at bedtime.c. Take with at least 8 ounces of water to improve absorption.

d. Take with milk to improve effectiveness.

ANS: B
Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI secretions. Antacids should not be taken with milk or foods high in vitamin D.

A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed toa. assess the level of hydrochloric acid.b. detect H. pylori antibodies.c. measure the pH of gastric secretions.

d. test for the presence of 13CO2.

ANS: D
When H. pylori is suspected, a noninvasive test is performed by administering 13C urea, which, in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies.

A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient toa. continue the medication for 4 more weeks.b. reduce the medication dose by half.c. stop taking the medication.

d. take the medication every other day.

ANS: A
With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not indicated.

A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid), clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibioticsa. allow for less toxic dosing. c. have synergistic effects.

b. combat bacterial resistance. d. improve acid suppression.

ANS: B
The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to cause synergistic effects. Antibiotics do not affect acid production

A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid?a. Take the antacid 2 hours after taking the propantheline.b. Take the antacid along with a meal.c. Take the antacid with milk.

d. Take the antacid with the propantheline bromine.

ANS: A
Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.

Which antacid is likely to cause acid rebound?a. Aluminum hydroxideb. Calcium carbonatec. Magnesium hydroxide

d. Magnesium trisilicate

ANS: B
While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant systemic absorption

An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patient’s provider to request an order for which laboratory tests?a. Liver enzymes and serum calciumb. Liver enzymes and serum magnesiumc. Renal function tests and serum calcium

d. Renal function tests and serum magnesium

ANS: D
Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia.

The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient?a. Cimetidine (Tagamet)b. Pantoprazole (Protonix)c. Rabeprazole (Aciphex)

d. Ranitidine (Zantac)

ANS: A
Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications are used to treat Zollinger-Ellison syndrome.

A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac) 300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort. What action will the nurse take?a. Contact the provider to discuss changing to cimetidine (Tagamet).b. Notify the provider to discuss increasing the dose.c. Reassure the patient that the drug may take 1 to 2 weeks to be effective.

d. Suggest that the patient split the medication into twice daily dosing.

ANS: C
Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy. Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450 system. Three hundred milligrams is the maximum dose.

A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do?a. Contact the provider to report possible drug toxicity.b. Reassure the patient that these symptoms will stop when the drug is discontinued.c. Request an order for serum hormone levels.

d. Suggest that the patient see an endocrinologist.

ANS: B
Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug toxicity. Serum hormone levels and endocrinology evaluation are not indicated

A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient?a. Adding an over-the-counter antacid to the patient’s drug regimenb. A dual drug therapy regimenc. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)

d. Lansoprazole (Prevacid) instead of ranitidine

ANS: D
This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated. Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI) such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists

A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazolea. can be used for long-term therapy.b. does not interact with other drugs.c. has fewer medication side effects.

d. is more potent than famotidine.

ANS: D
Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for long-term treatment and has drug interactions and drug side effects, as do all other medications.

The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders toa. decrease the dose of omeprazole.b. increase the dose of digoxin.c. increase the omeprazole to 60 mg per day.

d. monitor for digoxin toxicity.

ANS: D
Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for digoxin toxicity.

A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend?a. Alka-Seltzerb. Maaloxc. Mylicon

d. Tums

ANS: C
Mylicon is a brand-name simethicone, which is an antigas agent. Maalox Gas contains simethicone, while regular Maalox does not. The other products do not contain simethicone

A patient who recently began having mild symptoms of gastroesophageal reflux disease (GERD) is reluctant to take medication. What measures will the nurse recommend to minimize this patient’s symptoms? (Select all that apply.)a. Avoiding hot, spicy foodsb. Avoiding tobacco productsc. Drinking a glass of red wine with dinnerd. Eating a snack before bedtimee. Taking ibuprofen with foodf. Using a small pillow for sleeping

g. Wearing well-fitted clothing

ANS: A, B, E
Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing fitted clothing.

A woman is diagnosed with bacterial vaginosis and will begin taking metronidazole (Flagyl). What will the nurse teach the patient about this medication?a. “Abstain from sexual intercourse while taking this medication.”b. “Do not consume alcohol while taking this drug and for 48 hours after finishing the prescription.”c. “Take this medication on an empty stomach to increase absorption.”

d. “Topical preparations are ineffective for treating bacterial vaginosis.”

ANS: B
Metronidazole can cause a disulfiram-like reaction when taken with alcohol, so patients should be cautioned against using foods or drug products that contain alcohol. There is no need to abstain from sexual intercourse. Metronidazole should be taken with food. The topical preparation is effective against bacterial vaginosis.

The nurse is teaching the parent of an 11-year-old girl about the Gardasil vaccine. What will the nurse include in teaching?a. “Gardasil is given to females and not to males.”b. “Gardasil protects against cervical dysplasia.”c. “Gardasil reduces the need for routine Pap smears.”

d. “Gardasil will be given as a single injection.”

ANS: B
Gardasil protects against human papillomavirus, which is a cause of cervical dysplasia and cancer. It is offered to both females and males. The vaccine does not decrease the need for regular cervical cancer screening. It is given in a 3-vaccine series, with the second dose in 2 months and the third dose in 6 months.

A patient is taking azithromycin to treat a chancroid infection. What nonpharmacologic measures will the nurse recommend as adjunct therapy to treat this infection?a. Apply a bacteriostatic ointment to the lesions twice daily.b. Avoid washing the lesions to prevent spread of the infection.c. Cover the lesions with gauze at all times to minimize discomfort.

d. Use compresses to remove necrotic material and clean the lesions three times daily.

ANS: D
Patients should be counseled to cleanse the lesions three times daily and to use compresses to remove necrotic material. It is not necessary to apply bacteriostatic ointment or to cover the lesions with gauze. Washing the lesions is recommended.

A woman is diagnosed with gonorrhea and asks the nurse about treatment. Which statement will the nurse include in teaching?a. “Ceftriaxone IM is prescribed.”b. “Erythromycin ointment is prescribed.”c. “IM ceftriaxone and oral azithromycin are prescribed.”

d. “Oral doxycycline is prescribed.”

ANS: C
A single dose of IM ceftriaxone and a single dose of azithromycin are prescribed for gonorrhea. The use of two drugs improves treatment efficacy and slows the development of drug resistance. Erythromycin ophthalmic ointment is used on the neonate.

A woman is diagnosed with gonorrhea and receives ceftriaxone intramuscularly in clinic and a prescription for doxycycline to be taken twice daily for 7 days. She asks the nurse why she needs to take medicine since she has had a shot. How will the nurse respond?a. “Both medications are required to fully treat the gonorrheal infection.”b. “Doxycycline helps prevent spread of gonorrhea to your sexual partners.”c. “Patients with gonorrhea are always treated for chlamydia as well.”

d. “The second medication decreases your chances of disease recurrence.”

ANS: C
Patients with gonorrhea should be treated for chlamydia empirically. Doxycycline is used to treat chlamydia. Ceftriaxone does not prevent spread of gonorrhea to sexual partners or decrease the risk of relapse.

A woman is diagnosed with herpes simplex virus (genital herpes). Which statement by the patient indicates understanding of the medication regime?a. “Antiviral drugs, it taken long enough, can cure the virus.”b. “I can take a drug that reduces the frequency of outbreaks.”c. “If I am taking antiviral medication, I cannot pass the virus on to my partner.”

d. “I can use the medications once a month to treat symptoms.”

ANS: C
Suppressive therapy reduces the frequency of genital herpes recurrences by 70% in those who have frequent recurrences. Systemic antiviral drugs can control some of the signs and symptoms of genital herpes, but these do not cure herpes. Outbreaks occur even while on antiviral medication, and transmission can occur when patients are asymptomatic. Episodic treatment, to be effective, should begin within 1 day of lesion onset or during the prodrome period, not a given week each month.

A woman with complaints of abnormal vaginal discharge, vaginal soreness, pruritus, and dysuria is diagnosed with vulvovaginal candidiasis (VVC). Which statement will the nurse include in teaching?a. “Treatment with prescription medication is lifelong.”b. “Alcohol should be avoided during treatment.”c. “Candida albicans can be readily passed between sex partners.”

d. “Over the counter cream is used to treat the condition.”

ANS: D
Over the counter or prescribed medications can be used to treat the condition; treatment is episodic. The medications do not interact with alcohol. Uncomplicated VVC is not usually acquired through sexual intercourse; thus treatment of sexual partners is not necessary.