Take This Science Quiz And Learn About It

1. A patient has been admitted for an exacerbation of chronic obstructive pulmonary disease and will be receiving methylprednisolone (Solu-Medrol) 30 mg, intravenously every 4 hours. The medication is available in 40-mg/mL vials. How many mL will the nurse draw up for this dose?

40 mg : 1 mL :: 30 mg : x mL
Solve for x:
(40 X x) = (1 X 30); 40x = 30; x = 0.75, therefore x = 0.75 mL

Explanation

40 mg : 1 mL :: 30 mg : x mL
Solve for x:
(40 X x) = (1 X 30); 40x = 30; x = 0.75, therefore x = 0.75 mL

Submit

2. The patient is to receive medroxyprogesterone (Depo-Provera) 500 mg, weekly, intramuscularly, on Mondays for 4 weeks as part of palliative therapy for cancer. The medication is available in vials of 400 mg/mL. How many milliliters will the nurse draw up and administer with each injection? Round to the nearest tenth.

400 mg : 1 mL :: 500 mg : x mL
Solve for x: (400 X x) = (1 X 500); 400x = 500; x = 1.25, rounded to 1.3 mL

Explanation

400 mg : 1 mL :: 500 mg : x mL
Solve for x: (400 X x) = (1 X 500); 400x = 500; x = 1.25, rounded to 1.3 mL

Submit

3. The insulin order reads, "Check blood glucose levels before meals and at bedtime. For every 5 mg/dL over 150, give one unit of Regular Humulin insulin, subcutaneously." The patient's blood glucose level at 11:30, before lunch, was 203 mg/dL. In units, how much insulin will the nurse will give?

203 mg/dL is 53 mg/dL more than 150 mg/dL (203 – 150)
53 / 5 units = 10.6
One cannot administer “0.6” of a unit, so the answer is 10 units.

Explanation

203 mg/dL is 53 mg/dL more than 150 mg/dL (203 – 150)
53 / 5 units = 10.6
One cannot administer “0.6” of a unit, so the answer is 10 units.

Submit

4. The nurse is administering lispro insulin and should keep in mind that this insulin will start to have an effect within which time frame?

15 minutes

1 to 2 hours

80 minutes

3 to 5 hours

The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration is 3 to 5 hours.

Explanation

The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration is 3 to 5 hours.

5. The nurse is administering rapid-acting insulin. Which statement is true regarding its administration?

It should be given within 15 minutes of the patient beginning a meal.

It should be given after the meal has been completed.

It is administered once daily at the time of the midday meal.

It is taken only in the evenings with a snack before bedtime.

Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient beginning a meal. The other options are incorrect.

Explanation

Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient beginning a meal. The other options are incorrect.

6. When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). What is the nurse's best action?

Give the drug as ordered 30 minutes before breakfast.

Hold the drug and check the order with the prescriber.

Give the drug and monitor for adverse effects.

Give a reduced dose of the drug with breakfast.

There is a potential for cross allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order should be clarified.

Explanation

There is a potential for cross allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order should be clarified.

7. A 75-year-old woman with type 2 diabetes has recently been placed on glyburide, 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response?

“Take this medication in the evening, with a snack.”

“Take this medication in the morning, 30 minutes before breakfast.”

“This medication should be taken after the midday meal.”

“It does not matter what time of day you take this medication.”

The medication should be taken in the morning, 30 minutes before breakfast. When taken at that time it has a longer duration of action, causing it to release a constant amount of insulin. This may be beneficial in controlling blood glucose levels throughout the day.

Explanation

The medication should be taken in the morning, 30 minutes before breakfast. When taken at that time it has a longer duration of action, causing it to release a constant amount of insulin. This may be beneficial in controlling blood glucose levels throughout the day.

8. After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. Which laboratory test will best reflect the patient's adherence to the antidiabetic therapy over the past few months?

Hemoglobin levels

Hemoglobin A1C level

Fingerstick fasting blood glucose level

Serum insulin levels

The hemoglobin A1C level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are not correct.

Explanation

The hemoglobin A1C level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are not correct.

9. When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that the laboratory results that would indicate a therapeutic response would be a(n)

Random blood glucose level above 170 mg/dL.

Blood glucose level of less than 50 mg/dL after meals.

Fasting blood glucose level between 70 and 100 mg/dL.

Evening blood glucose level below 70 mg/dL.

A fasting blood glucose level between 70 and 100 mg/dL indicates a therapeutic response to glucose-elevating drugs. The other options are incorrect.

Explanation

A fasting blood glucose level between 70 and 100 mg/dL indicates a therapeutic response to glucose-elevating drugs. The other options are incorrect.

10. A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of lupus erythematosus. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image?

Weight loss

Weight gain

Pale skin color

Loss of hair

Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are possible body changes that may occur with long-term prednisone therapy.

Explanation

Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are possible body changes that may occur with long-term prednisone therapy.

11. A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery?

Hypotension

Delayed wound healing

Muscle weakness

Osteoporosis

Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient’s recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.

Explanation

Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient’s recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.

12. During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased

Incidence of nausea.

Tendency to bleed during menstruation.

Levels of triglycerides.

Risk for thrombosis.

Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are not correct.

Explanation

Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are not correct.

13. The nurse should instruct a patient who will be taking bisphosphonate alendronate (Fosamax) to take this medication at which time?

In the evening just before bedtime

In the morning with an 8-ounce glass of water

With the first bite of the morning meal

Between meals on an empty stomach

Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them.

Explanation

Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them.

14. When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, including

Hypothermia and seizures.

Nausea and diarrhea.

Irritability and confusion.

Fruity, acetone odor to the breath.

Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, and sweating. The other options are incorrect.

Explanation

Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, and sweating. The other options are incorrect.

15. A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. He has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, his pneumonia has resolved, but when monitoring his blood glucose levels, the nurse notices that his blood glucose level is still elevated, and he has required small amounts of sliding-scale insulin coverage. What is the best explanation for this elevation?

The antibiotics may cause an increase in glucose levels.

The corticosteroids may cause an increase in glucose levels.

His type 2 diabetes has converted to type 1.

The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin.

Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are not correct.

Explanation

Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are not correct.

16. The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route should be planned?

Oral

Intramuscular

Vaginal

Transdermal

Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route.

Explanation

Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route.

17. A woman visits a health center requesting oral contraception. Which lab test is most important for the nurse to assess before the patient begins oral contraception therapy?

Complete blood count

Urinalysis

Vaginal cultures

Pregnancy test

Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus—pregnancy category X.

Explanation

Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus—pregnancy category X.

18. When starting a patient's drug therapy with corticosteroids, the nurse is aware that some drug classes can have adverse interactions with corticosteroids, such as

Nonsteroidal antiinflammatory drugs.

Antibiotics.

Opioid analgesics.

Antidepressants.

Corticosteroids are known to increase the risk of gastrointestinal bleeding and ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs) also have the same side effects, therefore, combining corticosteroids with NSAIDs can further increase the risk of gastrointestinal complications. This is why the nurse should be aware of this adverse interaction and monitor the patient closely for any signs of bleeding or ulcers when starting corticosteroids. Antibiotics, opioid analgesics, and antidepressants do not have the same adverse interaction with corticosteroids.

Explanation

Corticosteroids are known to increase the risk of gastrointestinal bleeding and ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs) also have the same side effects, therefore, combining corticosteroids with NSAIDs can further increase the risk of gastrointestinal complications. This is why the nurse should be aware of this adverse interaction and monitor the patient closely for any signs of bleeding or ulcers when starting corticosteroids. Antibiotics, opioid analgesics, and antidepressants do not have the same adverse interaction with corticosteroids.

19. The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include?

Patients should use the injection site that is the most accessible.

During times of illness, patients should increase their insulin dosage by 25%.

When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first.

When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.

If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill. Patients should never adjust their own insulin doses!

Explanation

If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill. Patients should never adjust their own insulin doses!

20. A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. He has just become unconscious. What is the nurse's first action?

Call the lab to order a fasting blood glucose level.

Have the patient eat glucose tablets.

Have the patient consume fruit juice, a nondiet soft drink, or crackers.

Give him intravenous glucose.

Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose.

Explanation

Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose.

21. A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, "Why am I getting a patch? Can't I just take a pill?" What is the nurse's best response?

“The patch allows for blood levels to increase quickly.”

“If you don’t take the patch, you will have to have injections instead.”

“Oral forms are not absorbed well by the body. The patch allows for better absorption of the medication.”

“You will only have to wear the patch weekly.”

The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily.

Explanation

The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily.

22. The nurse is reviewing instructions for a patient with type 2 diabetes who also gives herself insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient is correct?

“I will call my doctor right away.”

“I will give myself the Regular insulin.”

“I will take an oral form of glucose.”

“I will rest until the symptoms pass.”

Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey; or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which should always be kept at hand. She should not wait for instructions from her physician nor delay taking the glucose by resting. The Regular insulin would only lower her blood glucose levels more.

Explanation

Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey; or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which should always be kept at hand. She should not wait for instructions from her physician nor delay taking the glucose by resting. The Regular insulin would only lower her blood glucose levels more.

23. When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of

Severe weight gain.

Irregular menses.

Multiple births.

Alopecia.

Multiple births are a possible consequence of treatment for infertility with ovulation-inducing drugs.

Explanation

Multiple births are a possible consequence of treatment for infertility with ovulation-inducing drugs.

24. During the administration of finasteride (Proscar), the nurse must remember which important precaution?

It must be taken on an empty stomach.

Finasteride should not be handled by pregnant women.

It is given by deep intramuscular injection to avoid tissue irritation.

The patient should be warned that alopecia is a common adverse effect.

Finasteride should not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals.

Explanation

Finasteride should not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals.

25. The nurse is preparing to administer insulin intravenously. Which statement about intravenous insulin is true?

Insulin aspart or lispro can be administered intravenously, although there must be a 50% dose reduction.

Any form of insulin can be administered intravenously at the same dose as that ordered for subcutaneous administration.

Only Regular insulin can be administered intravenously.

Insulin should never be given intravenously.

Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.

Explanation

Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.

26. When reviewing the risk factors for osteoporosis, the nurse recognizes that which of the following is considered a risk factor?

White or Asian race

African American race

History of participation in active sports

Obesity

Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis.

Explanation

Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis.

27. The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

Avoid the abdomen because absorption there is irregular.

Choose a different site at random for each injection.

Give the injection in the same area each time to promote consistent absorption.

Rotate sites within the same location for about 1 week before rotating to a new location.

Patients taking insulin injections should be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections would be rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection should be at least to 1 inch away from the previous site.

Explanation

Patients taking insulin injections should be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections would be rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection should be at least to 1 inch away from the previous site.

28. The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? The patient should

Double-up on the medication if a dose is missed.

Not be concerned about breast lumps or bumps that occur.

Report any weight gain of more than 5 pounds per week.

Take the medication on an empty stomach to enhance absorption.

Patients taking oral estrogen therapy should report weight gain of more than 5 pounds per week to a physician. The other statements are not true for estrogen replacement therapy.

Explanation

Patients taking oral estrogen therapy should report weight gain of more than 5 pounds per week to a physician. The other statements are not true for estrogen replacement therapy.

29. A female patient who lives in New York City is preparing to take a plane trip to Australia. She has been taking the SERM raloxifene (Evista). The nurse will provide which instructions to this patient?

She should stop taking the drug at least 72 hours before the trip.

She must remember to take this drug with a full glass of water each morning.

She should increase the calcium supplements that she takes with the drug.

No change in interventions is needed.

A patient taking a SERM should be informed that the drug must be discontinued 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.

Explanation

A patient taking a SERM should be informed that the drug must be discontinued 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.

30. A 73-year-old man is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate?

Significant increase in blood pressure

Significant decrease in blood pressure

Significant increase in bleeding tendencies

Reduction in the effectiveness of the sildenafil

In patients with preexisting cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lowers blood pressure substantially. The other options are not correct.

Explanation

In patients with preexisting cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lowers blood pressure substantially. The other options are not correct.

31. A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having plastic surgery. Which intervention is appropriate at this time?

She should continue to take the alendronate with water.

She should not take the alendronate until she can sit up for 30 minutes.

She can take the medication with breakfast.

She should stop taking the medication 72 hours before her surgery.

The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation.

Explanation

The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation.

32. The nurse recognizes that use of estrogen drugs is contraindicated in which of the following patients?

A patient who has atrophic vaginitis

A patient who has inoperable prostate cancer

A woman who has just given birth and wants to prevent postpartum lactation

A woman with a history of thrombophlebitis

Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation.

Explanation

Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation.

33. A patient who has type 2 diabetes is scheduled for a colonoscopy and has been NPO (nothing by mouth) since midnight. She is concerned because her medications are being held. What is the best action regarding the administration of her oral antidiabetic drugs?

Giving her half the original dose

Withholding all medications as ordered

Contacting the prescriber for further orders

Giving her the medication with a sip of water

When the diabetic patient is NPO, the prescriber should be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are not correct.

Explanation

When the diabetic patient is NPO, the prescriber should be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are not correct.

34. The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?

30 minutes before breakfast

With the first bite of each main meal

30 minutes after breakfast

Once daily at bedtime

When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.

Explanation

When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.

35. The nurse notes in the patient's medication orders that the patient is taking the tocolytic drugs terbutaline (Brethine). Based on this finding, the nurse interprets that the drug has been ordered for which problem?

Prevention of preterm labor in the 15th week of pregnancy

Prevention of preterm labor in the 22nd week of pregnancy

Stimulation of contractions in prolonged labor

Stimulation of ovulation as part of infertility treatments

Tocolytics relax uterine smooth muscles and stop the uterus from contracting.

Explanation

Tocolytics relax uterine smooth muscles and stop the uterus from contracting.

36. When a male patient is receiving androgen therapy, the nurse should monitor for signs of excessive androgens such as

Fluid retention.

Fluid volume depletion.

Restlessness.

Visual changes.

Fluid retention is an undesirable effect of androgens. The other options are incorrect.

Explanation

Fluid retention is an undesirable effect of androgens. The other options are incorrect.

37. The nurse is administering adrenal drugs to a patient. Which of the following actions is appropriate for this patient?

Administering oral drugs before meals to maximize absorption

Rinsing the oral cavity after using steroid inhalers

Administering the corticosteroids before bedtime to minimize adrenal suppression

Discontinuing the medication immediately if a weight gain of more than 5 pounds in 1 week is experienced

After the patient has used the steroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs should be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they should be discontinued by weaning, not abruptly.

Explanation

After the patient has used the steroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs should be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they should be discontinued by weaning, not abruptly.

38. A patient is receiving aminoglutethimide (Cytadren) therapy. The nurse knows that this medication is used for which condition?

Acute asthma

Addison’s disease

Chronic obstructive pulmonary disease

Cushing’s syndrome

Aminoglutethimide (Cytadren) is an adrenal steroid inhibitor that is used in the treatment of Cushing’s syndrome.

Explanation

Aminoglutethimide (Cytadren) is an adrenal steroid inhibitor that is used in the treatment of Cushing’s syndrome.

39. When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse should monitor for signs of which condition?

Dehydration

Hypokalemia

Hyponatremia

Hypoglycemia

Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia.

Explanation

Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia.

40. A patient is taking fludrocortisone for Addison's disease, and his wife is concerned about all the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse should include which information?

It may cause severe postural hypotension.

It should be taken with food or milk to minimize gastrointestinal upset.

The medication should be stopped immediately if nausea or vomiting occurs.

Weight gain of 5 pounds or more within a week is an expected adverse effect.

Patients receiving fludrocortisone should take it with food or milk to minimize gastrointestinal upset; weight gain of more than 5 pounds a week should be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis.

Explanation

Patients receiving fludrocortisone should take it with food or milk to minimize gastrointestinal upset; weight gain of more than 5 pounds a week should be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis.

41. A 48-year-old is diagnosed with metabolic syndrome and is started on metformin (Glucophage). The purpose of the metformin, in this situation, is to

Increase the pancreatic secretion of insulin.

Decrease insulin resistance.

Increase blood glucose levels.

Decrease the pancreatic secretion of insulin.

Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.

Explanation

Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.

42. A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of the treatment for postmenopausal osteoporosis. The nurse reviews potential adverse effects with this patient, including the possible occurrence of

Pregnancy.

Breast cancer.

Stress fractures.

Venous thromboembolism.

SERMs such as raloxifene increase the risk for venous thromboembolism. Postmenopausal women taking raloxifene were no more likely to develop breast, uterine, or ovarian cancer than were women taking a placebo. The other options are not correct.

Explanation

SERMs such as raloxifene increase the risk for venous thromboembolism. Postmenopausal women taking raloxifene were no more likely to develop breast, uterine, or ovarian cancer than were women taking a placebo. The other options are not correct.

43. When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle?

Monophasic

Biphasic

Triphasic

Long-acting

The triphasic products most closely duplicate the normal hormonal levels of the female menstrual cycle.

Explanation

The triphasic products most closely duplicate the normal hormonal levels of the female menstrual cycle.

44. While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse's best response?

“Estrogen patches are still the first choice for osteoporosis prevention.”

“Estrogen patches are often used as long-term therapy for osteoporosis prevention.”

“Estrogen patches are associated with a high risk for cardiovascular problems and are not the first choice for osteoporosis prevention.”

“Estrogen patches will be prescribed if the patient prefers patches to oral medications.”

Studies performed as part of the Women’s Health Initiative have indicated that because of a high incidence of cardiovascular problems, estrogen therapy is not considered the first choice for osteoporosis prevention.

Explanation

Studies performed as part of the Women’s Health Initiative have indicated that because of a high incidence of cardiovascular problems, estrogen therapy is not considered the first choice for osteoporosis prevention.

45. The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse should question an additional order for which drug or drug class?

Glitazone

Insulin

Metformin

Sulfonylurea

Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

Explanation

Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

46. The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which condition is found upon assessment?

Osteoporosis

Steroid psychosis

Dehydration and weight loss

Water retention

Dehydration and weight loss are the result of undersecretion of adrenocortical hormones, or Addison’s disease. The other responses are possible effects of glucocorticoid excess.

Explanation

Dehydration and weight loss are the result of undersecretion of adrenocortical hormones, or Addison’s disease. The other responses are possible effects of glucocorticoid excess.

47. A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action?

Giving magnesium sulfate along with the oxytocin

Administering the medication in an intravenous bolus

Administering the medication with an IV infusion pump

Monitoring fetal heart rate and maternal vital signs every 6 hours

Oxytocin is infused via an infusion pump, not via an intravenous bolus. Magnesium sulfate is not administered with oxytocin (but should be kept at the bedside for emergency use in case of severe hypertension). And fetal heart rate and maternal vital signs should be monitored continuously.

Explanation

Oxytocin is infused via an infusion pump, not via an intravenous bolus. Magnesium sulfate is not administered with oxytocin (but should be kept at the bedside for emergency use in case of severe hypertension). And fetal heart rate and maternal vital signs should be monitored continuously.

48. A patient is receiving finasteride (Proscar) for treatment of benign prostatic hyperplasia. The nurse should tell him that a possible effect of this medication is

Alopecia.

Increased hair growth.

Urinary retention.

Increased prostate size.

Finasteride is given to reduce prostate size in men with benign prostatic hyperplasia. It has been noted that men taking this medication experience increased hair growth.

Explanation

Finasteride is given to reduce prostate size in men with benign prostatic hyperplasia. It has been noted that men taking this medication experience increased hair growth.

49. A patient is being treated for primary amenorrhea. The nurse expects which drug to be used to treat this problem?

Oxytocin (Pitocin)

Estradiol transdermal (Estraderm)

Raloxifene (Evista)

Medroxyprogesterone (Provera)

Medroxyprogesterone, a progestin, is one of the drugs most commonly used for primary amenorrhea. Primary amenorrhea is not an indication for the other drugs listed.

Explanation

Medroxyprogesterone, a progestin, is one of the drugs most commonly used for primary amenorrhea. Primary amenorrhea is not an indication for the other drugs listed.

50. A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for potential drug interactions, including

Thyroid replacement therapy.

Oral anticoagulant therapy.

Nonsteroidal antiinflammatory drugs.

Beta blockers.

Orally administered soy may interfere with thyroid hormone absorption, so concurrent use should be avoided.

Explanation

Orally administered soy may interfere with thyroid hormone absorption, so concurrent use should be avoided.

51. The nurse is instructing a male patient about application of transdermal testosterone (Testoderm) patches. What body location is preferred for this specific patch?

Scrotum

Chest

Back

Thigh

Testoderm patches are applied to the scrotal skin. Other forms (e.g., Androderm) may be applied to the back, abdomen, upper arms, or thighs.

Explanation

Testoderm patches are applied to the scrotal skin. Other forms (e.g., Androderm) may be applied to the back, abdomen, upper arms, or thighs.

52. The nurse is reviewing the medication list of a patient who will be starting androgen therapy. Which drug classes, if taken with androgens, may have an interaction with them?

Oral anticoagulants

Nonsteroidal antiinflammatory drugs

Beta-blockers

Proton pump inhibitors

Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. They can also enhance the hypoglycemic effects of oral hypoglycemic (antidiabetic) drugs. The other options are incorrect.

Explanation

Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. They can also enhance the hypoglycemic effects of oral hypoglycemic (antidiabetic) drugs. The other options are incorrect.

53. A 21-year-old male athlete admits to using androgenic steroids. The nurse tells him that a possible adverse effect of these drugs is

Peliosis of the liver.

Renal failure.

Cirrhosis of the liver.

Heart failure.

Peliosis of the liver, the formation of blood-filled cavities, is a potential effect of androgenic anabolic steroid therapy and may be life threatening.

Explanation

Peliosis of the liver, the formation of blood-filled cavities, is a potential effect of androgenic anabolic steroid therapy and may be life threatening.

54. A 63-year-old male patient is scheduled for a physical examination, and he tells the nurse that he wants to start taking a vitamin formula that includes saw palmetto for prostate health. Which is the nurse's best response?

“I’ve heard many good things about saw palmetto.”

“Your doctor will talk to you about that.”

“There are very few adverse effects with saw palmetto therapy.”

“The doctor will need to draw some blood and do a digital rectal exam first.”

A prostatic-specific antigen test and digital rectal examination should be performed before initiation of treatment with saw palmetto for benign prostatic hyperplasia. Adverse effects may include gastrointestinal upset, headache, back pain, and dysuria.

Explanation

A prostatic-specific antigen test and digital rectal examination should be performed before initiation of treatment with saw palmetto for benign prostatic hyperplasia. Adverse effects may include gastrointestinal upset, headache, back pain, and dysuria.

55. The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug?

Dizziness

Drowsiness

Dysmenorrhea

Increased appetite

Dizziness is one of the possible adverse effects of the fertility drugs. They may also cause restlessness and anorexia.

Explanation

Dizziness is one of the possible adverse effects of the fertility drugs. They may also cause restlessness and anorexia.

56. The nurse notes in a female patient's history that she has an order for the androgen methyltestosterone. Based on this finding, the nurse interprets that the patient has which disorder?

Fibrocystic breast disease

Hereditary angioedema

Hypogonadism

Inoperable breast cancer

Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are not correct.

Explanation

Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are not correct.

57. Which conditions are indications for glucocorticoid drugs? Select all that apply.

Glaucoma

Cerebral edema

Chronic obstructive pulmonary disease and asthma

Organ transplantation

Varicella

Septicemia

Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. The others are indications for glucocorticoid therapy.

Explanation

Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. The others are indications for glucocorticoid therapy.

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58. A patient taking an oral contraceptive should be aware of potential drug interactions with which medications? Select all that apply.

Cephalexin (Keflex)

Guaifenesin (Robitussin)

Warfarin (Coumadin)

Isoniazid (INH)

Ibuprofen (Motrin)

Theophylline (Uniphyl)

Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of the following drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta-blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.

Explanation

Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of the following drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta-blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.

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59. The nurse notes in a patient's medication history that the patient is taking the synthetic androgen danazol (Danocrine). Indications for danazol include which conditions? Select all that apply.

Endometriosis

Decreased sexual libido

Postpartum breast engorgement

Fibrocystic breast disease

Hereditary angioedema

Metastatic breast cancer

Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease.

Explanation

Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease.

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