NURS 6521 ADVANCED_PHARM_Week 10 QUESTIONS AND ANSWERS 100%

A nurse is discussing with a 58-year-old male patient the causes of 1 out of 1 points erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? Response Feedback : Vascular disease is the most common physical cause of erectile dysfunction. Atherosclerosis of the penile artery is the primary cause of erectile dysfunction in more than half of men over age 50. Men with diabetes are more prone to erectile dysfunction because of a combination of vascular disease and neuropathy. A decrease in testosterone levels is not a common cause of erectile dysfunction. Emotional stress is not a physical factor. • Question 2 A patient has acquired primary hypogonadism and has been prescribed testosterone transdermal (Androderm) patches. When educating the patient on how to administer the drug, the nurse will instruct him to 1 out of 1 points Response Feedback: The patient should place the patch on the back, abdomen, upper arms, or thighs. He should not place it on the scrotum or on bony areas such as the shoulder or the hip. The skin area should not be oily, damaged, or irritated. The patch should stay in place for 7 days before replacement. • Question 3 1 out of 1 points A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following? Response Feedback : Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider. • Question 4 A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this 1 out of 1 points patient's erectile dysfunction (ED)? Response Feedback: Testosterone is used in treating erectile dysfunction and male climacteric symptoms when these conditions are secondary to androgen deficiency. PDE5 inhibitors do not address ED secondary to androgen deficiency. Tamsulosin is used to treat BPH. • Question 5 A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of 1 out of 1 points Response Feedback : A patient who has had a myocardial infarction and is prescribed testosterone is at a significantly higher risk for hypercholesterolemia. Patients taking testosterone are also at increased risk for prostate cancer and acute urethral obstruction; however, these risks are less significant. Gynecomastia is simply a side effect of the drug. • Question 6 A patient is receiving radiotherapy for an overactive thyroid gland and asks whether her milk is safe for her baby. If her treatment cannot be discontinued, what should the nurse recommend? 1 out of 1 points Response Feedback : A breast-feeding woman who is receiving any radioactive compounds should pump her breasts during the time that breast milk is radioactive and discard the milk into a biohazard container designed for radioactive materials. Breast-feeding can resume when the drug is stopped and the breast milk contains no radioactivity. It is not the role of the nurse to recommend alternative medication. • Question 7 1 out of 1 points A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? Response Feedback: Acetaminophen is the analgesic of choice during pregnancy. • Question 8 1 out of 1 points A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is Response Feedback: Adolescents are prone to experimentation with various substances, both legal and nonlegal; assessments related to this phenomenon are important during pregnancy. Insurance coverage, exercise, and dietary habits are considered less important. • Question 9 A 20-year-old woman has been prescribed estrogen. As with all women 1 out of 1 points taking estrogen, the nurse will carefully monitor the patient for which of the following? Response Feedback : Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen. • Question 10 1 out of 1 points A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient to also Response Feedback : The patient should be encouraged to exercise and lift light weights as often as she can to increase bone density. It is also important to have adequate amounts of vitamin C in her diet, but it would not be directly related to this therapy. Drinking at least 6 to 8 oz of milk daily is a good idea, but she is already taking a calcium and vitamin D supplement. There is no identified adverse relationship between artificial sweeteners and alendronate therapy. • Question 11 A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit? 1 out of 1 points Response Feedback: It is important to assess the patient's urinary patterns in order to gauge a therapeutic effect. Changes in serum cholesterol levels, bone growth, and hemoglobin levels are not associated with finasteride therapy. • Question 12 1 out of 1 points A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure Response Feedback : If prolonged drug use is necessary and poses a risk to the woman or the fetus, the pregnant woman and the fetus need to be monitored for both therapeutic and adverse effects of drug therapy. Serum levels of the drug should be monitored to detect elevations that may lead to adverse effects and the need for dosage adjustments. The FDA would not need to be informed that the woman is receiving drug therapy. At this point, with the patient already taking the drug, it is not necessary to check the FDA category of the drug. The use of nonpharmacologic alternatives is a good idea but would not be as critical as monitoring drug levels. • Question 13 A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because 1 out of 1 points Response Feedback : Drugs may compete with the hormones of pregnancy for albumin-binding sites, which may result in a larger amount of unbound (or free) drug in circulation, leaving the drug available to cross the placental membrane and enter the fetal circulation. A drug does not enter the fetal circulation as a direct result of increases in blood volume and heart rate or the occurrence of hemodilution. • Question 14 1 out of 1 points A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy? Response Feedback : The hemodynamic changes during pregnancy, such as increased blood volume and heart rate, increase the distribution of drugs. GFR and tidal volume both typically increase during pregnancy, resulting in increased excretion rates and increased absorption of inhaled drugs, respectively. Drug metabolism is not affected by pregnancy. • Question 15 1 out of 1 points A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication Response Feedback: Oxybutynin is available as a transdermal patch and causes dry mouth approximately 60% of patients. The drug is not noted to cause palpitations or lightheadedness and it is not administered as an IM injection. • Question 16 A male patient with a medical background tells the nurse that he is not 1 out of 1 points satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse? Response Feedback : Natural testosterone undergoes a high first-pass effect and is therefore not used orally. The form of testosterone that is used orally is a synthetic androgen that is less extensively metabolized and has a longer half-life than natural testosterones. Natural testosterone does not pose a higher risk of gynecomastia. • Question 17 A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with 1 out of 1 points Response Feedback : Fetal alcohol syndrome (FAS) can be the result of a mother using alcohol during pregnancy. Microcephaly or smallness of the head is a teratogenic characteristic of FAS. A high-pitched cry is a characteristic seen in children of mothers who used clemastine (Tavist) during pregnancy. Electrolyte imbalances and thrombocytopenia would not be common findings in mothers who abuse alcohol during their pregnancy. • Question 18 A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following? 1 out of 1 points Response Feedback: In a patient receiving warfarin concomitantly with etoposide, prothrombin time can become elevated and place the patient at an increased risk of bleeding. The heart rate, drug serum levels, and liver enzymes are not affected by concomitant use of warfarin. • Question 19 1 out of 1 points A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for which of the following? Response Feedback: Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma. • Question 20 1 out of 1 points The nurse has established peripheral IV access and begun an infusion of magnesium sulfate on a 29-year-old antepartum patient who is 35 weeks pregnant. Which of the following assessment findings most likely prompted the patient's physician to order magnesium sulfate for this patient? Response Feedback : Magnesium sulfate is used frequently for treating or preventing seizures associated with pre-eclampsia, eclampsia, and pregnancy-induced hypertension. Its effectiveness in preventing seizures in eclampsia is well accepted and documented. Impaired oxygenation, changes in LOC, and ECG changes are not indications for the administration of magnesium sulfate in the pregnant patient. • Question 21 A female patient has been prescribed estrogen therapy. Which of the 1 out of 1 points following will the nurse advise the patient is a common adverse effect of estrogen therapy? Response Feedback : The nurse will advise the patient that common adverse effects include breakthrough bleeding, changes in menstrual flow, dysmenorrhea, premenstrual-like syndrome, headache, nausea and vomiting, bloating, abdominal cramps, chloasma, and photosensitivity. Migraine headaches, dizziness, and changes in libido are less common adverse effects. • Question 22 1 out of 1 points The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during Response Feedback The critical period of organogenesis, during which the major fetal organs form, is from implantation up to approximately : day 58 to 60 after conception. If drugs that cause teratogenic effects are administered during this period, major malformations of fetal organ systems may result. • Question 23 1 out of 1 points A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend Response Feedback: Tylenol, which is acetaminophen, is the only analgesic recommended for use during pregnancy. • Question 24 1 out of 1 points A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include Response Feedback : Adverse effects of oxytocin are dose related and take two forms—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia. • Question 25 A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to 1 out of 1 points Response Feedback : A teaching priority would be to tell the patient to use another form of birth control if she was taking an oral contraceptive. Fluconazole may decrease the effectiveness of oral contraceptives. Taking an antiemetic or antidiarrheal for adverse GI effects would be an appropriate instruction for this drug. The nurse should also instruct the patient to take aspirin instead of acetaminophen for relief of minor discomforts because acetaminophen has the potential to damage the liver and kidneys. Taking the drug with food is recommended if the patient experiences GI distress. All of these instructions are important, but not as important as making sure that the patient does not inadvertently become pregnant while on the medication. • Question 26 1 out of 1 points A man is prescribed ciprofloxacin to treat a sexually transmitted infection. The nurse will instruct the patient to Response Feedback : To maximize the therapeutic effects of the drug, the nurse should encourage the patient to complete the entire drug therapy as prescribed. The dosage of ciprofloxacin is not reduced gradually but taken in the same dosage throughout the treatment period, and there is no indication that it is necessary for the patient to take the drug only at home. The prescriber would be the only person who could change the form of the drug to be used, and subcutaneous injection is not an identified route of administration for ciprofloxacin. • Question 27 A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the 1 out of 1 points intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? Response Feedback: Progesterone therapy carries risks of thrombotic events and vision loss. It is not associated with fluid loss, incontinence, or cognitive changes. • Question 28 1 out of 1 points A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? Response Feedback : Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable. • Question 29 1 out of 1 points A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize? Response Feedback : The primary goal of treatment with finasteride is to facilitate complete bladder emptying, resulting in less urgency and decreased frequency of voiding. Urethral pain, sexual side effects, and hematuria are possible but less commonly associated with BPH. Consequently, outcomes relating to bladder emptying would be prioritized. • Question 30 A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient? 1 out of 1 points Response Feedback : An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10 to 12 week time span between the initiation of oral contraceptives use and the prevention of pregnancy. • Question 31 1 out of 1 points A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of Response Feedback : Patients who take ciprofloxacin should avoid taking the drug with food that contains iron, calcium, magnesium, and other cations because the presence of these elements may reduce the bioavailability of ciprofloxacin. Because the woman has a history of osteoporosis, she is very likely taking a calcium supplement. Alcohol and nicotine should be avoided while on any drug therapy. Grapefruit juice is not known to interact with ciprofloxacin. • Question 32 A nurse is assigned to a patient who is at 32 weeks' gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor. 1 out of 1 points Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus? Response Feedback : In a patient receiving terbutaline, the nurse should closely monitor the patient's pulse rate and blood pressure. In addition, to increase placental perfusion, the nurse should have the patient lie on her left side during the infusion. This will help minimize the risk for hypotension and promote circulation to the fetus. Palpitations are a common adverse effect of the drug and should be reported but are unrelated to hypotension and fetal circulation. The nurse should advise the patient to limit her fluid intake during the infusion because of possible fluid overload. However, this, too, is unrelated to hypotension and fetal circulation. • Question 33 1 out of 1 points A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Response Feedback : Adverse effects are usually uncommon with finasteride therapy. However, there is a risk of sexual dysfunction related to the use of the drug. Excess fluid volume related to potential effects of drug therapy and hypercalcemia related to drug therapy, immobility, and breast cancer are risks associated with testosterone therapy. Finasteride does not present a risk of neoplasms. • Question 34 1 out of 1 points A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as Response Feedback : Maternal adverse effects from magnesium sulfate toxicity are sweating, hypotension, flaccid paralysis, hypothermia, and cardiac depression. A serum level of 10 to 12 mg/dL is associated with toxicity (normal levels without infusion of magnesium sulfate are 1.8–3 mg/dL). Common adverse effects include headache, hyporeflexia, weakness, thirst, flushing, and burning at the infusion site. These manifestations do not indicate hypersensitivity or idiosyncratic reactions. • Question 35 A 66-year-old man has made an appointment with his primary care 1 out of 1 points provider to discuss his recent erectile dysfunction (ED) and has requested a prescription for tadalafil (Cialis) based on television commercials he has seen. What characteristic of this patient would most likely contraindicate the use of tadalafil for his ED? Response Feedback : Like the other drugs in this class, tadalafil should not be taken within 48 hours of taking nitrates, such as nitroglycerin, because substantially lower blood pressure and possibly death may result. Nitroglycerin use is a contraindication for taking tadalafil, as it is for all drugs in this class. Allopurinol, ginseng, and low bone density do not contraindicate the use of tadalafil. • Question 36 Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to 1 out of 1 points the patient and his wife, the nurse should inform the wife about which of the following adverse effects? Response Feedback : Vaginal burning, itching, or both can occur in the female partner of a man using intraurethral alprostadil. The nurse will advise the wife to be aware that this is a possibility. The pharmacodynamics of alprostadil may lead to hemodynamic changes such as low blood pressure and increased heart rate in the man. However, these changes are not clinically important and would not affect the female partner. The drug is not known to decrease sexual desire in either men or women. • Question 37 Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to 1 out of 1 points Response Feedback : To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress. • Question 38 A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? 1 out of 1 points Response Feedback : The nurse has assessed that the patient is anxious and fearful that her baby will suffer because of her drug therapy. The nurse should work with the mother to design a plan of care to help decrease the mother's anxiety. Even though the other nursing diagnoses are plausible, the most appropriate nursing diagnosis is anxiety related to perceived danger of drug therapy to fetus or infant. • Question 39 A nurse is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? 1 out of 1 points Response Feedback : When a patient is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline. • Question 40 A nurse is working in a women's hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following? 1 out of 1 points Response Feedback : The nurse will monitor the patient's blood pressure for possible hypertension. Adverse effects of bethanechol are the same as with pilocarpine, which are hypertension, tachycardia, bronchiolar spasm, pulmonary edema, salivation, sweating, and nausea and vomiting. Bradycardia and decreased salivation are not identified adverse effects. If the drug is taken with a ganglionic blocking agent, a decrease in blood pressure could result. Sunday, August 6, 2017 11:17:20 PM EDT • Question 1 1 out of 1 points A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? Response Feedback: Because a prominent anticholinergic effect is dry mouth, good oral hygiene is very important to prevent dental caries and gum disorders. Dryness may be relieved with hard candies, chewing gum, or lip gloss. Chronic diarrhea, headaches, and a special diet are not issues with this drug. • Question 2 1 out of 1 points A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient? Response Feedback : An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10 to 12 week time span between the initiation of oral contraceptives use and the prevention of pregnancy. • Question 3 1 out of 1 points A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Response Feedback: Adverse effects are usually uncommon with finasteride therapy. However, there is a risk of sexual dysfunction related to the use of the drug. Excess fluid volume related to potential effects of drug therapy and hypercalcemia related to drug therapy, immobility, and breast cancer are risks associated with testosterone therapy. Finasteride does not present a risk of neoplasms. • Question 4 1 out of 1 points Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen? Response Feedback: Pain in the groin, headaches, dizziness, and chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone. • Question 5 1 out of 1 points A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to Response Feedback : A teaching priority would be to tell the patient to use another form of birth control if she was taking an oral contraceptive. Fluconazole may decrease the effectiveness of oral contraceptives. Taking an antiemetic or antidiarrheal for adverse GI effects would be an appropriate instruction for this drug. The nurse should also instruct the patient to take aspirin instead of acetaminophen for relief of minor discomforts because acetaminophen has the potential to damage the liver and kidneys. Taking the drug with food is recommended if the patient experiences GI distress. All of these instructions are important, but not as important as making sure that the patient does not inadvertently become pregnant while on the medication. • Question 6 1 out of 1 points A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following? Response Feedback: Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen. • Question 7 1 out of 1 points After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from Response Feedback: Clomiphene is used in treating ovulatory failure in patients who want to become pregnant and have a fertile partner. Estrogen and progesterone are contraindicated in women who may become pregnant and neither drug increases the chance of conception. Mifepristone is used to end an early pregnancy. • Question 8 1 out of 1 points Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to Response Feedback : To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress. • Question 9 1 out of 1 points A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications? Response Feedback : Most anticonvulsant drugs can have a teratogenic effect on the fetus. Dilantin can cause fetal hydantoin syndrome, which is characterized by craniofacial abnormalities, limb defects, growth deficiency, and mental deficiency. Insulin is not harmful in the pregnant woman, since it cannot pass through to the placenta. Lasix is classified as a category C drug, which indicates that animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans. Advil is classified as a category B drug, which indicates that animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women during the first and second trimesters of pregnancy. Advil is, however, considered a category D drug during the third semester (there is evidence of human fetal risk). • Question 10 1 out of 1 points A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is Response Feedback: Adolescents are prone to experimentation with various substances, both legal and nonlegal; assessments related to this phenomenon are important during pregnancy. Insurance coverage, exercise, and dietary habits are considered less important. • Question 11 1 out of 1 points A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize? Response Feedback: The primary goal of treatment with finasteride is to facilitate complete bladder emptying, resulting in less urgency and decreased frequency of voiding. Urethral pain, sexual side effects, and hematuria are possible but less commonly associated with BPH. Consequently, outcomes relating to bladder emptying would be prioritized. • Question 12 1 out of 1 points A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit? Response Feedback: It is important to assess the patient's urinary patterns in order to gauge a therapeutic effect. Changes in serum cholesterol levels, bone growth, and hemoglobin levels are not associated with finasteride therapy. • Question 13 1 out of 1 points A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include Response Feedback: Adverse effects of oxytocin are dose related and take two forms—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia. • Question 14 1 out of 1 points A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug? Response Feedback: Nocturia is a characteristic symptom of BPH. Strong smelling urine that is cloudy is suggestive of a urinary tract infection. Finasteride is not used for the treatment of ED. • Question 15 1 out of 1 points A nurse is working in a women's hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following? Response Feedback : The nurse will monitor the patient's blood pressure for possible hypertension. Adverse effects of bethanechol are the same as with pilocarpine, which are hypertension, tachycardia, bronchiolar spasm, pulmonary edema, salivation, sweating, and nausea and vomiting. Bradycardia and decreased salivation are not identified adverse effects. If the drug is taken with a ganglionic blocking agent, a decrease in blood pressure could result. • Question 16 1 out of 1 points A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? Response Feedback: Testosterone is used in treating erectile dysfunction and male climacteric symptoms when these conditions are secondary to androgen deficiency. PDE5 inhibitors do not address ED secondary to androgen deficiency. Tamsulosin is used to treat BPH. • Question 17 1 out of 1 points A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with Response Feedback : Fetal alcohol syndrome (FAS) can be the result of a mother using alcohol during pregnancy. Microcephaly or smallness of the head is a teratogenic characteristic of FAS. A high-pitched cry is a characteristic seen in children of mothers who used clemastine (Tavist) during pregnancy. Electrolyte imbalances and thrombocytopenia would not be common findings in mothers who abuse alcohol during their pregnancy. • Question 18 1 out of 1 points A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following? Response Feedback : Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider. • Question 19 1 out of 1 points A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following? Response Feedback : An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high- dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug. • Question 20 1 out of 1 points A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug Response Feedback : The expected benefits of the drug are obtained only when the drug is taken first thing in the morning with a glass of water, at least 30 minutes before taking other drugs, food, or beverages. Taking the drug with coffee or juice limits its absorption. After taking the drug, the patient should remain in an upright position to facilitate drug delivery to the stomach; therefore, taking the drug at bedtime is not advisable. • Question 21 1 out of 1 points A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of Response Feedback: A patient who has had a myocardial infarction and is prescribed testosterone is at a significantly higher risk for hypercholesterolemia. Patients taking testosterone are also at increased risk for prostate cancer and acute urethral obstruction; however, these risks are less significant. Gynecomastia is simply a side effect of the drug. • Question 22 1 out of 1 points A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend Response Feedback: Tylenol, which is acetaminophen, is the only analgesic recommended for use during pregnancy. • Question 23 1 out of 1 points On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate? Response Feedback : Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis. • Question 24 1 out of 1 points A nurse is working with a patient in the clinic who has erectile dysfunction. The patient has been prescribed sildenafil (Viagra). The patient wants to do everything he can to promote effectiveness of the drug. The nurse will instruct him to Response Feedback : Maximum plasma concentrations of sildenafil are reached within 30 to 120 minutes of oral dosing when taken on an empty stomach. The most frequent peak time is 60 minutes. However, when the drug is taken with a high-fat meal, absorption is slow and 60 extra minutes are needed to reach peak plasma levels. A high-fat meal reduces peak serum concentrations by 29%. Therefore, the patient should be advised to avoid high-fat meals when ingesting the drug. Avoiding a high-protein meal or drinking fluids will not help achieve quick effects from the drug. It is not advisable to increase the dosage of the drug without consulting the prescriber. • Question 25 1 out of 1 points A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? Response Feedback : Vascular disease is the most common physical cause of erectile dysfunction. Atherosclerosis of the penile artery is the primary cause of erectile dysfunction in more than half of men over age 50. Men with diabetes are more prone to erectile dysfunction because of a combination of vascular disease and neuropathy. A decrease in testosterone levels is not a common cause of erectile dysfunction. Emotional stress is not a physical factor. • Question 26 1 out of 1 points The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during Response Feedback: The critical period of organogenesis, during which the major fetal organs form, is from implantation up to approximately day 58 to 60 after conception. If drugs that cause teratogenic effects are administered during this period, major malformations of fetal organ systems may result. • Question 27 1 out of 1 points A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because Response Feedback : Drugs may compete with the hormones of pregnancy for albumin-binding sites, which may result in a larger amount of unbound (or free) drug in circulation, leaving the drug available to cross the placental membrane and enter the fetal circulation. A drug does not enter the fetal circulation as a direct result of increases in blood volume and heart rate or the occurrence of hemodilution. • Question 28 1 out of 1 points A nurse is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? Response Feedback: When a patient is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline. • Question 29 1 out of 1 points A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m 2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? Response Feedback : Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m 2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable. • Question 30 1 out of 1 points A 66-year-old man has made an appointment with his primary care provider to discuss his recent erectile dysfunction (ED) and has requested a prescription for tadalafil (Cialis) based on television commercials he has seen. What characteristic of this patient would most likely contraindicate the use of tadalafil for his ED? Response Feedback: Like the other drugs in this class, tadalafil should not be taken within 48 hours of taking nitrates, such as nitroglycerin, because substantially lower blood pressure and possibly death may result. Nitroglycerin use is a contraindication for taking tadalafil, as it is for all drugs in this class. Allopurinol, ginseng, and low bone density do not contraindicate the use of tadalafil. • Question 31 1 out of 1 points A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication Response Feedback: Oxybutynin is available as a transdermal patch and causes dry mouth approximately 60% of patients. The drug is not noted to cause palpitations or lightheadedness and it is not administered as an IM injection. • Question 32 1 out of 1 points A patient is pregnant and is at 7 weeks' gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be Response Feedback: The best response would be to tell the patient that insulin is the drug of choice because it does not cross the placenta and reach the fetus. Hyperglycemia is not associated with low birth weight. Telling the patient's physician is also appropriate; however, the nurse can offer information that can immediately allay the patient's concern. • Question 33 1 out of 1 points A patient is receiving radiotherapy for an overactive thyroid gland and asks whether her milk is safe for her baby. If her treatment cannot be discontinued, what should the nurse recommend? Response Feedback : A breast-feeding woman who is receiving any radioactive compounds should pump her breasts during the time that breast milk is radioactive and discard the milk into a biohazard container designed for radioactive materials. Breast- feeding can resume when the drug is stopped and the breast milk contains no radioactivity. It is not the role of the nurse to recommend alternative medication. • Question 34 1 out of 1 points A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as Response Feedback : Maternal adverse effects from magnesium sulfate toxicity are sweating, hypotension, flaccid paralysis, hypothermia, and cardiac depression. A serum level of 10 to 12 mg/dL is associated with toxicity (normal levels without infusion of magnesium sulfate are 1.8–3 mg/dL). Common adverse effects include headache, hyporeflexia, weakness, thirst, flushing, and burning at the infusion site. These manifestations do not indicate hypersensitivity or idiosyncratic reactions. • Question 35 1 out of 1 points A nurse is assigned to a patient who is at 32 weeks' gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor. Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus? Response Feedback : In a patient receiving terbutaline, the nurse should closely monitor the patient's pulse rate and blood pressure. In addition, to increase placental perfusion, the nurse should have the patient lie on her left side during the infusion. This will help minimize the risk for hypotension and promote circulation to the fetus. Palpitations are a common adverse effect of the drug and should be reported but are unrelated to hypotension and fetal circulation. The nurse should advise the patient to limit her fluid intake during the infusion because of possible fluid overload. However, this, too, is unrelated to hypotension and fetal circulation. • Question 36 1 out of 1 points Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42- year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects? Response Feedback : Vaginal burning, itching, or both can occur in the female partner of a man using intraurethral alprostadil. The nurse will advise the wife to be aware that this is a possibility. The pharmacodynamics of alprostadil may lead to hemodynamic changes such as low blood pressure and increased heart rate in the man. However, these changes are not clinically important and would not affect the female partner. The drug is not known to decrease sexual desire in either men or women. • Question 37 1 out of 1 points A 29-year-old pregnant patient is extremely upset about having to take medication for a pre- existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? Response Feedback : The nurse has assessed that the patient is anxious and fearful that her baby will suffer because of her drug therapy. The nurse should work with the mother to design a plan of care to help decrease the mother's anxiety. Even though the other nursing diagnoses are plausible, the most appropriate nursing diagnosis is anxiety related to perceived danger of drug therapy to fetus or infant. • Question 38 1 out of 1 points A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy? Response Feedback: The hemodynamic changes during pregnancy, such as increased blood volume and heart rate, increase the distribution of drugs. GFR and tidal volume both typically increase during pregnancy, resulting in increased excretion rates and increased absorption of inhaled drugs, respectively. Drug metabolism is not affected by pregnancy. • Question 39 1 out of 1 points The nurse practitioner has recommended that a breast-feeding woman take her prescribed medications just before her infant takes his longest nap of the day. The woman does not understand and asks the nurse to explain. The nurse will tell the woman that the recommendation was made to Response Feedback: One of the methods used to reduce neonatal drug exposure is to schedule drug therapy just after breast-feeding or before the infant goes to sleep for several hours. A drug's half-life helps to determine when breast-feeding can begin again. Assessing the blood concentration of the drug and the drug's potential adverse effects helps to determine the safest drug possible. • Question 40 1 out of 1 points A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? Response Feedback: The anticholinergic effects of tolterodine can cause dry mouth; headaches are another common adverse effects. Tolterodine is not associated with alterations in cardiac function and it is not contraindicated with hormone therapy. Hematuria is a pathological finding that would warrant follow up. 1.A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication 2.Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42- year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects? 3.A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend 4.A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? 5. A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? 6. After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from 7.A nurse is providing patient education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid which of the following drugs? 8.Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to 9.A nurse is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? 10.A nurse is providing patient education to a 23-year-old woman who is starting the norelgestromin/ethinyl estradiol transdermal system (Ortho Evra). Because this is the patient's first time to use the birth control patch, the nurse will instruct her to apply the patch 11.A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following? 12.A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? 13.A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is 14.A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following? 15.A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common adverse effect of estrogen therapy? 16.A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include 17.A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following? 18.A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure 19.A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as 20.A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to 21.A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? 22.A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with 23.A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with 24.A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of 25.A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? 26.A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? 27.A patient is pregnant and is at 7 weeks' gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be 28.A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response