Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank | Complete All Chapters ()

The nurse is caring for a 57-year-old woman who is complaining about gaining so much weight after menopause and suggests that thyroid hormone replacement would help her lose weight and speed up her metabolism. What is the nurses best response? A) Inducing a state of hyperthyroidism would result in weight loss. B) People who are not hypothyroid should not take thyroid hormones. C) People who take thyroid hormones without cause will end up damaging their heart. D) The body compensates for the extra hormone by reducing the amount secreted. Ans: D Feedback: Taking thyroid hormone with normal thyroid function results in disruption of the hypothalamicpituitarythyroid control resulting in decreased production of thyrotropinreleasing hormone (TRH) and thyroid-stimulating hormone (TSH) as the hypothalamus and pituitary sensed the rising levels of thyroid hormone. Because the thyroid was no longer stimulated to produce and secrete thyroid hormone, thyroid levels would actually fall. This would put the patient at greater risk of gaining weight. There is no evidence it would cause heart damage. Because thyroid hormone production is reduced, a state of hyperthyroidism is not induced. Even though the statement that people who are not hypothyroid should not take thyroid hormones is correct, it does not provide enough information to dissuade this patient from a dangerous practice. 24. The patient is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this patient? Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank A) Propylthiouracil Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank B) Radioactive iodine C) Alendronate D) Methimazole Ans: A Feedback: If an antithyroid drug is essential during pregnancy, propylthiouracil (PTU) is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus. Radioactive agents should not be used. Bisphosphonates should be used during pregnancy only if the benefit to the mother clearly outweighs the potential risk to the fetus. Methimazole is an antithyroid medication but would not be the drug of choice for the pregnant woman. 25. The nurse is discharging a patient with a new prescription for levothyroxine. What would the nurse teach the patient to report to her health care provider? (Select all that apply.) A) Nervousness B) Insomnia C) Chest pain D) Loss of hair E) Nausea Ans: A, B, C Feedback: Report chest pain, heart palpitations, nervousness, or insomnia. These adverse effects result from excessive stimulation and may indicate that drug dosage or intake of other stimulants needs to be reduced. Loss of hair is usually only seen in the first few months of therapy in children; nausea need not be reported unless it is persistent or interferes with adequate caloric intake. 26. The nurse tells the patient his or her serum calcium level is elevated and the patient asks what controls calcium levels in the body. What is the nurses best response? A) Renin B) Parathyroid hormone (PTH) C) Thyroid-stimulating hormone (TSH) D) Epoetin Ans: B Feedback: Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, epoetin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion. 27. The nurse is caring for a patient diagnosed with hyperparathyroidism who asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? (Select all that apply.) A) Stimulation of osteoclasts B) Increased intestinal absorption of calcium C) Stimulation of calcitriol production D) Increased excretion of calcium from kidneys E) Decreased retention of vitamin D Ans: A, B, C Feedback: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D. 28. The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.) A) Take the drug in the morning B) Wait 60 minutes before eating breakfast. C) Take the drug with a full glass of water. D) Remain upright for 30 minutes after taking the medication. E) Eat a breakfast high in calcium after taking the medication. Ans: A, C, D Feedback: Alendronate, ibandronate, and risedronate need to be taken on arising in the morning, with a full glass of water, fully 30 minutes before any other food or beverage, and the patient must then remain upright for at least 30 minutes; taking the drug with a full glass of water and remaining upright for at least 30 minutes facilitates delivery of the drug to the stomach. These drugs should not be given to anyone who is unable to remain upright for 30 minutes after taking the drug because serious esophageal erosion can occur. There is no need to eat a high-calcium breakfast, although the patient should make certain of adequate calcium intake. Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 29. The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient? A) Can you take aspirin without experiencing any bad effects? B) Are you taking theophylline to treat your asthma? C) Do you have a history of diarrhea? D) Are you taking digoxin? Ans: A Feedback: Zoledronic acid should be used cautiously in aspirin-sensitive asthmatic patients. Gastrointestinal (GI) distress may increase if bisphosphonates are combined with aspirin; this combination should, therefore, be avoided if possible. There is no drug interaction between theophylline and zoledronic acid or between digoxin and zoledronic acid. A history of diarrhea would not impact the ability to administer zoledronic acid. 30. The nurse is caring for a pediatric patient with hypercalcemia. What condition would the nurse suspect is causing this altered serum calcium level? A) Radiation injury B) Malignancy C) Kidney failure D) Hypothyroidism Ans: B Feedback: Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland and it would not be caused by kidney failure or hypothyroidism. 31. The nurse is caring for a patient who takes alendronate. What lab studies would the nurse assess regularly? A) Serum iodine B) Serum potassium C) Serum calcium D) Serum iron Ans: C Feedback: Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. Serum calcium levels need to be monitored carefully with any of the drugs that affect calcium levels. Administration of alendronate would not require monitoring of iodine, potassium, or iron levels. 32. The patient, newly prescribed cinacalcet hydrochloride (Sensipar), asks the nurse how this drug works. What is the nurses best response? A) It slows or blocks bones resorption of calcium. B) It promotes entry of calcium into bone. C) It balances the effects of parathyroid hormone to lower serum calcium levels. D) It increases the receptors sensitivity to extracellular calcium. Ans: B Feedback: Cinacalcet hydrochloride is a calcimimetic drug that increases the sensitivity of the calcium-sensing receptor to activation by extracellular calcium. In increasing the receptors sensitivity, cinacalcet lowers parathyroid hormone (PTH) levels, causing a concomitant decrease in serum calcium levels. Bisphosphonates act to slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization. Calcitonins balance the effects of PTH by reducing calcium levels. Cinacalcet does not promote entry of calcium into the bone. Chapter 20. Drugs Affecting the Reproductive System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: 1. Washing their hands after applying the gel 2. Wearing occlusive clothing while using the gel 3. Exposure to estrogens while using the gel 4. Skin-to-skin contact with pregnant women while using the gel 2. Education when prescribing androgens to male patients includes advising that: 1. Short-term use places the patient at risk for hepatocellular carcinoma. 2. Cholestatic hepatitis and jaundice may occur with low doses of androgens. 3. Gynecomastia is a rare occurrence with the use of androgens. 4. Low sperm levels only occur with long-term use of androgens. 3. Patients who are prescribed exogenous androgens need to be warned that decreased libido: 1. Is an unusual side effect of androgens and should be reported to the provider 2. Is treated with increased doses of androgens, so the patient should let the provider Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank know if he is having problems Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 3. May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam 4. May occur with androgen therapy 4. The U.S. Food and Drug Administration warns that androgens may cause: 1. Peliosis hepatis 2. Orthostatic hypotension 3. Menstrual irregularities 4. Acne 5. Monitoring for a patient who is using androgens includes evaluation of: 1. Complete blood count and C-reactive protein levels 2. Lipid levels and liver function tests 3. Serum potassium and magnesium levels 4. Urine protein and potassium levels 6. Male patients require before and during androgen therapy. 1. A digital prostate exam 2. A Doppler exam of testicular blood flow 3. Urine analysis for proteinuria 4. Serial orthostatic blood pressures 7. Absolute contraindications to estrogen therapy include: 1. History of any type of cancer 2. Clotting disorders 3. History of tension headaches 4. Orthostatic hypotension Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 8. Postmenopausal women with an intact uterus should not be prescribed: 1. Estrogen/progesterone combination 2. IM medroxyprogesterone (Depo Provera) 3. Estrogen alone 4. Androgens 9. Women who have migraines with an aura should not be prescribed estrogen because of: 1. The interaction between triptans and estrogen, limiting migraine therapy choices 2. An increased incidence of migraines with the use of estrogen 3. An increased risk of stroke occurring with estrogen use 4. Patients with migraines may be prescribed estrogen without any concerns 10. A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: 1. Counseling regarding decreasing or not smoking while taking oral contraceptives 2. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive 3. Advising that she may miss two pills in a row and not be concerned about pregnancy 4. Recommending that her next follow-up visit is in 1 year for a refill and annual exam 11. A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack. 4. If she gets nauseated with the medications she should call the office for an antiemetic prescription. 12. A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: 1. Low-dose oral estrogen 2. A low-dose estrogen/progesterone combination 3. A vaginal estradiol ring 4. Vaginal progesterone cream 13. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for: 1. Depression 2. Hypertension 3. Weight loss 4. Cataracts Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 14. When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects: 1. Hypertension and dysuria 2. Depression and weight gain 3. Abdominal pain and constipation 4. Orthostatic hypotension and dermatitis 15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson 16. Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light “period” off and on since receiving her Depo shot. What would be the management of Shana? 1. Reassurance that some spotting is normal the first few months of Depo and it should improve. 2. Schedule an appointment for an exam as this is not normal. 3. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding. 4. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot. 17. William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for before prescribing sildenafil. 1. Renal dysfunction 2. Unstable coronary artery disease 3. Benign prostatic hypertrophy 4. History of priapism 18. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: 1. Development of chest pain or dizziness 2. Weight gain 3. Priapism 4. Renal function 19. Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for: 1. Impotence when combined with antihypertensives 2. Fatal hypotension if combined with nitrates 3. Weight gain if combined with antidepressants 4. All of the above 20. Androgens are indicated for: 1. Symptomatic treatment for male deficiency 2. Female libido, endometriosis, and postmenopausal symptoms 3. Increased muscle mass 4. Symptomatic treatment in both sexes for cancer and HIV Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 5. 1, 2, and 4 Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 6. All of the above 21. Long-term use of androgens requires specific laboratory monitoring of: 1. Glucose, calcium, testosterone, and thyroid function 2. Calcium, testosterone, PSA, and liver function 3. Calcium, testosterone, PSA, liver function, glucose, and lipids 4. CBC, testosterone, PSA, and thyroid level 22. Effects of estrogen include: 1. Regulation of the menstrual cycle 2. Maintenance of bone density by increasing bone reabsorption 3. Maintenance of the normal structure of the skin and blood vessels 4. A and C 5. All of the above 23. Absolute contraindications that clinicians must consider when initiating estrogen therapy include: 1. Undiagnosed dysfunctional uterine bleeding 2. Deep vein or arterial thromboemboli within the prior year 3. Endometriosis 4. 1 and 2 5. All of the above 24. Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: 1. Nausea 2. Breakthrough bleeding 3. Breast tenderness 4. Pregnancy Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Chapter 22. Drugs Affecting the Reproductive System Answer Section MULTIPLE CHOICE 1. ANS: 4 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 1 PTS: 1 5. ANS: 2 PTS: 1 6. ANS: 1 PTS: 1 7. ANS: 2 PTS: 1 8. ANS: 3 PTS: 1 9. ANS: 3 PTS: 1 10. ANS: 1 PTS: 1 11. ANS: 3 PTS: 1 12. ANS: 3 PTS: 1 13. ANS: 1 PTS: 1 14. ANS: 2 PTS: 1 15. ANS: 3 PTS: 1 16. ANS: 1 PTS: 1 17. ANS: 2 PTS: 1 18. ANS: 1 PTS: 1 19. ANS: 2 PTS: 1 20. ANS: 5 PTS: 1 21. ANS: 3 PTS: 1 22. ANS: 4 PTS: 1 23. ANS: 4 PTS: 1 24. ANS: 2 PTS: 1 Chapter 21. Drugs Affecting the Bones and Joints MULTIPLE CHOICE 1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability. c. irritates the gastric mucosa to cause gastrointestinal upset. d. releases prostaglandins, which cause inflammation and pain in tissues. ANS: A COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins. 2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs a. exert direct actions to cause relaxation of smooth muscle. b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. c. interfere with neuronal pathways associated with prostaglandin action. d. suppress prostaglandin activity by blocking tissue receptor sites. ANS: B NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways. 3. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? a. Counsel the patient to discuss a prescription NSAID with the provider. b. Recommend adding aspirin to increase the antiinflammatory effect. c. Suggest asking the provider about a short course of corticosteroids. d. Tell the patient to increase the dose to 800 mg every 4 hours. ANS: A The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours. 4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. is an acidic compound. ANS: C Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid. 5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Nabumetone (Relafen) ANS: C Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors. 6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? a. It can result in adverse effects on her fetus. b. It causes an increased risk of Reyes syndrome. c. It increases hemorrhage risk. d. It will cause increased gastrointestinal distress. ANS: A Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution. 7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone) ANS: A Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect. 8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. A normal serum aspirin level is between 30 and 40 mg/dL. b. You may need to stop taking this drug a week prior to surgery. c. You will need to monitor aspirin levels if you are also taking warfarin. d. Your stools may become dark, but this is a harmless side effect. ANS: B Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported. 9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for tinnitus. b. Monitor the patient for signs of Reyes syndrome. c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose. ANS: A Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased. 10. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? a. I should limit sodium intake while taking this drug. b. I should take indomethacin on an empty stomach. c. I will need to check my blood pressure frequently. d. I will take the medication twice daily. ANS: B Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily. Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank 11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? a. Diclofenac sodium (Voltaren) b. Ketoprofen (Orudis) c. Ketorolac (Toradol) d. Naproxyn (Naprosyn) ANS: C Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain. 12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient? a. It may take several weeks to achieve therapeutic effects. b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen. c. Take ibuprofen twice daily for maximum analgesic benefit. d. Combine ibuprofen with acetaminophen for best effect. ANS: A OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen. 13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only. ANS: B This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling. 14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank information will the nurse include in teaching? Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank a. Do not take the medication during the first 2 days of your period. b. The initial dose will be twice the amount of subsequent doses. c. Take this medication with food to minimize gastrointestinal upset. d. Take the drug on a regular basis to prevent dysmenorrhea. ANS: B The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed. 15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium ANS: B Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation. 16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach. ANS: C The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food. 17. Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane) Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank ANS: A Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects. 18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose ANS: A Antigout drugs are excreted via the kidneys, so patients should have adequate renal function. 19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? a. I should increase my vitamin C intake. b. I will get yearly eye exams. c. I will increase my protein intake. d. I will limit fluids to prevent edema. ANS: B Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids. MULTIPLE RESPONSE 1. Which are characteristic signs of inflammation? (Select all that apply.) a. Edema b. Erythema c. Heat d. Numbness e. Pallor f. Paresthesia ANS: A, B, C Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise. Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test Bank Chapter 22. Drugs Affecting the Integumentary System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment? 1. Mupirocin (Bactroban) 2. Bacitracin and polymixin B (generic double antibiotic ointment) 3. Retapamulin (Altabax) 4. Oral cephalexin (Keflex) 2. Juakeem is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes: 1. Take the oral medication exactly as prescribed. 2. Insert one-half of the dose in each nostril twice a day. 3. Alternate treating one nare in the morning and the other in the evening. 4. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients. 3. Instructions for applying a topical antibiotic or antiviral ointment include: 1. Apply thickly to the infected area, spreading the medication well past the borders of the infection. 2. If the rash worsen