Week 4 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain

Week 4 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain A nurse is teaching a patient who is about to begin drug therapy with orlistat [Xenical]. The patient, whose BMI is 28, has hypertension and type 2 diabetes mellitus. Which statement by the patient indicates understanding of the teaching? "Dark urine and light-colored stools are expected side effects with this drug." "I should stop taking this drug once my blood pressure and serum glucose have stabilized." "I will need to take a multivitamin containing fat-soluble vitamins every day." "If I have fatty or oily stools or fecal incontinence, I should stop taking this drug." "I will need to take a multivitamin containing fat-soluble vitamins every day." Patients should take a multivitamin containing vitamins A, D, E, andK. The increased fat is lost in stools, resulting in fatty, oily stools, and fecal incontinence. These are expected side effects but are not dangerous and can be managed with bulk-forming laxatives. Orlistat is used for long term weight loss and should be given up to 2 years to sustain weight loss. Dark urine and light colored stools indicate possible liver damage and the need to discontinue the drug until liver damage has been ruled out. A patient will begin taking phentermine and topiramate [Osymia] to help with weight loss and asks the nurse why the second ingredient is necessary. Which is the correct response by the nurse? "Topiramate helps reduce the risk of seizures that can occur with phentermine." "Topiramate helps produce feelings of satiety to augment the drug effects." "Topiramate increases the appetite suppression caused by phentermine." "Topiramate increases the rate of weight loss by acting as a stimulant." "Topiramate helps produce feelings of satiety to augment the drug effects." Phentermine = appetite suppression Topiramate = antiseizure medication that acts to induce a sense of satiety A nurse is counseling a group of patients who are beginning a weight-loss diet. The nurse discusses the role of exercise in weight management. Which statement by a patient indicates a need for further teaching? "Exercise has a greater role in weight-loss maintenance than in weight loss itself." "Exercise helps by reducing abdominal fat and improving cardiovascular fitness." "Once I lose weight, I can reduce the amount of time per week I exercise." "I should begin with at least 30 minutes of exercise per day, 5 days/week." "Once I lose weight, I can reduce the amount of time per week I exercise." A nurse is teaching a group of patients about weight management options. Which statement by the patient indicates a need for further teaching? "Although some drugs often show benefits, these benefits do not outweigh the risks." " Antiobesity drugs should be used only as adjuncts to a comprehensive weight loss program of diet and exercise." "Most patients regain lost weight when antiobesity drugs are discontinued." "The side effects of most of these drugs are too uncomfortable to maintain compliance." "Although some drugs often show benefits, these benefits do not outweigh the risks." A patient asks a nurse which weight-loss diet is most effective. Which response by the nurse is appropriate? "Low-fat diets may be easiest for weight loss, because fat has a higher concentration of calories than proteins and carbohydrates." "Most diets do not work very well for long-term maintenance, so you should ask your provider about medications to lose weight." "You should be able to lose 30 to 40 pounds in the first 6 months of an effective weight- loss diet." "You should select a diet that has a higher fat ratio to prevent hunger between meals." "Low-fat diets may be easiest for weight loss, because fat has a higher concentration of calories than proteins and carbohydrates." A patient who has received a prescription for orlistat [Xenical] for weight loss asks the nurse how the drug works. The nurse will tell the patient that orlistat works by: altering how the body stores energy. reducing the body's absorption of fats. increasing the body's metabolic rate. suppressing the appetite. reducing the body's absorption of fats. Orlistat works by altering the absorption of fats. It does not affect how energy is stored, the metabolic rate, or the appetite. A nurse is working with a group of patients. One patient states, "My goal is to reduce my weight from 280 pounds to 230 pounds in 6 months." Which response by the nurse would be most appropriate for this patient? "Most weight loss occurs in the first 6 months, so you should try to reduce your weight to 200 pounds." "Safe and maintainable weight loss should be about 10% of body weight in 6 months." "That is a realistic goal for your weight-reduction program." "Weight loss of more than 20 pounds in 6 months could be dangerous." "Safe and maintainable weight loss should be about 10% of body weight in 6 months."(i.e., 28 pounds for this patient). A patient has been taking phentermine and topiramate [Osymia] for 6 months for weight loss. The nurse weighs the patient and notes a 3% weight loss since beginning the drug. The nurse will expect the prescriber to: continue the current dosage for 4 more weeks. discontinue the drug. increase the drug dosage. switch to another nonamphetamine agent. discontinue the drug. A female patient with diabetes who is obese will begin taking lorcaserin [Belviq] to help with weight loss. What will the nurse include when teaching this patient about this drug? "This drug is safe to take if you become pregnant." "This drug does not have serious adverse effects." "You may need to check your blood glucose levels more often." "You will need to increase your insulin dose to prevent hyperglycemia." "You may need to check your blood glucose levels more often." About 30% of patients with diabetes will experience an increase in hypoglycemic episodes when taking lorcaserin. A 50-year-old patient with a body mass index (BMI) of 26 and a waist circumference (WC) of 37 who smokes asks a nurse about drugs for weight loss. She tells the nurse, "I keep trying to eat less, but it does not work." What will the nurse do? Ask her to begin keeping a log of her food intake and activities. Counsel her to quit smoking to reduce her health risk. Suggest she begin walking every day to increase the number of calories burned. Tell her she is a candidate for drug therapy and suggest she contact her provider. Ask her to begin keeping a log of her food intake and activities. Which statement by a patient about to begin taking orlistat [Xenical] for weight loss therapy indicates an understanding of this drug's actions? "I can eat as much as I want and still lose weight." "I should avoid fat-soluble vitamin supplements while taking this drug." "If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence." "If I take the drug 4 times daily instead of twice daily, I will lose weight faster." "If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence." A nurse performing an admission historyon a patient learns that the patient is taking orlistat [Xenical], warfarin [Coumadin], and levothyroxine [Synthroid]. What will the nurse do? Contact the provider to discuss increasing the warfarin dose. Give the levothyroxine at least 4 hours before giving the orlistat. Suggest that the patient avoid fatty foods while taking these medications. Tell the patient to take the orlistat on an emptystomach. Give the levothyroxine at least 4 hours before giving the orlistat. A 5-year-old child is brought to the emergency department after ingesting diphenhydramine [Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed, the temperature is 37.1°C, and the heart rate is 110 beats/minute. The nurse will expect to: administer atropine to reverse the adverse effects. apply ice packs to stop the flushing. give activated charcoal to absorb the drug. prepare to provide mechanical ventilation. give activated charcoal to absorb the drug. A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child's health care provider? Cetirizine [Zyrtec] 5-mg chewable tablet once daily Loratadine [Claritin] 10-mg chewable tablet once daily Fexofenadine [Allegra] syrup 5 mL twice daily Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet oncedaily Cetirizine [Zyrtec] 5-mg chewable tablet once daily A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms. the medication may be taken once or twice daily. tolerance to sedation will occur in a few weeks. with renal impairment, this drug should be taken every other day. the medication may be taken once or twice daily. A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? Antihistamines should be avoided unless absolutely necessary. Second-generation antihistamines are safer than first-generation antihistamines. Antihistamines should not be taken during pregnancy but may be taken when breastfeeding. The margin of safety for antihistamines is clearly understood for pregnant patients. Antihistamines should be avoided unless absolutely necessary. A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by: anticholinergic properties that decrease rhinorrhea. blocking H1 receptors in nasal passages. reducing secretions at H2 receptor sites. having sedative effects, which help patients rest and sleep. blocking H1 receptors in nasal passages. A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say? "Allergy symptoms that are severe are caused by mediators other thanhistamine." "H1 blockers do not prevent the release of histamine from mast cells and basophils." "Second-generation H1 blockers contain less active drug and do not work in severe reactions." "Severe allergic reactions occur through actions on muscarinic receptors." "Allergy symptoms that are severe are caused by mediators other than histamine." An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? Give the medication as ordered. Monitor the child for bronchoconstriction. Question the order. Request an order to give the drug orally. Question the order. . A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug? The drug will reduce redness and itching but not edema. This antihistamine is not likely to cause sedation. The patient should avoid drinking alcohol while taking the drug. The patient should report shortness of breath while taking the drug. The patient should avoid drinking alcohol while taking the drug. A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? Cetirizine [Zyrtec] Fexofenadine [Allegra] Levocetirizine [Xyzal] Loratadine [Claritin] Fexofenadine [Allegra] A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of theantihistamines? "Antihistamines block H1 receptors to prevent actions of histamine at these sites." "Antihistamines block release of histamine from mast cells and basophils." "H1 antagonists can bind to H1 receptors, H2 receptors, and muscarinic receptors." "First-generation antihistamines are more selective than second-generation antihistamines." "Antihistamines block H1 receptors to prevent actions of histamine at these sites." A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching? "Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than NSAIDs." "Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatorydrugs." "Glucocorticoids help avert damage to tissues from lysosomal enzymes." "Glucocorticoids reduce the immune component of inflammation." Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatorydrugs. A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching? "Glucocorticoids have both endocrine and nonendocrine uses." "Patients treated for adrenocortical insufficiency receive pharmacologic doses." "Pharmacologic effects are achieved with low doses of glucocorticoids." "Physiologic doses are used to treat inflammatory disorders." "Glucocorticoids have both endocrine and nonendocrine uses." A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct? "As long as the drug is taken as prescribed, side effects usually do not occur." "By interrupting the inflammatory process, these drugs inhibit side effects." "Side effects can occur and are dependent on the dose and duration of treatment." "The negative feedback loop prevents side effects." "Side effects can occur and are dependent on the dose and duration of treatment." The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time? a. 8:00 AM b. 12:00 PM c. 4:00 PM d. 9:00 PM A A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching? "I should reduce the dose by half each day until I stop taking the drug." "I will need to have cortisol levels monitored during the withdrawal process." "The withdrawal schedule may take several months." "If I have surgery, I may need to take the drug for a while, even after I have stopped." "I should reduce the dose by half each day until I stop taking the drug." A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? a. Baseline vitamin D level Calcium and vitamin D supplements Estrogen therapy Skeletal x-rays before treatment Calcium and vitamin D supplements A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do? Contact the provider to ask about reducing the dose. Encourage the patient to restrict sodium intake. Reassure the patient that this is an expected side effect. Tell the patient to stop taking the drug. Contact the provider to ask about reducing the dose. A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It is a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about: reducing the patient's dose. using every-other-day dosing. increasing the patient's dose. tapering the dose. increasing the patient's dose. A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication? "At this dose, the concentration in your breast milk is safe." "Contact your provider to discuss lowering the dose." "There will be reversible side effects for your baby." "This drug is likely to cause growth retardation in your baby." "At this dose, the concentration in your breast milk is safe." A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information? "By reducing inflammation, this drug will slow the progression of your disease." "Glucocorticoids are used as adjunctive therapy during acute flare-ups." "Oral glucocorticoids cause less toxicity than intra-articular injections." "You may resume running when the pain and swelling improve." "Glucocorticoids are used as adjunctive therapy during acute flare-ups." A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)? Liver function tests Serum electrolytes Tuberculin skin test Vitamin D levels Serum electrolytes A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? Asthma and allergic rhinitis Gouty arthritis Seborrheic dermatitis Systemic fungal infection Systemic fungal infection A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct? Ask the patient about sodium intake. Obtain a blood glucose level. Suggest the patient limit potassium intake. Tell the patient to stop taking the drug. Ask the patient about sodium intake. A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct? "A smaller dose may be indicated for your child." "Ask your provider about every-other-day dosing." "Long-acting glucocorticoid preparations should prevent growth suppression." "Oral glucocorticoids rarely cause growth suppression." "Ask your provider about every-other-day dosing." A patient who has arthritis has been taking ibuprofen [Motrin] and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is correct? Contact the provider to discuss ordering an antiulcer medication. Counsel the patient to use over-the-counter antacids. Reassure the patient not to worry unless there is gastric pain. Tell the patient to stop taking the glucocorticoid immediately. Contact the provider to discuss ordering an antiulcer medication. Glucocorticoid therapy, especially when combined with NSAIDs, can increase the risk of gastric ulcer and possibly GI bleeding. Treatment with antiulcer medications is indicated, but not with OTC antacids, since the provider needs to be aware of this adverse effect. Gastric pain is usually decreased because of the glucocorticoids, so absence of gastric pain is not reassuring. A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do? Contact the provider to ask about reducing the dose. Encourage the patient to restrict sodium intake. Reassure the patient that this is an expected side effect. Tell the patient to stop taking the drug. Contact the provider to ask about reducing the dose. A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It is a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about: reducing the patient's dose. using every-other-day dosing. increasing the patient's dose. tapering the dose. increasing the patient's dose. A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct? a. "Anticholinergic effects are more common with second-generation antihistamines." b. "First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective." c. "Make sure you take antihistamines only when you have symptoms to minimize side effects." d. "You should take oral antihistamines daily during each allergy season to get maximum effects." ANS: D Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First- generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis. A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do? a. Request an order for an oral decongestant to replace the intranasal phenylephrine. b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn. c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours. d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine. ANS B. This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion A nurse provides teaching to a patient with allergic rhinitis who will begin using anintranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching? a. "If the glucocorticoid causes burning or itching, I should use it every other day." b. "I should use a decongestant if necessary before using the glucocorticoid." c. "I should use the glucocorticoid whenever I have symptoms." d. "I will probably develop systemic effects from the topical glucocorticoid." ANS: B A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats/minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to: a. discuss using an intranasal glucocorticoid and loratadine [Claritin]. b. report acute toxicity caused by pseudoephedrine. c. suggest using an agent with a sympathomimetic drug only. d. suggest using a topical decongestant to minimize systemic symptoms. ANS: A This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a sympathomimetic drug. Topical decongestants are not first-line drugs for allergic rhinitis. A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast [Singulair] to replace the glucocorticoid because the child has frequent nosebleeds. When teaching this child's parents about montelukast, the nurse will include which statement? a. "Montelukast is also effective for treating infectious rhinitis." b. "Montelukast may cause behavior changes in your child." c. "Montelukast will treat both congestion and rhinitis." d. "Montelukast works best when combined with a topical decongestant." ANS: B"Montelukast may cause behavior changes in your child." A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Phenylephrine drops ANS: A Diphenhydramine is effective in suppressing cough and also has sedative effects when used in doses to suppress cough. Fexofenadine/pseudoephedrine is a combination antihistamine/decongestant and will not help with cough. Guaifenesin helps make coughs more productive but will not suppress cough or help with sleep. A child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several years. The parents are concerned that the child's rate of growth has slowed. What will the nurse do? a. Reassure the parents that this is an expected side effect. b. Suggest that the parents discuss using fluticasone [Flonase] with the provider. c. Tell the parents to administer the drug only when symptoms are severe. d. Tell the parents that antihistamines work as well as intranasalglucocorticoids. ANS: B A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth in children. Although rare, it can occur; however, it is less likely with fluticasone and mometasone, so these two preparations are better options for children. Reassuring parents that this is an expected side effect is incorrect. Intranasal glucocorticoids should be given daily and not as needed. Antihistamines are not as effective as glucocorticoids, because antihistamines work only against one mediator of allergic inflammation. A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct? a. "Decongestants are too sedating for children and should not be used." b. "Decongestants should not be given to children under 7 years old." c. "Decongestant drops are recommended instead of decongestant sprays." d. "Decongestant sprays should be used no longer than 5 to 10 days." ANS: C Decongestant drops are recommended for children, because the number of drops can be controlled precisely. When sprays are used, the amount given is not well controlled. Decongestants cause CNS excitation. Decongestants may be given to children over the age of 4 years. Intranasal decongestants should not be used for longer than 5 days. A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct? a. "Any product will be effective when combined with vitamin C and zinc." b. "It is best to use single-agent medications to treat individual symptoms." c. "The fever indicates that your child may need an antibiotic; you should call your provider." d. "You should ask your provider to prescribe a combination product that will treat multiple symptoms." ANS: B Which medication used for asthma has off-label uses to treat allergic rhinitis? Diphenhydramine [Benadryl] Fexofenadine/pseudoephedrine [Allegra-D] Guaifenesin [Mucinex] Omalizumab [Xolair] Omalizumab [Xolair] A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin: a. dries secretions to help suppress coughing so patients can rest. b. helps stimulate the flow of secretions to increase cough productivity. c. helps to relieve chest pain associated with a cough. d. stimulates the body's natural immune responses. B A parent asks a nurse about giving diphenhydramine [Benadryl] to a child to relieve cold symptoms. Which response by the nurse is correct? a. "Benadryl must be given in higher doses to provide relief for cold symptoms." b. "Intranasal glucocorticoids are more effective for treating cold symptoms." c. "Nasal antihistamines are more effective for treating cold symptoms." d. "Because histamine does not cause cold symptoms, Benadryl would not be effective." ANS: D A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct? a. Pseudoephedrine [Sudafed] b. Fluticasone propionate [Fluticasone] c. Loratadine [Claritin] d. Intranasal cromolyn sodium [Atrovent] b. Fluticasone propionate [Fluticasone] Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids. What is ipratropium bromide [Atrovent]? A cholinergic agent used for perennial rhinitis An anticholinergic used for allergic rhinitis and colds A medication that is used only in patients with asthma A drug that is inappropriate for use in patients with allergic rhinitis ANS: BIpratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea. Ipratropium bromide is an anticholinergic. In addition to asthma, ipratropium bromide can be used for allergic rhinitis and the common cold. Ipratropium bromide can be used for allergic rhinitis. 958. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient's heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle-closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug. ANS: C Local effects of timolol and other beta blockers are generally minimal, but transient ocular stinging can occur. There is no need to monitor vital signs, because this does not represent a systemic reaction. This is not a sign of angle-closure glaucoma. Antihistamines will not help. 959. A nursing student asks the nurse to discuss the differences between POAG and angle- closure glaucoma. Which statement by the nurse is correct? a. "Angle-closure glaucoma may be asymptomatic until irreversible damage has occurred." b. "Both types are more common in African-American patients." c. "Drug therapy is the definitive treatment for angle-closure glaucoma." d. "Early treatment with prostaglandin analogs can stop the progression ofPOAG." ANS: D Prostaglandin analogs are first-line agents for treating POAG, and early treatment can stop the progression. Angle-closure glaucoma has a rapid onset of painful symptoms. POAG is more common in African Americans but angle-closure glaucoma is not. Surgery, not drugs, is the definitive treatment for angle-closure glaucoma. 960. A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a. "Systemic side effects will not occur with this agent." b. "You may experience an increased heart rate, but this is a harmless side effect." c. "You may need to wear dark glasses until this medication wears off." d. "You will be able to read as soon as the examination is completed." ANS: C Because the agent causes cycloplegia, which paralyzes the iris sphincter, the eyes are unable to respond to bright light, so patients should be advised to wear sunglasses until this effect wears off. Systemic side effects do occur with these agents. Tachycardia is a systemic effect and may indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be unable to focus; patients will have blurred vision until this effect wears off. 961. A nurse is preparing to administer timolol [Timoptic] eye drops to a patient who has open- angle glaucoma. The nurse notes that the patient has a historyof chronic obstructive pulmonary disease (COPD). The nurse will contact the provider to discuss changing to which medication? a. Betaxolol b. Carteolol c. Levobunolol d. Metipranol ANS: A Betaxolol is the only ophthalmic beta blocker that is beta1 selective, meaning that it has less chance of causing bronchial constriction. It is preferred for patients with asthma and COPD. 962.A patient with ocular hypertension will begin using brimonidine [Alphagan] for long-term reduction of increased ocular pressure (IOP). The nurse teaches the patient about this medication. Which statement by the patient indicates understanding of the teaching? a. "After using the drops, I should wait 15 minutes before putting in contacts." b. "Because this is a topical medication, drowsiness will not occur." c. "I will not have cardiovascular side effects when using this medication." d. "If my eyes begin to itch or turn red, it means I am allergic to this drug." ANS: A Patients using this drug should wait 15 minutes before putting in contacts, because soft contacts can absorb the drug. Even though the medication is topical, it can be absorbed systemically, causing systemic side effects such as drowsiness or lowered blood pressure. Itching and hyperemia may occur and do not indicate allergy. An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient's cornea. The nurse will expect the provider to order which treatment for this patient? a. High doses of vitamins C and E, beta-carotene, and zinc b. Laser therapy c. Pegaptanib [Macugen] d. Photodynamic therapy ANS: A This patient has three large drusen with minor vision changes, signs of intermediate age-related macular degeneration (ARMD). Patients with intermediate ARMD can significantly reduce their risk of developing advanced ARMD by taking high doses of vitamins C and E, beta-carotene, and zinc. Laser therapy, pegaptanib, and photodynamic therapy are used to manage wet, or neovascular, ARMD. A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching? a. "Blurred vision, tearing, or eye dryness may occur with this medication." b. "I may experience a bitter taste in my mouth after instilling these eye drops." c. "I will need to instill two eye drops three times daily in each eye." d. "If I notice redness in my eyes or eyelids, I should stop using these drops." ANS: C The fixed-dose preparation of dorzolamide and timolol is given as 1 drop twice daily. Blurred vision, tearing, eye dryness, and a bitter aftertaste are the expected side effects. Redness in the eyes or eyelids indicates an allergic conjunctivitis and means that the drops should be discontinued. A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, "My eyes used to be greenish-brown, but now they're brown." What will the nurse do? a. Reassure the patient that this is a harmless side effect. b. Report this toxic effect to the patient's provider. c. Tell the patient that this indicates an increased risk of migraine headaches. d. Tell the patient that this effect will reverse when the medication is withdrawn. ANS: A Latanoprost can cause a harmless, heightened brown pigment of the iris that stops when the medication is discontinued but does not regress. It is not a sign of a toxic reaction. It does not indicate an increased risk of developing migraines. It will not reverse. A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a. Asthma b. Atrioventricular heart block c. Pulmonary hypertension d. Sinus bradycardia ANS: A Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. Patients with asthma will develop shortness of breath and wheezing. These symptoms are not associated with AV block, pulmonary hypertension, or sinus bradycardia. A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching? a. "The drops help prevent my lenses from moving during the examination." b. "The drops will cause me to have blurred vision and sensitivity to light." c. "These drops allow the ophthalmologist to see inside my eyes." d. "This medication anesthetizes my eyes so that the examination won't be painful." ANS: D Anticholinergic agents are used to provide mydriasis and cycloplegia. They do not affect the sensation of pain and do not provide anesthesia. Cycloplegia refers to paralysis of the ciliary muscle and prevents the lens from moving during the examination. The desired effects, which facilitate eye examinations, do not allow the eye to focus or to respond to light, so blurred vision and photophobia occur. Mydriasis prevents the iris sphincter from contracting, allowing the examiner to see inside the eye. patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops d. Ocular decongestants ANS: B Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first-line agents. Ocular decongestants are used to treat redness caused by minor irritants. A nurse is teaching a patient diagnosed with wet ARMD who will begin receiving bevacizumab [Avastin]. Which statement by the patient indicates a need for further teaching? a. "I should be able to improve my visual acuity by using this drug." b. "I should report eye pain and photophobia to my provider if they occur." c. "This drug will help suppress the growth of new blood vessels." d. "This medication will not reduce the risk of blindness." ANS: D Bevacizumab can help reduce the risk of further impairment and progression to blindness. It can help improve visual acuity. Eye pain and photophobia are signs of endophthalmitis, which is an inflammation caused by infection; they should be reported to the provider. Bevacizumab works by suppressing the development of new blood vessels. A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? a. "Sunscreen should be applied 30 minutes before going outside." b. "I do not need sunscreen when it is cloudyoutside." c. "I should reapply sunscreen after swimming." d. "UV radiation does not penetrate through water." ANS: C Sunscreens should be reapplied after swimming and with profuse sweating. Most sunscreens should be applied at least 30 minutes before going outdoors, but some require application 2 hours before exposure. Clouds do not protect from all UV rays. UV radiation can penetrate at least several centimeters of clear water. A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane] d. Spironolactone ANS: B For moderate to severe acne, oral antibiotics are indicated. Doxycycline is a drug of first choice. Hormonal agents, such as oral contraceptive pills (OCPs), are used in female patients who are at least 15 years old. Isotretinoin is used when other treatments fail and acne is severe. Spironolactone is used when OCPs fail. A patient with psoriasis has been using a high-potency glucocorticoid. Because of skin atrophy, the provider has ordered a switch to calcitriol [Vectical], a vitamin D3 analog. What will the nurse teach this patient? a. "Calcitriol causes severe photosensitivity." b. "Itching, erythema, and irritation are indications of an allergic reaction." c. "Systemic effects do not occur with this topical agent." d. "You may apply calcitriol to all areas of the skin except the face." ANS: D Calcitriol may be applied twice daily to all areas except the face. It does not cause severe photosensitivity. Skin irritation does not occur. Systemic effects may occur. To provide protection against the full range of ultraviolet (UV) radiation, an organic sunscreen must contain which agent? a. Avobenzone b. Para-aminobenzoic acid (PABA) c. Titanium dioxide d. Zinc oxide ANS: A Only one organic sunscreen, avobenzone, absorbs the full range of UV radiation. The other agents do not protect against the full range of UV radiation. Titanium dioxide and zinc oxide are inorganic screens. A female patient with baldness asks a nurse about the safety and efficacy of minoxidil [Rogaine]. What will the nurse tell the patient? a. Hair regrowth is most effective when baldness has developed recently. b. Minoxidil cannot be used by female patients. c. Once hair has been restored, minoxidil may be discontinued, because hair loss will stop. d. Systemic side effects, such as headaches and flushing, are common. ANS: A Minoxidil is most effective at treating recent hair loss. It may be used in female patients. Hair loss may continue even with uninterrupted treatment. Systemic side effects are not common. A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching? a. "The drops help prevent my lenses from moving during the examination." b. "The drops will cause me to have blurred vision and sensitivity to light." c. "These drops allow the ophthalmologist to see inside my eyes." d. "This medication anesthetizes my eyes so that the examination won't be painful." ANS: D Anticholinergic agents are used to provide mydriasis and cycloplegia. They do not affect the sensation of pain and do not provide anesthesia. Cycloplegia refers to paralysis of the ciliary muscle and prevents the lens from moving during the examination. The desired effects, which facilitate eye examinations, do not allow the eye to focus or to respond to light, so blurred vision and photophobia occur. Mydriasis prevents the iris sphincter from contracting, allowing the examiner to see inside the eye. A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops d. Ocular decongestants ANS: B Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first-line agents. Ocular decongestants are used to treat redness caused by minor irritants. A nurse is teaching a patient diagnosed with wet ARMD who will begin receiving bevacizumab [Avastin]. Which statement by the patient indicates a need for further teaching? a. "I should be able to improve my visual acuity by using this drug." b. "I should report eye pain and photophobia to my provider if they occur." c. "This drug will help suppress the growth of new blood vessels." d. "This medication will not reduce the risk of blindness." ANS: D Bevacizumab can help reduce the risk of further impairment and progression to blindness. It can help improve visual acuity. Eye pain and photophobia are signs of endophthalmitis, which is an inflammation caused by infection; they should be reported to the provider. Bevacizumab works by suppressing the development of new blood vessels. A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? a. "Sunscreen should be applied 30 minutes before going outside." b. "I do not need sunscreen when it is cloudyoutside." c. "I should reapply sunscreen after swimming." d. "UV radiation does not penetrate through water." ANS: C Sunscreens should be reapplied after swimming and with profuse sweating. Most sunscreens should be applied at least 30 minutes before going outdoors, but some require application 2 hours before exposure. Clouds do not protect from all UV rays. UV radiation can penetrate at least several centimeters of clear water. A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane] d. Spironolactone ANS: B For moderate to severe acne, oral antibiotics are indicated. Doxycycline is a drug of first choice. Hormonal agents, such as oral contraceptive pills (OCPs), are used in female patients who are at least 15 years old. Isotretinoin is used when other treatments fail and acne is severe. Spironolactone is used when OCPs fail. A patient with psoriasis has been using a high-potency glucocorticoid. Because of skin atrophy, the provider has ordered a switch to calcitriol [Vectical], a vitamin D3 analog. What will the nurse teach this patient? a. "Calcitriol causes severe photosensitivity." b. "Itching, erythema, and irritation are indications of an allergic reaction." c. "Systemic effects do not occur with this topical agent." d. "You may apply calcitriol to all areas of the skin except the face." ANS: D Calcitriol may be applied twice daily to all areas except the face. It does not cause severe photosensitivity. Skin irritation does not occur. Systemic effects may occur. To provide protection against the full range of ultraviolet (UV) radiation, an organic sunscreen must contain which agent? a. Avobenzone b. Para-aminobenzoic acid (PABA) c. Titanium dioxide d. Zinc oxide ANS: A Only one organic sunscreen, avobenzone, absorbs the full range of UV radiation. The other agents do not protect against the full range of UV radiation. Titanium dioxide and zinc oxide are inorganic screens. .A female patient with baldness asks a nurse about the safety and efficacy of minoxidil [Rogaine]. What will the nurse tell the patient? a. Hair regrowth is most effective when baldness has developed recently. b. Minoxidil cannot be used by female patients. c. Once hair has been restored, minoxidil may be discontinued, because hair loss will stop. d. Systemic side effects, such as headaches and flushing, are common. ANS: A Minoxidil is most effective at treating recent hair loss. It may be used in female patients. Hair loss may continue even with uninterrupted treatment. Systemic side effects are not common. A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drugs with the provider? a. Higher potency topical glucocorticoids b. Topical keratolytic agents c. Topical immunosuppressants d. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) ANS: C If topical glucocorticoids fail to treat eczema without causing skin atrophy and hypopigmentation, topical immunosuppressants may be used. Higher potency glucocorticoids will only compound the adverse effects. Topical keratolytic agents are not indicated. Topical NSAIDs are not indicated. A patient has actinic keratosis and is unable to tolerate the effects of fluorouracil. The provider orders the nonsteroidal anti-inflammatory drug diclofenac sodium [Solaraze] 3% gel. What will the nurse include when teaching this patient about this medication? a. "Apply this medication three times daily for 30 days." b. "Dry skin, itching, and rash are common local side effects." c. "This drug has the same risk of GI side effects as with oral NSAIDs." d. "You do not need to protect your skin from sunlight with diclofenac." ANS: B Localized skin reactions are common effects with diclofenac. The medication is applied twice daily for 60 to 90 days. The risk of GI side effects is very low. Diclofenac causes sensitization to UV radiation, so patients should be taught to avoid exposure and to use sunscreen. A patient with actinic keratoses has received a prescription for fluorouracil [Carac]. Which statement by the patient indicates understanding of this medication? a. "Healing should occur 6 weeks after beginning treatment." b. "I will apply this drug twice daily." c. "Severe inflammation is an indication for stopping treatment." d. "Tissue ulceration and necrosis are desired effects." ANS: D Fluorouracil causes tissue disintegration, erosion, ulceration, and necrosis as part of the normal course of desired effects. Complete healing may take several months, although treatment lasts 2 to 6 weeks. Carac is applied once daily. Severe inflammation is part of the course of treatment and not an indication for discontinuing the medication. A nurse is discussing the use of tazarotene [Tazorac] with a patient who has psoriasis. Which statement by the patient indicates a need for further teaching? a. "I should use a sunscreen when using this medication." b. "I understand the gel can cause staining of clothing." c. "I will apply this once daily in the evening." d. "I will apply the medication to dry skin." ANS: B Tazarotene will not stain clothing. It is true that patients should use sunscreen while using this drug. It should be applied once daily in the evening to dry skin. An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest? a. Applying lotion to the skin after applying the drug b. Reducing the frequency to one application a day c. Discontinuing the medication, because this is likely an allergic reaction d. Requesting a prescription for a gel formulation of the drug ANS: B Benzoyl peroxide may cause drying and peeling of the skin. If signs of severe local irritation occur, such as burning or blistering, the frequency of application should be reduced. Applying lotion is not indicated. These symptoms are not consistent with an allergic reaction. There is no difference in skin reactions between the gel and the lotion formulations. A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently two to three times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face ANS: B Gentle cleansing two to three times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne. A 50-year-old patient receives botulinum toxin type A [Botox] injections for the first time on her forehead and around her eyes. One week later, she calls the clinic to report that she is experiencing droopy eyelids. The nurse will tell the patient that this effect: a. is normal and will resolve in a few days. b. may persist for 3 to 6 months but will resolve. c. may progress to cause drooling and dysphagia. d. represents an adverse effect that may be permanent. ANS: B Botox is a neurotoxin that acts on cholinergic neurons to block the release of acetylcholine. Injection into the wrong site or diffusion from the correct site into surrounding tissues can weaken muscles not intended as targets. This patient's droopy eyelids are an example of the wrong site being affected. Weakening of muscles can last 3 to 6 months but will resolve. It is incorrect totell the patient that it is a normal effect or that it will resolve in a matter of days. Drooling and dysphagia are likely when injections are around the mouth. It is not a permanent effect. A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. What will the nurse teach this patient? a. Peeling and drying are desired effects of this drug. b. Systemic effects may occur with this medication. c. Tinnitus is a common side effect of little concern. d. Tissue injury is unlikely at this dose. ANS: B Salicylic acid is readily absorbed through the skin, and systemic toxicity can result. Peeling and drying are not desired effects of salicylic acid. Tinnitus is a symptom of systemic toxicity. Tissue injury is likely in any concentration above 6%. A patient asks a nurse what a sun protection factor (SPF) of 15 indicates. The nurse will tell the patient that an SPF of 15 indicates: a. a 93% block of UVB radiation. b. half the protection of a sunscreen with an SPF of30. c. low protection. d. that it takes 15 minutes for the sun to burn. ANS: A A sun protection factor of 15 indicates a 93% block of UVB. As the SPF increases, the increment in protection gets progressively smaller, so an SPF of 15 is not half that of an SPF of 30. Low protection is indicated by an SPF of 2 to 14. The SPF is calculated by the time required for the development of erythema in the protected region divided by the time required for the development of erythema in the unprotected region. An infant has a severe contact diaper dermatitis. The provider orders triamcinolone acetonide [Kenalog] 0.1% cream to be applied three times daily. When teaching the infant's parents about this medication, the nurse will instruct them to apply: a. a thick layer and massage the cream into the skin. b. a thin layer and leave the diaper open as much as possible. c. the cream and place an occlusive dressing over the area. d. the cream and put the infant's diaper on tightly. ANS: B Topical glucocorticoids can be absorbed systemically and cause adverse effects. To minimize systemic and local adverse effects, the medication should be applied sparingly. Parents should be taught to avoid tight-fitting diapers. The cream should be rubbed gently into the skin. Occlusive dressings increase the risk of adverse effects. Putting the diaper on tightly creates an occlusive dressing. An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. "I should apply the Retin-A immediately after bathing." b. "I should apply the Retin-A twice daily." c. "I should augment this therapy with an abrasive soap." d. "I should use sunscreen every day." ANS: D Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin-A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin-A is applied once daily. Abrasive soaps intensify localized reactions to Retin-A and should not be used. A 50-year-old patient asks about using tretinoin [Renova] to minimize wrinkles. What will the nurse tell the patient? a. The drug may be discontinued once results are obtained. b. Results may be visible within a few weeks of starting therapy. c. Systemic toxicity is a common side effect in patients with sensitive skin. d. The drug is not effective on coarse wrinkles or sun-damaged skin. ANS: D Tretinoin is used to treat fine wrinkles, not coarse wrinkles, and does not repair sun-damaged skin. Treatment with Renova must continue to maintain the response to the drug. Results are not visible for up to 6 months after beginning therapy. Systemic toxicity is not common. A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin [Retin-A] and has been applying benzoyl peroxide twice daily. The provider asks the nurse to teach this patient about isotretinoin [Accutane], which the patient will begin taking in a few weeks. The nurse will include which statement when teaching this patient about this drug? a. "Alcohol may be consumed in moderation when taking this drug." b. "Skin rash, headache, and hair loss are common with this drug." c. "Tetracycline must be discontinued before beginning the isotretinoin." d. "Two pregnancy tests are required before each monthly refill of your prescription." ANS: C Adverse effects of isotretinoin can be increased by tetracycline, so tetracycline must be discontinued before therapy is started. Alcohol should be avoided, since it can potentiate hypertriglyceridemia. Skin rash, headache, and hair loss are not common side effects, although they can occur. Two pregnancy tests are required at the beginning of therapy; at each refill, only one pregnancy test is required. An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach this patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids ANS: A Benzoyl peroxide is a first-line drug for mild to moderate acne. Other topical antibiotics and retinoids are used when first-line therapy fails. A patient with severe psoriasis will begin taking acitretin [Soriatane]. The nurse obtains a health history and learns that the patient takes a combination oral contraceptive. What willthe nurse do? a. Counsel the patient to use another form of birth control along with the OCP. b. Tell the patient she may stop using contraception when the medication is withdrawn. c. Tell the patient that acitretin is safe to take during pregnancy. d. Tell the patient to report spotting to the provider so that another form of contraceptive may be ordered. ANS: A Acitretin is contraindicated during pregnancy and can reduce the effectiveness of progestin-only oral contraceptives. Patients should be counseled to use two reliable forms of birth control when taking this drug. Patients must continue using birth control for at least 3 months after treatment has stopped. Acitretin is teratogenic. Patients may experience spotting with progestin-only contraceptives, which this woman is not taking. A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoy