Pharmacotherapeutics for Advanced Practice Nurse Advanced Practice Nurse Prescribers 5th Edition Prescribers 5th Edition Woo Robinson Test Bank Woo Robinson Test Bank

22. The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patients theophylline dose? A) Decrease theophylline dosage immediately. B) Increase theophylline dosage immediately. C) Increase theophylline dose when normal thyroid function returns. D) Decrease theophylline dose when normal thyroid function returns. Ans: B Feedback: Theophylline clearance is decreased in hypothyroid states. As the patient approaches normal thyroid function, theophylline dose may need to be adjusted frequently. As the drug is cleared more quickly, the dosage may need to be increased. 23. 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? A) Propylthiouracil 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: S - The Marketplace to Buy and Sell your Study Material D 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. 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: 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 know if he is having problems 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