Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants

Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants A patient who breastfeeds her infant asks the nurse about the immunity the infant receives from breast milk. What does the nurse tell the patient about immunity through breastfeeding? a. "The immunity protects the infant from hypersensitivity reactions." b. "The immunity provides phagocytes to help the infant fight infections." c. "The immunity results from the transfer of IgA through the breast milk." d. "The immunity protects the infant from respiratory and gastrointestinal (GI) microbes." - ANS ANS: C IgA crosses breast milk and, in the GI tract, where it is not absorbed, provides passive immunity to microbes. Infants do not receive protection from hypersensitivity reactions through breast milk. Phagocytes are not transmitted through breast milk. Infants are not protected from respiratory microbes via breast milk. DIF: Cognitive Level: Analysis REF: p. 574TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is caring for a patient infected with the human immunodeficiency virus(HIV). Which finding would most concern the nurse? a. High level of macrophages b. Low neutrophil count c. Low red blood cell (RBC) count d. Very low helper T lymphocyte count - ANS ANS: D The nurse understands that this patient may be vulnerable to opportunistic infections, especially if there were an indication of the HIV conversion to acquired immunodeficiency syndrome (AIDS). A very low helper T lymphocyte count would most concern the nurse, because the helper T cells are essential to the immune system, and people with AIDS have a low or deficient count. A high level of macrophages could indicate an inflammatory response. A low RBC count may indicate anemia. A low neutrophil count can be caused by multiple conditions, but a high count most likely indicates an infection. DIF: Cognitive Level: Analysis REF: p. 572TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is teaching a nursing student about a specific acquired immunity system. Which statement by the student indicates a need for further teaching? a. "Cell-mediated immunity and humoral immunity are both types of specific acquired immune responses." b. "Each exposure to an antigen causes a faster, more intense response." c. "Immune responses occur only after exposure to a foreign substance." d. "The skin is a factor in specific acquired immunity." - ANS ANS: D The skin is a physical barrier that confers natural immunity. It is not a factor in specific acquired immunity. Cell-mediated and humoral immunity are both types of specific acquired immunity. In specific acquired immunity, each exposure to an antigen evokes a more intense response more quickly. Specific acquired immunity occurs only after initial exposure to an antigen. DIF: Cognitive Level: Analysis REF: p. 571TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A patient has a Type IV hypersensitivity (delayed-type hypersensitivity) response to an infection. The nurse understands which two types of cells are necessary for this response? a. Antigen-presenting cells and mast cells b. Cytolytic T lymphocytes and target cells c. Immunoglobulin cells and dendritic cells d. Infected macrophages and CD4 helper T cells - ANS ANS: D The object of Type IV hypersensitivity (delayed-type hypersensitivity) is to rid the body of bacteria that replicate within macrophages. The macrophage activates the CD4 cell, which in turn activates the macrophage. The other cells listed are not a part of this response. DIF: Cognitive Level: Application REF: p. 578TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is reviewing the immune system with a group of nursing students. One student asks about the difference between cell-mediated immunity and humoral immunity. What should the nurse reply? a. "Humoral immunity does not involve helper T cells in the immune response." b. "Humoral immunity does not have a role in hypersensitivity reactions." c. "Humoral immunity requires cytolytic T cells that attack antigens directly." d. "Humoral immunity uses cells produced by B lymphocytes in the immune response." - ANS ANS: D Humoral immunity refers to immunity mediated by antibodies, which are produced by B lymphocytes. Helper T cells have an essential role in antibody production by B cells. The antibody immunoglobulin E plays a role in hypersensitivity reactions. Cytolytic T cells do not produce antibodies; they are key players in cellular immunity. DIF: Cognitive Level: Analysis REF: p. 571TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is caring for a patient who has undergone organ transplantation. Because the sequence of amino acids in the major histocompatibility complex (MHC) molecules of the donor is different from that of the patient, the nurse will expect to administer which class of drugs? a. Antibiotics b. Antihistamines c. Immune globulins d. Immunosuppressants - ANS ANS: D The MHC molecules from one individual are recognized as foreign by the immune system of another individual; therefore, when an attempt is made to transplant organs between individuals who are not identical twins, immune rejection of the transplant is likely. Immunosuppressants are given to counter this response. Antibiotics are used to destroy bacteria. Antihistamines block hypersensitivity reactions. Immune globulins are given to confer passive immunity when specific acquired immunity has not yet developed a response. DIF: Cognitive Level: Application REF: p. 576TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is teaching a group of nursing students about antibodies. The nurse correctly explains which type of response is triggered when antigens bind to antibodies on mast cells or basophils? a. Acquired immune response b. Autoimmune response c. Hypersensitivity reaction d. Transplant rejection - ANS ANS: C When antigens bind to antibodies on mast cells and basophils, chemical mediators of hypersensitivity reactions are released. Although hypersensitivity is an acquired response, mast cells and basophils do not play a role in other acquired responses. An autoimmune response occurs when the immune system fails to discriminate between self and nonself. Transplant rejection occurs when the MHC molecules of the donor are different from those of the patient. DIF: Cognitive Level: Analysis REF: p. 573TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation Which statement is true about helper T cells? a. They are useful but are not essential to immune responses. b. They do not play a role in antibody production. c. They have highly specific receptors to antigens on their surface. d. They prevent CD4 molecules from attaching to antigens. - ANS ANS: C Helper T cells have highly specific cell surface receptors that recognize individual antigens. Helper T cells play an essential role in several functions of the immune response. They have an essential role in the production of antibodies by B cells. They carryCD4 molecules on their surface and are also referred to as CD4 cells. DIF: Cognitive Level: Analysis REF: p. 572TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is teaching a group of nursing students about immunoglobulins. Which statement by a student indicates a need for further teaching? a. "IgD provides a first line of defense against microbes entering the body through the lungs." b. "IgE plays a role in hypersensitivity reactions and responses to parasites." c. "IgG and IgM participate in the complement response to promote target-cell lysis." d. "Neonatal immunity is the result of IgG crossing the placenta." - ANS ANS: A IgD serves as a receptor for antigen recognition on B cells, which is the only place it is found. IgE is involved in hypersensitivity responses and responses to parasites. IgG and IgM are involved in complement responses. IgG crosses the placenta and confers passive immunity on the fetus. DIF: Cognitive Level: Analysis REF: p. 576TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A nurse is discussing the role of antibodies in the complement system with a group of nursing students. Which statement by a student is correct? a. "Antibodies activate the complement cascade by turning on the alternative pathway." b. "Antibodies that are free in solution can activate the complement system." c. "Antibodies flag target cells to be lysed by membrane attack complexes." d. "Antibody receptors are nonspecific to antigenic determinants." - ANS ANS: C Lysis of target cells that have been tagged with antibodies is the most dramatic effect of the complement system. Antibodies activate the complement cascade by turning on the classical pathway. C1 cannot bind with free antibodies. Antibody receptors are specific to antigen determinants .DIF: Cognitive Level: Analysis REF: p. 578TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation A provider has ordered intravenous promethazine [Phenergan] for an adult patient postoperatively to prevent nausea and vomiting (N/V). What will the nurse do? a. Administer the drug at a rate of 25 mg/minute or more to achieve maximum effects. b. Contact the provider to suggest using dimenhydrinate [Dramamine] instead. c. Ensure that the IV is infusing freely through a large-bore needle. d. Monitor the patient closely for cardiac dysrhythmias. - ANS ANS: C Promethazine can cause severe local tissue injury if it extravasates into tissues, so the medication should be administered in an IV that is flowing freely through a large-bore needle. The drug should be administered at a rate of 25 mg/minute or less. Dimenhydrinate is indicated for motion sickness, not postoperative N/V. Cardiac dysrhythmias were a concern with two antihistamines no longer on the market, astemizole and terfenadine. DIF: Cognitive Level: Application REF: p. 601TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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: a. administer atropine to reverse the adverse effects. b. apply ice packs to stop the flushing. c. give activated charcoal to absorb the drug. d. prepare to provide mechanical ventilation. - ANS ANS: C In acute toxicity, patients present with agitation, a flushed face, tachycardia, and uncoordinated movements. There is no specific antidote, so drug removal is the focus of treatment, starting with activated charcoal to absorb the drug, followed by a cathartic to enhance excretion. Atropine would cause an increase in the heart rate. Application of ice packs is recommended for hyperthermia and not for flushing. The child's temperature is normal. Mechanical ventilation is not indicated with this presentation of symptoms, although cardiovascular collapse may eventually develop. DIF: Cognitive Level: Application REF: p. 601TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily b. Loratadine [Claritin] 10-mg chewable tablet once daily c. Fexofenadine [Allegra] syrup 5 mL twice daily d. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily - ANS ANS: A The child is receiving a low dose of cetirizine and can receive up to 5 mg/day in either a single dose or two divided doses. Cetirizine is available in a chewable tablet, which this child may tolerate better, so the parents should be encouraged to explore this option with their provider. The loratadine 10-mg chewable tablet is approved for children 6 years and older. Fexofenadine would be safe for this child, but it is unlikely that the syrup would be any better than the cetirizine syrup. Desloratadine is not approved for children under the age of 12 years. DIF: Cognitive Level: Application REF: p. 602TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: a. fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms. b. the medication may be taken once or twice daily. c. tolerance to sedation will occur in a few weeks. d. with renal impairment, this drug should be taken every other day. - ANS ANS: B Fexofenadine may be given 60 mg twice daily or 180 mg once daily. Fexofenadine does not need to be given with food. Sedation is not a common side effect of fexofenadine. There is no caution to reduce the dosage or increase the dosing interval in patients with renal impairment who take fexofenadine. DIF: Cognitive Level: Application REF: p. 602TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? a. Antihistamines should be avoided unless absolutely necessary. b. Second-generation antihistamines are safer than first-generation antihistamines. c. Antihistamines should not be taken during pregnancy but may be taken when breastfeeding. d. The margin of safety for antihistamines is clearly understood for pregnant patients. - ANS ANS: A Antihistamines are pregnancy Category C, with debate currently occurring regarding degree of effects on the fetus. They should be avoided unless absolutely necessary. All antihistamines have adverse effects on the fetus. Antihistamines can be excreted in breast milk. The margin of safety of antihistamines in pregnancy is not clear, so these agents should be avoided unless a clear benefit of treatment outweighs any risks. DIF: Cognitive Level: Application REF: p. 601TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 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: a. anticholinergic properties that decrease rhinorrhea. b. blocking H1 receptors in nasal passages. c. reducing secretions at H2 receptor sites. d. having sedative effects, which help patients rest and sleep. - ANS ANS: B Histamine does not mediate cold symptoms, so antihistamines do not provide relief through H1 blockade. Their anticholinergic effects at muscarinic receptor sites can moderately reduce rhinorrhea, so some patients may experience some relief of this symptom. H1-receptor sites do not play a role in cold symptoms. H2-receptor sites do not play a role in cold symptoms. Sedative side effects do not alleviate cold symptoms. DIF: Cognitive Level: Application REF: p. 600TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. "Allergy symptoms that are severe are caused by mediators other thanhistamine." b. "H1 blockers do not prevent the release of histamine from mast cells and basophils." c. "Second-generation H1 blockers contain less active drug and do not work in severe reactions." d. "Severe allergic reactions occur through actions on muscarinic receptors." - ANS ANS: A Severe allergic reactions with symptoms of anaphylaxis are caused by mediators other than histamine, so the benefits of antihistamines are limited. H1 blockers do not block the release of histamine, but this is why they are not effective in anaphylaxis. Second-generation agents are as effective as first-generation agents in allergic reactions mediated by histamine; neither is effective for treating anaphylaxis. DIF: Cognitive Level: Application REF: p. 598TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Give the medication as ordered. b. Monitor the child for bronchoconstriction. c. Question the order. d. Request an order to give the drug orally. - ANS ANS: C Promethazine can cause severe respiratory depression, especially in very young patients; it is contraindicated in children younger than 2 years. The medication should not be given as ordered. It is not safe to give the drug and then monitor for bronchoconstriction. The drug is not safe in this age group when given orally. DIF: Cognitive Level: Application REF: p. 600TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug? a. The drug will reduce redness and itching but not edema. b. This antihistamine is not likely to cause sedation. c. The patient should avoid drinking alcohol while taking the drug. d. The patient should report shortness of breath while taking the drug. - ANS ANS: C Hydroxyzine is a first-generation antihistamine and has sedative effects, so patients should be cautioned not to consume alcohol while taking the drug. In capillary beds, antihistamines reduce edema, itching, and redness. This antihistamine causes sedation. It is not associated with respiratory depression at therapeutic doses. DIF: Cognitive Level: Application REF: p. 601TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms? a. Desloratadine [Clarinex] b. Dimenhydrinate [Dramamine] c. Hydroxyzine [Vistaril] d. Promethazine [Phenergan] - ANS ANS: B Some antihistamines, including dimenhydrinate and promethazine, are labeled for use in motion sickness. Promethazine, however, is contraindicated in children under age 2 years and should be used with caution in children older than 2 years because of the risks for severe respiratory depression. Desloratadine and hydroxyzine are not used for motion sickness. DIF: Cognitive Level: Application REF: p. 599TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. Cetirizine [Zyrtec] b. Fexofenadine [Allegra] c. Levocetirizine [Xyzal] d. Loratadine [Claritin] - ANS ANS: B Fexofenadine isthe least sedating ofthe second-generation antihistamines and so isthe least likely to have synergistic effects with alcohol. Cetirizine, levocetirizine, and loratadine all have sedative side effects to some extent and thus would be less safe. DIF: Cognitive Level: Analysis REF: p. 601TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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 the antihistamines? a. "Antihistamines block H1 receptors to prevent actions of histamine at these sites." b. "Antihistamines block release of histamine from mast cells and basophils." c. "H1 antagonists can bind to H1 receptors, H2 receptors, and muscarinic receptors." d. "First-generation antihistamines are more selective than second-generation antihistamines." - ANS ANS: A Antihistamines block H1 receptors to prevent the actions of histamine. They do not block the release of histamine. H1 antagonists do not bind to H2 receptors; they do bind to muscarinic receptors. Second-generation antihistamines are more selective than first-generation antihistamines. DIF: Cognitive Level: Application REF: p. 598TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching? a. "Because this is a topical drug, liver toxicity will not occur." b. "I should cover areas where the gel is applied to protect them from sunlight." c. "I will apply equal amounts of gel to all affected areas." d. "The topical formulation has the same toxicity as the oral formulation." - ANS ANS: B Diclofenac is available in topical and oralpreparations. Patients should be warned to protect treated areas from sunlight. Side effects occur, such as liver toxicity, even with topical dosing. Patients should apply smaller amounts to the upper extremities. Systemic toxicity is lower with topical formulations.DIF: Cognitive Level: ApplicationREF: p. 613TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies An older male patient with an increased risk of MI is taking furosemide [Lasix] and low- dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss: a. adding an antihypertensive medication. b. obtaining serum electrolytes. c. ordering a potassium-sparing diuretic. d. withdrawing the aspirin. - ANS ANS: D This patient shows signs of renal impairment, as evidenced by weight gain despite the use of diuretics, decreased urine output, hypertension, and elevated serum creatinine and BUN. ASA can cause acute, reversible renal impairment and should be withdrawn. Hypertensive medications do not treat the underlying cause. Serum electrolytes are not indicated. Addition of a potassium-sparing diuretic is not indicated. DIF: Cognitive Level: Application REF: p. 607TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A woman who has arthritis is breastfeeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient? a. NSAIDs are safe to take while breastfeeding. b. NSAIDs are not safe, even in small amounts. c. She should take only COX-2 inhibitors while breastfeeding. d. She should request a prescription for narcotic analgesics. - ANS ANS: A NSAIDs are safe and may be takenwhile breastfeeding. It is not necessaryto use a COX-2 inhibitor while breastfeeding. Narcotics cross breast milk and should be used cautiously while breastfeeding. DIF: Cognitive Level: Application REF: p. 609TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true? a. "COX-1 inhibitors protect against colorectal cancer." b. "COX-1 inhibitors protect against myocardial infarction and stroke." c. "COX-1 inhibitors reduce fever." d. "COX-1 inhibitors suppress inflammation." - ANS ANS: B COX-1 inhibitors have beneficial effect of reducing platelet aggregation and thus reducing the risk of myocardial infarction and stroke. COX-2 inhibitors protect against colorectal cancer, reduce inflammation, and reduce fever. DIF: Cognitive Level: Analysis REF: p. 603TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen? a. It does not inhibit cyclooxygenase. b. It has minimal effects at peripheral sites. c. It is more similar to opioids than to nonsteroidal anti-inflammatory drugs(NSAIDs). d. It is selective for cyclooxygenase-2. - ANS ANS: B The differences between the effects of acetaminophen and aspirin are thought to result from selective inhibition of cyclooxygenase; acetaminophen has only minimal effects on cyclooxygenase at peripheral sites, which may explain why acetaminophen does not have adverse GI, renal, and antiplatelet effects. Acetaminophen is a selective COX inhibitor. It is not more similar to opioids than NSAIDs. It is not selective for COX-2. DIF: Cognitive Level: Application REF: p. 616TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss: a. administering epinephrine. b. changing to a first-generation NSAID. c. reducing the dose of aspirin. d. giving an antihistamine. - ANS ANS: A Aspirin can cause a hypersensitivity reaction in some patients. This may start withprofuse watery rhinorrhea and progress to generalized urticaria, bronchospasm, laryngeal edema, and shock. It is not a true anaphylactic reaction, because it is not mediated by the immune system. Epinephrine is the treatment of choice. Patients with sensitivity to ASA often also have sensitivity to NSAIDs; the first indication with this patient is to treat the potential life-threatening effect, not to change the medication. Reduction of the dose of ASA is not indicated, because this reaction is not dose dependent. Antihistamines are not effective, because this is not an allergic reaction. DIF: Cognitive Level: Application REF: p. 608TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching? a. "I may experience tinnitus with higher doses of this medication." b. "I may take up to 800 mg 4 times daily for pain." c. "I should limit alcohol intake to fewer than three drinks a day." d. "I will take this medication with meals to help prevent stomach upset." - ANS ANS: A NSAIDs do not cause salicylism and therefore do not cause tinnitus with higher doses. The maximum dose for adults is 3200 mg/day, or 800 mg 4 times/day. Patients taking NSAIDs should be cautioned to limit alcohol intake. Taking NSAIDs with meals helps prevent GI upset. DIF: Cognitive Level: Application REF: p. 608TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatorymedication. c. lower dose of the oral ketorolac for long-term pain management. d. intranasal preparation of ketorolac for pain management at home. - ANS ANS: A Ketorolac is not indicated for chronic or minor pain and should not be used longer than 5 days. Patients discharged home will be instructed to use other NSAIDs for pain. A fixed-dose opioid/NSAID is not indicated. Low-dose ketorolac would not be used, because 5 days would have passed. The intranasal therapy would not be indicated after 5 days. DIF: Cognitive Level: Application REF: p. 614TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. "Aspirin is safe during the second and third trimesters of pregnancy." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." c. "Aspirin may induce premature labor and should be avoided in the third trimester." d. "You should use a first-generation nonsteroidal anti-inflammatory medication." - ANS ANS: B Aspirin poses risks to the pregnant patient and her fetus, including premature closure ofthe ductus arteriosus. ASA is not safe, especially in the third trimester, because it can cause anemia and can contribute to postpartum hemorrhage. ASA does not induce labor but can prolong labor by inhibiting prostaglandin synthesis. NSAIDs have similar effects and also should be avoided. DIF: Cognitive Level: Application REF: p. 608TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? a. Acetylcysteine [Mucomyst] b. Activated charcoal c. Hemodialysis d. Respiratory support - ANS ANS: A The nurse should anticipate giving acetylcysteine, because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed, so it must be given much sooner. Hemodialysis is not indicated. Respiratory support is used for ASA overdose. DIF: Cognitive Level: Application REF: p. 618TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 μg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the aspirin dose to treat the patient's headache. b. Notify the provider of possible renaltoxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient's symptoms have subsided. - ANS ANS: D This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated. DIF: Cognitive Level: Application REF: p. 608TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should avoid any type of COX inhibitor because of the risk of Reye syndrome. b. The patient should increase the dose to a level that suppresses inflammation. c. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead. d. The patient should use acetaminophen because of its selective effects on uterine smooth muscle. - ANS ANS: C Aspirin (ASA) has analgesic effects for joint pain, muscle pain, and headache, but it is relatively ineffective against visceral pain, including uterine smooth muscle pain, for which NSAIDs are indicated. The risk of Reye syndrome is associated with the use of ASA in children to treat fever. Increasing the ASA dose to anti-inflammatory levels is useful for rheumatic fever, tendonitis, and bursitis. Acetaminophen is not effective for dysmenorrhea. DIF: Cognitive Level: Application REF: p. 605TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching? a. "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase." b. "NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, they do not provide protective benefits against those conditions." c. "Unlike aspirin, first-generation NSAIDs do not carrya risk of hypersensitivity reactions." d. "Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation." - ANS ANS: C Nonaspirin first-generation NSAIDs carry a risk of hypersensitivity reactions similar to the risk posed by ASA. These agents cause reversible COX inhibition, whereas ASA causes irreversible COX inhibition. NSAIDs do not provide protective benefits for myocardial infarction or stroke, as does ASA. Nonaspirin first-generation NSAIDs do cause suppression of platelet aggregation, but the suppression isreversible. DIF: Cognitive Level: Application REF: p. 610TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient who takes daily doses of aspirin is scheduled for surgery next week. Thenurse should advise the patient to: a. continue to use aspirin as scheduled. b. reduce the aspirin dosage by half until after surgery. c. stop using aspirin immediately. d. stop using aspirin 3 days before surgery. - ANS ANS: C Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. An interval of 3 days is not long enough for the bleeding effects of aspirin to be reversed. Cutting the dose in half would not reduce the effects of bleeding associated with aspirin use. DIF: Cognitive Level: Application REF: p. 607TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. "Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than NSAIDs." b. "Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs." c. "Glucocorticoids help avert damage to tissues from lysosomal enzymes." d. "Glucocorticoids reduce the immune component of inflammation." - ANS ANS: B Glucocorticoids have many side effects. They are used because of their multiple mechanisms of action, including their ability to limit tissue damage caused by the inflammatory process and suppression of the immune component of inflammation. DIF: Cognitive Level: Analysis REF: p. 622TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "Glucocorticoids have both endocrine and nonendocrine uses." b. "Patients treated for adrenocortical insufficiency receive pharmacologic doses." c. "Pharmacologic effects are achieved with low doses of glucocorticoids." d. "Physiologic doses are used to treat inflammatory disorders." - ANS ANS: A Glucocorticoids have applications for both endocrine and nonendocrine disorders. Adrenocortical insufficiency requires physiologic, or low-dose, treatment. Pharmacologic doses are used when large doses are required, such as to suppress inflammation. Physiologic doses are used to treat endocrine disorders. DIF: Cognitive Level: Application REF: p. 619TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. "As long as the drug is taken as prescribed, side effects usually do not occur." b. "By interrupting the inflammatory process, these drugs inhibit side effects." c. "Side effects can occur and are dependent on the dose and duration of treatment." d. "The negative feedback loop prevents side effects." - ANS ANS: C When taken in pharmacologic doses, as for inflammatory disorders, glucocorticoids can cause an array of serious adverse effects. When glucocorticoids are given in pharmacologic doses, side effects can occur even when the drugs are taken as prescribed. Interruption of the inflammatory process causes some of the adverse effects. The negative feedback loop does not inhibit side effects. DIF: Cognitive Level: Application REF: p. 622TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Pharmacologic and Parenteral Therapies 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 - ANS ANS: A To allow the adrenals to recover, the hydrocortisone dose should be administered before 9:00 AM. The other times are incorrect for oral administration of daily hydrocortisone. DIF: Cognitive Level: Application REF: p. 626TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. "I should reduce the dose by half each day until I stop taking the drug." b. "I will need to have cortisol levels monitored during the withdrawal process." c. "The withdrawal schedule may take several months." d. "If I have surgery, I may need to take the drug for a while, even after I have stopped." - ANS ANS: A Glucocorticoid therapy can suppress adrenal function, so withdrawal should be done slowly to allow recovery of adrenal function. Reducing the dose of a glucocorticoid by half each day is not recommended. Patients should have their cortisol levels monitored to determine when therapy can be stopped. The withdrawal schedule may take several months. Patients who have stopped the drug may still experience adrenal insufficiency in times of physiologic stress, such as surgery. DIF: Cognitive Level: Application REF: p. 625TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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 b. Calcium and vitamin D supplements c. Estrogen therapy d. Skeletal x-rays before treatment - ANS ANS: B Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A baseline vitamin D level is not recommended. Estrogen therapy can help in postmenopausal women, but its risks outweigh its benefits. Patients should undergo evaluation of the bone mineral density of the lower spine, not skeletal x-rays. DIF: Cognitive Level: Analysis REF: p. 627TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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? a. Contact the provider to ask about reducing the dose. b. Encourage the patient to restrict sodium intake. c. Reassure the patient that this is an expected side effect. d. Tell the patient to stop taking the drug. - ANS ANS: A High-dose glucocorticoid therapy can cause myopathy, manifesting as weakness. If muscle weakness occurs, the dose should be reduced. Reducing the sodium intake is recommended to minimize sodium and water retention. Muscle weakness is not an expected side effect, because it indicates myopathy. It is incorrect to tell the patient to stop taking the drug, because a glucocorticoid must be withdrawn slowly to allow time for recovery of adrenal function. DIF: Cognitive Level: Application REF: p. 623TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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: a. reducing the patient's dose. b. using every-other-day dosing. c. increasing the patient's dose. d. tapering the dose. - ANS ANS: C Because of their adrenal suppression, patients taking glucocorticoids long-term require increased doses at times of stress and even for a time after stopping the drug until adrenal function returns. This patient's lower blood pressure is an indication that glucocorticoid levels may be depleted. Reducing the dose would only exacerbate the patient's problems. Every-other-day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it would not be useful now. Tapering of doses is used to allow adrenal function to recover as the drug is discontinued. DIF: Cognitive Level: Application REF: p. 625TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. "At this dose, the concentration in your breast milk is safe." b. "Contact your provider to discuss lowering the dose." c. "There will be reversible side effects for your baby." d. "This drug is likely to cause growth retardation in your baby." - ANS ANS: A Women who are nursing may take physiologic or low pharmacologic doses of glucocorticoids without achieving concentrations in breast milk that affect the nursing infant. It is not necessary to lower the dose. Since there are negligible levels, there are no effects on the infant. Large pharmacologic doses can cause growth retardation and other adverse effects in the infant. DIF: Cognitive Level: Application REF: p. 622TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. "By reducing inflammation, this drug will slow the progression of your disease." b. "Glucocorticoids are used as adjunctive therapy during acute flare-ups." c. "Oral glucocorticoids cause less toxicity than intra-articular injections." d. "You may resume running when the pain and swelling improve." - ANS ANS: B Glucocorticoids are used as adjunctive therapy to treat acute exacerbations of rheumatoid arthritis. Glucocorticoids reduce pain and inflammation but do not alter the course of the disease. Oral glucocorticoids produce side effects similar to those of all glucocorticoids, but they are absorbed more rapidly and completely than intra-articular injections. Patients should be warned against overactivity even though their pain has been reduced, because they can further injure their joints. DIF: Cognitive Level: Application REF: p. 621TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies Apatient who has beentaking a glucocorticoid forseveralmonths arrivesinthe 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)? a. Liver function tests b. Serum electrolytes c. Tuberculin skin test d. Vitamin D levels - ANS ANS: B This patient shows signs of iatrogenic Cushing syndrome, which may include serum electrolyte disturbances; therefore, the electrolyte levels should be monitored. Liver function tests, tuberculin skin testing, and vitamin D levels are not indicated. DIF: Cognitive Level: Application REF: p. 624TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection - ANS ANS: D Glucocorticoids are contraindicated in patients with a history of systemic fungal infections. Glucocorticoids are used to treat asthma, allergic rhinitis, gout, and seborrheic dermatitis. DIF: Cognitive Level: Application REF: p. 626TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. Ask the patient about sodium intake. b. Obtain a blood glucose level. c. Suggest the patient limit potassium intake. d. Tell the patient to stop taking the drug. - ANS ANS: A Because of their mineralocorticoid activity, glucocorticoids can cause sodium and water retention and potassium loss. Asking about the sodium intake can help the nurse evaluate this patient. Although glucocorticoids can affect glucose tolerance, this patient does not have signs of hyperglycemia. Patients with sodium and water retention should be encouraged to increase their potassium intake. Telling a patient to stop taking the drug is incorrect, because a glucocorticoid must be withdrawn slowly to allow time for recovery of adrenal function. DIF: Cognitive Level: Application REF: p. 625TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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. "A smaller dose may be indicated for your child." b. "Ask your provider about every-other-day dosing." c. "Long-acting glucocorticoid preparations should prevent growth suppression." d. "Oral glucocorticoids rarely cause growth suppression." - ANS ANS: B Growth retardation can be minimized with alternate-day dosing of glucocorticoids. Giving smaller doses does not prevent this effect with long-term therapy. Long-acting glucocorticoids do not prevent this effect. Oral glucocorticoids have the same side effects .DIF: Cognitive Level: Application REF: p. 623TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. Contact the provider to discuss ordering an antiulcer medication. b. Counsel the patient to use over-the-counter antacids. c. Reassure the patient not to worry unless there is gastric pain. d. Tell the patient to stop taking the glucocorticoid immediately. - ANS ANS: A 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. The glucocorticoid should be withdrawn slowly, not immediately. DIF: Cognitive Level: Application REF: p. 624TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths/minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 μg twice daily and has used 2 puffs of albuterol[Proventil HFA], 90 mcg/puff, every4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg - ANS ANS: C Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack. DIF: Cognitive Level: Analysis REF: p. 689TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine - ANS ANS: A LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available. DIF: Cognitive Level: Application REF: p. 690TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? a. "You may have another dose in 4 hours." b. "You may need to take two inhalations instead of one." c. "You should have peak effects in about 6 hours." d. "You should see improved effects within the next week." - ANS ANS: D Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. The medication is given once daily, with inhalation of one capsule. Peak effects occur in 3 hours. DIF: Cognitive Level: Application REF: p. 686TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths/minute, a heart rate of 96 beats/minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do? a. Contact the provider to request a systemic glucocorticoid. b. Contact the provider to suggest using a long-acting beta2 agonist. c. Evaluate the need for teaching about MDI use. d. Question the patient about how much albuterol has been used. - ANS ANS: D To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted. DIF: Cognitive Level: Application REF: p. 689TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent? a. Growth may be slowed, but eventual adult height will not be reduced. b. The growth rate is not impaired, but overall height will be reduced. c. The growth rate slows while the drug is used and only resumes when the drug isstopped. d. Long-term use of the drug results in a decrease in adult height. - ANS ANS: A Glucocorticoids can slow growth in children and adolescents, but they do not reduce the eventual adult height. The growth rate will return to normal within a year, even when the drug is continued. Long-term use does not affect the eventual adult height. DIF: Cognitive Level: Application REF: p. 678TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication. c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid. - ANS ANS: A The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid. DIF: Cognitive Level: Application REF: p. 678TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy - ANS ANS: B Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. Patients should increase both their calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased steroids in times of stress. It is not necessary to use two reliable forms of birth control. DIF: Cognitive Level: Application REF: p. 678TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication? a. "I may notice mood changes in my child." b. "I should give this medication twice daily." c. "I will give my child one 4-mg chewable tablet daily." d. "This drug can alleviate symptoms during an acute attack." - ANS ANS: A Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some patients have reported mood changes when taking this drug, so parents should be warned of this effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does not treat symptoms of an acute attack. DIF: Cognitive Level: Application REF: p. 680TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? a. Contact the provider to report systemic anticholinergic side effects. b. Discontinue the aerosol treatment immediately. c. Notify the provider of a possible allergic reaction. d. Reassure the patient that these are expected side effects. - ANS ANS: D The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions, but the patient's symptoms are not those associated with anaphylaxis. DIF: Cognitive Level: Analysis REF: p. 686TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations." - ANS ANS: D Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta2- adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation. DIF: Cognitive Level: Application REF: p. 690TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbation of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d. Using an ipratropium/albuterol combination twice daily. - ANS ANS: A For patients with chronic, severe COPD, the risk of exacerbations may be reduced with roflumilast. Theophylline is used only when other bronchodilators are not effective. Oral steroids are not indicated for this use. Ipratropium is used to treat bronchospasm in COPD. DIF: Cognitive Level: Analysis REF: p. 691TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonists d. Short-acting beta2 agonists - ANS ANS: D Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management. DIF: Cognitive Level: Analysis REF: p. 689TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse is teaching a group of nursing students about the different formulations of beta2- adrenergic agonist medications. Which statement by a student indicates understanding of the teaching? a. "Beta2-adrenergic agonists provide quick relief via any formulation." b. "Long-acting beta2 agonists may be used alone to prevent attacks." c. "Short-acting beta2 agonists are usually given by nebulizer." d. "Oral beta2 agonists are not useful for short-term treatment." - ANS ANS: D Oral beta2 agonists are used only for long-term control. All formulations vary; long-acting beta2 agonists (LABAs) and oral preparations are used for long-term control, whereas short-acting beta2 agonists (SABAs) are useful for acute episodes. LABAs are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may be given by MDI or nebulizer and usually are given by MDI.DIF: Cognitive Level: Application REF: p. 682TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication? a. "After the loading dose has been given, the patient will receive 6 mg/kg/hour." b. "Dosing istitrated based on the serum theophylline levels." c. "If the patient's serum theophylline level is less than 15 mcg/mL, the rate should be reduced." d. "The patient will receive a loading dose of 180 mg over 5 minutes." - ANS ANS: B Dosing for aminophylline is based on each patient's serum theophylline levels. The loading dose usually is 6 mg/kg; after that, the maintenan