Pharmacotherapeutics Exam 3 - Practice Questions With Correct Answers

A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated potassium levels C. Neck and back pain D. Hypoglycemia - Answer Answer: C Rationale: Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia. *Reference Ch. 72 - Gluocorticoids* A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary sodium. B. Take antibiotics to prevent infection. C. Never abruptly withdraw therapy. D. Have an eye examination every year. - Answer Answer: C Rationale: Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, but the use of antibiotics without a known infection is inappropriate. Sodium intake should be restricted while the patient is taking glucocorticoids. Eye examinations are recommended every 6 months for patients on glucocorticoid therapy. *Reference Ch. 72 - Glucocorticoids* A patient has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. The chart indicates that the patient has developed Cushing's syndrome. When performing a physical assessment, the nurse anticipates finding all but which manifestation of Cushing's syndrome? A. Hypoglycemia B. Muscle weakness C. Glucosuria D. "Buffalo hump" - Answer Answer: A Rationale: Cushing's syndrome is manifested by hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, and lowered resistance to infection. Redistribution of fat produces a "potbelly," "moon face," and "buffalo hump." *Reference Ch. 72 - Glucocorticoids* A patient with rheumatoid arthritis has been taking high-dose aspirin and complains of gastric upset and pain. What does the nurse anticipate will be prescribed for this patient? A. Taking a lower dose of aspirin B. Biweekly injections of methotrexate [Rheumatrex] C. Obtaining a prescription for celecoxib [Celebrex] D. Daily drug therapy with prednisone - Answer Answer: C Rationale: If aspirin causes gastrointestinal upset or pain, a cyclooxygenase-2 (COX-2) inhibitor (celecoxib) should be considered. Methotrexate is administered once a week. Daily prednisone therapy is not indicated; prednisone is usually administered for exacerbations and as short-term therapy. *Reference Ch. 73 - Rheumatoid Arthritis* A patient with rheumatoid arthritis is prescribed methotrexate [Rheumatrex]. The nurse will expect to observe therapeutic effects with this drug in which time period? A. 3 to 7 days B. 3 to 6 weeks C. 3 to 4 months D. 1 to 2 years - Answer Answer: B Rationale: Methotrexate acts faster than all other disease-modifying antirheumatic drugs. Therapeutic effects may develop in 3 to 6 weeks. *Reference Ch. 73 - Rheumatoid Arthritis* A patient with acute gouty arthritis requests information on the preferred drug to take to treat a painful flare-up. The nurse should recommend which medication? A. Allopurinol B. Febuxostat C. Probenecid D. Naproxen - Answer Answer: D Rationale: NSAIDs and glucocorticoids are preferred drugs for treating acute gouty attacks. Benefits derive mainly from anti-inflammatory actions. Four drugs—allopurinol, febuxostat, probenecid, and pegloticase—are used long term to prevent gouty attacks. Benefits derive from lowering plasma uric acid levels. These drugs lack anti-inflammatory and analgesic actions and therefore are not effective against acute gouty attacks. Naproxen (or a nonsteroidal anti-inflammatory drug) is considered the agent of first choice to treat acute gouty arthritis. *Reference Ch. 74 - Drugs for Gout* A patient is prescribed allopurinol for chronic tophaceous gout. The patient develops a rash. What is the priority intervention by the nurse? A. Stop the medication and assess the patient for liver and kidney failure. B. Instruct the patient to avoid exposing the skin to sunlight. C. Administer diphenhydramine (Benadryl) with the dose of allopurinol. D. Monitor the patient for respiratory depression. - Answer Answer: A Rationale: A serious toxic reaction to allopurinol is hypersensitivity syndrome. The medication should be immediately discontinued; the patient should be observed for rash, fever, eosinophilia, and liver and kidney dysfunction. *Reference Ch. 74 - Drugs for Gout* A patient with gout has not experienced relief with conventional drug therapy. The nurse anticipates which agent will be prescribed for the patient? A. Pegloticase B. Allopurinol C. Probenecid D. Solu-Medrol - Answer Answer: A Rationale: Pegloticase is indicated as ULT for patients refractory to conventional treatment. *Reference Ch. 74 - Drugs for Gout* A patient has been prescribed sildenafil [Viagra] for erectile dysfunction. Which instruction should the nurse include in the teaching plan? A. Take the medication on an empty stomach. B. Drink plenty of fluids to prevent priapism. C. Avoid taking nitroglycerin with this drug. D. Constipation is a common adverse effect. - Answer Answer: C Rationale: Taking nitrates with sildenafil may result in severe hypotension. Sildenafil can be taken with or without food. Patients who experience priapism (an erection lasting longer than 4 hours) should contact their health care provider immediately. *Reference Ch. 66 - Drugs for ED* A patient is taking finasteride [Proscar] for benign prostatic hyperplasia (BPH). The nurse should explain that this medication has what effect? A. Decreases the size of the prostate gland B. Relaxes smooth muscle of the prostate gland C. Reduces the risk of prostate cancer D. Improves sexual performance during intercourse - Answer Answer: A Rationale: Finasteride [Proscar] promotes the regression of prostate epithelial tissue and decreases the size of the mechanical obstruction. *Reference Ch. 66 - Drugs for ED* The nurse should instruct a patient prescribed sildenafil [Viagra] to avoid taking this medication with what? A. Grapefruit juice B. Milk C. Crackers D. Eggs - Answer Answer: A Rationale: Inhibitors of CYP3A4 (for example, ketoconazole, itraconazole, erythromycin, cimetidine, saquinavir, ritonavir, and grapefruit juice) can suppress metabolism of sildenafil, thereby increasing its levels. *Reference Ch. 66 - Drugs for ED* A patient who takes over-the counter-diphenhydramine [Benadryl] for seasonal allergy symptoms complains of drowsiness. What should the nurse do? A. Instruct the patient to drink caffeinated beverages. B. Recommend taking the medication with meals. C. Ask the patient's health care provider to prescribe hydroxyzine [Vistaril]. D. Tell the patient to take cetirizine [Zyrtec] instead of diphenhydramine. - Answer Answer: D Rationale: Second-generation antihistamines, such as cetirizine, cross the blood-brain barrier poorly and hence produce much less sedation than first-generation antihistamines.