TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 66-70
Chapter 66: Drugs for Erectile Dysfunction and Benign
Prostatic Hyperplasia
MULTIPLE CHOICE
1. A male patient is being treated for benign prostatic hyperplasia (BPH) by another
provider but cannot remember which drug he is taking. He comes to the clinic seeking
treatment for erectile dysfunction and receives a prescription for sildenafil (Viagra). What
will the nurse teach this patient?
a. “Sildenafil is not safe to take in conjunction with finasteride (Proscar).”
b. “Sildenafil is safe with any medication for benign prostatic hyperplasia.”
c. “To be safe, you should have a transurethral resection before starting sildenafil.”
d. “You should not take sildenafil if you are taking silodosin (Rapaflo).”
ANS: D
Sildenafil should not be taken with alpha1-adrenergic antagonists, such as silodosin,
because of the risk of severe decreases in blood pressure. Finasteride is not an alpha1-
adrenergic antagonist and may be taken with sildenafil. Not all medications for BPH
are safe to take with sildenafil. Invasive treatments for BPH are used when symptoms
are severe.
DIF: Cognitive Level: Application REF: Benign Prostatic Hyperplasia |
Treatment Modalities | Drug Therapy | 5-Alpha-Reductase Inhibitors | Alpha1-
Adrenergic Antagonists TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
2. A nurse is teaching a patient about the use of sildenafil (Viagra) for erectile dysfunction.
Which statement by the patient indicates understanding of the teaching?
a. “If my erection lasts longer than 4 hours, I should contact my provider.”
b. “I should not use nitroglycerin within 12 hours of using sildenafil.”
c. “I should take this drug about 15 minutes before sexual activity.”
d. “This drug may cause me to have an erection when I don’t want one.”
ANS: A
Priapism can occur and can cause tissue damage to the penis, so an erection lasting
longer than 4 hours should be reported. Patients who use nitroglycerin should not use
sildenafil within 24 hours of taking this drug. Patients should be advised to take
sildenafil 30 minutes to 4 hours before anticipated sexual activity. Sildenafil does not
, cause an erection without sexual stimuli.
DIF: Cognitive Level: Application REF: Sildenafil | Mechanism of Action |
Adverse Effects | Priapism | Drug Interactions | Nitrates | Preparations,
Dosage, and Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
3. A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil (Viagra)
for erectile dysfunction. When he asks the nurse how to take the medication, the nurse
will tell him to:
a. begin taking one tablet twice daily, 12 hours apart.
b. start with one tablet about 1 hour before anticipated sexual activity.
c. take 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity.
d. take two tablets 1 hour before sexual activity with a high-fat meal.
ANS: B
Patients older than 65 years should start with a low dose of 25 mg and may take the
drug 1 hour before anticipated sexual activity. Sildenafil is taken when needed and not
on a routine basis. Dosing at 25 to 100 mg per dose 30 minutes to 4 hours before
sexual activity is the standard recommendation for men younger than 65 years. Two
tablets is a high dose; consumption of a high-fat meal would interfere with absorption
of sildenafil.
DIF: Cognitive Level: Application REF: Sildenafil | Preparations,
Dosage, and Administration TOP: Nursing Process: Planning MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
4. A nurse is obtaining a history from a patient who will receive tadalafil (Cialis) for erectile
dysfunction. The patient reports that he expects to have sexual activity three or four times
a week. What should the nurse tell the patient?
a. Adverse effects of tadalafil resolve more quickly than those of sildenafil.
b. There is an increased risk of priapism with frequent sexual activity.
c. He should take tadalafil 30 to 60 minutes before sexual activity.
d. He should talk to his provider about daily dosing of tadalafil.
ANS: D
Tadalafil is approved for daily dosing and can be given daily for men who anticipate
sexual activity twice a week or more. Tadalafil has longer effects—up to 36 hours—
than sildenafil, and adverse effects take longer to resolve. There is no increased risk of
priapism associated with an increase in sexual activity. Because tadalafil has longer
effects, dosing and sexual activity do not have to be closely timed.
DIF: Cognitive Level: Application REF: Tadalafil | Actions and Uses |
Adverse Effects TOP: Nursing Process: Planning MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
, Therapies
5. A male patient tells the nurse he awakens once or twice each night to void and has
difficulty starting his stream of urine. He describes these symptoms as “annoying.” The
patient’s provider examines him and notes that the prostate is moderately enlarged. The
patient is sexually active and tells the nurse that he does not want to take any medication
that will interfere with sexual function. The nurse anticipates the provider will order:
a. doxazosin (Cardura).
b. finasteride (Proscar).
c. silodosin (Rapaflo).
d. a transurethral prostatectomy.
ANS: A
Nonselective alpha1-adrenergic antagonists do not commonly affect sexual function
and are useful in patients with mild to moderate symptoms, so doxazosin would be a
drug of choice for this patient. Finasteride is a 5-alpha-reductase inhibitor and is used
for patients with more severe enlargement of the prostate; it also reduces ejaculate
volume and libido. Silodosin is a selective alpha1-adrenergic antagonist and can cause
abnormal ejaculation. Transurethral prostatectomy is reserved for patients with more
severe enlargement of the prostate.
DIF: Cognitive Level: Application REF: Benign Prostatic Hypertrophy |
Treatment Modalities | 5-Alpha-Reductase Inhibitors | Finasteride | Alpha1-
Adrenergic Antagonists | Adverse Effects TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
6. A patient who has erectile dysfunction asks a nurse whether sildenafil (Viagra) would be
a good medication for him to take. Which aspect of this patient’s history would be of
most concern?
a. Benign prostatic hypertrophy
b. Mild hypertension
c. Occasional use of nitroglycerin
d. Taking finasteride
ANS: C
Patients taking nitroglycerin should not take sildenafil. Having BPH is not a
contraindication. Mild hypertension requires caution but is not a contraindication.
Patients with BPH taking finasteride may take sildenafil.
DIF: Cognitive Level: Application REF: Is Sildenafil Safe for Men with
CHD? TOP: Nursing Process: Assessment MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient
is taking multiple medications, including terazosin (Hytrin). During the evening rounds,
, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the
patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to
suspect:
a. priapism.
b. sinus infection.
c. allergic reaction.
d. adverse effects.
ANS: D
The principal adverse effects of terazosin and doxazosin are hypotension, fainting,
dizziness, somnolence, and nasal congestion. No evidence indicates priapism, sinus
infection, or an allergic reaction.
DIF: Cognitive Level: Analysis REF: Alpha1-Adrenergic Antagonists |
Adverse Effects TOP: Nursing Process: Assessment MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
8. Tadalafil (Cialis) was prescribed 4 weeks ago for a patient with erectile dysfunction. The
patient also takes prazosin (Minipress) for hypertension. Which statement by the patient
best demonstrates understanding of the use of tadalafil (Cialis)?
a. “I can take this up to 2 times a day, just before intercourse.”
b. “I have a little renal trouble, so I should take a higher dose.”
c. “I should take this medication with food.”
d. “I should take this medication no more than once a day.”
ANS: D
Tadalafil should be taken no more than once a day and without regard to meals.
Tadalafil has a half-life of 17.5 hours and should not be taken twice a day. Men with
moderate renal or hepatic insufficiency should take a reduced dosage. This patient
may be confusing the actions of tadalafil and prazosin.
DIF: Cognitive Level: Application REF: Tadalafil | Actions and Use |
Preparation and Dosage for Erectile Dysfunction TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
1. Which are contraindications for taking sildenafil (Viagra)? (Select all that apply.)
a. Patients who are taking nitroglycerin for angina pectoris
b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye
c. Patients with BPH who are taking alpha1-adrenergic antagonists
d. Patients with a blood pressure of 100/60 mm Hg
e. Patients with a history of myocardial infarction (MI) in the past 6 months
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