M8: Repro, contracpetives, HRT, STI's, Drugs-bone/joint

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

Answer 1

4. Skin-to-skin contact with pregnant women while using the gel

Question 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.

Answer 2

2.Cholestatic hepatitis and jaundice may occur with low doses of androgens.

Question 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

Answer 3

4.May occur with androgen therapy

Question 4

The U.S. Food and Drug Administration warns that androgens may cause:
1.Peliosis hepatis
2.Orthostatic hypotension
3.Menstrual irregularities
4.Acne

Answer 4

1.Peliosis hepatis

Question 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

Answer 5

2.Lipid levels and liver function tests

Question 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

Answer 6

1.A digital prostate exam

Question 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

Answer 7

2.Clotting disorders

Question 8

Postmenopausal women with an intact uterus should not be prescribed:
1.Estrogen/progesterone combination
2.IM medroxyprogesterone (Depo Provera)
3.Estrogen alone
4. Androgens

Answer 8

3. Estrogen alone

Question 9

Women who have migraines with an aura should not be prescribed estrogen because of:
1. The interaction between triptans and estrogen, limiting migraine therapy choices
2. An increased incidence of migraines with the use of estrogen
3. An increased risk of stroke occurring with estrogen use
4. Patients with migraines may be prescribed estrogen without any concerns

Answer 9

3. An increased risk of stroke occurring with estrogen use

Question 10

A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes:
1. Counseling regarding decreasing or not smoking while taking oral contraceptives
2. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive
3. Advising that she may miss two pills in a row and not be concerned about pregnancy
4. Recommending that her next follow-up visit is in 1 year for a refill and annual exam

Answer 10

1. Counseling regarding decreasing or not smoking while taking oral contraceptives

Question 11

A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?
1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour.
2. Both medications are best tolerated if taken on an empty stomach.
3. She should use a backup method of birth control, such as condoms, for the rest of the current pill pack.
4. If she gets nauseated with the medications, she should call the office for an antiemetic prescription.

Answer 11

3. She should use a backup method of birth control, such as condoms, for the rest of the current pill pack.

Question 12

A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects, she should be prescribed:
1. Low-dose oral estrogen
2. A low-dose estrogen/progesterone combination
3. A vaginal estradiol ring
4. Vaginal progesterone cream

Answer 12

3. A vaginal estradiol ring

Question 13

Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:
1. Depression
2. Hypertension
3. Weight loss
4. Cataracts

Answer 13

1. Depression

Question 14

When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects:
1. Hypertension and dysuria
2. Depression and weight gain
3. Abdominal pain and constipation
4. Orthostatic hypotension and dermatitis

Answer 14

2. Depression and weight gain

Question 15

The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to:
1. The potential development of significant hypertension
2. Increased risk of strokes
3. Decreased bone density
4. The risk of a life-threatening rash such as Stevens-Johnson

Answer 15

3. Decreased bone density

Question 16

Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light “period” off and on since receiving her Depo shot. What would be the management of Shana?
1. Reassurance that some spotting is normal the first few months of Depo and it should improve.
2. Schedule an appointment for an exam as this is not normal.
3. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding.
4. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot.

Answer 16

1. Reassurance that some spotting is normal the first few months of Depo and it should improve.

Question 17

William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for _______ before prescribing sildenafil.
1. Renal dysfunction
2. Unstable coronary artery disease
3. Benign prostatic hypertrophy
4. History of priapism

Answer 17

2. Unstable coronary artery disease

Question 18

Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:
1. Development of chest pain or dizziness
2. Weight gain
3. Priapism
4. Renal function

Answer 18

1. Development of chest pain or dizziness

Question 19

Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for:
1. Impotence when combined with antihypertensives
2. Fatal hypotension if combined with nitrates
3. Weight gain if combined with antidepressants
4. All of the above

Answer 19

2. Fatal hypotension if combined with nitrates

Question 20

Androgens are indicated for:
1. Symptomatic treatment for male deficiency
2. Female libido, endometriosis, and postmenopausal symptoms
3. Increased muscle mass
4. Symptomatic treatment in both sexes for cancer and HIV
5. 1, 2, and 4
6. All of the above

Answer 20

5. 1, 2, and 4
6. Symptomatic treatment for male deficiency
7. Female libido, endometriosis, and postmenopausal symptoms
8. Symptomatic treatment in both sexes for cancer and HIV

Question 21

Long-term use of androgens requires specific laboratory monitoring of:
1. Glucose, calcium, testosterone, and thyroid function
2. Calcium, testosterone, PSA, and liver function
3. Calcium, testosterone, PSA, liver function, glucose, and lipids
4. CBC, testosterone, PSA, and thyroid level

Answer 21

3. Calcium, testosterone, PSA, liver function, glucose, and lipids

Question 22

Effects of estrogen include:
1. Regulation of the menstrual cycle
2. Maintenance of bone density by increasing bone reabsorption
3. Maintenance of the normal structure of the skin and blood vessels
4. 1 and 3
5. All of the above

Answer 22

4. 1 and 3
5. Regulation of the menstrual cycle
6. Maintenance of the normal structure of the skin and blood vessels

Question 23

Absolute contraindications that clinicians must consider when initiating estrogen therapy include:
1. Undiagnosed dysfunctional uterine bleeding
2. Deep vein or arterial thromboemboli within the prior year
3. Endometriosis
4. 1 and 2
5. All of the above

Answer 23

4. 1 and 2
5. Undiagnosed dysfunctional uterine bleeding
6. Deep vein or arterial thromboemboli within the prior year

Question 24

Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent:
1. Nausea
2. Breakthrough bleeding
3. Breast tenderness
4. Pregnancy

Answer 24

2. Breakthrough bleeding

Question 25

Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:
1.Hemoglobin
2.Serum calcium
3.White blood count
4.Serum potassium

Answer 25

4. Serum potassium

Question 26

The mechanism of action of oral combined contraceptives that prevents pregnancy is:
1.Estrogen prevents the luteinizing hormone surge necessary for ovulation.
2.Progestins thicken cervical mucus and slow tubal motility.
3.Estrogen thins the endometrium making implantation difficult.
4.Progestin suppresses follicle stimulating hormone release.

Answer 26

2.Progestins thicken cervical mucus and slow tubal motility.

Question 27

To improve actual effectiveness of oral contraceptives women should be educated regarding:
1.Use of a back-up method if they have vomiting or diarrhea during a pill packet
2.Doubling pills if they have diarrhea during the middle of a pill pack
3.The fact that they will have a normal menstrual cycle if they miss two pills
4.The fact that mid-cycle spotting is not normal and the provider should be contactedimmediately

Answer 27

1.Use of a back-up method if they have vomiting or diarrhea during a pill packet

Question 28

A contraindication to the use of combined contraceptives is:
1.Adolescence (not approved for this age)
2.A history of clotting disorder
3.Recent pregnancy
4.Being overweight

Answer 28

2.A history of clotting disorder

Question 29

Obese women may have increased risk of failure with which contraceptive method?
1.Combined oral contraceptives
2.Progestin-only oral contraceptive pill
3.Injectable progestin
4.Combined topical patch

Answer 29

4.Combined topical patch

Question 30

Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend, so she would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:
1.Recommend she return to the clinic at the start of her next menses to get aDepo Provera shot.
2.Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a backup method for the first 7 days.
3.Prescribe oral contraceptives and have her start them the same day as the visit with a backup method used for the first 7 days.
4.Discuss the advantages of using the topical birth control patch and recommend she
consider using the patch.

Answer 30

3.Prescribe oral contraceptives and have her start them the same day as the visit with a backup method used for the first 7 days.

Question 31

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:
1. Immediate protection against pregnancy the first week of using the pill
2. No back-up method is needed when starting
3. Menses occur during the week
4. They can start the pill on the Sunday after the office visit

Answer 31

3. Menses occur during the week

Question 32

The topical patch combined contraceptive (Ortho Evra) is:
1. Started on the first day of the menstrual cycle
2. Recommended for women over 200 pounds
3. Not as effective as oral combined contraceptives
4. Known to have more adverse effects, such as nausea, than the oral combined contraceptives

Answer 32

1. Started on the first day of the menstrual cycle

Question 33

Progesterone-only pills are recommended for women who:
1. Are breastfeeding
2. Have a history of migraine
3. Have a medical history that contradicts the use of estrogen
4. All of the above

Answer 33

4. All of the above

Question 34

Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?
1. Increased migraine headaches
2. Increased risk of developing blood clots
3. Irregular vaginal bleeding for the first few months
4. Increased risk for hypercalcemia

Answer 34

3. Irregular vaginal bleeding for the first few months

Question 35

An advantage of using the NuvaRing vaginal ring for contraception is:
1. It does not require fitting and is easy to insert.
2. It is inserted once a week, eliminating the need to remember to take a daily pill.
3. Patients get a level of estrogen and progestin equal to combined oral contraceptives.
4. It also provides protection against vaginal infections.

Answer 35

1. It does not require fitting and is easy to insert.

Question 36

Oral emergency contraception (Plan B) is contraindicated in women who:
1. Had intercourse within the past 72 hours
2. May be pregnant
3. Are taking combined oral contraceptives
4. Are using a diaphragm

Answer 36

2. May be pregnant

Question 37

The goals of treatment when prescribing for sexually transmitted infections include:
1.Treatment of infection
2.Prevention of disease spread
3.Prevention of long-term sequelae from the infection
4.All of the above

Answer 37

4.All of the above

Question 38

The drug of choice for treatment of primary or secondary syphilis is:
1.Ceftriaxone IM
2.Benzathine penicillin G IM
3.Oral azithromycin
4.Oral ciprofloxacin

Answer 38

2.Benzathine penicillin G IM

Question 39

The drug of choice for treatment of early latent or tertiary syphilis is:
1.Ceftriaxone IM
2.Benzathine penicillin G IM
3.Oral azithromycin
4.Oral ciprofloxacin

Answer 39

2.Benzathine penicillin G IM

Question 40

Demione is a 24-year-old patient who is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be:
1.IM ceftriaxone
2.IM benzathine penicillin G
3.Oral azithromycin
4.Any of the above

Answer 40

2.IM benzathine penicillin G

Question 41

Treatment for suspected gonorrhea is:
1.Ceftriaxone 250 mg IM x 1
2.Ceftriaxone 2 grams IM x 1
3.Ciprofloxacin 500 mg PO x 1
4.Doxycycline 100 mg bid x 7 days

Answer 41

1.Ceftriaxone 250 mg IM x 1

Question 42

When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with:
1.Azithromycin 1-gram PO x 1
2.Amoxicillin 500 mg PO x 1
3.Ciprofloxacin 500 mg PO x 1
4.Penicillin G 2.4 million units IM x 1

Answer 42

1.Azithromycin 1-gram PO x 1

Question 43

Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened forgonorrhea and chlamydia in:
1.4 weeks
2.3 to 6 weeks
3.3 to 6 months
4.1 year

Answer 43

3.3 to 6 months

Question 44

A test of cure is recommended after treating chlamydia in which patient population?
1. Men who have sex with men
2. Adolescent females
3. Pregnant patients
4. All of the above

Answer 44

3. Pregnant patients

Question 45

Treatment for chancroid in a nonpregnant patient would be:
1. Oral azithromycin
2. IM ceftriaxone
3. Oral ciprofloxacin
4. Any of the above

Answer 45

4. Any of the above

Question 46

Jamie was treated for chancroid. Follow-up testing after treatment of chancroid would be:
1. Syphilis and HIV testing at 3-month intervals
2. Chancroid-specific antigen test every 3 months
3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure
4. Annual HIV testing if engaging in high-risk sexual behavior

Answer 46

1. Syphilis and HIV testing at 3-month intervals

Question 47

Helima presents with a complaint of vaginal discharge that, when tested, meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be:
1. Metronidazole 500 mg PO bid x 7 days
2. Doxycycline 100 mg PO bid x 7 days
3. Intravaginal tinidazole daily x 5 days
4. Metronidazole 2 grams PO x 1 dose

Answer 47

1. Metronidazole 500 mg PO bid x 7 days

Question 48

Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding the fact that:
1. The most recent partners in the past 60 days should also be treated.
2. Alcohol should not be consumed during and for 1 day after metronidazole is taken.
3. Condoms should be used during intercourse if intravaginal clindamycin cream is used.
4. Co-treatment for chlamydia is necessary.

Answer 48

2. Alcohol should not be consumed during and for 1 day after metronidazole is taken.

Question 49

Sydney presents to the clinic with vulvovaginal candidiasis. Appropriate treatment for her would be:
1. OTC intravaginal clotrimazole
2. OTC intravaginal miconazole
3. Oral fluconazole one-time dose
4. Any of the above

Answer 49

4. Any of the above

Question 50

If a woman presents with recurrent vulvovaginal candidiasis, she may be treated with:
1. Weekly intravaginal butoconazole for 3 months
2. Fluconazole 150 mg PO daily x 7 doses then monthly for 6 months
3. Weekly fluconazole 150 mg PO x 6 months
4. Intravaginal tioconazole x 14 days

Answer 50

3. Weekly fluconazole 150 mg PO x 6 months

Question 51

Zoe presents with genital warts present on her labia. Patient-applied topical therapy for warts includes:
1. Podofilox 0.5% gel
2. Podophyllin 10% resin
3. Trichloracetic acid
4. Any of the above

Answer 51

1. Podofilox 0.5% gel

Question 52

Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have a Trichomonas infection. Treatment for her would include:
1. Metronidazole 2 grams PO x 1 dose
2. Topical intravaginal metronidazole daily x 7 days
3. Intravaginal clindamycin daily x 7 days
4. Azithromycin 2 grams PO x 1 dose

Answer 52

1. Metronidazole 2 grams PO x 1 dose

Question 53

In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding:
1. Necessity of treating sexual partner simultaneously
2. Abstaining from intercourse until both partners are treated
3. Need for retesting in 3 months due to high reinfection rate
4. All of the above

Answer 53

4. All of the above

Question 54

The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:
1.Cardiovascular risk
2.Risk of stroke or other thromboembolic event
3.Breast cancer
4.Vasomotor symptoms

Answer 54

4.Vasomotor symptoms

Question 55

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:
1.2 years
2.5 years
3.10 years
4.15 years

Answer 55

2.5 years

Question 56

Dosage changes of conjugated equine estrogen (Premarin) are made at intervals.
1.1 to 2 weeks
2.2 to 4 weeks
3.6 to 8 weeks
4.12 weeks

Answer 56

3.6 to 8 weeks

Question 57

The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is:
1.Ability to deliver higher doses of estrogen in a non-oral form
2.The vaginal cream formula provides moisture to the vaginal area
3.Relief of symptoms without increasing cardiovascular risk
4.All of the above

Answer 57

3.Relief of symptoms without increasing cardiovascular risk

Question 58

Women with an intact uterus should be treated with both estrogen and progestin due to:
1.Increased risk for endometrial cancer if estrogen alone is used
2.Combination therapy provides the best relief of menopausal vasomotor symptoms
3.Reduced risk for colon cancer with combined therapy
4.Lower risk of developing blood clots with combined therapy

Answer 58

1. Increased risk for endometrial cancer if estrogen alone is used

Question 59

Ongoing monitoring for women on ERT includes:
1.Lipid levels, repeated annually if abnormal
2.Annual health history and review of risk profile
3.Annual mammogram
4.All of the above

Answer 59

4.All of the above

Question 60

Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencingduring menopause. Education for a woman considering hormone replacement would include:
1.Explaining that HRT is totally safe if used short term
2.Telling her to ignore media hype regarding HRT
3.Discussing the advantages and risks of HRT
4.Encouraging the patient to use phytoestrogens with the HRT

Answer 60

3.Discussing the advantages and risks of HRT

Question 61

Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?
1. She is correct, black women do not have much risk of developing osteoporosis due to their dark skin.
2. Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.
3. If she doesn’t drink alcohol, her risk of developing osteoporosis is low.
4. If she has not lost more than 10% of her weight lately, her risk is low.

Answer 61

2. Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.

Question 62

Drugs that increase the risk of osteoporosis developing include:
1. Oral combined contraceptives
2. Carbamazepine
3. Calcium channel blockers
4. High doses of vitamin D

Answer 62

2. Carbamazepine

Question 63

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:
1. Inhibiting magnesium resorption in the kidneys
2. Increasing calcium absorption from the GI tract
3. Acting on the bone to inhibit osteoblast activity
4. Selectively acting on the estrogen receptors in the bone

Answer 63

4. Selectively acting on the estrogen receptors in the bone

Question 64

Sallie has been diagnosed with osteoporosis and is asking about the “once a month” pill to treat her
condition. How do bisphosphonates treat osteoporosis?
1. By selectively activating estrogen pathways in the bone
2. By reducing bone resorption by inhibiting parathyroid hormone (PTH)
3. By reducing bone resorption and inhibiting osteoclastic activity
4. By increasing PTH production

Answer 64

3. By reducing bone resorption and inhibiting osteoclastic activity

Question 65

Inadequate vitamin D intake can contribute to the development of osteoporosis by:
1. Increasing calcitonin production
2. Increasing calcium absorption from the intestine
3. Altering calcium metabolism
4. Stimulating bone formation

Answer 65

2. Increasing calcium absorption from the intestine

Question 66

The drug recommended as primary prevention of osteoporosis in women over age 70 years is:
1. Alendronate (Fosamax)
2. Ibandronate (Boniva)
3. Calcium carbonate
4. Raloxifene (Evista)

Answer 66

1. Alendronate (Fosamax)

Question 67

The drug recommended as primary prevention of osteoporosis in men over age 70 years is:
1. Alendronate (Fosamax)
2. Ibandronate (Boniva)
3. Calcium carbonate
4. Raloxifene (Evista)

Answer 67

1. Alendronate (Fosamax)

Question 68

The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is:
1. Annual dual-energy x-ray absorptiometry (DEXA) scans
2. Annual vitamin D level
3. Annual renal function evaluation
4. Electrolytes every 3 months

Answer 68

3. Annual renal function evaluation

Question 69

Bisphosphonate administration education includes:
1. Taking it on a full stomach
2. Requiring sitting erect for at least 30 minutes afterward
3. Drinking it with orange juice
4. Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach

Answer 69

2. Requiring sitting erect for at least 30 minutes afterward

Question 70

IV forms of bisphosphonates are used for all the following except:
1. Severe gastric irritation with oral forms
2. Known cancer mets into the bone
3. Persons with advancing renal dysfunction
4. Progression of bone loss on oral formulations

Answer 70

3. Persons with advancing renal dysfunction

Question 71

What is the established frequency of repeating DEXA imaging after stating bisphosphonates?
1. Every 2 years
2. Every 5 years
3. There is no evidence-based time line for monitoring after the first 2 years
4. There need to be annual exams

Answer 71

3. There is no evidence-based time line for monitoring after the first 2 years

Question 72

What is the duration of SERM use for menopausal issues?
1. It matches the 5 years for estrogen products
2. The bone health impact allows long-term use
3. The increased risk of breast cancer encourages tapering as soon as possible
4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur

Answer 72

2. The bone health impact allows long-term use

Question 73

Why are SERMS generally not ordered for women early into menopause?
1. The rapid onset of severe hot flashes can be unbearable.
2. The bone remodeling effect results in osteoporosis.
3. They tend to induce intermittent spotting.
4. They create more risk with breast cancer than they are worth.

Answer 73

1. The rapid onset of severe hot flashes can be unbearable.

Question 74

A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2
1.converts arachidonic acid into a chemical mediator for inflammation.
2.directly causes vasodilation and increased capillary permeability.
3.irritates the gastric mucosa to cause gastrointestinal upset.
4.releases prostaglandins, which cause inflammation and pain in tissues.

Answer 74

1.converts arachidonic acid into a chemical mediator for inflammation.

Question 75

A nursing student asks how nonsteroidal anti-inflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
1.exert direct actions to cause relaxation of smooth muscle.
2.inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
3.interfere with neuronal pathways associated with prostaglandin action.
4.suppress prostaglandin activity by blocking tissuereceptor sites.

Answer 75

2.inhibit cyclooxygenase that is necessary for prostaglandin synthesis.

Question 76

A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?
1.Counsel the patient to discuss a prescription NSAID with the provider.
2.Recommend adding aspirin to increase the anti-inflammatory effect.
3.Suggest asking the provider about a short course of corticosteroids.
4.Tell the patient to increase the dose to 800 mgevery 4 hours.

Answer 76

1.Counsel the patient to discuss a prescription NSAID with the provider.

Question 77

A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin
1. increases gastrointestinal secretions.
2. increases hypersensitivity reactions.
3. inhibits both COX-1 and COX-2.
4. is an acidic compound.

Answer 77

3. inhibits both COX-1 and COX-2.

Question 78

A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient’s provider to discuss changing from aspirin to which drug?
1. A COX-2 inhibitor
2. Celecoxib (Celebrex)
3. Enteric-coated aspirin
4. Nabumetone (Relafen)

Answer 78

3. Enteric-coated aspirin

Question 79

A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason?
1. It can result in adverse effects on her fetus.
2. It causes an increased risk of Reyes syndrome.
3. It increases hemorrhage risk.
4. It will cause increased gastrointestinal distress.

Answer 79

1. It can result in adverse effects on her fetus.

Question 80

The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication?
1. Aspirin (Bayer)
2. Acetaminophen (Tylenol)
3. Anakinra (Kineret)
4. Prednisone (Deltasone)

Answer 80

1. Aspirin (Bayer)

Question 81

The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
1. A normal serum aspirin level is between 30 and 40 mg/dL.
2. You may need to stop taking this drug a week prior to surgery.
3. You will need to monitor aspirin levels if you are also taking warfarin.
4. Your stools may become dark, but this is a harmless side effect.

Answer 81

2. You may need to stop taking this drug a week prior to surgery.

Question 82

A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action?
1. Assess the patient for tinnitus.
2. Monitor the patient for signs of Reyes syndrome.
3. Notify the provider of severe aspirin toxicity.
4. Request an order for an increased aspirin dose.

Answer 82

1. Assess the patient for tinnitus.
   mild toxicity starts at 30_mg/dL

Question 83

The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching?
1. I should limit sodium intake while taking this drug.
2. I should take indomethacin on an empty stomach.
3. I will need to check my blood pressure frequently.
4. I will take the medication twice daily.

Answer 83

2. I should take indomethacin on an empty stomach.

Question 84

The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication?
1. Diclofenac sodium (Voltaren)
2. Ketoprofen (Orudis)
3. Ketorolac (Toradol)
4. Naproxyn (Naprosyn)

Answer 84

3. Ketorolac (Toradol)

Question 85

A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient?
1. It may take several weeks to achieve therapeutic effects.
2. Unlike aspirin, there is no increased risk of bleeding with ibuprofen.
3. Take ibuprofen twice daily for maximum analgesic benefit.
4. Combine ibuprofen with acetaminophen for best effect.

Answer 85

1. It may take several weeks to achieve therapeutic effects.

Question 86

The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action?
1. Assess the patient for drug-seeking behaviors.
2. Notify the provider that the drug is not effective.
3. Reassure the patient that swelling will decrease eventually.
4. Remind the patient that this drug is given for pain only.

Answer 86

2. Notify the provider that the drug is not effective.

Question 87

The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?
1. Do not take the medication during the first 2 days of your period.
2. The initial dose will be twice the amount of subsequent doses.
3. Take this medication with food to minimize gastrointestinal upset.
4. Take the drug on a regular basis to prevent dysmenorrhea.

Answer 87

2. The initial dose will be twice the amount of subsequent doses.

Question 88

The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need?
1. Calcium level
2. Complete blood count
3. Electrolytes
4. Potassium

Answer 88

2. Complete blood count
   agranulocytosis

Question 89

The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?
1. Avoid all alcohol except beer.
2. Include salmon in the diet.
3. Increase fluid intake.
4. Take on an empty stomach.

Answer 89

3. Increase fluid intake.

Question 90

Which antigout medication is used to treat chronic tophaceous gout?
1. Allopurinol (Zyloprim)
2. Colchicine
3. Probenecid (Benemid)
4. Sulfinpyrazone (Anturane)

Answer 90

1. Allopurinol (Zyloprim)

Question 91

The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which laboratory result?
1. Elevated BUN and creatinine
2. Increased serum uric acid
3. Slight increase in the white blood count
4. Increased serum glucose

Answer 91

1. Elevated BUN and creatinine

Question 92

The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates an understanding of the teaching?
1. I should increase my vitamin C intake.
2. I will get yearly eye exams.
3. I will increase my protein intake.
4. I will limit fluids to prevent edema.

Answer 92

2. I will get yearly eye exams.

Question 93

Which are characteristic signs of inflammation? (Select all that apply.)
1. Edema
2. Erythema
3. Heat
4. Numbness
5. Pallor
6. Paresthesia

Answer 93

1. Edema
2. Erythema
3. Heat