pharm II Flashcards
A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which
statement by the student indicates the need for further teaching?
a. “Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins.”
b. “Dilation of arterioles has a direct effect on arterial pressure.”
c. “Dilation of veins by alpha-adrenergic antagonists improves cardiac output.”
d. “Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure.”
ANS: C
Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic
antagonists. Alpha-adrenergic antagonists block alpha1 receptors on both arterioles and veins.
When alpha1 receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct
effect on arterial pressure occurs. When alpha1 receptors on veins are blocked by alpha-
adrenergic antagonists, an indirect effect on arterial pressure occurs
- A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-
blocking agent to be given preoperatively. What does the nurse understand about this agent?
a. It is ordered to prevent perioperative hypertensive crisis.
b. It prevents secretion of catecholamines by the adrenal tumor.
c. It reduces contraction of smooth muscles in the adrenal medulla.
d. It is given chronically after the surgery to prevent hypertension.
ANS: A
Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive
catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute
hypertension during surgery. These agents do not prevent secretion of catecholamines; they
block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They
are given chronically in patients who have inoperable tumors
- The nurse is discussing home management with a patient who will begin taking an alpha-
adrenergic antagonist for hypertension. Which statement by the patient indicates
understanding of the teaching?
a. “I need to stop the medication if my heart rate increases.”
b. “I should not drive while taking this medication.”
c. “I should take the first dose at bedtime.”
d. “I will stop taking the medication if I feel dizzy.”
ANS: C
Orthostatic hypotension is a common side effect of this class of drugs and is most severe with
the first dose. Administering the first dose at bedtime eliminates the risk associated with this
first-dose effect. Tachycardia is an expected side effect; if severe, it can be treated with other
medications. Patients should not drive during the first 12 to 24 hours after taking these agents,
because fainting and dizziness may occur, but they may drive after that. Dizziness is not an
indication for stopping the drug; patients who experience dizziness are instructed to sit or lie
down until symptoms pass.
A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the
nurse how the drug works to relieve the discomfort associated with this condition. Which
statement by the patient after the nurse’s teaching indicates understanding of the drug’s effects?
a. “It causes bronchodilation, which increases oxygen flow.”
b. “It helps reduce the heart’s oxygen needs.”
c. “It improves blood flow to the heart.”
d. “It increases cardiac output.”
ANS: B
Blockade of beta1 receptors in the heart reduces cardiac work by reducing the heart rate, the
force of contraction, and the velocity of impulse conduction through the AV node. Beta
blockers result in bronchoconstriction, not bronchodilation. They do not increase blood flow
to the heart. Cardiac output is decreased, not increased.
A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the
nurse is important when teaching this patient about the medication?
a. “Check your hands and feet for swelling and report that to your provider.”
b. “It is safe to take this medication with a calcium channel blocker.”
c. “Stop taking the drug if you become short of breath.”
d. “Take your pulse and do not take the medication if your heart rate is fast.”
Patients taking propranolol can develop heart failure because of the suppression in myocardial
contractility. Patients should be taught to watch for signs, which include shortness of breath,
night coughs, and swelling of the extremities. Use of these agents with calcium channel
blockers is contraindicated, because the effects are identical and excessive cardiosuppression
can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the
drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not
be given if the pulse is less than 60 beats per minute
- A patient who has been diagnosed with rheumatoid arthritis for 1 month and has
generalized symptoms is taking high-dose NSAIDs and an oral glucocorticoid. The provider
has ordered methotrexate (Rheumatrex). The patient asks the nurse why methotrexate is
necessary since pain and swelling have been well controlled with the other medications. The
nurse will tell the patient that:
a. a methotrexate regimen can reduce overall costs and side effects of treatment.
b. starting methotrexate early can help delay joint degeneration.
c. starting methotrexate now will help increase life expectancy.
d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels.
ANS: B
Current guidelines for treatment of RA recommend starting a DMARD early—within 3
months of diagnosis for most patients—in order to delay joint degeneration. Methotrexate
may take up to 3 to 6 weeks to be at therapeutic levels, so NSAIDs and glucocorticoids should
be continued until this occurs. Methotrexate is expensive and has more toxic side effects.
Patients taking methotrexate have been shown in some data to have decreased life expectancy.
Patients may eventually be able to stop taking NSAIDs altogether
- A patient is beginning therapy with oral methotrexate (Rheumatrex) for rheumatoid arthritis.
The nurse will teach this patient about the importance of:
a. having routine renal and hepatic function tests.
b. limiting folic acid consumption.
c. reporting alopecia and rash.
d. taking the medication on a daily basis.
ANS: A
Periodic tests of renal and liver function are mandatory for patients taking methotrexate.
Patients taking methotrexate should take folic acid supplements. Alopecia and rash are not
worrisome side effects. Methotrexate is taken once weekly
- A patient with rheumatoid arthritis is taking leflunomide (Arava) and an oral contraceptive.
She tells the nurse she would like to get pregnant. What will the nurse tell her? a.
That leflunomide is not dangerous during the first trimester of pregnancy
b. That plasma levels of leflunomide will drop rapidly when she stops taking it
c. To ask her provider about an 11-day course of cholestyramine
d. To stop taking leflunomide when she stops using contraception
ANS: C
Leflunomide is contraindicated during pregnancy. Patients desiring pregnancy must follow a
three-step protocol that includes stopping the drug, taking cholestyramine to chelate the
leflunomide, and ensuring that leflunomide drug levels are below 20 mcg/L before getting
pregnant. Leflunomide is teratogenic and is not safe during pregnancy. Plasma levels of
leflunomide may take 2 years to drop without using cholestyramine. It is not correct to stop
taking leflunomide without following the protocol.
- A patient will begin taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis. The patient
is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
a. That an eye exam is necessary at the beginning of therapy with this drug
b. That the dose of NSAIDs may be decreased when beginning hydroxychloroquine
c. To obtain tests of renal and hepatic function while taking this drug
d. To stop taking methotrexate when starting hydroxychloroquine
ANS: A
Hydroxychloroquine can cause retinal damage so an eye exam is necessary at the onset of
treatment as well as every 6 months during treatment. Patients taking other drugs should
continue to take those when beginning treatment with hydroxychloroquine since full
therapeutic effects take months to develop. Renal and hepatic toxicity are not concerns. The
drug is usually combined with methotrexate.
- A patient will begin taking etanercept (Enbrel) for severe rheumatoid arthritis. The patient has
been taking methotrexate (Rheumatrex). The patient asks if the etanercept is stronger than the
methotrexate. The nurse will tell the patient that etanercept _____ methotrexate.
a. has synergistic effects with
b. helps reduce adverse effects associated with
c. is better at delaying progression of joint damage than
d. has fewer adverse effects than
ANS: C
Etanercept has been shown to reduce symptoms in patients with moderate to severe RA who
have not responded to methotrexate. It does not have synergistic effects with methotrexate or
reduce adverse effects of methotrexate. It has many adverse effects.
A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest
radiograph is negative. The nurse will expect this patient to:
a. begin taking antituberculosis drugs at the beginning of treatment with etanercept.
b. have periodic chest radiographs during treatment with etanercept.
c. have regular monitoring of symptoms to detect active tuberculosis.
d. undergo tuberculosis treatment prior to beginning etanercept treatment.
ANS: D
Since TB in a patient taking etanercept is often extrapulmonary and disseminated, it is
important to test all patients for TB. Those who test positive for latent TB should be treated
for TB before etanercept treatment is begun. It is not correct to begin TB treatment
concurrently with etanercept treatment. Latent TB must be treated and not monitored.
- A child has juvenile idiopathic arthritis and will begin a course of etanercept (Enbrel). The nurse
will conduct a thorough health history with special attention to:
a. bone growth development.
b. immunization status.
c. pulmonary function.
d. seasonal allergies.
ANS: B
Patients beginning therapy with etanercept should be fully immunized to prevent the risk of
communicable diseases as well as to avoid giving live-virus vaccines, since etanercept
suppresses immunity. Bone growth development, pulmonary function, and seasonal allergies
are not of special concern with this drug
- A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a
nursing student. Which statement by the student indicates a need for further education about the
care of a patient receiving this drug?
a. “Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild.”
b. “I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed.”
c. “I will administer an antihistamine and acetaminophen before beginning the infusion.”
d. “I will monitor this patient’s blood pressure, respiratory rate, and oxygen saturation
closely.”
ANS: A
Rituximab can cause severe infusion-related hypersensitivity reactions. Nurses should be
prepared to administer epinephrine, steroids, and O2 if needed. Antihistamines and
acetaminophen are given before infusion. Close monitoring of vital signs and oxygenation are
indicated
- A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir
(Zovirax) 400 mg PO BID for 10 days. After 7 days of therapy, the patient reports having an
increased number of lesions. The nurse will expect the provider to:
a. extend this patient’s drug
therapy to BID for 12 months.
b. give intravenous foscarnet every 8 hours for 2 to 3 weeks.
c. increase the acyclovir dose to 800 mg PO 5 times daily.
d. order intravenous valacyclovir (Valtrex) 1 gm PO BID for 10 days.
ANS: B
Foscarnet is active against all known herpesviruses and is used in immunocompromised
patients with acyclovir-resistant HSV or VZV. This patient is demonstrating resistance to
acyclovir, so extending acyclovir therapy or increasing the acyclovir dose will not be
effective. Valacyclovir is not approved for use in immunocompromised patients because of
the risk for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks
the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the
patient that:
a. antiviral medications are not safe during pregnancy.
b. intravenous antiviral agents will be used if an outbreak occurs.
c. oral acyclovir (Zovirax) may be used during pregnancy.
d. topical acyclovir (Zovirax) must be used to control outbreaks.
ANS: C
Oral acyclovir is devoid of serious adverse effects and may be used safely during pregnancy.
It is incorrect to tell this patient that antiviral medications are not safe during pregnancy. Oral
acyclovir is used to suppress recurrent genital herpes near term; intravenous antiviral
medications are not indicated. It is not necessary to rely on topical medications because oral
acyclovir is safe
The nurse is caring for a patient receiving intravenous acyclovir (Zovirax). To prevent
nephrotoxicity associated with intravenous acyclovir, the nurse will:
a. hydrate the patient during the infusion and for 2 hours after the infusion.
b. increase the patient’s intake of foods rich in vitamin C.
c. monitor urinary output every 30 minutes.
d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
ANS: A
The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2
hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help
prevent nephrotoxicity. Monitoring urine output is important but would not help prevent
nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion
A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing
treatment with acyclovir. After 2 weeks, the patient’s dose is increased to 90 mg/kg over 2 hours
from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling.
What will the nurse do?
a. Notify the provider and request an order for a serum calcium level.
b. Notify the provider of potential foscarnet overdose.
c. Request an order for a creatinine clearance level.
d. Request an order of IV saline to be given before the next dose.
ANS: A
Foscarnet frequently causes hypocalcemia and other electrolyte and mineral imbalances.
Paresthesias, numbness in the extremities, and perioral tingling can indicate hypocalcemia, so
a calcium level should be drawn. These are not signs of foscarnet overdose. Nephrotoxicity
may occur, but these are not signs of renal complications, so a creatinine clearance is not
indicated. If nephrotoxicity occurs, prehydration with IV saline is indicated to reduce the risk
of renal injury
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission
laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and
inflammation. The nurse will prepare this patient for:
a. dual therapy with pegylated interferon alfa and ribavirin.
b. no medication therapy at this time.
c. pegylated interferon alfa only until ALT levels are elevated.
d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.
ANS: B
Current recommendations are that treatment is used only for patients with HCV viremia,
persistent elevation of ALT, and evidence of hepatic fibrosis and inflammation upon liver
biopsy. Dual therapy has been the regimen of choice for patients with the above symptoms,
but the addition of a protease inhibitor has been shown to improve outcomes. It is not correct
to give pegylated interferon alfa until ALT levels are elevated. Triple drug therapy is used for
patients with the above symptoms.
A nursing student asks a nurse why pegylated interferon alfa is used instead of regular
interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:
a. decreases the need for additional medications.
b. has fewer adverse effects than interferon.
c. is administered less frequently than interferon.
d. may be given orally to increase ease of use
Pegylated interferon alfa preparations are preferred because of their convenience and superior
efficacy. These preparations may be given once weekly instead of three or more times per
week like the regular interferon. Using pegylated interferons does not decrease the need for
additional medications. Pegylated interferons have similar adverse effects. Pegylated
interferons are not given orally.
A female patient who has hepatitis C is being treated with pegylated interferon alfa and
ribavirin (Ribasphere). It will be important for the nurse to teach this patient that: a. if she gets
pregnant, she should use the inhaled form of ribavirin (Virazole).
b. if she is taking oral contraceptives, she should also take a protease inhibitor.
c. she should use a hormonal contraceptive to avoid pregnancy.
d. she will need a monthly pregnancy test during her treatment.
ANS: D
Ribavirin causes severe fetal injury and is contraindicated during pregnancy. Women taking
ribavirin must rule out pregnancy before starting the drug, monthly during treatment, and
monthly for 6 months after stopping treatment. Inhaled ribavirin is also embryo lethal and
teratogenic. Adding a protease inhibitor will reduce the efficacy of oral contraceptives.
Women using ribavirin should use two reliable forms of birth control.
