Renal patho, NP, pharm

Question 1

patho

Poorly controlled diabetes could have led to Mr Tan’s chronic kidney disease. How should the nurse explain the pathogenesis of chronic kidney disease resulting from diabetes mellitus type 2?

A. High blood sugar can damage small blood vessels in the kidneys eventually affecting filtration and other kidney functions.”

B. “Elevated sugar levels can increase the risk for infections which can ultimately affect kidney function.”

C. “If sugar levels are not maintained, they can cause an inflammatory response in the kidneys which results in damage.”

D. “Increased blood sugar affects the large blood vessels within the kidneys that reduces the kidneys’ filtering capacity.”

Answer 1

A

Question 2

patho

The doctor advised Mr Song’s nurse to observe if the ulcer becomes open with partial thickness loss of skin. This is an indication that the pressure ulcer has progressed to:

A. stage 1

B. stage 2

C. stage 3.

D. stage 4

Answer 2

B

Question 3

patho

ABG analysis was done on an AKl patient and revealed metabolic acidosis. What parameter changes should the nurse expect from the results that support this acid-base imbalance?

A. Increased pH, decreased PaCO2 decreased HCO3

B. Increased pH, Increased PaCO2 increased HCO3

C. Decreased pH, Increased PaCO2 Increased HCO3

D. Decreased pH, decreased PaCO2 decreased HCO3

Answer 3

D
Respi acidosis: HCO3 normal
Metabolic acidosis: HCO3 decreased because they bind to H+ to form carbonic acid H2CO3

Question 4

Patho

Digital rectal examination was performed on Mr Chew. Which of the following findings suggest the presence of benign prostatic hyperplasia? The prostate is:

A. warm to touch.

B. nodular and hard,

C. enlarged and rubbery

Answer 4

C

Question 5

patho

Increaged uric acid levels is a risk factor for gouty arthritis. What process(es) is/are involved in its development?

A. Urate super saturation and crystallisation

B. Filtration of urate

C. Hydrolysation of uric acid

D. Electrochemical oxidation of uric acid

Answer 5

A.

Question 6

NPQ: The nurse educates the patient with osteoarthritis (OA) about the importance of:

1. Maintaining a sedentary lifestyle
2. Balancing rest and activity
3. Eating a high-fiber dieta

Answer 6

2

Question 7

NPQ: What is the primary goal of pharmacological therapy in managing gout?

1. Relief of pain and inflammation during acute attacks
2. Reducing blood pressure
3. Increasing fluid intake

Answer 7

1

Question 8

NPQ: What is the primary goal of nutritional managementin CKD?

1. Increase protein intake
2. Promote dietary fiber intake
3. Prevent malnutrition and electrolyte imbalances

Answer 8

3

Question 9

NPQ: Which parameter is closely monitored during -haemodialysis to assess fluid removal?

1. Blood pressure
2. Blood glucose level
3. Blood urea nitrogen (BUN)
4. Body Weight

Answer 9

4

Question 10

NPQ: Which nursing intervention is important to preventcomplications associated with continuous bladder irrigation?

1. Monitoring urine output hourly
2. Changing the irrigation solution every 12 hours
3. Assessing for signs of fluid overload

Answer 10

3

Question 11

NPQ: Which of the following signs or symptoms should prompt immediate medical attention in a post-TURP patient?

1. Mild hematuria with small blood clots
2. Temperature elevation of 1°C above baseline
3. Severe hematuria with large blood clots or decreased urineoutput
4. Mild discomfort at the surgical site

Answer 11

3

Question 12

WEB

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:
A. Hypervolemia
B. Hypokalemia
C. Increased BUN level
D. Decreased Creatinine level

Answer 12

A and C
The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney’s ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood…hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.

Question 13

WEB

_____________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine.*
A. Urea
B. Creatinine
C. Potassium
D. Magnesium

Answer 13

B.
Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.

Question 14

WEB

A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury?
A. Post-renal
B. Intra-renal
C. Pre-renal
D. Intrinsic renal

Answer 14

C.
Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding…patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.

Question 15

WEB

Select all the patients below that are at risk for acute intra-renal injury?
A. A 45 year old male with a renal calculus.
B. A 65 year old male with benign prostatic hyperplasia.
C. A 25 year old female receiving chemotherapy.
D. A 36 year old female with renal artery stenosis.
E. A 6 year old male with acute glomerulonephritis.
F. An 87 year old male who is taking an aminoglycoside medication for an infection.

Answer 15

The answers are: C, E, and F.
These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

Question 16

WEB

A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient?
A. Low-sodium, high-protein, and low-potassium
B. High-protein, low-potassium, and low-sodium
C. Low-protein, low-potassium, and low-sodium
D. High-protein and high-potassium

Answer 16

C.
The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).

** from notes: sodium and fluid restriction diet**

Question 17

WEB CKD

Which patient below is NOT at risk for developing chronic kidney disease?
A. A 58 year old female with uncontrolled hypertension.
B. A 69 year old male with diabetes mellitus.
C. A 45 year old female with polycystic ovarian disease.
D. A 78 year old female with an intrarenal injury.

Answer 17

The answer is C.
risk factors are:
Hypertension (A)
Diabetes mellitus (B)
Recurrent pyelonephritis
Glomerulonephritis
Polycystic kidney disease
Family history of CKD
History of exposure to toxins
Age over 65
Ethnicity
Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD

Question 18

WEB CKD

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood?
A. Calcium
B. Urea
C. Phosphate
D. Erythropoietin

Answer 18

The answer is B.
FROM NOTES: #2 Uraemic syndrome
Retention of metabolic wastes; could manifest as impaired healing, pruritus, dermatitis, uraemic frost (crystallised urea deposits on the skin)
.
.
This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this as well.

Question 19

WEB CKD

You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply:
A. “This medication will help keep my calcium level normal.”
B. “I will take this medication with meals or immediately after.”
C. “It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication.”
D. “This medication will help prevent my phosphate level from increasing.”

Answer 19

The answers are B and D.
FROM NOTES: Calcium acetate treats calcium deficiency and control hyperphosphotemia (D). side effect of abdomen discomfort –> take with food (B)
;
;
Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient’s phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

Question 20

WEB CKD

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:
A. Low protein, low sodium, low potassium, low phosphate diet
B. High protein, low sodium, low potassium, high phosphate diet
C. Low protein, high sodium, high potassium, high phosphate diet
D. Low protein, low sodium, low potassium, high phosphate diet

Answer 20

The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patients will have increased urea levels), low sodium to prevent fluid retention, low potassium to prevent hyperkalemia (remember glomerulus isn’t filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.

Question 21

WEB UTI

You’re caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY:
A. Increased WBC
B. Crystalluria
C. Positive McBurney’s Sign
D. Feeling the need to void even though a catheter is present
E. Dark and cloudy urine
F. Cramping

Answer 21

The answers are A, D, E and F. These are common signs and symptoms of a urinary tract infection. Options B and C are not.

Question 22

WEB UTI

On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:
A. Encourage voiding every 2-3 hours while awake.
B. Restrict fluid intake to 1-2 liters per day.
C. Monitor intake and output daily.
D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of urinary tract infections prior to discharge home.

Answer 22

The answers are A and C.
Option D is wrong become this is not a nursing intervention but a patient goal. In addition, it is an incorrect patient goal for preventing UTIs. Vaginal sprays should be avoided. Option B is wrong because fluid intake should be encouraged of 2-3 liters per day. This will help the urinary system flush out the presenting infection.

Question 23

WEB UTI

You’re providing discharge teaching to a female patient on how to prevent urinary tract infections. Which statement is INCORRECT?
A. “Void immediately after sexual intercourse.”
B. “Avoid wearing tight fitting underwear.”
C. “Try to void every 2-3 hours.”
D. “Use scented sanitary napkins or tampons during menstruation.”

Answer 23

The answer is D.
Options A, B, C are all correct statements in how to avoid a UTI. Option D is wrong because the patient should AVOID scented sanitary napkins or tampons during menstruation. It is also best to use sanitary napkins that are NOT SCENTED and AVOID using tampons (scented or not scented).

Question 24

WEB UTI

A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to prevent which of the following complications?
A. Brown urine
B. Crystalluria
C. Renal Stenosis
D. Renal Calculi

Answer 24

The answer is B. Antibiotics called sulfonamides such as Bactrim (Sulfamethoxazole/Trimethoprim) can cause crystalluria. This complication tends to happen when the urine is concentrated. Therefore, the patient should consume 2.5 to 3L of fluid per day to keep the urine diluted.

Question 25

WEB UTI

The physician orders a urine culture on your patient in room 5505 with a urinary tract infection. In addition, the patient is ordered to start IV Bactrim (Sulfamethoxazole/Trimethoprim). How will you proceed with following this order?
A. First, hang the antibiotic, and then collect the urine culture.
B. First, hang the antibiotic and when the antibiotic is finished infusing collect the urine culture.
C. First, collect the urine culture, and then hang the antibiotic.
D. First, collect the urine culture and then hold the dose of the antibiotic until the urine culture is back from the lab.

Answer 25

The answer is C.
It is very important to collect the urine culture FIRST and then immediately hang the antibiotic. If the antibiotic is hung first it will decrease the lab’s ability to properly identify the bacteria growing in the urine (hence the antibiotic is fighting the infection). It takes approximately 2 days for a urine culture result to come back. Therefore, antibiotic therapy should not be held. The patient needs treatment to prevent the infection from spreading.

Question 26

Pharm

Drugs to avoid in AKI?

Answer 26

Triple whammy:
1. ACE-inhibitors: ‘pril’
2. NSAIDs eg aspirin, ‘coxib’, ibuprofen, naxoprofen
3. diuretics eg furosemide (loop), thiazide, spironolactone (k sparing)

Question 27

pharm

name the drug names and classes for CKD (5 types)

Answer 27

1. Erythropoiesis-stimulating agents/erythopoetin: Epoetin alfa
2. Potassium binder: Sodium polystyrene sulfonate, sodium zirconium cyclosilicate
   3.Ca based potassium binder: Calcium carbonate, Calcium acetate, Sevelamer, Lanthanum
3. Vit D supplement: Calcitriol, cinacalcet
4. Loop diuretic: Furosemide

Question 28

pharm

MOA and purpose of each CKD drug (5)

Answer 28

1. epoetin alfa
   - Stimulate erythropoiesis
   - treats Anaemia
2. Potassium binder: Sodium polystyrene sulfonate, sodium zirconium cyclosilicate
   - Bind to the excess potassium in the bowels excreted from the body through the stool. Capture potassium in exchange for calcium or sodium ions found in the colon
   - treats hyperkalemia
3. Ca based phophate binder: Calcium carbonate, Calcium acetate, Sevelamer, Lanthanum
   - Kidneys excrete 90% of daily phosphate load. Patients with kidney problems can’t regulate phosphate levels.
   - prevent or to treat calcium deficiency and also treat hyperphosphatemia
4. Vit D supplement: Calcitriol, cinacalcet
   - An active form of vitamin D3 elevates the plasma levels of calcium, stimulating intestinal calcium uptake, increasing reabsorption of calcium by the kidneys.
   - treat hyperparathyroidism
5. Loop diuretic: Furosemide
   - inhibiting the luminal Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle binding to the chloride transport channel more sodium, chloride, and potassium to stay in the urine.
   - reduce volume overload

Question 29

pharm

adverse effect of each CKD drug (total 5)?

Answer 29

1. Erythropoiesis-stimulating agents/erythopoetin: Epoetin alfa
   Headache, fever, nausea, diarrhoea, insomnia, cough, URTI, oedema
   Hypertension, seizures, heart failure, MI, stroke
2. Potassium binder: Sodium polystyrene sulfonate, sodium zirconium cyclosilicate
   Oedema, Hypokalaemia (duhh if u overcorrect hyper-K),
   Constipation, Diarrhoea, Fecal impaction, Nausea, Vomiting, Abdominal discomfort, Bloating
   Low calcium and magnesium level, Retention of sodium ions

3.Ca based potassium binder: Calcium carbonate, Calcium acetate, Sevelamer, Lanthanum
Oedema, Hypophosphatemia (duh if overcorrect hyper),
Constipation, Abdominal discomfort, Bloating

4. Vit D supplement: Calcitriol, cinacalcet
   Constipation, excessive night-time urination, bone pain due to high calcium (duh), magnesium and phosphates,
   BUN and creatinine increase, Cardiac arrhythmias
5. Loop diuretic: Furosemide
   Minor hypokalaemia, postural hypotension, tinnitus, nausea, diarrhoea, dizziness, fatigue,
   Significant hypokalaemia, blood dyscrasias (abnormal), dehydration, ototoxicity (inner ear damage), electrolyte imbalance, circulatory collapse

Question 30

pharm

name 2 drugs for incontinence and class

Answer 30

1. Anticholinergics: Oxybutynin, Solifenacin, Tolterodine
2. Beta-3 adrenergic agonist: mirabegron

Question 31

pharm

MoA and adverse effects of the 2 incontinence drugs

Answer 31

both for urge incontinence
1. anticholergenics (eg oxybutynin, tolterodine, solifenacin) SE: blurred vision, dry eyes, mouth, constipation, confusedd and dizzy, rapid heart rate, cannot sweat –> overheat, bladder retains pee (duh)

2. beta-3 adrenergic agonists(eg mirabegron) SE: Urinary retention, Headache, Hypertension, Diarrhoea, Constipation,Upper respiratory tract infection

Question 32

pharm

name 2 drugs class for BPH and example

Answer 32

1. Alpha 1 blocker:
   Tamsulosin, Alfuzosin
2. 5-Alpha-Reductase Inhibitor:
   Finasteride, Dutasteride

Question 33

pharm

MoA and adverse effects (shared) of the 2 BPH drugs

Answer 33

1. Alpha 1 blocker: Tamsulosin, Alfuzosin
   relax bladder neck muscles and muscle fibers
   *osim relaxes muscles
2. 5-Alpha-Reductase Inhibitor: Finasteride, Dutasteride
   reduces the size of the prostate gland
   *steride sounds like steroid, which** reduce **inflammation

SE for both: Dizziness, Postural hypotension, Weakness
Erectile dysfunction, Ejaculation dysfunction

Question 34

pharm

BIG HINT UTI: which part of bacteria does the 5 types of antibiotics target?

Answer 34

1. betalactam eg amoxicillin/clavulamate, aminopenicillin
   target: cell wall (transpeptidation/vertical)
2. fluoroquinolones eg ciprofloxacin
   target: DNA synthesis inhibition (specifically stops replication and transcription)
3. sulfonamides eg Trimethoprim Sulfamethoxazole (TMP-SMZ)/bactrim
   target: folate/folic acid synthesis
4. novel class eg fosfomycin
   target: cell wall (transglycosylation/horizontal)
5. DNA synthesis inhibitor eg nitrofuratoin
   target :duh.
   most specific to UTI

Question 35

NP

2 types of dialysis and complications

Answer 35

1. hemodialysis: Vascular access is typically established through a surgically created arteriovenous fistula (AVF)
   complications: hypotension, muscle cramps, infection
2. peritoneal dialysis: insertion of a peritoneal dialysis catheter into the abdominal cavity
   Complications: peritonitis (infection of the peritoneum), catheter-related
   issues, and fluid imbalances

Question 36

NP

hemodialysis pre and post care + AVF care?
1. Pre-Dialysis Care
Assessment:
assessment of the patient’s __, __, __, ___
Assess vascular access site (AVF) for patency, signs
of infection, and adequate blood flow.
___ administration and consideration
​
2. Post-Dialysis Care
Monitor for__ (due to remove water from body from
dialysis),__ and __ signs
* Check body weight again after dialysis
* Monitor vital signs, patient’s response, comfort level
* Monitor blood results to prevent electrolyte imbalance
* Administer medications as prescribed (serve hypertension and DM medications after dialysis)
​
3. AVF care
Exercising for the AV fistula after surgery: Recommended arm and finger exercises that will strengthen the fistula.
​
Keeping the AV fistula clean to prevent infection:
- Look for __, __, __ around the fistula area.
- a __ can be a sign of infection.
- Clean the AV fistula __ (before/after) dialysis
​
Maintain proper blood flow through the fistula and to reduce the risk of blood clots
- Do not wear __ shirts.
- Do not wear jewelry (such as bracelets) that may restrict blood flow on the access arm.
- When carrying things (groceries, bags, luggage), make sure the straps or handles don’t tighten around the AV fistula.
- blood pressure taken or blood drawn, use the __ arm.
- When sitting or sleeping, make certain that your head, pillow or cushion doesn’t rest on the AV fistula.
​
Checking the AV fistula blood flow daily
- Place your fingers over the AV fistula, you should be able to feel the motion of the ___ flowing through it.
- Listen for blood flow, use a stethoscope and place the __ flat on the AV fistula. The sound hear is called the “__”. Any change in the pitch may indicate a ___ or ___of the fistula. This sound may** change from a ___ noise to a ___ sound**.

Answer 36

1. Pre-Dialysis Care
   Assessment:
   assessment of the patient’s* vital signs, fluid status,
   body weight, and general health status.*
   Assess vascular access site (AVF) for patency, signs
   of infection, and adequate blood flow.
   Medication Administration consideration
2. Post-Dialysis Care
   Monitor for weight loss (due to remove water from body from
   dialysis),** bleeding signs** & infection signs
   * Check body weight again after dialysis
   * Monitor vital signs, bleeding signs, infection signs, patient’s response, comfort level
   * Monitor blood results to prevent electrolyte imbalance
   * Administer medications as prescribed (serve hypertension and DM medications after dialysis)
3. AVF care
   Exercising for the AV fistula after surgery: Recommended arm and finger exercises that will strengthen the fistula.

Keeping the AV fistula clean to prevent infection:
- Look for pain, redness, or swelling around the fistula area.
- a fever can be a sign of infection.
- Clean the AV fistula before dialysis

Maintain proper blood flow through the fistula and to reduce the risk of blood clots
- Do not wear tight-fitting shirts.
- Do not wear jewelry (such as bracelets) that may restrict blood flow on the access arm.
- When carrying things (groceries, bags, luggage), make sure the straps or handles don’t tighten around the AV fistula.
- blood pressure taken or blood drawn, use the non-fistula arm.
- When sitting or sleeping, make certain that your head, pillow or cushion doesn’t rest on the AV fistula.

Checking the AV fistula blood flow daily
- Place your fingers over the AV fistula, you should be able to feel the motion of the blood flowing through it.
- Listen for blood flow, use a stethoscope and place the bell flat on the AV fistula. The sound hear is called the “bruit” (pronounced broo-ee). Any change in the pitch may indicate a clot (thrombolysis) or a narrowing (stenosis) of the fistula. This sound may** change from a whooshing noise to a whistle-like sound**.

Question 37

textbook

The nurse is providing teaching to a patient who has
been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient?
1. Avoid consuming large amounts of kale, cauliflower, or cabbage.
2. Rise slowly from a lying or sitting position to
standing.
3. Count the pulse for one full minute before taking
this medication.
4. Restrict fluid intake to no more than 1 L per
24-hour period.

Answer 37

2.
Loop diuretics such as furosemide
(Lasix) may dramatically reduce a patient’s circulating
blood volume from diuresis and may cause orthostatic
hypotension. To minimize the chance for syncope and
falls, the patient should be taught to rise slowly from a
lying or sitting position to standing. Options 1, 3, and
4 are incorrect. Kale, cauliflower, and cabbage contain
vitamin K, which does not need to be restricted during diuretic therapy. Monitoring the pulse along with
the blood pressure to assess for reflex tachycardia is
advised, but the pulse does not need to be taken for one
full minute before taking the drug. Fluids should not be
restricted during diuretic therapy unless ordered by the
provider.

Question 38

Q5 of chappter 13

. To avoid the first-dose phenomenon, the nurse
knows that the initial dose of prazosin (Minipress)
should be:
1. Very low and given at bedtime.
2. Doubled and given before breakfast.
3. The usual dose and given before breakfast.
4. The usual dose and given immediately after breakfast

Answer 38

Answer: 1
Rationale: Drugs that cause a “first-dose phenomenon” should have very low initial doses administered at bedtime. The decline in blood pressure due to prazosin is often marked when beginning pharmacotherapy and when increasing the dose. This “first dose phenomenon” can lead to syncope due to reduced blood flow to the brain. Options 2, 3, and 4 are incorrect. Doses of antihypertensive medications should
never be doubled, but should be gradually increased to avoid hypotension, and the best time to give prazosin in the initial phases of therapy is at bedtime.

Question 39

chapter 47

A patient with a history of benign prostatic hyperplasia is complaining of feeling like he “cannot empty his
bladder.” He has been taking finasteride (Proscar) for
the past 9 months. What should the nurse advise this
patient to do?
1. Continue to take the drug to achieve full therapeutic effects.
2. Discuss the use of a low-dose diuretic with the
healthcare provider.
3. Decrease the intake of coffee, tea, and alcohol.
4. Return to the healthcare provider for laboratory
studies and a prostate exam.

Answer 39

Answer: 4
Rationale: Finasteride promotes shrinking
of enlarged prostates and helps restore urinary function with full therapeutic effects obtained within 6
to 12 months. Because this patient reports a sudden
increase in urinary symptoms after taking the drug for
9 months, he should be evaluated by the healthcare provider for prostate cancer screening. Options 1, 2, and 3
are incorrect. Continuing to take the dose, or a low-dose
diuretic, with the onset of new symptoms would not
be appropriate. Decreasing bladder irritants, such as
coffee, tea, and alcohol, may help overall but does not
explain the sudden increase in symptoms

Question 40

chapter 47

A patient is given a prescription for finasteride (Proscar) for treatment of benign prostatic hyperplasia.
Essential teaching for this patient includes which of
the following? (Select all that apply.)
1. Full therapeutic effects may take 3 to 6 months.
2. Hair loss or male-pattern baldness may be an
adverse effect.
3. The drug should not be handled by pregnant
women, especially if it is crushed.
4. Blood donation should not occur while taking this
drug.
5. Report any weight gain of over 2 kg (5 lb) in 1
week.

Answer 40

Answer: 1, 3, 4 Rationale: Enlarged prostatic tissue will
decrease over a period of 3 to 6 months. The drug is teratogenic and should not be handled by pregnant women. Blood donation should not occur while taking finasteride because the blood may be given to a
woman. Options 2 and 5 are incorrect. Finasteride in lower doses is given under the trade name “Propecia” for treatment of male pattern baldness. There is a concern for edema and weight gain when alpha-adrenergic
antagonists are used to treat BPH, but finasteride
(Proscar) is a 5-alpha reductase inhibitor, not an alphaadrenergic antagonist, and edema and weight gain are
not associated with its use.

Question 41

chapter 32

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give?
1. Eating raw fruits and vegetables must be avoided.
2. Frequent rest periods should be taken to avoid excessive fatigue.
3. Skin and mucous membranes should be protected from traumatic injury.
4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

Answer 41

Answer: 2
Rationale: Epoetin alfa (Epogen, Procrit) is
ordered to treat anemia, and the patient with anemia
may experience periods of excessive fatigue and weaness related to the diminished oxygen-carrying capacity from low RBC counts. Adequate rest periods should be planned and patients taught to avoid overexertion
until the epoetin alfa has had therapeutic effects and the RBC counts improve. Options 1, 3, and 4 are incorrect. Avoiding fresh fruits or vegetables is not necessary for a patient who is taking epoetin alfa but may be appropriate for a patient with low WBC counts. Patients
with anemia do not necessarily have low platelet counts (thrombocytopenia) and do not need to routinely avoid
activities that may cause direct tissue injury. Limiting
direct sun exposure and wearing sunscreen are excellent health practices but are not required as part of epoetin alfa therapy
*ciprofloxacin then is photosensitive