Download STUDY GUIDE NS1040 CH

STUDY GUIDE NS1040 CH. 68 69 71
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____
1. The nurse is providing patient education for patients preparing to receive renal transplants. The nurse
____
2.
____
3.
____
4.
____
5.
____
6.
____
7.
discusses the pros and cons of using cyclosporine (Sandimmune) to prevent allograft rejection.
Which statement by one of the patients best shows that no further teaching is required?
“Cyclosporine does not
a. cause renal damage.”
c. suppress bone marrow.”
b. increase the risk of infection.”
d. cause hypertension.”
The nurse is caring for a patient who has been taking cyclosporine for 9 months to prevent rejection
of a renal allograft. Upon reviewing the patient’s laboratory results, the nurse notes that the blood
urea nitrogen and serum creatinine have risen sharply in the past 2 weeks. The nurse should suspect
__________ and assess the patient for other signs and symptoms related to ___________.
a. leukocytosis; infection
b. fluid volume overload; congestive heart failure
c. hypotension; dehydration
d. nephrotoxicity; organ rejection
The nurse is administering medications to a patient who is receiving cyclosporine (Sandimmune).
Which medication, when administered concurrently with cyclosporine, would warrant a reduction in
the dosage of cyclosporine?
a. Phenytoin (Dilantin)
b. Prednisone
c. Ketoconazole (Nizoral)
d. Trimethoprim/sulfamethoxazole (Bactrim)
Which drug, when given concurrently with cyclosporine (Sandimmune), can lead to toxic levels of
cyclosporine?
a. Phenytoin (Dilantin)
b. Rifampin (Rifadin)
c. Erythromycin
d. Trimethoprim/sulfamethoxazole (Bactrim)
The nurse is caring for a patient taking tacrolimus (Prograf) on a renal telemetry unit. Which adverse
effect associated with this medication would most concern the nurse?
a. Gingival hyperplasia
c. Risk of infection
b. Blood glucose level of 120 mg/dL
d. Tremors and insomnia
The nurse is caring for a patient who recently receive a renal transplant. The patient is taking
sirolimus (Rapamune) to prevent transplant rejection. What other medications would the nurse
expect the patient to be taking?
a. Rifampin and ketoconazole
c. Cyclosporine and glucocorticoids
b. Carbamazepine and phenobarbital
d. Amphotericin B and erythromycin
A nurse working on the transplantation unit is caring for a patient taking sirolimus (Rapamune).
Upon reviewing the patient’s laboratory results, the nurse understands that sirolimus can
significantly affect these results and should anticipate which of the following?
a. Increased cholesterol
c. Increased hemoglobin
b. Increased leukocytes
____
____
d. Increased potassium
8. The nurse is caring for a patient who received a transplant a few months ago. The patient has been
9.
____ 10.
____ 11.
____ 12.
____ 13.
____ 14.
____ 15.
taking azathioprine (Imuran) and comes to the clinic for laboratory work. Which laboratory test
would the nurse anticipate for this patient?
a. Bilirubin
c. Serum azathioprine levels
b. Blood urea nitrogen (BUN)
d. Complete blood cell (CBC) count
The nurse is teaching a class on immunosuppressants to a group of nurses to review their current
knowledge. The nurse asks, “Which patient is likely to receive Rho(D) immune globulin RhIG
(RhoGAM)?” The group correctly gives which of the following answers?
a. A pregnant patient who is Rho negative
b. A renal transplant patient who is Rho positive
c. A bone marrow transplant patient who is Rho negative
d. A heart transplant patient who is Rho positive
The nurse is preparing to administer antibodies to a patient. By which route will the nurse administer
the antibodies used to prevent acute rejection?
a. Oral
c. Intravenous
b. Intramuscular
d. Transdermal
The nurse is caring for a patient who has been taking cyclosporine (Sandimmune). During a followup appointment, the patient starts making conversation. What comment by the patient would most
concern the nurse?
a. “I have coffee every morning.”
b. “I enjoy tea in the afternoons.”
c. “I drink grapefruit juice with my breakfast.”
d. “I take aspirin for headaches.”
The nurse is preparing to draw blood for measurement of a serum cyclosporine (Sandimmune) level.
At what time should the serum cyclosporine level be drawn?
a. Two hours after the dose was given
c. Six hours after the dose was given
b. Just prior to the next dose
d. The timing of levels is irrelevant.
The nurse, who is serving as a preceptor for a graduate nurse, frequently asks questions to assess the
graduate nurse’s level of knowledge. The nurses are discussing the effects of H1 versus H2 receptors.
The graduate nurse correctly states that the major response to the activation of H2 receptors is
a. nausea and vomiting.
c. functioning as an antagonist for H1.
b. vasodilation of cutaneous vessels.
d. secretion of gastric acid.
The nurse is providing an educational activity on common over-the-counter medications to a group
of school nurses. The nurse asks the group, “What finding would you most likely see in a child who
was given a therapeutic dose of a first-generation antihistamine?”
a. Hyperactivity
c. Sedation
b. Nausea and vomiting
d. Rhinitis
Two nursing students are discussing the indications for use of an H1 blocker. One student quizzes the
other by asking, “Which of the following patients would least likely benefit from the use of an H1
blocker?” The other student would be correct to respond that the patient who would least likely
benefit from an H1 blocker would be a patient with
a. a common cold.
c. pruritus.
b. motion sickness.
d. rhinitis.
____ 16. A patient comes to the clinic with allergic rhinitis. Which of the following second-generation agents,
____ 17.
____ 18.
____ 19.
____ 20.
____ 21.
____ 22.
____ 23.
administered nasally, would be most appropriate for this patient?
a. Azelastine (Astelin)
c. Desloratadine (Clarinex)
b. Chlorpheniramine (Chlor-Trimeton)
d. Phenindamine (Nolahist)
A child is brought to the emergency department by frantic parents who say the child is “seeing
things.” Assessment reveals incoordination, ataxia, and hallucinations. Further history from the
parents reveals that the child was found confused around a bunch of different pills, primarily H1
antagonists. The nurse should prepare to treat the child with
a. benzodiazepines.
c. activated charcoal and a cathartic.
b. anticholinergics.
d. warming blankets.
A pregnant patient asks the nurse about the safety of using antihistamines for allergic rhinitis. What
information should the nurse provide regarding the safety of antihistamines during pregnancy?
a. “These agents are safe during pregnancy.”
b. “These agents should not be used during the first trimester.”
c. “Safety has not been proven during pregnancy.”
d. “The agents are safe only during the third trimester.”
A patient presents to the clinic with signs and symptoms of a cold. The prescriber orders an H1
blocker for the patient, with the first dose to be taken immediately. What should the nurse do first?
a. Question the order.
b. Provide a small glass of water to the patient.
c. Provide a small snack to the patient.
d. Administer the medication as ordered.
A patient requests and is given an oral antihistamine for hay fever. The patient later complains that
the medication causes stomach upset. What recommendation should the nurse make to help reduce
the stomach upset?
a. “Take frequent sips of liquids to reduce this effect.”
b. “Take the medication with an antacid.”
c. “Discontinue the drug because this is a serious adverse effect.”
d. “Take the medication with meals to decrease this effect.”
A patient who has taken glucocorticoids for 3 years tells a nurse, “I’ve lost my job. I don’t know
how I’m going to support my family and pay all the bills.” Which glucocorticoid dosage adjustment
would the nurse expect?
a. Decreased dosage
c. Alternate-day dosing
b. Increased dosage
d. Double the dose
The nurse is teaching a group of nursing students about the use of glucocorticoids and the resultant
physiological effects. Which statement by one of the students best demonstrates understanding of
these effects?
a. “Glucocorticoids inhibit the metabolism of fatty acids for fuel.”
b. “Glucocorticoids block the synthesis of glucose from amino acids.”
c. “Glucocorticoids promote the storage of glucose in the form of glycogen.”
d. “Glucocorticoids increase cellular sensitivity to insulin.”
The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for
the patient. Which nursing diagnosis is the priority for the plan of care?
a. Risk for disturbed sensory perception, auditory
b. Risk for infection
c. Risk for fluid volume deficit
d. Risk for ineffective airway clearance
____ 24. The nurse would question an order for the administration of a glucocorticoid in a patient with
a. systemic lupus erythematosus.
c. systemic fungal infections.
b. rheumatoid arthritis.
d. asthma.
____ 25. The nurse is preparing to administer medication to a patient taking betamethasone. Which additional
____ 26.
____ 27.
____ 28.
____ 29.
____ 30.
drug, when administered concurrently with betamethasone, would put the patient at risk for
cardiotoxicity?
a. Furosemide (Lasix)
c. Digoxin (Lanoxin)
b. Calcium carbonate
d. Insulin
The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse expects the
prescriber to order that the drug be administered at what time?
a. 0800
c. 1600
b. 1200
d. 2100
A patient with severe asthma has taken high-dose glucocorticoids for 2 months. The symptoms have
resolved, and the patient is ready to stop the medication. What patient education would the nurse
provide about discontinuing the medication?
a. The dose should be tapered off over 7 to 10 days.
b. The drug can be stopped immediately if it is no longer needed.
c. The drug must be continued for life.
d. An inhaled form of glucocorticoid must be added to the medication regimen.
The nurse is caring for a patient receiving long-term glucocorticoid therapy. Upon assessment, the
nurse notes that the patient has 1+ pitting edema of the lower extremities. What instruction provided
by the nurse would be most appropriate for this patient?
a. “Augment your diet with calcium supplements.”
b. “Decrease your sodium intake.”
c. “Take the glucocorticoid every 3 to 4 days instead of daily.”
d. “Discontinue the glucocorticoid.”
Medication education for a patient receiving glucocorticoids should include the preferred use of
which medication for management of mild pain?
a. Aspirin
c. Ibuprofen
b. Acetaminophen
d. Naproxen sodium
The nurse should question a prescription for high-dose corticosteroids for a patient with
a. uncontrolled diabetes mellitus.
b. rheumatoid arthritis.
c. status asthmaticus.
d. exacerbation of chronic obstructive pulmonary disease (COPD).
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 31. A patient has taken cyclosporine (Sandimmune) since receiving a heart transplant 5 years earlier.
The nurse should frequently assess the patient for which signs and symptoms? (Select all that apply.)
a. Infection
b. Increased appetite
c. Goiter
d. Nephrotoxicity
e. Increased bone density
____ 32. A patient taking mycophenolate mofetil (CellCept) as prophylaxis for rejection of an allogenic heart
develops fatigue, sweating, and a large neck mass. The patient must be immediately assessed for
which complications? (Select all that apply.)
a. Thyroid disease
b. Lymphoma
c. Streptococcal pharyngitis
d. Sepsis
e. Lyme disease
____ 33. A patient is brought to the emergency department by friends, who say they found the patient barely
responsive with a bottle of diphenhydramine (Benadryl) by the bed. What clinical manifestations
would the nurse expect to find? (Select all that apply.)
a. Dilated pupils
b. Urinary frequency
c. Pallor
d. Drooling
e. Tachycardia
____ 34. The nurse has administrated an H1 antagonist to a 12-year-old patient who is now exhibiting
paradoxical excitation. Which of the following signs and symptoms would assist the nurse in
drawing this conclusion? (Select all that apply.)
a. Insomnia
b. Sedation
c. Nervousness
d. Tremors
e. Dryness
____ 35. The nurse would anticipate the complete blood count in a patient on long-term glucocorticoid
therapy to demonstrate which of the following? (Select all that apply.)
a. Decreased hematocrit
b. Increased red blood cells
c. Increased leukocytes
d. Increased monocytes
e. Increased lymphocytes
STUDY GUIDE NS1040 CH. 68 69 71
Answer Section
MULTIPLE CHOICE
1. ANS: C
Cyclosporine does not suppress bone marrow; no further teaching is required. Cyclosporine may
cause renal damage as a result of nephrotoxicity; further teaching is required. An adverse effect of
cyclosporine is an increased risk of infection, because the drug can suppress the immune system;
further teaching is required. Cyclosporine causes hypertension in 50% of patients; further teaching is
required.
PTS:
TOP:
MSC:
2. ANS:
1
DIF: Cognitive Level: Application
REF: p. 814
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
The nurse should suspect nephrotoxicity and investigate signs and symptoms related to organ
rejection because of the rising creatinine and blood urea nitrogen. Nothing indicates that the patient
has an infection or leukocytosis. Nothing indicates that the patient has a fluid volume overload or
CHF. Nothing indicates that the patient has hypotension or dehydration.
PTS:
TOP:
MSC:
3. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 815
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Concurrent use of ketoconazole would warrant a reduction in the dosage of cyclosporine.
Ketoconazole often is given concurrently with cyclosporine so that the patient’s dosage of
cyclosporine, which is costly, can be reduced. Phenytoin would cause a decrease in cyclosporine
levels. Prednisone often is given concurrently with cyclosporine to suppress the immune response.
Trimethoprim/sulfamethoxazole reduces levels of cyclosporine in the body.
PTS:
TOP:
MSC:
4. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 815
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Erythromycin can inhibit cyclosporine metabolism, leading to increased levels of the drug.
Phenytoin, rifampin, and trimethoprim/sulfamethoxazole reduce the levels of cyclosporine in the
body.
PTS:
TOP:
MSC:
5. ANS:
1
DIF: Cognitive Level: Application
REF: p. 815
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Tremors are the adverse effect that causes the most concern, because they may indicate
neurotoxicity. Gingival hyperplasia is an anticipated effect of the medication. Hyperglycemia may
be a concern, but the value given is just a borderline value. Risk of infection is a concern for any
patient with a renal transplant, but an actual infection would be more likely to concern the nurse.
PTS:
TOP:
MSC:
6. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 816
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Sirolimus should be used in conjunction with cyclosporine and glucocorticoids to reduce the risk of
transplant rejection. Rifampin can reduce and ketoconazole can increase therapeutic levels of
sirolimus and cyclosporine; therefore, they are not indicated for transplant patients. Carbamazepine
and phenobarbital are not indicated, because they can reduce the therapeutic levels of sirolimus and
cyclosporine. Amphotericin B and erythromycin are not indicated, because they can increase the
therapeutic levels of sirolimus and cyclosporine.
PTS:
TOP:
MSC:
7. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 816
Nursing Process: Planning
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
The nurse should expect an increase in serum cholesterol. An increase in leukocytes suggests
infection and would not be an expected finding. Sirolimus does not increase the hemoglobin level.
Sirolimus reduces the potassium level.
PTS:
TOP:
MSC:
8. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 816
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
The nurse would expect a complete blood cell count for this patient to assess for neutropenia and
thrombocytopenia. Bilirubin and BUN are not indicated with azathioprine therapy. Azathioprine
levels are not indicated in this situation; there is no evidence of toxicity that suggests the level
should be measured.
PTS:
TOP:
MSC:
9. ANS:
1
DIF: Cognitive Level: Application
REF: p. 817
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
The patient most likely to receive Rho(D) immune globulin is a pregnant patient who is Rh negative.
The other responses are incorrect.
PTS:
TOP:
MSC:
10. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 819
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
The antibodies used to prevent acute rejection are administered intravenously. Antibodies are
administered intravenously.
PTS:
TOP:
MSC:
11. ANS:
1
DIF: Cognitive Level: Application
REF: pp. 818-819
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Grapefruit juice has been shown to increase cyclosporine levels by 50% to 200% and may lead to
toxicity. Coffee, tea, and aspirin are not contraindicated for patients taking cyclosporine.
PTS:
TOP:
MSC:
12. ANS:
1
DIF: Cognitive Level: Application
REF: p. 815
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
B
The serum cyclosporine level should be drawn just prior to the next dose. The level would be too
high if the sample were drawn just 2 hours after the dose was given. Six hours after the dose was
given is not appropriate, because dosage adjustment is based on trough levels. Timing is relevant to
determining the correct dosage.
PTS:
TOP:
MSC:
13. ANS:
1
DIF: Cognitive Level: Application
REF: pp. 815-816
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
The major response to activation of H2 receptors is secretion of gastric acid. Nausea and vomiting are
not responses to H2 activation. Vasodilation of cutaneous vessels is not a response to H2 activation.
H2 does not act as an antagonist for H1.
PTS:
TOP:
MSC:
14. ANS:
1
DIF: Cognitive Level: Application
REF: p. 822
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation
C
The first-generation antihistamines are highly sedating and even at therapeutic doses may cause
central nervous system (CNS) depression. Hyperactivity may be seen with overdose or high levels of
the medication in children. Nausea and vomiting would not typically be seen after administration of
an antihistamine. Rhinitis should be diminished after administration of an antihistamine.
PTS:
TOP:
MSC:
15. ANS:
1
DIF: Cognitive Level: Application
REF: p. 825
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
Antihistamines are of practically no value against the common cold. They neither prevent colds nor
shorten their duration. Antihistamines are useful for treating allergic disorders, motion sickness,
itching, and insomnia. Antihistamines show a moderate reduction in rhinorrhea.
PTS:
TOP:
MSC:
16. ANS:
1
DIF: Cognitive Level: Application
REF: p. 823
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
Azelastine blocks the release of histamine and is indicated for allergic or vasomotor rhinitis. It is
administered by nasal spray and is a second-generation medication. Chlorpheniramine is a firstgeneration agent and is administered by mouth. Desloratadine is a second-generation medication
administered only by mouth. Phenindamine is also a first-generation medication taken by mouth.
PTS: 1
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
REF: p. 826
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
17. ANS: C
No specific antidote to antihistamine poisoning is available. Treatment is directed at drug removal
and symptom management. Activated charcoal will help to absorb the drug, and a cathartic will help
to remove it from the GI tract. Benzodiazepines are not indicated for treatment. Anticholinergic
agents would only contribute to the antihistamine response. Warming blankets would be indicated
for hypothermia, which is not described in this situation.
PTS:
TOP:
MSC:
18. ANS:
1
DIF: Cognitive Level: Application
REF: p. 825 | p. 827
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
The margin of safety for antihistamine use in pregnancy is not known. Antihistamines should be
used only when absolutely necessary but not in the third trimester.
PTS:
TOP:
MSC:
19. ANS:
1
DIF: Cognitive Level: Application
REF: p. 824
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
Antihistamines are of practically no value against the common cold; they neither prevent colds nor
shorten their duration. Therefore, the nurse should question the order. There is no need to have water
prior to ingesting an H1 blocker. There is no need to have food in the stomach prior to ingesting an
H1 blocker. H1 blockers can cause drowsiness in some instances; therefore, because the patient has to
leave the clinic, the person should not take the medication until reaching home. The nurse should not
administer the medication.
PTS:
TOP:
MSC:
20. ANS:
1
DIF: Cognitive Level: Application
REF: p. 823
Nursing Process: Planning
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
D
Gastrointestinal disturbances are common with antihistamines and may be minimized by taking the
drug with meals. Frequent sips of liquids will not reduce the effects. Taking the medication with an
antacid will not reduce the effects. Discontinuing the drug would not be recommended, because a
serious adverse effect is not evident in this scenario.
PTS:
TOP:
MSC:
21. ANS:
1
DIF: Cognitive Level: Application
REF: p. 824
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
B
At times of physiological stress, the adrenals secrete large amounts of glucocorticoids and
epinephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels
are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compensate
for the increased levels of stress. Reducing the dosage would put the patient at risk for
glucocorticoid insufficiency. Alternate-day dosing results in decreased dosing, which would put the
patient at risk for glucocorticoid insufficiency. The dosage needs to be increased, but doubling the
dose is too large of an increase.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 846
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential
22. ANS: C
Glucocorticoids promote the storage of glucose in the form of glycogen. The most consistent effect
of glucocorticoids on fat metabolism is not inhibition but stimulation of lipolysis (fat breakdown).
Glucocorticoids promote rather than block the synthesis of glucose from amino acids.
Glucocorticoids do not increase cellular sensitivity to insulin. Other drugs, such as the sulfonylureas,
increase cellular sensitivity to insulin.
PTS:
TOP:
MSC:
23. ANS:
1
DIF: Cognitive Level: Application
REF: p. 846
Nursing Process: Implementation
NCLEX Client Needs Category: Health Promotion and Maintenance
B
Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the
susceptibility to infection by suppressing host defenses. Glucocorticoids do not disturb sensory
perception. Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid
volume excess. Glucocorticoids do not promote a risk of ineffective airway clearance.
PTS:
TOP:
MSC:
24. ANS:
1
DIF: Cognitive Level: Application
REF: p. 850
Nursing Process: Planning
NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential
C
The nurse should question administration of a glucocorticoid to a patient with a fungal infection,
because the drug could mask the symptoms of a systemic-wide infection. The use of glucocorticoids
in a patient with systemic lupus erythematosus is expected, because it is an autoimmune disorder that
would respond to glucocorticoid intervention. The use of glucocorticoids in a patient with
rheumatoid arthritis is expected, because it is an autoimmune disorder that would respond to
glucocorticoid intervention. The use of glucocorticoids in a patient with asthma is expected, because
it is an inflammatory disorder that would respond to glucocorticoid intervention.
PTS:
TOP:
MSC:
25. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 850
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
C
Concurrent use of betamethasone and digoxin would put the patient at risk for cardiotoxicity as a
result of hypokalemia, which increases the risk of digoxin-induced dysrhythmias. Furosemide with
betamethasone could result in some slight alterations in electrolytes but should not lead to toxicity.
Calcium carbonate is an antacid and should not predispose the patient to cardiotoxicity. Glucose
levels may be affected, but this should not lead to cardiotoxicity.
PTS:
TOP:
MSC:
26. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 851
Nursing Process: Evaluation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
To allow the adrenals to recover, the doses should be administered prior to 0900 in the morning.
These times are incorrect for oral administration of daily hydrocortisone.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 853
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
27. ANS: A
To minimize the impact of adrenal insufficiency, glucocorticoid withdrawal should be gradual.
Abrupt termination of long-term therapy of high-dose glucocorticoids may result in adrenal crisis.
The drug should not be continued for life unless it is taken because of adrenal gland removal. An
inhaled form could be used but is not required.
PTS:
TOP:
MSC:
28. ANS:
1
DIF: Cognitive Level: Application
REF: p. 851
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
B
The patient should be advised to restrict sodium intake to prevent the retention of fluid associated
with glucocorticoid therapy. There is no need to augment the diet with calcium supplements, because
there is no indication that the patient is calcium deficient. Glucocorticoids must be taken on a daily
basis, preferably at the same time each day. The medication should never be abruptly discontinued;
it should be tapered to prevent insult to the adrenals.
PTS:
TOP:
MSC:
29. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 850
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
B
The nurse should counsel the patient to use acetaminophen for mild pain, because it does not cause
gastric upset, as do nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and
naproxen sodium, when taken by a patient who also is taking glucocorticoids.
PTS:
TOP:
MSC:
30. ANS:
1
DIF: Cognitive Level: Application
REF: p. 851
Nursing Process: Implementation
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A
High-dose steroids would further complicate a hyperglycemic state. High-dose corticosteroids are
used in rheumatoid arthritis. High-dose corticosteroids are used in status asthmaticus. High-dose
corticosteroids are used for an exacerbation of COPD.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 851
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
31. ANS: A, D
The nurse should frequently assess the patient for evidence of infection and nephrotoxicity, because
cyclosporine suppresses the immune system and may cause nephrotoxicity. Cyclosporine is not
known to increase appetite, cause goiter, or increase bone density.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 815
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
32. ANS: B, C, D
The patient requires immediate assessment for lymphoma and sepsis, which are major adverse
effects of immunosuppressive drugs. The patient also may be susceptible to streptococcal
pharyngitis. Thyroid disease and Lyme disease are not adverse effects of mycophenolate mofetil.
PTS:
TOP:
MSC:
33. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 818
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A, E
The clinical manifestations the nurse would expect to see are dilated pupils, flushed face,
hyperpyrexia, tachycardia, dry mouth, and urinary retention. Urinary frequency, pallor, and drooling
are not anticholinergic effects.
PTS:
TOP:
MSC:
34. ANS:
1
DIF: Cognitive Level: Application
REF: p. 825
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
A, C, D
Paradoxical excitation is more common in children and may result in insomnia, nervousness,
tremors, and even convulsions. Sedation and fatigue would be more common in the elderly.
PTS:
TOP:
MSC:
35. ANS:
1
DIF: Cognitive Level: Analysis
REF: p. 824
Nursing Process: Assessment
NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
B, C
Glucocorticoids increase the number of circulating red blood cells and polymorphonuclear
leukocytes. Glucocorticoids reduce the numbers of lymphocytes, eosinophils, basophils, and
monocytes.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 846
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential