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PHARM HESI V1 315 EXAM ALL
100% CORRECT
What hormone stimulates the release of the follicle-stimulating hormone (FSH) from both male and female glands? A)Growth hormone-releasing hormone (GHRH) B)Thyrotropin-releasing hormone (TRH) C)Gonadotropin-releasing hormone (GnRH) D)Prolactin-releasing hormone (PRH) c The male and female glands respond to luteinizing hormone (LH) and FSH, which are released from the anterior pituitary in response to stimulation from GnRH that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth. TRH stimulates the thyroid-stimulating hormone, which targets the thyroid gland. PRH stimulates the release of prolactin, which is necessary for milk production. A nurse is providing patient education to a patient as part of her work in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception, what will the nurse stress? A)Ova quickly degenerate and most are absorbed in the body before the age of 12. B)The ovaries at birth contain all of the ova that a woman will have. C)Ova aggregate, causing millions to be contained in a storage site called a follicle. D)Follicles produce only estrogen; the uterus produces progesterone. b
It would be important to explain that the woman's ova do not increase or decrease from birth to childbearing years. The nurse will stress that all the ova that a woman will have will be present at birth. The patient should understand that if she does not ovulate 1 month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate over a lifetime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone. ‘‘ The nursing instructor is discussing the physiology of pregnancy with her clinical group. What hormone, produced during pregnancy, would the instructor tell the students helps to maintain the pregnancy until birth of the fetus? A)High levels of estrogen only B)High levels of estrogen, low levels of progesterone C)Low levels of estrogen, high levels of progesterone D)High levels of estrogen and progesterone D Feedback: In a pregnant woman, both estrogen and progesterone hormones have specific functions. High levels of both hormones are needed for the maintenance of pregnancy. The nursing instructor is talking with her class of students about the female reproductive system. A student is trying to understand the role of progesterone in the body. What nonreproductive affect does progesterone have on the body? A)Decreased body temperature B)Decreased appetite C)Anti-insulinD)Increased uterine motility C Feedback:
C Feedback: Prostaglandins in the uterus stimulate uterine contractions to clamp off vessels in the lining of the uterus, which is the cause of the cramping. The decrease of estrogen and progesterone after the involution of the corpus luteum triggers the release of follicle- stimulating hormone (FSH) and luteinizing hormone (LH). The decreased levels of FSH and LH cause the inner lining of the uterus to slough off because the vascular system is no longer being stimulated. High, not low, levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off. What drug would the nurse expect to administer if beta-specific adrenergic agonist effects are desired to prevent bronchospasm during anesthesia? A)Dobutamine (Dobutrex) B)Ephedrine (generic) C)Isoproterenol (Isuprel) D)Phenylephrine (Neo-Synephrine) C Isoproterenol is a beta-specific adrenergic agonist used to prevent bronchospasm during anesthesia. Phenylephrine is an alpha-specific adrenergic agonist. Both dobutamine and ephedrine are alpha- and beta-adrenergic agonists. The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided? A)A 47-year-old woman with hypertensionB)A 52-year-old man with adult onset diabetes C)A 17-year-old girl with symptoms of an upper respiratory infection D)A 62-year-old man with gout A Feedback: Phenylephrine, a potent vasoconstrictor and alpha1-agonist with little or no effect on the heart or bronchi, is used in many combination cold and allergy products. Patients with hypertension should avoid these drugs because serious increases in blood pressure could occur. Use of this
drug in patients with diabetes and gout are not contraindicated. An upper respiratory infection may be an indication for the drug. ‘‘ The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include? A)Monitoring the patient for diarrhea B)Monitoring blood pressure and heart rate every 2 to 4 hours C)Assessing skin turgor for dehydration D)Assessing for fatigue and lethargy B Sympathetic stimulation will cause hypertension and increased heart rate so it is important these be monitored. Sympathetic stimulation will also result in increased sweating, decreased gastrointestinal activity, and a sense of anxiety and heightened awareness. Diarrhea, dehydration, fatigue, and lethargy would not be expected. A nurse receives an order for clonidine (Catapres) for a 25-year-old pregnant woman. What is the nurse's priority action? A)Weigh the patient to obtain correct dose/kg/day. B)Have a second nurse check the dose before administering the drug. C)Consult with the physician about the order. D)Make sure the patient is wearing a fetal monitor. Ans:C Feedback: The nurse would consult with the physician to ensure awareness of the pregnancy and desire to administer this drug. There are no adequate studies about use during pregnancy and lactation, so use should be reserved for situations in which the benefit to the mother outweighs any
The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support patients experiencing shock. They are used in patients of all ages. Therefore, the other options are incorrect responses. A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence? A)Phenylephrine B)Propranolol C)Phenylalanine D)Phentolamine Ans:D Feedback: Maintain phentolamine on standby in case extravasation occurs; infiltration of the site with 10 mL of saline containing 5 to 10 mg of phentolamine is usually effective in saving the area. Phenylephrine, propranolol, and phenylalanine are not indicated for use when extravasation occurs. The pharmacology instructor is discussing adrenergic agonists with the nursing class. Which drugs would the instructor tell the nursing students are generally indicated for the treatment of shock, bronchospasm, and some types of asthma? A)Sympathomimetic drugs B)Beta-blocking drugs C)Parasympathetic stimulating drugs D)Anticatecholamine drugs Ans:A Feedback: These drugs generally are indicated for the treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Beta-blocking drugs, parasympathetic stimulating drugs, and anticatecholamine drugs are not the drugs of choice in these situations. When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.) A)Dobutamine (Dobutrex)
B)Epinephrine (Adrenalin, Sus-Phrine) C)Dopamine (Intropin)D)Clonidine (Catapres)E)Albuterol (Proventil) Ans:A, B, C Feedback: Agents that affect both alpha- and beta- receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine. Clonidine is an alpha-specific adrenergic agonist; albuterol is a beta-specific adrenergic agonist. The nurse is admitting a mental health patient and collects the medication history. The patient says he takes Haldol, midodrine, hydrochlorothiazide, acetaminophen, and Cymbalta. The nurse will call the provider to discuss what dangerous drug combination? A)Haldol and midodrine B)Hydrochlorothiazide and midodrine C)Cymbalta and midodrine D)Acetaminophen and midodrine Ans:AFeedback: Midodrine can precipitate increased drug effects of digoxin, beta-blockers, and many antipsychotics. Such combinations should be avoided. The other drug combinations do not pose any immediate concerns. A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The patient weighs 12.5 kg. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV? A)0.0625 mg B)0.075 mg C)0.08 mg D)0.085 mg Ans:A Feedback: To calculate the minimum dosage, multiply the child's weight in kg by the lower dosage range; 12.5 × 0.005 = 0.0625 mg. When giving beta-specific adrenergic agonists, at what age is an adult dose given? A)10 years B)11 years C)12 years D)13 years
The nurse provides teaching to a patient with chronic obstructive pulmonary disease who has been prescribed budesonide (Pulmicort) two puffs and fluticasone (Flovent) three puffs t.i.d. The nurse evaluates that further teaching is needed when the patient makes what statement? A)"Take all five puffs as quickly as possible." B)"Replace the inhalers before they run out." C)"Rinse the mouth after taking the medication." D)"Continue medication even when symptoms start to subside." Ans:A Feedback: The nurse needs to review how to administer the drug via inhalation because the patient must hold the medication in the airways as long as possible before exhaling and should not try to rush the treatment. The other statements are correct and would not require clarification. The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea? A)"Take with a meal."B)"Take 1 hour before meals."C)"Take before bedtime."D)"Split the dose into two equal doses." Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea. If the patient takes only one dose per day, it should be taken immediately after breakfast. If spaced throughout the day, eating something before taking the pill will reduce risk of nausea. Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach.
What would be important for the nurse to teach the parents of a pediatric patient about the use of topical corticosteroids? A)"Apply the medication sparingly." B)"Apply directly to open lesions." C)"After applying cover with a bandage." D)"Reapply as often as needed to keep the rash coated with the medication." Ans:A Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption. The nurse is teaching the patient who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? A)"Avoid large crowds of people tightly packed together." B)"Avoid working in areas with other people." C)"Avoid exercising to reduce risk of injury." D)"Avoid touching other people who may carry germs." Ans:A Feedback: With long-term therapy, the importance of avoiding exposure to infection—crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the patient should be encouraged to seek medical care. These patients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources. The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this patient? A)Assessing capillary refill time B)Assessing cardiac rhythm
The nurse is caring for a patient who works night shift from 2200 (10 pm) to 0600 (6 am) and normally sleeps from 0800 (8 am) until 1600 (4 pm) each day. The nurse would teach this patient to take his or her corticosteroid at what time of the day? A)06:00 (6 am) B)08:00 (8 am) C)16:00 (4 pm) D)22:00 (10 pm) Ans:C Feedback: If a person works all night and goes to bed at 8 am, arising at 4 pm to carry on the day's activities before going to work at 10 pm, the hypothalamus will release corticotropin- releasing hormone at about 4 pm in accordance with the new sleep-wake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A patient on this schedule who is taking replacement corticosteroids would then need to take them at 4 pm, or on arising. All other options would not be optimal. For what reason might a nurse administer androgen injections to a 9-year-old boy? A)Ovarian atrophy B)Dwarfism C)Acromegaly D)Hypogonadism Ans:D Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly. A patient is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this patient knowing prolonged use of corticosteroids puts the patient at risk for what? A)Adrenal stormB)Adrenal atrophyC)Stunted growth D)Hypothalamic insufficiency Ans:B Feedback:
Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids. The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect? A)9 to 10 am B)12 to 1 pm C)8:30 to 9:00 am D)4 to 6 pm Ans:AFeedback: Prednisone's peak effect occurs 1 to 2 hours after administering the drug. If given at 8 am, the expected peak would occur between 9 and 10 am.
Nursing care for the postoperative patient requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? A)Poor wound healing B)Inflammation C)Autoimmune response D)Lack of mobility Ans:AFeedback: Patients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an anti-inflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome. ‘‘ The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drug's anti-inflammatory action? A)Arachidonic acid B)Phagocytes C)Lymphocytes D)Antibodies
A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? A)Liver function test (LFT) B)Cholesterol levelC)VisionD)hand and wrist radiographs Ans:DFeedback: Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision. The nurse assesses the patient taking anabolic steroids for what serious adverse effects? A)Elevated blood urea nitrogen (BUN) B)Elevated blood glucose level C)BradycardiaD)Jaundice Ans:D Feedback: Anabolic steroids all have black box warnings as alerts to the potentially serious effects of liver tumors, hepatitis, and blood lipid level changes that might be associated with increased risk of coronary artery disease. As a result, the nurse should assess for jaundice that could be an early indication of liver dysfunction. Elevated BUN, blood glucose levels, and bradycardia are not commonly reported adverse effects. What therapeutic effect will the nurse assess for in the male patient taking anabolic steroids? A)Thinning of the skin B)Body hair loss C)Increase in red blood cells (RBCs) and hemoglobin D)Gynecomastia Ans C: Feedback: Therapeutic effects include promotion of body tissue-building processes, reverse catabolic or tissue-destroying processes, and increased hemoglobin and red blood cell mass. Thinning of the
skin and body hair loss are not associated effects of anabolic steroids. Gynecomastia is an adverse effect and would not be a therapeutic effect for which the drug was administered. An woman is prescribed androgens. The nurse teaches the patient to anticipate what effect from the drug? A)Atrophy of breasts B)Rapid bone growth C)Loss of pubic hair D)Nervousness Ans:D Feedback: Antiestrogen effects—flushing, sweating, vaginitis, nervousness, and emotional lability—can be anticipated when these drugs are used in women. When androgens are administered to women you would not expect the results to include atrophy of the breasts, rapid bone growth, or loss of pubic hair. The nurse is caring for a patient who has been taking androgens and has been admitted to the ICU following a car accident. What lab results will the nurse interpret as more indicative of androgen therapy than actual disease states? (Select all that apply.) A)Decreased thyroid functionB)Increased creatinine levelsC)Increased creatinine clearance D)Elevated liver enzymesE)Increased white blood cell (WBC) count Ans:A, B, C Feedback: While a patient is taking androgens, thyroid function may be decreased, as well as increased creatinine and creatinine clearance, results that are not associated with disease states. These effects can last up to 2 weeks after the discontinuation of therapy. Elevated liver enzymes may indicate a potentially life- threatening effect that has been documented is hepatocellular cancer. Increased WBC count would indicate an infection. Increased liver enzymes and WBC are not associated with androgen therapy but instead indicate a disease state. The 63-year-old male patient receives a prescription for androgens. The nurse evaluates that the patient understood drug teaching when he makes what statement?
The nurse administers danazol (Danocrine) be a woman for what purpose? A)Reverse folic acid deficiencies B)Increase hair growth C)Decrease symptoms of endometriosis D)Prevent toxic shock syndrome. Ans:CFeedback: Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome. The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance his performance. What findings would the nurse associate with this practice? (Select all that apply.) A)Personality changes B)Sexual dysfunction C)Increased serum lipid levels D)Cardiomyopathy E)Weight loss Ans:A, B, C, D Feedback: Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off- label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss. The nurse learns a patient receiving a new prescription for oxandrolone takes a lipid- lowering medication daily. What will the nurse tell the patient about this drug interaction? A)Lipid-lowering drug becomes much less effective. combination Ans:A Feedback:
Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid- lowering agents. Lipid-lowering medications do not impact anabolic steroids and there is no increased risk for toxicity of either drug. What supplement would be safest for a diabetic female athlete wishing to improve athletic performance? A)Bee pollen B)Damiana C)Wild yam D)Spirulina Ans:C Feedback: Wild yam is an estrogen-like herb used to increase athletic performance, slow the aging process, and improve energy and stamina. It can be toxic to the liver and may cause breast pain but is the safest of these supplements. Bee pollen is associated with serious allergic reactions and random studies have found wide variety of ingredients in each product. Damiana interferes with antidiabetic agents so it would not be appropriate for this patient. Spirulina may contain toxic metals and can cause serious reactions in children and pets. It interferes with vitamin B12absorption and there are no studies to prove it is effective in the claims it makes. When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered? A)Long-term B)Short-term C)Continuous D)Intermittent Ans:D Feedback: Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy. The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what? A)Renal stonesB)DeathC)CirrhosisD)Malignant hyperthermia
