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- An adolescent patient who is on the school swim team asks a nurse about ways to prevent swimmer's ear. The nurse will tell the patient to: a. allow the ears to drain well after every swim and shower. b. clean the ears with a cotton-tipped applicator after swimming. c. keep the ear canals free of cerumen.
d. use antifungal ear drops before and after swimming. CORRECT ANSWERS✅ ANS: A
Acute otitis externa (OE) can be minimized by keeping the natural defenses of the external auditory canal (EAC) healthy. Swimmers should be taught to dry the EAC after showering and swimming. Cleaning the ears with cotton-tipped swabs can remove the cerumen and abrade the epithelium. Removing cerumen removes the natural barrier to infection. Antifungal ear drops are used to treat acute OE but not as a preventive measure.
- An 18-month-old child is seen in the clinic with a temperature of 40° C. The child's parents tell the nurse that the child developed the fever the previous evening and was inconsolable during the night. The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to: a. ask the parent to return to the clinic in 2 days to see whether antibiotics need to be started. b. discuss a referral to an ear, nose, and throat specialist for follow-up treatment. c. teach the parent to give analgesics for 3 days while observing for worsening symptoms.
d. tell the parent to administer amoxicillin at 45 mg/kg/dose twice daily. CORRECT ANSWERS✅ ANS: D
Patients with severe symptoms of AOM should begin treatment with antibiotics upon diagnosis. For children 6 months to 2 years of age, treatment should begin when the diagnosis is certain, as evidenced by erythema of the tympanic membrane (TM) and distinct discomfort. Amoxicillin 45 mg/kg/dose twice daily is indicated. Observation for 2 days is not recommended for this child, because the diagnosis is certain; therefore, asking the parent to return in 2 days or to give only symptomatic treatment is incorrect. Referral to an ear, nose, and throat (ENT) specialist is not recommended unless the child has recurrent AOM or if treatments repeatedly fail.
- A patient has been diagnosed with fungal otitis externa (otomycosis). The nurse correctly explains that for the first course of treatment the patient should expect: a. acidifying drops for 1 week. b. antibiotic ear drops. c. intravenous (IV) antifungal agents.
d. oral antibiotics. CORRECT ANSWERS✅ ANS: A
As a rule, otomycosis can be managed with thorough cleansing and application of acidifying drops (2% acetic acid solution applied three or four times a day for 7 days). If that does not work, an antifungal drug solution can be tried. If the infection fails to respond to the drug, oral antifungal therapy may be needed. Neither antibiotic ear drops nor oral antibiotics are indicated as the first course of treatment. IV antifungal agents are not indicated at all.
- A provider has told a parent that a 3-year-old child has a minor ear infection and that an antibiotic would be prescribed in a couple of days if the child's symptoms worsened. The parent asks the nurse why the child cannot get an antibiotic today. Which response by the nurse is correct? a. "If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best." b. "Most ear infections are caused by viruses, so antibiotics are not effective." c. "Most ear infections will resolve on their own without antibiotics."
d. "Your child will develop tolerance to antibiotics if they are prescribed too often." CORRECT
ANSWERS✅ ANS: C
The vast majority of acute otitis media (AOM) episodes resolve without treatment, so unless the child is very ill, observation is the initial choice. Spontaneous rupture of the tympanic membrane can occur, but clinicians do not wait for it to happen to obtain a culture that will guide treatment. About 70% to 90% of AOM episodes are bacterial in origin. Patients do not develop tolerance to antibiotic effects; overuse of antibiotics can lead to resistant organisms.
- A 6-year-old child has otitis media and is being treated with amoxicillin [Amoxil] and ibuprofen [Motrin]. The child's parent calls the nurse to report that the child's pain is not relieved with the ibuprofen. The child is afebrile and there is no drainage from either ear. The nurse will discuss which additional treatment with the child's provider? a. Adding acetaminophen [Tylenol] to the pain medication regimen b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals c. Changing the antibiotic to amoxicillin/clavulanate [Augmentin]
d. Performing a tympanostomy to relieve pressure in the middle ear CORRECT ANSWERS✅ ANS: B
For children over age 5 years, the AAP guidelines recommend topical anesthetic ear drops for pain relief; this is contraindicated if the TM is perforated. This child does not have drainage, indicating intact eardrums. Adding another oral analgesic will not be as effective as a topical anesthetic. The child is afebrile, so there is no concern about a resistant infection. Tympanostomy is not indicated.
- A nurse is discussing health maintenance with the parent of a newborn infant. Which statement by the parent indicates understanding of ways to reduce the incidence of otitis media?
warmed before administration to prevent dizziness, which may occur with instillation of cold drops. Cerumen should not be removed. Inserting cotton-tipped swabs may damage the epithelium. The use of earplugs may lead to further problems with bacterial otitis externa.
- A nurse is teaching a parent about the observation strategy for managing a 3-year-old child's ear infection. Which statement by the parent indicates understanding of the teaching? a. "I should not give analgesics, because they may mask important symptoms." b. "I will give ibuprofen or acetaminophen for pain or fever as needed." c. "I will let my provider know if the symptoms are not better in 1 week."
d. "There is a slight risk of mastoiditis if antibiotic therapy is delayed." CORRECT ANSWERS✅ ANS: B
Observation is defined as management by symptomatic relief alone for 48 to 72 hours to allow time for AOM to resolve on its own. Parents should be taught to administer analgesics/antipyretics. Providing pain relief does not mask an important symptom. Parents should notify the provider if symptoms worsen or do not improve in 48 to 72 hours. There is no significant difference in the risk of developing mastoiditis.
- A child has been diagnosed with otitis media with effusion (OME), and the child's parent asks the nurse what this means. The nurse will explain that OME is: a. a condition with a heightened risk of acute otitis media. b. an acute ear infection with fluid in the middle ear. c. an infection of the skin and tissues of the outer ear.
d. fluid in the middle ear without localized or systemic infection. CORRECT ANSWERS✅ ANS: D
OME occurs in many children after an episode of AOM. It is characterized by fluid in the middle ear without evidence of local or systemic illness. It does not necessarily pose a heightened risk of AOM. OME is not an acute ear infection or an infection of the outer ear.
- A 12-month-old child attends day care and is seen in a clinic for a second middle ear infection since age 8 months. The parent calls the nurse to report that after the third day of giving amoxicillin [Amoxil], the child continues to have a temperature of 39.5° C and is unable to sleep well because of pain. What will the nurse do? a. Encourage the parent to discuss amoxicillin/clavulanate [Augmentin] with the child's provider. b. Recommend that the parent consider removing the child from day care to reduce exposure to infection.
c. Schedule a clinic appointment for the child to receive ceftriaxone [Rocephin] IM. d. Tell the parent the child will probably need surgery for tympanostomy tubes to reduce
infections. CORRECT ANSWERS✅ ANS: A
Resistant AOM is on the rise because of the emergence of resistant pathogens such as Haemophilus influenzae and Moraxella catarrhalis, which are resistant to beta-lactam antibiotics, and Streptococcus pneumoniae, which synthesizes altered penicillin-binding proteins. Resistance is treated with high-dose amoxicillin/clavulanate. The high dose of amoxicillin increases activity against amoxicillin-resistant S. pneumoniae, and the clavulanate component overcomes beta- lactam resistance of H. influenzae and M. catarrhalis. Removing a child from day care can help reduce the number of ear infections in infants and young children. This child has only experienced two episodes, and removing the child from day care may not be easy for this family, so this recommendation is not appropriate at this time. IM Rocephin is not recommended. Surgery for bilateral myringotomy tympanotomy tubes (BMTTs) is used to reduce the number of episodes in children with recurrent AOM.
- A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? a. "Sunscreen should be applied 30 minutes before going outside." b. "I do not need sunscreen when it is cloudy outside." c. "I should reapply sunscreen after swimming."
d. "UV radiation does not penetrate through water." CORRECT ANSWERS✅ ANS: C
Sunscreens should be reapplied after swimming and with profuse sweating. Most sunscreens should be applied at least 30 minutes before going outdoors, but some require application 2 hours before exposure. Clouds do not protect from all UV rays. UV radiation can penetrate at least several centimeters of clear water.
- A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane]
d. Spironolactone CORRECT ANSWERS✅ ANS: B
For moderate to severe acne, oral antibiotics are indicated. Doxycycline is a drug of first choice. Hormonal agents, such as oral contraceptive pills (OCPs), are used in female patients who are at least 15
- A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drugs with the provider? a. Higher potency topical glucocorticoids b. Topical keratolytic agents c. Topical immunosuppressants
d. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) CORRECT ANSWERS✅ ANS: C
If topical glucocorticoids fail to treat eczema without causing skin atrophy and hypopigmentation, topical immunosuppressants may be used. Higher potency glucocorticoids will only compound the adverse effects. Topical keratolytic agents are not indicated. Topical NSAIDs are not indicated.
- A patient has actinic keratosis and is unable to tolerate the effects of fluorouracil. The provider orders the nonsteroidal anti-inflammatory drug diclofenac sodium [Solaraze] 3% gel. What will the nurse include when teaching this patient about this medication? a. "Apply this medication three times daily for 30 days." b. "Dry skin, itching, and rash are common local side effects." c. "This drug has the same risk of GI side effects as with oral NSAIDs."
d. "You do not need to protect your skin from sunlight with diclofenac." CORRECT ANSWERS✅ ANS: B
Localized skin reactions are common effects with diclofenac. The medication is applied twice daily for 60 to 90 days. The risk of GI side effects is very low. Diclofenac causes sensitization to UV radiation, so patients should be taught to avoid exposure and to use sunscreen.
- A patient with actinic keratoses has received a prescription for fluorouracil [Carac]. Which statement by the patient indicates understanding of this medication? a. "Healing should occur 6 weeks after beginning treatment." b. "I will apply this drug twice daily." c. "Severe inflammation is an indication for stopping treatment."
d. "Tissue ulceration and necrosis are desired effects." CORRECT ANSWERS✅ ANS: D
Fluorouracil causes tissue disintegration, erosion, ulceration, and necrosis as part of the normal course of desired effects. Complete healing may take several months, although treatment lasts 2 to 6 weeks. Carac is applied once daily. Severe inflammation is part of the course of treatment and not an indication for discontinuing the medication.
- A nurse is discussing the use of tazarotene [Tazorac] with a patient who has psoriasis. Which statement by the patient indicates a need for further teaching? a. "I should use a sunscreen when using this medication." b. "I understand the gel can cause staining of clothing." c. "I will apply this once daily in the evening."
d. "I will apply the medication to dry skin." CORRECT ANSWERS✅ ANS: B
Tazarotene will not stain clothing. It is true that patients should use sunscreen while using this drug. It should be applied once daily in the evening to dry skin.
- An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest? a. Applying lotion to the skin after applying the drug b. Reducing the frequency to one application a day c. Discontinuing the medication, because this is likely an allergic reaction
d. Requesting a prescription for a gel formulation of the drug CORRECT ANSWERS✅ ANS: B
Benzoyl peroxide may cause drying and peeling of the skin. If signs of severe local irritation occur, such as burning or blistering, the frequency of application should be reduced. Applying lotion is not indicated. These symptoms are not consistent with an allergic reaction. There is no difference in skin reactions between the gel and the lotion formulations.
- A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently two to three times daily c. Eliminating greasy foods from the diet
d. Using an abrasive agent to scrub the face CORRECT ANSWERS✅ ANS: B
Gentle cleansing two to three times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne.
erythema in the protected region divided by the time required for the development of erythema in the unprotected region.
- An infant has a severe contact diaper dermatitis. The provider orders triamcinolone acetonide [Kenalog] 0.1% cream to be applied three times daily. When teaching the infant's parents about this medication, the nurse will instruct them to apply: a. a thick layer and massage the cream into the skin. b. a thin layer and leave the diaper open as much as possible. c. the cream and place an occlusive dressing over the area.
d. the cream and put the infant's diaper on tightly. CORRECT ANSWERS✅ ANS: B
Topical glucocorticoids can be absorbed systemically and cause adverse effects. To minimize systemic and local adverse effects, the medication should be applied sparingly. Parents should be taught to avoid tight- fitting diapers. The cream should be rubbed gently into the skin. Occlusive dressings increase the risk of adverse effects. Putting the diaper on tightly creates an occlusive dressing.
- An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. "I should apply the Retin-A immediately after bathing." b. "I should apply the Retin-A twice daily." c. "I should augment this therapy with an abrasive soap."
d. "I should use sunscreen every day." CORRECT ANSWERS✅ ANS: D
Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin-A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin-A is applied once daily. Abrasive soaps intensify localized reactions to Retin-A and should not be used.
- A 50-year-old patient asks about using tretinoin [Renova] to minimize wrinkles. What will the nurse tell the patient? a. The drug may be discontinued once results are obtained. b. Results may be visible within a few weeks of starting therapy. c. Systemic toxicity is a common side effect in patients with sensitive skin.
d. The drug is not effective on coarse wrinkles or sun-damaged skin. CORRECT ANSWERS✅ ANS: D
Tretinoin is used to treat fine wrinkles, not coarse wrinkles, and does not repair sun-damaged skin. Treatment with Renova must continue to maintain the response to the drug. Results are not visible for up to 6 months after beginning therapy. Systemic toxicity is not common.
- A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin [Retin-A] and has been applying benzoyl peroxide twice daily. The provider asks the nurse to teach this patient about isotretinoin [Accutane], which the patient will begin taking in a few weeks. The nurse will include which statement when teaching this patient about this drug? a. "Alcohol may be consumed in moderation when taking this drug." b. "Skin rash, headache, and hair loss are common with this drug." c. "Tetracycline must be discontinued before beginning the isotretinoin."
d. "Two pregnancy tests are required before each monthly refill of your prescription." CORRECT
ANSWERS✅ ANS: C
Adverse effects of isotretinoin can be increased by tetracycline, so tetracycline must be discontinued before therapy is started. Alcohol should be avoided, since it can potentiate hypertriglyceridemia. Skin rash, headache, and hair loss are not common side effects, although they can occur. Two pregnancy tests are required at the beginning of therapy; at each refill, only one pregnancy test is required.
- An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach this patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin
d. Topical retinoids CORRECT ANSWERS✅ ANS: A
Benzoyl peroxide is a first-line drug for mild to moderate acne. Other topical antibiotics and retinoids are used when first-line therapy fails.
- A patient with severe psoriasis will begin taking acitretin [Soriatane]. The nurse obtains a health history and learns that the patient takes a combination oral contraceptive. What will the nurse do? a. Counsel the patient to use another form of birth control along with the OCP. b. Tell the patient she may stop using contraception when the medication is withdrawn. c. Tell the patient that acitretin is safe to take during pregnancy.
b. "Both types are more common in African-American patients." c. "Drug therapy is the definitive treatment for angle-closure glaucoma."
d. "Early treatment with prostaglandin analogs can stop the progression of POAG." CORRECT
ANSWERS✅ ANS: D
Prostaglandin analogs are first-line agents for treating POAG, and early treatment can stop the progression. Angle-closure glaucoma has a rapid onset of painful symptoms. POAG is more common in African Americans but angle-closure glaucoma is not. Surgery, not drugs, is the definitive treatment for angle-closure glaucoma.
- A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a. "Systemic side effects will not occur with this agent." b. "You may experience an increased heart rate, but this is a harmless side effect." c. "You may need to wear dark glasses until this medication wears off."
d. "You will be able to read as soon as the examination is completed." CORRECT ANSWERS✅ ANS: C
Because the agent causes cycloplegia, which paralyzes the iris sphincter, the eyes are unable to respond to bright light, so patients should be advised to wear sunglasses until this effect wears off. Systemic side effects do occur with these agents. Tachycardia is a systemic effect and may indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be unable to focus; patients will have blurred vision until this effect wears off.
- A nurse is preparing to administer timolol [Timoptic] eye drops to a patient who has open- angle glaucoma. The nurse notes that the patient has a history of chronic obstructive pulmonary disease (COPD). The nurse will contact the provider to discuss changing to which medication? a. Betaxolol b. Carteolol c. Levobunolol
d. Metipranolol CORRECT ANSWERS✅ ANS: A
Betaxolol is the only ophthalmic beta blocker that is beta1 selective, meaning that it has less chance of causing bronchial constriction. It is preferred for patients with asthma and COPD. The other agents are not beta1 selective.
- A patient with ocular hypertension will begin using brimonidine [Alphagan] for long-term reduction of increased ocular pressure (IOP). The nurse teaches the patient about this medication. Which statement by the patient indicates understanding of the teaching? a. "After using the drops, I should wait 15 minutes before putting in contacts." b. "Because this is a topical medication, drowsiness will not occur." c. "I will not have cardiovascular side effects when using this medication."
d. "If my eyes begin to itch or turn red, it means I am allergic to this drug." CORRECT ANSWERS✅ ANS:
A
Patients using this drug should wait 15 minutes before putting in contacts, because soft contacts can absorb the drug. Even though the medication is topical, it can be absorbed systemically, causing systemic side effects such as drowsiness or lowered blood pressure. Itching and hyperemia may occur and do not indicate allergy.
- An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient's cornea. The nurse will expect the provider to order which treatment for this patient? a. High doses of vitamins C and E, beta-carotene, and zinc b. Laser therapy c. Pegaptanib [Macugen]
d. Photodynamic therapy CORRECT ANSWERS✅ ANS: A
This patient has three large drusen with minor vision changes, signs of intermediate age-related macular degeneration (ARMD). Patients with intermediate ARMD can significantly reduce their risk of developing advanced ARMD by taking high doses of vitamins C and E, beta-carotene, and zinc. Laser therapy, pegaptanib, and photodynamic therapy are used to manage wet, or neovascular, ARMD.
- A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching? a. "Blurred vision, tearing, or eye dryness may occur with this medication." b. "I may experience a bitter taste in my mouth after instilling these eye drops." c. "I will need to instill two eye drops three times daily in each eye."
d. "If I notice redness in my eyes or eyelids, I should stop using these drops." CORRECT ANSWERS✅
ANS: C
d. "This medication anesthetizes my eyes so that the examination won't be painful." CORRECT
ANSWERS✅ ANS: D
Anticholinergic agents are used to provide mydriasis and cycloplegia. They do not affect the sensation of pain and do not provide anesthesia. Cycloplegia refers to paralysis of the ciliary muscle and prevents the lens from moving during the examination. The desired effects, which facilitate eye examinations, do not allow the eye to focus or to respond to light, so blurred vision and photophobia occur. Mydriasis prevents the iris sphincter from contracting, allowing the examiner to see inside the eye.
- A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops
d. Ocular decongestants CORRECT ANSWERS✅ ANS: B
Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first-line agents. Ocular decongestants are used to treat redness caused by minor irritants.
- A nurse is teaching a patient diagnosed with wet ARMD who will begin receiving bevacizumab [Avastin]. Which statement by the patient indicates a need for further teaching? a. "I should be able to improve my visual acuity by using this drug." b. "I should report eye pain and photophobia to my provider if they occur." c. "This drug will help suppress the growth of new blood vessels."
d. "This medication will not reduce the risk of blindness." CORRECT ANSWERS✅ ANS: D
Bevacizumab can help reduce the risk of further impairment and progression to blindness. It can help improve visual acuity. Eye pain and photophobia are signs of endophthalmitis, which is an inflammation caused by infection; they should be reported to the provider. Bevacizumab works by suppressing the development of new blood vessels.
- A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching? a. "Chewable calcium tablets are not absorbed well and are not recommended." b. "I should not take more than 600 mg of calcium at one time." c. "I should take enough supplemental calcium to provide my total daily requirements."
d. "If I take calcium with green, leafy vegetables, it will increase absorption." CORRECT ANSWERS✅
ANS: B
To help ensure adequate absorption of calcium, no more than 600 mg should be consumed at one time. Chewable calcium tablets are recommended because of their more consistent bioavailability. The amount of supplemental calcium should be enough to compensate for what is not consumed in the diet and should not constitute the total amount needed per day. Green, leafy vegetables reduce the absorption of calcium.
- A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient's medication record, administered concurrently, would require additional patient monitoring by the nurse? a. Digoxin [Lanoxin] b. Furosemide [Lasix] c. Lorazepam [Ativan]
d. Pantoprazole [Protonix] CORRECT ANSWERS✅ ANS: A
Parenteral calcium may cause severe bradycardia in patients taking digoxin; therefore, the heart rate should be monitored closely. Concurrent administration of calcium chloride and pantoprazole, lorazepam, or furosemide is not known to lead to drug interactions.
- A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate [Fosamax] to zoledronate [Reclast]. Which statement by the patient indicates a need for further teaching? a. "I will need to have blood tests periodically while taking this drug." b. "I will only need a dose of this medication every 1 to 2 years." c. "This drug is less likely to cause osteonecrosis of the jaw."
d. "This drug is only given intravenously." CORRECT ANSWERS✅ ANS: C
Raloxifene is a selective estrogen receptor modulator (SERM) that has estrogenic effects in some tissues and antiestrogenic effects in others. It can preserve bone mineral density while protecting against breast and endometrial cancers. Estrogen promotes breast cancer and would not be indicated. Pamidronate and teriparatide are not protective against breast cancer.
- A patient has severe Paget disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider? a. Alendronate [Fosamax] b. Calcifediol [25-Hydroxy-D3] c. Calcitonin-salmon [Miacalcin]
d. Long-acting NSAIDs CORRECT ANSWERS✅ ANS: C
Calcitonin-salmon is the drug of choice for rapid relief of pain associated with Paget disease. Alendronate, calcifediol, and NSAIDs are not indicated.
- A patient with metastatic cancer has had several fractures secondary to bone metastases. The provider orders denosumab [Xgeva]. What will the nurse teach this patient? a. Denosumab may delay healing of these fractures. b. Denosumab should be given subcutaneously every 12 months. c. Denosumab will improve hypocalcemia.
d. Unlike bisphosphonates, denosumab does not increase osteonecrosis of the jaw (ONJ). CORRECT
ANSWERS✅ ANS: A
Because denosumab suppresses bone turnover, fracture healing may be delayed. Denosumab is given every 6 months. Denosumab can exacerbate hypocalcemia. Denosumab can increase the incidence of ONJ.
- A patient taking risedronate IR [Actonel] for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient? a. These are common side effects of this drug. b. These symptoms indicate serious toxicity. c. The patient should discuss taking risedronate DR [Atelvia] with the provider.
d. The medication should be taken after a meal to reduce symptoms. CORRECT ANSWERS✅ ANS: A
Diarrhea and headaches are common adverse effects of risedronate IR. These symptoms do not indicate toxicity. The side effects of Atelvia are similar to those of Actonel. Taking the medication after a meal will not reduce these effects.
- A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9. mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding __ daily and __ IU of vitamin D3 each day. a. 1200 mg of calcium once; 10, b. 1500 mg of calcium twice; 1000 c. 600 mg of calcium once; 10,
d. 600 mg of calcium twice; 2000 CORRECT ANSWERS✅ ANS: C
Women older than 50 years need 1200 mg of calcium per day. This patient is getting 600 mg/day. She should add 600 mg/day to compensate for what she does not get in her diet, because the amount of a supplement should be enough to make up the difference. Her vitamin D level is low, so she needs a vitamin D supplement. To treat deficiency, adults older than 19 years should get 10,000 IU/day. An additional intake of 1200 mg of calcium once daily is too much calcium. An additional intake of 1500 mg of calcium twice daily is too much calcium, and 1000 IU of vitamin D is not enough to treat deficiency. An additional intake of 600 mg of calcium twice daily is too much calcium, and 2000 IU of vitamin D is not sufficient to treat deficiency.
- A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug: a. at bedtime to minimize adverse effects. b. for a maximum of 1 to 2 years. c. while sitting upright with plenty of water.
d. with coffee or orange juice to increase absorption. CORRECT ANSWERS✅ ANS: C
Alendronate can cause esophagitis, and this risk can be minimized if the patient takes the drug with water while in an upright position. Taking the drug at bedtime is not indicated. The drug may be taken up to 5 years before re-evaluation is indicated. Coffee and orange juice reduce the absorption of alendronate and should be delayed for 30 minutes after taking the drug.
- A patient is taking alendronate [Fosamax] to treat Paget disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to:
