Question 1

The nurse provides teaching for a patient who will begin taking bosentan [Tracleer] for pulmonary arterial hypertension (PAH). Which statement by the patient indicates a need for further teaching about this medication?

Accepted Answer

Liver injury may occur with bosentan but all cases to date have been reversible. The medication may be taken without regard to meals. Patients taking bosentan should not take cyclosporine concurrently. Patients will need to have liver enzymes measured monthly while taking the drug.

Question 2

A pregnant patient begins active labor at 30 weeks' gestation. The provider orders dexamethasone 6 mg intramuscularly to be given twice daily for 4 doses. The patient asks the nurse what effect this drug will have on the fetus. The nurse will tell her that the dexamethasone is given to:

Accepted Answer

When preterm delivery cannot be prevented, injecting the pregnant patient with glucocorticoids can accelerate fetal lung maturation. Glucocorticoids do not improve cognitive function, neuromotor development, or physical size in the fetus.

Question 3

A nurse counsels a patient who is to begin taking gamma-hydroxybutyrate [Xyrem] for narcolepsy. It is important for the nurse to warn the patient that respiratory depression is a potential risk with concomitant use of:

Accepted Answer

The nurse should advise the patient to avoid alcohol when taking gamma-hydroxybutyrate, because combining the two increases the risk of respiratory depression. Gamma-hydroxybutyrate has no drug-to-drug interactions with beta blockers, caffeine, or nicotine.

Question 4

A patient with a history of heart disease develops pulmonary arterial hypertension (PAH), and the provider is considering prescribing sildenafil [Revatio]. The nurse caring for this patient will perform a careful drug history and notify the provider if the patient is taking which medication?

Accepted Answer

Patients taking sildenafil should not take nitroglycerin, since the combination can produce a life-threatening drop in blood pressure. Beta blockers, calcium channel blockers, and warfarin are not contraindicated with sildenafil.

Question 5

A nurse is caring for a premature infant who has received poractant alfa [Curosurf] 2.5 mL/kg via direct intratracheal instillation to prevent respiratory distress syndrome. The infant demonstrated initial improvement after the dose but has begun to deteriorate. Which treatment will the nurse expect the neonatologist to order?

Accepted Answer

When poractant alfa is given, subsequent doses are half the initial doses. Glucocorticoids are given prenatally; their use postnatally is in dispute.

Question 6

A patient who has pulmonary arterial hypertension (PAH) is receiving epoprostenol [Flolan] at a rate of 210 ng/min using a portable pump. The patient weighs 70 kg. The patient calls the clinic to report headache, nausea, and vomiting. The nurse will counsel the patient to:

Accepted Answer

Headache, nausea, and vomiting are common side effects of epoprostenol and are dose dependent. Patients should contact their provider to discuss these side effects and any necessary dosage adjustments. 100 ng/min is below the maintenance dose range for this patient; patients should not adjust doses without contacting the provider. The side effects are not serious and do not warrant hospitalization. Interruption of the drug can have life-threatening consequences.

Question 7

A patient with cystic fibrosis uses inhaled tobramycin [TOBI] 300 mg every 12 hours in repeated cycles of 4 weeks on and 4 weeks off. The patient reports hoarseness and tinnitus. The nurse will tell the patient that:

Accepted Answer

Inhaled tobramycin can cause tinnitus but does not cause hearing loss. Hoarseness is a common side effect. An intravenous aminoglycoside can cause hearing loss and is not used chronically for cystic fibrosis. Hearing loss will not occur with inhaled tobramycin. Inhaled tobramycin does not increase the risk of renal toxicity.

Question 8

An adult patient with sickle cell anemia is being treated for a severe acute crisis with an opioid analgesic, a glucocorticoid, and hydroxyurea. The patient's complete blood count reveals neutrophils 2000/mm³, platelets 85,000/mm³, reticulocytes 85,000/mm³, and a hemoglobin of 4.2 gm/dL. What will the nurse anticipate doing?

Accepted Answer

Hydroxyurea can cause severe myelosuppression with life-threatening reductions in blood-cell counts. This patient's neutrophil count and hemoglobin level indicate toxicity, so the hydroxyurea should be interrupted until blood counts improve. Decreasing or increasing the glucocorticoid is not indicated. Increasing the hydroxyurea would worsen the myelosuppression.

Question 9

A nurse is quizzing a nursing student who is preparing to care for a patient with cystic fibrosis. The patient uses inhaled tobramycin [TOBI], dornase alfa [Pulmozyme], ibuprofen, and salmeterol [Serevent Diskus]. Which statement by the student indicates understanding of this patient's drug regimen?

Accepted Answer

Salmeterol is a long-acting bronchodilator that also improves ciliary function. Dornase alfa decreases sputum viscosity but must be administered daily for life, not as needed. Ibuprofen is used in cystic fibrosis to suppress the inflammatory response that underlies the destruction of lung tissue. Tobramycin is given using a small-volume nebulizer, not a metered-dose inhaler.

Quiz 107: Additional Noteworthy Drugs

The nurse provides teaching for a patient who will begin taking bosentan [Tracleer] for pulmonary arterial hypertension (PAH) . Which statement by the patient indicates a need for further teaching about this medication?

A pregnant patient begins active labor at 30 weeks' gestation. The provider orders dexamethasone 6 mg intramuscularly to be given twice daily for 4 doses. The patient asks the nurse what effect this drug will have on the fetus. The nurse will tell her that the dexamethasone is given to:

A nurse counsels a patient who is to begin taking gamma-hydroxybutyrate [Xyrem] for narcolepsy. It is important for the nurse to warn the patient that respiratory depression is a potential risk with concomitant use of:

A patient with a history of heart disease develops pulmonary arterial hypertension (PAH) , and the provider is considering prescribing sildenafil [Revatio]. The nurse caring for this patient will perform a careful drug history and notify the provider if the patient is taking which medication?

A patient who has pulmonary arterial hypertension (PAH) is receiving epoprostenol [Flolan] at a rate of 210 ng/min using a portable pump. The patient weighs 70 kg. The patient calls the clinic to report headache, nausea, and vomiting. The nurse will counsel the patient to:

A patient with cystic fibrosis uses inhaled tobramycin [TOBI] 300 mg every 12 hours in repeated cycles of 4 weeks on and 4 weeks off. The patient reports hoarseness and tinnitus. The nurse will tell the patient that:

A nurse is quizzing a nursing student who is preparing to care for a patient with cystic fibrosis. The patient uses inhaled tobramycin [TOBI], dornase alfa [Pulmozyme], ibuprofen, and salmeterol [Serevent Diskus]. Which statement by the student indicates understanding of this patient's drug regimen?