Question 1

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 2

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 3

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 2,000/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 4

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.

Question 5

A patient with cancer is taking rasburicase (Elitek) to treat hyperuricemia and develops neutropenia with fever and respiratory distress on the fourth day of treatment. The nurse caring for this patient will expect to:

Accepted Answer

Rasburicase is used for management of hyperuricemia in patients undergoing treatment with chemotherapy for leukemias, lymphomas, and solid tumors. Fever and respiratory distress may occur; patients should be monitored closely. These symptoms do not warrant stopping the drug, and they do not indicate severe sepsis.

Question 6

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 7

A previously healthy patient develops sepsis. The patient's lab tests reveal deterioration of renal and hepatic function, and the provider orders drotrecogin alfa (Xigris) to be given intravenously at a rate of 1,440 mcg per hour for 96 hours. The patient, who weighs 60 kg, has a history of myocardial infarction and takes 81 mg of aspirin daily. What will the nurse do?

Accepted Answer

Patients should take drotrecogin alfa with caution if they have used more than 650 mL of aspirin within 7 days. This patient has used less than that, so the medication should be given as ordered while monitoring for signs of bleeding, which may occur as a side effect of the drug. Drotrecogin alfa is not contraindicated with aspirin but should be used with caution with higher doses. It is not necessary to decrease the dose of drotrecogin alfa with this dose of aspirin. Platelets are not indicated.

Question 8

A patient with cystic fibrosis uses inhaled tobramycin (TOBI) 300 mg every 12 hours in repeating 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 9

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 10

A patient who has pulmonary arterial hypertension (PAH) is receiving epoprostenol (Flolan) at a rate of 210 ng per minute 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. One hundred ng per minute 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.

Quiz 107: Miscellaneous Noteworthy Drugs

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 with cancer is taking rasburicase (Elitek) to treat hyperuricemia and develops neutropenia with fever and respiratory distress on the fourth day of treatment. The nurse caring for this patient will expect to:

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

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 patient who has pulmonary arterial hypertension (PAH) is receiving epoprostenol (Flolan) at a rate of 210 ng per minute 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: