Post13 Hormones/Osteo

Which of the following drugs would INCREASE the cardiovascular adverse effects of thyroid hormones?
A. acetominophen
B. beta blockers
C. parasympathomimetic drugs
D. sympathomimetic drugs

F.H. is a 42 year old type 1 diabetic who has been receiving insulin for a long time. He needs a very high dose of insulin to maintain his blood glucose within the target range. Which of the following drugs might be added to his medications to help control his blood glucose?
A. glucagon.
B. bromocriptine.
C. growth hormone.
D. metformin (GLUCOPHAGE).

Which of the following are adverse effects of metformin (GLUCOPHAGE)?
A. hypotension
B. headache
C. blurred vision
D. hyperglycemia

Which of the following would you predict as an effect of insulin administration?
A. Increased blood glucose
B. Decreased white blood cell count
C. Increased serum sodium
*D. Decreased serum potassium

After subcutaneous administration of regular insulin, the peak effect is seen:
A. within 5-10 minutes
B. in 2-4 hours
C. in 8-12 hours
D. after 2 weeks of therapy

Match the drug to its MAJOR mechanism of aciton.

glipizide (GLUCOTROL)     Increases insulin release
acarbose (PRECOSE)     Delays absorption of carbohydrate
repaglinide (PRANDIN)     Increases insulin release
NPH insulin     Replaces insulin

For many years, women have been prescribed estrogen with or without progesterone at menopause to reduce hotflashes and protect the bones and blood vessels. In 2002 the Women's Health Initiative published findings (JAMA 2002 Jul 17;288(3):366-8) substantiated by other reviews (JAMA 2002 Aug 21;288(7):872-81) that showed the effect of postmenopausal hormone replacement therapy (HRT) to include:
A. It increases the risk of breast cancer.
B. It reduces the risk of blood clots, heart attack and stroke.
C. It increases the risk of colon cancer.
D. It increases the risk of osteoporotic bone fractures.

A patient is to receive 12 units of regular insulin AND sliding scale insulin as follows: for BS (blood sugar) less than 80: give sugar, for BS 81-140: give no insulin, for BS 141-200 give 2 units regular insulin, for BS 201-250 give 4 units regular insulin, for BS 251-300 give 6 units regular insulin, for BS 301-350 give 8 units regular insulin. For BS over 350 give 10 units regular insulin. This morning the blood sugar was 40. What should you do?
A. Give 12 units Humalog insulin with sugar.
B. Give 12 units Humulin-R with sugar.
C. Give 12 units Humulin-N with sugar.
D. Give sugar.

LC is a 33 year old who has been taking oral contraceptives. She reports a recent weight gain and says her right foot is so swollen she can barely get her shoe on. Her left foot is normal. What is the significance of these complaints?
A. These symptoms may eventually require a trip to the doctor, but they are not related to the BCPs.
B. She is probably pregnant, and should pick up an over-the counter kit to check before she takes any more BCPs.
C. She has probably developed a blood clot in her right leg (thrombophlebitis), and should go to the hospital to have it checked.
D. She is showing signs of menopause and could probably safely stop taking the BCPs without getting pregnant.

Pregnancy may cause swelling but the unilateral nature of her leg swelling is classically related to a major clot in the vien that prevents fluid from returning to the heart. Pieces of the clot could break off and travel to her lungs. These emboli can result in death, so she should go to the hospital to be tested for blood clots and be put on anticoagulants as needed. Women who get thrombophlebitis are 3-4 times more likely to have been taking BCP than those who do not get such clots. The risk of thrombophlebitis is not related to lenght of therapy and this risk dissappears when the pills are stopped.

Which of the following is the least expensive prevention for osteoporosis?
A. Forteo
B. Evista
C. Calcium supplements with vitamin D
D. Flomax

Altough not the most effective strategy, calcium supplements are the least expensive. Vitamin D improve efficacy without significant increase in cost. Thsi therapy costs about $12/month. Flomax is for benign prostatic hypertrophy. (Fosamax is for osteoporosis prevention, but at $70/30 days, costs more than Ca/vitD.) Forteo costs about $500/month and between cost and a black box warning from the FDA regarding osteosarcoma, it is reserved for those at greatest risk for fracture. Evista is about $70/month. (figures from rxlist 8-2004)

Which of the following are adverse effects of glipizide (GLUCOTROL)?
A. hypertension
B. headache
C. chest pain
D. muscle pain

After subcutaneous administration of regular insulin, the peak effect is seen:
A. within 5-10 minutes
B. in 2-4 hours
C. in 8-12 hours
D. after 2 weeks of therapy


LC is a 33 year old who has been taking oral contraceptives for the past 8 years. To assess her risk of having adverse effects from this medication, the most important question you should ask is:
A. "Are you allergic to eggs?"
B. "Do you smoke?"
C. "Have any family members been diagnosed with osteoporosis?"
D. "Has anyone in your family died of colon cancer?"

Pre13 Hormones/Osteo

Which of the following is an adverse effect of the oral contraceptives?
A. hypertension
B. acne
C. decrease in breast size
D. pregnancy

Dysfunctional uterine bleeding is managed with:
A. testosterone
B. oxytocin
C. thyroid
D. progestin

Your cousin has complained of fatigue for some time. You notice she is gaining weight and that her skin has become very dry. She is cold all the time and is not as sharp mentally as she used to be. Her primary care provider says she has a thyroid problem that needs pharmacological support. Which of the following drugs should she take?
A. progesterone
B. a sympathomimetic drug
C. methimazole (TAPAZOLE)
D. levothyroxine (SYNTHROID)

K.R. is a 30 year old type 1 diabetic. He takes regular insulin four times a day. He is complaining that he is really hungry, feels weak, and has a headache. You notice that he is confused and his heart rate is increased and he is sweating. The most likely reason for these symptoms is
A. lipodystrophy.
B. allergy.
C. hypoglycemia.
D. hyperglycemia.

Which of the following is a combination medication for Type 2 diabetes?
A. Metformin
B. Acarbose
C. Metaglip
D. Glipizide

Production of thyroid hormones requires adequate dietary intake of
A. iodine/iodide.
B. vitamin B12.
C. calcium.
D. cholesterol

A patient should be told to take pioglitizone:
A. By injecting it into a different site each day.
B. Without regard to meals.
C. 3x/day, 30 minutes before each meal.
D. 3x/day, 30 minutes after each meal.

The hypothalamus secretes:
A. releasing factors that act on the anterior pituitary
B. most of the important hormones we currently use as drugs
C. antidiuretic hormone and oxytocin
D. epinephrine and norepinephrine

When hormones are used for contraception, what doses are appropriate?
A. High doses of both estrogen and progesterone
B. Low dose estrogen, but high dose progesterone
C. High dose estrogen, but low dose progesterone
D. Low doses of both estrogen and progesterone

Glucotrol works by:
A. Improving hepatic glucose release
B. Blocking thyroid hormone production
C. Stimulating pancreatic insulin release
D. Stimulating thyroid hormone production

If your client took regular insulin at 0700 (7am) but forgot to eat, what time would a hypoglycemic reaction be most likely to occur?
A. 0900 (9am)
B. 1500 (3pm)
C. 1800 (6 pm)
D. 2100 (9 pm)

Inadequate dietary intake of iodide/iodine would result in defective production of
A. aldosterone.
B. T3 and T4
C. insulin.
D. calcitonin.

The hypothalamus secretes:
A. releasing factors that act on the anterior pituitary
B. antidiuretic hormone and oxytocin
C. most of the important hormones we currently use as drugs
D. epinephrine and norepinephrine

Post12 Psych/Seizure/Abuse

An herb thought to be useful in treating memory problems is:
A. Ginseng
B. St John's Wort
C. Ginkgo Biloba
D. Echinacea

Which of the following should patients and/or their caregivers be told when they start taking antidepressant drugs?
A. Drugs often deplete potassium. Keep diet high in potassium rich food.
B. The drugs may stimulate sexual appetite.
C. Dry mouth should be managed with ice chips or sugarless gum.
D. It is safe to use herbal supplements such as St. John's wort to enhance the antidepressant effect of the drugs.

Use of St John's wort with antidepressants can lead to serotonin syndrome. Up to 70% of pts on SSRIs may have reduced libido and inability to reach orgasm. SE include anticholinergic effects such as dry mouth. Avoid sugar gum to reduce cavities.

Fluoxetine (PROZAC) relieves depression by:
A. increasing the amount of serotonin in the synaptic cleft
B. blocking release of norepinephrine from the pre-synaptic nerve
C. increasing the metabolism of MAO (mono-amine oxidase)
D. depressing the metabolism of MAO

Lamotrigine is indicated for:
A. Tonic-clonic seizures
B. Status epilepticus
C. Insomnia
D. Absence seizures

Zolpidem is indicated for:
A. Bipolar disease
B. Absence seizures
C. Tonic-clonic seizures
D. Insomnia

Severe alcohol withdrawal:
A. May not be manifested until several days after alcohol ingestion has stopped.
B. Includes signs and symptoms of hallucinations, agitation, sweating, rapid heart rate.
C. Is treated aggressively with benzodiazepines or the patient could die.
D. All of the above.

Ms. J is brought to the emergency room in a semi-comatose state. She has a low blood pressure and is breathing slowly. Her pupils are pinpoint. These signs and symptoms are most consistent with a drug overdose on which of the following?
A. Amphetamines
B. Cocaine
C. A hallucinogen such as LSD
D. An opiate such as heroin

A patient with a 3 week history of fatigue, sadness, irritability, boredom and difficulty paying attention in school seeks medical attention for insomnia. Sertraline 50 mg/day is furnished but 2 days later the patient states the symptoms have not improved. The best course of action is to:
A. Explain that more time is needed to see effect
B. Increase the dose of sertraline
C. Switch to paroxetine
D. Add zolpidem for the next 6 weeks
She is depressed and is being treated with an appropriate drug and dose. It takes several weeks for an SSRI to rebuild the receptors to give a therapeutic effect. The dose can be increased after a week or so if needed, but 2 days is too early. Zolpidem could be given for sleep but not for that long.

A patient receiving donepezil and memantine comes to the hospital with nausea and vomiting. You note he swallows frequently and drools clear saliva. His skin is wet with sweat. BP is low at 80/50 and heart rate is low at 50. You should treat shock and......
A. give atropine.
B. discontinue the memantine.
C. give physostigimine.
D. increase the donepezil dose.
This patient is in cholinergic crisis, from too much ACh. (Too much parasympathetic.) Block with atropine, an anticholinergic. Physostigmine would increase AcH as would increasing the donepezil dose. This toxicity is from the donepezil, so discontinuing the memantine would not help.

When evaluating care provided by hospitals, the Joint Commission may review whether chemical restraints are used appropriately, in the treatment of patients, or inappropriately, to "police" irritating behavior. Which of the following is an appropriate use of chemical restraints?
A. The nurse administers risperidone to an elderly confused patient who tried to climb over the bedrail when the family has just agreed to leave one member at the bedside around the clock.
B. A patient with a drug overdose is yelling obcenities in the emergency room and other patients are complaining. The nurse gives a dose of haloperidol.
C. The doctor orders vicodin for a delirious patient who has pulled out 2 IV lines in the last hour.
D. A patient is agitated and restless, writhing around in bed which is causing the dressings to be torn off a wound. The nurse gives a dose of midazolam.
Before using any restraints, other options should be tried, such as having a "sitter" at the bedside who can call the nurse if the patient attempts to do something that would be detrimental to their health (such as pull out a tube or fall out of bed). Vicodin is for pain, not to minimize agitated, confused behavior. (If you picked this, be careful that you are answering the question written, not making up your own. It does not say this patient is in pain.) Stopping a patient from using foul language is not necessary for their safety or treatment. Joint Commission would ask us to put the patient in a private room. A patient whose agitated behavior is causing negative effects on the treatment of a wound can be given a chemical restraint.

An herb thought to be useful in treating anxiety and sleeping problems is:
A. Ginseng
B. Senna
C. Kava
D. Saw Palmetto         

The mechanism of action of phenytoin (DILANTIN)is
A. beta receptor blockade.
B. GABA inhibition.
C. calcium channel blockade.
D. reducing sodium transport.

Ethosuximide is indicated for:
A. Partial seizures
B. Tonic-clonic seizures
C. Absence seizures
D. Status epilepticus

An alcoholic who was driving drunk is admitted to the hospital after an auto accident. Which statement is FALSE?
A. Folic acid, thiamine, and multivitamins will probably be ordered.
B. Delirium tremors (DTs) may develop and result in death if the patient is not treated with a drug such as lorazepam (ATIVAN).
C. Alcohol depletes liver fat so the patient will need a diet high in fat.
D. Prolonged night blindness from alcohol may have contributed to the accident.

Mr. B is brought in by ambulance with a drug overdose. He was found outdoors after a relatively cold night. He is in a coma, blood pressure is low, and his body temperature is low. Which drug would you suspect he overdosed on?
A. Alcohol
B. Cocaine
C. A hallucinogen such as LSD
D. Marijuana or hashish

Which of the following are/is a cholinesterase inhibitor(s), appropriate for the treatment of symptoms of Alzheimer's disease?
A. physostigmine, pyridostigmine
B. donepezil, galatamine, rivastigimine
C. memantine
D. carbamazepine, ethosuximide, lamotrigine
Donepezil, Galatamine, and Rivastigimine are acetylchoinesterase inhibitors that increase the amount of AcH in the synapse and improve memory in Alzhiemer's pts. Physostigmine and pyridostigmine are also acetylcholinesterase inhibitors but are used in glaucoma and myasthenia gravis respectively. Memantine is used for Alzheimers but does not work on AChE. The other drugs are used for seizures.

Pre11 Psych/Seizure/Abuse

If an anxious patient starts taking a benzodiazepine orally, effectiveness should be seen:
A. within about 10 minutes
B. within about 1 hourC. within 2-3 weeks
D. within 6-8 weeks

Which of the following should patients and/or their caregivers be told when they start taking antidepressant drugs?
A. Drugs often deplete potassium. Keep diet high in potassium rich food.
B. The drugs may stimulate sexual appetite.
C. Dry mouth should be managed with ice chips or sugarless gum.D. It is safe to use herbal supplements such as St. John's wort to enhance the antidepressant effect of the drugs.

The drug zolpidem is useful in treating:
A. anxiety
B. insomniaC. depression
D. bipolar disease

Diazepam (VALIUM) is used to treat:
A. Psychotic behavior
B. Postoperative pain
C. Depression
D. Anxiety
Under what conditions would you hold (not administer) galantamine?
A. The ordered dose is 120 mg orally.B. The patient says she got dizzy when getting out of bed yesterday.
C. There has been no improvement in 4 weeks of therapy.
D. The patient does not remember her MD ordering the drug.

Addiction, dependence, tolerance can result from therapeutic drug therapy. The following statements are true except (select all that apply):
A. Addiction,dependence and tolerance result typically in individuals with personality disorders.   
B. Addiction or dependence is predictable therefore all medications must be prescribed sparingly.   
C. High potential abuse medication must be carefully prescribed and monitored.         
D. Patients who become addicted or dependent on medications often started their use as a result of an injury or disease.         

Patients who take medications with abuse potential need to understand the following concepts (select all that apply):
A. Dosage control
B. Taking any medications in combination with other drugs
C. Cross tolerance
D. Alcohol and nicotine use

Psychiatric drug therapy requireds a working knowledge of psychiatry. Psychiatric medications pose difficulties for general practitioners and are often left to the specialists. This is typically because (select all that apply):
A. Primary care physicians are not licensed to prescribe psychiatric medications.
B. Psychiatric patients often require both medication and psychotherapy for successful therapy.
C. Side effects are often mistaken for psychiatric illnesses and left untreated
D. Psychiatric patients often have more than one illness which requires highly specialized treatments often needing medication changes and different dosing until the right medication is found.

Seizures have many underlying causes which must be considered in order to provide appropriate treatment. These causes include but are not limited to the following (select all that apply):
A. chronic depression
B. head trauma
C. alcohol or abuse drug use
D. neoplastic diseases

When understanding seizure care, patients can still experience seizures even with treatment. Which of the following are important nursing care implications? (select all that apply)
A. Assessing suicide risk if not taking seizure mediation appropriately.
B. Protect the teeth and tongue with fingers if necessary
C. Keep patients safe from injury during seizures such as moving furniture and maintaining an airway
D. instruct patients in special considerations with seizure medication such as taking with food, exercise, and fluids

Under what conditions would you hold (not administer) galantamine?
A. There has been no improvement in 4 weeks of therapy.
B. The patient says she got dizzy when getting out of bed yesterday.
C. The patient does not remember her MD ordering the drug.
D. The ordered dose is 120 mg orally.
Patients treated for psychiatric disorders often have difficulty finding the right medication for them. This is due to the following concepts (select all that apply):
A. balancing drug interactions
B. dosing challedges
C. Psychiatric medication mutate and are often misunderstood
D. mixed symptoms and disorders which sometimes contradict one another

Seizures have different etiologies therefore it is important to understand different seizure disorders and their treatments. Which statement (s) are true? (select all that apply)
A. Infectious diseases can cause seizures and the primary treatment is not only to control the seizure but to treat the underlying cause.
B. Seizures have known causes and are treated accordingly.
C. Medications can cause seizures therefore must be considered as a possible cause.
D. Babies and children can have febrile seizures which are controlled with acetaminophen.

Post14 GI

The patient is comatose following ingestion of an unknown poison. Staff in the Emergency Room will:
A. Induce vomiting with ondansetron (ZOFRAN)
B. Administer a universal poisoning antidote
C. Insert a stomach tube and give activated charcoal
D. Suppress symptoms with tricyclic antidepressants

Client teaching for someone taking over-the-counter antacids might include which statement?
A. If gastrointestinal bleeding does not stop within 2 weeks, consult your practitioner.
B. Although antacids are the mainstay of therapy for peptic ulcers, they must be taken frequently to be effective.
C. If constipation results from magnesium antacids, try switching to aluminum antacids.
D. Antacids interfere with absorption of many medicines, so take them at different times.

When administering psyllium and bran (METAMUCIL) to treat constipation, it is important to:
A. Allow the solution to sit for 30 minutes before the patient drinks it
B. Give 4-6 glasses of water each day
C. Have bathroom or bedpan access ready for 15 minute onset of action
D. All of the above

Which of the following combination products would be most likely to treat heartburn (acid indigestion) associated with excessive gas, without side effects of either constipation or diarrhea?
A. GAVISCON (aluminum hydroxide and magnesium carbonate)
B. MYLANTA (aluminum hydroxide, magnesium hydroxide and simethicone)
C. METAMUCIL (psyllium)
D. PHOSPHAJEL CAPS (aluminum phosphate)

A patient has one medium sized tube into the stomach and one small tube into the small intestine. To give sucralfate to this patient:
A. Dissolve the tablet and put down the stomach tube.
B. None of the above. A patient with tubes into the stomach and intestine should not be receiving sucralfate.
C. Give the tablet rectally.
D. Dissolve the tablet and put down the intestinal tube.

The most effective drugs for treating gastric ulcers are:
A. Histamine stimulants
B. Aluminum Antacids
C. Anticholinergics
D. Antibiotics

The most important vitamins for an alcoholic to take are:
A. D and C
B. The B vitamins
C. Vitamin A and E
D. The fat soluble vitamins

Lansoprazole is a Category B proton pump inhibitor, available in several forms. What precautions should you advise about/monitor for in patients taking this drug?
A. Do not take if pregnant.
B. Get out of bed slowly.
C. Do not open capsule before swallowing.
D. Do not crush delayed release beads inside the capsule.

Category X drugs should be avoided in pregnancy. B is almost as safe as you can get. The capsule contains time release beads. It can be opened and mixed with foods such as applesauce for patients who have trouble swallowing tablets, but the beads should not be crushed, as this removes the time release properties of the beads. There are no side effects relating to BP or pulse that would cause dizziness when getting out of bed.

MD orders should be questioned if the drug ordered would be dangerous for the patient to receive, if the patient needs a drug which is not ordered and when multiple drugs are ordered for the same condition when combination therapy is not called for. Which drug order should be questioned?
A. No prescription for a stool softner in a patient on morphine for cancer.
B. Lansoprozole in a hospitalized patient without a prior history of ulcer disease.
C. Metronidazole in a patient who just had open bowel surgery.
D. Metoclopramide in a diabetic patient with nausea from slow peristalsis.