A
Which information should the nurse include in the education for the parent of a child with rickets?
1. Avoid dairy products while taking vitamin D.
2. Be sure to take brand name, not generic, vitamin D.
3. Spend at least 20 minutes/day in the sunlight.
4. Take your vitamin D on an empty stomach.
Answer: 3
Explanation:
1. Dairy products are good sources of vitamin D and should be consumed.
2. Generic vitamin D is fine to take.
3. Twenty minutes/day in the sun will provide all the vitamin D that is required.
4. Vitamin D should be taken with food, not on an empty stomach.
The nurse has completed medication education for a client prescribed allopurinol (Zyloprim). Which client statements indicate an understanding of the information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "It may take a few days or weeks for me to get the full effect of this medication."
2. "I should not drink alcohol while taking this drug."
3. "If I develop a skin rash, I should contact the prescriber."
4. "I should not crush this medication."
5. "I should take this medication with food.
Answer: 1, 2, 3, 5
Explanation:
1. It may take 1-3 weeks for blood levels of uric acid to return to normal range.
2. Alcohol may inhibit the renal excretion of uric acid.
3. Skin rash is a possible adverse reaction of allopurinol and can be serious.
4. Allopurinol tablets may be crushed for administration.
5. Allopurinol should be taken with or after meals.
Which describe the goals of pharmacotherapy for a client with rheumatoid arthritis?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Increase rheumatoid factors
2. Reduce pain
3. Prevent fractures
4. Minimalize disability
5. Control inflammation
Answer: 2, 4, 5
Explanation:
1. Rheumatoid factors are autoantibodies that attack the client's tissues, activating complement and drawing leukocytes into the area, where they attack the cells of the synovial membranes and blood.
2. The goals of pharmacotherapy for a client with rheumatoid arthritis include the reduction of pain, minimizing physical disability, and controlling inflammation.
3. The prevention of fractures is not a pharmacotherapeutic goal for a client with rheumatoid arthritis.
4. The goals of pharmacotherapy for a client with rheumatoid arthritis include the reduction of pain, minimizing physical disability, and controlling inflammation.
5. The goals of pharmacotherapy for a client with rheumatoid arthritis include the reduction of pain, minimizing physical disability, and controlling inflammation.
Which is an important function of calcium?
1. Regulate acid-base balance
2. Improve glucose absorption
3. Increase energy
4. Regulate nerve transmission
Answer: 4
Explanation:
1. Calcium does not regulate acid-base balance.
2. Calcium does not improve glucose absorption.
3. Calcium does not increase the energy level.
4. Adequate calcium levels help transmit nerve impulses.
The nurse is preparing to provide education for a client prescribed Raloxifene. Which common adverse effects should the nurse include in the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Flu like symptoms
2. Leg cramps
3. Hot flashes
4. Peripheral edema
5. Weight gain
Answer: 2, 3, 5
Explanation: 1. Flu-like symptoms are a less common adverse effect of raloxifene.
2. Leg cramps are a common adverse effect of raloxifene.
3. Hot flashes are a common adverse effect of raloxifene.
4. Peripheral edema is a less common adverse effect of raloxifene.
5. Weight gain is a common adverse effect of raloxifene.
The nurse has provided education for a client prescribed (Fosamax). Which statements made by the client indicate an understanding of the information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "I cannot lie down for at least 30 minutes after taking the prescription."
2. "Milk will help with the absorption of this medication."
3. "I should call my healthcare provider if I experience heartburn."
4. "I must take this with a full glass of water."
5. "The prescription can be taken with or without food."
Answer: 1, 3, 4
Explanation:
1. The client must stay upright for at least 30 minutes to prevent GI upset.
2. Milk will interfere with the absorption of alendronate; it should be taken on an empty stomach.
3. Alendronate is irritating to the esophagus; the client must contact the physician if heartburn occurs.
4. Alendronate must be taken on an empty stomach with a full glass of water to ensure absorption.
5. Food will interfere with the absorption of alendronate; it should be taken on an empty stomach.
Which statement should the nurse include in a client's education when discussing calcium supplementation?
1. "This drug may cause insomnia."
2. "Take your calcium with a meal."
3. "The vitamin D supplement can be taken separately."
4. "Take the calcium on an empty stomach."
Answer: 2
Explanation:
1. Insomnia is not an adverse effect of calcium ingestion.
2. Calcium is best absorbed if taken with a meal.
3. Vitamin D facilitates absorption of calcium.
4. Calcium should be taken with food for best absorption or within 1 hour of meals.
Which statement made by a client supports their diagnosis of acute gouty arthritis?
1. "I experience numbness in my joints."
2. "My muscles feel very weak."
3. "My attacks occur at night."
4. "I have a great deal of stiffness in the morning."
Answer: 3
Explanation:
1. Acute gouty arthritis is not associated with numbness in the joints.
2. Muscle weakness is not associated with gout.
3. Attacks of acute gouty arthritis have a sudden onset, often occur at night
4. Morning stiffness is not specifically associated with acute gouty arthritis.
Which conditions should the nurse associate with the development of hypocalcemia despite normal dietary intake?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Malabsorption syndrome
2. Hyperparathyroidism
3. Chronic kidney disease
4. Excessive vomiting
5. Multiple blood transfusions
Answer: 1, 3, 4, 5
Explanation:
1. Malabsorption syndrome can result in hypocalcemia.
2. Hypoparathyroidism results in a decrease of PTH causing hypocalcemia.
3. Chronic kidney disease may cause excessive calcium loss in the urine.
4. Excessive vomiting is associated with the loss of calcium.
5. Multiple blood transfusions can result in hypocalcemia.
The nurse has provided education to a client prescribed Adalimumab (Humira). Which statement made by the client indicates further teaching is required?
1. "I am glad I do not have to take the prescription daily."
2. "I will practice drawing up the prescription in a syringe."
3. "I will store the prescription in the refrigerator."
4. "I will stop using echinacea."
Answer: 2
Explanation:
1. Adalimumab is administered by the subcutaneous route, usually every other week. Doses differ by indication.
2. Adalimumab is available in a single-use pen injection system for home administration.
3. The prescription should be stored in the refrigerator.
4. Echinacea should be avoided because it may decrease the immunosuppressive effects of adalimumab.
Which should the nurse plan to administer to a client to restore their calcium balance?
1. Calcium supplements and dark green, leafy vegetables
2. Calcium supplements and milk products
3. Calcium supplements and potassium
4. Calcium supplements and vitamin D
Answer: 4
Explanation:
1. Dark green, leafy vegetables are not the best of the sources of calcium listed.
2. Calcium supplements and milk products are good choices, but the client must also have vitamin D.
3. Potassium is not necessary with this illness.
4. Calcium supplements and vitamin D are considered the most effective treatments for osteomalacia.
Which pharmacological effects are used to prevent hyperuricemia for a client with gout?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Break down the uric acid
2. Inhibit the formation of uric acid
3. Excrete the uric acid
4. Convert uric acid to a less toxic form
5. Eliminate the uric acid
Answer: 2, 3, 4
Explanation:
1. Uric acid can be reduced not broken down but can be converted to a less toxic form.
2. A strategy to prevent hyperuricemia includes inhibiting the formation of uric acid.
3. A strategy to prevent hyperuricemia includes excreting the uric acid.
4. A strategy to prevent hyperuricemia includes converting the uric acid into a less toxic form.
5. Uric acid cannot be eliminated from the body; it is a byproduct of purines in the body
Which is the nurse's primary concern for a client with a low calcium level?
1. Seizures
2. Bone fractures
3. Hypoglycemia
4. Depression
Answer: 1
Explanation:
1. A low calcium level puts the client at risk for seizures.
2. A consistently low calcium level will result in bone fractures, but this is not the immediate concern.
3. A low calcium level will not result in hypoglycemia.
4. A low calcium level will not result in depression
Which is a contributing factor to the symptoms of gout?
1. An increase in the excretion of uric acid
2. Buildup of uric acid in the blood
3. Cartilage loss in the joints
4. Decrease in uric acid in the blood
Answer: 2
Explanation:
1. An increase in excretion would not cause gout.
2. Gout is due to buildup of uric acid in blood or joints.
3. Cartilage loss is characterized by osteoarthritis.
4. A decrease in uric acid would not cause gout.
The nurse is preparing to provide education for a client prescribed sodium hyaluronate (Hyalgan). Which information should the nurse plan on including in the instructions?
1. "You will be receiving one injection a month."
2. "You will need to return to the clinic every 3 months."
3. "This will help prevent friction of the joints."
4. "Sodium hyaluronate is a synthetic fluid that is injected around your joints."
Answer: 3
Explanation:
1. Treatment consists of one injection per week for 3 to 5 weeks.
2. Treatment consists of one injection per week for 3 to 5 weeks.
3. Sodium hyaluronate is a natural chemical found in high amounts within synovial fluid. Administered by injection directly into the knee joint, this drug replaces or supplements the body's natural hyaluronic acid that deteriorated because of the inflammation of OA. Treatment consists of one injection per week for 3 to 5 weeks. By coating the articulating cartilage surface, Hyalgan helps provide a barrier that prevents friction and further inflammation of the joint.
4. Sodium hyaluronate is a natural chemical found in high amounts within synovial fluid. Administered by injection directly into the knee joint, this drug replaces or supplements the body's natural hyaluronic acid that deteriorated because of the inflammation of OA
Which is the next step in the process of vitamin D activation after the dietary products are consumed?
1. Calcium is absorbed in the small intestine.
2. Calcifediol is formed.
3. Calcitriol is formed.
4. Cholecalciferol is synthesized
Answer: 4
Explanation:
1. The formation of calcium is not the next step in the process of vitamin D activation after the dietary products are consumed.
2. After dietary products are consumed, cholecalciferol is synthesized from cholesterol. Calcifediol is formed from cholecalciferol.
3. The formation of calcitriol is not the next step in the process of vitamin D activation after the dietary products are consumed.
4. After dietary products are consumed, cholecalciferol is synthesized from cholesterol. Calcifediol is formed from cholecalciferol. Calcitriol is formed which results in the increased absorption of calcium in the small intestine
Which assessment is the best to determine the effectiveness of bisphosphonate therapy for a client with osteoporosis?
1. Normal serum calcium levels
2. Absence of fractures
3. Bone density scan
4. Absence of bone pain
Answer: 3
Explanation:
1. The bone density scan, not the levels of serum calcium, is the best assessment measure to determine the effectiveness of bisphosphonates.
2. The bone density scan, not the absence of fractures, is the best assessment measure to determine the effectiveness of bisphosphonates.
3. The bone density scan is the best assessment tool to determine the effectiveness of bisphosphonates.
4. The bone density scan, not the absence of bone pain, is the best assessment measure to determine the effectiveness of bisphosphonates
Which assessment should the nurse include in the treatment plan for a client receiving calcium intravenously (IV)?
1. Serum glucose levels
2. Intravenous (IV) site
3. Serum potassium levels
4. Level of consciousness
Answer: 2
Explanation:
1. The client's glucose levels will not be affected when receiving intravenous (IV) calcium.
2. The intravenous (IV) site must be assessed, as extravasation may lead to necrosis of tissue at the insertion site.
3. The client's serum potassium levels should not be affected when receiving intravenous (IV) calcium.
4. The level of consciousness is not directly affected by intravenous calcium.
Which assessment findings should the nurse anticipate for the client that has overdosed on vitamin D?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Abdominal cramping
2. Muscle twitching
3. Vomiting
4. Fatigue
5. Excessive thirst
Answer: 3, 4, 5
Explanation:
1. Abdominal cramping is a symptom of hypocalcemia.
2. Muscle twitching is a symptom of hypocalcemia.
3. Vomiting is associated with hypercalcemia that occurs after an overdose of vitamin D.
4. Fatigue is associated with hypercalcemia that occurs after an overdose of vitamin D.
5. Excessive thirst is associated with hypercalcemia that occurs after an overdose of vitamin D.
Which information should the nurse include in the education for a client prescribed denosumab (Prolia)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "I will administer your prescription in the form of an injection."
2. "You may feel more fatigued than usual when taking this prescription."
3. "Be certain to keep your appointments for follow-up."
4. "Do not take any kind of calcium supplement or vitamin D supplement while taking this drug."
5. "We must monitor your cholesterol while you are taking this drug."
Answer: 1, 2, 3, 5
Explanation:
1. Denosumab is administered subcutaneously.
2. An adverse reaction of this drug is fatigue.
3. This drug can cause severe hypocalcemia, so it is important to monitor lab values.
4. Calcium and vitamin D supplementation may be necessary to keep serum calcium at normal level.
5. This drug may result in hypercholesterolemia.
Which testing should the nurse instruct the client receiving hydroxychloroquine sulfate (Plaquenil) to do on a regular basis?
1. Hearing tests
2. Eye exams
3. Serum glucose
4. Blood pressure
Answer: 2
Explanation:
1. Hearing tests are not necessary when the client receives hydroxychloroquine sulfate.
2. Blurred vision, inability to read, and visual field disturbances can occur when receiving hydroxychloroquine sulfate so the client must have regular eye exams.
3. Serum glucose monitoring is not necessary when the client receives hydroxychloroquine sulfate.
4. Blood pressure monitoring is not necessary when the client receives hydroxychloroquine sulfate.
The nurse has taught the client with osteoporosis about how to manage the illness. Which statement by the client indicates that additional teaching is necessary?
1. "I will avoid drinking alcohol."
2. "I will walk for 30 minutes every day."
3. "I will take my calcium when I wake up."
4. "I will drink milk regularly."
Answer: 3
Explanation:
1. Avoiding alcohol will help with osteoporosis.
2. Walking will help with osteoporosis.
3. Calcium should be taken with meals.
4. Drinking milk will help with osteoporosis.
Which symptoms associated with an adverse effect of alendronate (Fosamax) should the nurse instruct the client to report?
1. Ringing in the ears
2. Flushed skin
3. Visual changes
4. Muscle spasms
Answer: 4
Explanation:
1. Ringing in the ears is not an adverse effect of alendronate.
2. Flushed skin is not an adverse effect of alendronate.
3. Visual changes are not adverse effects of alendronate.
4. Muscle spasms indicate a low calcium level, which can be caused by alendronate. If untreated, the client is at risk for seizures.
Which describes the mechanism of action of selective estrogen receptor modulators (SERMs)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Increase bone density
2. Increase calcium levels in the bone
3. Decrease bone resorption
4. Inhibit synthesis of microtubules
5. Increase bone mass
Answer: 1, 3, 5
Explanation:
1. Selective estrogen receptor modulators increase bone density.
2. Calcium supplements increase calcium levels.
3. Selective estrogen receptor modulators decrease bone resorption.
4. Selective estrogen receptor modulators do not inhibit synthesis of microtubules.
5. Selective estrogen receptor modulators increase bone mass.
Which should the nurse anticipate to be included in the treatment of advanced osteoarthritis?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Acetaminophen
2. Topical ointments
3. Tramadol
4. Biological response modifiers
5. Intraarticular corticosteroids
Answer: 1, 2, 3, 5
Explanation:
1. Acetaminophen is used in the treatment of advanced osteoarthritis.
2. Topical ointments are used in the treatment of advanced osteoarthritis.
3. Tramadol is used in the treatment of advanced osteoarthritis.
4. Biological response modifiers are prescribed for the treatment of rheumatoid arthritis.
5. Intraarticular corticosteroids is used in the treatment of advanced osteoarthritis