WGU D116 Unit 6

An adult who has been self-medicating using nutritional therapy for an elevated cholesterol level complains of repeated episodes of flushing.

What should the provider suspect that the patient has been taking?

1. Pyridoxine

2. Thiamine

3. Niacin

4. Riboflavin

3. Niacin

Correct! Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation with resultant flushing, dizziness, and nausea. Flushing is not a side effect of thiamine, riboflavin, or pyridoxine because they do not cause vasodilation.

A patient will begin taking iron supplements to treat anemia. Which food should the provider recommend that the patient take the iron with to facilitate absorption?

1. Orange juice

2. Red meats

3. Cereal

4. Dairy products

1. Orange juice

Correct! Orange juice is a good source of vitamin C, and vitamin C facilitates the absorption of iron. Cereals are often fortified with iron but do not facilitate its absorption. Calcium interferes with the absorption of iron. Red meats are a natural source of iron.

Which vitamin has the highest risk for toxicity?

1. Vitamin A

2. Vitamin C

3. Vitamin B1

4. Vitamin B2

Vitamin A

Correct! Vitamins A, D, E, and K are fat soluble and are stored in the body. Excess intake may lead to toxicity.

True or False

Taking a multivitamin-mineral (MVM) supplement increases overall nutrient intake and helps some people get the recommended amounts of vitamins and minerals when they cannot or do not get them from food alone.

True

False

True

Correct! Taking an MVM increases their overall nutrient intake.

A patient with a vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis.

Which of the following therapies should the provider order?

1. IM cyanocobalamin and folic acid

2. PO cyanocobalamin and blood transfusions

3. PO cyanocobalamin and folic acid

4. IM cyanocobalamin and antibiotics

1. IM cyanocobalamin and folic acid

Correct! This patient is showing signs of more severe vitamin B12 deficiency with neurologic symptoms; therefore, cyanocobalamin should be given parenterally along with folic acid. Antibiotics are indicated only when signs of infection are present. Oral cyanocobalamin is not recommended.

A patient tells her provider that she is thinking about getting pregnant and asks about nutritional supplements.

What should the provider recommend?

1. A balanced diet high in green vegetables and grains

2. Vitamin B12 supplements

3. A multivitamin with iron

4. 400 to 800 mcg of folic acid per day

4. 400-800 mg of folic acid per day

Correct! The current recommendation is that all women of childbearing age take folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant. Vitamin B12 supplements are not recommended.

A patient is diagnosed with a moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin, 500 mcg per day.

What should the nurse contact the provider to do?

1. Discuss intramuscular dosing

2. Request an order for folic acid

3. Suggest platelet transfusion therapy

4. Suggest an increased dose

4. Suggest an increased dose

Correct! Patients with a vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1,000 to 10,000 mcg per day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when B12 deficiency is severe.

A patient in her twenties has frequent urinary tract infections (UTIs), and her prescriber suggests drinking cranberry juice. She asks how drinking this can help.

Which response from the provider is correct?

1. Cranberry juice reduces the odor of the urine.

2. Cranberry juice helps treat established infections.

3. Cranberry juice acidifies the urine to slow the growth of the bacteria.

4. Cranberry juice prevents bacteria from adhering to the urinary tract wall.

4. Cranberry juice prevents bacteria from adhering to the urinary tract wall

Correct! Cranberry juice helps prevent UTIs by preventing bacteria from adhering to the urinary tract wall. It does not acidify the urine or treat established infections. It can reduce odor, but this action does not contribute to decreased infections.

A provider is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the provider will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement?

1. Ginkgo biloba

2. St. John's wort

3. Ma huang (ephedra)

4. Coenzyme Q-10

1. Ginkgo biloba

Correct! Ginkgo biloba can suppress platelet aggregation and will increase the risk of bleeding in patients taking antiplatelet medications and anticoagulants. Coenzyme Q-10, ma huang, and St. John's wort do not have antiplatelet actions.

Kava's mechanism of action most similarly resembles that of which drug?

1. Amitriptyline

2. Fluoxetine

3. Diazepam

4. Hydroxyzine pamoate

3. Diazepam (valium)

Correct! Kava has targeted actions on the GABA pathway. Diazepam is the prototype drug that directly affects GABA receptors.

True or False

Some supplements can decrease the effects of drugs

True

St. Johns wart can decrease the effectiveness of birth control pills, leading to breakthrough bleeding and an increased risk of unintended pregnancy

True or false

Some supplements can increase the effects - including unwanted side effects - of drugs

True

Herbs that decrease BS may interact with anti-diabetes drugs to cause blood sugar to drop too far

T or F

Some interactions between supplements and drugs are very dangerous

True

Interactions can decrease the effectiveness of critically important drugs - such as drugs that prevent transplanted organs from being rejected

What can the herb schisandra do if taking with other drugs?

May slow down the processes in your body that change drugs into inactive substances (metabolism) which increases the amount of drug in your body which causes the effects of the drug to become too strong

Which herb is one that decreases the effects of drugs?

Black cohosh

Echinacea

Saw palmetto

St. John's wort

St. Johns Wart

Speeds up metabolism which makes less of the drug able to be used and decreases the effects of the drug

What are some of the OTC drugs that can interact with herbal supplements?

Aspirin

Pseudoephedrine

Faxofenadine (allegra)

Name some drugs that have a narrow therapeutic range

Carbamazepine (used to prevent seizures)

Cyclosporine (used to prevent organ transplant rejection)

Digoxin (used to treat heart problems)

Levothyroxine (used to treat thyroid problems)

Phenytoin (used to treat seizures)

Warfarin (an anticoag)

The provider is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs.

Which effect of this dietary supplement should most concern the provider?

1. It counteracts the effects of CNS depressants.

2. It enhances the effects of digoxin.

3. It accelerates the metabolism of some drugs.

4. It increases the risk of bleeding.

3. It accelerates the metabolism of some drugs

Induction of P450 accelerates the metabolism of many drugs, causing a loss of therapeutic effects because it is metabolized too quickly

St. Johns wart reduces the effects of digoxin

Can also intensify the effects of serotonin

A client states he has been using the herbal product saw palmetto. The nurse determines the product is helpful when the client reports?

Less difficulty initiating urination

Used to relieve BPH s/s: urinary hesitancy, urgency, and a decrease in urinary stream

A client receiving a theophylline (tx COPD and asthma) drug states he is taking st. john's wart. Nursing assessment should include?

The respiratory status for increased respiratory distress

St. John's Wart DECREASES the effect of theyophylline which may cause the client to experience exacerbation of respiratory distress

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene.

Which statement should the provider include when teaching this patient about the medication?

1. "Vasomotor symptoms are a common side effect of this drug."

2. "Raloxifene reduces the risk of thromboembolism."

3. "Use of this drug increases the risk of endometrial carcinoma."

4. "This drug is associated with an increased risk of breast cancer."

1. Vasomotor symptoms are a common side effect of this drug

Correct! Raloxifene can induce hot flashes in patients taking this drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.

A provider provides teaching to a patient who has had a hysterectomy and who is about to begin hormone therapy to manage menopausal symptoms.

Which statement by the patient indicates an understanding of the teaching?

1. "I will need a progestin and estrogen combination since I have had a hysterectomy."

2. "Because I am not at risk for uterine cancer, I can take hormones indefinitely."

3. "I should take the lowest effective dose for the shortest time needed."

4. "I can take estrogen to reduce my risk of cardiovascular disease."

3. "I should take the lowest effective dose for the shortest time needed"

Correct! For patients who have undergone a hysterectomy, progestin is unnecessary; estrogen-only preparations still carry an increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but there is an increased risk of stroke and breast cancer with estrogen.

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in two months.

What should the nurse recommend for this patient?

1. The patient should ask her provider about an OC with less progestin.

2. The patient should request an OC containing less estrogen after surgery.

3. The patient should discuss an alternative method of birth control prior to surgery.

4. The patient should take the OC at bedtime after her surgery to reduce side effects.

3. The patient should discuss an alternative method of birth control prior to surgery

Correct! Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least four weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The OC containing estrogen should be stopped four weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

True or False

Raloxifene is a selective estrogen receptor modifier. Its use in osteoporosis has some benefit, but not without risks. According to a black box warning in its package insert, its use should be limited in patients with estrogen receptor-positive breast cancer.

False

Raloxifene has a black box warning for venous thromboembolism and stroke because it is a selective estrogen receptor modifier

Progesterone is contraindicated in women who have what?

Undergone a hysterectomy

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the provider. The patient is concerned about the adverse effects of ET.

What should the provider tell the patient?

1. "Transdermal preparations have fewer side effects."

2. "An intravaginal preparation may be best for her."

3. "An estrogen-progesterone product will reduce side effects."

4. "Side effects of ET are uncommon among women her age."

1. Transdermal preparations have fewer side effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than oral preparations do

Correct! Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than oral preparations do. Progesterone is contraindicated in women who have undergone a hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiencies such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET.

A provider is teaching a male adult patient about the use of testosterone gel.

Which statement by the patient indicates an understanding of the teaching?

1. "I should apply this to my forearms and neck after showering."

2. "I should not let my child touch the gel to prevent behavioral problems."

3. "I should not swim or bathe after applying the gel for three to four hours."

4. "I should keep treated areas exposed to the air so they can dry."

2. "I should not let my child touch the gel to prevent behavioral problems"

Correct! Testosterone administered via gels can be transferred to others by skin-to-skin contact. In children, virilization can occur as well as aggressive behaviors. The gel should be applied to clean, dry skin on the upper arms, shoulders, or abdomen and should be covered with clothing. Swimming and bathing are allowed five to six hours after application.

A patient with erectile dysfunction is prescribed tadalafil 2.5 mg daily.

Which medication history finding would indicate the need to discontinue this prescription?

1. Carvedilol 6.25 mg twice daily

2. Nitro-tab 0.4 mg sublingual as needed

3. Labetalol 25 mg twice daily

4. Nitrofurantoin 100 mg daily

2. Nitro-tab 0.4 sublingual as needed

Use of PDE5 inhibitors is contraindicated in patients receiving nitrate preparations due to the risk of profound hypotension

Correct! Use of PDE5 inhibitors is contraindicated in patients receiving nitrate preparations due to the risk of profound hypotension. Labetalol is administered for hypertension. Carvedilol is administered for chronic heart failure. Tadalafil should be used with caution in these patients but may still be administered. Nitrofurantoin is an antimicrobial that does not affect tadalafil administration.

Which phosphodiesterase type 5 (PDE5) inhibitor offers the most flexibility in dosing due to its longer duration of effect?

1. Sildenafil

2. Avanafil

3. Tadalafil

4. Vardenafil

3. Tadalafil

Correct! Tadalafil may be taken up to 36 hours before sexual activity.

What is a potential advantage of the alprostadil intracavernous injections compared to the phosphodiesterase type 5 (PDE5) inhibitors?

1. Quicker onset of action

2. Fewer side effects

3. Improved efficacy

4. Number of doses allowed per 24 hours

1. Quicker onset of action

Correct! Erections typically occur within 5 to 20 minutes after alprostadil injections. PDE5 inhibitors take at least 30 minutes for onset.

A patient receiving doxazosin presents for a routine evaluation.

Which assessment finding would be most concerning?

1. Dizziness when standing

2. Blood pressure 96/58

3. Diminished ejaculate volume

4. Increased nasal congestion

BP of 96/58

Correct! Hypotension, dizziness, and nasal congestion are all adverse effects of doxazosin, an alpha1-adrenergic antagonist. However, hypotension would be the most concerning because it can lead to inadequate peripheral tissue perfusion. Diminished ejaculate volume is seen with the administration of 5-alpha reductase inhibitors, not with doxazosin administration.

Which vitamin B deficiency is associated with cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum and vulva?

1. Niacin (nicotinic acid)

2. Pyridoxine (vitamin B6)

3. Thiamine (vitamin B1)

4. Riboflavin (vitamin B2)

4. Riboflavin (vitamin B2)

Correct! Riboflavin deficiency produces the symptoms described and can be treated with riboflavin supplements. The signs listed do not indicate deficiencies of niacin, pyridoxine, or thiamine.

A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision.

Which vitamin should the provider order for this patient?

1. Nicotinic acid (niacin) PO

2. Intramuscular pyridoxine (vitamin B6)

3. Ascorbic acid (vitamin C) IV

4. Intravenous thiamine (vitamin B1)

4. IV thiamine (Vitamin B1)

Correct! Alcoholics who are malnourished have a form of thiamine deficiency called Wernicke-Korsakoff syndrome, which is characterized by nystagmus, diplopia, ataxia, confusion, and short-term memory loss. Parenteral thiamine is indicated for treatment. Ascorbic acid is given to treat a vitamin C deficiency, which leads to scurvy. Pyridoxine is given for vitamin B6 deficiency, also common in alcoholics, but this patient does not have the symptoms of seborrheic dermatitis and peripheral neuropathy. Nicotinic acid is used for niacin deficiency, which is characterized by severe dry, rough skin.

A patient appears malnourished. The patient's folic acid levels are low, and vitamin B12 levels are normal.

What should this patient's treatment include?

1. A diet high in folic acid

2. Oral folic acid and vitamin B12

3. Intramuscular folic acid

4. Oral folic acid supplements

1. A diet high in folic acid

Correct! If a folic acid deficiency is caused by a poor diet, it should be corrected with dietary measures, not supplements. Intramuscular or oral supplements of folic acid are not indicated. Vitamin B12 is not recommended.

A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused.

What should the provider suspect in this patient?

1. Iron deficiency anemia

2. Celiac disease

3. Folic acid deficiency

4. Vitamin B12 deficiency

4. Vitamin B12 Deficiency

Correct. When patients present with megaloblastic anemia, it is essential to distinguish between a folic acid deficiency and a vitamin B12 deficiency. If neurologic deficits are observed, a vitamin B12 deficiency is more likely to be the cause. This patient does not have signs of celiac disease. Iron deficiency anemia would be indicated by low hemoglobin and hematocrit.

A patient will begin taking immunosuppressant drugs for rheumatoid arthritis (RA).

Which dietary supplement should this patient avoid?

1. Feverfew

2. Glucosamine

3. Black cohosh

4. Echinacea

4. Echinacea

Correct! Echinacea stimulates the immune system, so it should not be used in patients with autoimmune diseases such as RA; it also compromises the effectiveness of immunosuppressive drugs. Black cohosh, feverfew, and glucosamine are not contraindicated in patients with RA.

A patient admitted to the emergency department with abdominal pain tells the provider he has been taking kava.

Which action should be the provider's priority at this time?

1. Assess breath sounds and respiratory effort

2. Review liver function studies

3. Monitor cardiovascular status

4. Review complete blood count results

4. Review liver function studies

Correct! Kava can cause severe liver injury and, in some cases, require liver transplantation. This patient has abdominal pain, which can be the result of liver damage, so liver function tests should be reviewed. Kava does not affect the respiratory system, the cardiovascular system, or the blood-forming organs.

A patient who will begin combination estrogen-progestin therapy (EPT) for menopause asks the nurse why she cannot take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia.

What response from the provider about progestin is correct?

1. "Progestin decreases your risk of endometrial cancer."

2. "Progestin lowers your risk of myocardial infarction (MI)."

3. "Progestin prevents deep vein thrombosis (DVT)."

4. "Progestin increases bone resorption to prevent fractures."

1. Progestin decreases your risk of endometrial cancer

Correct! In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease the risk of MI or DVT.

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills.

The nurse should recommend discussing which contraceptive method with the provider?

1. Progestin-only oral contraceptives

2. Tubal ligation and condoms

3. An intrauterine device with a spermicide

4. DMPA (Depo-Provera) and condoms

4. Depo-Provera and condoms

Correct! This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her. Patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and is not recommended to be used by young women because it is irreversible. Progestin-only oral contraceptives must be taken every day.

An adult male patient will begin androgen therapy for testicular failure.

Which statement by the patient indicates understanding of the treatment regimen?

1. "My libido may improve while I am taking this medication."

2. "Taking this drug may lead to the development of prostate cancer."

3. "This will restore fertility, so I can have a child."

4. "I will need to have X-rays of my hands and feet every six months."

1. "My lipido may improve while I am taking this medication"

Correct! Treatment with androgen replacement therapy in patients with testicular failure helps restore libido. A side effect of androgens is premature epiphyseal closure; this is not a concern in adults, so radiographs to evaluate this are not indicated. Androgens can promote the growth of prostate cancer when it occurs, but they do not cause it. Androgens do not restore fertility.

Which finding would indicate that terazosin has been effective for a patient with benign prostatic hyperplasia (BPH)?

1. Decreased prostate size

2. Improved urinary hesitation

3. Increased urinary frequency

4. Decreased serum prostate-specific antigen levels

2. Improved urinary hesitation

Correct! Terazosin is an alpha1-adrenergic antagonist. These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement.