Pharmacology Quiz 2 NU 160

Correct Answer D: Avoid driving until effects are known.

Explanation of the Correct Answer:

Cyclobenzaprine is a centrally acting skeletal muscle relaxant commonly prescribed to treat acute muscle spasms associated with musculoskeletal conditions. It works by depressing motor activity primarily in the brainstem, leading to muscle relaxation. One of the most important safety considerations when starting cyclobenzaprine is its sedative effect, which can cause drowsiness, dizziness, and impaired cognitive or motor performance.

Because of these central nervous system effects, clients are advised to avoid driving, operating heavy machinery, or engaging in hazardous activities until they understand how the drug affects them individually. This is particularly crucial during the initial stages of treatment or when the dose is increased, as sedation may be pronounced.

Why the Other Options Are Incorrect:

A. Monitor for increased muscle spasms

Incorrect. Cyclobenzaprine is used to reduce muscle spasms, not increase them. If spasms worsen, it may indicate an ineffective response, but it is not a common or expected adverse effect of the drug.

B. Discontinue medication if nausea occurs.

Incorrect. Nausea is a relatively mild and non-life-threatening side effect of cyclobenzaprine. It should not be a reason for abrupt discontinuation. Instead, clients should report persistent or severe nausea to their provider, who may adjust the dose or provide supportive measures.

C. Expect urine to turn orange

Incorrect. Orange discoloration of urine is associated with medications like phenazopyridine, not cyclobenzaprine. This is not an expected or typical side effect of this muscle relaxant.

Summary:

The nurse should teach the client to avoid driving until the effects of cyclobenzaprine are known, due to its potential to cause sedation and impair motor and cognitive function, especially during the initial treatment period.

Correct Answer D: I have an increased risk of getting pneumonia while taking this medication.

Explanation of the Correct Answer:

Esomeprazole is a proton pump inhibitor (PPI) used to reduce gastric acid production, commonly prescribed for gastroesophageal reflux disease (GERD), peptic ulcers, and other acid-related conditions. While effective, long-term use of PPIs like esomeprazole can lead to several adverse effects, one of which is an increased risk of pneumonia.

PPIs reduce the acidity of the stomach, which diminishes the natural defense against ingested pathogens. With less acid to kill bacteria, organisms can more easily travel to the respiratory tract, especially in older adults or hospitalized patients, increasing the risk of community-acquired or aspiration pneumonia.

Why the Other Options Are Incorrect:

A. I won’t pass gas as often now that I am taking this medication.

Incorrect. Esomeprazole may help reduce bloating or indigestion in some cases, but passing gas (flatulence) is not a specific target or guaranteed effect of this medication.

B. I will need to take a daily stool softener while taking this medication.

Incorrect. While constipation may occur in some individuals, it is not common enough to justify routine stool softener use unless prescribed. Patients should manage bowel changes based on symptoms.

C. I will take this medication each morning with my breakfast.

Incorrect. Esomeprazole should be taken at least 1 hour before a meal, typically in the morning, on an empty stomach, for maximum effectiveness. Taking it with food can reduce absorption.

Summary:

The statement that best shows understanding is D, recognizing that esomeprazole increases the risk of pneumonia, which is a known and important potential side effect of long-term PPI use.

Correct Answer:

A. Calcium carbonate

E. Aluminum hydroxide

Explanation of the Correct Answers:

A. Calcium carbonate:

Calcium carbonate is a common antacid used to relieve symptoms of heartburn or indigestion. One of its side effects is constipation. Calcium can reduce the motility of the gastrointestinal tract, leading to slower bowel movements. This is especially notable in individuals who take high doses of calcium carbonate, such as those using it as a calcium supplement or frequently for acid reflux.

E. Aluminum hydroxide:

Aluminum hydroxide, often found in antacids like Maalox and Mylanta, can also cause constipation. It has a tendency to slow down the passage of stool through the intestines. This is one of the reasons that aluminum-based antacids are sometimes combined with magnesium-based ones to balance their side effects.

Why the Other Options Are Incorrect:

B. Magnesium oxide:

Magnesium oxide is used for its antacid properties but is more likely to cause diarrhea, not constipation. Magnesium salts, in general, have a laxative effect and can promote bowel movements. Therefore, magnesium oxide is not associated with constipation.

C. Magnesium hydroxide:

Like magnesium oxide, magnesium hydroxide is known for its laxative effect. It works by drawing water into the intestines to stimulate bowel movements. It is commonly used in over-the-counter medications like Milk of Magnesia, and constipation is not a typical side effect.

D. Sodium bicarbonate:

Sodium bicarbonate, commonly known as baking soda, is used to neutralize stomach acid and can temporarily relieve heartburn. It does not typically cause constipation. In fact, it is more likely to cause symptoms like belching or bloating due to the release of carbon dioxide. It does not slow down bowel movements in the way calcium or aluminum-based antacids do.

Summary:

The antacids that can cause constipation are calcium carbonate and aluminum hydroxide. Both of these medications can slow gastrointestinal motility, leading to fewer bowel movements. Magnesium-based antacids, on the other hand, typically cause diarrhea, while sodium bicarbonate does not usually affect bowel movements.

Correct Answer C: Administer the medications 5 minutes apart.

Explanation of the Correct Answer:

It is important to administer timolol and pilocarpine eye drops at least 5 minutes apart to ensure that one medication does not dilute or interfere with the action of the other. By waiting between administrations, you maximize the effectiveness of each medication.

Why the Other Options Are Incorrect:

A. Hold pressure on the conjunctiva sac for 2 min following application of drops.

Incorrect. While punctal occlusion is often recommended with some eye medications to reduce systemic absorption, this is more critical with medications that have significant systemic side effects (e.g., timolol). However, this is not the best choice in this scenario as per standard practice.

B. It is not necessary to remove contact lenses before administering medications.

Incorrect. Contact lenses should be removed before administering eye drops, as some medications can adhere to the lenses, causing irritation or affecting the drug's effectiveness.

D. Administer the medications by touching the tip of the dropper to the surface of the eye.

Incorrect. The dropper tip should never touch the eye or eyelashes to avoid contamination and possible infection.

Summary:

The correct teaching for the client is to administer the medications 5 minutes apart to allow each medication to be effective without interference.

Correct Answer B: Inspect your mouth for lesions daily.

Explanation of the Correct Answer:

Fluticasone is an inhaled corticosteroid (ICS) used for the long-term control of chronic obstructive pulmonary disease (COPD) and asthma. It helps reduce inflammation in the airways, making breathing easier over time.

One of the potential side effects of inhaled corticosteroids like fluticasone is the development of oral thrush, which is a fungal infection that can cause lesions in the mouth. It is important for the client to inspect their mouth daily for any signs of white patches, sores, or irritation. If these symptoms occur, the client should report them to their healthcare provider, as they may need treatment with antifungal medication. Rinsing the mouth with water after using the inhaler can help prevent this side effect.

Why the Other Options Are Incorrect:

A. Skip the morning dose if you do not have any symptoms. 

This is not a recommended instruction. Fluticasone is a maintenance medication used regularly to control inflammation and symptoms over time. Even if the client does not have symptoms, it is important to use the medication as prescribed. Skipping doses could reduce its effectiveness in managing the condition.

C. Use this medication to relieve an asthma attack.

This is incorrect. Fluticasone is a preventive medication, not a rescue medication. It does not provide immediate relief during an asthma attack. For acute attacks, the client should use a short-acting beta-agonist (SABA), such as albuterol, which works quickly to open the airways.

D. Check your heart rate before each dose.

Checking the heart rate is not typically necessary for fluticasone use. Fluticasone does not have significant effects on heart rate. However, if the client is taking other medications that could affect the heart rate (such as certain bronchodilators), they might need to monitor their heart rate, but it is not required for fluticasone itself.

Summary:

The correct instruction is B because oral thrush is a common side effect of inhaled corticosteroids like fluticasone. Checking the mouth for lesions daily helps detect and prevent this issue early.

Correct Answers:

A. Clients should avoid live vaccines while on immunomodulator therapy.

C. Regular follow-up visits and bloodwork are essential for monitoring health status.

E. Clients should report any signs of infection immediately, such as fever or unusual fatigue.

Explanation of the Correct Answers:

Azathioprine is an immunosuppressant often used to treat autoimmune conditions like inflammatory bowel disease (IBD) and rheumatoid arthritis, and to prevent organ transplant rejection. Because it suppresses the immune system, specific safety precautions and monitoring are essential.

A. Clients should avoid live vaccines while on immunomodulator therapy.

Correct. Live vaccines (such as MMR, varicella, and intranasal flu vaccine) can pose a serious risk of infection in immunosuppressed individuals. Clients should be instructed to avoid live vaccines unless cleared by their healthcare provider.

C. Regular follow-up visits and bloodwork are essential for monitoring health status.

Correct. Azathioprine can cause bone marrow suppression, liver toxicity, and increased infection risk. Regular CBCs and liver function tests are essential to monitor for leukopenia, anemia, or hepatotoxicity.

E. Clients should report any signs of infection immediately, such as fever or unusual fatigue.

Correct. Because azathioprine weakens the immune system, clients are at increased risk of infections. Fever, sore throat, or unexplained fatigue should be reported immediately, as they may indicate a serious infection.

Why the Other Options Are Incorrect:

B. It is safe to receive live vaccines if administered at least 30 days after starting the medication.

Incorrect. Live vaccines are generally contraindicated during immunosuppressive therapy regardless of timing, unless specifically advised by a specialist.

D. Handwashing is not necessary if the client avoids sick individuals.

Incorrect. Frequent handwashing is essential for infection prevention, especially when the immune system is compromised. Avoiding sick individuals is not a substitute for good hygiene practices.

F. Clients can discontinue their medication if they feel well after a few weeks.

Incorrect. Azathioprine must be taken consistently as prescribed. Stopping without medical guidance can lead to relapse or rejection in transplant patients. Always consult a healthcare provider before making changes.

Summary:

Correct patient teaching for azathioprine includes avoiding live vaccines, attending regular bloodwork appointments, and promptly reporting infection signs. Stopping the medication without medical advice or neglecting hygiene are unsafe practices.

Correct Answer C: Tremors

Explanation of the Correct Answer:

Albuterol is a beta-2 agonist commonly used to treat asthma and chronic obstructive pulmonary disease (COPD) by relaxing the muscles in the airways and increasing airflow to the lungs. While it is an effective bronchodilator, it can cause several side effects due to its systemic effects.

Tremors (C): One of the most common side effects of albuterol is tremors. These are typically fine shakes or tremors in the hands and fingers, which occur because albuterol stimulates beta-2 receptors not just in the lungs, but also in other parts of the body, including skeletal muscles. This can lead to muscle twitching or tremors, especially at higher doses.

Why the Other Options Are Incorrect:

A. Nausea : Nausea is not as common as tremors with albuterol use, though it can occur. It’s more likely to be seen if the medication is used in excess or if the patient is sensitive to the drug.

B. Headache : Headache can be a side effect of albuterol, but it is less common than tremors. Headaches may result from the vasodilation effects or other systemic effects of the drug.

D. Drowsiness : Drowsiness is not a common side effect of albuterol. In fact, albuterol is more likely to cause symptoms like nervousness or restlessness due to its stimulating effects on the beta-2 receptors. It does not generally cause sedation or drowsiness.

Summary:

The most common side effect of albuterol is tremors. Although nausea, headache, and drowsiness can occur, they are less frequent compared to tremors

Correct Answer C: Renal stones

Explanation of the Correct Answer:

Calcium supplements are commonly prescribed for clients with osteoporosis to support bone mineral density and reduce fracture risk. However, one of the known adverse effects of calcium supplementation—particularly in high doses or when combined with inadequate fluid intake—is the development of renal (kidney) stones. These stones typically form when there is an excess of calcium excreted into the urine (hypercalciuria), leading to crystallization and the eventual formation of calcium oxalate or calcium phosphate stones.

The hallmark symptom of renal stones is flank pain, which can be severe, sharp, and radiating toward the lower abdomen or groin, depending on the stone’s location within the urinary tract. Clients may also report associated symptoms such as hematuria, nausea, vomiting, or dysuria. This presentation should prompt the nurse to suspect nephrolithiasis as a possible complication of calcium supplementation.

Why the Other Options Are Incorrect:

A. Hepatitis

Incorrect. Hepatitis involves inflammation of the liver and is not associated with calcium supplementation. It typically presents with right upper quadrant abdominal pain, jaundice, and abnormal liver function tests, not flank pain.

B. Hip fracture

Incorrect. Hip fractures are a complication of osteoporosis itself and not a result of taking calcium. In fact, calcium supplementation is intended to help prevent fractures. Additionally, hip fractures would present with localized hip or groin pain, not flank pain.

D. Pancreatitis

Incorrect. While extremely high levels of calcium (as seen in hyperparathyroidism) can rarely trigger pancreatitis, this is not a common side effect of calcium supplements alone. Pancreatitis is characterized by epigastric pain that may radiate to the back, not flank pain, making this an unlikely explanation in this case.

Summary:

The client’s report of flank pain while taking a daily calcium supplement is most consistent with renal stones, a known adverse effect of calcium supplementation due to its potential to increase urinary calcium and promote stone formation

Correct Answer:

A. The medication will open the airways.

D. The medication will prevent wheezing.

E. The medication will decrease coughing episodes.

Explanation of the Correct Answers:

A. The medication will open the airways.

Albuterol is a beta-2 agonist that works by relaxing the smooth muscles around the airways, leading to bronchodilation. This helps open the airways, making it easier for the person to breathe, which is why albuterol is used in the treatment of conditions like asthma and COPD.

D. The medication will prevent wheezing.

By opening the airways, albuterol can prevent wheezing, which is commonly caused by constricted or narrowed airways. Wheezing is a hallmark symptom of asthma and other respiratory conditions, and albuterol helps alleviate it by improving airflow.

E. The medication will decrease coughing episodes.

Although albuterol is primarily used to alleviate wheezing and shortness of breath by opening the airways, it can indirectly reduce coughing episodes as well. This is because coughing can often be triggered by constricted or narrowed airways, and by improving airflow, albuterol can make breathing easier, thus reducing coughing that may be associated with bronchoconstriction.

Why the Other Options Are Incorrect:

B. The medication will reduce inflammation.

Albuterol is a bronchodilator, not an anti-inflammatory drug. While it helps open up the airways, it does not directly reduce inflammation in the airways. Medications like steroids are used for that purpose, but albuterol itself does not have an anti-inflammatory effect.

C. The medication will stimulate flow of mucus.

Albuterol does not stimulate mucus production. It works by relaxing the muscles of the airways to allow for easier breathing, but it does not directly affect mucus production or clearance. Mucus flow and secretion are typically managed by other types of treatments, such as expectorants.

Summary:

Albuterol opens the airways, prevents wheezing, and can reduce coughing by improving airflow. It does not directly reduce inflammation or stimulate mucus flow. Therefore, the correct answers are A, D, and E.