Gold compounds are contraindicated in patients with all of the following conditions except

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1. As a well-rounded health care provider, you know that corticosteroid therapy is indicated in all of the following conditions except:

1. osteoarthritis
2. rheumatoid arthritis
3. systemic lupus erythematosus
4. acute spinal cord injury

2. Oral steroids are prescribed on a taper in order to:

1. achieve optimal serum levels.
2. ensure drug reliability.
3. ensure compliance.
4. prevent steroid withdrawal syndrome.

3. Orlando who has been taking steroids for rheumatoid arthritis over several years presents with a compression vertebral fracture. This fracture is due to:

1. an entirely separate condition.
2. the osteoporotic effect of long-term steroid use.
3. deterioration in rheumatoid arthritis.
4. an excessively high dose of steroids.

4. Tom is admitted into the emergency department with an acute spinal cord injury. Methylprednisolone is contraindicated for treatment when the injury:

1. is a high cervical lesion.
2. occurred less than 4 hours ago.
3. occurred less than 8 hours ago.
4. occurred more than 8 hours ago.

5. Which of the following statements about intravenous administration of steroids is true?

1. Steroids administered intravenously must be diluted.
2. Steroids administered intravenously can be either in diluted or undiluted form.
3. Steroids should be given IV push only.
4. Intravenous administration of steroids is contraindicated in acutely ill clients.

6. An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following?

1. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.
2. Potential for injury related to GI toxicity and decrease in bleeding time.
3. Altered protection related to GI bleeding and increasing platelet aggregation.
4. Risk for injury related to thrombocytosis prolonged prothrombin time.

7. Teaching has been adequate when a client being treated with acetylsalicylic acid states:

1. “I can crush the pills before i swallow them.”
2. “I should take the pills with antacids.”
3. “Taking the pills on an empty stomach will help absorption.”
4. “If the pills smell like vinegar, I should throw them out.”

8. Which of the following groups of clients are most at risk for GI bleeding from the use of NSAIDs?

1. Clients with dysmenorrhea
2. Clients with headaches
3. Clients with arthritis
4. Clients with renal failure

9. To minimize the risk of dyspnea and GI bleeding, OTC ibuprofen is given:

1. IV
2. With orange juice
3. On an empty stomach
4. With meals

10. Which of the following NSAIDs is used to prevent thrombosis?

1. Motrin
2. Toradol
3. Aspirin
4. naproxen

11. Nurse Corrine may expect to administer azathioprine (Imuran) to a transplant client in which of the following conditions?

1. Prevention of chronic rejection
2. Prevention of acute rejection
3. Management of chronic rejection
4. Treatment of acute rejection

12. Which of the following laboratory tests should be monitored when a client is receiving azathioprine?

1. CBC
2. BUN
3. Electrolytes
4. Sedimentation rate

13. In a transplant client, the action of cyclosporine is to:

1. Defend the body against foreign antigens.
2. Inhibit T cells in response to antigens.
3. Inhibit B cell immunoglobulin.
4. Intensify the production of T lymphocytes

14. Client teaching for mycophenolate mofetil must include instructions to:

1. Take with food.
2. Avoid use of corticosteroid.
3. Monitor for adverse effects.
4. Practice effective contraception.

15. Which of the following client comments demonstrates that teaching has been successful regarding cyclosporine therapy?

1. “I need to mix the medicine in Styrofoam.”
2. “I should take the medication on an empty stomach.”
3. “I need to be consistent about when i take it and also monitor how much fat is in my food.”
4. “If I vomit I should take another dose.”

16. Antirheumatics are used to:

1. Directly affect the inflammatory response
2. Encourage excretion of autoantibodies
3. Retard progression of joint deterioration
4. Mediate the action of NSAIDs

17. Gold compounds are contraindicated in clients with:

1. Liver dysfunction
2. Cardiac disease
3. Preexisting dermatitis
4. Rheumatoid arthritis

18. Which of the following agents can be used in treatment of rheumatoid arthritis, Sjögren’s syndrome, and SLE?

1. auranofin (Ridaura)
2. allopurinol (Zyloprim)
3. sulfasalazine (Azulfidine)
4. chloroquine (Aralen)

19. Frequent eye examinations are recommended in clients receiving:

1. chloroquine
2. colchicine
3. penicillamine
4. gold compounds

20. Nurse Pia is instructing a client receiving probenecid (Benemid), she should cover all of the following information except the need to:

1. Change dietary habits.
2. Increase fluid intake.
3. Have frequent laboratory work done.
4. Recognize side effects.

21. Enrique who is under chemotherapy has the following CBC results: WBC 5000/mm3, RBC platelet 10,000/mm3. Which of the following is he at risk for?

1. Infection
2. Bleeding
3. Angina
4. None of the above

22. Lorraine who is on chemotherapy has a history of cardiac disease. The client is at risk for cardiac complications because:

1. White blood cells are reduced.
2. Oxygen-carrying capacity may be reduced.
3. Sodium levels may rise meaning fluid overload.
4. Hematocrit is lowered.

23. Which of the following is the priority nursing diagnosis for a client undergoing chemotherapy?

1. Decreased cardiac output
2. Fear
3. Altered nutrition
4. Anxiety

24. Which of the following contributes most to the debilitation of an individual during a course of chemotherapy?

1. Diarrhea
2. Alopecia
3. Constipation
4. Pain

25. Combination chemotherapy is used in the treatment of cancer because:

1. Single-agent therapy produces cell lines that are resistant.
2. Two drugs are more likely to work.
3. Single-agent therapy requires larger doses for long remissions.
4. Two cancers may be present.

1. Answer: A. osteoarthritis. Osteoarthritis is not an indication for corticosteroid therapy. It has an inflammatory component, but the disease is not severe enough to suppress the immune system. Lupus, spinal injury, and rheumatoid arthritis are conditions that require suppression of the immune system in order for the client to survive.
2. Answer: D. prevent steroid withdrawal syndrome. Steroids are tapered off in order to prevent a withdrawal syndrome. Optimal serum levels do not require tapering in order to be maintained. Tapering has nothing to do with drug reliability. Compliance is not dependent on tapering.
3. Answer: B. the osteoporotic effect of long-term steroid use. In a client on long-term steroids, a compression vertebral fracture can be assumed to be due to the steroids’ bone-softening effect.
4. Answer: D. occurred more than 8 hours ago. Research has shown that steroids are ineffective when given more than 8 hours after acute spinal injury.
5. Answer: B. Steroids administered intravenously can be either in diluted or undiluted form. IV steroids can either be diluted or given without dilution.
6. Answer: A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding. The nursing diagnosis addresses all the interactions that pose a threat to the client taking both these drugs. Choice B is incorrect because bleeding time is prolonged not decreased when both drugs are used. Choice C is incorrect because platelet aggregation is inhibited not increased when both drugs are used. Choice D is incorrect because thrombocytosis does not occur with use of either drugs.
7. Answer: D. “If the pills smell like vinegar, I should throw them out.” Any aspirin should be discarded if a vinegar odor is noticed. Crushing is not recommended for sustained-release preparations. Antacids impair absorption. Taking the medication on an empty stomach will increase GI irritation.
8. Answer: C. Clients with arthritis. Clients with arthritis are taking the drugs for prolonged periods of time and may take higher doses. Choices A and B are incorrect because the use of NSAIDs with these clients is intermittent. Renal failure is a contraindication for NSAIDs because most of the drug is excreted through the kidneys.
9. Answer: D. With meals. Taking ibuprofen with meals will decrease GI irritation. Ibuprofen is never given IV. Orange juice may promote acidity and increase gastric irritation. Ibuprofen will cause GI upset if given on an empty stomach.
10. Answer: C. Aspirin. Aspirin prevents platelet aggregation and thereby has an anticoagulant effect.
11. Answer: B. Prevention of acute rejection. Azathioprine inhibits humoral and cellular immunity during the early stages of lymphoid differentiation and is useful in preventing the onset of acute rejection.
12. Answer: A. CBC. CBC will identify leukopenia, a common side effect.
13. Answer: B. Inhibit T cells in response to antigens. The primary action of cyclosporine is to inhibit T-cell generation in response to transplant antigens.
14. Answer: D. Practice effective contraception. Effective contraception is essential because of the potential for teratogenic effects. It is recommended that the drug be taken on empty stomach. The drug is often given with corticosteroid. All medication should be monitored for side effects.
15. Answer: C. “I need to be consistent about when i take it and also monitor how much fat is in my food.” Cyclosporines need to be taken consistently in relation to meals, and fat content should not vary to maintain serum levels.
16. Answer: C. Retard progression of joint deterioration. These drugs cannot stop the disease itself but are believed to retard or prevent the process of joint deterioration. For choice A, the inflammatory process is affected indirectly. Autoantibodies are not excreted. Disease modifying antirheumatic drugs are used in combination with NSAIDs but do not mediate their effect.
17. Answer: A. Liver dysfunction. An adverse reaction to gold compounds is liver toxicity; therefore, use care in clients with preexisting liver dysfunction.
18. Answer: D. chloroquine (Aralen). Chloroquine has had documented success in the treatment of rheumatoid arthritis, Sjögren’s syndrome, and SLE. Auranofin and sulfasalazine are used in the treatment of rheumatoid arthritis, but none are used in the treatment of all three syndromes.
19. Answer: A. chloroquine. Corneal deposits are an adverse reaction associated with chloroquine administration, necessitating frequent eye examination.
20. Answer: C. Have frequent laboratory work done. Side effects of probenecid treatment are relatively benign, and there is no indication that there is a need for frequent laboratory evaluation.
21. Answer: B. Bleeding. A platelet count of 10,000/mm3 means that the client does not have enough platelets to clot the blood; therefore, the possibility of bleeding is high. Choice A is a normal value of WBC. Angina would only be a risk if the client had a lower RBC count.
22. Answer: B. Oxygen-carrying capacity may be reduced. If hemoglobin and red cell counts drop from myelosuppression, the oxygen-carrying capacity will fall, leaving the person at risk for angina.
23. Answer: A. Decreased cardiac output. Decreased cardiac output is more important than the other choices because it can jeopardize the client’s life.
24. Answer: A. Diarrhea. Diarrhea will cause debilitation as fluid and nutrients are lost at a time when the body most needs to be nourished.
25. Answer: A. Single-agent therapy produces cell lines that are resistant. Single-agent therapy tends to produce resistant tumor cells, making remission or cure impossible.