Gastrointestinal Drugs and Medications: Nursing Pharmacology

1. 1. Question

The nurse is giving instructions to a client receiving cholestyramine (Prevalite). Which statement made by the
client indicates a need for further teachings?

o  A. "This medication will help lower my cholesterol".

o  B. "I will continue taking my multivitamins".

o  C. "I will sip the cholestyramine powder for a long time for faster absorption".

o  D. "I will include a high fiber rich food in my diet".

Incorrect
Correct Answer: C. “I will sip the cholestyramine powder for a long time for faster absorption”.
Sipping the medication for a long time may cause tooth discoloration or tooth decay. Regular brushing of teeth is
therefore recommended.
 Option A: Cholestyramine is a bile acid sequestrant. It works by helping the body remove bile
acids, which can lower cholesterol levels in the blood.
 Option B: Cholestyramine may decrease the absorption of some vitamins such as vitamin K and
folate.
 Option D: High fiber diet is advised to prevent constipation (a side effect of the medication).

2. 2. Question

Which of the following conditions can you safely administer metoclopramide (Reglan)?

o  A. Patient with bowel obstruction

o  B. Patient with gastrointestinal hemorrhage

o  C. Patient undergoing radiation

o  D. Patients with pheochromocytoma

Incorrect
Correct Answer: C. Patient undergoing radiotherapy
Metoclopramide can be safely administered to patients having vomiting episodes following radiation,
chemotherapy, and surgery.
 Options A & B: It is contraindicated in patients with conditions where stimulation of
gastrointestinal motility might be harmful, such as mechanical bowel obstruction, bowel
perforation, or gastrointestinal hemorrhage.
 Option D: Hypertensive crises may occur in patients with pheochromocytoma due to induction of
catecholamine release from the tumor.

3. 3. Question

A client has been taking Ibuprofen for a while and was given misoprostol (Cytotec). Which of the following is
exhibiting the therapeutic effect of Cytotec?

o  A. Relief of constipation

 o  B. Relief of diarrhea

o  C. Relief of vomiting

o  D. Relief of gastric ulcer

Incorrect
Correct Answer: D. Relief of gastric ulcer
Misoprostol (Cytotec) is a synthetic (man-made) prostaglandin that is used to reduce the risk of stomach ulcers in
patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs, for example, aspirin, ibuprofen, etc.).
 Options A & C: These are not related to the medication.
 Option B: Although a side effect, it is not the intended therapeutic effect.

4. 4. Question

A geriatric patient is prescribed with cimetidine (Tagamet) for the treatment of heartburn. Which of the following is
the most frequent CNS side effect of the medication?

o  A. Agitation

o  B. Drowsiness

o  C. Headache

o  D. Somnolence

Incorrect
Correct Answer: A. Agitation
Cimetidine an H2-receptor antagonist passes the blood-brain barrier, and central nervous system side effects can
happen. The most common serious side effects are confusion, agitation, depression, and disorientation.
 Options B, C, & D: These are the less common side effects of cimetidine.

5. 5. Question

A nurse is administering an IV bolus of cimetidine (Tagamet). Which of the following should the nurse monitor
closely follow the administration?

o  A. Respiratory rate

o  B. Skin turgor

o  C. Blood pressure

o  D. Temperature

Incorrect
Correct Answer: C. Blood pressure
Rapid intravenous administration of Cimetidine causes hypotension due to arterial vasodilation. It is
recommended to be injected slowly over a period of not less than 5 minutes.
 Options A, B, & D: These are not related to this medication.

6. 6. Question
 A client has been given loperamide hydrochloride (Imodium). Which of the following conditions is the medication
indicated for?

o  A. Abdominal pain

o  B. Patients with an ileostomy

o  C. Bloody Diarrhea

o  D. Acute dysentery

Incorrect
Correct Answer: B. Patients with an ileostomy
Loperamide hydrochloride is an antidiarrheal agent. It can also be used to reduce the volume of drainage from an
ileostomy.
 Options A, C, & D: It is contraindicated in patients with abdominal pain in the absence of diarrhea,
and in patients with acute dysentery, which is characterized by blood in stools and high fever.

7. 7. Question

A client has been given ondansetron (Zofran). For which of the following post-operative condition should the nurse
administer this medication?

o  A. Abdominal infection

o  B. Incisional pain

o  C. Atelectasis

o  D. Vomiting

Incorrect
Correct Answer: D. Vomiting
Ondansetron is a selective 5-HT3 receptor antagonist used to prevent nausea and vomiting that may be caused
by surgery or by medicine to treat cancer (chemotherapy or radiation).
 Options A, B, & C: These are not related to this medication.

8. 8. Question

A client with a duodenal ulcer is diagnosed with H. pylori infection. The physician prescribed amoxicillin (Wymox),
pantoprazole (Prevacid), and clarithromycin (Biaxin). Which statement made by the nurse correctly explains the
purpose of these medications?

o  A. "These medicines will minimize acid production and will coat the ulcer".

o  B. "These medicines will stop the acid production and will kill the bacteria".

o  C. "The ulcer will heal because the medications will kill the bacteria".

o  D. "These medicines will control the ulcer and motion sickness".

Incorrect
Correct Answer: B. “These medicines will stop the acid production and will kill the bacteria”.
 The triple therapy treatment of H-pylori infection includes 2 antibiotics (Clarithromycin and Amoxicillin) and one
proton pump inhibitor such as omeprazole, lansoprazole, pantoprazole, or esomeprazole.

9. 9. Question

A patient with Crohn’s disease is receiving an infusion therapy of infliximab (Remicade). Which of the following
should the nurse do while the patient is on this medication?

o  A. Monitoring liver function test prior to the infusion

o  B. Monitoring the vomiting episodes

o  C. Monitoring the frequency and consistency of bowel movements

o  D. Monitoring urine output and orientation

Incorrect
Correct Answer: C. Monitoring the frequency and consistency of bowel movements
Crohn’s disease is a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea,
weight loss, and fever. Infliximab works by reducing the inflammation in the colon, thereby decreasing diarrhea.
 Options A, B, & D: These are not related to this medication.

10. 10. Question

A client has been prescribed with pancrelipase (Pancrease). Which of the following symptoms would prompt the
nurse that the medication is having its therapeutic effect if which of the following is noted?

o  A. Negative abdominal pain

o  B. An absence of constipation

o  C. An absence of diarrhea

o  D. Reduction of excess fat in feces

Incorrect
Correct Answer: D. Reduction of excess fat in feces
Pancrelipase is used to help improve food digestion in certain conditions (cystic fibrosis, pancreatitis) where the
pancreas is not working properly. This medicine minimizes the amount of steatorrhea (fatty stools).
 Options A, B, & C: These are not related to this medication.

11. 11. Question

A nurse is giving nothing per orem instructions to a malnourished client with diarrhea and frequent abdominal pain
episodes who is about to receive a Total Parenteral Nutrition. Which statement made by the nurse is
the most appropriate?

o  A. "It will help in your weight loss".

o  B. "It can assure you that you feel better after receiving TPN".

o  C. "It will decrease your diarrhea and your bowel can rest".
 o  D. "It will give you less time in the hospital".

Incorrect
Correct Answer: C. “It will decrease your diarrhea, and your bowel can rest”.
The priority in this kind of situation is to stop diarrhea and to provide fluids and electrolyte thru the use of TPN.
The bowel is rested so that the abdominal cramping will also stop.

12. 12. Question

A client is receiving sulfasalazine (Azulfidine) for the treatment of ulcerative colitis. Which of the following
assessment findings will concern the nurse most?

o  A. Drowsiness

o  B. Decreased urine output

o  C. Urine discoloration

o  D. Vomiting

Incorrect
Correct Answer: B. Decreased urine output
Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal bleeding, and abdominal pain
in patients with ulcerative colitis. It is nephrotoxic, so a decrease in urine output is the most serious concern.
 Options A, C, & D: These are also side effects but are less serious.

13. 13. Question

A client has been prescribed sucralfate (Carafate) for the treatment of gastric ulcers. The nurse instructs the client
that this medication is taken?

o  A. 1 hour before meals

o  B. 1 hour after meals

o  C. At the same time with an antacid

o  D. Lunch time

Incorrect
Correct Answer: A. 1 hour before meals
Sucralfate is a gastric protective agent. It works by forming a protective layer on the ulcer to serve as a barrier
against acid, bile salts, and enzymes in the stomach. Taken by mouth on an empty stomach at least 1 hour before
or 2 hours after eating.
 Options B & D: The medication is taken on an empty stomach.
 Option C: Antacid decreases the absorption of sucralfate in the body. It is recommended to avoid
taking an antacid within 30 minutes before or after taking sucralfate.

14. 14. Question

Tincture of opium is given to a patient who is having diarrheal episodes. Which of the following is true regarding
this medication?

o  A. Opium tincture is not a controlled substance.

 o  B. Opium tincture can be used with medications like naltrexone and buprenorphine.

o  C. Has an unpleasant taste and it can be diluted with 15-30 ml water.

o  D. It increases intestinal motility and peristalsis.

Incorrect
Correct Answer: C. Has an unpleasant taste and can be diluted with 15-30 ml of water.
Opium tincture is an oral liquid medication used to control diarrhea. It has an unpleasant taste so it should be
diluted with 15-30 ml of water.
 Option A: Opium tincture contains morphine which is a controlled substance.
 Option B: Opium tincture should not be used with medications like naltrexone and buprenorphine
because they increase sedation and lower the beneficial effect of opium tincture.
 Option D: It is an antidiarrheal, so a decreased motility and peristalsis are expected.

15. 15. Question

A nurse is giving medicine instructions to a client with hemorrhoids who is receiving a Mineral oil. Which of the
following statements made by the client indicates further teaching?

o  A. "I can take it at least 2 hours before bedtime".

o  B. "It can interfere with the absorption of the vitamin E that I am taking".

o  C. "If I miss a dose of mineral oil liquid, I'll take it as soon as I remember".

o  D. "I can use mineral oil liquid for an extended period to prevent further damage".

Incorrect
Correct Answer: D. “I can use mineral oil liquid for an extended period to prevent further damage”.
Mineral oil liquid is a lubricant laxative that works by slowing the absorption of water from the bowel, which softens
the stool. The use of mineral oil liquid for a long time may result in loss of normal bowel function.
 Options A, B, & C: These are correct statements regarding mineral oil.

16. 16. Question

A nurse is giving discharge instructions to a client who is receiving a bulk-forming laxative as part of the home
medications. All of which are examples of bulk-forming laxative, except?

o  A. docusate Sodium (Colace)

o  B. methylcellulose (Citrucel)

o  C. polycarbophil (Fibercon)

o  D. psyllium (Metamucil)

Incorrect
Correct Answer: A. Docusate Sodium (Colace)
Docusate Sodium (Colace) is an example of a surfactant laxative that softens the stool by drawing more water
and fat into poo.
 Options B, C, & D: These are common examples of bulk-forming laxatives. They retain fluid in the
poo and increase the weight or bulk of the stool.
17. 17. Question

A client with a history of chest pain is admitted to irritable bowel syndrome. As a nurse, which of the following
medicines will you least expect to be a part of the medical management?

o  A. alosetron (Lotronex)

o  B. tegaserod (Zelnorm)

o  C. lubiprostone (Amitiza)

o  D. loperamide (Imodium)

Incorrect
Correct Answer: B. Tegaserod (Zelnorm).
The use of tegaserod is restricted to patients with IBS due to the serious cardiovascular adverse effect that may
happen such as heart attack and stroke.
 Option A: Alosetron (Lotronex) is a selective 5-HT3 receptor antagonist used specifically for
women with irritable bowel syndromes.
 Option B: Tegaserod (Zelnorm) is a serotonin type 4 receptor partial agonist used for women
below 65 years old who have irritable bowel syndrome with constipation.
 Option C: Lubiprostone (Amitiza) is a chloride channel activator used to treat irritable bowel
syndrome with constipation among women 18 years of age and older.

18. 18. Question

What is the priority nursing intervention for a client receiving antiemetic?

o  A. Monitor intake and output

o  B. Keep items far away from the bed

o  C. Give the client privacy by letting him walk around the room

o  D. Keep bed in low position with side rails up

Incorrect
Correct Answer: D. Keep bed in low position with side rails up
Antiemetics can cause drowsiness; hence the priority nursing intervention is to protect the client from an injury
such as raising the side rails and keeping the bed in a low position.
 Option A: Intake and output can be monitored but it is not the most priority intervention.
 Options B & C: These will risk the client for fall.

19. 19. Question

An osmotic laxative will be prescribed for a client. The nurse understands which medications are osmotic
laxative? Select all that apply

o  A. senna (Senokot)

o  B. mineral Oil (Kondremul)

o  C. polyethylene glycol and electrolytes (GoLYTELY)

 o  D. sodium Phosphate (Fleet enema)

o  E. bisacodyl (Dulcolax)

Incorrect
Correct Answer: C & D
Polyethylene glycol and sodium phosphate are osmotic laxatives that are used to attract water into the large
intestines to produce bulk and stimulate peristalsis. Other osmotic are Magnesium hydroxide (Milk of Magnesia)
and Magnesium citrate (Citrate of Magnesia).
 Options A & E: Senna and bisacodyl are stimulant laxatives.
 Option B: Mineral oil is a lubricant laxative.

20. 20. Question

Which of the following statements best describes the action of antacids?

o  A. Antacids neutralize gastric acid

o  B. Antacids block the production of gastric acid

o  C. Antacids block dopamine

o  D. Antacids enhance the action of acetylcholine

Incorrect
Correct Answer: A. Antacids neutralize gastric acid
Antacids act to bring the pH above 3. Antacids are a group of drugs that have been on the market for many years.
They were initially first-line defense against peptic ulcer disease; however, the discovery of proton pump inhibitors
revolutionized the treatment of peptic ulcer disease. Currently, antacid use is restricted to the relief of mild
intermittent gastroesophageal reflux disease (GERD) associated with heartburn. Other choices are incorrect
because they describe the actions of anti-acid drugs.
 Option B: The antacids reduce the acid reaching the duodenum by neutralizing the acid present
in the stomach. The salts’ mechanism of neutralization of acid varies, and each salt has a
different mechanism with the ultimate goal of acid neutralization.
 Option C: The formulation of aluminum hydrochloride and water results in the neutralization of the
acid in the stomach. It is also known to inhibit pepsin activity. Aluminum hydroxide is complexed
with a sulfated polysaccharide sucrose octasulfate to form sucralfate. This complex does not
have a significant buffering action against the acid or has no effect on the pepsin secretion and
does not alter the gastric acid production in any way. Nevertheless, it is known to heal chronic
ulcers and prevent acute mucosal damage induced chemically by reducing access to pepsin and
acid.
 Option D: Calcium salts neutralize gastric acidity resulting in increased gastric and duodenal bulb
pH; they additionally inhibit the proteolytic activity of pepsin if the pH is greater than 4 and
increase lower esophageal sphincter tone. The calcium released from calcium carbonate is
known to increase peristalsis in the esophagus, pushing the acid into the stomach and providing
relief from symptoms of heartburn. The calcium salts also form combined insoluble compounds
with dietary phosphate and prevent the absorption later.

21. 21. Question

Jam is under chemotherapy in which nausea is an expected side effect. Which of the following drugs is indicated
to prevent such side effects?

o  A. metoclopramide
 o  B. cimetidine

o  C. tagamet

o  D. famotidine

Incorrect
Correct Answer: A. metoclopramide
This is the only drug among the choices that is indicated to prevent nausea. Metoclopramide has been approved
by the FDA specifically to treat nausea and vomiting in patients with gastroesophageal reflux disease or diabetic
gastroparesis by increasing gastric motility. It is also used to control nausea and vomiting in chemotherapy
patients.
 Option B: Cimetidine is a gastric acid reducer used in the short-term treatment of duodenal and
gastric ulcers. The drug is effective in managing gastric hypersecretion, and therefore, used for
the management of reflux esophagitis disease and in the prevention of stress ulcers. With the
development of proton pump inhibitors, such as omeprazole, approved for the same indications,
cimetidine is available as an over the counter formulation for the prevention of heartburn or acid
indigestion, along with the other H2-receptor antagonists.
 Option C: Tagamet (cimetidine) is a histamine receptor antagonist used to treat and prevent
certain types of ulcer, and to treat conditions that cause the stomach to produce too much acid.
Tagamet is also used to treat gastroesophageal reflux disease (GERD), when stomach acid
backs up into the esophagus and causes heartburn.
 Option D: Famotidine decreases the production of stomach acid, and its pharmacologic activity is
used in the treatment of acid-related gastrointestinal conditions. Famotidine is a competitive
histamine H-receptor antagonist (H2RA) that binds to the H-receptors located on the basolateral
membrane of the parietal cell in the stomach, effectively blocking histamine actions. Its
pharmacologic activity results in the inhibition of gastric secretion by suppressing acid
concentration and volume of gastric secretion.

22. 22. Question

Which of the following drugs will reduce the effectiveness of sucralfate?

o  A. ranitidine

o  B. sucralfate

o  C. metoclopramide

o  D. meclizine

Incorrect
Correct Answer: A. ranitidine
Ranitidine decreases the effectiveness of sucralfate because it decreases the acid content of gastric secretion.
Ranitidine is a competitive inhibitor of histamine H2-receptors. The reversible inhibition of H2-receptors in gastric
parietal cells results in a reduction in both gastric acid volume and concentration. Ranitidine’s acid-lowering effect
is more pronounced for basal and nocturnal acid secretion than it is for food-stimulated acid secretion. Additional
indirect effects of ranitidine are decreased pepsin secretion and increased nitrate-reducing bacterial flora.
 Option B: Sucralfate is a unique anti-ulcer drug. It is a basic aluminum salt of sucrose octasulfate.
It prevents hydrolysis by preventing the formation of the enzyme-substrate complex. It adsorbs to
pepsin and decreases its concentration. Increases mucous hydrophobicity, viscosity, sulfation,
and the aluminum and carbohydrate content, which leads to improved mucosal protection from
acid. It also increases the production of mucus by increasing prostaglandin production. Sucralfate
 prevents the breakdown of mucus by pepsin A, reducing ulcerogenesis. It increases
prostaglandin dependent and independent production of bicarbonate by stomach and duodenum.
 Option C: Metoclopramide is a gastric stimulant that does not alter pH. It has been approved by
the FDA specifically to treat nausea and vomiting in patients with gastroesophageal reflux
disease or diabetic gastroparesis by increasing gastric motility. It is also used to control nausea
and vomiting in chemotherapy patients.
 Option D: Meclizine is an antihistamine and its GI effect is antiemetic. It is a first-generation
antihistamine (non-selective H1 antagonist). It also has central anticholinergic actions. The
blocking actions on these receptors give meclizine its antiemetic and antivertigo properties.
Meclizine, an FDA- approved drug, is a first-generation antihistamine used for the symptomatic
management of motion sickness. These symptoms include dizziness, nausea, and vomiting. It
also treats vertigo symptoms caused by vestibular diseases that commonly affect the inner ear,
such as Meniere’s disease.

23. 23. Question

Extrapyramidal symptoms are a side effect of which of the following drugs?

o  A. ranitidine

o  B. omeprazole

o  C. famotidine

o  D. metoclopramide

Incorrect
Correct Answer: D. metoclopramide
A side effect of metoclopramide is EPS. Tardive dyskinesia an adverse effect, often seen in antipsychotic
medications, that generally manifests as grimacing, lip-smacking, and tongue flicking as well as general
choreoathetoid movements of the body. Because it can sometimes be irreversible, it is the most threatening
potential complication of metoclopramide overdose, and metoclopramide treatment should be discontinued in any
patient who develops tardive dyskinesia. Extrapyramidal adverse effects have been observed in metoclopramide
overdose, particularly in infants and the elderly, who are at the greatest risk.
 Option A: Transient pain at the site of intramuscular (IM) injection has been reported. Transient
local burning or itching has been reported with intravenous (IV) administration of ranitidine. The
2015 Beers Criteria list identifies ranitidine as a therapy that may potentially trigger or exacerbate
delirium in adults older than 65 years of age. Caution should be used when treating the elderly
with ranitidine. Long-term use of ranitidine for greater than 2 years may also be associated with
vitamin B12 deficiency.
 Option B: Omeprazole is indicated for the short-term treatment of peptic ulcer disease in adults
where most patients heal within four weeks. Patients with duodenal ulcer disease and H. pylori
infection disease that is active for up to one year may benefit from combination therapy that
includes omeprazole with clarithromycin, amoxicillin, and metronidazole. Omeprazole is a proton
pump inhibitor. It inhibits the parietal cell H+ / K+ ATP pump, the final step of acid production.
 Option C: Famotidine decreases the production of stomach acid, and its pharmacologic activity is
used in the treatment of acid-related gastrointestinal conditions. Famotidine is a competitive
histamine H-receptor antagonist (H2RA) that binds to the H-receptors located on the basolateral
membrane of the parietal cell in the stomach, effectively blocking histamine actions. Its
pharmacologic activity results in the inhibition of gastric secretion by suppressing acid
concentration and volume of gastric secretion.

24. 24. Question

Which histamine-2 antagonist is associated with the most drug interactions?

 o  A. ranitidine

o  B. cimetidine

o  C. Prilosec

o  D. nizatidine

Incorrect
Correct Answer: B. cimetidine
Cimetidine was the first histamine-2 antagonist developed and is associated with the most toxic drug interactions
of the group. High doses of cimetidine (over 5 g/day) can cause reversible impotence or gynecomastia. This effect
appears to be the result of the antiandrogenic potential of cimetidine, which depends on an increase in prolactin
levels secondary to histamine H2 receptor blockade. Also, cimetidine has non-specific actions that stimulate
prolactin secretion, causing galactorrhea in men in a dose-related pattern. The effects could also be related to a
blockade of the 2-hydroxylation of estradiol. However, gynecomastia in men is not an adverse effect with the other
H2 receptor blockers (ranitidine, famotidine, and nizatidine).
 Option A: Severe toxicity to ranitidine is rare, and there currently is no antidote for ranitidine
overdose. Patients may present with CNS depression or severe hypotension. Supportive
treatment and monitoring based on the presenting symptoms may be warranted.
 Option C: Omeprazole is considered a benign drug; however, the primary adverse effects of
omeprazole include headache, abdominal pain, nausea, diarrhea, vomiting, and flatulence in
adults. The major adverse effects in the pediatric population are similar to adults; the most
frequent events were reportedly fever and respiratory. Proton pump inhibitors (PPI) therapy may
correlate with an increased risk of Clostridioides difficile (C. diff) associated diarrhea.
 Option D: H2RAs are generally well-tolerated. Mild side effects may include headache,
drowsiness, fatigue, abdominal pain, constipation, or diarrhea. The use of H2RAs in patients with
renal impairment, hepatic impairment, or who are over 50 years of age has correlated with central
nervous system side effects such as delirium, confusion, hallucinations, or slurred speech.

25. 25. Question

Hydrochloric acid secretion is blocked by which of the following categories of drugs?

o  A. Antacids

o  B. Gastric stimulants

o  C. Histamine-2 antagonists

o  D. Antihistamines

Incorrect
Correct Answer: C. histamine-2 antagonists
This is the only category of drugs that reduces the volume of secretions. H2RAs decrease gastric acid secretion
by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and
action of the endogenous ligand histamine. H2 blockers thus function as competitive antagonists. By blocking the
histamine receptor and thus histamine stimulation of parietal cell acid secretion, H2RAs suppress both stimulated
and basal gastric acid secretion that is induced by histamine.
 Option A: The antacids reduce the acid reaching the duodenum by neutralizing the acid present
in the stomach. The salts’ mechanism of neutralization of acid varies, and each salt has a
different mechanism with the ultimate goal of acid neutralization. It is known to heal chronic ulcers
and prevent acute mucosal damage induced chemically by reducing access to pepsin and acid.
  Option B: Gastrointestinal stimulants are drugs that increase motility of the gastrointestinal
smooth muscle, without acting as a purgative. These drugs have different mechanisms of action
but they all work to move the contents of the gastrointestinal tract faster.
 Option D: First-generation antihistamines easily cross the blood-brain barrier into the central
nervous system and antagonize H-1 receptors, which leads to a different therapeutic and adverse
effect profile in contrast to second-generation antihistamines, which selectively bind to peripheral
histamine receptors.

26. 26. Question

Which category of drugs prevents/treats constipation by the osmotic drawing of water from extravascular space to
intestinal lumen?

o  A. Stimulants

o  B. Bulk-forming agents

o  C. Hyperosmotic agents

o  D. Lubricants

Incorrect
Correct Answer: C. Hyperosmotic agents
Hyperosmotic agents change the osmotic gradient between the intestine and extravascular space causing water
to move into the intestinal lumen and balance the gradient. Hyperosmotic agents reduce intraocular pressure by
creating an osmotic gradient between the blood and the intraocular fluid compartments that causes fluid to shift
from the eye to the blood. These agents are most effective when used for a short period of time. Systemic side
effects and a limited period of efficacy in maintaining a reduction in intraocular pressure preclude their chronic use
in the treatment of glaucoma.
 Option A: Caffeine has a unique mechanism as a stimulant as it works as an inhibitor at the
adenosine receptors. Agonism at these receptors induces a sensation of drowsiness, and
therefore inhibition at these receptors leads to increased energy levels. The general mechanism
of action of amphetamines is the induction of catecholamines, specifically norepinephrine and
dopamine. These catecholamines lead to increased energy levels, euphoria, increased libido, and
higher cognition. The induction of most of the effects of cocaine is through the blockade of the
dopamine transporter protein. This results in increased dopamine levels at the synaptic cleft, and
hence the effects of dopamine become amplified.
 Option B: Bulk-forming laxatives absorb liquid in the intestines. This creates a bulky, more liquid-
like stool that’s softer and easier to pass. Common bulk-forming laxatives include psyllium
(Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel). Bulk-forming laxatives are
different from these laxatives. They’re most similar to stool softeners in that they help the bowels
retain water. Unlike stimulant laxatives, they don’t stimulate nerves that speed up the movement
of bowels through the intestines. They also don’t lubricate the stools like lubricant laxatives do.
Osmotic laxatives differs from bulk-forming types by helping the intestines — not the bowels —
retain water.
 Option D: Lubricant is a substance which is used to control (more often to reduce) friction and
wear of the surfaces in a contact of the bodies in relative motion [1]. Depending on its nature,
lubricants are also used to eliminate heat and wear debris, supply additives into the contact,
transmit power, protect, seal.

27. 27. Question

Which of the following is a bulk-forming agent?

 o  A. Glycerin

o  B. FiberCon

o  C. Lactulose

o  D. Milk of Magnesia

Incorrect
Correct Answer: B. FiberCon
FiberCon is the bulk-forming agent. Polycarbophil is used to treat constipation. It is known as a bulk-forming
laxative. It increases the bulk in the stool, an effect that helps to cause movement of the intestines. It also works
by increasing the amount of water in the stool, making the stool softer and easier to pass. Choices A and B are
incorrect because they are hyperosmotic agents.
 Option A: This medication is used as a moisturizer to treat or prevent dry, rough, scaly, itchy skin
and minor skin irritations (e.g., diaper rash, skin burns from radiation therapy). Emollients are
substances that soften and moisturize the skin and decrease itching and flaking.
 Option C: Lactulose is used in preventing and treating clinical portal-systemic encephalopathy;
first used in clinical practice in 1966. Its chief mechanism of action is by decreasing the intestinal
production and absorption of ammonia. Lactulose, also known as 1,4 beta galactoside-fructose, is
a non-absorbable synthetic disaccharide made up of galactose and fructose. The human small
intestinal mucosa does not have the enzymes to split lactulose, and hence lactulose reaches the
large bowel unchanged. Lactulose is metabolized in the colon by colonic bacteria to
monosaccharides, and then to volatile fatty acids, hydrogen, and methane.
 Option D: Milk of Magnesia is a saline laxative. This medication is used for a short time to treat
occasional constipation. It is a laxative (osmotic-type) that is thought to work by drawing water
into the intestines, an effect that helps to cause movement of the intestines. This medication is
also used to treat symptoms caused by too much stomach acid such as heartburn, upset
stomach, or indigestion. It is an antacid that works by lowering the amount of acid in the stomach.

28. 28. Question

A client needs rapid cleansing of the bowel, which category is best used?

o  A. Bacid

o  B. Bulk-forming agent

o  C. Intestinal flora modifiers

o  D. Saline laxatives with magnesium

Incorrect
Correct Answer: D. Saline laxatives with magnesium
Saline laxatives are the best agents for rapid bowel cleansing. Magnesium citrate is a saline laxative that is
thought to work by increasing fluid in the small intestine. It usually results in a bowel movement within 30 minutes
to 3 hours.
 Option A: Bacid is an intestinal flora modifier. This product can help restore the normal balance of
intestinal bacteria. This product has been used for diarrhea and other stomach/intestinal
problems. It has also been used for vaginal and urinary tract infections. Some diet supplement
products have been found to contain possibly harmful impurities/additives.
 Option B: Bulk-forming agents will not produce rapid cleansing. Bulk-forming laxatives absorb
liquid in the intestines. This creates a bulky, more liquid-like stool that’s softer and easier to pass.
 Common bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and
methylcellulose (Citrucel). Bulk-forming laxatives are different from these laxatives. They’re most
similar to stool softeners in that they help the bowels retain water. Unlike stimulant laxatives, they
don’t stimulate nerves that speed up the movement of bowels through the intestines. They also
don’t lubricate the stools like lubricant laxatives do. Osmotic laxatives differ from bulk-forming
types by helping the intestines — not the bowels — retain water.
 Option C: Intestinal flora modifiers will not not produce rapid cleansing as well. Probiotics are
usually defined as products which contain viable non-pathogenic microorganisms able to confer
health benefits to the host. There are specific gastrointestinal effects of probiotics such as
alleviating inflammatory bowel disease, reducing acute diarrhoea in children, inhibiting
Salmonella and Helicobacter pylori, removing cholesterol, secreting enzymes and bacteriocins
and immunomodulation.

29. 29. Question

Which of the following categories is used for diarrhea and constipation?

o  A. Bulk-forming agents

o  B. Intestinal flora modifiers

o  C. Cascara

o  D. Milk of Magnesia

Incorrect
Correct Answer: A. Bulk-forming agents
Bulk-forming agents are used for diarrhea and constipation. Bulk-forming agents will not produce rapid cleansing.
Bulk-forming laxatives absorb liquid in the intestines. This creates a bulky, more liquid-like stool that’s softer and
easier to pass. Common bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and
methylcellulose (Citrucel). Bulk-forming laxatives are different from these laxatives. They’re most similar to stool
softeners in that they help the bowels retain water. Unlike stimulant laxatives, they don’t stimulate nerves that
speed up the movement of bowels through the intestines. They also don’t lubricate the stools like lubricant
laxatives do. Osmotic laxatives differ from bulk-forming types by helping the intestines — not the bowels — retain
water.
 Option B: Probiotics are usually defined as products which contain viable non-pathogenic
microorganisms able to confer health benefits to the host. There are specific gastrointestinal
effects of probiotics such as alleviating inflammatory bowel disease, reducing acute diarrhoea in
children, inhibiting Salmonella and Helicobacter pylori, removing cholesterol, secreting enzymes
and bacteriocins and immunomodulation.
 Option C: Cascara sagrada used to be approved by the U.S. Food and Drug Administration
(FDA) as an over-the-counter (OTC) drug for constipation. Cascara sagrada contains chemicals
that stimulate the bowel and have a laxative effect.
 Option D: This medication is used for a short time to treat occasional constipation. It is a laxative
(osmotic-type) that is thought to work by drawing water into the intestines, an effect that helps to
cause movement of the intestines. This medication is also used to treat symptoms caused by too
much stomach acid such as heartburn, upset stomach, or indigestion. It is an antacid that works
by lowering the amount of acid in the stomach.

30. 30. Question

Which of the following may be used for bowel preparation and is not recommended for the treatment of
constipation?
 o  A. Correctol

o  B. Fiberall

o  C. Mineral oil

o  D. Castor oil

Incorrect
Correct Answer: D. castor oil
Castor oil is not recommended for treatment of constipation because it causes such severe abdominal pain.
Castor oil can be used as an irritant/stimulative laxative. Castor oil is a natural emollient and a few drops may also
be used to remedy dry skin, as a massage oil, and may benefit hair as a treatment. Castor oil contains ricinoleic
acid, a fatty acid that comprises about 90% of the oil.
 Option A: Bisacodyl is used to treat constipation. It may also be used to clean out the intestines
before a bowel examination/surgery. Bisacodyl is known as a stimulant laxative. It works by
increasing the movement of the intestines, helping the stool to come out.
 Option B: This medication is used to treat constipation. It increases the bulk in your stool, an
effect that helps to cause movement of the intestines. It also works by increasing the amount of
water in the stool, making the stool softer and easier to pass. Psyllium, one type of bulk-forming
laxative, has also been used along with a proper diet to treat high cholesterol.
 Option C: Mineral oil is used to treat constipation. It is known as a lubricant laxative. It works by
keeping water in the stool and intestines. This helps to soften the stool and also makes it easier
for stool to pass through the intestines.

Endocrine Drugs and Medications: Nursing Pharmacology Practice

1. 1. Question

Humatrope (somatropin) is being given to a female patient with turner syndrome. Which of the following findings is
associated with this medication?
 o  A. Decreases ALT and AST level

o  B. Mild hyperglycemia

o  C. Hypotension

o  D. Water intoxication

Incorrect
Correct Answer: B. Mild hyperglycemia
Humatrope (somatropin) is a growth hormone. Excess growth hormone causes insulin resistance and
hyperglycemia.
 Option A: Elevated AST and ALT are expected.
 Option C: Hypertension, not hypotension is a side effect.
 Option D: Water intoxication is not a related symptom to this medication.

2. 2. Question

A nurse provides instructions to a client regarding the administration of the prednisone and instructs the client that
the best time to take the medication is during?

o  A. Before breakfast

o  B. After breakfast

o  C. Evening

o  D. Before bedtime

Incorrect
Correct Answer: B. After breakfast
Prednisone is a corticosteroid (glucocorticoids) and It should be administered early in the morning because it
helps in decreasing the risk for adrenal insufficiency and stimulates the burst of glucocorticoids released naturally
by the adrenal glands each morning.
 Option A: Prednisone can cause gastric upset and should always be taken with a meal.
 Options C & D: One of the common side effects of the medication is insomnia so it is best taken
in the morning.

3. 3. Question

A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would alert the
need to decrease the dosage?

o  A. Alopecia

o  B. Jaundice

o  C. Diarrhea

o  D. Drowsiness

Incorrect
Correct Answer: D. Drowsiness
 One of the side effects of taking antidiuretic hormone is water intoxication which is manifested by a headache,
drowsiness, light-headedness, and shortness of breath. This could indicate the need to reduce the dosage.
 Options A, B, & C: These are not related signs to this medication.

4. 4. Question

Which of the following medications decreases their action while taking thyroid hormone?

o  A. Metformin

o  B. Warfarin

o  C. Zoloft

o  D. Epinephrine

Incorrect
Correct Answer: A. Metformin
Metformin, an oral hypoglycemic drug when taken with a thyroid hormone decreases their action.
 Options B, C, & D: Warfarin (an anticoagulant), Zoloft (an antidepressant), and Epinephrine (a
sympathomimetic) increases their action when taken with a thyroid hormone.

5. 5. Question

Prednisone is prescribed for a client with diabetes mellitus who is using Humulin 70/30 daily. Which of the
following prescription changes does the nurse expect during the medication therapy?

o  A. An addition of an oral hypoglycemic medication

o  B. Increased dosage of prednisone

o  C. Increased dosage of humulin 70/30

o  D. Decreased dosage of humulin 70/30

Incorrect
Correct Answer: C. Increased dosage of humulin 70/30
Prednisone, a glucocorticoid, can cause an increase in blood glucose level due to the ability of the liver to be
resistant to insulin during the medication therapy, hence people with diabetes need to increase the dosage of their
insulin.
 Options A, B, & D: These will not help the cause.

6. 6. Question

A nurse is instructing a client regarding intranasal vasopressin (Pitressin). The nurse tells the client which of the
following is a side effect specific to the medication?

o  A. Rhinitis

o  B. Headache

o  C. Flushing
 o  D. Nausea

Incorrect
Correct Answer: A. Rhinitis
High doses of vasopressin administered via intranasal route may cause rhinitis and nasal congestion.
 Options B, C, & D: These are the side effects of the medication administered intravenously.

7. 7. Question

A nurse is performing an assessment on a newly admitted patient who is taking propylthiouracil (PTU) daily. The
nurse suspects that the client has a history of?

o  A. Addison's disease

o  B. Cushing's syndrome

o  C. Grave's disease

o  D. Myxedema

Incorrect
Correct Answer: C. Grave’s disease
Graves’ disease is an autoimmune disease that is characterized by overactivity of the thyroid gland resulting in
the excessive production of thyroid hormone. The primary goal of treatment for graves disease is to eliminate
excess thyroid hormone and decrease the occurrence of long term complications. It includes antithyroid
medications such as propylthiouracil (PTU) which inhibits the synthesis of thyroid hormone.
 Options A & B: These are disorders related to adrenal function.
 Option D: Myxedema indicates hypothyroidism.

8. 8. Question

A nurse is giving discharge instructions to a patient who is taking Synthroid (levothyroxine). The nurse instructs
the client to notify the physician if which of the following occurs?

o  A. Cold intolerance

o  B. Tremors

o  C. Coarse, dry hair

o  D. Muscle cramps

Incorrect
Correct Answer: B. Tremors
Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism which includes heat
tolerance, tremors, nervousness, tachycardia, chest pain, hyperthermia, and insomnia.
 Options A, C, & D: These are signs of hypothyroidism.

9. 9. Question

A nurse is giving instructions to a patient who is taking levothyroxine (Synthroid). The nurse tells the client that the
best time to take this medication is?

o  A. During bedtime

 o  B. After lunch

o  C. Taken with food

o  D. Taken on an empty stomach

Incorrect
Correct Answer: D. Taken on an empty stomach
Levothyroxine is primarily used for the treatment of hypothyroidism. It is taken on an empty stomach usually
before breakfast to enhance absorption.

10. 10. Question

Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following therapeutic
response should you expect?

o  A. Decreased blood pressure

o  B. Decreased attention span

o  C. Decreased urinary output

o  D. Decreased blood sugar

Incorrect
Correct Answer: C. Decreased urinary output
The therapeutic response of this medication is decreased urine output because it promotes renal conservation of
water.
 Options A, B, & D: These are unrelated effects to this medication.

11. 11. Question

A patient with adrenal insufficiency is to be discharged and is given prednisone as a home medication. The nurse
instructs the patient the following, except?

o  A. To avoid aspirin-containing products

o  B. To avoid foods rich in potassium

o  C. To avoid caffeinated drinks

o  D. To avoid individuals with respiratory infections

Incorrect
Correct Answer: B. To avoid foods rich in potassium
One of the side effects of taking prednisone is hypokalemia especially when it is combined with drugs that
decrease potassium levels (e.g., diuretics) so potassium-rich food should be included in the diet.

12. 12. Question

Viagra (sildenafil) is given to a patient with erectile dysfunction. Which of the following history is contraindicated
with the medication?

o  A. Blurred vision

 o  B. Neuralgia

o  C. Use of vitamins

o  D. Use of nitrates

Incorrect
Correct Answer: D. Use of nitrates
Viagra (sildenafil) is contraindicated in patients taking nitrates, nitroprusside, and beta-blockers. Viagra, when
taken with nitrates can cause a significant drop in blood pressure.
 Options A & B: Blurred vision and neuralgia are the side effects of this medication.
 Option C: The use of vitamins is not contraindicated with the use of sildenafil.

13. 13. Question

Glucotrol (glipizide) is prescribed to a patient with diabetes mellitus. The nurse instructed the patient to avoid
which of the following?

o  A. Soft drinks

o  B. Whole grain cereals

o  C. Alcohol

o  D. Organ meats

Incorrect
Correct Answer: C. Alcohol
Alcohol when combined with glipizide, a disulfiram-like reaction (flushing, headache, and nausea) happens. In
addition, large amounts of alcohol cause hypoglycemia.
 Options A, B, & D: Soft drinks, whole grain cereals, and organ meats are not to be avoided.

14. 14. Question

A nurse is teaching a patient on how to mix regular insulin and NPH insulin in the same syringe. Which of the
following actions, if performed by the patient , indicates the need for further teaching?

o  A. Withdraws regular insulin first

o  B. Withdraws NPH insulin first

o  C. Injects an amount of air equivalent to the desired dose of insulin

o  D. Injects air into the NPH insulin first

Incorrect
Correct Answer: B. Withdraws NPH insulin first
The regular insulin is drawn into the syringe first then the NPH, this will avoid contaminating the regular insulin vial
with another type.
 Options A, C, & D: These are appropriate actions when preparing regular and NPH insulin.

15. 15. Question

 A patient is taking insulin glargine injection daily. The nurse instructed the client that the onset of action will likely
happen?

o  A. 2-4 hours after administration

o  B. 4-12 hours after administration

o  C. 6-12 hours after administration

o  D. 18-24 hours after administration

Incorrect
Correct Answer: A. 2-4 hours after administration
Insulin glargine is a long-acting insulin with an onset of 2-4 hours, no peak, and its duration of action is 24 hours.

16. 16. Question

A private nurse visits a client who is taking Humulin NPH insulin daily. The client asks the nurse how the storage
of the unopened vials of insulin. The nurse tells the client to:

o  A. Store it at room temperature

o  B. Store it in the freezer

o  C. Store it in the refrigerator

o  D. Keep the insulin in a sunlight, dry place

Incorrect
Correct Answer: C. Store it in the refrigerator
 Option C: Unopened insulin is stored in the refrigerator until the expiry date.
 Option A: Only opened vials are stored at room temperature and it will only last for 28 days.
 Option B: It should never be stored in the freezer.
 Option D: Insulin is sensitive to light.

17. 17. Question

A client with diabetes mellitus type I was prescribed with exenatide (Bydureon). The nurse will take which of the
following appropriate actions?

o  A. Withdraw the insulin from the prefilled pen into an insulin syringe

o  B. Monitor for signs of nausea, vomiting, and gastric upset

o  C. Administer the medication twice a day during pre-meals

o  D. Hold the medication and call the physician to question the prescription

Incorrect
Correct Answer: D. Hold the medication and call the physician to question the prescription
Exenatide (Bydureon) is only used to treat diabetes mellitus type 2 only. Therefore, holding the medication and
calling the physician to question the order.
 Option A: Prefilled pens are ready for injection.
  Options B & C: Although these are correct about the medication, it should not be administered in
this kind of situation.

18. 18. Question

Which of the following insulin cannot be mixed with any other type of insulin?

o  A. Insulin glargine

o  B. Insulin aspart

o  C. Insulin isophane

o  D. Insulin lispro

Incorrect
Correct Answer: A. Insulin glargine
Insulin glargine when mixed with any other types of insulin changes its duration of action ( a combination of long-
acting and short-acting insulin) so it is advised that it should not be mixed with any other type of insulin.

19. 19. Question

Which of the following medications causes hypoglycemia, except?

o  A. Salicylates

o  B. Oral contraceptives

o  C. Sulfonamides

o  D. Anticoagulants

Incorrect
Correct Answer: B. Oral contraceptives
Medications such as thiazide diuretics, corticosteroids, oral contraceptives, estrogen, and sympathomimetics
cause hyperglycemia.

20. 20. Question

A nurse is providing instruction to a client who is prescribed with repaglinide (Prandin). All of which is true
regarding this medication, except?

o  A. Do not skip the dose when a meal is not taken

o  B. Dizziness may occur while taking it

o  C. Has quicker and shorter duration of action

o  D. Used to treat type II diabetes mellitus

Incorrect
Correct Answer: A. Do not skip the dose when a meal is not taken
Repaglinide (Prandin) is a meglitinide type of antidiabetic that has a quick onset of action which allows a client to
take the medication with meals and skip a dose when a meal is skipped.
  Options B, C, & D: Repaglinide is an oral antihyperglycemic agent used for the management of
type II diabetes. It has a fast onset and duration of action making it a good medication for treating
postprandial blood glucose spikes. Since the medication causes changes in the blood sugar, a
client may experience signs of hypoglycemia such as dizziness or lightheadedness.

21. 21. Question

Which of the following is a contraindication to the administration of growth hormone?

o  A. The height of the child is under 4 feet

o  B. The child's age is between 5 and 6

o  C. The epiphyseal shaft is open

o  D. The epiphyseal shaft is closed

Incorrect
Correct Answer: D. The epiphyseal shaft is closed
A closed epiphyseal shaft is a contraindication for administration of growth hormone. Human growth hormone is
produced via the anterior pituitary of the brain in the acidophilic, somatotrophic cells. Its production is tightly
regulated through several complex feedback mechanisms in response to stress, exercise, nutrition, sleep, and
growth hormone itself. The primary regulation factors are growth hormone-releasing hormone (GHRH) produced
in the hypothalamus, somatostatin, produced in various tissues throughout the body, and ghrelin, which is
produced in the gastrointestinal tract. There are no exact height or age requirements for the administration of
growth hormone.
 Option A: GHRH functions to promote HGH production and release. Somatostatin inhibits the
release of GHRH as well as the HGH release response to GHRH stimulus and increases in
hypoglycemia. Ghrelin is a hormone produced by the stomach as part of the hunger response.
Functionally, the ghrelin response is protective against hypoglycemia. When elevated, ghrelin
binds to somatotrophs to stimulate HGH secretion.
 Option B: Insulin-like growth factor-1 also acts to inhibit HGH by both directly inhibiting
somatotrophic HGH release and indirectly through synergistically increasing the release of
somatostatin. Additionally, HGH will negatively feedback into the hypothalamus, thus decreasing
GHRH production. The net effect of this regulatory mechanism produces a pulsatile release of
HGH into circulation that varies hourly.
 Option C: In general, HGH levels will be increased in childhood, spike to their highest levels
during puberty, and subsequently decrease with increased age. HGH has two mechanisms of
effect: direct action and indirect action. The direct effects of HGH on the body are through its
action on binding to target cells to stimulate a response. The indirect effects occur primarily by the
action of insulin-like growth factor-1, which hepatocytes primarily secrete in response to elevated
HGH binding to surface receptors.

22. 22. Question

Miley has been taking growth hormones for quite some time now. As a recipient of the agent, she should be
aware that a side effect of growth hormone is:

o  A. Increased tumor growth

o  B. Soft tissue hypertrophy

o  C. Dwarfism
 o  D. Hyperthyroidism

Incorrect
Correct Answer: A. Increased tumor growth
Growth hormone may increase the size of a tumor if one is present. In addition to the lack of evidence for
effectiveness of human growth hormone in these proposed uses, it causes side effects such as diabetes, carpal
tunnel syndrome, fluid retention, joint and muscle pain, and high blood pressure. Many of these side effects were
seen in studies that used much higher doses of human growth hormone than are now used in elderly people, so
there is hope that studies using lower doses alone or in combination with modest doses of anabolic steroids may
show a positive ratio of benefits to side effects. Hypothyroidism and soft tissue atrophy are the side effects.
Dwarfism is the indication for therapy.
 Option B: Anabolic-androgenic steroids (AAS) and other hormones such as growth hormone (GH)
and insulin-like growth factor-1 (IGF-1) have been shown to increase muscle mass in patients
suffering from various diseases related to muscle atrophy.
 Option C: Recombinant human growth hormone therapy (rhGH) is an effective treatment for
patients suffering from growth hormone deficiency. Early intervention can prevent short stature
and the psychosocial stress associated with it.
 Option D: Hyperthyroidism is associated with increased serum IGF-I levels and marked
alterations in the neuroregulation of GH secretion. These changes involve decreased GH
responsiveness to GHRH at the pituitary level and, at the hypothalamic level, a lack of
suppressive effect of an oral glucose load.

23. 23. Question

Vasopressin is which of the following pituitary hormones?

o  A. Antidiuretic hormone

o  B. Desmopressin acetate

o  C. Oxytocin

o  D. ACTH

Incorrect
Correct Answer: A. Antidiuretic hormone
Vasopressin is an antidiuretic hormone. Vasopressin or antidiuretic hormone (ADH) or arginine vasopressin (AVP)
is a nonapeptide synthesized in the hypothalamus. Science has known it to play essential roles in the control of
the body’s osmotic balance, blood pressure regulation, sodium homeostasis, and kidney functioning. ADH
primarily affects the ability of the kidney to reabsorb water; when present, ADH induces expression of water
transport proteins in the late distal tubule and collecting duct to increase water reabsorption.
 Option B: Desmopressin (1-deamino-8-D-arginine vasopressin) is a synthetic analog of
vasopressin aka antidiuretic hormone created in 1977 used in the treatment in a wide variety of
medical conditions to include nocturnal polyuria, hemophilia A, diabetes insipidus, on Willebrand
disease, uremic bleeding, as well as many off label uses such as an adjunct with hypertonic
saline to prevent rapid sodium correction, intracranial hemorrhage associated with varying
antiplatelet agents, and trauma resuscitation with active hemorrhage.
 Option C: Oxytocin is indicated and approved by the FDA for two specific time frames in the
obstetric world: antepartum and postpartum. In the antepartum period, exogenous oxytocin is
FDA-approved for strengthening uterine contractions with the aim of successful vaginal delivery
of the fetus. In regards to the postpartum period, oxytocin is FDA-approved when it is time to
deliver the placenta during the third stage of labor and also to control postpartum hemorrhage.
 Option D: Adrenocorticotropic hormone (ACTH) is a tropic hormone produced by the anterior
pituitary. The hypothalamic-pituitary axis controls it. ACTH regulates cortisol and androgen
 production. Diseases associated with ACTH include Addison disease, Cushing syndrome, and
Cushing disease.

24. 24. Question

Which of the following drugs will decrease the effects of vasopressin?

o  A. digoxin (Lanoxin)

o  B. lithium (Lithane)

o  C. penicillin (Pen-Vee-K)

o  D. azithromycin (Zithromax)

Incorrect
Correct Answer: B. lithium (Lithane)
Lithium is known to decrease the effects of vasopressin. Lithium is a salt, and antidiuretic hormone acts on the
water that influences the sodium/water balance. Lithium modifies sodium transport in nerve and muscle cells. It
alters the metabolism of neurotransmitters, specifically catecholamines and serotonin. It may alter intracellular
signaling via second messenger systems by inhibition of inositol monophosphate. This inhibition, in turn, affects
neurotransmission through the phosphatidylinositol secondary messenger system.
 Option A: Digoxin has two principal mechanisms of action which are selectively employed
depending on the indication. It increases the force of contraction of the heart by reversibly
inhibiting the activity of the myocardial Na-K ATPase pump, an enzyme that controls the
movement of ions into the heart. Digoxin induces an increase in intracellular sodium that will drive
an influx of calcium in the heart and cause an increase in contractility. Digoxin has vagomimetic
effects on the AV node. By stimulating the parasympathetic nervous system, it slows electrical
conduction in the atrioventricular node, therefore, decreases the heart rate.
 Option C: Penicillin inhibits the cross-linking of peptidoglycan in the cell wall. The catalyst for this
reaction is penicillin-binding proteins, such as the enzyme DD-transpeptidase. Penicillin’s four-
membered ?-lactam ring can bind to DD-transpeptidase to irreversibly inactivate it. The bacteria,
therefore, are unable to build their cell walls even while other proteins continue to break down the
wall.
 Option D: Azithromycin is a broad-spectrum macrolide antimicrobial and is among the most
prescribed antimicrobial drugs in the United States. It is a derivative of erythromycin with greatly
enhanced activity against gram-negative bacteria (including Enterobacteriaceae) and provides
coverage of many gram-positive organisms. As an inhibitor of bacterial protein synthesis (rather
than a peptidoglycan cell-wall inhibitor like beta-lactam agents), azithromycin is effective against
many “atypical” bacteria such as chlamydiae (e.g., Chlamydia trachomatis and Chlamydophila
psittaci), legionella (i.e., Legionella pneumophila), mycoplasma (e.g., Mycoplasma pneumoniae),
and mycobacteria (e.g., Mycobacterium avium).

25. 25. Question

When caring for a client taking parathyroid medication, which of the following nursing interventions is a priority?

o  A. Monitor serum calcium levels

o  B. Evaluate bowel function

o  C. Measure serum acid phosphatase

 o  D. Check for side effects

Incorrect
Correct Answer: A. Monitor serum calcium levels
Serum calcium levels are altered when pathology exists in this gland. This is because the gland regulates the
balance of calcium and phosphorus. In the bones, PTH stimulates the release of calcium in an indirect process
through osteoclasts which ultimately lead to resorption of the bones. Most of the physiologic calcium reabsorption
in the nephron takes place in the proximal convoluted tubule and additionally at the ascending loop of Henle.
 Option B: In the small intestine, vitamin D allows the absorption of calcium through an active
transcellular pathway and a passive paracellular pathway. The transcellular pathway requires
energy, while the paracellular pathway allows for the passage of calcium through tight junctions.
 Option C: Parathyroid hormone decreases phosphate reabsorption at the proximal convoluted
tubule. Phosphate ions in the serum form salts with calcium that are insoluble, resulting in a
decreased plasma calcium. The reduction of phosphate ions, therefore, results in more ionized
calcium in the blood.
 Option D: The 2 umbrella categorizations of parathyroid dysfunctions are hyperparathyroidism
and hypoparathyroidism. The inappropriately high secretion of PTH is classified as
hyperparathyroidism while the inappropriately low secretion of PTH is designated as
hyperparathyroidism.

26. 26. Question

Drew is diagnosed with Type I diabetes mellitus. As a nurse taking care of the client, you should know that in his
condition:

o  A. Insulin is produced but is malformed.

o  B. The beta cells of the pancreas stop producing insulin.

o  C. The client cannot be treated.

o  D. Diagnosis is made in clients over age 50.

Incorrect
Correct Answer: B. The beta cells of the pancreas stop producing insulin.
In type I diabetes mellitus, the beta cells stop producing insulin completely. T1DM is characterized by the
destruction of beta cells in the pancreas, typically secondary to the autoimmune destruction of beta cells. The
result is the absolute destruction of beta cells, and consequentially, insulin is absent or extremely low.
 Option A: There is no such pathophysiologic process as malformed insulin. A patient with DM has
the potential for hyperglycemia. The pathology of DM can be unclear since several factors can
often contribute to the disease. Hyperglycemia alone can impair pancreatic beta-cell function and
contributes to impaired insulin secretion. Consequentially, there is a vicious cycle of
hyperglycemia leading to the impaired metabolic state. Blood glucose levels above 180 mg/dL
are often considered hyperglycemic in this context, though because of the variety of mechanisms,
there is no clear cutoff point.
 Option C: Clients with type I diabetes can be treated with insulin. Since T1DM is a disease
primarily due to the absence of insulin, insulin administration through daily injections, or an insulin
pump, is the mainstay of treatment. Metformin is the first line of the prescribed diabetic
medications and works by lowering basal and postprandial plasma glucose.
 Option D: The diagnosis can be made in clients at any age. Globally, 1 in 11 adults has DM (90%
having T2DM). The onset of T1DM gradually increases from birth and peaks at ages 4 to 6 years
and then again from 10 to 14 years. Approximately 45% of children present before age ten years.
The prevalence in people under age 20 is about 2.3 per 1000.
27. 27. Question

Which of the following statements involving Type II diabetes mellitus is correct?

o  A. It involves inefficient insulin production.

o  B. It involves cessation of Insulin production by the beta cells of the pancreas.

o  C. It involves increased insulin receptor responsiveness.

o  D. It involves the infant client.

Incorrect
Correct Answer: A. It involves inefficient insulin production.
In type II diabetes mellitus, insulin is produced in insufficient amounts along with reduced insulin receptor
responsiveness. T2DM involves a more insidious onset where an imbalance between insulin levels and insulin
sensitivity causes a functional deficit of insulin. Insulin resistance is multifactorial but commonly develops from
obesity and aging.
 Option B: In type II diabetes mellitus, the beta cells do produce insulin but in inadequate amounts.
A patient with DM has the potential for hyperglycemia. The pathology of DM can be unclear since
several factors can often contribute to the disease. Hyperglycemia alone can impair pancreatic
beta-cell function and contributes to impaired insulin secretion. Consequentially, there is a vicious
cycle of hyperglycemia leading to the impaired metabolic state. Blood glucose levels above 180
mg/dL are often considered hyperglycemic in this context, though because of the variety of
mechanisms, there is no clear cutoff point.
 Option C: There is decreased rather than increased insulin responsiveness. Insulin resistance is
attributable to excess fatty acids and proinflammatory cytokines, which leads to impaired glucose
transport and increases fat breakdown. Since there is an inadequate response or production of
insulin, the body responds by inappropriately increasing glucagon, thus further contributing to
hyperglycemia. While insulin resistance is a component of T2DM, the full extent of the disease
results when the patient has inadequate production of insulin to compensate for their insulin
resistance.
 Option D: T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged
and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices.
The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has
various etiologies, presentations, and treatments.

28. 28. Question

A major side effect of insulin use that can be life threatening is:

o  A. Hyperglycemia

o  B. Stomach upset

o  C. Hypoglycemia

o  D. Tremors

Incorrect
Correct Answer: C. Hypoglycemia
The action of insulin will lower glucose levels, which may prove fatal if levels drop too low. Hypoglycemia is, by
far, the most common adverse effect of insulin therapy. The other adverse effects of insulin therapy include weight
 gain, and rarely electrolyte disturbances like hypokalemia, especially when used along with other drugs causing
hypokalemia.
 Option A: Some patients who take insulin before bed, wake up with high blood sugar levels. This
effect occurs when the insulin causes a hypoglycemic condition in the body, which activates the
antihyperglycemic hormones such as cortisol and adrenaline, resulting in rebound
hyperglycemia.; this can be corrected by reducing the dose of bedtime insulin or changing the
time of insulin dosing.
 Option B: The subcutaneous route of administration also has its adverse effects. Pain at the
injection site, lipodystrophy at the site of injection are the most common adverse effects of daily
subcutaneous injections. Other adverse effects like peripheral hyperinsulinemia and decreased
compliance are also seen in the population using the subcutaneous route for administration of
insulin.
 Option D: Insulin taken in large doses will cause symptoms of hypoglycemia in the patient. Some
of these symptoms include headache, dizziness, palpitations, sweating, abdominal pain, and
blurring of vision. The immediate therapy for such patients is increasing the levels of glucose. In a
conscious patient, this can be done by eating a high energy bar or drinking a glass of glucose
water. If the patient is unconscious, he needs to be hospitalized and given dextrose solution
intravenously and monitor glucose levels continuously.

29. 29. Question

Nurse Casey is studying insulin administration. She should be knowledgeable that regular insulin:

o  A. Is slow acting

o  B. Is used IV

o  C. Is a suspended insulin

o  D. Peaks in 6 to 12 hours

Incorrect
Correct Answer: B. Is used IV
Regular insulin is the only insulin preparation that can be administered IV. When administered intravenously, U-
100 administration should be with close monitoring of serum potassium and blood glucose. Do not use if the
solution is viscous or cloudy; administration should only take place if it is colorless and clear.
 Option A: Regular insulin is rapid-acting. In patients with DM (mainly type 1 but also can be in
type 2) and on an insulin regimen, blood glucose should be monitored between meals to prevent
hypoglycemia. Additionally, weight measurements are necessary due to insulin-associated weight
gain. Insulin regular onset of effect is 1 hour.
 Option C: It is a crystalline zinc preparation. For intravenous infusions, to minimize insulin
adsorption to plastic IV tubing, flush the intravenous tube with priming infusion of 20 mL from a
100 mL-polyvinyl chloride bag insulin, every time a new intravenous tubing is added to the insulin
infusion container.
 Option D: It peaks in 2 to 4 hours. Insulin regular onset of effect is 1 hour, peaks at 2 to 4 hours,
and the duration of the effect lasts 4-hours.

30. 30. Question

Signs of hypoglycemia include:

o  A. Fruity breath, thirst, flushed skin

o  B. Diarrhea, itching, hypertension

 o  C. Anxiety, weakness, pallor, sweating

o  D. Muscle ache, fever, thirst

Incorrect
Correct Answer: C. Anxiety, weakness, pallor, sweating
These are signs of hypoglycemia, along with restlessness, chills, confusion, nausea, hunger, tachycardia,
weakness, or headache. Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety)
or cholinergic (hunger, diaphoresis, paresthesias). Neurogenic symptoms and signs arise from sympathoadrenal
involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia.
 Option A: These are signs of hyperglycemia. Symptoms of severe hyperglycemia include
polyuria, polydipsia, and weight loss. As the patient’s blood glucose increases, neurologic
symptoms can develop. The patient may experience lethargy, focal neurologic deficits, or altered
mental status. The patient can progress to a comatose state.
 Option B: Neuroglycopenic signs and symptoms are signs and symptoms that result from direct
central nervous system (CNS) deprivation of glucose. These include behavioral changes,
confusion, fatigue, seizure, coma, and potential death if not immediately corrected.
 Option D: Patients who have diabetes can present with symptoms of hypoglycemia at relatively
higher serum glucose levels. The chronic hyperglycemia alters the “set point” in which
neuroglycopenic/neurogenic symptoms become apparent. This phenomenon is referred to as
“pseudohypoglycemia” because the serum glucose may be within normal range despite symptom
presentation.

31. 31. Question

Estrogen is given in the management of all of the following conditions except:

o  A. Dysfunctional uterine bleeding

o  B. Primary hypogonadism

o  C. Suppression of ovulation

o  D. Endometrial carcinoma

Incorrect
Correct Answer: D. Endometrial carcinoma
Estrogen is given in the management of dysfunctional uterine bleeding, primary hypogonadism, and suppression
of ovulation. The primary use of estrogen therapy lies in its treatment of menopausal symptoms. Although there is
a reduction in the use of estrogen therapy as a preventative treatment, it is still routinely used to treat menopausal
symptoms locally. Typically, drugs administered vaginally are used mainly for their local effects, but they can also
have systemic effects. Choices A, B, and C are all indicators for estrogen treatment.
 Option A: Localized estrogen treatment often relieves these symptoms and significantly increases
the quality of life, which includes life-changing improvements in sexuality, the incidence of urinary
tract infections, and incontinence. The method of estrogen delivery is vital in assessing its
benefits and uses. For example, the use of estrogen transdermally, in stark contrast to orally, has
been linked to a lower risk of deep vein thrombosis, cholecystitis, osteoporosis, and stroke.
 Option B: Estrogen is a steroid hormone that plays a central role in the reproductive system by
altering the transcription of genes in specific organs and tissues, primarily the uterus and vagina.
The genes undergo alteration through the act of estrogen on certain receptors, known as nuclear
transcription factors. These nuclear transcription factors, once bound by estrogen, are then able
to bind to promoter regions in sequences of specific genes and are therefore able to regulate
these genes
  Option C: Estrogen therapy (ET), a form of hormone replacement therapy (HRT), is a useful way
of combating the uncomfortable symptoms that often accompany menopause. Roughly 1.5 million
women between the ages of 45 and 55 experience menopausal symptoms, which often involve
hot flashes, flushing, and night sweats, also known as vasomotor symptoms.

32. 32. Question

Progestins have been known to cause which of the following:

o  A. Decrease HDL level

o  B. Increase aspartate transaminase

o  C. Increase HDL levels

o  D. Decrease aspartate transaminase

Incorrect
Correct Answer: A. Decrease HDL level
Progestins decrease HDL levels, which may predispose the client to increased cardiac risk. Progestins are
synthetic progestogens. Progestin drugs can be subclassified in two ways: (1) generationally or (2) based upon
structural properties.
 Option B: Progesterone enters the cell by passive diffusion through the plasma membrane and
binds to the progesterone receptor in the nucleus. When unbound, the progesterone receptor
exists as a monomer. After binding progesterone, the receptor undergoes a conformational
change and becomes a dimer, which increases receptor binding to DNA.
 Option C: Most progestins exert their contraceptive effects by suppressing the secretion of
gonadotropin-releasing hormone (GnRH) by the hypothalamus and luteinizing hormone (LH) and
follicle-stimulating hormone (FSH) by the pituitary gland. This adventitiously alters the menstrual
cycle to suppress ovulation.
 Option D: Progestins also provide other benefits by secondary mechanisms such as thickening
cervical mucus to prevent penetration by sperm, slowing tubal motility by impairing fallopian tube
motility, and inducing endometrial atrophy.

33. 33. Question

A constant dose of estrogen with varying doses of progestin are found in:

o  A. monophasic pills

o  B. biphasic pills

o  C. triphasic pills

o  D. Depo-Provera

Incorrect
Correct Answer: B. biphasic pills
Biphasic oral contraceptive pills deliver the same amount of estrogen each day while progestin dose is increased
halfway through the cycle.
 Option A: Monophasic pills have a constant dose of estrogen and progestin throughout the
month. Monophasic birth control is a type of oral contraceptive. Each pill is designed to deliver the
same level of hormone throughout the entire pill pack. That’s why it’s called “monophasic,” or
single phase. Most birth control pill brands offer 21- or 28-day formulations.
  Option C: Triphasic pills may have variations in estrogen as well as progestin levels. Triphasic
oral contraceptive pills have 3 different doses of progestin and estrogen that change
approximately every 7 days.Option D: Depo-Provera is a progestin product only. Depo-Provera is
a well-known brand name for medroxyprogesterone acetate, a contraceptive injection that
contains the hormone progestin.
 Option D: Depo-Provera is given as an injection every three months. Depo-Provera typically
suppresses ovulation, keeping your ovaries from releasing an egg. It also thickens cervical mucus
to keep sperm from reaching the egg.

34. 34. Question

Androgens are medically indicated in the management of all of the following except:

o  A. Hirsutism

o  B. Hypogonadism

o  C. Metabolic stimulation in prepubertal boys

o  D. Bodybuilding

Incorrect
Correct Answer: D. Bodybuilding
Androgens can be dangerous drugs and are medically indicated only in severe conditions, such as female
hirsutism or male hypogonadism, and as metabolic stimulators. Anabolic androgenic steroids are used by some
bodybuilders to enhance performance. While the cardiovascular implications of supraphysiological androgen
levels require further clarification, use is associated with sudden death, left ventricular hypertrophy, thrombo-
embolism and cerebro-vascular events.
 Option A: Hirsutism is a condition in women that results in excessive growth of dark or coarse hair
in a male-like pattern — face, chest and back. With hirsutism, extra hair growth often arises from
excess male hormones (androgens), primarily testosterone.
 Option B: Hypogonadism occurs in 19% of men in their 60s, 28% of men in their 70s, and 49% of
men in their 80s. Testosterone is FDA-approved as replacement therapy in men who have low
testosterone levels and those with symptoms of hypogonadism. It is essential to distinguish
between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism. Symptoms
highly suggestive of hypogonadism include decreased spontaneous erections, decreased
nocturnal penile tumescence, decreased libido, decreased beard growth, and shrinking testicles.
 Option C: Prepubertal patients are able to increase their plasma concentration of testosterone
after an acute stimulation with HCG provided they have some testicular tissue. This test is useful
in detecting the presence of intra abdominal testes before puberty.

35. 35. Question

A relative contraindication to therapy with androgens is:

o  A. Hepatic failure

o  B. Pregnancy

o  C. Prostate cancer

o  D. Hypogonadism

Incorrect
 Correct Answer: A. Hepatic failure
Hepatic failure is considered a relative contraindication because antiandrogens have been known to cause
hepatotoxicity. While topical testosterone delivery systems avoid first-pass hepatic metabolism, there remains
concern regarding TRT in patients with chronic liver disease. The majority of reports of liver toxicity and jaundice
are limited to orally-administered alkylated forms of testosterone.
 Option B: Pregnancy is considered an absolute contraindication. Hyperestrogenism can be a side
effect of replacement therapy because testosterone undergoes aromatization to estrogen.
Aromatase inhibitors may be necessary. Therefore, estradiol levels in men need to be assessed
to rule out hyperestrogenism.
 Option C: Prostate cancer is an indication for anti androgen administration. Serum PSA levels
can increase in response to testosterone treatment, so it is essential to rule out prostate cancer
before starting therapy as it can worsen the disease process. Patients on replacement therapy
require reevaluation for prostate cancer at three months and one year after beginning
treatment.There have been no significant effects of testosterone on lower urinary tract symptoms
and BPH. Physicians need to specifically address the risks and benefits of testosterone therapy
before initiating treatment.
 Option D: Hypogonadism would not be considered a contraindication, but it most certainly is not
an indication for therapy. Hypogonadism occurs in 19% of men in their 60s, 28% of men in their
70s, and 49% of men in their 80s. Testosterone is FDA-approved as replacement therapy in men
who have low testosterone levels and those with symptoms of hypogonadism. It is essential to
distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism.
Symptoms highly suggestive of hypogonadism include decreased spontaneous erections,
decreased nocturnal penile tumescence, decreased libido, decreased beard growth, and
shrinking testicles.

36. 36. Question

Which of the following is a contraindication for use of oxytocin to induce labor?

o  A. Missed abortion

o  B. Placenta previa

o  C. Hyperbilirubinemia

o  D. Pregnancy past due date

Incorrect
Correct Answer: B. Placenta previa
Use of oxytocin is contraindicated in the presence of placenta previa. Labor induction in this condition could be
fatal to the fetus. Placenta previa is an indication for cesarean section. Specific contraindications to oxytocin
include hypersensitivity to the hormone itself or any part of its synthetic version and vaginal deliveries that are in
themselves contraindicated. These include the patient having an active genital herpes infection, vasa previa,
complete placenta previa, invasive cervical cancer, and prolapse or presentation of the umbilical cord).
 Option A: Oxytocin is indicated and approved by the FDA for two specific time frames in the
obstetric world: antepartum and postpartum. In the antepartum period, exogenous oxytocin is
FDA-approved for strengthening uterine contractions with the aim of successful vaginal delivery
of the fetus. There are three situations during the antepartum period in which oxytocin is indicated
for mothers who have preeclampsia, maternal diabetes, premature rupture of the membranes; for
mothers with inactive uteri that require stimulation to start labor; and for mothers with inevitable or
incomplete abortions in their second trimester.
 Option C: Hypoosmolarity causes swelling of the red blood cells and makes them fragile and
susceptible to hemolysis. Various studies have approved the effects of oxytocin on jaundice.
 Some studies have suggested that the extensive use of oxytocin in labor induction is one of the
factors leading to neonatal jaundice
 Option D: When oxytocin is released, it stimulates uterine contractions, and these uterine
contractions, in turn, cause more oxytocin to be released; this is what causes the increase in both
the intensity and frequency of contractions and enables a mother to carry out vaginal delivery
completely. The head of the fetus pushes against the cervix, the nerve impulses from this action
travel to the mother’s brain, which activates the posterior pituitary to secrete oxytocin. This
oxytocin is then carried through the blood to the uterus to increase uterine contractions further,
and the cycle continues until parturition.

37. 37. Question

During labor induction with oxytocin, the nurse knows that relaxation of vascular smooth muscle can cause:

o  A. Hypertension, premature atrial contractions

o  B. Hyperglycemia, premature ventricular contractions

o  C. Hyperglycemia, hypertension

o  D. Hypotension and flushing

Incorrect
Correct Answer: D. Hypotension and flushing
Relaxation of vascular smooth muscle will cause vasodilation leading to hypotension and flushing. Oxytocin is an
oligopeptide hormone that contains nine amino acyl residues, or in other words, a nonapeptide hormone. It is one
of the two hormones stored and released from the posterior pituitary gland but created in the hypothalamus. It is
specifically released from the paraventricular nucleus of the hypothalamus into the posterior pituitary gland for
later use.
 Option A: Oxytocin also has both antidiuretic and vasodilatory effects, increasing cerebral,
coronary, and even renal blood flow. Not only does oxytocin stimulate uterine contractions, but it
also causes contractions of the myoepithelial cells in the female breasts. This activity occurs in
the alveolar ducts. Such contractions are what force milk from these ducts into even larger
sinuses, which enable milk expulsion.
 Option B: Most hormones create negative feedback loops after they are released, but oxytocin is
one of the few that exhibit positive feedback loops, i.e., that the release of oxytocin leads to
actions that stimulate even more of a release of oxytocin. This feedback is comparable to
antidiuretic hormone (ADH), also known as vasopressin (the second and the only other hormone
stored and released from the posterior pituitary), which exhibits a negative feedback loop after
release. Less of this hormone will be released after it exhibits its effect on the body.
 Option C: Exogenous oxytocin causes the same response in the female reproductive system as
that of endogenous oxytocin. Both types of oxytocin stimulate uterine contractions in the
myometrium by causing G-protein coupled receptors to stimulate a rise in intracellular calcium in
uterine myofibrils. Oxytocin receptor activation is what causes many signals that then stimulate
uterine contraction by increasing levels of intracellular calcium, which is where positive feedback
comes into play.

38. 38. Question

Julia is a mother who is receiving oxytocin therapy. The nurse must continuously evaluate:

o  A. Membrane integrity

o  B. Uterine contractions

 o  C. Cervical dilation

o  D. Cervical effacement

Incorrect
Correct Answer: B. Uterine contractions
A client receiving oxytocin therapy requires continuous monitoring of maternal vital signs, fluid intake and output,
electronic fetal monitoring, and uterine contractions. It is essential to monitor patient fluids (both intake and
outtake) while administering oxytocin, as well as the frequency of uterine contractions, patient blood pressure, and
heart rate of the unborn fetus. When oxytocin is released, it stimulates uterine contractions, and these uterine
contractions, in turn, cause more oxytocin to be released; this is what causes the increase in both the intensity
and frequency of contractions and enables a mother to carry out vaginal delivery completely.
 Option A: When oxytocin is given to women who are in the first or second stages of labor, or to
women to cause induction of labor, uterine rupture, as well as maternal subarachnoid
hemorrhages, maternal death, and even fetal death, can result. If oxytocin is given in doses too
large or even slowly during 24 hours, the medication can exhibit an antidiuretic effect resulting in
extreme water intoxication; this can result in coma, seizures, and even death in the mother.
 Option C: Oxytocin is the commonest induction agent used worldwide. It has been used alone, in
combination with amniotomy or following cervical ripening with other pharmacological or non-
pharmacological methods. Prior to the introduction of prostaglandin agents oxytocin was used as
a cervical ripening agent as well.
 Option D: Comparison between the use of intravenous oxytocin alone with a combination of
oxytocin and either vaginal or intracervical PGE2 demonstrate that prostaglandins result in a
significantly lower cesarean delivery rate and an increased proportion of vaginal deliveries within
24 hours.

39. 39. Question

Which drug is used to manage preterm labor by causing smooth muscle relaxation?

o  A. Oxytocin

o  B. Prostaglandin

o  C. Ritodrine

o  D. Estrogen

Incorrect
Correct Answer: C. Ritodrine
Ritodrine is used to arrest uterine contractions in preterm labor. Tocolysis is effective because it focuses on both
delaying and weakening uterine contractions. The pharmacology targets the activity of the myometrium. The
myometrium is the smooth muscle in the uterus. Tocolysis is used in the setting of preterm labor. Preterm birth is
delivery before 37 weeks gestation and after 20 weeks. To diagnose preterm labor, continued contractions
happen during the gestational age range mentioned previously to produce cervical changes.
 Option A: Oxytocin is used to stimulate labor. From a physiologic perspective, the myometrium is
responsible for the contractional effort of childbirth. Like all smooth muscles, this process is
calcium-mediated. The start of a contraction does not require any nerve input nor hormonal
stimulus. It begins with a spontaneous depolarization of the cell surface, which opens voltage-
gated calcium channels. The influx of calcium into the cells binds to intracellular calmodulin. This
new complex activates myosin light chain kinase, an enzyme that phosphorylates myosin light
chains, which are located on a critical portion of the myosin heads. The phosphorylation and
 dephosphorylation of the myosin head cause the continual bridging to actin filaments. This
repetitive process results in the myometrium of contraction.
 Option B: Prostaglandins can cause vasodilation or vasoconstriction in vascular smooth muscle
cells, activate or inhibit platelet aggregation, induce labor, regulate hormones, and decrease
intraocular pressure. PGF2 alpha can be applied vaginally or intramuscularly to induce abortion in
pregnant patients. In some cases, misoprostol (PGE1) can be used rectally for the treatment of
postpartum hemorrhage.
 Option D: Estrogen is a steroid hormone associated with the female reproductive organs and is
responsible for the development of female sexual characteristics. Estrogen is often referred to the
following structures as either estrone, estradiol, and estriol. Of the previously mentioned forms of
estrogen, estradiol is the most common form of estrogen hormone for hormone replacement
therapy (HRT) in the treatment of symptoms of menopause. In the uterus, estrogen helps to
proliferate endometrial cells in the follicular phase of the menstrual cycle, thickening the
endometrial lining in preparation for pregnancy.

40. 40. Question

Which of the following drugs poses the greatest threat to an insulin-dependent diabetic who is pregnant?

o  A. Ritodrine hydrochloride

o  B. Oxytocin

o  C. Prostaglandin

o  D. Ergotrate

Incorrect
Correct Answer: A. Ritodrine hydrochloride
The only drug that poses a threat to diabetics who are pregnant is ritodrine. Tocolytic therapy in Japan consists of
two main drugs, ritodrine hydrochloride and magnesium sulfate, unlike many Western countries. Ritodrine, the
main traditional drug in Japan, is a beta-2 stimulant that causes maternal hyperglycemia. Using both ritodrine and
glucocorticoid could cause maternal hyperglycemia.
 Option B: Oxytocin can be a good choice to decrease the blood glucose level and increase the
insulin level. The hypoglycemic effect of OT can be explained by increasing glucose uptake via
insulin-like signaling pathway (20, 21).
 Option C: Both arachidonic acid and prostaglandin E2 reverse the teratogenic effects of high
glucose concentrations on neural tube development in mouse embryos in culture. Arachidonic
acid supplementation also protects against diabetes-induced neural tube defects in vivo.
 Option D: This medication is used after childbirth to help stop bleeding after delivery of the
placenta (afterbirth). Ergonovine maleate belongs to a class of drugs known as ergot alkaloids. It
works by increasing the stiffness of the uterus muscles after the last stage of labor.