Unit 4 Review Questions:
This Unit 4 review covers high-yield pharmacology and pathophysiology concepts involving cardiovascular disease, diabetes, thyroid disorders, respiratory conditions, neurologic disorders, musculoskeletal conditions, gastrointestinal and genitourinary disorders, and pain management. Key concepts include medication adverse effects, contraindications, drug interactions, first-line treatment principles, patient education, and clinical decision-making.
Cardiovascular Review Questions and Answers
What is the most common adverse effect of ACE inhibitors?
Answer: Dry, persistent cough.
A dry, nonproductive cough is a well-recognized adverse effect of ACE inhibitors such as lisinopril. It is associated with accumulation of bradykinin and other mediators. If the cough is persistent or troublesome, the prescriber may consider changing therapy, often to an angiotensin II receptor blocker (ARB).
What should a patient taking spironolactone know about potassium?
Answer: Potassium supplements may need to be discontinued or avoided.
Spironolactone is a potassium-sparing diuretic. It can increase serum potassium levels and cause hyperkalemia, particularly in patients with kidney impairment or those taking other medications that increase potassium. Patients should not routinely take potassium supplements unless specifically instructed by their healthcare professional.
What should a pregnant patient taking an ACE inhibitor do?
Answer: Contact the healthcare provider promptly because ACE inhibitors should generally be discontinued during pregnancy.
ACE inhibitors can cause serious fetal harm, particularly during later pregnancy, including fetal renal dysfunction, oligohydramnios, skull abnormalities, and neonatal complications. Pregnancy should be reported promptly so the treatment plan can be reassessed.
Why may metoprolol be combined with nifedipine?
Answer: To reduce reflex tachycardia.
Dihydropyridine calcium channel blockers such as nifedipine can cause reflex increases in heart rate. A beta blocker such as metoprolol can reduce this response and may also decrease myocardial oxygen demand.
What teaching helps reduce orthostatic hypotension from vasodilators?
Answer: Instruct the patient to change positions slowly and avoid standing abruptly.
Vasodilating medications can lower blood pressure and produce orthostatic hypotension, dizziness, and an increased risk of falls. Patients should move gradually from lying to sitting and from sitting to standing.
What lifestyle measures can help prevent hypertension?
Answer: Reduce sodium intake, maintain a healthy weight, exercise regularly, moderate alcohol consumption, and avoid tobacco.
Family history contributes to hypertension risk, but environmental and lifestyle factors also play important roles. Dietary patterns such as the DASH diet, regular physical activity, and weight management can help lower blood pressure.
What medications improve outcomes after myocardial infarction?
Answer: ACE inhibitors and beta blockers are commonly used when clinically appropriate.
Following myocardial infarction, evidence-based therapies may reduce recurrent cardiovascular events and mortality. Treatment depends on the patient’s ventricular function, blood pressure, kidney function, comorbidities, and other clinical factors.
Which two antiarrhythmic drug classes have similar cardiac effects?
Answer: Beta blockers and calcium channel blockers.
Certain beta blockers and nondihydropyridine calcium channel blockers, particularly verapamil and diltiazem, can decrease heart rate, slow AV-node conduction, and reduce myocardial contractility.
What symptom is concerning in a patient taking simvastatin who is prescribed azithromycin?
Answer: New muscle pain or weakness.
Muscle pain, tenderness, or weakness may indicate statin-associated muscle injury. Severe muscle injury can progress to rhabdomyolysis and acute kidney injury. Drug interactions should also be considered when statins are combined with other medications.
What treatment may be used for significant warfarin-associated bleeding?
Answer: Vitamin K, with additional reversal therapy when indicated.
Warfarin increases bleeding risk when anticoagulation becomes excessive. Management depends on the INR, severity and location of bleeding, and clinical circumstances. Serious or life-threatening bleeding may require intravenous vitamin K plus a rapid-acting factor replacement product such as four-factor prothrombin complex concentrate (PCC).
Endocrine Review Questions and Answers
What short-term complications should be assessed in a newly diagnosed patient with diabetes?
Answer: Hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA).
These are important acute complications of diabetes. Peripheral neuropathy, vascular disease, and other chronic complications generally develop over a longer period.
Which insulin is appropriate for rapid correction of premeal hyperglycemia?
Answer: A rapid-acting insulin such as insulin lispro.
Rapid-acting insulin analogs, including lispro, aspart, and glulisine, have a relatively rapid onset and short duration. They are commonly administered around mealtimes according to the prescribed regimen.
What dietary strategy is important for patients with type 1 diabetes?
Answer: Carbohydrate counting.
Carbohydrate counting helps patients coordinate food intake with insulin therapy and other diabetes-management strategies. Individualized nutrition planning should account for activity, insulin regimen, glucose targets, and overall health.
What laboratory test provides an estimate of average blood glucose over approximately three months?
Answer: Hemoglobin A1C (HbA1c).
HbA1c reflects average glycemic exposure over roughly the previous two to three months, although factors affecting red blood cell survival can influence the result.
How is insulin glargine generally administered?
Answer: Once daily at a consistent time, according to the prescribed regimen.
Insulin glargine is a long-acting basal insulin with a relatively flat glucose-lowering profile. It is not used as a rapid mealtime insulin.
What medication is used for thyroid storm?
Answer: Propylthiouracil (PTU) may be used as part of treatment for thyroid storm.
Thyroid storm is a medical emergency characterized by severe manifestations of thyrotoxicosis. Treatment generally requires multiple interventions, including a thionamide, beta blockade when appropriate, corticosteroids, supportive care, and treatment of the precipitating cause.
Which findings suggest hypothyroidism?
Answer: Bradycardia, cold intolerance, fatigue, and low body temperature are characteristic findings.
Hypothyroidism can slow metabolic processes and produce fatigue, cold intolerance, weight changes, dry skin, constipation, and a reduced heart rate.
Why should hypothyroidism be treated during pregnancy?
Answer: Adequate maternal thyroid hormone is important for fetal brain and physical development.
Untreated maternal hypothyroidism can adversely affect pregnancy and fetal development. Levothyroxine is the standard thyroid hormone replacement treatment and is generally considered safe during pregnancy when appropriately prescribed and monitored.
How does radioactive iodine treat Graves disease?
Answer: Radioactive iodine is taken up by thyroid tissue and destroys thyroid cells, reducing thyroid hormone production.
Radioactive iodine is an established treatment for hyperthyroidism caused by Graves disease. Patients should receive individualized radiation-safety instructions, and treatment commonly results in eventual hypothyroidism requiring thyroid hormone replacement.
Respiratory Review Questions and Answers
How do H1 antihistamines work?
Answer: They block H1 histamine receptors and reduce histamine-mediated symptoms.
H1 antihistamines do not primarily prevent histamine release. First-generation agents are more likely to cross the blood-brain barrier and cause sedation, while many second-generation agents are less sedating.
What should a patient taking hydroxyzine know?
Answer: Alcohol and other central nervous system depressants should generally be avoided unless specifically approved by the prescriber.
Hydroxyzine is a first-generation antihistamine with sedating properties. Combining it with alcohol or other sedatives can increase impairment and CNS depression.
What is important when using a metered-dose inhaler?
Answer: Use proper inhaler technique and allow appropriate time between puffs when multiple puffs are prescribed.
Patients should coordinate inhaler actuation with inhalation and follow the specific instructions for their device. A spacer can improve medication delivery for many patients using pressurized metered-dose inhalers.
How should long-acting beta2 agonists be used in asthma?
Answer: LABAs should be used with an inhaled corticosteroid rather than as monotherapy for asthma.
LABAs provide prolonged bronchodilation but do not adequately treat the underlying airway inflammation. Current asthma management generally incorporates an ICS-containing regimen.
Which medication provides rapid bronchodilation?
Answer: An inhaled short-acting bronchodilator can provide rapid symptom relief, depending on the treatment plan.
Short-acting beta2 agonists such as albuterol have traditionally been used as rescue medications. However, contemporary asthma guidelines increasingly emphasize ICS-containing reliever strategies, depending on age and asthma severity.
What is the role of inhaled corticosteroids in asthma?
Answer: Inhaled corticosteroids reduce airway inflammation and help prevent exacerbations.
ICS medications are controller therapies rather than immediate rescue treatments. Patients should understand the difference between maintenance and reliever medications.
What is the purpose of guaifenesin?
Answer: It is an expectorant that helps increase respiratory secretions and may make coughing more productive.
Guaifenesin is intended to loosen mucus rather than suppress the cough reflex.
When are oral antihistamines most effective for seasonal allergies?
Answer: They are generally most useful when taken consistently according to the medication’s directions during periods of allergen exposure.
Second-generation antihistamines are commonly preferred because they generally cause less sedation than first-generation agents.
Which bronchodilator is commonly preferred for stable COPD maintenance?
Answer: Long-acting inhaled bronchodilators are generally preferred for maintenance treatment.
Depending on symptoms and exacerbation risk, COPD treatment may include a long-acting beta2 agonist (LABA), long-acting muscarinic antagonist (LAMA), or combination therapy.
Neurologic and Musculoskeletal Review Questions and Answers
Why is epinephrine the medication of choice for anaphylaxis?
Answer: Epinephrine activates multiple adrenergic receptors, producing effects that counter several life-threatening features of anaphylaxis.
Epinephrine produces alpha- and beta-adrenergic effects, including vasoconstriction, increased cardiac activity, and bronchodilation. Intramuscular epinephrine is first-line treatment for anaphylaxis.
How should the first dose of an alpha-adrenergic antagonist be administered?
Answer: The first dose is often taken at bedtime.
Alpha-adrenergic antagonists can cause a pronounced first-dose effect involving orthostatic hypotension. Taking the first dose at bedtime can reduce the risk of injury from dizziness or fainting.
What may cause dyskinesias in a patient taking levodopa/carbidopa?
Answer: Levodopa-related dyskinesias can occur with treatment, particularly as exposure continues.
Involuntary movements may occur as a complication of Parkinson disease treatment. The prescriber may adjust the medication regimen to reduce troublesome dyskinesias.
What are important risk factors for Alzheimer disease?
Answer: Advancing age and family history are important risk factors.
Genetic factors can influence Alzheimer’s disease risk, but genetic testing does not provide a definitive prediction that an individual will develop the disease.
What should a patient taking phenytoin know about oral contraceptives?
Answer: Phenytoin can reduce the effectiveness of hormonal contraceptives.
Patients taking enzyme-inducing antiseizure medications such as phenytoin should discuss reliable alternative or additional contraception with their healthcare provider.
What laboratory monitoring may be necessary for certain antiseizure medications?
Answer: Drug serum concentrations may be useful for medications with established therapeutic ranges.
Therapeutic drug monitoring can help evaluate adherence, toxicity, drug interactions, and whether concentrations are within the expected therapeutic range.
When should aspirin generally be discontinued before surgery?
Answer: The timing depends on the indication for aspirin, bleeding risk, and surgical procedure.
Aspirin irreversibly inhibits platelet function, so its effects can persist for the life of affected platelets. Patients should not independently stop prescribed aspirin, particularly when it is being used for cardiovascular protection. The surgical and prescribing teams should determine whether and when it should be held.
How can long-term glucocorticoid therapy affect bone health?
Answer: Long-term glucocorticoid therapy increases the risk of osteoporosis and fractures.
Glucocorticoids can decrease bone formation and calcium absorption while increasing bone resorption. Appropriate patients may require calcium and vitamin D optimization, lifestyle measures, fracture-risk assessment, and pharmacologic osteoporosis prevention or treatment.
Why is methotrexate started early in rheumatoid arthritis?
Answer: Methotrexate is a disease-modifying antirheumatic drug (DMARD) that can slow disease progression and help prevent joint damage.
NSAIDs and glucocorticoids can reduce pain and inflammation, but they do not provide the same disease-modifying effect. Early DMARD treatment is important in preventing progressive joint damage.
What treatment is considered for recurrent gout?
Answer: Urate-lowering therapy is considered for patients with recurrent or otherwise clinically significant gout.
Medications such as allopurinol or febuxostat can reduce serum urate levels. Acute gout attacks are treated differently and may involve NSAIDs, colchicine, or corticosteroids.
Hormonal, Gastrointestinal, and Genitourinary Review Questions
What are the primary benefits of menopausal hormone therapy?
Answer: Hormone therapy can effectively treat vasomotor and other menopausal symptoms and help prevent bone loss in appropriate patients.
Hormone therapy should be individualized based on age, time since menopause, symptoms, medical history, risks, and treatment goals. People with a uterus generally need progestogen when systemic estrogen is prescribed to reduce endometrial cancer risk.
Who may need estrogen alone rather than combined estrogen-progestogen therapy?
Answer: A patient who has had a hysterectomy may generally use estrogen-only systemic therapy when hormone therapy is otherwise appropriate.
Progestogen is generally added to systemic estrogen when the uterus is present to protect against endometrial hyperplasia and cancer.
What is the treatment goal of terazosin in BPH?
Answer: To improve lower urinary tract symptoms such as urinary hesitancy and difficulty with urine flow.
Terazosin is an alpha-1 adrenergic antagonist. It relaxes smooth muscle in the prostate and bladder neck, improving urinary flow. It does not primarily shrink the prostate or lower PSA levels.
What teaching is essential when metronidazole is prescribed?
Answer: Avoid alcohol during treatment and for the period recommended by the medication guidance after the final dose.
Alcohol combined with metronidazole has traditionally been associated with a disulfiram-like reaction. Patients should follow current prescribing and medication-label instructions regarding alcohol avoidance.
How should bulk-forming laxatives be taken?
Answer: Take them with adequate fluid.
Bulk-forming agents such as psyllium absorb water and increase stool bulk. Adequate fluid intake helps reduce the risk of obstruction and supports their effectiveness.
Why should loperamide generally be avoided in certain infectious diarrheas?
Answer: Slowing intestinal motility can potentially delay elimination of pathogens and may increase complications in some infectious diarrheal illnesses.
Patients with bloody diarrhea, high fever, severe illness, or suspected invasive infection should seek medical evaluation rather than relying on antimotility medications.
What is an important interaction between TMP-SMX and glipizide?
Answer: TMP-SMX can increase the risk of hypoglycemia in patients taking sulfonylureas such as glipizide.
Patients may require closer blood glucose monitoring and medication review during treatment.
What is a common treatment option for uncomplicated cystitis?
Answer: Appropriate short-course antibiotic therapy is used when bacterial cystitis is confirmed or strongly suspected, based on current guidelines, patient factors, and local resistance patterns.
Nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin are among commonly recommended options for uncomplicated cystitis in appropriate patients. Fluoroquinolones are generally reserved for situations where other suitable options are inappropriate.
What medication treats genital herpes?
Answer: Antiviral medications such as acyclovir or valacyclovir.
Genital herpes caused by HSV is treated with antiviral therapy. Treatment can reduce symptom duration and severity and may reduce transmission risk when used as suppressive therapy, but it does not eradicate latent HSV infection.
Lipid and Heart Failure Review
Which medication is commonly used for significant LDL cholesterol elevation and elevated ASCVD risk?
Answer: A statin is generally first-line pharmacologic therapy when indicated.
For a patient with substantially elevated LDL cholesterol and elevated cardiovascular risk, a moderate- or high-intensity statin may be appropriate depending on the patient’s overall risk profile.
How has treatment of HFrEF evolved?
Answer: Guideline-directed medical therapy for HFrEF commonly includes four major medication classes: an ARNI/ACE inhibitor/ARB pathway drug, an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor.
For appropriate patients with heart failure with reduced ejection fraction, sacubitril/valsartan may replace an ACE inhibitor or ARB. Contemporary treatment emphasizes combination guideline-directed therapy rather than relying on a single medication.
Population Health and Genetics Review
What is incidence?
Answer: Incidence measures new cases of a disease occurring in a population during a specified period.
Incidence is useful for understanding the occurrence of new disease and evaluating changes in disease risk.
What is prevalence?
Answer: Prevalence measures the proportion of a population that has a disease or condition at a specified time or during a specified period.
Unlike incidence, prevalence includes existing cases and is influenced by both disease occurrence and disease duration.
What is relative risk?
Answer: Relative risk compares the incidence of disease in an exposed group with the incidence in an unexposed group.
A relative risk greater than 1 suggests higher disease incidence in the exposed group, whereas a value below 1 suggests lower incidence.
What does multifactorial inheritance mean?
Answer: Multifactorial traits result from the combined influence of multiple genes and environmental factors.
Conditions such as hypertension, type 2 diabetes, obesity, coronary artery disease, and some cancers involve complex interactions between genetic susceptibility and environmental or lifestyle factors.
What is a gene-environment interaction?
Answer: It occurs when genetic susceptibility and environmental exposure combine to influence disease risk.
Family history can increase susceptibility, but it does not necessarily determine whether an individual will develop a multifactorial disease. Diet, physical activity, environmental exposures, stress, and other factors can modify risk.
How can family and twin studies help researchers understand disease?
Answer: They can help estimate the relative contributions of genetic and environmental influences.
Monozygotic twins share nearly all of their genetic material, whereas dizygotic twins share approximately half of their segregating genetic material. Differences and similarities between twin pairs can provide information about heritable traits.
Health Disparities, Culture, and Complementary Therapies
What is an important factor in health disparities?
Answer: Social, economic, environmental, healthcare-system, and access-related factors can contribute to differences in health outcomes.
Healthcare disparities are complex and can involve differences in access, affordability, quality, communication, health literacy, discrimination, geography, and other social determinants of health.
How can clinicians improve health literacy?
Answer: Use plain language, confirm understanding, encourage questions, and provide information in the patient’s preferred language when needed.
Health information should be understandable and actionable. The teach-back method is particularly useful for confirming that patients understand instructions.
What are the three domains of the PEN-3 cultural model?
Answer: Cultural identity, relationships and expectations, and cultural empowerment.
The PEN-3 model provides a framework for incorporating cultural factors into health assessment and intervention planning.
What should nurses consider when patients use complementary or alternative therapies?
Answer: Ask about all supplements and complementary therapies and evaluate their safety, evidence, interactions, and potential adverse effects.
Patients may not consider herbal products to be medications, so nurses should specifically ask about them. For example, kava has been associated with serious liver injury, while red yeast rice can contain compounds chemically related to lovastatin and may increase the risk of statin-like adverse effects.
Aging and Pediatric Health Review
What is a common cardiovascular change associated with aging?
Answer: Increased arterial stiffness can contribute to higher blood pressure and left ventricular changes.
Aging can reduce vascular compliance and exercise capacity. These changes do not mean that cardiovascular symptoms should automatically be attributed to aging; new symptoms require appropriate assessment.
What endocrine changes occur with aging?
Answer: Aging affects several endocrine systems, including thyroid, pancreatic, adrenal, and reproductive hormone function.
Changes in endocrine function can influence metabolism, body composition, glucose regulation, and energy levels.
What contributes to anorexia of aging?
Answer: Reduced appetite, changes in taste and smell, altered appetite-regulating hormones, reduced energy requirements, and other physiologic and social factors can contribute.
Older adults remain at risk for malnutrition despite having lower caloric requirements.
What causes menopausal hot flashes?
Answer: Changes in ovarian hormone production, particularly declining estrogen levels, contribute to vasomotor symptoms.
Hot flashes are associated with altered thermoregulatory control during the menopausal transition.
What is the most common childhood cancer?
Answer: Leukemia is the most common cancer diagnosed in children.
Childhood cancer is relatively uncommon compared with adult cancer, but it remains an important cause of morbidity and mortality. Survival has improved substantially for many pediatric cancers because of advances in diagnosis and multimodal treatment.
What is an important long-term concern after childhood cancer treatment?
Answer: Survivors may experience late effects related to the cancer itself or its treatment.
Potential late effects vary according to cancer type and therapy and may involve endocrine, neurologic, cardiovascular, reproductive, psychosocial, and other systems.
How should hypertension in children be evaluated?
Answer: Evaluation may include repeated blood pressure measurements, ambulatory blood pressure monitoring when appropriate, lifestyle assessment, and evaluation for secondary causes or target-organ effects.
Pediatric hypertension requires age-, sex-, and height-appropriate interpretation. Treatment may include lifestyle interventions and medication when indicated.
How is asthma confirmed in an older child?
Answer: Spirometry demonstrating variable expiratory airflow limitation can support confirmation of asthma.
A family history and elevated IgE or eosinophil levels may support an atopic history but do not independently establish the diagnosis.
What is a characteristic feature of cystic fibrosis?
Answer: Production of thick, sticky mucus is a defining feature.
Cystic fibrosis affects multiple organs, particularly the lungs and gastrointestinal system. Patients may develop recurrent respiratory infections, pancreatic insufficiency, malnutrition, and CF-related diabetes.
Medication Safety in Infants and Older Adults
Why may newborns require lower medication doses?
Answer: Immature hepatic and renal systems can alter medication metabolism and elimination.
Newborns have developing pharmacokinetic systems, which can increase medication exposure and toxicity for certain drugs.
Why are infants particularly vulnerable to medication toxicity?
Answer: Immature hepatic metabolism, renal elimination, protein binding, and blood-brain barrier function can alter drug effects.
Drugs with narrow therapeutic ranges require careful dosing and monitoring.
What should a nurse assess when an older adult has a subtherapeutic medication level?
Answer: Medication adherence should be assessed before assuming that the dose needs to be increased.
The nurse can review the medication supply, administration schedule, missed doses, adverse effects, cost barriers, and the patient’s understanding of the regimen.
What is an important measure of kidney function in older adults taking multiple medications?
Answer: Estimated kidney function, such as estimated glomerular filtration rate (eGFR) or creatinine clearance when appropriate, should be considered.
Serum creatinine alone can be misleading in older adults because creatinine production varies with muscle mass.
What complication can occur with excessive caffeine intake?
Answer: Severe caffeine toxicity can cause agitation, tremors, tachycardia, hypertension, and seizures.
Large amounts of concentrated caffeine or energy drinks can produce significant cardiovascular and neurologic stimulation.
What baseline information is important before starting methylphenidate in a child?
Answer: Height, weight, appetite, cardiovascular history, and blood pressure/heart rate should be assessed.
Methylphenidate can suppress appetite and affect growth trajectories. Monitoring growth and cardiovascular parameters is important during treatment.
Why are sedating cough medicines generally not recommended for young infants?
Answer: Infants are particularly vulnerable to central nervous system depression and serious adverse effects from certain cough and cold medications.
Many over-the-counter cough and cold products are not recommended for young children. Parents should consult a pediatric healthcare professional before giving these products.
Immunization Review
Where is the hepatitis B vaccine administered in infants?
Answer: The anterolateral thigh is the preferred intramuscular injection site for infants.
The vastus lateralis muscle provides an appropriate injection site during infancy.
Which vaccine type is generally contraindicated in significantly immunocompromised children?
Answer: Live vaccines such as varicella may be contraindicated depending on the patient’s immune status.
Inactivated vaccines are generally safer for immunocompromised patients, although vaccine recommendations should be individualized according to the child’s condition and current immunization guidelines.
Medication Adverse Effects and Clinical Priorities
Which antihypertensive medication commonly causes a persistent dry cough?
Answer: Lisinopril and other ACE inhibitors.
A new persistent dry cough after initiating an ACE inhibitor is a classic medication-related adverse effect. ARBs generally have a much lower incidence of this cough.
Which postoperative complaint requires priority assessment after IV morphine?
Answer: A spreading rash or reaction around the IV site requires prompt assessment.
The nurse should assess the IV site and the patient for infiltration, phlebitis, tissue injury, or a systemic hypersensitivity reaction.
Which patient should receive priority assessment?
Answer: Clinical priority should be based on acuity, instability, risk of deterioration, and immediate safety concerns—not age alone.
When several patients appear stable, the nurse should identify the patient with the greatest potential for an acute complication and perform a focused assessment.
Pain Management Review Questions and Answers
Where does conscious pain perception occur?
Answer: Pain perception involves processing within the cerebral cortex along with several interconnected CNS structures.
Pain is not generated by a single brain region. Sensory, emotional, cognitive, and behavioral components involve multiple neural pathways.
What type of pain warns of actual or potential tissue injury?
Answer: Acute pain.
Acute pain generally serves a protective function and is associated with tissue injury or a potentially harmful stimulus. Chronic pain persists beyond expected tissue healing and may involve complex biologic and psychosocial mechanisms.
How do endogenous opioids reduce pain?
Answer: Endogenous opioids such as endorphins and enkephalins bind to opioid receptors and inhibit pain signaling.
These substances influence pain transmission through opioid receptors in the central and peripheral nervous systems.
What adverse effect after lidocaine with epinephrine requires attention?
Answer: Significant nervousness and tachycardia may indicate excessive systemic absorption or an adverse reaction.
Some transient cardiovascular effects can occur because of epinephrine, but pronounced symptoms require assessment.
How should a transdermal buprenorphine patch be managed?
Answer: Apply it according to the prescribed schedule and rotate application sites.
Rotating sites can reduce local skin irritation. Patients should follow the specific product instructions regarding application, heat exposure, replacement, and disposal.
What are classic signs of opioid toxicity?
Answer: Respiratory depression, decreased level of consciousness, and pinpoint pupils are classic findings.
A patient with significant opioid-induced respiratory depression requires immediate assessment and intervention. Naloxone may be administered when indicated, along with airway and ventilatory support.
When should sumatriptan be avoided?
Answer: It is contraindicated in patients with certain cardiovascular conditions, including established coronary artery disease.
Triptans can cause coronary vasoconstriction and are therefore inappropriate for patients with specific cardiovascular contraindications.
Which headache may respond rapidly to supplemental oxygen?
Answer: Cluster headache.
High-flow oxygen is an established acute treatment option for cluster headache in appropriate patients.
Is acupuncture effective for cancer pain?
Answer: Acupuncture may be considered as a complementary therapy, but evidence varies by pain condition and clinical context.
It should not automatically replace evidence-based cancer pain treatment. Complementary approaches should be discussed with the oncology team and integrated safely into an individualized pain-management plan.
What is appropriate for severe cancer pain?
Answer: Opioid analgesics are an important treatment option for moderate-to-severe cancer pain.
Cancer pain management should be individualized according to pain severity, cause, previous opioid exposure, kidney and liver function, adverse effects, and patient goals. Nonopioid and nonpharmacologic approaches may also be used alongside opioids.
Mental Health Review: Schizophrenia and Mood Disorders
What are the major symptom categories of schizophrenia?
Answer: Positive, negative, and cognitive symptoms.
Positive symptoms include hallucinations and delusions. Negative symptoms can include reduced emotional expression, reduced motivation, and social withdrawal. Cognitive symptoms may affect attention, memory, and executive functioning.
How is schizophrenia treated?
Answer: Treatment commonly involves antipsychotic medication combined with psychosocial interventions and supportive care.
First-generation and second-generation antipsychotics differ in their receptor profiles and adverse-effect patterns. Treatment should be individualized, and psychosocial interventions can support functioning, adherence, and recovery.
What characterizes major depressive disorder?
Answer: Persistent depressed mood or loss of interest accompanied by additional emotional, cognitive, physical, and behavioral symptoms that cause clinically significant impairment.
Symptoms may include sleep disturbance, appetite or weight changes, fatigue, impaired concentration, feelings of worthlessness, and suicidal thoughts. A diagnosis requires evaluation against established diagnostic criteria.
How does bipolar disorder differ from major depression?
Answer: Bipolar disorder includes episodes of mania or hypomania, with or without depressive episodes.
Treatment differs because antidepressant monotherapy may be inappropriate in some patients with bipolar disorder. Mood stabilizers and certain atypical antipsychotics are commonly used depending on the phase and type of bipolar disorder.
Anxiety, PTSD, and OCD Review
What is a common complication of panic disorder?
Answer: Agoraphobia.
Agoraphobia involves significant fear or avoidance of situations where escape or assistance may be perceived as difficult. It can develop in association with recurrent panic attacks.
How long must excessive worry persist for generalized anxiety disorder?
Answer: At least six months.
GAD involves excessive and difficult-to-control worry about multiple areas of life, accompanied by associated symptoms such as restlessness, fatigue, irritability, muscle tension, and sleep disturbance.
What is a common treatment approach for generalized anxiety disorder?
Answer: Psychotherapy, particularly cognitive behavioral therapy, and medications such as SSRIs or SNRIs are commonly used.
Buspirone may also be used and does not have the same dependence profile as benzodiazepines.
What is the significance of recurrent nightmares after trauma?
Answer: They may indicate trauma-related re-experiencing and should prompt assessment for PTSD or another trauma-related condition.
The nurse should sensitively assess trauma history and related symptoms rather than assuming that nightmares have a purely physical or nutritional cause.
What is an evidence-based treatment approach for PTSD?
Answer: Trauma-focused psychotherapy is a major component of treatment, with medications such as SSRIs used when appropriate.
Treatment should be individualized according to symptoms, comorbidities, patient preferences, and severity.
What characterizes obsessive-compulsive disorder?
Answer: OCD involves recurrent obsessions, compulsions, or both that are time-consuming or cause significant distress or impairment.
Evidence-based treatment includes exposure and response prevention (ERP), a form of CBT, and medications such as SSRIs. Treatment-resistant severe OCD may require specialized interventions.
Stress and Adaptation Review Questions
How does stress affect immunity?
Answer: Stress hormones, particularly cortisol, can alter immune function.
Chronic or severe stress can affect inflammatory and immune responses through neuroendocrine mechanisms.
What is the most important factor influencing an individual’s stress response?
Answer: The individual’s appraisal of and ability to cope with the stressor can strongly influence the response.
Two people can respond differently to the same stressor because of differences in coping resources, previous experiences, social support, and perception of control.
What causes cold, clammy skin during an acute stress response?
Answer: Sympathetic activation causes peripheral vasoconstriction and sweating.
Norepinephrine and other stress-response mechanisms redirect blood flow and activate sweat glands, producing characteristic skin changes.
What are the stages of the general adaptation syndrome?
Answer: Alarm, resistance, and exhaustion.
The alarm stage represents the initial stress response. During resistance, the body attempts to adapt to the ongoing stressor. Prolonged stress without successful adaptation can lead to exhaustion.
What hormone contributes to stress-related hyperglycemia?
Answer: Cortisol.
Cortisol increases glucose availability through mechanisms including stimulation of gluconeogenesis. Other stress hormones, including epinephrine and norepinephrine, can also contribute.
Acute Stress Disorder and PTSD
When can PTSD be diagnosed after trauma?
Answer: PTSD requires symptoms lasting more than one month after the traumatic event.
Symptoms occurring from three days to one month after trauma may meet criteria for acute stress disorder rather than PTSD, depending on the full clinical presentation.
What is a first-line treatment approach for acute stress disorder?
Answer: Trauma-focused cognitive behavioral therapy is an important evidence-based treatment approach.
Treatment focuses on helping the individual process the traumatic experience and develop effective coping strategies. Routine psychological debriefing is not recommended as a universal preventive intervention.
Why is prolonged benzodiazepine use concerning in trauma-related disorders?
Answer: Benzodiazepines can cause dependence, tolerance, sedation, and other adverse effects and may interfere with effective trauma-focused treatment.
Their use should be carefully evaluated and individualized rather than used as a routine long-term treatment for PTSD or acute stress symptoms.
Chronic and Cancer Pain Review
What medication can interact significantly with duloxetine?
Answer: Tramadol can increase the risk of serotonin toxicity when combined with serotonergic medications such as duloxetine.
Tramadol has opioid activity and also affects serotonin and norepinephrine pathways. Combining it with serotonergic antidepressants can increase the risk of serotonin syndrome and other adverse effects.
What should be assessed first in unexplained chronic generalized pain?
Answer: A comprehensive assessment should include sleep quality, physical symptoms, psychosocial factors, medications, and functional status.
Poor sleep can contribute to increased pain sensitivity and fatigue. A thorough assessment helps determine whether additional diagnostic testing or treatment is appropriate.
What is an appropriate intervention for severe pain in a hospice patient?
Answer: Provide timely, appropriately prescribed analgesia, such as an opioid when indicated, while prioritizing comfort and the patient’s goals of care.
Hospice care emphasizes comfort, dignity, and symptom management for patients with advanced illness. Severe pain should be assessed and treated promptly.
Key Exam Takeaways
For Unit 4 exam preparation, focus on recognizing medication adverse effects, contraindications, drug interactions, monitoring parameters, and first-line treatment principles. High-yield associations include ACE inhibitors with dry cough, spironolactone with hyperkalemia, phenytoin with reduced hormonal contraceptive effectiveness, opioids with respiratory depression, LABAs with the need for appropriate ICS therapy in asthma, and methotrexate as a disease-modifying treatment for rheumatoid arthritis.
Also remember the distinction between acute and chronic disease management, the importance of individualized treatment in diabetes and cardiovascular disease, and the role of cultural factors and health literacy in medication adherence. Current clinical guidelines should be used when recommendations in older study materials differ from contemporary practice.
References
American College of Cardiology. (2024). 2024 ACC/AHA/ACCP/HRS guideline for the management of patients with atrial fibrillation. https://www.acc.org/guidelines
American Diabetes Association Professional Practice Committee. (2026). Standards of care in diabetes—2026. Diabetes Care. https://diabetesjournals.org/care/issue
American Heart Association. (2024). 2022 AHA/ACC/HFSA guideline for the management of heart failure. https://www.heart.org/
Centers for Disease Control and Prevention. (2025). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/
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