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WorksheetsFolic Acid: Therapeutic Uses and Nursing Care
Total questions: 94
Worksheet time: 47mins
Which condition is an established therapeutic indication for folic acid supplementation?
Megaloblastic anemia due to deficiency
Iron-deficiency anemia in adolescents
Hemolytic anemia from G6PD deficiency
Aplastic anemia from medication toxicity
For women of childbearing potential, folic acid is recommended primarily to prevent which outcome?
Neural tube defects in early pregnancy
Gestational diabetes in late pregnancy
Placental abruption after the third trimester
Preterm labor due to infection risk
Which patient scenario reflects another therapeutic use of folic acid beyond anemia treatment?
Malabsorption syndromes such as sprue
Chronic kidney disease stage five
Autoimmune hemolysis requiring steroids
Thalassemia major requiring transfusions
Folic acid may be used as a supplement in individuals with alcohol use disorder because:
Dietary intake and liver injury reduce stores
It potentiates disulfiram aversion therapy
It directly treats alcohol withdrawal tremors
It prevents hepatic encephalopathy symptoms
Which statement best reflects precautions and contraindications for folic acid?
Safe during pregnancy at recommended doses
Use with caution during lactation period
Avoid indiscriminate use to not mask B12 deficiency
Contraindicated in all pediatric populations
Which drug interaction profile is accurate for folic acid therapy?
Methotrexate decreases folate levels available
Sulfonamides decrease folate levels available
Folic acid lowers phenytoin blood levels
Folic acid elevates warfarin blood levels
Which nursing actions are appropriate when initiating folic acid therapy for suspected megaloblastic anemia?
Assess for pallor, fatigue, palpitations, paresthesia
Obtain baseline folate, Hgb, Hct, RBC, reticulocytes
Monitor these laboratory values periodically
Defer assessment until after two weeks of therapy
Which food is listed as a source of folic acid in the table?
Dark green vegetables
Seafood and fish
Dairy products
Bran cereals
Which pair correctly matches the therapeutic and pharmacologic classes of vitamin A?
Lipid‑soluble vitamin; Retinoid
Water‑soluble vitamin; Carotenoid
Lipid‑soluble vitamin; Catecholamine
Water‑soluble vitamin; Retinoid
Which function is attributed to vitamin A?
Pigment required for night vision
Primary cofactor for hemoglobin
Main source of cellular ATP
Electrolyte for neuromuscular firing
Long‑term ingestion of high amounts of vitamin A is most associated with which effects?
Drying and scaling of the skin
Alopecia and fatigue
Anorexia and vomiting
Bradycardia and miosis
Leukopenia development
Which best describes sildenafil’s primary mechanism in erectile dysfunction?
Enhances nitric oxide by blocking PDE‑5
Blocks androgen receptors in corpus cavernosum
Stimulates alpha‑1 receptors to increase tone
Inhibits prostaglandin synthesis in penile tissue
A patient is starting sildenafil. Which instruction is most appropriate regarding food and beverages?
Avoid high‑fat meals and avoid grapefruit juice
Take with a large meal and orange juice
Avoid dairy products and take with food
Take on empty stomach with grapefruit juice
Which concurrent medication is an absolute contraindication to sildenafil due to risk of severe hypotension and cardiac events?
Organic nitrates such as nitroglycerin
Low‑dose aspirin for cardioprotection
Statins for hyperlipidemia control
Beta‑blockers for hypertension
Common adverse effects of sildenafil include which set of symptoms?
Headache, flushing, nasal congestion, dizziness
Cough, diarrhea, insomnia, pruritus
Myalgias, edema, constipation, tinnitus
Dry mouth, sedation, bradycardia, rash
Which drug interaction may decrease the effectiveness of sildenafil?
Rifampin induces metabolism of sildenafil
Ketoconazole inhibits metabolism strongly
Warfarin competes for albumin binding
Metformin reduces intestinal absorption
Which adverse visual effect is associated with sildenafil therapy?
Blurred vision and altered color perception
Nystagmus with central scotomas
Night blindness with dry conjunctivae
Photophobia with conjunctival injection
Which definition correctly matches the type of combined oral contraceptive?
Monophasic: constant estrogen and progestin for 21 days
Biphasic: varying estrogen and progestin each three phases
Triphasic: constant progestin with estrogen always constant
Quadriphasic: progestin‑only with no estrogen throughout
Which statement best describes triphasic combined oral contraceptives?
Both estrogen and progestin vary across three phases
Only progestin varies while estrogen stays constant
Only estrogen varies while progestin is constant
Neither hormone varies but pill color changes
Which description matches the quadriphasic product containing estradiol valerate and dienogest?
Four‑phase regimen with synthetic estrogen and progestin
Single‑phase regimen with natural estrogen only
Three‑phase regimen containing two progestins total
Continuous regimen without any estrogen component
How do progestin‑only minipills primarily prevent pregnancy?
Thicken cervical mucus to impede sperm penetration
Suppress gonadotropins to fully stop ovulation
Thin endometrium to prevent implantation alone
Induce tubal spasm to block fertilization
Which statement about progestin‑only minipills is accurate?
Less effective than estrogen‑progestin combinations
More effective than combined pills for all users
Equal efficacy to combined pills in every case
Ineffective in women over thirty years old
A patient with prior venous thromboembolism asks about oral contraceptives. Which option is contraindicated?
Estrogen‑containing combined oral contraceptives
Copper intrauterine device contraception
Progestin‑only minipill contraception
Barrier methods such as condoms
Regarding emergency contraception with plan B, which statement is correct?
Best taken within 72 hours; not after 7 days
Use only after 7 days; otherwise ineffective
Must be taken with food for absorption
Contains estrogen only without progestin
Finasteride belongs to which pharmacologic class and indication?
5‑alpha reductase inhibitor used for BPH
Alpha‑1 blocker used for hypertension
Androgen receptor blocker used for acne
GnRH agonist used for endometriosis
Which counseling point is most important for finasteride handling by women of childbearing potential?
Avoid handling crushed tablets due to absorption
Take daily to prevent male pattern baldness
Use during pregnancy to treat urinary symptoms
Co‑administer with testosterone for synergy
Which adverse effects are commonly associated with finasteride?
Headache, rash, dizziness, asthenia are minor
Severe agranulocytosis and pancreatitis
Profound hypotension and syncope routinely
Cholestatic jaundice and severe pruritus
Which is a primary therapeutic action of oxytocin in obstetrics?
Increases frequency and force of uterine contractions
Relaxes uterine muscle to delay preterm labor
Blocks prostaglandins to reduce contractions
Inhibits oxytocin receptors to prevent labor
Which adverse fetal effect is most associated with oxytocin administration?
Fetal tachycardia with hyperstimulation
Congenital malformations increase
Fetal bradycardia consistently
Neonatal hypoglycemia universally
Which maternal adverse effect is a serious risk of oxytocin use, especially with high parity?
Uterine rupture and possible seizures
Renal failure with oliguria
Hepatic necrosis with jaundice
Pulmonary fibrosis progression
Which black box warning pertains to oxytocin?
Not for elective induction without indications
Do not exceed twelve hours of infusion total
Use only under midwife supervision at home
Never administer after delivery of placenta
What interaction may occur when vasoconstrictors are used with oxytocin?
Severe hypertension may develop
Profound hypotension may occur
Bradycardia may progress rapidly
Arrhythmias may be prevented
Which brief mechanism best characterizes ondansetron?
5‑HT3 receptor antagonist antiemetic
D2 receptor agonist prokinetic
H1 receptor blocker antihistamine
NK1 receptor agonist antiemetic
Which mechanism best explains ondansetron’s antiemetic effect?
Blocking serotonin 5-HT3 receptors in GI tract and brain
Stimulating dopamine D2 receptors in the chemoreceptor zone
Inhibiting histamine H1 receptors in the vestibular system
Neutralizing gastric acid in the stomach lumen
A major caution with ondansetron in patients with cardiac abnormalities is the potential to:
Prolong the QT interval and cause dysrhythmias
Increase blood pressure and cause hypertensive crisis
Induce bradycardia with AV block progression
Trigger coronary vasospasm and angina attacks
Which interaction increases the risk of serotonin syndrome when given with ondansetron?
Concomitant use of serotonin-norepinephrine reuptake inhibitors
Concurrent therapy with beta-adrenergic antagonists
Daily administration of proton pump inhibitors
Use with antacids containing aluminum hydroxide
Medroxyprogesterone primarily targets which tissue and action?
Endometrium with suppression of estrogen effects on uterus
Myometrium with direct uterine contraction inhibition
Ovaries with stimulation of follicle development
Pituitary with inhibition of gonadotropin-releasing hormone
Which is an adverse effect associated with medroxyprogesterone therapy?
Breakthrough bleeding and breast tenderness
Severe hypoglycemia with confusion episodes
Photosensitivity with bullous skin reactions
Hyperkalemia with peaked T waves
A highlighted risk of medroxyprogesterone includes:
Thromboembolic disorders and hypertension
Severe neutropenia and aplastic anemia
Pancreatitis with hypertriglyceridemia
Thyroid storm with arrhythmias
Which boxed or highlighted warning applies to certain progestin–estrogen combinations?
Increased risk of stroke, DVT, MI, and pulmonary emboli
Irreversible hepatic failure with long-term use
Permanent vision loss due to optic neuritis
Severe hypothermia in older adults
Which drug interaction may DECREASE medroxyprogesterone serum levels?
Carbamazepine and barbiturates induction
Azole antifungals coadministration
Protease inhibitor ritonavir addition
Nifedipine extended-release therapy
St. John’s wort with medroxyprogesterone may:
Decrease effectiveness and cause abnormal bleeding
Increase progestin concentration causing toxicity
Prevent thromboembolic complications entirely
Enhance bone density and fracture prevention
Psyllium mucilloid’s mechanism for relieving constipation is best described as:
Bulk-forming by swelling with water to increase stool mass
Stimulant laxative that increases intestinal peristalsis
Osmotic laxative drawing fluid into intestinal lumen
Stool softener that lowers surface tension of stool
A practical counseling point for psyllium is that it:
Requires adequate water to prevent esophageal obstruction
Works immediately within minutes after a single dose
Should be used with undiagnosed abdominal pain
Enhances absorption of warfarin and digoxin
Which statement about 5-alpha reductase inhibitors in BPH is accurate?
They reduce dihydrotestosterone to decrease prostate size
They acutely relax smooth muscle to relieve symptoms
They inhibit PDE5 to improve urinary flow directly
They raise testosterone to stimulate hair growth only
Common complications of 5-alpha reductase inhibitor therapy include:
Decreased libido and ejaculate volume
Gynecomastia development in males
Rapid onset of effects within two weeks
Potential erectile dysfunction symptoms
Regarding onset of benefit for 5-alpha reductase inhibitors, patients should be counseled that:
Therapeutic effects may take six months or longer
Symptom relief occurs within twenty-four hours
Maximal improvement appears in one to two weeks
Results are guaranteed by three months of use
Proton pump inhibitors reduce gastric acid by:
Irreversibly blocking the H+/K+ ATPase enzyme
Competitively antagonizing histamine H2 receptors
Neutralizing acid with alkaline compounds
Coating the mucosa to prevent acid contact
Appropriate PPI use includes:
Short-term treatment of PUD and GERD
First-line chronic therapy for all dyspepsia
As-needed use with every acidic meal
Replacement of antibiotics in H. pylori ulcers
Tocolytics are used clinically to:
Inhibit uterine contractions to delay preterm labor
Induce stronger uterine contractions for delivery
Stimulate cervical ripening for labor induction
Increase fetal heart rate during distress
The typical goal of tocolysis is to delay labor for:
Approximately 24 to 72 hours for fetal lung maturation
At least four weeks until full term is reached
Only three to six hours for maternal transport
Indefinitely until spontaneous contractions cease
An adverse effect associated with tocolytic therapy can include:
Tachycardia in mother and fetus
Severe hypoglycemia in mother
Fetal bradycardia consistently
Maternal seizures universally
Which counseling point applies to bismuth subsalicylate for diarrhea?
Avoid with aspirin due to salicylate content
Expect red stool from harmless dye effect
Use with strong acids to enhance binding
Acts primarily by stimulating peristalsis
A benign effect sometimes seen with bismuth subsalicylate therapy is:
Black tongue or black stool discoloration
Blue urine or scleral pigmentation
Yellow palms and nail beds discoloration
Brown tooth enamel with pitting lesions
Which best describes the action of sucralfate?
Mucosal protectant forming a barrier over ulcers
Prokinetic agent increasing gastric emptying
Systemic antacid lowering serum gastrin levels
H2 blocker reducing nocturnal acid secretion
Which best describes sucralfate’s primary mechanism for peptic ulcer management?
Forms a protective gel barrier over ulcers
Neutralizes gastric acid broadly in stomach
Irreversibly blocks H+/K+ ATPase in parietal cells
Eradicates Helicobacter pylori directly
When should sucralfate be administered in relation to meals for optimal effect?
One hour before meals on empty stomach
With meals to enhance absorption
Two hours after meals with antacids
Only at bedtime with milk
A patient on sucralfate also takes phenytoin, digoxin, and warfarin. Which action minimizes interaction risk?
Separate dosing by at least two hours
Crush and co-administer medications
Increase sucralfate frequency daily
Take all drugs together with food
Which is the most common adverse effect of sucralfate?
Constipation due to minimal absorption
Diarrhea from mucosal irritation
Renal toxicity causing oliguria
Hypoglycemia with prolonged use
Sucralfate safety in pregnancy and lactation is best characterized as:
Generally considered safe for both
Contraindicated during first trimester
Unsafe during breastfeeding only
Restricted to second trimester use
Methylnaltrexone is best used for which indication?
Opioid-induced constipation in palliative care
Acute opioid overdose with respiratory depression
Chronic idiopathic constipation without opioids
Prevention of opioid withdrawal symptoms
Sulfasalazine is therapeutically used primarily to treat:
Inflammatory bowel disease and rheumatoid arthritis
Peptic ulcer disease and GERD
Celiac disease and pancreatitis
Diverticulitis and acute appendicitis
Which statement best describes misoprostol’s gastrointestinal actions?
Decreases acid and increases protective mucus
Only neutralizes acid without mucus changes
Blocks histamine receptors in parietal cells
Stimulates acid secretion and blood flow
Misoprostol is specifically helpful to prevent ulcers in patients:
Taking high doses of NSAIDs or corticosteroids
With Helicobacter pylori positive tests
On long-term proton pump inhibitors
With lactose intolerance and gastritis
Which is a key contraindication for misoprostol use?
Pregnancy due to uterotonic effects
Renal failure requiring dialysis
Asthma with beta-agonist therapy
History of gallstones and cholecystitis
Which adverse effects are most commonly associated with misoprostol?
Diarrhea and abdominal cramping
Rash and photosensitivity
Bradycardia and hypotension
Dry mouth and urinary retention
Beyond hypomagnesemia, IV magnesium sulfate is used during labor primarily to:
Stop preterm labor and prevent seizures
Induce uterine contractions rapidly
Reverse epidural-induced hypotension
Prevent uterine atony postpartum
Which timeframe best describes onset of therapeutic effects for magnesium sulfate?
Approximately 30 to 60 minutes post-dose
Immediately within one to two minutes
Delayed effect after twelve to twenty hours
Only after steady state in five days
Early signs of magnesium sulfate overdose most likely include:
Flushing, sedation, confusion, thirst, weakness
Tinnitus, tachycardia, hyperreflexia, tremor
Urticaria, bronchospasm, hypotension, rash
Nausea, vomiting, diarrhea, abdominal pain
Severe magnesium toxicity can progress to which life-threatening complication?
Respiratory depression with neuromuscular blockade
Acute hepatic failure with coagulopathy
Malignant hyperthermia with rigidity
Anaphylaxis with airway edema
Which patient requires greatest caution with magnesium supplementation?
Chronic kidney disease due to accumulation
Asthma using inhaled beta-agonists
Type 1 diabetes on insulin therapy
Irritable bowel syndrome with diarrhea
What is the appropriate antidote for magnesium sulfate toxicity?
Calcium gluconate administered intravenously
Sodium bicarbonate continuous infusion
Naloxone titrated intravenous boluses
Flumazenil given slow intravenous push
Which black box warning is associated with terbutaline use during pregnancy?
Use beyond 48–72 hours may cause fetal death
First trimester exposure causes neural defects
Breastfeeding increases severe maternal bradycardia
Inhaled forms cause irreversible lung fibrosis
Key goals in inflammatory bowel disease management include:
Manage symptoms and adjust diet
Aggressively rehydrate during diarrhea
Routinely induce vomiting for relief
Administer sulfasalazine for control
For patients with enteral feeding tubes, which precautions are most important?
Prevent dehydration with frequent flushes
Implement fall and wander risk precautions
Maintain head-of-bed elevation
Avoid aspiration by NPO after midnight
A patient receiving TPN should expect which infusion pattern?
Typically continuous over a 24-hour period
Rapid boluses every four hours
Nightly infusions over two hours
Alternate-day cyclic eight-hour infusions
A patient on TPN suddenly develops dyspnea and chest pain. What is the priority immediate position to reduce air embolism risk?
High Fowler’s, head midline
Reverse Trendelenburg, left side
Prone with head turned right
Right lateral with knees flexed
Supine with legs elevated
When TPN is unavailable temporarily, which solution should be used to prevent hypoglycemia from abrupt cessation?
D5W infusion at low rate
D10 solution as substitute
Normal saline maintenance
Half-normal saline bolus
Lactated Ringer’s drip
Which practice helps prevent hypoglycemia or hyperglycemia in patients receiving TPN?
Monitor blood glucose routinely
Administer vitamin K daily
Warm TPN to body temperature
Give TPN through peripheral IV
Hang tubing for seventy-two hours
A nurse removes refrigerated TPN from the fridge. What is the correct handling before infusion?
Warm in microwave for one minute
Hang within one hour of removal
Allow to sit for six hours first
Administer ice-cold to reduce fever
Dilute with sterile saline bag
Norethindrone is best described as which pharmacologic class?
Selective estrogen receptor modulator
Progestin that mimics progesterone
Androgen receptor partial agonist
Combined estrogen-progestin mixture
Antigonadotropin GnRH antagonist
Which set of findings most strongly suggests fluid overload with impending pulmonary edema?
Dry mucosa, hypotension, flat neck veins
Crackles, JVD, pink frothy sputum
Wheezes, bradycardia, cyanotic lips
Hyperactive bowel sounds, fever, rash
Stridor, hypotension, narrow pulse pressure
A patient with symptomatic hyperkalemia should receive which immediate therapy combination?
Kayexalate orally plus NS bolus
IV insulin with dextrose infusion
Furosemide IV plus magnesium
Oral calcium carbonate tablets
Amiloride with spironolactone
Beyond shifting potassium intracellularly, which medication stabilizes cardiac membranes in severe hyperkalemia?
IV calcium gluconate administration
Oral sodium bicarbonate tablets
Nebulized albuterol as single agent
IV normal saline at maintenance
Subcutaneous insulin glargine
If medications fail to correct life‑threatening hyperkalemia, which intervention is appropriate?
Therapeutic hypothermia induction
Immediate hemodialysis initiation
Plasmapheresis with albumin
Whole blood exchange transfusion
Epinephrine continuous infusion
Which is the preferred therapy for significant hyponatremia with severe neurologic symptoms?
Hypotonic saline infusion
Hypertonic saline solution
Isotonic dextrose solution
Lactated Ringer’s bolus
Oral water restriction only
Which electrolyte strategy treats hypokalemia?
IV piggyback potassium replacement
IV calcium chloride infusion
Oral sodium restriction diet
IV magnesium sulfate routinely
Desmopressin intranasal therapy
Which acid–base imbalance is classically associated with COPD exacerbation and opioid overdose, respectively?
Respiratory acidosis involvement
Metabolic alkalosis involvement
Respiratory alkalosis involvement
Metabolic acidosis involvement
Typical manifestations of respiratory acidosis include which findings?
Shortness of breath and irritability
Anxiety and confusion
Bradycardia with profound fatigue
Tingling fingers and carpopedal spasm
Excessive treatment of respiratory acidosis with sodium bicarbonate can lead to which complication?
Metabolic alkalosis development
Respiratory alkalosis development
Metabolic acidosis worsening
Hyperkalemic cardiac arrest
Lactic acidosis formation
Kussmaul respirations with high BUN and creatinine most strongly indicate which disorder?
Respiratory alkalosis from anxiety
Metabolic acidosis from renal failure
Metabolic alkalosis from vomiting
Respiratory acidosis from COPD
Mixed alkalosis after diuretic use
Repeated vomiting most commonly produces which acid–base state and why?
Metabolic acidosis from bicarb loss
Metabolic alkalosis from acid loss
Respiratory acidosis from hypoventilation
Respiratory alkalosis from hyperventilation
Mixed acidosis from CO2 retention
Which situation is classically linked to respiratory alkalosis?
Panic attack with hyperventilation
Severe diarrhea with dehydration
Advanced kidney failure history
Opioid overdose respiratory depression
Prolonged vomiting and NG suction
Which IV solution is contraindicated in a patient with cerebral swelling due to risk of death?
Mannitol administration
Hypertonic saline
Isotonic normal saline
Dextrose 10 percent
Lactated Ringer’s
