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WorksheetsFolic Acid: Therapeutic Uses and Nursing Care
Total questions: 87
Worksheet time: 44mins
Which condition is an established therapeutic indication for folic acid supplementation?
Hemolytic anemia due to G6PD mutation
Iron-deficiency microcytic anemia management
Megaloblastic anemia secondary to deficiency
Aplastic anemia from marrow failure
A public health program aims to reduce congenital abnormalities. Which folic acid benefit supports this policy?
Prevents neural tube defects early pregnancy
Prevents chromosomal trisomy at conception
Prevents cleft palate formation late gestation
Prevents cardiac septal defects midtrimester
Which patients may appropriately receive folic acid as part of therapy? Select all that apply.
Adults with alcohol use disorder and poor diet
Patients with malabsorption syndrome (sprue)
Healthy adolescents for general wellness
Women of child‑bearing age before pregnancy
What is a key precaution regarding indiscriminate folic acid use?
It can mask manifestations of vitamin B12 deficiency
It can permanently suppress erythropoiesis
It can cause severe teratogenic neural damage
It can trigger acute hemolysis in all patients
Which statement best reflects safety guidance for folic acid in reproductive contexts?
Contraindicated during pregnancy at any dose
Safe in pregnancy, caution during lactation
Unsafe in lactation, safe for neonates
Only safe with concurrent vitamin B12
A patient is taking phenytoin. How does folic acid affect phenytoin blood levels?
Unpredictable effect independent of metabolism
No effect on levels or metabolism
Increases levels by inhibiting metabolism
Decreases levels via increased metabolism
Which medications can decrease folic acid levels through interaction?
Metformin and insulin
Methotrexate and sulfonamides
Aspirin and acetaminophen
Warfarin and clopidogrel
Which nursing actions are appropriate when initiating folic acid therapy for suspected megaloblastic anemia? Select all that apply.
Assess for pallor and easy fatigability
Obtain baseline Hgb and Hct levels
Record RBC and reticulocyte counts
Skip monitoring once symptoms improve
Which food is a source of both iron and Vitamin B12 according to the table?
Dairy provides both iron and Vitamin B12
Seafood provides both iron and Vitamin B12
Eggs provide both iron and Vitamin B12
Meat provides both iron and Vitamin B12
Which foods are listed as sources of folic acid in the table? Select all that apply.
Nuts
Dried beans and legumes
Fortified grains like breads and cereal
Dark green vegetables
Which food is indicated as a source of Vitamin B12 but not folic acid?
Bran shows Vitamin B12 only
Beets show Vitamin B12 only
Dairy products show Vitamin B12 only
Yeast shows Vitamin B12 only
Vitamin A belongs to which therapeutic class?
Lipid-soluble vitamin class
Water-soluble vitamin class
Essential mineral class
Fatty acid derivative class
Which statement best describes a key physiologic role of Vitamin A?
Acts as pigment required for night vision
Primary regulator of thyroid hormone synthesis
Serves as primary cofactor for hemoglobin
Main source of cellular ATP production
Which adverse effect pattern is associated with acute Vitamin A toxicity?
Hepatotoxicity with elevated liver enzymes
Teratogenic birth defects during pregnancy
Dry skin, alopecia, fatigue, anorexia, leukopenia
Headache, irritability, drowsiness, delirium, coma
Long-term high intake of Vitamin A is most likely to cause which clinical picture?
Sudden severe headache and delirium
Increased absorption with mineral oil
Drying and scaling of skin with alopecia
Immediate coma after single ingestion
Which combination should be avoided because it can decrease Vitamin A absorption?
Bran and fortified grains
Sildenafil and Vitamin A tablets
Iron and folic acid supplements
Mineral oil and cholestyramine
Which statement best describes sildenafil’s mechanism of action in erectile dysfunction?
Enhances acetylcholine at muscarinic receptors in penile tissue
Stimulates nitric oxide synthase to release endothelial NO
Blocks alpha‑1 receptors to reduce penile sympathetic tone
Inhibits PDE‑5 to increase cGMP in corpora cavernosa
Which combination can cause the most serious adverse effect when sildenafil is used?
Statins with sildenafil causing rhabdomyolysis risk
Calcium channel blockers with sildenafil causing AV block
Organic nitrates with sildenafil causing profound hypotension
Beta‑blockers with sildenafil causing severe bradycardia
A patient asks about common adverse effects of sildenafil. Which are typical?
Hypoglycemia with tremors
Priapism lasting over six hours
Nasal congestion complaints
Headache and flushing symptoms
Which counseling point about administration is appropriate for sildenafil?
Avoid grapefruit juice when taking the medication
Always take with high‑fat meals to boost absorption
Take only at bedtime to prevent daytime side effects
Combine with nitroglycerin for improved efficacy
Which patient should NOT receive sildenafil based on contraindications?
Individual using nitroglycerin for angina therapy
Healthy adult with performance anxiety issues
Patient with mild seasonal allergic rhinitis
Smoker without cardiovascular disease history
Which drug interaction increases sildenafil levels and risk of toxicity?
Protease inhibitors such as ritonavir or amprenavir
Rifampin inducing hepatic enzymes strongly
Warfarin anticoagulation given concurrently
Metformin used for type 2 diabetes control
What is the primary use of stool softener laxatives?
Prevent constipation, especially after recent surgery
Induce catharsis for colonoscopy bowel prep
Treat infectious diarrhea due to enteric pathogens
Reduce gastric acid in peptic ulcer disease
Which description correctly matches an oral contraceptive formulation type?
Quadriphasic: four‑phase schedule of hormone changes
Monophasic: constant estrogen and progestin dose
Biphasic: constant estrogen, rising progestin later
Triphasic: three phases varying both hormones
Which statement best describes quadriphasic oral contraceptives containing estradiol valerate and dienogest?
They are emergency contraception taken within 72 hours
They are progestin-only and thicken cervical mucus
They use synthetic estrogen with progestin in phased doses
They are contraindicated only after seven days of use
Progestin-only minipills primarily prevent pregnancy by which mechanism?
Shrinking enlarged prostates via 5-alpha inhibition
Suppressing ovulation more effectively than combinations
Producing thick, viscous cervical mucus blocking sperm
Increasing uterine contraction frequency and force
Which is a correct comparison between minipills and estrogen–progestin combinations?
Minipills are more effective at preventing VTE
Minipills are less effective than combination pills
Combination pills create thicker cervical mucus
Combination pills are emergency use within 72 hours
A patient with any history of venous thromboembolism should avoid which therapy?
Ondansetron for chemotherapy nausea
Oxytocin for postpartum hemorrhage
Progestin-only minipills exclusively
Oral contraceptives containing estrogen
Which statement about plan B emergency contraception is accurate?
Best taken within 72 hours, not after 7 days
Indicated primarily for BPH management
Effective only when combined with oxytocin
Requires prior use of quadriphasic pills
Finasteride’s therapeutic role in benign prostatic hyperplasia involves which effect?
Promotes shrinkage of enlarged prostate tissue
Induces rapid, painful uterine contractions
Blocks serotonin at 5-HT3 receptors
Acts as vasoconstrictor causing severe HTN
Which administration alert is appropriate for finasteride?
Safe for women; not absorbed through skin
Avoid handling by pregnant women
Tablets may be crushed for dosing
Do not donate blood while on drug
Common adverse effects of finasteride include which symptoms?
Rash and asthenia
Rapid uterine contractions
Headache and dizziness
Fetal tachycardia
Which clinical use of oxytocin is correct?
Increase frequency and force of uterine contractions
Shrink enlarged prostate and restore urinary flow
Serve as emergency contraception within 72 hours
Block 5-HT3 receptors to reduce emesis
What is a highlighted common adverse effect of oxytocin?
Rapid, painful uterine contractions with fetal tachycardia
Severe hypertension due to vasodilators
Headache, rash, dizziness, asthenia
Urinary retention improvement in BPH
Which maternal risk increases with oxytocin, especially after five or more deliveries?
Seizures prevented by oxytocin
Coma risk eliminated
Postpartum hemorrhage decreases
Uterine rupture risk increases
What is the black box warning associated with oxytocin?
Do not donate blood while taking the drug
Not for initiating labor without medical indications
Take only within 72 hours after intercourse
Avoid in any history of VTE
Which drug interaction may occur with oxytocin?
Minipills block oxytocin receptor binding
Concurrent vasoconstrictors may cause severe hypertension
Finasteride reduces oxytocin’s uterine effects
Ondansetron increases risk of VTE with OCs
Which mechanism of action best matches ondansetron?
Uterine stimulant increasing contraction force
Selective 5-HT3 receptor antagonism as antiemetic
5-alpha reductase inhibition for BPH therapy
Estrogen–progestin phased dosing contraception
Which mechanism best describes ondansetron’s therapeutic action in nausea management?
Blocks 5-HT3 receptors in GI tract and brain
Stimulates dopamine D2 receptors in chemoreceptor zone
Enhances acetylcholine release in enteric neurons
Inhibits histamine H1 receptors in vestibular pathways
A patient taking ondansetron with an SSRI develops agitation, diaphoresis, and hyperreflexia. What interaction risk explains this presentation?
Additive serotonergic effects causing serotonin syndrome
Competitive CYP3A4 inhibition causing toxicity
Reduced renal clearance increasing drug accumulation
Anticholinergic synergy leading central delirium
Which cardiac precaution is most appropriate when prescribing ondansetron to a patient with congenital long QT?
Monitor for QT prolongation and dysrhythmias
Increase dose to overcome nausea quickly
Co-administer triptans to enhance antiemesis
Avoid IV route due to reduced efficacy
Primary target tissue for medroxyprogesterone’s progestin effect is which structure?
Anterior pituitary gland
Hypothalamic arcuate nucleus
Endometrium of the uterus
Ovarian granulosa cells
Which statement accurately describes a therapeutic use of medroxyprogesterone when combined with estrogen?
Treats vasomotor symptoms of menopause
Induces lactation in postpartum period
Enhances bone formation in adolescents
Prevents serotonin syndrome with SSRIs
Which adverse effect profile is most consistent with medroxyprogesterone?
Breakthrough bleeding and spotting
Hypoglycemia with tremor
Weight gain with breast tenderness
Thromboembolic disorders including DVT
Vaginal candidiasis with amenorrhea
Which black box and risk statement is correct regarding medroxyprogesterone use?
Concomitant use prevents fetal toxicity in pregnancy
Receiving injections associated with bone mineral density loss
Long-term therapy lowers risk of breast cancer
Combined with estrogens increases stroke and DVT risk
Which drug interaction is correctly matched with its effect on medroxyprogesterone?
Azole antifungals increase drug effects
Carbamazepine decreases serum levels
Ritonavir reduces progestin activity
St. John’s wort decreases effectiveness
Which contraindication should lead to avoiding medroxyprogesterone therapy?
Pregnancy or lactation due to adverse effects
History of migraine without aura
Mild eczema treated with emollients
Seasonal allergic rhinitis only
Which scenario best describes a known adverse effect of psyllium mucilloid when taken improperly?
Photosensitivity with UV light exposure
Hepatotoxicity with elevated transaminases
Hypoglycemia due to insulin release
Esophageal swelling causing obstruction
A patient on warfarin starts psyllium mucilloid. What interaction is most likely?
Increased warfarin bioavailability
Reduced warfarin absorption and effect
Warfarin converted to active metabolite
No change in anticoagulation level
5-alpha reductase inhibitors primarily do which of the following?
Decrease testosterone by blocking converting enzyme
Block androgen receptors in target tissues
Increase PDE5 activity to improve erections
Stimulate Leydig cells to make more testosterone
Proton pump inhibitors reduce gastric acid by what mechanism?
Neutralize acid via bicarbonate buffering
Block the enzyme that secretes hydrochloric acid
Antagonize histamine H2 receptors
Stimulate mucous production to coat lining
Which clinical use best matches tocolytics described here?
Delay preterm labor contractions 24–72 hours
Induce elective labor in post-term pregnancy
Reduce uterine bleeding after delivery
Treat dysmenorrhea with uterine relaxation
Which statement about bismuth subsalicylate is accurate?
Rapidly induces hypokalemia
Acts by binding and absorbing toxins
May cause harmless black tongue or stool
Should not be taken with aspirin
Which statement best describes sucralfate’s mechanism in peptic ulcer disease?
Neutralizes gastric acid throughout the stomach lumen
Forms a viscous protective barrier over the ulcer base
Directly eradicates Helicobacter pylori organisms
Irreversibly inhibits proton pumps in parietal cells
A patient is prescribed sucralfate. How should dosing be timed relative to meals and antacids to optimize efficacy?
Take with meals and immediately after antacids
Take one hour before meals and avoid antacids
Take one hour before meals; separate antacids by 30 minutes
Take two hours after meals; take antacids together
Which adverse effect profile and elimination property are typical of sucralfate?
Sedation; highly protein bound and biliary cleared
Abdominal cramping; renally excreted unchanged
Constipation; minimally absorbed and eliminated in feces
Diarrhea; extensively absorbed and hepatically metabolized
Methylnaltrexone is most appropriately used for which clinical scenario?
Acute peptic ulcer bleeding requiring acid suppression
Opioid-induced constipation in palliative care patients
Abortifacient in first-trimester unintended pregnancy
Inflammatory bowel disease with extraintestinal arthritis
Sulfasalazine belongs to which pharmacologic class and is therapeutically used for what?
Prostaglandin analog; NSAID-induced ulcer prevention
Opioid antagonist; chronic constipation
Sulfonamide; rheumatoid arthritis
5-aminosalicylate; inflammatory bowel disease
Which statements about misoprostol are accurate? Select all that apply.
Prostaglandin E analog that decreases gastric acid
Contraindicated during pregnancy due to uterine effects
Stimulates protective mucus and bicarbonate secretion
Causes diarrhea and abdominal cramping as adverse effects
In which patient is misoprostol particularly useful for ulcer prophylaxis?
A patient on high-dose NSAIDs or corticosteroids
A patient with hypomagnesemia requiring replacement
A patient with Helicobacter pylori eradication therapy
A patient with opioid-induced constipation
Which statement correctly links prototype and therapeutic class for magnesium sulfate?
Prototype laxative; drug for hypokalemia and sedation
Prototype cathartic; drug for hypomagnesemia replacement
Prototype diuretic; drug for hypermagnesemia treatment
Prototype antacid; drug for peptic ulcer prophylaxis
Which early sign most reliably indicates magnesium sulfate overdose in a laboring patient?
Flushing with sedation and confusion
Bradycardia with chest pain
Severe hypertension with tremors
Pupil dilation with photophobia
Which action is appropriate when administering IV magnesium sulfate to prevent preterm labor?
Monitor for respiratory depression closely
Encourage rapid bolus administration
Discontinue seizure precautions entirely
Avoid checking deep tendon reflexes
For a patient with inflammatory bowel disease, which management goals are most appropriate?
Maintain a detailed food diary
Increase vomiting to remove irritants
Provide fluids for diarrhea
Start sulfasalazine therapy
Manage symptoms consistently
Which precaution reduces aspiration risk during enteral tube feedings?
Avoid routine tube flushes
Place patient fully supine
Elevate the head of the bed
Restrict all oral fluids
Which statement about TPN administration is correct?
It contains only water and electrolytes
It should be changed weekly
It must be given via the GI tract
It is infused over a 24-hour period
Which contraindication or caution applies to magnesium sulfate therapy?
Use to prevent seizures in preeclampsia
Chronic kidney disease increases toxicity risk
Calcium gluconate serves as antidote
Routine use for hypermagnesemia
Serious heart disease present
Which complication can occur at extreme magnesium levels due to neuromuscular blockade?
Respiratory paralysis with circulatory collapse
Enhanced reflexes with tachypnea
Improved cardiac conduction velocity
Increased urine output with thirst relief
A patient on TPN develops sudden dyspnea and chest pain. What is the immediate positioning intervention to manage suspected air embolism?
Reverse Trendelenburg on the left side
Supine with legs elevated
Right lateral decubitus with head down
High Fowler position leaning forward
Which statement about handling TPN solutions is most appropriate for safe administration?
Shake vigorously to mix lipids
Warm TPN by microwaving before use
Use within one hour after removal from fridge
Store TPN at room temperature all day
If TPN is temporarily unavailable for a patient dependent on it, what infusion is the appropriate substitute?
Dextrose 10% solution
Lactated Ringer’s
Half-normal saline
Normal saline 0.9%
Which monitoring is essential during TPN therapy to prevent metabolic complications?
Hourly arterial blood gases
Routine blood glucose checks
Daily urinalysis for ketones
Continuous EEG monitoring
Norethindrone is best described as which pharmacologic class and action?
Progestin prototype mimicking progesterone
Selective estrogen receptor modulator
Androgen that suppresses LH surge
Gonadotropin-releasing hormone agonist
Which combination of findings most strongly suggests fluid overload?
Jugular venous distension
Dry mucous membranes
Crackles on auscultation
Fatigue and edema
Orthostatic hypotension
Which signs most specifically indicate pulmonary edema requiring emergency action?
High respiratory rate
Generalized pruritus
Pink frothy sputum
Painful breathing
Low oxygen saturation
A symptomatic patient with hyperkalemia requires immediate therapy. Which initial treatments are appropriate?
IV insulin with dextrose
Hemodialysis if medications fail
Hypertonic saline bolus
Calcium gluconate IV
Kayexalate to remove potassium
Which clinical signs suggest a deep vein thrombosis at the site of concern?
Localized edema
Warmth over the vein
Streaking along the vessel
Generalized pallor
Cold extremity distal to site
Which assessment best screens for suspected bowel obstruction at bedside?
Listening to bowel sounds
Checking fecal occult blood
Palpating for rebound tenderness
Percussion for shifting dullness
Which counseling is appropriate for patients on hormone replacement therapy such as estrogen, testosterone, or estradiol?
No need for routine monitoring
Testosterone patches require daily changes
Grapefruit juice is contraindicated
Avoid smoking to reduce clot risk
Increased risk of DVT and PE
Which intravenous fluid type is classified as crystalloid?
Packed red blood cells
Total parenteral nutrition
Albumin colloid solution
Normal saline or Lactated Ringer’s
A patient with COPD presents with shortness of breath, irritability, anxiety, and confusion. Which acid–base disorder is most likely?
Respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
Metabolic acidosis
Excessive administration of IV sodium bicarbonate can convert which condition into an alkalosis?
Respiratory acidosis to respiratory alkalosis
Metabolic alkalosis to respiratory acidosis
Metabolic acidosis to metabolic alkalosis
Respiratory alkalosis to metabolic alkalosis
Which findings best align with respiratory alkalosis?
High BUN and creatinine
Kussmaul respirations pattern
Panic attack and hyperventilation
Bradycardia and fatigue
Which features are characteristic of metabolic acidosis?
Bradycardia predominates
High BUN and creatinine
Kussmaul respirations
Treatment with sodium bicarbonate
Vomiting most commonly leads to which acid–base disturbance and why?
Respiratory alkalosis by hypoventilation
Metabolic alkalosis by losing gastric acid
Respiratory acidosis by CO2 retention
Metabolic acidosis by losing base in stool
A patient with suspected cerebral swelling requires IV fluids. Which agent is specifically contraindicated due to risk of death?
Mannitol administration
Hypertonic saline
Dextrose solution
Isotonic crystalloid
Which statements about proton pump inhibitors are accurate?
They directly neutralize acid
They are the prazoles
Short-term use is typical
They may cause osteoporosis
