D027 Cardiovascular & Endocrine Review Q&A for Midterm Study
Student Name
Western Governors University
D027 Advanced Pathopharmacological Foundations
Prof. Name
Date
D027 Cardiovascular & Endocrine Review Q&A for Midterm Study
The D027 Cardiovascular & Endocrine Review covers high-yield concepts in pharmacology, pathophysiology, medication safety, and clinical decision-making. For the midterm, students should understand not only what a medication does but also its major adverse effects, contraindications, interactions, monitoring requirements, and patient-teaching points. The review also includes diabetes, thyroid disorders, respiratory and neurologic conditions, musculoskeletal and gastrointestinal disorders, pain management, mental health, stress, genetics, health disparities, pediatrics, aging, and immunization.
Cardiovascular Review Questions and Answers
What is the most common adverse effect of ACE inhibitors?
Answer: A dry, persistent cough.
ACE inhibitors such as lisinopril may cause a persistent, nonproductive cough. The reaction is associated with increased bradykinin and other substances in the respiratory tract. If the cough becomes difficult to tolerate, the prescriber may consider an alternative such as an angiotensin II receptor blocker (ARB), depending on the patient’s clinical situation.
What should patients taking spironolactone know about potassium?
Answer: Potassium supplements and potassium-containing salt substitutes should generally be avoided unless specifically recommended.
Spironolactone is a potassium-sparing diuretic. Because it reduces potassium excretion, it can cause hyperkalemia, particularly in patients with impaired kidney function or those taking other medications that increase potassium. Patients should discuss supplements and salt substitutes with their healthcare professional before using them.
What should a pregnant patient taking an ACE inhibitor do?
Answer: Contact the healthcare provider promptly.
ACE inhibitors can cause serious fetal complications and are generally avoided during pregnancy. Potential complications include fetal kidney dysfunction, oligohydramnios, and neonatal problems. A patient who becomes pregnant while taking an ACE inhibitor should contact the prescribing clinician promptly so the medication regimen can be reassessed.
Why may metoprolol be combined with nifedipine?
Answer: Metoprolol can help control reflex tachycardia associated with nifedipine.
Nifedipine is a dihydropyridine calcium channel blocker that relaxes vascular smooth muscle and may cause reflex increases in heart rate. Metoprolol, a beta blocker, slows the heart rate and can reduce this response in appropriately selected patients.
How can patients reduce orthostatic hypotension caused by vasodilators?
Answer: Change positions slowly and avoid standing abruptly.
Vasodilating medications can lower blood pressure and cause dizziness when a person changes position. Patients should move gradually from lying to sitting and from sitting to standing. Adequate hydration, when appropriate, and fall-prevention measures may also be important.
Which lifestyle changes can help manage hypertension?
Answer: Reduce sodium intake, maintain a healthy weight, exercise regularly, moderate alcohol consumption, and avoid tobacco.
Lifestyle modification is an important part of blood pressure management. A heart-healthy eating pattern such as the DASH diet, regular physical activity, weight management, and tobacco avoidance can support cardiovascular health. Family history and other risk factors should also be considered.
Which medications can improve outcomes after myocardial infarction?
Answer: ACE inhibitors and beta blockers are commonly used when clinically appropriate.
Evidence-based medications after myocardial infarction can reduce cardiovascular complications and mortality in appropriate patients. Treatment depends on factors such as left ventricular function, blood pressure, kidney function, comorbidities, and medication tolerance.
Which two antiarrhythmic medication groups can produce similar cardiac effects?
Answer: Beta blockers and nondihydropyridine calcium channel blockers.
Beta blockers and nondihydropyridine calcium channel blockers such as verapamil and diltiazem can decrease heart rate and slow atrioventricular-node conduction. They can also reduce myocardial contractility, although their specific indications and clinical effects differ.
What symptom is concerning when a patient taking simvastatin is prescribed azithromycin?
Answer: New muscle pain, tenderness, or weakness.
Muscle symptoms in a patient taking a statin require attention because they can indicate statin-associated muscle injury. Severe muscle injury can lead to rhabdomyolysis and kidney damage. Potential medication interactions should be reviewed whenever a new drug is added.
How is significant warfarin-associated bleeding treated?
Answer: Vitamin K and, when indicated, rapid factor replacement therapy.
Management depends on the INR, severity and location of bleeding, and overall clinical condition. Serious or life-threatening bleeding may require intravenous vitamin K together with a rapid reversal product such as four-factor prothrombin complex concentrate (PCC).
Endocrine Review Questions and Answers
What short-term complications should be monitored in a newly diagnosed patient with diabetes?
Answer: Hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA).
Acute glucose abnormalities can develop rapidly and may require urgent treatment. Long-term complications, including neuropathy, kidney disease, and vascular disease, generally develop over a longer period and require ongoing preventive care.
Which insulin can be used for rapid correction of premeal hyperglycemia?
Answer: Rapid-acting insulin such as lispro, aspart, or glulisine.
Rapid-acting insulin analogs have a relatively quick onset and short duration. They are commonly administered around meals according to an individualized insulin plan and glucose-management strategy.
What dietary strategy is important for many patients with type 1 diabetes?
Answer: Carbohydrate counting.
Carbohydrate counting helps patients coordinate food intake with insulin doses. Nutrition planning should be individualized based on insulin regimen, activity, glucose targets, nutritional needs, and other health conditions.
Which laboratory test estimates average blood glucose over approximately two to three months?
Answer: Hemoglobin A1C (HbA1c).
HbA1c reflects average glucose exposure over roughly the previous two to three months. Conditions that change red blood cell lifespan can affect its accuracy, so results should be interpreted in the appropriate clinical context.
How is insulin glargine generally administered?
Answer: It is generally administered once daily according to the prescribed regimen.
Insulin glargine is a long-acting basal insulin designed to provide relatively consistent glucose-lowering activity. It is not intended to replace rapid-acting mealtime insulin when that component is prescribed.
What medication may be included in the treatment of thyroid storm?
Answer: Propylthiouracil (PTU) may be used as part of a comprehensive treatment regimen.
Thyroid storm is a life-threatening manifestation of severe thyrotoxicosis. Management may include a thionamide such as PTU, beta blockade when appropriate, corticosteroids, supportive treatment, and management of the precipitating condition.
Which findings are commonly associated with hypothyroidism?
Answer: Bradycardia, cold intolerance, fatigue, and reduced body temperature can occur.
Hypothyroidism slows metabolic processes. Other possible findings include dry skin, constipation, changes in weight, fatigue, and reduced heart rate.
Why is treatment of hypothyroidism important during pregnancy?
Answer: Adequate maternal thyroid hormone is important for pregnancy and fetal development.
Maternal thyroid hormone supports fetal neurologic and physical development. Untreated hypothyroidism can contribute to adverse maternal and fetal outcomes. Levothyroxine is the standard thyroid hormone replacement therapy when treatment is indicated.
How does radioactive iodine treat Graves disease?
Answer: Thyroid tissue absorbs radioactive iodine, which destroys thyroid cells and reduces thyroid hormone production.
Radioactive iodine is an established treatment for Graves disease and some other causes of hyperthyroidism. Patients receive individualized radiation-safety instructions. Hypothyroidism commonly develops after treatment and can subsequently be treated with thyroid hormone replacement.
Respiratory Review Questions and Answers
How do H1 antihistamines work?
Answer: They block H1 histamine receptors and reduce histamine-related symptoms.
H1 antihistamines reduce the effects of histamine at H1 receptors. First-generation medications are more likely to cause sedation because they cross the blood-brain barrier more readily. Many second-generation antihistamines produce less sedation.
What should patients taking hydroxyzine know?
Answer: Avoid alcohol and other central nervous system depressants unless specifically approved by a healthcare professional.
Hydroxyzine can cause significant drowsiness. Combining it with alcohol, opioids, sedatives, or other central nervous system depressants can increase sedation and impairment.
What is important when using a metered-dose inhaler?
Answer: Correct inhaler technique and proper timing between puffs are essential.
Patients should coordinate inhaler activation with inhalation and follow the instructions for their specific device. A spacer can improve medication delivery for many patients using a pressurized metered-dose inhaler.
How should long-acting beta2 agonists be used in asthma?
Answer: LABAs should be incorporated into an appropriate inhaled-corticosteroid-containing regimen rather than used as asthma monotherapy.
LABAs provide prolonged bronchodilation but do not adequately address airway inflammation when used alone. Current asthma treatment emphasizes ICS-containing therapy.
Which medication provides rapid bronchodilation?
Answer: A short-acting bronchodilator can provide rapid symptom relief when appropriate.
Short-acting beta2 agonists such as albuterol can provide rapid bronchodilation. However, modern asthma guidelines also emphasize inhaled corticosteroid-containing reliever strategies for appropriate patients.
What is the role of inhaled corticosteroids in asthma?
Answer: They reduce airway inflammation and help prevent exacerbations.
Inhaled corticosteroids are controller medications rather than immediate rescue treatments. Patients should understand the difference between their long-term controller medication and their prescribed reliever therapy.
What is guaifenesin used for?
Answer: Guaifenesin is an expectorant that helps loosen respiratory mucus.
Guaifenesin can increase and loosen respiratory secretions, making mucus easier to cough up. It supports productive coughing rather than directly suppressing the cough reflex.
When are oral antihistamines useful for seasonal allergies?
Answer: They can help control allergy symptoms when used as directed during periods of allergen exposure.
Second-generation antihistamines are often preferred for allergic rhinitis because they generally cause less sedation than first-generation medications.
Which bronchodilators are commonly used for stable COPD maintenance?
Answer: Long-acting inhaled bronchodilators are commonly used for maintenance treatment.
COPD treatment may include a long-acting beta2 agonist, long-acting muscarinic antagonist, or combination therapy. Medication selection depends on symptoms, exacerbation history, comorbidities, and individual treatment response.
Neurologic and Musculoskeletal Review Questions
Why is epinephrine the first-line medication for anaphylaxis?
Answer: Epinephrine rapidly counteracts several life-threatening effects of anaphylaxis.
Intramuscular epinephrine is the first-line treatment for anaphylaxis. Its alpha- and beta-adrenergic effects help increase blood pressure, reduce airway swelling, produce bronchodilation, and support cardiovascular function.
How should the first dose of an alpha-adrenergic antagonist be administered?
Answer: The first dose is often administered at bedtime when consistent with the medication’s prescribing instructions.
Alpha-adrenergic antagonists can cause a first-dose effect characterized by dizziness, orthostatic hypotension, or fainting. Taking the initial dose at bedtime may reduce the risk of injury from these effects.
What can cause dyskinesias in patients taking levodopa/carbidopa?
Answer: Long-term levodopa treatment can cause involuntary dyskinetic movements.
Dyskinesias can develop as a complication of Parkinson disease treatment, particularly with prolonged levodopa exposure. If these movements become troublesome, the prescriber may adjust the medication regimen.
What are major risk factors for Alzheimer disease?
Answer: Advancing age and family history are important risk factors.
Age is the strongest known risk factor for late-onset Alzheimer disease. Genetic factors can also influence susceptibility. A family history increases risk but does not mean that an individual will necessarily develop the disease.
What should patients taking phenytoin know about oral contraceptives?
Answer: Phenytoin can reduce the effectiveness of some hormonal contraceptives.
Phenytoin induces hepatic enzymes that can increase the metabolism of certain hormonal contraceptives. Patients should discuss effective contraceptive options with a healthcare professional.
When may serum drug levels be monitored for antiseizure medications?
Answer: Therapeutic drug monitoring may be used when clinically appropriate.
Some antiseizure medications have established therapeutic ranges. Drug concentrations may help clinicians evaluate adherence, toxicity, drug interactions, or unexpected treatment response.
When should aspirin be stopped before surgery?
Answer: The timing depends on the indication for aspirin, surgical bleeding risk, and the specific procedure.
Aspirin irreversibly affects platelet function, so its effects can persist for the lifespan of affected platelets. Patients should not independently discontinue prescribed aspirin, particularly when it is being used for cardiovascular protection. The prescribing and surgical teams should determine whether it should be held and when.
How does long-term glucocorticoid therapy affect bone health?
Answer: Long-term glucocorticoid use increases the risk of osteoporosis and fractures.
Glucocorticoids can decrease bone formation, reduce calcium absorption, and increase bone resorption. Depending on individual risk, patients may need fracture-risk assessment, adequate calcium and vitamin D intake, weight-bearing activity, fall prevention, and osteoporosis treatment.
Why is methotrexate started early in rheumatoid arthritis?
Answer: Methotrexate is a disease-modifying antirheumatic drug that can reduce disease progression and joint damage.
NSAIDs and corticosteroids can help control symptoms but do not provide the same disease-modifying effect. Early DMARD therapy is an important component of rheumatoid arthritis management.
What treatment may be considered for recurrent gout?
Answer: Urate-lowering therapy may be appropriate for recurrent or clinically significant gout.
Medications such as allopurinol and febuxostat reduce serum urate levels. Acute gout attacks are treated differently and may involve NSAIDs, colchicine, or corticosteroids depending on patient-specific factors.
Hormonal, Gastrointestinal, and Genitourinary Review
What are the primary benefits of menopausal hormone therapy?
Answer: Hormone therapy can effectively treat vasomotor symptoms and help prevent bone loss in appropriately selected patients.
Hormone therapy should be individualized according to age, time since menopause, symptoms, medical history, risks, and treatment goals. Patients with an intact uterus generally require a progestogen with systemic estrogen to reduce endometrial hyperplasia and cancer risk.
Who may need estrogen-only therapy?
Answer: Patients who have had a hysterectomy may generally use systemic estrogen without a progestogen when hormone therapy is otherwise appropriate.
When the uterus is present, systemic estrogen is generally combined with a progestogen to protect the endometrium. After hysterectomy, a progestogen is often unnecessary unless another clinical indication exists.
What is the treatment goal of terazosin for BPH?
Answer: Terazosin improves lower urinary tract symptoms and urinary flow.
Terazosin is an alpha-1 adrenergic antagonist. It relaxes smooth muscle in the prostate and bladder neck, which can improve symptoms such as urinary hesitancy and difficulty initiating urination. It does not primarily reduce prostate size.
What teaching is important when metronidazole is prescribed?
Answer: Patients should follow medication-specific instructions regarding alcohol avoidance during treatment and after the final dose.
Patients should follow the prescribing information and healthcare provider’s instructions concerning alcohol. Metronidazole can also cause gastrointestinal effects and a metallic taste.
How should bulk-forming laxatives be taken?
Answer: They should be taken with adequate fluid.
Bulk-forming laxatives such as psyllium absorb water and increase stool bulk. Adequate fluid intake helps these medications work effectively and lowers the risk of obstruction.
Why should loperamide be avoided in certain infectious diarrheas?
Answer: Slowing intestinal movement can worsen or prolong some infectious diarrheal illnesses.
Antimotility medications may be inappropriate when diarrhea is accompanied by blood, high fever, severe abdominal symptoms, or suspected invasive infection. Such patients may require medical evaluation rather than self-treatment.
What interaction can occur between TMP-SMX and glipizide?
Answer: TMP-SMX can increase the risk of hypoglycemia in patients taking sulfonylureas such as glipizide.
Patients taking both medications may need closer glucose monitoring and medication review. Symptoms of hypoglycemia should be recognized promptly and treated appropriately.
What is a common treatment option for uncomplicated cystitis?
Answer: Appropriate short-course antibiotic therapy is commonly used when bacterial cystitis is suspected or confirmed.
Antibiotic selection depends on current recommendations, local resistance patterns, allergies, kidney function, pregnancy status, and other patient-specific factors. Common options for appropriate patients include nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin.
Which medications are used to treat genital herpes?
Answer: Antiviral medications such as acyclovir and valacyclovir.
Antiviral treatment can reduce the duration and severity of genital herpes symptoms. Suppressive treatment may decrease outbreak frequency and lower transmission risk, although it does not eradicate latent HSV infection.
Lipid Management and Heart Failure Review
Which medication is commonly used for significant LDL cholesterol elevation and elevated ASCVD risk?
Answer: Statins are generally first-line pharmacologic therapy when indicated.
Statins lower LDL cholesterol and reduce cardiovascular risk. The appropriate treatment intensity depends on factors such as existing cardiovascular disease, LDL level, diabetes, age, and overall ASCVD risk.
What medications are commonly included in guideline-directed therapy for HFrEF?
Answer: Appropriate patients with heart failure with reduced ejection fraction may receive four major medication classes.
Contemporary HFrEF treatment commonly includes:
- An ARNI, ACE inhibitor, or ARB
- An evidence-based beta blocker
- A mineralocorticoid receptor antagonist
- An SGLT2 inhibitor
Sacubitril/valsartan may be used in place of an ACE inhibitor or ARB for appropriate patients. Treatment must be individualized based on kidney function, blood pressure, potassium levels, comorbidities, and medication tolerance.
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 helps researchers determine how frequently new cases develop. It is useful for studying disease risk and evaluating changes in the occurrence of health conditions.
What is prevalence?
Answer: Prevalence measures the proportion of a population living with a disease or condition at a particular time or during a specified period.
Unlike incidence, prevalence includes existing cases. It is influenced by disease occurrence as well as how long people live with the condition.
What is relative risk?
Answer: Relative risk compares disease incidence in an exposed group with incidence in an unexposed group.
A relative risk greater than 1 indicates higher incidence in the exposed group, while a value below 1 indicates lower incidence. Relative risk is commonly used in epidemiologic studies.
What does multifactorial inheritance mean?
Answer: Multifactorial traits result from interactions among multiple genes and environmental factors.
Many common conditions have complex genetic and environmental causes. Examples include hypertension, type 2 diabetes, obesity, coronary artery disease, and some cancers.
What is a gene-environment interaction?
Answer: It occurs when genetic susceptibility and environmental exposures jointly influence disease risk.
Genetic susceptibility does not necessarily determine whether someone develops a disease. Factors such as diet, physical activity, environmental exposure, stress, and other circumstances can influence how genetic risk is expressed.
How do family and twin studies help researchers?
Answer: They help estimate the relative contributions of genetic and environmental factors to health conditions and traits.
Identical twins share nearly all of their genetic material, while fraternal twins share approximately half of their segregating genetic material. Differences and similarities between twin pairs can therefore provide information about heritability and environmental influences.
Health Disparities, Culture, and Complementary Therapies
What factors contribute to health disparities?
Answer: Social, economic, environmental, healthcare-system, and access-related factors can contribute to differences in health outcomes.
Health disparities can be influenced by affordability, healthcare access, geographic barriers, health literacy, communication, quality of care, discrimination, and broader social determinants of health. Nurses and other healthcare professionals should consider these factors during assessment and care planning.
How can clinicians improve health literacy?
Answer: Use plain language, encourage questions, confirm understanding, and provide information in the patient’s preferred language when appropriate.
The teach-back method is particularly useful. Instead of simply asking whether the patient understands, the clinician asks the patient to explain the instructions in their own words. This helps identify misunderstandings before the patient leaves the healthcare setting.
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 examining cultural influences on health behaviors and developing culturally responsive health interventions.
What should nurses consider when patients use complementary therapies?
Answer: Ask about 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 supplements. Some products can cause clinically important adverse effects or interact with prescription medications. For example, kava has been associated with serious liver injury, while red yeast rice can contain compounds related to lovastatin and may produce statin-like effects.
Aging and Pediatric Health Review
What cardiovascular change commonly occurs with aging?
Answer: Increased arterial stiffness can contribute to changes in blood pressure and cardiovascular function.
Aging can reduce vascular compliance and contribute to higher systolic blood pressure. However, new cardiovascular symptoms should not automatically be considered a normal consequence of aging and should receive appropriate assessment.
What endocrine changes occur with aging?
Answer: Aging can affect thyroid, pancreatic, adrenal, reproductive, and other endocrine functions.
Changes in endocrine activity may influence metabolism, body composition, glucose regulation, energy, and reproductive hormone levels. The degree of change varies among individuals.
What contributes to anorexia of aging?
Answer: Reduced appetite, altered taste and smell, hormonal changes, lower energy needs, and social or medical factors can contribute.
Older adults may require fewer calories but remain vulnerable to malnutrition. Chronic illness, medication effects, oral health problems, depression, social isolation, and difficulty accessing food can further reduce nutritional intake.
What causes menopausal hot flashes?
Answer: Changes in ovarian hormone production, particularly declining estrogen levels, contribute to vasomotor symptoms.
Hormonal changes during the menopausal transition can affect the body’s thermoregulatory system. This may cause sudden episodes of warmth, flushing, and sweating.
What is the most common childhood cancer?
Answer: Leukemia is the most commonly diagnosed cancer in children.
Childhood cancer is uncommon compared with adult cancer, but leukemia represents a major category of pediatric malignancy. Improvements in diagnosis and treatment have increased survival for many childhood cancers.
What is an important long-term concern after childhood cancer treatment?
Answer: Survivors may experience late effects related to the original disease or its treatment.
Late effects depend on the type of cancer and treatments received. Potential problems can involve endocrine, cardiovascular, neurologic, reproductive, psychosocial, and other systems.
How should hypertension in children be evaluated?
Answer: Evaluation can include repeated blood pressure measurements, ambulatory monitoring when appropriate, lifestyle assessment, and investigation for secondary causes or target-organ effects.
Pediatric blood pressure must be interpreted using age-, sex-, and height-specific standards. Lifestyle interventions are often important, while medication may be indicated for selected patients.
How is asthma supported by objective testing in an older child?
Answer: Spirometry demonstrating variable expiratory airflow limitation can support an asthma diagnosis.
A family history of asthma or atopy may provide useful context, and biomarkers such as eosinophils or IgE can sometimes support phenotyping. However, these findings do not independently establish the diagnosis.
What is a characteristic feature of cystic fibrosis?
Answer: Cystic fibrosis causes abnormally thick and sticky secretions.
The disease affects multiple organs, particularly the respiratory and gastrointestinal systems. Patients may experience recurrent respiratory infections, pancreatic insufficiency, nutritional problems, and cystic-fibrosis-related diabetes.
Medication Safety in Infants and Older Adults
Why may newborns require lower or carefully adjusted medication doses?
Answer: Immature hepatic and renal systems can change medication metabolism and elimination.
Newborns have developing pharmacokinetic systems. Some medications may therefore remain in the body longer or reach higher concentrations, increasing the risk of toxicity.
Why are infants particularly vulnerable to medication toxicity?
Answer: Developmental differences in hepatic metabolism, kidney function, protein binding, and other physiologic processes can alter drug effects.
Medication dosing in infants must account for developmental changes. Extra caution is needed with medications that have narrow therapeutic ranges.
What should a nurse assess when an older adult has a subtherapeutic medication level?
Answer: Assess adherence and medication use before assuming the dose needs to be increased.
The nurse should review missed doses, medication schedules, adverse effects, cost, access, and the patient’s understanding of the treatment plan. Increasing the dose without identifying the cause could create toxicity if the patient subsequently resumes taking the medication correctly.
What kidney function measure is important when older adults take multiple medications?
Answer: Estimated kidney function, such as eGFR or creatinine clearance when appropriate, should be considered.
Serum creatinine alone may not accurately reflect kidney function in every older adult because creatinine production is influenced by muscle mass. Kidney function is particularly important when dosing medications that are substantially eliminated by the kidneys.
What can happen with excessive caffeine intake?
Answer: Severe caffeine toxicity can cause agitation, tremors, tachycardia, hypertension, and seizures.
Large amounts of caffeine, particularly concentrated caffeine products, can produce significant cardiovascular and neurologic stimulation. Severe symptoms require urgent medical evaluation.
What baseline information should be assessed before starting methylphenidate in a child?
Answer: Height, weight, appetite, cardiovascular history, blood pressure, and heart rate should be assessed.
Methylphenidate may affect appetite and growth and can produce cardiovascular effects. Growth and cardiovascular parameters should therefore be monitored during treatment.
Why are sedating cough and cold medicines generally avoided in young infants?
Answer: Young children are especially vulnerable to serious adverse effects and central nervous system depression from certain products.
Many over-the-counter cough and cold medications are not recommended for young children. Parents and caregivers should consult a pediatric healthcare professional before giving these products to infants or young children.
Immunization Review Questions and Answers
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 intramuscular site during infancy. Vaccine administration should follow current age-specific recommendations and proper injection technique.
Which vaccine types may be contraindicated in significantly immunocompromised children?
Answer: Certain live vaccines, such as varicella vaccine, may be contraindicated depending on the patient’s immune status.
Live vaccines can pose risks to people with significant immunosuppression. Vaccine recommendations should be individualized according to the child’s condition and current immunization guidance.
Medication Adverse Effects and Clinical Priorities
Which antihypertensive medication commonly causes a persistent dry cough?
Answer: ACE inhibitors such as lisinopril.
A persistent, nonproductive cough is a classic adverse effect associated with ACE inhibitors. ARBs generally cause this type of cough much less frequently.
Which postoperative finding requires prompt assessment after IV morphine?
Answer: A spreading rash or reaction around the IV site requires prompt assessment.
The nurse should evaluate the IV site and assess the patient for possible infiltration, phlebitis, tissue injury, or systemic hypersensitivity. Respiratory status, oxygenation, blood pressure, heart rate, and level of consciousness should also be considered when an opioid-related or allergic complication is suspected.
How should nursing priority be determined when caring for multiple patients?
Answer: Prioritize according to acuity, instability, risk of deterioration, and immediate safety concerns.
Age alone should not determine priority. When several patients appear stable, the nurse should identify which patient has the greatest risk for an acute complication and perform an appropriate focused assessment.
Pain Management Review Questions
Where does conscious pain perception occur?
Answer: Conscious pain perception involves the cerebral cortex and interconnected central nervous system structures.
Pain is a multidimensional experience involving sensory, emotional, cognitive, and behavioral components. Multiple neural pathways and brain structures participate in the perception and interpretation of pain.
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 actual or potential tissue injury. Chronic pain persists beyond expected healing and may involve biological, psychological, and social factors.
How do endogenous opioids reduce pain?
Answer: Endogenous opioids such as endorphins and enkephalins bind to opioid receptors and reduce pain signaling.
These naturally occurring substances influence pain transmission in the central and peripheral nervous systems by activating opioid receptors and reducing the transmission of pain signals.
What adverse effects after lidocaine with epinephrine require assessment?
Answer: Significant nervousness, palpitations, or tachycardia require evaluation.
Epinephrine can temporarily stimulate the cardiovascular system. Pronounced symptoms may indicate excessive systemic absorption or another adverse reaction and should be assessed appropriately.
How should a transdermal buprenorphine patch be managed?
Answer: Apply and replace it according to the prescribed schedule and rotate application sites.
Rotating sites can help reduce local skin irritation. Patients should follow the specific product instructions concerning placement, replacement, heat exposure, and disposal.
What are classic signs of opioid toxicity?
Answer: Respiratory depression, decreased consciousness, and pinpoint pupils.
Severe opioid toxicity can cause life-threatening respiratory depression. Immediate assessment and intervention are required. Naloxone may be administered when clinically indicated, together with appropriate airway and ventilatory support.
When should sumatriptan be avoided?
Answer: It is contraindicated in certain cardiovascular conditions, including established coronary artery disease.
Triptans can cause vasoconstriction. Patients with specific cardiovascular contraindications should not use these medications unless a qualified healthcare professional determines that treatment is appropriate.
Which headache may respond rapidly to supplemental oxygen?
Answer: Cluster headache.
High-flow oxygen is an established acute treatment for cluster headache in appropriate patients. Other acute and preventive treatments may be used depending on the individual’s clinical presentation.
Can acupuncture be used for cancer pain?
Answer: Acupuncture may be considered as a complementary treatment in some patients, although evidence varies by condition and clinical context.
Complementary therapies should not automatically replace evidence-based cancer pain treatment. Patients should discuss acupuncture and other complementary approaches with their healthcare team.
What treatment is appropriate for severe cancer pain?
Answer: Opioid analgesics are an important option for moderate-to-severe cancer pain.
Pain management should be individualized according to pain severity, cause, previous opioid exposure, kidney and liver function, adverse effects, and patient goals. Nonopioid medications and nonpharmacologic therapies may also be incorporated.
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, processing speed, and executive functioning.
How is schizophrenia treated?
Answer: Treatment commonly combines antipsychotic medication with psychosocial interventions and supportive care.
First-generation and second-generation antipsychotics have different receptor profiles and adverse-effect patterns. Treatment should be individualized according to symptoms, response, adverse effects, preferences, and treatment goals. Psychosocial interventions can support functioning and recovery.
What characterizes major depressive disorder?
Answer: Major depressive disorder involves persistent depressed mood or loss of interest accompanied by additional symptoms that cause clinically significant distress or impairment.
Possible symptoms include sleep changes, appetite or weight changes, fatigue, impaired concentration, feelings of guilt or worthlessness, psychomotor changes, and suicidal thoughts. Diagnosis requires a comprehensive assessment using established diagnostic criteria.
How does bipolar disorder differ from major depressive disorder?
Answer: Bipolar disorder includes episodes of mania or hypomania, with or without depressive episodes.
The occurrence of mania or hypomania distinguishes bipolar disorders from major depressive disorder. Treatment depends on the specific bipolar disorder and current phase and may include mood stabilizers or selected atypical antipsychotics. Antidepressant monotherapy may not be appropriate for some patients.
Anxiety, PTSD, and OCD Review
What is a possible complication associated with panic disorder?
Answer: Agoraphobia can occur with panic disorder.
Agoraphobia involves significant fear or avoidance of situations where a person believes escape could be difficult or help might not be available. It can occur alongside recurrent panic attacks.
How long must excessive worry persist for generalized anxiety disorder?
Answer: At least six months.
Generalized anxiety disorder involves excessive, difficult-to-control worry about multiple areas of life for at least six months. Associated symptoms can include fatigue, restlessness, irritability, muscle tension, and sleep disturbances.
What are common evidence-based treatments for generalized anxiety disorder?
Answer: Cognitive behavioral therapy and medications such as SSRIs or SNRIs are commonly used.
Treatment should be individualized according to symptom severity, comorbidities, preferences, and response. Buspirone is another medication option and does not have the same dependence profile as benzodiazepines.
What can recurrent nightmares after trauma indicate?
Answer: They may indicate trauma-related re-experiencing and should prompt assessment for PTSD or another trauma-related condition.
Nightmares should be considered alongside other symptoms, including avoidance, negative changes in mood or cognition, and hyperarousal. A sensitive, comprehensive assessment is important.
What is an evidence-based treatment approach for PTSD?
Answer: Trauma-focused psychotherapy is a major evidence-based treatment.
Trauma-focused therapies can help individuals process traumatic experiences and develop effective coping strategies. Certain medications, including SSRIs, may also be appropriate depending on symptoms, comorbidities, preferences, and treatment response.
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 treatments include exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy, and medications such as SSRIs. Severe or treatment-resistant OCD may require specialized psychiatric care.
Stress and Adaptation Review
How does stress affect the immune system?
Answer: Stress hormones, particularly cortisol, can alter immune function.
The stress response involves neuroendocrine pathways that influence inflammatory and immune activity. Chronic or severe stress may have broader effects on immune regulation.
What influences an individual’s response to stress?
Answer: How the person appraises the stressor and the coping resources available can strongly influence the response.
People can respond differently to the same stressful event because of previous experiences, social support, perceived control, coping strategies, and individual interpretation of the situation.
What causes cold, clammy skin during an acute stress response?
Answer: Sympathetic activation can cause peripheral vasoconstriction and sweating.
During acute stress, sympathetic nervous system activity can redirect blood flow and stimulate sweat glands. The result may be cool, pale, or clammy skin.
What are the stages of the general adaptation syndrome?
Answer: Alarm, resistance, and exhaustion.
The alarm stage represents the body’s initial reaction to a stressor. During resistance, the body attempts to adapt to ongoing stress. Prolonged stress without adequate recovery can eventually contribute to exhaustion.
Which 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 increase blood glucose during acute stress.
Acute Stress Disorder and PTSD
When can PTSD be diagnosed after trauma?
Answer: PTSD requires symptoms lasting longer than one month after the traumatic event.
Symptoms occurring from three days to one month after trauma may meet criteria for acute stress disorder, depending on the complete clinical presentation. Persistent symptoms beyond one month may meet criteria for PTSD.
What is an evidence-based treatment approach for acute stress disorder?
Answer: Trauma-focused cognitive behavioral therapy is an important treatment approach.
Treatment can help individuals process traumatic experiences and develop healthier coping strategies. Routine psychological debriefing is not recommended as a universal preventive intervention after trauma.
Why is prolonged benzodiazepine use concerning in trauma-related disorders?
Answer: Long-term use can cause dependence, tolerance, sedation, and other adverse effects.
Benzodiazepines require careful evaluation when used over extended periods. They are not routinely recommended as long-term treatment for PTSD and should not automatically replace evidence-based trauma-focused therapies.
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 medications can increase the risk of serotonin syndrome and other adverse effects.
What should be assessed first in unexplained chronic generalized pain?
Answer: Perform a comprehensive assessment that considers physical symptoms, sleep, medications, psychosocial factors, and functional status.
Poor sleep can increase pain sensitivity and contribute to fatigue. A broad assessment can help identify possible causes, contributing factors, medication-related issues, and appropriate treatment options.
What is an appropriate intervention for severe pain in hospice care?
Answer: Provide timely, appropriately prescribed analgesia while prioritizing comfort and the patient’s goals of care.
Hospice care emphasizes comfort, dignity, and quality of life. Severe pain should be assessed promptly and treated using an individualized plan that may include opioids, nonopioid medications, and other supportive interventions.
Key D027 Unit 4 Exam Takeaways
For the D027 Unit 4 midterm, focus on connections between medications, adverse effects, contraindications, drug interactions, monitoring, and patient education. Memorizing isolated facts is less useful than understanding why a medication is prescribed and what findings require follow-up.
Important associations include:
- ACE inhibitors: Persistent dry cough and important pregnancy-related safety concerns.
- Spironolactone: Potassium retention and hyperkalemia risk.
- Phenytoin: Can reduce the effectiveness of some hormonal contraceptives.
- Opioids: Toxicity can cause respiratory depression, sedation, and pinpoint pupils.
- LABAs: Used as part of an appropriate ICS-containing asthma regimen rather than as asthma monotherapy.
- Methotrexate: Disease-modifying therapy for rheumatoid arthritis.
- Rapid-acting insulin: Used around meals according to the prescribed insulin plan.
- Insulin glargine: Long-acting basal insulin.
- Epinephrine: First-line treatment for anaphylaxis.
- Sumatriptan: Has important cardiovascular contraindications.
- SSRIs/SNRIs and CBT: Common evidence-based approaches for anxiety disorders.
- ERP: Important behavioral treatment for OCD.
- Trauma-focused psychotherapy: Major evidence-based treatment approach for PTSD.
- Incidence: Measures new cases.
- Prevalence: Measures existing cases.
- Relative risk: Compares disease incidence between exposed and unexposed groups.
For exam preparation, distinguish acute treatment from long-term management, and remember that medication choices depend on individual patient factors. When older study materials conflict with contemporary recommendations, students should consult current clinical guidelines and authoritative sources.
References
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/
American College of Cardiology. (2024). 2024 ACC/AHA/ACCP/HRS guideline for the management of patients with atrial fibrillation. https://www.acc.org/guidelines
Centers for Disease Control and Prevention. (2025). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/
Centers for Disease Control and Prevention. (2025). Adult immunization schedule. https://www.cdc.gov/vaccines/schedules/
Centers for Disease Control and Prevention. (2024). Health literacy. https://www.cdc.gov/health-literacy/
Global Initiative for Asthma. (2025). Global strategy for asthma management and prevention. https://ginasthma.org/
Global Initiative for Chronic Obstructive Lung Disease. (2025). Global strategy for prevention, diagnosis and management of COPD. https://goldcopd.org/
D027 Cardiovascular & Endocrine Review Q&A for Midterm Study
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Gout. https://www.niams.nih.gov/health-topics/gout
National Institute of Mental Health. (n.d.). Mental health information. https://www.nimh.nih.gov/health
National Institute of Neurological Disorders and Stroke. (n.d.). Neurological disorders. https://www.ninds.nih.gov/
U.S. Food and Drug Administration. (n.d.). Drug safety and availability. https://www.fda.gov/drugs/drug-safety-and-availability
World Health Organization. (2023). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension