Advanced Patho/Pharm: Saunders Immune Meds

A client is diagnosed with herpes simplex virus type 1 (HSV 1). The health care provider prescribes a topical medication for treatment. The nurse anticipates that which medication will be prescribed? 1. Acyclovir 2. Salicylic acid 3. Gentamicin sulfate 4.Mupirocin calcium

Correct answer: 1 Rationale: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against herpes simplex virus types 1 and 2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Salicylic acid is a keratolytic. Gentamicin sulfate is an antibacterial agent and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial agent that is active against Staphylococcus aureus, beta-hemolytic streptococci, and Streptococcus pyogenes.

A client is receiving acyclovir by the intravenous (IV) route for treatment of cytomegalovirus (CMV) infection. After reconstituting the powder dispensed by the pharmacy, the nurse should administer this medication via which method? 1. Slow IV infusion over 1 hour 2. Rapid IV bolus over 5 minutes 3. Continuous IV infusion over 24 hours 4.Continuous IV infusion over 12 hours

Correct answer: 1 Rationale: Acyclovir is an antiviral medication. It is dispensed as a powder to be reconstituted for IV administration and is administered by slow IV infusion over 1 hour. It is not given as an IV bolus or continuous infusion or by intramuscular or subcutaneous injection. To minimize the risk of renal damage, the client should be hydrated during the infusion and for 2 hours after the infusion.

The nurse is caring for a client with a diagnosis of Chlamydia. Because the client has a history of noncompliance with medication administration, the health care provider prescribes azithromycin. When educating the client about azithromycin, the nurse should make which statement? 1. "One dose of this medication will be needed." 2. "This medication is given only every 72 hours." 3. "You will need to take this medication every 6 hours." 4."You will need to return tomorrow for your second dose."

Correct answer: 1 Rationale: Azithromycin is a macrolide antibiotic. The usual pharmacological treatment for urethral, cervical, or rectal chlamydial infections is doxycycline or azithromycin. Azithromycin is often prescribed when compliance may be a problem because only one dose is needed; however, expense is a concern with this medication. The responses in the remaining options are incorrect.

The home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse should monitor which item to monitor the effectiveness of this medication with each visit? 1. Rash 2. Fever 3. Pain relief 4.Sore throat

Correct answer: 1 Rationale: Clotrimazole is a topical antifungal agent used in the treatment of cutaneous fungal infections. The nurse monitors the effectiveness of this medication by noting the presence or absence of a skin rash, which is characteristic of this infection. Fever, pain relief, and sore throat are unrelated to the use of this medication.

The nurse reinforces medication instructions on therapy with cyclosporine to a client who has received a kidney transplant. Which statement by the client would indicate a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4."I need to call the health care provider if my urine volume decreases or it becomes cloudy."

Correct answer: 1 Rationale: Cyclosporine is an immunosuppressant medication. Because of the effects of the medication, the client should not receive any vaccinations without first consulting the health care provider. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia. The client must be able to self-monitor blood pressure to check for the side effect of hypertension.

The nurse provides instructions to a client who will be taking cyclosporine oral solution. Which action should the nurse tell the client to do? 1. Mix the concentrate with orange juice. 2. Mix the concentrate with grapefruit juice. 3. Avoid diluting the concentrate for administration. 4.Dilute the concentrate in a Styrofoam cup before administration.

Correct answer: 1 Rationale: Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. To improve palatability the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice is avoided because it can raise cyclosporine levels. The client is instructed to dilute the concentrate in a glass, not Styrofoam, to ensure ingestion of the complete dose.

A client has a prescription for ketoconazole. Which instruction should the nurse include in the client's teaching plan? 1. Avoid exposure to sunlight. 2. Take the medication with an antacid. 3. Take the medication on an empty stomach. 4.Limit alcohol consumption to 2 ounces per day.

Correct answer: 1 Rationale: Ketaconazole is an antifungal medication. The client also should avoid exposure to sunlight because the medication increases photosensitivity. Antacids should be avoided for 2 hours after ketoconazole is taken because gastric acid is needed to activate the medication; however, it should be taken with food. The client should avoid concurrent use of alcohol because the medication is hepatotoxic.

Ketoconazole is prescribed for an assigned client. The nurse prepares to administer the medication by which method? 1. With food 2. With an antacid 3. With 8 oz (235 ml) of water 4.On an empty stomach

Correct answer: 1 Rationale: Ketoconazole is an antifungal medication. It should be administered with food to minimize gastrointestinal irritation. The remaining options are incorrect. The medication requires acidity and should be administered at least 2 hours apart from an antacid.

Levofloxacin is prescribed for a client. While teaching the client about the medication, what should the nurse tell the client to take the medication with? 1. Water 2. An antacid 3. A zinc preparation 4. An iron supplement

Correct answer: 1 Rationale: Levofloxacin is a fluoroquinolone and should be administered with water. Antacids, zinc, and iron supplements decrease absorption and should be taken at least 4 hours before or 2 hours after the medication.

A client has been given a prescription for sulfasalazine. Which allergy should the nurse assess for in the client prior to administration? 1. Sulfonamides or salicylates 2. Salicylates or acetaminophen 3. Shellfish or calcium channel blockers 4.Histamine receptor antagonists or beta blockers

Correct answer: 1 Rationale: Sulfasalazine is a sulfonamide. The client who has been prescribed sulfasalazine should be checked for history of allergy to either sulfonamides or salicylates because the chemical composition of sulfasalazine and that of these medications are similar. The other options are not associated with an allergy to sulfasalazine.

The nurse is providing discharge instructions to a client who will be taking tacrolimus daily following allogenic liver transplantation. The nurse instructs the client that which is a frequent side effect related to this medication? 1. Diarrhea 2. Confusion 3. Loss of memory 4.A decrease in urine output

Correct answer: 1 Rationale: Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients who receive allogenic liver transplants. Frequent side effects include headache, tremors, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Toxic effects include nephrotoxicity and pleural effusion, which can occur frequently. Nephrotoxicity is characterized by increasing serum creatinine and a decrease in urine output. Thrombocytopenia, leukocytosis, anemia, and atelectasis occur occasionally. Neurotoxicity, including tremor, headache, and mental status changes, also can occur. It is imperative for the nurse to assess laboratory results, particularly renal function tests, and to monitor intake and output closely.

A client is receiving tobramycin. The nurse evaluates that the medication therapy is effective if which laboratory test result is noted? 1.WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) 2.Sodium level of 145 mEq/L (145 mmol/L)and chloride level of 106 mEq/L (106 mmol/L) 3.Sodium level of 140 mEq/L (140 mmol/L) and potassium level of 3.9 mEq/L (3.9 mmol/L) 4.White blood cell (WBC) count of 15,000 mm3 (15 × 109/L) and a blood urea nitrogen level of 38 mg/dL (13.7 mmol/L)

Correct answer: 1 Rationale: Tobramycin is an antibiotic (aminoglycoside) that causes nephrotoxicity and ototoxicity. The medication is working if the WBC count drops back into the normal range and kidney function remains normal. A WBC count of 15,000 mm3 (15 × 109/L) is elevated, indicating that infection is still present. The sodium, chloride, and potassium levels are all normal values and are unrelated to the effectiveness of this medication.

A client receiving a dose of intravenous vancomycin begins to experience chills, tachycardia, syncope, and flushing of the face and trunk. What is the nurse's best interpretation of these findings? 1. The medication is infusing too rapidly. 2. The client is allergic to the medication. 3. The client is experiencing upper airway obstruction. 4.The medication has interacted with another medication the client is receiving.

Correct answer: 1 Rationale: Vancomycin is an antibiotic. The client is experiencing manifestations of what is called "red neck syndrome." This is a response due to histamine release that occurs with rapid or bolus injection of this medication. The client may experience chills, fever, flushing of the face or trunk, tachycardia, syncope, tingling, and an unpleasant taste in the mouth. The corrective action is to administer the medication more slowly. An antihistamine such as diphenhydramine may be administered as well. Although the client can experience an allergic reaction to the medication, the manifestations in the question best describe "red neck syndrome." There is no indication that the client is experiencing an upper airway obstruction. In addition, there are no data in the question that indicate that the client is taking another medication.

The nurse is presenting information on treatment of influenza and the use of oseltamivir. The nurse should provide which information on the use of oseltamivir? Select all that apply. 1. The incidence of flu complications is reduced. 2. Oseltamivir is effective for all types of influenza. 3. Dosing must begin within 2 days after symptom onset. 4. No interactions with other medications have been reported. 5. It is best to begin dosing within the first 12 hours after symptom onset. 6.Oseltamivir is highly toxic to the liver, and liver function studies must be performed.

Correct answer: 1, 2, 3, 4, 5 Rationale: Options 1 through 5 are correct. Oseltamivir is an antiviral medication that reduces complications of the flu and is effective for all flu types. Treatment must begin early, no later than 2 days after symptom onset, and preferably much sooner, even during the first 12 hours, because benefits decline greatly when treatment is delayed. It has no reported interactions with other medications. The only major side effects are nausea and vomiting. It is not toxic to the liver.

Tobramycin sulfate is prescribed. The nurse is administering the medication by intermittent intravenous infusion every 8 hours. The nurse monitors the client for signs of an adverse effect related to this medication and determines that which, if noted on assessment, would indicate its presence? 1. Client complaint of diarrhea 2. Client complaint of ringing in the ears 3. A white blood cell count of 6000 mm3 (6 × 109/L) 4.A blood urea nitrogen (BUN) of 10 mg/dL (3.6 mmol/L)

Correct answer: 2 Rationale: Adverse effects of tobramycin sulfate[an aminoglycoside] include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances. The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). A normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). The correct option is the only one that indicates an adverse effect of the medication.

An aminoglycoside, given by intermittent intravenous infusion, is prescribed for a client with an infection. Which finding would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Bradycardia 2. Difficulty hearing 3. Increased appetite 4.Weakness and drowsiness

Correct answer: 2 Rationale: All aminoglycosides are capable of causing renal toxicity, vestibular and auditory toxicity. When aminoglycoside levels in the body exceed the normal, this can lead to different adverse effects that cannot be reversed or even fatal. Symptoms of kidney toxicity are decreased urine output, increased thirst, tachycardia or elevated heart rate, decreased appetite, and dizziness. Symptoms of ototoxicity include loss of hearing, dizziness or unsteadiness, ear fullness, lightheadedness and extreme sensitivity to head movements. Weakness and drowsiness are associated with infection but do not indicate an adverse effect.

A client is receiving amoxicillin orally every 8 hours. Which finding would indicate to the nurse that the client is experiencing a frequent minor side effect related to the medication. 1. Fever 2. Vaginal drainage 3. Severe watery diarrhea 4.Severe abdominal cramps

Correct answer: 2 Rationale: Amoxicillin is a type of penicillin. Frequent minor side effects include gastrointestinal disturbances, headache, and oral or vaginal candidiasis (perineal itching). A less common but more harmful effect that can occur include superinfection, such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms and signs include abdominal cramps, severe watery diarrhea, and fever.

A client is receiving amphotericin B by the intravenous (IV) route. During ongoing therapy with this medication, the nurse should most closely assess the client for which finding that indicates a complication? 1. Decreased pulse 2. Decreased urine output 3. Decreased body temperature 4.Decreased blood urea nitrogen level

Correct answer: 2 Rationale: Amphotericin B is an antifungal medication and can cause side and adverse effects such as chills, fever, headache, vomiting, and impaired renal function. A decreased urine output is an indication of impaired renal function. Changes in the pulse and temperature are not related to impaired renal function. The blood urea nitrogen level would be elevated if renal function was impaired. The nurse monitors for these side and adverse effects and also carefully assesses the IV site because of the irritating effects of the medication.

A client is receiving amphotericin B by the intravenous (IV) route. The nurse determines that the client is having an adverse effect to the medication if which laboratory study result is noted? 1. Elevated platelet count 2. Elevated serum creatinine 3. Low white blood cell count 4.Lowered hemoglobin and hematocrit

Correct answer: 2 Rationale: Amphotericin B is an antifungal medication. It exerts direct toxicity on cells of the kidneys and causes renal impairment in most clients. To evaluate renal injury, tests of kidney function should be performed weekly, and intake and output should be monitored. If the serum creatinine level rises above 3.5 mg/dL (309 mcmol/L), the dose of amphotericin B should be reduced. The laboratory abnormalities in the remaining options are unrelated to the use of this medication.

The client with human immunodeficiency virus (HIV) infection has been started on therapy with zidovudine. The nurse reviews the laboratory results and determines that the client is experiencing an adverse effect of the medication if which is noted? 1. Phosphorus 4.5 mg/dL (1.45 mmol/L) 2. Hemoglobin of 10 g/dL (100 mmol/L) 3. Blood glucose level 70 mg/dL (4 mmol/L) 4.Blood urea nitrogen (BUN) 10 mg/dL (3.6 mmol/L)

Correct answer: 2 Rationale: An adverse effect of this medication therapy is agranulocytopenia and anemia. The nurse carefully monitors the CBC count for these changes. With early HIV infection or in the client who is asymptomatic, CBC counts are monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, these counts are monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The normal hemoglobin level is 14 to18 g/dL (140 to180 mmol/L); thus this client is experiencing anemia. The remaining options identify normal values. The normal phosphorus 3.0 to4.5 mg/dL (0.97 to 1.45 mmol/L). The normal blood glucose level is 70 to110 mg/dL (4 to 6 mmol/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

A client who has received a kidney transplant is taking azathioprine, and the nurse provides instructions about the medication. Which statement by the client would indicate a need for further instruction? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4."I need to call the health care provider if more than 1 dose is missed."

Correct answer: 2 Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are to be reported immediately to the health care provider (HCP). The medication may be taken with meals to minimize nausea. The client should also call the HCP if more than 1 dose is missed.

Azithromycin has been prescribed for a client. The nurse should instruct the client to take the medication in which way? 1. With meals 2. 1 hour before meals 3. With an aluminum-containing antacid 4.With a magnesium-containing antacid

Correct answer: 2 Rationale: Azithromycin is a macrolide antibiotic. It should be taken 1 hour before or 2 hours after meals. It is not administered with meals, and it should not be taken with either aluminum- or magnesium-containing antacids.

Cyclosporine is prescribed for a client who received a kidney transplant. The nurse would be most concerned if a review of the medical record revealed that the client currently is taking which prescribed medication? 1. Digoxin 2. Phenytoin 3. Prednisone 4.Propranolol

Correct answer: 2 Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Medications known to lower cyclosporine levels include phenytoin (anticonvulsive medication), phenobarbital, rifampin, and trimethoprim-sulfamethoxazole. Cyclosporine levels should be monitored and the dosage adjusted in clients taking these medications.

The nurse is monitoring a client receiving cyclosporine. Which sign or symptom should indicate to the nurse that the client is experiencing an adverse effect of this medication? 1. Nausea 2. Tremors 3. Alopecia 4.Hypotension

Correct answer: 2 Rationale: Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. Adverse effects of cyclosporine are nephrotoxicity, infection, hypertension, tremors, and hirsutism. Of these, nephrotoxicity and infection are the most serious.

A child with human immunodeficiency virus (HIV) infection is receiving zidovudine. Which finding indicates to the nurse that the child may be experiencing an adverse effect from the medication? 1. The child complains of pain in his lower legs. 2. The child's skin is pale and the child is feeling tired. 3. The child has some swelling in the hands and around the ankles. 4. The child is clinging to his parents and won't allow them to leave.

Correct answer: 2 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine effectively interferes with HIV replication but can cause bone marrow suppression. Anemia occurs most commonly after 4 to 6 weeks of therapy. Hematology studies need to be monitored for anemia and granulocytopenia. Tiredness and a pale color could indicate that the child is anemic. Complaints of pain is not associated with the medication but can be associated with the diagnosis; swelling is not usually a characteristic of the infection but could be an indication of an underlying problem. If the child is clinging to the parents, this could indicate fear but is not associated with an adverse effect of the medication.

The nurse is caring for a client admitted to the hospital for an infection who is receiving an aminoglycoside twice a day, intravenously. The nurse is planning to obtain blood for a peak aminoglycoside level. When should the blood be drawn? 1. A peak level is not indicated. 2. 1 hour after completing the infusion 3. 1 hour before administration of the infusion 4.15 minutes before administration of the infusion

Correct answer: 2 Rationale: Peak medication levels are obtained 1 hour after completing the infusion. Therefore, the times in the remaining options are incorrect.

The nurse is preparing to administer piperacillin/tazobactam. An abnormal elevation in which laboratory value should prompt the nurse to withhold the medication and notify the health care provider (HCP) before administering the medication? 1. Hematocrit and hemoglobin 2. Blood urea nitrogen and creatinine 3. Prothrombin time and partial thromboplastin time 4.Aspartate aminotransferase and alanine transaminase

Correct answer: 2 Rationale: Piperacillin/tazobactam is a penicillin-type antibiotic normally eliminated rapidly by the kidney but that can accumulate to harmful levels if renal function is severely impaired. Dosages must be reduced in clients with renal impairment. Therefore, an elevation in blood urea nitrogen and creatinine should be reported to the HCP for dosage adjustment.

A 2-year-old with Pneumocystis jiroveci pneumonia is to begin treatment with highly active antiretroviral therapy (HAART). The nurse anticipates that the health care provider will prescribe which combination? 1.One immunoglobulin and one nucleoside analogue 2.Two nucleoside analogues and one protease inhibitor 3.Two protease inhibitors and one broad-spectrum antibiotic 4.One nucleoside reverse transcriptase inhibitor and one non-nucleoside reverse transcriptase inhibitor

Correct answer: 2 Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection in the client with acquired immunodeficiency syndrome. HAART consists of the combination of 2 nucleoside analogues, which target viral replication during the reverse transcription phase of the cell cycle, and a protease inhibitor, which targets viral replication at a different phase. The remaining options are incorrect descriptions of combination therapies.

Tacrolimus is prescribed to a client for prevention of organ rejection after renal transplantation. Which prescription should the nurse anticipate to be prescribed, along with the tacrolimus, for this client? 1. Phenytoin 2. Prednisone 3. Fluconazole 4.Erythromycin

Correct answer: 2 Rationale: Tacrolimus is an immunosuppressant used as an alternative medication to cyclosporine for prevention of organ rejection in clients after transplantation. The medication is more effective than cyclosporine but is more toxic. Concurrent use of glucocorticoids such as prednisone is recommended during administration of this medication. The medications in the remaining options would not be prescribed unless a secondary disorder existed.

The nurse is providing discharge instructions to the mother of a child who has been prescribed tetracycline hydrochloride. The nurse stresses to the mother the importance of which measure in giving this medication to the child? 1. Give the medication with milk. 2. Use a straw when giving the medication. 3. Give the medication with chocolate milk. 4.Dilute the medication with water in a Styrofoam cup.

Correct answer: 2 Rationale: Tetracycline is an antibiotic. Because tetracycline can cause permanent staining of the teeth, a straw should be used, and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after the consumption of milk. Diluting the medication with water is unnecessary.

A client with a respiratory tract infection is receiving intravenous tobramycin sulfate. The nurse should assess for which adverse effect of this medication? 1. Nausea 2. Vertigo 3. Vomiting 4.Hypotension

Correct answer: 2 Rationale: Tobramycin sulfate is an aminoglycoside. Ringing in the ears and vertigo are symptoms of ototoxicity that may indicate dysfunction of the eighth cranial nerve. This is a frequent adverse effect of therapy with the use of aminoglycosides and could result in permanent hearing loss. In clients with these symptoms, the nurse should withhold the dose of the medication and notify the health care provider. Nausea, vomiting, and hypotension are rare side effects of the medication.

The nurse caring for a client who is taking an aminoglycoside should monitor the client for which adverse effects of the medication? Select all that apply. 1. Seizures 2. Ototoxicity 3. Renal toxicity 4. Dysrhythmias 5.Hepatotoxicity

Correct answer: 2, 3, 4 Rationale: Aminoglycosides are administered to inhibit the growth of bacteria. Adverse effects of this medication include confusion, ototoxicity, renal toxicity, gastrointestinal irritation, palpitations or dysrhythmias, blood pressure changes, and hypersensitivity reactions. Therefore, the remaining options are incorrect.

Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions should the nurse include when administering this medication? Select all that apply. 1. Restrict fluid intake. 2. Monitor liver function studies. 3. Instruct the client to avoid alcohol. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6.Administer the medication on an empty stomach.

Correct answer: 2, 3, 5 Rationale: Ketoconazole is an antifungal medication. There is no reason for the client to restrict fluid intake; in fact, this could be harmful to the client. The medication is hepatotoxic, and the nurse monitors liver function. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The client is also instructed to avoid alcohol. In addition, the client is instructed to avoid exposure to the sun because the medication increases photosensitivity.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the health care provider (HCP) immediately if which occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4.Muscle aches

Correct answer: 3 Rationale: Amikacin is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified.

The nurse is creating a plan of care for a client who is receiving amphotericin B intravenously. A main component of the plan of care is monitoring for adverse effects related to the administration of this medication. Which should the nurse include in a list of manifestations to watch for? 1. Fatigue 2. Confusion 3. Visual difficulties 4.Increased urinary output

Correct answer: 3 Rationale: Amphotericin B is an antifungal. Vision and hearing alterations, seizures, hepatic failure, paresthesias (tingling, numbness, or pain in the hands and feet), and coagulation defects also occur. Other adverse effects include nephrotoxicity, which occurs commonly and is evidenced by decreased urine output. Cardiovascular toxicity (as evidenced by hypotension and ventricular fibrillation) and anaphylactic reaction occur rarely.

Azathioprine is prescribed for a client to suppress rejection of a renal transplant. In planning for administration of the medication, the nurse understands that which description is the mechanism of action of this medication? 1. It crosslinks DNA. 2. It blocks all T cell functions. 3. It inhibits the proliferation of B and T lymphocytes. 4.It decreases the activity of thymus-derived lymphocytes.

Correct answer: 3 Rationale: Azathioprine is an immunosuppressant; it suppresses cell-mediated and humoral immune responses by inhibiting the proliferation of B and T lymphocytes. It generally is used as an adjunct to cyclosporine and glucocorticoids to help suppress transplant rejection. The remaining options are incorrect mechanisms of action.

The nurse asks the student nurse, "What does it mean when an antibiotic is classified as a bactericidal agent?" The nurse determines that the student nurse has a correct understanding when which statement is made? 1. "It has low efficacy." 2. "It has a very low potency." 3. "It kills the infectious agent." 4."It slows the growth of the infectious agent."

Correct answer: 3 Rationale: Bactericidal agents cause bacterial cell death and lysis and thus kill the infectious agent. Potency refers to the strength of an antibiotic, and efficacy is related to antibiotic effectiveness. An antibiotic is classified as bacteriostatic if the agent slows bacterial growth, allowing the body to complete the cycle of destruction.

The nurse is preparing to administer a prescribed dose of cyclosporine by intravenous (IV) administration. Which priority item would the nurse have available during administration of this medication? 1. A code cart 2. Oral airway 3. Epinephrine 4.A suction catheter

Correct answer: 3 Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Because of the risk of anaphylaxis during administration of cyclosporine by the IV route, epinephrine and oxygen must be immediately available for use. An oral airway or a suction machine is not the priority item. A code cart should be available, but it is not the priority item.

Cyclosporine is prescribed for the client following allogenic kidney transplantation. The nurse should provide which instruction to the client regarding the medication? 1. There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4.The medication is administered by the intravenous (IV) route on a monthly basis.

Correct answer: 3 Rationale: Cyclosporine is an immunosuppressant. To avoid toxicity from high medication levels and to avoid organ rejection from low medication levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; IV administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.

A client who has been diagnosed with pneumonia has been given a prescription for erythromycin. Client teaching about this medication should include which best instruction? 1. Take the medication with juice. 2. Take the medication with a meal. 3. Take the medication on an empty stomach. 4.Take the medication at bedtime with a snack.

Correct answer: 3 Rationale: Erythromycin is a macrolide antibiotic. Oral erythromycin should best be administered on an empty stomach with a full glass of water (1 hour before or 2 hours following ingestion of food). Some preparations may be administered with food if gastrointestinal upset occurs, but it is best to administer on an empty stomach.

Abacavir has been prescribed for a client, and the nurse provides instructions about the medication. Which statement by the client indicates the need for further instruction? 1. "This medication will not cure my infection." 2. "Eating small, frequent meals will help offset the nausea." 3. "This medication will reduce the risk of transmitting the infection to others." 4."I should check with my health care provider before taking any over-the-counter medications."

Correct answer: 3 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiretroviral agent that is used to treat human immunodeficiency virus (HIV) infection in combination with other medications. It will not cure HIV infection, nor will it reduce the risk of transmitting the infection to others. Eating small, frequent meals will help offset nausea. The client who is taking this medication should check with the health care provider before taking any over-the-counter medications

The health care provider (HCP) writes a prescription for zidovudine for a client who was admitted to the hospital. The nurse should contact the HCP to verify the prescription if which finding is noted in the assessment data? 1. History of renal calculi 2. Complaints of diarrhea 3. Bone marrow depression 4.Complaints of abdominal discomfort

Correct answer: 3 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. A contraindication to the medication is a history of hypersensitivity to this medication. Cautions include bone marrow suppression, renal and hepatic dysfunction, and conditions that cause decreased hepatic blood flow. A history of renal calculi, diarrhea, and complaints of abdominal discomfort are not contraindications or cautions related to this medication.

Zidovudine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Urea nitrogen level 2. Magnesium and calcium levels 3. Complete blood cell (CBC) count 4.Sedimentation rate and prothrombin time

Correct answer: 3 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Because anemia and granulocytopenia can occur with this medication, a CBC count will be done periodically. A urea nitrogen level tests kidney function. A magnesium level and calcium level check electrolyte and mineral balance. A sedimentation rate and prothrombin time assessed for the presence of inflammation and coagulation ability.

Zidovudine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that which is a common side effect of this medication? 1. Lethargy 2. Weakness 3. Headache 4.Constipation

Correct answer: 3 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Common side effects include nausea and headache. Lethargy, weakness, and constipation are not side effects of this medication.

A client admitted to the hospital is taking zidovudine. The nurse monitors the client for which adverse effect of the medication? 1. Colitis 2. Ototoxicity 3. Neurotoxicity 4.Visual disturbances

Correct answer: 3 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infections. Adverse effects include anemia, granulocytopenia, and neurotoxicity as evidenced by ataxia, fatigue, lethargy, and nystagmus. Seizures can also occur. Colitis, ototoxicity, and visual disturbances are not adverse effects of this medication.

The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs and the client is complaining of a headache. What vital sign is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4.Pulse oximetry

Correct answer: 3 Rationale: Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

A client asks the nurse why the health care provider (HCP) changed to a different antibiotic for treating streptococcal throat infection. The nurse should make which best response? 1. "Antibiotics all have the same method of action." 2. "You probably misunderstood what the health care provider said." 3. "Bacteria are capable of developing resistance to frequently used antibiotics." 4."Try this medicine, and if you're not better in 5 to 7 days, return to the office."

Correct answer: 3 Rationale: Many infections can have the same symptoms but are caused by different organisms or by organisms that have developed a resistance to a certain antibiotic and require a change to a different antibiotic. Antibiotics that are specific to the type of pathogen causing the infection are prescribed, and selection of the correct antibiotic is important. To say that the client misunderstood does not answer the client's question. The advice to try a medicine and wait 5 to 7 days does not give the client correct information, and the client might need to return sooner to the HCP if symptoms are still evident.

A client is scheduled to receive a first dose of pentamidine intravenously. What should the nurse plan to carefully monitor as the priority during administration of the first dose? 1. Pulse rate 2. Breath sounds 3. Blood pressure 4.Respiratory rate

Correct answer: 3 Rationale: Pentamidine is an anti-infective medication. The blood pressure is monitored frequently during administration because pentamidine can cause severe and sudden hypotension, even with a single dose. The client should be supine while receiving the medication and resuscitation equipment should be available. Although the items in the remaining options may be monitored, they are not the priority with this medication.

The nurse is preparing to administer pentamidine to an assigned client by the intravenous route. The nurse plans to monitor which item most closely after administering this medication? 1. Capillary refill 2. Peripheral pulses 3. Blood pressure (BP) 4.Level of consciousness

Correct answer: 3 Rationale: Pentamidine is an antiinfective medication. Life-threatening and fatal hypotension can occur after the administration of pentamidine. The client must be in a supine position with frequent BP checks after administration. The remaining options are not associated with the administration of this medication.

The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication? Select all that apply. 1. Ototoxicity 2. Palpitations 3. Nephrotoxicity 4. Bone marrow suppression 5. Gastrointestinal (GI) effects 6.Increased white blood cell (WBC) count

Correct answer: 3, 4, 5 Rationale: Adverse effects of sulfonamides include nephrotoxicity, bone marrow suppression, GI effects, hepatotoxicity, dermatological effects, and some neurological symptoms, including headache, dizziness, vertigo, ataxia, depression, and seizures. Options 1, 2, and 6 are unrelated to these medications.

A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1. Pain relief 2. Enhanced immunity 3. Increased serum glucose 4.Decreased inflammation

Correct answer: 4 Rationale: A corticosteroid acts as an antiinflammatory. Although reduction of inflammation may relieve pain, this is not the indication of the use of corticosteroids in the allergic response. Corticosteroids increase serum glucose, but this is not a therapeutic response. These medications decrease immunity.

Abacavir has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? 1. Promotes viral DNA growth 2. Prevents the production of DNA 3. Splits DNA to prevent its production 4.Inhibits activity of HIV-1 reverse transcriptase

Correct answer: 4 Rationale: Abacavir is an antiretroviral agent that inhibits activity of HIV-1 reverse transcriptase and inhibits viral DNA growth. Abacavir does not promote viral DNA growth or do anything that would prevent the production of DNA.

The client with acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci infection has been receiving pentamidine. The nurse caring for the client should monitor the client most closely for signs of which adverse effect of the medication? 1. Nausea 2. Fatigue 3. Vomiting 4.Infection

Correct answer: 4 Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Pentamidine is an antiinfective medication. Adverse effects of pentamidine include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The client also should have ongoing monitoring of a number of parameters because of the nature and side effects of the medication, including complete blood cell count; liver function; blood glucose; blood urea nitrogen; and serum creatinine, calcium, and magnesium levels. The items in the remaining options are not associated with an adverse effect of this medication.

The nurse is monitoring a client who is receiving intravenous (IV) acyclovir. The nurse would monitor the client closely for which primary toxic effect of the medication? 1. Ototoxicity 2. Neurotoxicity 3. Cardiotoxicity 4.Nephrotoxicity

Correct answer: 4 Rationale: Acyclovir is an antiviral medication. Although the most common side and adverse reactions with this medication are phlebitis and inflammation at the IV site, reversible nephrotoxicity, evidenced by elevated serum creatinine and BUN levels, can occur in some clients. The cause of nephrotoxicity is deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and the use of other nephrotoxic medications. Ototoxicity, neurotoxicity, and cardiotoxicity are not specific to this medication.

The nurse is monitoring a client with herpes simplex virus (HSV) who is receiving intravenous (IV) acyclovir. Which laboratory result would be of concern as a possible adverse effect of this medication? 1. Platelet count of 300,000 mm3 (300 × 109/L) 2. Prothrombin time of 12 seconds (12 seconds) 3. White blood cell count of 6000 mm3 (6 × 109/L) 4.Blood urea nitrogen (BUN) of 36 mg/dL (12.9 mmol/L)

Correct answer: 4 Rationale: Acyclovir is an antiviral medication. Although the most common side and adverse reactions with this medication are phlebitis and inflammation at the IV site, reversible nephrotoxicity, evidenced by elevated serum creatinine and BUN levels, can occur in some clients. The cause of nephrotoxicity is deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and the use of other nephrotoxic medications. The laboratory values identified in the remaining options are within normal limits.

The health care provider (HCP) prescribed tetracycline for a 5-year-old pediatric client. The nurse questions this prescription for what reason? 1. It is classified as a narrow-spectrum antibiotic. 2. It is identified as safe for use during pregnancy. 3. It is used to treat a wide variety of disease processes. 4.It is contraindicated in children younger than 8 years of age.

Correct answer: 4 Rationale: All tetracyclines are contraindicated in children younger than 8 years of age because the medication deposits in bone and teeth enamel and can result in permanent discoloration of developing teeth. Tetracyclines are broad-spectrum antibiotics. Tetracyclines are used to treat specific infections and are contraindicated during pregnancy because of their effects on developing teeth.

Azithromycin is prescribed for a client. The nurse provides instructions to the client about the medication and emphasizes that it is best to take the medication with which item? 1. Milk 2. Antacid 3. The evening meal 4.Water on an empty stomach

Correct answer: 4 Rationale: Azithromycin is a macrolide antibiotic that has excellent tissue penetration properties and can reach high concentrations in infected tissues. It has a long duration of action, which allows it to be dosed once daily. Taking the medication with milk, an antacid, or food decreases both the rate and the extent of gastrointestinal absorption. Therefore, it is best to take the medication with water on an empty stomach.

A client has been given a prescription for a course of azithromycin. The nurse should tell the client that this medication will relieve which problem? 1. Pain 2. Joint inflammation 3. High blood pressure 4.Signs and symptoms of infection

Correct answer: 4 Rationale: Azithromycin is a macrolide antibiotic used to treat infection. It is not used to treat pain, joint inflammation, or blood pressure.

The nurse is caring for a client with a urinary tract infection (UTI). The culture report reveals the presence of Pseudomonas aeruginosa. The nurse anticipates that which medication will be prescribed to treat the infection? 1. Isoniazid 2. Rifampin 3. Ethambutol 4.Ciprofloxacin

Correct answer: 4 Rationale: Ciprofloxacin is an antimicrobial agent that is used to treat UTIs caused by P. aeruginosa. The medications identified in the other options are antituberculosis medications.

The nurse is collecting data from a client with a history of renal transplantation. The nurse understands that which medication is the medication of choice for preventing organ rejection? 1. Probenecid 2. Prednisone 3. Indomethacin 4.Cyclosporine

Correct answer: 4 Rationale: Cyclosporine is a powerful immunosuppressant and is the medication of choice for preventing organ rejection following allogenic transplantation. Prednisone is a glucocorticoid and may be administered concurrently with the cyclosporine. Probenecid is a uricosuric agent used to treat hyperuricemia. Indomethacin is a nonsteroidal antiinflammatory agent.

Cyclosporine is prescribed to be administered by the intravenous (IV) route. Which is an inappropriate action in preparing and administering this medication? 1.Mixing the solution and covering it with a paper bag 2.Administering the medication over a period of 2 to 6 hours 3.Mixing 1 mL of concentrate in 50 mL of 0.9% sodium chloride and administering by infusion 4.Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection

Correct answer: 4 Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. For IV administration of cyclosporine, 1 mL of concentrate is diluted in 20 to 100 mL of 0.9% sodium chloride or 5% dextrose. The solution should be protected from light. The initial dose is 5 to 6 mg/kg (one third of the oral dose) administered over a 2- to 6-hour infusion.

Blood work has been drawn on a client who has been taking cyclosporine following allogenic liver transplantation. The nurse should check the results of which test to determine the presence of an adverse effect related to this medication? 1. Hematocrit level 2. Cholesterol level 3. Hemoglobin level 4.Blood urea nitrogen (BUN) level

Correct answer: 4 Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity is one of the most common adverse effects of cyclosporine. Nephrotoxicity is evaluated by monitoring the BUN and creatinine levels. The laboratory tests in the remaining options are unrelated to the adverse effects associated with the administration of this medication.

A client who has undergone renal transplantation is receiving ongoing therapy with cyclosporine. The nurse would be sure to immediately report which abnormal finding? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Decreased white blood cell (WBC) count 4.Elevated blood urea nitrogen (BUN) level

Correct answer: 4 Rationale: Cyclosporine is an immunosuppressant. The use of cyclosporine can cause nephrotoxicity. This complication is detected by assessing for elevated levels of BUN and serum creatinine. Decreased hemoglobin level and WBC count are incorrect because cyclosporine does not depress the bone marrow.

The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101°F (38.3°C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition? 1. That the dose of the medication is too low 2. That the client is experiencing toxic effects of the medication 3. That the client has developed inadequacy of thermoregulation 4.That the client has developed another infection caused by leukopenic effects of the medication

Correct answer: 4 Rationale: Frequent adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

A client is receiving ganciclovir. Which nursing action is appropriate during the time the client is receiving this medication? 1. Monitoring blood glucose levels for elevation 2. Administering the medication on an empty stomach only 3. Applying pressure to venipuncture sites for at least 1 minute 4.Providing the client with a soft toothbrush and an electric razor

Correct answer: 4 Rationale: Ganciclovir is an antiviral medication. Common adverse effects of ganciclovir are neutropenia and thrombocytopenia. For this reason, the nurse implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and an electric razor to minimize risk of trauma that could result in bleeding. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach. Pressure on venipuncture sites should be held for approximately 10 minutes.

The nurse is caring for a client receiving gentamicin intravenously. What statement made by the client should most concern the nurse? 1. "I am experiencing dizziness." 2. "I am experiencing heartburn." 3. "I am experiencing abdominal pain." 4."I am experiencing ringing in my ears."

Correct answer: 4 Rationale: Gentamicin is is an aminoglycoside. This medication is ototoxic. If the client experiences ringing in the ears, ototoxicity should be suspected. Dizziness, heartburn, and abdominal pain are not associated with this medication. Remembering that gentamicin causes ototoxicity will lead you to this option.

The nurse is collecting subjective and objective data from a client and notes that the client is taking abacavir. The nurse determines that this medication has been prescribed to treat which condition? 1. Otitis media 2. Heart failure 3. Urinary tract infection 4.Human immunodeficiency virus (HIV) infection

Correct answer: 4 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiviral medication and is used to treat HIV infection, in combination with other agents. It is not used to treat the conditions noted in the other options.

Zidovudine has been prescribed for a client who asks the nurse about the action of the medication. The nurse responds that this medication performs which function? 1. Increases neutrophils 2. Kills bacteria and fungi 3. Promotes the function of natural killer cells 4.Slows the replication of human immunodeficiency virus (HIV)

Correct answer: 4 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It interferes with viral RNA-dependent DNA polymerase, an enzyme necessary for viral HIV replication. It slows HIV replication, reducing the progression of HIV infection. Zidovudine does not increase neutrophils, kill bacteria and fungi, or promote the function of natural killer cells.

The nurse is collecting subjective and objective data from a client and notes that the client is taking zidovudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Ulcerative colitis 2. Hyperthyroidism 3. Addison's disease 4.Human immunodeficiency virus (HIV) infection

Correct answer: 4 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It is not used to treat ulcerative colitis, hyperthyroidism, or Addison's disease.

Zidovudine has been prescribed for a client, and the nurse provides instructions to the client about expected effects with this medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "This medication can cause some nausea." 3. "I will have to have blood tests done periodically." 4."If I experience diarrhea, I need to contact my health care provider."

Correct answer: 4 Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other retroviral agents to treat human immunodeficiency virus (HIV) infection. Diarrhea is an occasional side effect of the medication and does not warrant notification of the health care provider. Monitoring temperature, knowing that nausea can occur, and understanding the need for periodic blood tests reflect an understanding of the medication instructions.

Itraconazole is prescribed for a client to treat a fungal infection. The nurse monitors the client closely for which manifestation that is indicative of an adverse effect? 1. Diarrhea 2. Headache 3. Increased urine output 4.Anorexia and abdominal pain

Correct answer: 4 Rationale: Itraconazole is an antifungal medication. Hepatitis is an adverse effect associated with the medication, and if anorexia of any degree, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice develops, the health care provider should be notified.

Itraconazole is prescribed for a client with a fungal infection of the hands. The nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "I should take the medication on an empty stomach." 2. "I should decrease my fluid intake while taking the medication." 3. "I may become unusually fatigued while taking this medication." 4."If my urine becomes very dark in color, I should contact my health care provider (HCP)."

Correct answer: 4 Rationale: Itraconazole is an antifungal medication. The client should be instructed to take the medication with food because it increases the absorption of the medication. Fluid should be increased to prevent constipation, which can occur as a side effect. Hepatitis is an adverse reaction associated with the medication, and if anorexia of any degree, abdominal pain, unusual tiredness or weakness, dark urine, or jaundice develops, the HCP should be notified.

The nurse notes that a client is receiving lamivudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4.Human immunodeficiency virus (HIV)

Correct answer: 4 Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and provide prophylaxis in health care workers who are at risk of acquiring HIV infection after occupational exposure to the virus. This medication is not used to treat the conditions identified in the remaining options.

A client who is receiving nitrofurantoin calls the clinic complaining of troublesome effects related to the medication. Which side or adverse effect(s) indicates the need to stop treatment with this medication? 1. Nausea 2. Anorexia 3. Diarrhea 4.Cough and chest pain

Correct answer: 4 Rationale: Nitrofurantoin is an antimicrobial medication. Gastrointestinal (GI) effects are the most frequent side effects to this medication and can be minimized by administering the medication with milk or meals. However, they are not an indication for discontinuing the medication. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on radiography, indicate the need to stop the treatment. These abnormalities typically resolve in 2 to 4 days after discontinuation of this medication.

The school nurse is providing instructions to the parents of the children attending the school regarding the application of permethrin. Which action should the nurse tell the parents to take? 1. Apply permethrin before washing the hair. 2. Apply permethrin at bedtime and rinse it off in the morning. 3. Avoid saturating the hair and scalp when applying permethrin. 4.Allow permethrin to remain on the hair for 10 minutes and then rinse with water.

Correct answer: 4 Rationale: Permethrin is a medication that may be prescribed to treat scabies. The instructions for the use of permethrin include wash, rinse, and towel-dry the hair; apply sufficient volume to saturate the hair and scalp; allow the medication to remain on the hair for 10 minutes; and then rinse with water. The remaining options are incorrect instructions.

A client is receiving tacrolimus to prevent organ rejection. Which is a nursing consideration associated with this medication? 1. Give with cyclosporine. 2. Assess for hypoglycemia. 3. Give with grapefruit juice. 4.Assess platelet count for thrombocytopenia.

Correct answer: 4 Rationale: Tacrolimus is an immunosuppressant and is an alternative to cyclosporine for prevention of organ rejection in clients receiving an organ transplant. It should never be given with cyclosporine because of its toxic effects on the kidney. This medication will cause hyperglycemia (not hypoglycemia). Grapefruit juice can increase tacrolimus levels, so it should be avoided to prevent toxicity. Tacrolimus suppresses the bone marrow, so it can cause anemia, thrombocytopenia, and neutropenia.

A child has been prescribed tetracycline hydrochloride. The nurse providing medication information to the mother should plan to emphasize which instruction about giving this medication to the child? 1. Give the medication with milk. 2. Give the medication with ice cream. 3. Mix the medication in a Styrofoam cup. 4.Use a straw when giving the medication.

Correct answer: 4 Rationale: Tetracycline is an antibiotic. Because tetracycline can cause staining of the teeth, straws should be used and the mouth rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk, which would eliminate the options of giving the medication with milk or ice cream. Mixing the medication in a Styrofoam cup is unnecessary.

The client is receiving tobramycin intravenously every 8 hours. Which finding would indicate to the nurse that the client is experiencing an adverse medication effect? 1. A sedimentation rate of 10 mm/hr (10 mm/hr) 2. A total bilirubin level of 0.5 mg/dL (8.5 mcmol/L) 3. A white blood cell count of 6000 mm3 (6 × 109/L). 4.A blood urea nitrogen (BUN) level of 30 mg/dL (10.8 mmol/L)

Correct answer: 4 Rationale: Tobramycin is an aminoglycoside. Adverse effects of tobramycin include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus, dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances. The normal BUN concentration is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal sedimentation rate is less than or equal to 15 mm/hr. The normal total bilirubin level is 0.3 to 1.0 mg/dL (5.1 to 17 mcmol/L). A normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L)

The nurse is about to administer the next intravenous dose of tobramycin when the client complains of vertigo and a ringing in the ears. What is the most appropriate nursing action? 1. Hang the dose immediately. 2. Check the client's pupillary responses. 3. Give a dose of droperidol with the tobramycin. 4.Withhold the dose and call the health care provider (HCP).

Correct answer: 4 Rationale: Tobramycin is an aminoglycoside. Ringing in the ears and vertigo are symptoms that may indicate dysfunction of the eighth cranial nerve. Ototoxicity is a toxic effect of therapy with aminoglycosides and could result in permanent hearing loss. The nurse should withhold the dose and notify the HCP. The remaining options are inappropriate nursing actions.

A client with acquired immunodeficiency syndrome who is taking zidovudine 200 mg orally 3 times daily has severe neutropenia noted on follow-up laboratory studies. The nurse interprets that which change is likely to occur at this point? 1.The medication dose probably will be reduced. 2.Prednisone probably will be added to the medication regimen. 3.Epoetin alfa probably will be added to the medication regimen. 4.The medication probably will be discontinued until laboratory results indicate bone marrow recovery.

Correct answer: 4 Rationale: Zidovudine is a nucleoside-nucleotide reverse transcriptase inhibitor. Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or severe neutropenia develops, treatment should be discontinued until evidence of bone marrow recovery is noted. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is administered to clients experiencing anemia.