Immune System Patho Pharm

19.The client diagnosed with AIDS has a positive skin test for tuberculosis. Which medication order should the nurse anticipate? 1.Fluconazole (Diflucan), an antifungal. 2.Ethambutol (Myambutol), an anti-infective. 3.Acyclovir (Zovirax), an antiviral. 4.Enfuvirtide (Fuzeon), an HIV fusion inhibitor.

Answer: 2 Rationale: 1.Diflucan treats fungal infections, and Mycobacterium avium complex (tuberculosis) is a bacterium. 2.Ethambutol is a treatment for tuberculosis. 3.Zovirax treats viral infections, and the causative agent for tuberculosis is a bacterium. 4. This is the newest classification of drugs used to treat HIV viral infections, but it is effective against viruses, not bacteria.

13.The pregnant client's HIV test is positive. Which medication should the client take to prevent transmission of the virus to the fetus? 1.Efavirenz (Sustiva), a non-nucleoside reverse transcriptase inhibitor. 2.Lopinavir (Kaletra), a protease inhibitor. 3.Zidovudine (AZT), a nucleoside reverse transcriptase inhibitor. 4.Ganciclovir (Cytovene), an antiviral.

Answer: 3 Rationale: 1.Sustiva is not approved for prevention of transmission of HIV in pregnant women. 2.Kaletra is not approved for prevention of transmission of HIV to the fetus. 3.Although AZT is a pregnancy category C drug, research has proved that taking the drug during pregnancy reduces the risk of maternal-to-fetal transmission of the HIV virus by almost 70%. This is the only medication approved for this purpose. 4.Ganciclovir is not approved for prevention f transmission of HIV to the fetus.

88. 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 preventionof 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.

120. 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).

105. 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.

26. 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.

64. 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.

78. 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.

114. 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.

109. 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.

1. 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.

41. 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.

71. 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.

103. 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.

31. 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.

An 87-year-old client receives a pneumococcal vax, what type of immunity is achieved following this vaccine inoculation?

acquired active immunity

The client diagnosed w acquired immunodeficiency syndrome (AIDS) is prescribed a combo of a protease inhibitor, a non nucleoside reverse transcriptase inhibitor, and two nucleoside reverse transcriptase inhibitors. Which statement best describes the scientific rationale for combining these meds? A. the combo prevents or delays the client's complications from HIV infect b. Multiple meds are needed to eradicate infection c. combo is less expensive

A. the combo prevents or delays the client's complications from HIV infect

21.The client with allergies is prescribed diphenhydramine (Benadryl), an antihistamine. Which statement indicates the client understands the teaching concerning this medication? 1."If I get any ringing in my ears, I should notify my HCP." 2."I will probably get drowsy when I take this medication." 3."It is not uncommon to get a buffalo hump or moon face." 4."I will have to taper off the medications when I quit taking them."

Answer: 2 Rationale: 1.Tinnitus (ringing in the ears) is not a side effect of antihistamines; tinnitus usually occurs with aspirin toxicity. 2.Antihistamines cause drowsiness; therefore, the client should avoid driving or engaging in hazardous activities. 3.A buffalo hump and moon face are side effects of glucocorticoids, not of antihistamines. 4.Benadryl does not require tapering when discontinuing the medication.

61. 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.

6. 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.

The home health nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis w trimethoprim sulfa? 1. the client has a positive HIV viral load 2. The client's WBC count is 5000 3. The client has a hacking cough 4. The client's CD4 count is less than 300/mm3

4. The client's CD4 count is less than 300/mm3

The client diagnosed with AIDS has a positive skin test for tuberculosis. Which medication order should the nurse anticipate? 1. Fluconazole (Diflucan), an antifungal. 2. Ethambutol (Myambutol), an anti-infective. 3. Acyclovir (Zovirax), an antiviral. 4. Enfuvirtide (Fuzeon), an HIV fusion inhibitor.

Answer 2. In a patient with AIDS, still treat with regular TB meds (Ethambutol is an anti TB drug).

The client has a severe anaphylactic reaction to insect bites. Which priority discharge intervention should the nurse discuss with the client? 1.Wear an insect repellent on exposed skin. 2. Keep prescribed antihistamines on their person. 3. Have an "EpiPen" available at all times. 4. Wear a MedicAlert identification bracelet

Answer 3. Clients with documented severe anaphylaxis should carry an EpiPen, which is a prescribed injectable device containing epinephrine.

Q1: A client develops sneezing, coughing, itchy eyes, and itchy skin when in contact with animals. The nurse realizes that this immune response is caused by which immune system cell? A. B cells B. T cells C. Natural killer cells D. Cytokines

Answer B: Rationale: T cells are activated in hypersensitivity reactions. Choice A produces antibodies in response to specific antigens. Choice C kills tumor cells, fungi, viral-infected cells, and foreign tissue. Choice D is incorrect because cytokines are hormone-like polypeptides that act as messengers of the immune system and facilitate communication between the different cells.

A client, prescribed prednisone after a liver transplant, develops hypertension. What mechanism is responsible for the development of hypertension? A. Renin-angiotensin II-aldosterone (RAAS) activation following transplant rejection. B. Prednisone mediated upregulation of vascular alpha 1 receptors C. Compensatory water retention due to increased lipoprotein production D. Prednisone mediated released of antidiuretic

Answer B: Prednisone is a synthetic glucocorticoid. Its actions mimic those of cortisol, which mediates the blood pressure via upregulation of alpha 1 receptors on vascular smooth muscle cells. Note that prednisone/cortisol only increase receptor number. Receptor activation is caused by norepinephrine. Choices A, C and D are incorrect. There is no indication that the client is rejecting the liver transplant. Symptoms of rejection include jaundice, easy bruising, encephalopathy and malaise (A). An increase in lipoprotein production and subsequent water retention is seen with nephrotic syndrome (C). Progesterone does not mediate the release of ADH (AHDF).

A client's white blood cell differential reveals an elevated monocyte count. What does this elevation indicate to the nurse? A. Acute infection B. Hypersensitivity reaction C. Chronic inflammatory disorder D. Chronic bacterial infection

Answer C Rationale: An elevated monocyte count is seen in chronic inflammatory disorders. Choice A would have an elevation in neutrophils. Choice B would show an elevation in eosinophils. Choice D would show an elevation in lymphocytes.

The home health nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa (Bactrim)? 1. The client has a positive HIV viral load. 2. The client's white blood cell count is 5000/mm3. 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3.

Answer4. The client with a CD4 count of less than 300/mm3 is at risk for developing Pneumocystis carinii pneumonia (PCP). Bactrim is prophylaxis for PCP. Normal levels for CD4 are 450-1400/mm3.

15.The client diagnosed with acquired immunodeficiency syndrome (AIDS) is prescribed a combination of a protease inhibitor, a non-nucleoside reverse transcriptase inhibitor, and two nucleoside reverse transcriptase inhibitors. Which statement best describes the scientific rationale for combining these medications? 1.The combination prevents or delays the client's complications from HIV infection. 2.Multiple medications are needed to eradicate all of the HIV infection. 3.The combination of medications is less expensive than hospitalization for HIV. 4.Protease inhibitors counteract the side effects of the other medications.

Answer: 1 Rationale: 1. The current treatment is a combination of HAART (highly active antiretroviral therapy) medications. These medications can decrease HIV detectable levels with current technology. They are not a cure, are expensive, and have serious side effects, but the mortality rate from AIDS has decreased 70% with this therapy. 2. The problem with a retrovirus is that it does not die until the host dies. The medications delay the onset of problems. There is no cure for an HIV infection. 3. The medications can cost$24,000-$30,000 per year, and hospitalization would be more expensive, but this is not the reason for the medications to be prescribed. 4.Protease inhibitors have their own side effects and can complicate the side effects from the other medications.

11.The clinic nurse is discussing medication compliance with a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which information should the nurse discuss with the client? 1.The availability of insurance to pay for the medications. 2.Whether the client wants to try to manage the disease without medications. 3.Include over-the-counter herbs in the medication regimen. 4.The importance of taking multiple vitamins at least twice a day.

Answer: 1 Rationale: 1.If the client does not have insurance to help pay for the medications, the client may have trouble complying with the regimen. The current regimens include four or more daily medications costing more than $6000 per drug per year. 2.Currently, AIDS cannot be managed with-out the use of medications. With the medications, it is possible to reduce the viral load to undetectable in serum samples. 3.Many over-the-counter medications and herbs interact with the medications used to treat AIDS. The nurse should assess each over-the-counter preparation taken by the client but should not encourage their use. 4.One multiple vitamin is usually sufficient. The body excretes any water-soluble vitamin that is not needed. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

26.The clinic nurse is discussing over-the-counter (OTC) oxymetazoline (Afrin 12 Hour Nasal Spray), a sympathomimetic, with a client experiencing nasal congestion. Which information should the nurse discuss with the client? 1.Do not use the Afrin spray any longer than 3-5 days. 2.Clear the nose immediately after using the nasal spray. 3.Immediately swallow the postnasal medication residue. 4.Take additional nasal sprays if congestion is not relieved.

Answer: 1 Rationale: 1.Prolonged use of sympathomimetic nasal sprays causes hyper secretion of mucous and nasal congestion to worsen once the drug effects wear off. This sometimes leads to a cycle of increased drug use, as the condition worsens. This rebound congestion is why it should not be used for more than 3-5 days. 2. The client should avoid clearing the nose immediately after spraying so that the medication can stay in the nares. 3. The postnasal medication should be spit out, not swallowed. 4. The medication should be administered exactly as prescribed; additional dosing will not speed relief of the nasal congestion.

28.Which interventions should the nurse implement for the elderly client receiving antihistamine therapy? Select all that apply. 1.Auscultate the client's breath sounds. 2.Assess the client's level of consciousness. 3.Evaluate the client's intake and output. 4.Encourage the client to ambulate. 5.Provide an acid-ash diet for the client.

Answer: 1, 2, 3 Rationale: 1.Anticholinergic effects of antihistamines may trigger bronchospasms; therefore, the nurse should assess for wheezing or difficulty breathing. 2.Elderly clients are at an increased risk of increased sedation and other anti-cholinergic effects; therefore, the nurse should assess the level of consciousness. 3.Antihistamines promote urinary retention, and the nurse should ensure adequate intake and output. 4.Antihistamines cause drowsiness; there-fore, the nurse should institute safety and fall precautions and not encourage the client to ambulate without assistance. 5.There are no dietary precautions for clients taking antihistamines.

30.The nurse administers a dose of an intravenous antibiotic to the client. Twenty minutes later the client is complaining of shortness of breath, itching, and difficulty swallowing. Which intervention should the nurse implement first? 1.Prepare to administer subcutaneous epinephrine. 2.Discontinue the client's intravenous antibiotic. 3.Assess the client's apical pulse and blood pressure. 4.Administer 10 liters of oxygen via nasal cannula.

Answer: 2 Rationale: 1. The drug of choice for an anaphylactic reaction is epinephrine (Adrenalin) administered subcutaneously, but it is not the first intervention. 2. The nurse should realize that the client is having an allergic reaction to the intravenous antibiotic and immediately discontinue the medication. This is the nurse's first intervention. 3. The nurse should not take time to assess the client when it is apparent the client is having an allergic reaction to the antibiotic. 4.Oxygen should be applied, but it is not the nurse's first intervention in this situation. The antibiotic that is causing the anaphylactic reaction should be discontinued first.

12.The nurse received a needle stick with a contaminated needle from a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which medications should the nurse begin within hours of the needle stick? 1.A combination of antiviral and antifungal medications with an antibiotic. 2.A combination of a protease inhibitor and nucleoside reverse transcriptase inhibitors. 3.Single-agent therapy with a non-nucleoside transcriptase inhibitor. 4.No medications are recommended to prevent the conversion to HIV-positive.

Answer: 2 Rationale: 1.These medications treat actual infections and are sometimes administered prophylactically, but they will not prevent conversion to HIV-positive status. 2. The combination of specific medications depends on the health-care facility's protocol, but most include a combination of two nucleoside reverse transcriptase inhibitors and a protease inhibitor. The Centers for Disease Control and Prevention has a hotline that can be accessed for specific recommendations (800-458-5231 or www.cdc.gov). 3.Single-agent therapy is not recommended because of the speed at which the virus can mutate. 4.There are medications that can possibly prevent conversion to HIV-positive status.

14.The nurse is caring for clients diagnosed with acquired immunodeficiency syndrome (AIDS). Which actions by the unlicensed assistive personnel (UAP) warrants immediate action by the nurse? Select all that apply. 1.The UAP uses nonsterile gloves to empty the client's urinal. 2.The UAP is taking a glass of grapefruit juice to the client. 3.The UAP dons gloves to remove the client's meal tray. 4.The UAP provides a tube of moisture barrier cream to a client. 5.The UAP fills the client's water pitcher with ice and water.

Answer: 2, 3 Rationale: 1. This is standard precaution and does not require intervention by the nurse. 2.Many of the protease inhibitors used to treat AIDS interact with grapefruit juice. The nurse should stop the UAP until the nurse can determine if the client is receiving a medication that would interact with the grapefruit juice. 3. The client's meal tray does not have body fluids that can transmit the HIV virus to the UAP; therefore, this action warrants intervention from the nurse. The UAP needs to understand how the HIV virus is transmitted. 4. The client can apply his or her own moisture barrier protection cream. This does not warrant immediate intervention by the nurse.5. This is a comfort measure and does not warrant intervention by the nurse. MEDICATION MEMORY JOGGER: Grape-fruit juice can inhibit the metabolism of certain medications. Specifically, grape-fruit juice inhibits cytochrome P450-3A4found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grapefruit juice.

17.The client diagnosed with AIDS is to receive an initial dose of amphotericin B (Fungizone), an antifungal agent. Which intervention should the nurse implement first? 1.Administer IVPB in 500 mL of D5W over 6 hours. 2.Administer Demerol 25 mg IVP over 5 minutes. 3.Administer a test dose of 1 mg over 20 minutes. 4.Administer acetaminophen (Tylenol) 650 mg orally.

Answer: 3 Rationale: 1. The medication should be administered daily over 6 hours but not before the nurse knows the client will not have a re-action to the medication. Amphotericin Bis compatible only with D5W. 2.Demerol is used as a premedication to prevent an extrapyramidal reaction. 3. The first action by the nurse is to administer a small test dose of Fungizone to assess for the client's potential response. 4. This is done to prevent a febrile reaction to the medication.

18.The client diagnosed with AIDS and cytomegalovirus retinitis is prescribed the antiviral agent ganciclovir (Cytovene). The client has a single lumen implanted port. Which information about the medication should the home health nurse discuss with the client? 1.The client will have to take the medication for the rest of his or her life. 2.The client will take the medication for 1 week each month. 3.The medication should infuse over 1 hour every day. 4.The medication can run simultaneously with the client's TPN.

Answer: 3 Rationale: 1.Before HAART (highly active antiretroviral therapy), the client would have had to continue taking ganciclovir for the rest of his or her life to prevent blindness; now with HAART, however, the CD4 counts are able to rebound and the client usually only needs to take the medication for 3-6 months. 2. This is not the regimen for ganciclovir. Itis administered daily. 3.Initial therapy is intravenous and care must be taken not to infuse the medication too rapidly. The infusion should be administered on a pump over 1 hour. 4. The medication is incompatible with TPN. MEDICATION MEMORY JOGGER: Nothing should run in the same line as TPN. This is an infection-control issue.

22.The client has a severe anaphylactic reaction to insect bites. Which priority discharge intervention should the nurse discuss with the client? 1.Wear an insect repellent on exposed skin. 2.Keep prescribed antihistamines on their person. 3.Have an "Epi Pen" available at all times. 4.Wear a Medic-Alert identification bracelet.

Answer: 3 Rationale: 1.Wearing insect repellent is an appropriate intervention, but if the client has an insect bite, the repellent will not help prevent anaphylaxis. Therefore, this is not the priority intervention. 2.Antihistamines are used in clients with anaphylaxis, but it takes at least 30 minutes for the medication to work, and if the client has an insect bite, it is not the priority medication. 3.Clients with documented severe anaphylaxis should carry an Epi Pen, which is a prescribed injectable device containing epinephrine that the client can administer to himself or herself in case of an insect bite. This will save the client's life; therefore, this is the priority intervention. 4. The client should wear an identification bracelet stating the allergy, but it will not help the client if he or she is bitten by an insect; therefore, it is not the priority intervention.

29.The health-care provider has prescribed the topical steroid hydrocortisone for a client experiencing allergic dermatitis. Which instruction should the nurse discuss with the client? 1.Wash the inflamed area with soap and water. 2.Apply an adherent dressing after applying the medication. 3.Rub the cream into the irritated and inflamed area. 4.Wash the hands before applying the topical steroid.

Answer: 4 Rationale: 1. The area should be washed with warm water before applying the cream; instruct the client not to use soap, which could further irritate the area. 2. The area should be left open after the medication is applied. An adherent dressing may stick to the area and cause further irritation of the affected area. 3. The cream should be applied gently to the in flamed area; it should not be rubbed into the area. 4. The client should have clean hands before applying the cream to the affected area to help prevent infection.

16.The home health nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa (Bactrim)? 1.The client has a positive HIV viral load. 2.The client's white blood cell count is 5000/mm3. 3.The client has a hacking cough and dyspnea. 4.The client's CD4 count is less than 300/mm3.

Answer: 4 Rationale: 1. The client who is HIV positive could be expected to have a positive viral load. This is a reason to institute HAART (highly active antiretroviral therapy) but not Bactrim. 2. This is a normal WBC count and is not areas on to start a prophylactic antibiotic. 3. This client is showing symptoms of Pneumocystis carinii pneumonia (PCP); any treatment now would not be prophylactic. 4. The client with a CD4 count of less than 300/mm3is at risk for developing Pneumocystis carinii pneumonia (PCP). Bactrim is prophylaxis for PCP. Nor-mal levels for CD4 are 450-1400/mm3.

27.The male client taking a nasal glucocorticoid spray calls the clinic nurse and reports that the medication is not helping his condition. Which question should the nurse ask the client first? 1."Are you sure you are taking the spray correctly?" 2."Did you shake the bottle before taking the spray?" 3."What time of the day are you taking the medication?" 4."How long have you been using the spray?"

Answer: 4 Rationale: 1. This is an appropriate question, but it is not the first question the nurse should ask the client. 2. The spray bottle should be shaken thoroughly, but this is not the first question the nurse should ask the client. 3. The client should take the medication as prescribed, but this is not the first question the nurse should ask the client. 4. The medication may take 2-4 weeks to be effective. Therefore, the nurse should first determine how long the client has been taking the medication.

1.The nurse is administering medications to the clients on a medical unit. Which medication should the nurse question be administering? 1.Atropine, an anti-muscarinic, to a client with myasthenia gravis. 2.Chloroquine, an antimalarial, to a client with a butterfly rash. 3.Prednisone, a corticosteroid, to a client with polymyalgia rheumatica. 4.Mestinon, a cholinesterase inhibitor, to a client in a cholinergic crisis.

Answer: 4 Rationale: 1.Atropine works in an opposite manner from the cholinesterase inhibitors administered to treat myasthenia gravis, but atropine in small doses is prescribed to reduce the gastrointestinal side effects of the cholinesterase inhibitor. The nurse would not question this medication. 2. The antimalarial medications are prescribed to treat cutaneous lupus erythematosus. The nurse would not question this medication. 3. The client diagnosed with polymyalgia rheumatica must take the prescribed steroid medication or he or she can become blind. The nurse would not question this medication. 4.Mestinon is prescribed to increase the available amount of acetylcholine for muscle movement. A client in a cholinergic crisis has too much medication on board. The nurse would question administering this medication until the crisis is resolved.

23.The client with seasonal allergic rhinitis is prescribed fluticasone (Flonase), an intranasal glucocorticosteroid. Which intervention should the nurse implement first? 1.Instruct the client not to eat licorice. 2.Explain that this is for short-term use. 3.Instruct not to use other nasal decongestants. 4.Assess the nares for excoriation or bleeding.

Answer: 4 Rationale: 1.Glucocorticoid intranasal spray should be used with caution in clients taking herbal supplements such as licorice, which may potentiate the effects of glucocorticoids, but this is not the first intervention the nurse should implement. 2.Therapy usually begins with two sprays in each nostril twice a day and then decreases to one dose per day for a specific period. The nurse should educate the client, but this is not the first intervention. 3.Concomitant use of a local nasal decongestant spray may increase the risk of nasal irritation or bleeding. Both sprays may be used together for a client with chronic rhinitis but not for seasonal allergies. The nurse should educate the client, but this is not the first intervention. 4. The nurse must first assess the client's nares because broken mucous membranes allow direct access to the blood-stream, increasing the likelihood of systemic effects of the drug. Therefore, this is the first intervention the nurse should implement. The HCP may not prescribe the medication if nasal excoriation or bleeding is present. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

2.The client diagnosed with systemic lupus erythematosus (SLE) is experiencing an acute exacerbation and the HCP has ordered high doses of glucocorticoid medications. Which statement supports the goal of this therapy? 1.To provide a permanent cure for lupus. 2.To allow a peaceful, dignified death. 3.To help enable the client to maintain weight. 4.To prevent permanent damage to the organs.

Answer: 4 Rationale: 1.There is no cure for SLE. The goal of treatment is to prevent or minimize damage to the internal organs. 2. The goal is not death, but to assist the client to live as full a life as possible. 3. The medication may have a side effect of weight gain, but this is not the desired result. 4. The goal of high-dose steroids during an exacerbation is to decrease the inflammatory response in the internal organs and prevent permanent damage.

The nurse received a needle stick w a contaminated needle from a client diagnosed w AIDS. Which meds should the nurse begin within hours of the needle stick? A. A combo of antiviral and antifungal B. combo of protease inhibitors and nucleoside reverse transcriptase inhibitors

B. combo of protease inhibitors and nucleoside reverse transcriptase inhibitors

35. 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.

104. 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.

45. 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.

89. 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 preventionof 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.

57. 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 he 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.

87. 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.

24. 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 glucocorticoidssuch as prednisone is recommended during administration of this medication. The medications in the remaining options would not be prescribed unless a secondary disorder existed.

15. 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: Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. 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 of Cyclosporine include infection, nephrotoxicity, infection; hepatotoxicity; hypertension. leukopenia, hyperkalemia; ¯ urine flow (oliguria), and hirsutism. The remaining options are unrelated to the use of this medication.

113. 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.

70. 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

75. 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.

76. 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.

77. 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

51. 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.

121. 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.

94. 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.

66. 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.

119. 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.

10. 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: 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 antimicrobial used to treat PCP. Frequent side and adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The remaining options are inaccurate interpretations.

33. 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.

36. 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.

112. 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.

62. 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.

47. 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.

72. 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.

79. 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.

110. 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.