Pharm 2
A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? a. "Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." b. "Benzodiazepines promote sleep through effects on the limbic system." c. "Benzodiazepines depress neuronal functions by acting at a single site in the brain." d. "Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system."
a. "Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." All beneficial and most adverse effects of benzodiazepines occur from depressant actions in the central nervous system (CNS); the various effects depend on the site of action. Anterograde amnesia is the result of effects in the hippocampus and the cerebral cortex. Benzodiazepines act at multiple sites in the CNS. Muscle relaxant effects are the result of actions on supraspinal motor areas in the CNS. Benzodiazepines promote sleep through effects on cortical areas and on the sleep-wakefulness "clock."
A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct? a. "You will need to take only two drugs for the next 4 months." b. "As long as you remain symptomatic, you will not have to take more medication." c. "The four-drug regimen will continue for 3 more months." d. "You will have to take maintenance drugs indefinitely."
a. "You will need to take only two drugs for the next 4 months." Patients with drug-sensitive tuberculosis take four drugs for 2 months during the induction phase, followed by two drugs for 4 months in the continuation phase. Drug therapy does not stop after the induction phase, even for asymptomatic patients. Although drug therapy is prolonged, it is not indefinite.
A nurse provides teaching for a patient about to begin taking an first-generation antipsychotic (FGA) drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs? a. "Sedation may occur initially, but will subside in 1 to 2 weeks." b. "I may feel lightheaded or dizzy and should sit or lie down if this occurs." c. "Dry mouth and constipation are uncommon with this medication." d. "I may experience gynecomastia and galactorrhea."
c. "Dry mouth and constipation are uncommon with this medication." Anticholinergic effects are common with FGAs, so this statement indicates a need for further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can occur with FGAs.
A patient who has fibromyalgia is diagnosed with major depression. The provider orders a tricylic antidepressant (TCA). The nurse will teach this patient to: a. avoid foods containing tyrosine. b. take the medication in the morning. c. sit or lie down when feeling lightheaded. d. consume alcohol in moderation.
c. sit or lie down when feeling lightheaded. Orthostatic hypotension can occur with TCAs. Patients should be advised to sit or lie down if they feel lightheaded to prevent falls. Foods containing tyrosine cause adverse effects in patients taking MAOIs. Patients taking TCAs should be counseled to avoid all alcohol. Because TCAs cause sedation, the medication should be taken at bedtime.
A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic? a. Norfloxacin [Noroxin] b. Daptomycin [Cubicin] c. Ciprofloxacin [Cipro] d. Levofloxacin [Levaquin]
b. Daptomycin [Cubicin] Daptomycin is active against MRSA. Levofloxacin and norfloxacin are not approved to treat MRSA. Ciprofloxacin is a poor choice for staphylococcal infections, including MRSA.
A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every other day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching? a. "I may need to take potassium supplements while taking this drug." b. "I will need to have blood drawn for serum creatinine and BUN levels every 3 to 4 days." c. "I may experience headaches and pain in my lower back, legs, and abdomen." d. "I should take acetaminophen and diphenhydramine before each infusion."
c. "I may experience headaches and pain in my lower back, legs, and abdomen." Headaches, lower back pain, leg pain, and abdominal pain occur with intrathecal administration of amphotericin B. Patients taking amphotericin may experience hypokalemia and may need potassium supplements. Acetaminophen and diphenhydramine should be taken to minimize infusion reaction effects. Renal function should be monitored every 3 to 4 days during treatment.
A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching? a. "This medication will help my child focus so he can learn new behaviors." b. "I should report insomnia and poor appetite to his provider." c. "This drug will make him less impulsive while he's at school." d. "I will make sure he takes his medication after breakfast every day."
c. "This drug will make him less impulsive while he's at school." Stimulants do not suppress negative behaviors directly and do not directly cause a decrease in hyperactivity. They act by improving attention and focus so that positive behaviors can be learned to replace negative behaviors. Insomnia and poor appetite are common side effects and should be reported to the provider, because alternate dosing regimens often counteract these effects. Taking the medication either during or after breakfast prevents morning appetite suppression at breakfast time. Stimulants improve focus and allow new, more positive behaviors to be learned.
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? a. "Cephalosporins have increased activity against gram-negative bacteria with each generation." b. "Cephalosporins are assigned to generations based on their relative costs to administer." c. "Later generations of cephalosporins have lower resistance to destruction by beta-lactamases." d. "First-generation cephalosporins have better penetration of the cerebrospinal fluid."
a. "Cephalosporins have increased activity against gram-negative bacteria with each generation." With each progression from first-generation agents to fifth-generation agents, the cephalosporins show increased activity against gram-negative organisms, increased resistance to destruction by beta-lactamases, and increased ability to reach the CSF. Cost is not a definitive factor. First-generation drugs have less penetration of the CSF. Resistance to destruction by beta-lactamases increases with increasing generations.
The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching? a. "I may have a deficiency of vitamin B6." b. "I may be more susceptible to infection from neutropenia." c. "I may experience fatigue from anemia." d. "I may have a deficiency of folic acid."
a. "I may have a deficiency of vitamin B6." A deficiency of vitamin B12, not vitamin B6, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.
A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do? a. Administer the dose and tell the patient that the side effects are temporary. b. Contact the prescriber to request an order for serum electrolytes. c. Hold the dose and notify the prescriber of the patient's lithium level. d. Request an order for amiloride [Midamor].
a. Administer the dose and tell the patient that the side effects are temporary. This patient is experiencing side effects that are common and that occur at therapeutic levels of the drug. The lithium level is therapeutic and not toxic, so the nurse should give the dose and reassure the patient that the side effects will diminish over time. In the presence of low sodium, lithium can accumulate to toxic doses; therefore, if the lithium level were elevated, evaluating serum electrolytes would be advisable. The dose does not need to be withheld, because the patient does not have toxic levels of lithium. Amiloride is used if patients are experiencing lithium-induced polyuria, which this patient does not have.
A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him? a. Boceprevir is contraindicated in males whose partners are pregnant. b. He should use dual drug therapy with pegylated interferon alfa and ribavirin only. c. This combination drug therapy is safe for him to use. d. He should use a barrier contraceptive when having sex.
a. Boceprevir is contraindicated in males whose partners are pregnant. The triple combination is dangerous for pregnant women whose partners are using it, so it is contraindicated for any man whose partner is pregnant. Barrier contraceptives should be used by couples to prevent pregnancy when either partner is taking the triple combination therapy. Ribavirin is teratogenic and is not safe when a partner is pregnant. This combination is not safe for pregnant women whose partners are taking these drugs.
A family has just returned from a camping trip, and all family members have diarrhea and colicky abdominal pain after eating. The parents report that they drank water from a well while on the camping trip. While awaiting stool cultures, the nurse will expect the provider to order which agent empirically? a. Metronidazole [Flagyl] b. Iodoquinol [Yodoxin] c. Miltefosine [Impavido] d. Sodium stibogluconate [Pentostam]
a. Metronidazole [Flagyl] This family most likely has giardiasis, which can be acquired by drinking contaminated water. Metronidazole is the drug of choice for this infection. Iodoquinol is used for asymptomatic amebiasis. Miltefosine and sodium stibogluconate are used to treat leishmaniasis.
A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a. Secondary b. Tertiary c. Primary d. Congenital
a. Secondary Secondary syphilis occurs when the organism spreads to the bloodstream, causing systemic symptoms such as fever, headache, reduced appetite, and general malaise, along with enlarged lymph nodes and joint pain. Congenital syphilis occurs when infants are exposed to T. pallidum in utero; early symptoms include sores, rhinitis, and point tenderness over bones. Primary syphilis is characterized by a primary lesion, called a chancre, at the point of entry, along with enlarged lymph nodes. Tertiary syphilis develops 5 to 40 years after the initial infection and can involve the brain, heart, and other sites.
A patient taking metronidazole [Flagyl] for asymptomatic intestinal amebiasis complains of tingling and numbness of the hands and feet. What action by the nurse is most appropriate? a. Withhold the drug and notify the prescriber. b. Stress the need to avoid constrictive clothing and crossing the legs. c. Inform the patient that numbness is a common and reversible side effect. d. Encourage the patient to exercise to improve circulation.
a. Withhold the drug and notify the prescriber. The nurse should withhold the drug and notify the prescriber, because these symptoms may indicate neurologic involvement. Numbness is not a common side effect of metronidazole. Encouraging the patient to move the hands and feet frequently to improve circulation would not address the neurologic symptoms. Advising the patient to avoid constrictive clothing and crossing the legs would not address the neurologic symptoms.
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order: a. amoxicillin-clavulanic acid [Augmentin]. b. ampicillin. c. nafcillin. d. penicillin G [Benzylpenicillin].
a. amoxicillin-clavulanic acid [Augmentin]. Beta-lactamase inhibitors are drugs that inhibit bacterial beta-lactamases. These drugs are always given in combination with a penicillinase-sensitive penicillin. Augmentin contains amoxicillin and clavulanic acid and is often used when patients fail to respond to amoxicillin alone. Ampicillin is similar to amoxicillin, but amoxicillin is preferred and, if drug resistance occurs, ampicillin is equally ineffective. Pharmaceutical chemists have developed a group of penicillins that are resistant to inactivation by beta-lactamases (eg, nafcillin), but these drugs are indicated only for penicillinase-producing strains of staphylococci. Penicillin G would be as ineffective as amoxicillin if beta-lactamase is present.
A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to: a. discontinue the gentamicin. b. give an analgesic to control headache discomfort. c. obtain a gentamicin trough before the next dose is given d. obtain renal function tests to evaluate for potential nephrotoxicity.
a. discontinue the gentamicin. A persistent headache may be a sign of developing ototoxicity, and since ototoxicity is largely irreversible, gentamicin should be withdrawn at the first sign of developing ototoxicity. A gentamicin trough should be obtained before the next dose is given when high gentamicin levels are suspects. Analgesics are not indicated until a serious cause of the headache has been ruled out. A headache is an early sign of ototoxicity, not nephrotoxicity.
A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: a. height and weight. b. results of an electrocardiogram (ECG). c. family history of psychosis. d. renal function.
a. height and weight. Side effects of methylphenidate include a reduced appetite, and children taking these drugs should be monitored for growth suppression. Baseline height and weight measurements help with this ongoing assessment. The value of an ECG for children has not been proven, except when known heart disease is a factor. Excessive use of stimulants can produce a state of psychosis but is not related to the family history. Renal function tests are not indicated.
A patient has been taking haloperidol for two months and has become restless and constantly needs to be in motion. Which statement by the nurse indicates a need for further education? a. "This patient may need to take a benzodiazepine or a beta blocker." b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the haloperidol." c. "Anticholinergic medications may help control these symptoms." d. "The provider may try a low-potency first generation antipsychotic instead of the haloperidol."
b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the haloperidol." The patient is showing signs of akathisia, which can resemble an exacerbation of psychosis. If the two are confused and the provider orders more of the FGA, the symptoms may actually increase. Anticholinergic medications may be used, a low-potency FGA may be ordered, or a benzodiazepine or beta blocker may be prescribed.
A nurse is teaching a parent about treating a child for scabies. Which statement by the parent indicates understanding of the treatment? a. "I will apply the cream to the visible burrows and areas of itching." b. "I should wash all bedding and clothing as well as applying the medicine." c. "The cream may cause systemic side effects." d. "More than one application of the cream may be needed."
b. "I should wash all bedding and clothing as well as applying the medicine." Besides applying a pesticide-containing cream or lotion, bedding and clothing should be washed to prevent reinfestation. The cream should be applied to the entire body from the neck down, not just areas of irritation. Only one application is necessary. The cream does not cause systemic side effects.
A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient? a. "Stop taking the drug immediately and resume taking it once your symptoms subside." b. "You will need laboratory tests to determine if these are serious effects of the drug." c. "Take the drug with food to minimize these side effects." d. "Take the medication in the evening to avoid experiencing these kinds of symptoms."
b. "You will need laboratory tests to determine if these are serious effects of the drug." As with all NRTIs, pancreatitis may occur and may manifest as nausea, vomiting, and abdominal pain. The patient will need evaluation of serum amylase, triglycerides, and calcium. Taking the drug with food or at a different time of day are not indicated. It is not correct to discontinue the drug and to resume it when symptoms subside, since pancreatitis may be fatal.
A patient whose spouse has died recently reports feeling down most of each day for the past three months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost five pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? a. Bipolar depression b. Major depression c. Grief and sadness d. Hypomania
b. Major depression This patient has symptoms of major depression, which include depressed mood, loss of pleasure in usual activities, insomnia, weight loss, and feelings of fatigue. For a diagnosis of major depression, these symptoms must be present most of the day, nearly every day, for at least 2 weeks. Grief and sadness and situational depression are common responses to the death of a loved one, but this patient's symptoms go beyond this normal response. This patient does not show signs of hypomania.
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? a. Administering the antibiotic immediately b. Obtaining all cultures before the antibiotic is administered c. Delaying administration of the antibiotic until the culture results are available d. Administering antipyretics as soon as possible
b. Obtaining all cultures before the antibiotic is administered It is essential that samples of exudates and body fluids (in this case, blood cultures) be obtained for culture before initiation of treatment. Administration of the antibiotic is important but not more important than obtaining specimens for culture. Antipyretics may be indicated, but the priority is obtaining specimens for culture. Treatment may be initiated before the test results are available.
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Request an order to increase this patient's dose of glucocorticoids. b. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. c. Question the patient about the consumption of milk and any other dairy products. d. Instruct the patient to exercise the right foot and ankle to minimize the pain.
b. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at highest risk are children, patients older than 60 years, transplant patients, and any patients taking glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out. Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not correct to request an increase in the glucocorticoid dosing.
A patient who has human immunodeficiency virus (HIV) infection has developed pneumocystis pneumonia (PCP) and will receive parenteral pentamidine [Pentam 300]. The nurse caring for this patient will: a. teach the patient that darkening of the urine may occur with this drug. b. administer the drug with the patient supine and monitor the blood pressure closely. c. tell the patient to report yellow discoloration of the sclerae. d. inform the patient to report coughing and shortness of breath.
b. administer the drug with the patient supine and monitor the blood pressure closely. Parenteral pentamidine can cause sudden and severe hypotension in 1% of patients, so patients should receive the drug while lying down, and nurses should monitor the blood pressure while giving the drug. Coughing and shortness of breath occur with the inhaled form of the drug. Darkening of the urine is a side effect of metronidazole. Yellow discoloration of the sclerae occurs with nitazoxanide.
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: a. inhibit autolysins. b. disrupt bacterial cell wall synthesis. c. disinhibit transpeptidases. d. inhibit host cell wall function.
b. disrupt bacterial cell wall synthesis. PCNs weaken the cell wall, causing bacteria to take up excessive amounts of water and subsequently rupture. PCNs inhibit transpeptidases and disinhibit autolysins. PCNs do not affect the cell walls of the host.
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a. hypoglycemia. b. kernicterus. c. rash. d. birth defects.
b. kernicterus. Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain. Sulfonamides promote kernicterus by displacing bilirubin from plasma proteins. Sulfonamides should not be given to infants under 2 months of age or to pregnant women after 32 weeks' gestation. Sulfonamides do not cause birth defects or hypoglycemia. Serious rashes may occur but are not the primary concern in the newborn.
A patient is being treated for trichinosis. The patient asks the nurse why the provider has ordered prednisone in addition to the anthelmintic medication. The nurse will tell this patient that this is ordered to: a. suppress the patient's allergic response to the anthelmintic agent. b. reduce the inflammation that occurs during larval migration. c. suppress dermatologic symptoms that occur with heavy infestation. d. prevent swelling of the legs caused by larval infestation of lymphatics.
b. reduce the inflammation that occurs during larval migration. Trichinosis is acquired by eating undercooked pork containing encysted larvae, which migrate from the intestine to the skeletal muscle. Prednisone is given to reduce the inflammation that results from larval migration. This parasite does not affect lymphatics or cause elephantiasis. Prednisone is not given to counter allergic reactions to the drug. Dermatologic symptoms are not part of trichinosis infestations.
A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement? a. "Sun exposure will minimize the drug's effects." b. "Apply the medication over the entire body twice daily for 2 weeks." c. "Use the medication for at least 1 week after the symptoms have cleared." d. "This drug is effective after a single application."
c. "Use the medication for at least 1 week after the symptoms have cleared." The nurse should advise the patient to continue therapy for at least 1 week after the symptoms have cleared up. The medication should be applied only to affected areas. Sun exposure will not delay the effects of clotrimazole. The drug must be applied twice daily for several weeks.
A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Tinidazole [Tindamax] b. Azithromycin [Zithromax] c. Acyclovir [Zovirax] d. Metronidazole [Flagyl]
c. Acyclovir [Zovirax] Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. Azithromycin, metronidazole, and tinidazole are antibiotics and do not have antiviral effects.
A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication? a. Gentamicin b. Tobramycin c. Amikacin [Amikin] d. Paromomycin
c. Amikacin [Amikin] When resistance to gentamicin and tobramycin is common, amikacin is the drug of choice for initial treatment of aminoglycoside-sensitive infections. Gentamicin would not be indicated, because resistance is more likely to develop. Paromomycin is used only for local effects within the intestine and is given orally. Tobramycin is not indicated, because organisms can more readily develop resistance.
A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? a. Imipramine [Tofranil] b. Isocarboxazid [Marplan] c. Bupropion [Wellbutrin] d. Trazodone [Oleptro]
c. Bupropion [Wellbutrin] Bupropion does not cause weight gain, sexual dysfunction, or sedation, so it may be a useful adjunct to or substitute for an SSRI when those side effects become intolerable. Imipramine causes sedation. Isocarboxazid is an MAOI and is not used unless other drugs are ineffective. Trazodone causes sedation.
A patient arrives in the emergency department after a bicycle-automobile accident with multiple dirty abrasions. Which product might be used initially to cleanse this patient's wounds? a. Soap and water b. Isopropanol (isopropyl alcohol) c. Hydrogen peroxide d. Povidone iodine [Betadine]
c. Hydrogen peroxide Hydrogen peroxide does not have good antiseptic properties, because the antimicrobial component is destroyed by catalase in tissues. It is useful initially because the frothing that occurs when catalase liberates oxygen loosens debris and facilitates cleansing of a dirty wound. Isopropanol is irritating to the skin. Povidone iodine is used on intact skin. Soap and water can be used, but hard scrubbing is necessary on a dirty abrasion and can be painful.
A patient has been treated for an acute attack of P. vivax malaria. For relapse prevention, the nurse expects the provider to order which medication? a. Quinine [Qualaquin] b. Doxycycline [Vibramax] c. Primaquine phosphate d. Chloroquine [Aralen Phosphate]
c. Primaquine phosphate The agent of choice for preventing relapse of P. vivax malaria is primaquine, which is highly active against the hepatic forms of P. vivax. Chloroquine is the drug of choice for treating mild to moderate acute attacks of either type of malaria. Doxycycline is used for chloroquine-resistant malaria. Quinine has little effect on hepatic forms of malaria, so it is not useful for relapse prevention.
A clinic nurse is preparing to sterilize instruments used in clinic procedures. The nurse will place the instruments in glutaraldehyde [Cidex-7]. Which actions are necessary when using this product? (Select all that apply.) a. Acidifying the solution to improve its antiseptic properties b. Cleansing the hands with an alcohol-based hand rub c. Soaking the instruments for 10 hours or longer d. Removing blood from the instruments before soaking them e. Ensuring adequate ventilation in the room where the solution is used
c. Soaking the instruments for 10 hours or longer d. Removing blood from the instruments before soaking them e. Ensuring adequate ventilation in the room where the solution is used To completely eliminate bacterial spores, all blood first should be removed from the instruments and equipment, which then should be immersed in glutaraldehyde for at least 10 hours. Because fumes from the solution can irritate the respiratory tract, adequate ventilation is essential. The solution works best at an alkaline pH. Cleansing the hands is always a good idea but is not necessary to ensure proper sterilization of the instruments.
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: a. pegylated interferon alfa only until ALT levels are elevated. b. dual therapy with pegylated interferon alfa and ribavirin. c. no medication therapy at this time. d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.
c. no medication therapy at this time. Current recommendations are that treatment is used only for patients with HCV viremia, persistent elevation of ALT, and evidence of hepatic fibrosis and inflammation upon liver biopsy. Dual therapy has been the regimen of choice for patients with the above symptoms, but the addition of a protease inhibitor has been shown to improve outcomes. It is not correct to give pegylated interferon alfa until ALT levels are elevated. Triple drug therapy is used for patients with the above symptoms.
A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of: a. antibiotic resistance. b. liver disease. c. renal disease. d. interpatient variation.
c. renal disease. The aminoglycosides are eliminated primarily by the kidneys, so in patients with renal disease, doses should be reduced or the dosing interval should be increased to prevent toxicity. Patients with antibiotic resistance would be given amikacin. Interpatient variation may occur but cannot be known without knowing current drug levels. Aminoglycosides are not metabolized by the liver, so liver disease would not affect drug levels.
A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching? a. "I may not feel the effects of Buspar for a few weeks." b. "I may need to use a sedative medication if I experience insomnia." c. "I can drink alcohol when taking Buspar, but not grapefruit juice." d. "I should stop taking the Ativan when I start taking the Buspar."
d. "I should stop taking the Ativan when I start taking the Buspar." Ativan should not be withdrawn quickly; it must be tapered to prevent withdrawal symptoms. Moreover, Buspar does not have immediate effects. Because no cross-dependence occurs with these two medications, they may be taken together while the benzodiazepine is tapered. Because Buspar does not have sedative effects, patients can consume alcohol without increasing sedation. Levels of Buspar can be increased by grapefruit juice, leading to drowsiness and a feeling of dysphoria. Buspar can cause nervousness and excitement and does not have sedative effects, so patients with insomnia must use a sedative. Buspar does not have immediate effects.
A patient with schizophrenia is prescribed clozapine [Clozaril]. The nurse discusses the side effects of this medication with a nursing student. Which statement by the student nurse indicates a need for further teaching about this drug? a. "Use of this drug requires weekly evaluation of blood work." b. "Fever, sore throat, and sores in the mouth should be reported immediately." c. "Blood counts are necessary for several weeks after discontinuation of the drug." d. "If the absolute neutrophil count (ANC) is less than 3000, the drug will be discontinued permanently."
d. "If the absolute neutrophil count (ANC) is less than 3000, the drug will be discontinued permanently." Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops below 1000/mcL, the drug must be discontinued permanently. Blood counts must be evaluated weekly, and this evaluation should be continued for several weeks after withdrawal of the drug. Fever, sore throat, and mouth ulcers are symptoms of agranulocytosis and should be reported immediately.
A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient? a. "You must stop drinking before adequate treatment can begin." b. "You will begin a regimen of isoniazid and rifampin." c. "You must take rifampin daily for 4 months." d. "You must take isoniazid with close monitoring of hepatic function."
d. "You must take isoniazid with close monitoring of hepatic function." Isoniazid has an increased incidence of hepatotoxicity, especially when given with alcohol. Patients who consume alcohol or who have liver damage should receive isoniazid with caution and should have close monitoring of liver function. It is unrealistic to ask the alcoholic to stop drinking to undergo treatment. Rifampin is toxic to the liver, especially in alcoholics. Giving both drugs would only increase the risk of hepatotoxicity.
A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do? a. Request an order to change the penicillin to vancomycin. b. Give the gentamicin intravenously and the penicillin intramuscularly. c. Infuse the gentamicin and the penicillin together to prevent fluid overload. d. Administer gentamicin, flush the line, and then give the penicillin.
d. Administer gentamicin, flush the line, and then give the penicillin. Gentamicin should not be infused with penicillins in the same solution, because PCN inactivates gentamicin; therefore, the nurse should give one first, flush the line, and then give the other. The nurse cannot give a drug IM when it is ordered IV without an order from the prescriber. These two drugs should not be infused in the same solution. There is no indication for changing the PCN to vancomycin; that should be done for serious infections.
The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a. Ask the provider whether the ciprofloxacin can be given orally. b. Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. c. Request an order for concurrent administration of metronidazole [Flagyl]. d. Suggest that the provider order a different antibiotic for this patient.
d. Suggest that the provider order a different antibiotic for this patient. Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis and should not be given to these patients. It is not correct to administer the drug and monitor for this effect. Giving the drug by a different route will not alter this effect. Metronidazole is given when C. difficile occurs.
A recent immigrant from the Middle East is being treated for P. falciparum malaria and has completed a course of chloroquine [Aralen Phosphate]. What will the nurse do? a. Teach the patient to notify the provider if symptoms recur so that relapse medication may be started. b. Contact the provider to discuss nondrug methods to prevent reinfection, such as DEET insect repellents. c. Ask the provider about genetic screening for this patient before starting the next medication. d. Tell the patient that no further treatment is necessary, because relapse in unlikely.
d. Tell the patient that no further treatment is necessary, because relapse in unlikely. P. falciparum malaria does not relapse once a clinical cure has been achieved, so no further treatment is necessary. Although this patient is from the Middle East and is at increased risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency, genetic testing is unnecessary unless primaquine is given. Because no further treatment is indicated, genetic testing is not necessary. There is no need to use nondrug methods, because the patient is no longer in an area where infection is likely. This form of malaria will not relapse, so there is no need to teach the patient to report new symptoms.
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? a. The provider may increase the clindamycin dose to treat this infection. b. This is a known side effect of clindamycin, and the patient should consume extra fluids. c. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms. d. The patient should stop taking the clindamycin now and contact the provider immediately.
d. The patient should stop taking the clindamycin now and contact the provider immediately. Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity of clindamycin; if severe diarrhea occurs, the patient should be told to stop taking clindamycin immediately and to contact the provider so that treatment with vancomycin or metronidazole can be initiated. Increasing the dose of clindamycin will not treat this infection. Consuming extra fluids while still taking the clindamycin is not correct, because CDAD can be fatal if not treated. Taking Lomotil or bulk laxatives only slows the transit of the stools and does not treat the cause.
A parent has used permethrin [Nix] twice to treat head lice in a child. Two weeks after the last treatment, head lice are again found in the child's hair. The parent asks the nurse what to do. The nurse will recommend asking the child's provider about which therapy? a. Applying lindane 1% shampoo b. Ordering permethrin 5% [Elimite] c. Cutting the child's hair d. Using benzyl alcohol [Ulesfia]
d. Using benzyl alcohol [Ulesfia] Permethrin 1% [Nix] is the drug of choice for lice, but it fails in about 5% of patients as the result of drug resistance. When drug resistance occurs, patients should be treated with malathion or benzyl alcohol. Lindane has serious central nervous system (CNS) side effects and should not be used unless other treatments fail. Cutting the child's hair is not necessary. Permethrin 5% [Elimite] is used to treat scabies.
A child is seen in the clinic after complaining of intense perianal itching. The provider diagnoses the child with pinworms and orders mebendazole [Vermox]. The nurse will expect to teach the child's parents to: a. report serious adverse effects that can occur with death of the causative parasite. b. administer the drug with a high-fat meal to improve absorption. c. avoid driving or other hazardous activities until the drug's effects wear off. d. give each family member one dose of the drug now and another dose in 2 weeks.
d. give each family member one dose of the drug now and another dose in 2 weeks. Mebendazole is administered as a single dose once and then again in 2 weeks when given to treat pinworms. It should be given to all household members when one person is infested. Albendazole is given with a high-fat meal. Praziquantel can cause drowsiness. Ivermectin causes a Mazotti reaction, which occurs in patients treated for onchocerciasis with symptoms resulting from death of the parasite.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. increase the patient's intake of foods rich in vitamin C. b. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. c. monitor urinary output every 30 minutes. d. hydrate the patient during the infusion and for 2 hours after the infusion.
d. hydrate the patient during the infusion and for 2 hours after the infusion. The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. pyelonephritis. b. acute cystitis. c. urinary tract infection. d. prostatitis.
d. prostatitis. The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria.
A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to: a. begin treating this patient with a two-drug regimen of isoniazid and rifampin. b. order a nucleic acid amplification test of the patient's sputum. c. order a chest radiograph and a sputum culture to assess for active tuberculosis. d. reassure the patient that this is not considered a positive test result.
d. reassure the patient that this is not considered a positive test result. This patient has a moderate risk of tuberculosis; the area of induration would have to be 10 mm or greater to be considered a positive skin test result. Without other clinical signs, there is no indication to treat this patient or to perform diagnostic testing, so a chest x-ray or sputum cultures are not recommended.
A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from the hospital will: a. suggest that the patient try alternative remedies for sleep. b. contact the provider to suggest an order for ramelteon [Rozerem]. c. instruct the patient to use alcohol in moderation. d. request an order to change to trazodone [Desyrel] for sleep.
d. request an order to change to trazodone [Desyrel] for sleep. Trazodone is an atypical antidepressant with sedative actions and can be used to prolong sleep duration. It is useful for treating insomnia related to antidepressants such as Prozac. Ramelteon is not a drug of choice to treat patients who have difficulty maintaining sleep. Patients who are depressed or at increased risk for suicide should not take barbiturates, because overdose can readily cause death. Alcohol is contraindicated when taking barbiturates. Alternative remedies have not shown effectiveness in treating insomnia.
To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given: a. to children once the permanent teeth have developed. b. to patients taking calcium supplements. c. with dairy products or antacids. d. to pregnant patients after the fourth month of gestation.
d. to pregnant patients after the fourth month of gestation. Tetracyclines bind to calcium in developing teeth, resulting in yellow or brown discoloration. They should not be given to pregnant women after the fourth month of gestation, because they will cause staining of deciduous teeth in the fetus. In children, discoloration occurs when tetracyclines are given between the ages of 4 and 8 years, because this is when permanent teeth are developing. Tetracycline binds with calcium, so absorption is diminished when the drug is given with calcium supplements, dairy products, or calcium-containing antacids; however, this does not affect tooth development.