PHARM 6-12 test questions

A patient is prescribed demeclocycline. The nurse would teach the patient to be alert for signs of which of the following? A) Photosensitivity B) Abdominal pain C) Cramping D) Blood dyscrasias

A( Feedback: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias are an adverse reaction of lincosamides.)

An HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. When assessing the patient, the nurse would immediately report which of the following to the primary health care provider? A) Peripheral neuropathy B) Headache C) Excoriation D) Taste alteration

A( Feedback: The nurse should immediately report symptoms of peripheral neuropathy to the primary health care provider. Headache and taste alteration are some of the mild adverse effects of the drug and are not cause for immediate concern. Excoriation is an adverse effect of imiquimod and does not occur in patients being administered didanosine.)

A nurse is caring for a client with burns. The client is prescribed topical silver sulfadiazine. The nurse would be alert for which of the following? A) Facial edema B) Skin necrosis C) Headache D) Rash

B( Feedback: Skin necrosis is an adverse effect of silver sulfadiazine that the nurse should be alert for. Facial edema and rash are adverse effects of mafenide, used for second- and third-degree burns. Headache is an adverse effect of sulfadiazine, used for urinary tract infection.)

A client develops a cough and fever and laboratory test results reveal leukopenia after the client receives sulfonamide therapy. When developing the client's plan of care, the nurse would identify which nursing diagnosis? A) Impaired Urinary Elimination B) Impaired Skin Integrity C) Risk for Secondary Infection D) Deficient Knowledge

C( Feedback: Fever and leukopenia suggest an infection, which can occur secondarily with sulfonamide therapy. Therefore, Risk for Infection would be the most appropriate nursing diagnosis. Impaired Urinary Elimination would be appropriate if the client was experiencing changes in urinary output. Impaired Skin Integrity would be appropriate if the client developed a rash or hypersensitivity reaction. Deficient Knowledge would be appropriate if the client lacked understanding of the drug therapy, which is not evident in this situation.)

A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate understanding of the information when they identify that an empty stomach is essential for the administration of which drug? A) Ciprofloxacin B) Moxifloxacin C) Levofloxacin D) Norfloxacin

D( Feedback: Although any of the fluoroquinolones can be given on an empty stomach, it is essential that norfloxacin is given in such a manner.)

30. A client who is receiving oral systemic antifungal therapy has a nursing diagnosis of Risk for Ineffective Renal Tissue Perfusion. Which of the following would be least appropriate for the nurse to include in the client's plan of care? A) Monitoring urine output hourly B) Monitoring serum creatinine levels C) Evaluating blood urea nitrogen levels D) Premedicating the client with an antihistamine

D( Feedback: For the nursing diagnosis of ineffective renal tissue perfusion, the nurse would monitor the client's urine output hourly and evaluate serum creatinine and BUN levels frequently. Premedicating the client with an antihistamine would only be appropriate if the client was receiving amphotericin B via IV infusion.)

A patient is being treated with saquinavir. The nurse would assess the patient for which of the following? A) Increase in patient's weight B) Evidence of liver dysfunction C) Photosensitivity D) Allergic skin reaction

A( Feedback: Patients taking saquinavir experience redistribution of body fat, with the movement to the center of the body. The nurse should spend time with these patients, encouraging them to verbalize their feelings regarding this change in appearance. Taking saquinavir does not cause liver dysfunction, photosensitivity, or any allergic skin reactions.)

A nurse is caring for a client who is being administered sulfasalazine. Which of the following instructions should the nurse include to ensure that the client gets the full benefits of the treatment? A) Take dosage while eating or immediately after eating. B) Increase food intake for the duration of sulfonamide therapy. C) Take the drug with a full glass of milk instead of water. D) Drink at least two to three 8-ounce glasses of fluid every day.

A( Feedback: The nurse should administer sulfasalazine with food or immediately afterward. Increasing the food intake during sulfonamide therapy is not necessary, as long as a proper diet is maintained and the physician's recommendations are followed. Two to three 8-ounce glasses of fluid is not enough; the client should drink at least eight to ten 8-ounce glasses of fluid every day. All drugs should be taken with water and not milk, juice, or any other liquid, unless specifically instructed by the physician.)

A client is entering the continuation phase of treatment for tuberculosis. Which of the following would the nurse expect the client to receive? Select all that apply. A) Isoniazid B) Rifampin C) Ciprofloxacin D) Pyrazinamide E) Ethambutol

A, B( Feedback: The continuation phase includes only the drugs isoniazid and rifampin.)

When completing the preadministration assessment for any antitubercular drug, which of the following would the nurse include? Select all that apply. A) Culture and sensitivity testing B) Complete blood count C) Family and contacts history D) Radiographic studies E) Medication history

A, B, C, D, E( Feedback: Preadministration assessment for any antitubercular drug should include culture and sensitivity testing, complete blood count, radiographic studies, medication history, and a family and contacts history for those with active TB.)

A group of nursing students are reviewing information about helminthes. The students demonstrate understanding when they identify which of the following as a helminth? Select all that apply. A) Roundworms B) Pinworms C) Ringworms D) Hookworms E) Tapeworms

A, B, D, E( Feedback: Roundworms, pinworms, hookworms, and tapeworms are examples of helminths. Ringworm is a fungal infection.)

A nursing instructor is preparing a class about cephalosporins for a group of nursing students. When describing progression from first-generation to fourth-generation cephalosporins, which of the following would the instructor include as the result? Select all that apply. A) An increase in the sensitivity of gram-negative microorganisms B) A decrease in the sensitivity of gram-negative microorganisms C) An increase in the sensitivity of gram-positive microorganisms D) A decrease in the sensitivity of gram-positive microorganisms E) An increase in the sensitivity of viral microorganisms

A, D (Feedback: In general, progression from first-generation to fourth-generation cephalosporins shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.)

A nurse is reviewing the medical record of a client who is prescribed tetracycline. The nurse would be alert for an increased risk of toxicity if the client is taking which of the following? Select all that apply. A) Digoxin (Lanoxin) B) Phenytoin (Dilantin) C) Vancomycin (Vancocin) D) Warfarin (Coumadin) E) Carbamazepine (Tegretol)

A, D( Feedback: Tetracyclines may increase the risk of toxicity in clients who take digoxin for heart disease and increase the risk of bleeding in clients who take warfarin.)

After teaching the client about taking his prescribed sulfonamide therapy, the nurse determines that the client needs additional teaching when he states which of the following? A) "I should take the drug with a large glass of water each time." B) "I can take the drug at different times of the day each day." C) "I have to finish the full prescription for the medication." D) "I should call my doctor if my symptoms seem to get worse."

B( Feedback: It is important that the client takes the drug at the scheduled intervals consistently throughout the course of the therapy because a certain amount of the drug must be in the body at all times for the infection to be controlled. The client is correct in taking the drug with a large glass of water each time, finishing the full prescription, and calling the doctor if symptoms get worse.)

A group of nursing students are reviewing information about antiviral agents. The students demonstrate understanding of the information when they identify which of the following as a drug category used for treating viral infections? Select all that apply. A) Antiattachment B) Antiretroviral C) Antitranscription D) Antireplication E) Antiviral

B, E( Feedback: The drugs used to treat viral infections can be split into two categories: antiviral and antiretroviral agents.)

A patient in the initial phase of TB is prescribed ethambutol. The nurse monitors the client for which of the following suggesting an adverse reaction? A) Hypersensitivity B) Skin eruptions C) Joint pain D) Myalgia

C( Feedback: Joint pain is an adverse reaction of ethambutol. Hypersensitivity and skin eruptions are adverse reactions of isoniazid. Myalgia is an adverse reaction of pyrazinamide.)

After reviewing information about lincosamide therapy, a group of nursing students demonstrate understanding of the information when they identify which of the following as a contraindication? A) Children younger than 9 years B) Patients with pre-existing liver disease C) Patients taking cisapride D) Patients with myasthenia gravis

C( Feedback: Lincosamide is contraindicated in patients taking cisapride. Tetracyclines are contraindicated in children younger than 9 years of age and pregnant women. Macrolides are contraindicated in patients with pre-existing liver disease and patients with myasthenia gravis.)

After teaching a group of nursing students about amphotericin B, the instructor determines that the teaching was successful when the students identify which of the following as true? Select all that apply. A) The drug is light sensitive. B) It can be administered via IM injection. C) The drug can cause renal damage. D) Amphotericin B is administered in the outpatient setting. E) The drug should be used within 8 hours.

: A, C, E( Feedback: Amphotericin B is given only under close supervision in the hospital setting, can cause renal damage, is given IV usually over a period of 6 hours, and should be protected from light and used within 8 hours of reconstitution.)

A nurse is administering an IV infusion of amphotericin B. The nurse would be alert for which of the following adverse reactions during the first 30 to 60 minutes of the infusion? Select all that apply. A) Muscle pain B) Hypotension C) Nausea D) Decreased renal function E) Chills

: B, C, E( Feedback: When the nurse administers amphotericin B by IV infusion, immediate adverse reactions can occur within 15 to 20 minutes of beginning the infusion, including nausea, vomiting, hypotension, tachypnea, fever, and chills; therefore, it is important for the nurse to carefully monitor the client's temperature, pulse, respirations, and blood pressure during the first 30 to 60 minutes of treatment.)

A client who is on sulfonamide therapy is about to be discharged. Which of the following precautions should the nurse instruct the client to follow to reduce the effects of photosensitivity? A) Wear protective clothing and sunscreen when outside. B) Increase fluid intake. C) Avoid lights while indoors. D) Wear protective footwear.

A (Feedback: The nurse should encourage a client to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid lights while indoors; the skin becomes sensitive only to harsh sunlight during sulfonamide therapy. Wearing protective footwear may protect the feet from injury, but it will not protect the skin from the harmful effects of photosensitivity.)

A client develops a severe case of pseudomembranous colitis secondary to fluoroquinolone therapy. The fluoroquinolone is stopped immediately and the client receives intravenous fluids and protein supplementation. The physician prescribes medication as part of the treatment plan. The nurse would expect to administer which of the following? A) Fidaxomicin B) Metronidazole C) Norfloxacin D) Moxifloxacin

A( Feedback: Moderate to severe cases of pseudomembranous colitis may require treatment with intravenous (IV) fluids and electrolytes, protein supplementation, and treatment with drugs such as fidaxomicin (Dificid) to eliminate the microorganism. Metronidazole is used to treat infections involving anaerobic organisms. Norfloxacin and moxifloxacin are fluoroquinolones and would not be used.)

A nurse understands that anthelmintic drugs are contraindicated in which patients? A) Patients who are pregnant B) Patients with myasthenia gravis C) Patients with clinical depression D) Children younger than 15 years

A( Feedback: Anthelmintic drugs are contraindicated in patients who are pregnant. Quinine, not anthelmintic drugs, should not be prescribed for patients with myasthenia gravis. Anthelmintic drugs are not known to be contraindicated in patients with clinical depression or in children younger than 15.)

A nurse is caring for a client with a urinary tract infection. After administering a sandwich and a large glass of cranberry juice to a client, the nurse observes that the client has developed diarrhea. Which of the following is the most likely cause of the client's condition? A) Extremely large dosage of cranberry juice B) Lack of activity or exercise C) Occurrence of crystalluria D) Minimized food and fluid intake

A( Feedback: Clients may develop gastrointestinal distress such as diarrhea if they have consumed extremely large doses of cranberry juice. The recommended dose is 6 ounces of juice twice daily. Cranberry juice on an empty stomach or immediately after dosage will not lead to diarrhea if taken in the recommended amount. Minimized food and fluid intake or lack of exercise does not increase the chances of diarrhea. Crystalluria does not cause diarrhea.)

After administering sulfonamides to a client, the nurse observes that he has developed a fever, cough, and muscular aches. The nurse also observes that the client has developed lesions in the form of red wheals on the neck and the mouth. The nurse interprets these findings as indicating which of the following? A) Stevens-Johnson syndrome (SJS) B) Anaphylactic shock C) Thrombocytopenia D) Leukopenia

A( Feedback: Clients with Stevens-Johnson syndrome (SJS) may complain of fever, cough, muscular aches and pains, and headache. Additional signs include lesions on the neck and mouth. Lesions are not symptoms of leukopenia or anaphylactic shock. A client with thrombocytopenia develops bruises on the skin but not lesions in the form of red wheals.)

After teaching a group of nursing students about the actions of the various antifungal drugs, the instructor determines that the teaching was successful when the students identify which drug as having only fungistatic activity? A) Fluconazole B) Amphotericin B C) Miconazole D) Nystatin

A( Feedback: Fluconazole has fungistatic activity, whereas amphotericin B, miconazole, and nystatin exert both fungicidal and fungistatic activity.)

After taking penicillin as prescribed, a patient shows signs of diarrhea and informs the nurse that there is blood in his stools. Which of the following interventions should the nurse do next? A) Contact primary health provider immediately. B) Have the patient consume yogurt with his next meal. C) Decrease fiber content in diet. D) Continue with prescribed regimen.

A( Feedback: If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the patient's condition at this stage. Changes in the diet are not recommended unless instructed by the primary health care provider.)

A client who is receiving statin therapy as treatment for elevated lipid levels is also prescribed daptomycin. The nurse would assess which of the following laboratory test results for changes? A) Creatine phosphokinase levels B) Blood glucose levels C) White blood cell count D) International normalized ratio

A( Feedback: Myopathy with elevated creatine phosphokinase (CPK) levels may occur if daptomycin is administered with statin drugs (cholesterol reduction). Therefore, the nurse would assess CPK levels. The combination of statin therapy and daptomycin has no effect on blood glucose levels, white blood count, or international normalized ratio (INR).)

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan? A) Take the drug on an empty stomach. B) Take the drug along with a meal. C) Take the drug along with milk or fruit juice. D) Take the drug immediately after meals.

A( Feedback: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, with dairy products, or immediately after meals.)

A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which action by the nurse would be most appropriate? A) Inform the primary health care provider. B) Obtain the patient's occupational history. C) Administer an antipyretic drug. D) Obtain specimens for kidney function tests.

A( Feedback: Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.)

An HIV-positive patient is in a continuing phase of TB. The patient has completed the initial phase of the treatment program. In the continuing phase, the patient has shown no positive sputum results for 6 months. The nurse knows that under what circumstances does the treatment in the second phase last for 4 months or more? A) Positive sputum culture after the completion of initial treatment B) Inclusion of pyrazinamide in the initial treatment C) Following the same eating habits in the continuing phase D) Nausea or vomiting after completing the initial treatment

A( Feedback: Positive sputum culture after the completion of initial treatment leads to treatment in the second phase lasting for 4 to 7 months. Following the same eating habits (diet) will not cause treatment in the second phase to last for 4 months or more, nor will nausea or vomiting occurring after completing the initial treatment. Noninclusion of pyrazinamide in the initial treatment leads to the second phase lasting for 4 to 7 months or more.)

A nursing instructor is describing the different categories of antiretroviral agents used in treatment for HIV infection. The instructor determines that the teaching was successful when the students identify which category as affecting an enzyme so that new viral particles cannot mature? A) Protease inhibitors B) Reverse transcriptase inhibitors C) Nonnucleoside reverse transcriptase inhibitors D) Integrase inhibitors

A( Feedback: Protease inhibitors block the protease enzyme so the new viral particles cannot mature. Reverse transcriptase inhibitors block the reverse transcriptase enzyme so the HIV material cannot change into DNA in the new cell, preventing new HIV copies from being created. Nonnucleoside reverse transcriptase inhibitors latch on to the reverse transcriptase molecule to block the ability to make viral DNA. Integrase inhibitors prevent enzymes from inserting HIV genetic material into the cell's DNA.)

A nurse suspects that a client receiving oral penicillin therapy is developing pseudomembranous colitis based on assessment of which of the following? A) Bloody diarrhea B) Pruritus C) Chills D) Hives

A( Feedback: Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with C. difficile (C. diff) bacteria. It is manifested by bloody diarrhea. Pruritus and hives would suggest an allergic reaction. Chills could indicate a wide range of problems.)

A nurse is caring for a patient who is receiving penicillin. The nurse would assess for which of the following as a common adverse reaction? A) Inflammation of the tongue and mouth B) Impaired oral mucous membranes C) Severe hypotension D) Sudden loss of consciousness

A( Feedback: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.)

The health care professional has recommended sulfonamide therapy for a client. While obtaining the client's medical history, the nurse discovers that he is taking oral anticoagulants. Which of the following are the possible effects of combining sulfonamide therapy with oral anticoagulants? A) Increased action of the anticoagulant B) Increased risk of anaphylactic shock C) Rendering of sulfonamide therapy ineffective D) Development of leukopenia

A( Feedback: Taking sulfonamide drugs when the client is already taking oral anticoagulants may result in increased action of the anticoagulants. Anaphylactic shock and leukopenia are some of the adverse reactions of sulfonamides but are not associated with mixing sulfonamides and anticoagulants. Oral anticoagulants do not decrease the effectiveness of sulfonamides.)

A client receiving levofloxacin comes to the clinic for a follow-up visit. The client tells the nurse, "I used sunscreen but it didn't help." Which response by the nurse would be most helpful? A) "Be sure to wear long sleeves and a wide-brimmed hat in addition to using sunscreen." B) "I guess you didn't apply enough sunscreen to be effective." C) "Maybe we need to change your medication because this is unusual." D) "The sunscreen should have worked. Are you sure you actually did use it?"

A( Feedback: The fluoroquinolone drugs cause severe photosensitivity reactions. Clients may experience "sunburn" reactions even when they use sunscreen or sunblock products. Caution clients to wear cover-up clothing with long sleeves and wide-brimmed hats when outside in addition to sunblock preparations. Remind them that sunscreen needs to be applied repeatedly throughout the day or when going into water. Clients should be aware that glare during hazy or cloudy days can cause skin reactions as readily as direct sunlight on a clear day. Telling the client that he didn't apply enough or questioning the client's actual use of sunscreen is inappropriate. There is no need to change the medication because the client's report is not unusual.)

A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections? A) Rotate injection sites for frequent parenteral injections. B) Monitor patient's vital signs each morning. C) Monitor signs of liver dysfunction weekly. D) Administer streptomycin to promote nutrition.

A( Feedback: The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor the patient's vital signs every 4 hours and not once every morning.)

A patient is receiving chloroquine. The nurse would instruct the client to do which of the following? A) Avoid foods that acidify the urine. B) Take the drug on an empty stomach. C) Increase dosage if dosage missed once. D) Discontinue drug if color of urine changes.

A( Feedback: The nurse should educate the patient to avoid foods that acidify the urine (cranberries, plums, prunes, meats, cheeses, eggs, fish, and grains), as they may interact with the antimalarial drug and increase excretion and thereby decrease the effectiveness of chloroquine while taking the drug. Taking the drug on an empty stomach is not advisable for antimalarial drugs. The nurse should instruct the patient to adhere to the dosage regimen unless instructed otherwise. Yellow or brownish discoloration of the urine during chloroquine treatment is normal; there is no need to discontinue the therapy.)

A patient who is receiving antiretroviral therapy is about to be discharged. Which of the following precautions should the nurse instruct the patient to follow to reduce the effects of photosensitivity? A) Wear protective clothing when outside. B) Increase fluid intake. C) Avoid lights while indoors. D) Use tanning beds for tan.

A( Feedback: The nurse should encourage the patient to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid indoor lights as the skin becomes sensitive to sunlight but not indoor lights. The use of tanning beds should be avoided.)

A patient with skin lesions due to a viral infection has been prescribed a topical antiviral agent. When teaching the patient about this therapy, which of the following would the nurse emphasize? A) The drug will not prevent the spread of the disease to others. B) Topical drugs should be applied using the hand, not a finger cot or gloves. C) All lesions should be left open and not covered in any way. D) Sexual contact when lesions are present is permissible if barrier methods are used.

A( Feedback: The nurse should inform the patient that application of the drug does not prevent the spread of the disease to others. Topical drugs should be applied with a finger cot or gloves but not with bare hands. The nurse should instruct the patient to cover all lesions and not leave them open. The nurse should also stress the importance of avoiding sexual contact when lesions are present irrespective of contraceptive measures.)

A patient is receiving linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. The nurse would instruct the patient that he is at risk for which of the following should he consume foods containing tyramine while taking linezolid? A) Severe hypertension B) Drowsiness C) Nervousness D) Nausea

A( Feedback: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Tyramine-containing foods interacting with linezolid do not cause drowsiness, nervousness, or nausea.)

A nurse is assigned to care for a patient with TB in a health care facility. The patient has been prescribed pyrazinamide. Which of the following would the nurse identify as a contraindication to the prescribed therapy? A) Acute gout B) Age younger than 13 years C) Diabetic retinopathy D) Cataracts

A( Feedback: The nurse should know that pyrazinamide is contraindicated among patients with acute gout. Pyrazinamide is also contraindicated in patients with acute hepatic or renal impairment and in patients with diabetes mellitus. Ethambutol is contraindicated in patients with diabetic retinopathy, patients with cataracts, and patients who are younger than 13 years of age.)

A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which ongoing assessment would the nurse complete? A) Monitoring for appearance of adverse reactions B) Monitoring patient's vital signs every 24 hours C) Assessing patient's history of contacts D) Use DOT to administer the drug to the patient

A( Feedback: The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every 4 hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the preadministration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.)

A patient with a severe stomachache visits the health care facility. A parasitic infection is suspected. The nurse would expect to collect which of the following specimens? A) Stool B) Blood C) Urine D) Saliva

A( Feedback: The nurse should obtain stool samples of patients with suspected parasitic infection. There is no need to obtain samples of blood, urine, or saliva in cases of suspected parasitic infection.)

A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform? A) Inspect mouth and gums regularly. B) Instruct patient to avoid brushing teeth. C) Offer patient a liquid diet. D) Instruct the patient to gargle every 2 hours.

A( Feedback: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every 2 hours may not help relieve the symptoms and may even aggravate the existing condition.)

After teaching a group of nursing students about the action of sulfonamides, the instructor determines that the teaching was successful when the students state that the action of this class of drugs is primarily which of the following? A) Bacteriostatic B) Bactericidal C) Promotor of folic acid activity D) Bacterial cell metabolizer

A( Feedback: The sulfonamides are primarily bacteriostatic because of their ability to inhibit the activity of folic acid in bacterial cell metabolism. They are not bactericidal.)

A nurse is caring for a client who is receiving a fluoroquinolone as an intravenous infusion. The nurse would check the infusion rate at which frequency? A) Every 15 minutes B) Every 30 minutes C) Every 45 minutes D) Every 60 minutes

A( Feedback: When administering a fluoroquinolone IV, the nurse should check the infusion rate every 15 minutes and adjust it if necessary.)

A client is prescribed sulfadiazine one tablet twice daily for 10 days. When reviewing the client's history, the nurse notes that the client is also taking warfarin. The nurse would be alert for which of the following? A) Prolonged clotting times B) Increased risk of infection C) Decreased antibiotic effect D) Decreased white blood cell count

A( Feedback: When warfarin and sulfonamides are given concomitantly, an increase in action of the anticoagulant is seen, leading to an increase in clotting time, such as PT/INR, and an increased risk of bleeding. An increased risk of infection and a decrease in the white blood cell count would occur when a sulfonamide is given with methotrexate. The combination of warfarin and sulfonamide does not impact the effect of the antibiotic.)

A client asks the nurse why she needs to increase her fluid intake while taking sulfonamides. Which response by the nurse would be most appropriate? A) "The fluids will help to decrease your risk for kidney stones." B) "You need fluids so that you won't develop a reaction in the sunlight." C) "Fluids prevent you from getting dehydrated." D) "You need fluids to keep your blood count from dropping too low."

A( Feedback: With sulfonamides, the client is at risk for crystalluria and kidney stones. Increasing fluid intake helps to reduce the risk for their development. Fluids will have no effect on the development of photosensitivity or maintaining blood counts. Although fluids help to minimize the risk for dehydration, this is not the reason for increasing fluid intake with sulfonamide therapy.)

The nurse suspects that a client who is taking a sulfonamide has leukopenia. Which assessment findings would support this suspicion? Select all that apply. A) Sore throat B) Cough C) Nausea D) Photosensitivity E) Bruising

A, B( Feedback: Antibiotics including sulfonamides can lead to leukopenia, which would be manifested by fever, sore throat, or cough. Thrombocytopenia is also possible and would be manifested by easy bruising or unusual bleeding from minor to moderate trauma. Nausea and photosensitivity are adverse reactions to sulfonamides.)

A patient is ordered to receive neomycin as part of the treatment plan for hepatic coma. Which of the following would be most important for the nurse to assess before administering this drug? Select all that apply. A) Ability to swallow B) Level of consciousness C) Baseline vital signs D) Pulmonary function E) Culture and sensitivity results

A, B( Feedback: During the early stages of hepatic coma, various changes in the level of consciousness may be seen. At times, the patient may appear lethargic and respond poorly to commands. Because of these changes in the level of consciousness, the patient may have difficulty swallowing, and a danger of aspiration is present. If the patient appears to have difficulty taking an oral drug, the nurse should withhold the drug and contact the primary health care provider. Baseline vital signs are important but are not the priority when the patient has hepatic coma. The drug does not affect the patient's respiratory function. There is no infection; therefore, there is no need for culture and sensitivity testing.)

Sulfonamides are commonly used to treat which of the following types of infections? Select all that apply. A) Ulcerative colitis B) Urinary tract infection C) Acute otitis media D) Upper respiratory tract infection E) Osteomyelitis

A, B, C (Feedback: Sulfonamides are often used to treat ulcerative colitis, urinary tract infection, and acute otitis media.)

A group of nursing students are reviewing information about antiretroviral therapy. The students demonstrate understanding of the information when they identify which conditions as requiring cautious use of this class of drugs? Select all that apply. A) Diabetes B) Hemophilia C) Impaired hepatic function D) Impaired renal function E) Hypertension

A, B, C( Feedback: Antiretroviral drugs should be used cautiously in clients with diabetes, impaired hepatic function, pregnancy, or hemophilia.)

Antiviral drugs have limited use because they are effective against only a small number of specific viral infections. The nurse would expect antiviral drugs to be used for which infection? Select all that apply. A) Human immunodeficiency virus (HIV) B) Herpes simplex virus (HSV) C) Cytomegalovirus (CMV) D) Rotavirus E) Rhinovirus

A, B, C( Feedback: Antiviral drugs are used in the treatment or prevention of infections caused by cytomegalovirus (CMV), herpes simplex virus (HSV) 1 and 2, herpes zoster, human immunodeficiency virus (HIV), influenza A and B, respiratory syncytial virus (RSV), and hepatitis B and C. They are not used for rotavirus or rhinovirus infections.)

A nurse is reviewing information about cidofovir in preparation for administration. The nurse understands that which of the following are true? Select all that apply. A) It should not be given to clients who have renal impairment. B) The drug should not be given to clients receiving aminoglycosides. C) Cidofovir is used in the treatment of cytomegalovirus retinitis. D) It is administered by placing one drop in both eyes twice daily. E) The drug should not be given with HMG-CoA reductase inhibitors.

A, B, C( Feedback: Cidofovir should not be given to clients who have renal impairment or who are receiving other nephrotoxic drugs, such as aminoglycosides. The drug is used to treat cytomegalovirus retinitis and is administered IV.)

A nurse is providing care to a client receiving highly active antiretroviral therapy (HAART). The nurse would expect the client to receive which of the following antiretroviral agents? Select all that apply. A) Protease inhibitors B) Reverse transcriptase inhibitors C) Nonnucleoside reverse transcriptase inhibitors D) Entry inhibitors E) Integrase inhibitors

A, B, C( Feedback: HAART includes three categories of antiretroviral drugs: protease inhibitors, reverse transcriptase inhibitors, and nonnucleoside reverse transcriptase inhibitors.)

A nurse is reviewing the medical records of several patients who are to receive antibacterial drug therapy. The nurse understands that aminoglycosides would be contraindicated in clients with which of the following conditions? Select all that apply. A) Pre-existing hearing loss B) Pregnancy C) Parkinsonism D) Diabetes E) Hyperlipidemia

A, B, C( Feedback: The aminoglycosides are contraindicated in clients with pre-existing hearing loss, myasthenia gravis, and parkinsonism and during lactation and pregnancy.)

A client is receiving amphotericin B IV. The nurse identifies a nursing diagnosis of Impaired Comfort related to medication administration. The nurse determines that the plan of care was effective when which outcome is achieved? select all that apply A) Client remains free from rigors. B) Client exhibits a blood pressure within acceptable parameters. C) Client maintains a patent IV infusion site. D) Client maintains a urine output of at least 30 mL/hour. E) Client demonstrates procedure for cleaning involved area.

A, B, C( Feedback: The patient receiving amphotericin B IV can experience rigors, hypotension, and problems with the IV infusion site. Therefore, remaining free from rigors and maintaining a stable blood pressure and a patent IV infusion site would indicate that the plan of care for impaired comfort is successful. A urine output of 30 mL/hour would be an indicator of adequate renal tissue perfusion. Cleaning the involved area would not be appropriate because the client has a systemic fungal infection.)

A patient is to receive tetracycline therapy at home. After teaching the patient about foods to avoid when taking the drug, the nurse determines that the teaching was successful when the patient states he will avoid which of the following? Select all that apply. A) Yogurt B) Cheese C) Calcium-fortified cereals D) Citrus fruits E) Green leafy vegetables

A, B, C( Feedback: The patient should avoid dairy products including yogurt, cheese, milk, cream, ice cream, ice milk, or frozen custard before or after taking tetracycline. Citrus fruits and green leafy vegetables should not be avoided.)

A client is receiving gentamicin. Assessment of which of the following would lead the nurse to suspect that the client is developing nephrotoxicity? Select all that apply. A) Proteinuria B) Hematuria C) Decreased urine output D) Increased serum creatinine E) Decreased fluid intake

A, B, C, D( Feedback: Proteinuria, hematuria, decreased urine output, increased serum creatinine, and increased blood nitrogen urea (BUN) are suggestive of nephrotoxicity. Decreased fluid intake would support dehydration.)

Which of the following is true of secondary drugs to treat tuberculosis? Select all that apply. A) Secondary drugs are less effective than primary drugs. B) Secondary drugs are more toxic than primary drugs. C) Secondary drugs are used to treat extrapulmonary TB. D) Secondary drugs are used to treat drug-resistant TB. E) Secondary drugs are used as the first line to treat HIV patients with TB.

A, B, C, D( Feedback: Secondary drugs are used to treat extrapulmonary and drug-resistant TB. Secondary drugs are less effective and more toxic than primary drugs used to treat TB.)

Clients receiving antiretroviral drugs for HIV infection may continue to contract opportunistic infections. The nurse would be alert for which of the following when assessing the client during therapy? Select all that apply. A) Fever B) Malaise C) Sore throat D) Lethargy E) Hypotension

A, B, C, D( Feedback: The nurse's ongoing assessment of HIV-positive clients should include close monitoring for signs of infection such as fever, malaise, sore throat, or lethargy.)

After teaching a group of nursing students about antiprotozoal drugs, the instructor determines that the teaching was successful when the group identifies which of the following as an indication for use? Select all that apply. A) Toxoplasmosis B) Malaria C) Giardiasis D) Pneumocystis carinii pneumonia E) Trichomoniasis

A, B, C, D, E( Feedback: Antiprotozoal drugs are used in the treatment of malaria, giardiasis, toxoplasmosis, intestinal amebiasis, trichomoniasis, and Pneumocystis carinii pneumonia.))

Which of the following would the nurse emphasize when teaching the client and family about measures to prevent reinfection and the transmission of a parasitic infection to others? Select all that apply. A) Wash hands thoroughly before preparing or eating food. B) Disinfect toilets daily. C) Bathe daily. D) Disinfect the bathtub or shower stall immediately after bathing. E) Avoid putting fingers in the mouth or biting fingernails.

A, B, C, D, E( Feedback: Important measures to include in the teaching plan to prevent reinfection and the transmission of a parasitic infection to others include the following: washing hands thoroughly before preparing or eating food, disinfecting toilets daily, bathing daily (showering is best), disinfecting the bathtub or shower stall immediately after bathing, and avoiding putting fingers in the mouth or biting fingernails.)

The nurse must monitor a client carefully for signs of bleeding when which of the following antifungals is concomitantly administered with warfarin (Coumadin)? Select all that apply. A) Fluconazole (Diflucan) B) Itraconazole (Sporanox) C) Ketoconazole (Nizoral) D) Griseofulvin (Grisactin) E) Voriconazole (Vfend)

A, B, C, D, E( Feedback: The concomitant administration of fluconazole, itraconazole, ketoconazole, griseofulvin, and voriconazole with warfarin increases the client's risk of bleeding.)

When developing the plan of care for a client receiving antitubercular therapy, the nurse would identify which of the following as a goal? Select all that apply. A) Client will state adverse reactions to report. B) Client will maintain adequate nutritional status. C) Client and family demonstrate an understanding of the drug regimen. D) Client manages the therapeutic regimen effectively. E) Client exhibits a negative sputum culture.

A, B, C, D, E( Feedback: The goals for a client taking antitubercular drugs can include identification and treatment of adverse reactions including ability to report adverse reaction, maintenance of adequate nutritional status, demonstration of understanding of the drug regimen by client and family, effective management of the therapeutic regimen by the client, and achievement of therapeutic response.)

Which of the following would the nurse identify as a goal for a client who is receiving an antiviral drug? Select all that apply. A) Adverse reactions are identified and treated. B) Adequate nutritional status is maintained. C) Perceptions of body changes are managed successfully. D) Skin integrity is successfully maintained. E) Therapeutic response is achieved.

A, B, C, D, E( Feedback: The goals for a client taking antiviral drugs can include the following: adverse reactions are identified and treated, adequate nutritional status is maintained, perceptions of body changes are managed successfully, skin integrity is successfully maintained, and therapeutic response is achieved.)

A nurse is working in an ambulatory care setting that involves seeing clients with infections that require treatment. Which of the following would be important for the nurse to assess in these clients? Select all that apply. A) Client's use of self-remedies B) Review of lab results C) Vital signs D) Client's symptoms E) Client's general appearance

A, B, C, D, E( Feedback: When assessing a client who may have an infection, the nurse should gather information about the client's general appearance; vital signs; symptoms, including the length of time the client has been experiencing them; and any self-remedies used. In addition, the nurse should review the results of any laboratory and diagnostic tests.)

Which of the following should be included in the nurse's preadministration assessment prior to administering a penicillin to a client? Select all that apply. A) Allergy history B) Medical history C) Medication history D) Blood glucose levels E) Current symptoms

A, B, C, E( Feedback: An allergy history, medical and surgical history, medication history, and the current symptoms of the infection should be included in the nurse's preadministration assessment prior to a client receiving a penicillin.)

A nurse would expect to administer antihelminthic therapy cautiously to which of the following clients? Select all that apply. A) Clients who are lactating B) Clients with hepatic impairment C) Clients with anemia D) Clients with diabetes E) Clients with renal impairment

A, B, C, E( Feedback: Antihelminthic drugs should be used cautiously in lactating clients and clients with hepatic or renal impairment and malnutrition or anemia.)

A nurse would expect to administer pyrazinamide cautiously to which clients? Select all that apply. A) Clients with diabetes B) Clients with hepatic impairment C) Clients with renal impairment D) Clients with hypertension E) Clients with HIV infection

A, B, C, E( Feedback: Pyrazinamide should be used cautiously in clients during pregnancy and lactation and in clients with hepatic or renal impairment, HIV infection, or diabetes.)

After teaching a group of students about tetracyclines, the instructor determines that the teaching was successful when the students identify which of the following as a true statement? Select all that apply. A) Tetracyclines are broad-spectrum antibiotics. B) Tetracyclines may cause permanent discoloration of the teeth in children. C) Tetracyclines can be used when penicillins are contraindicated. D) Tetracyclines are contraindicated in children younger than 6 years. E) Tetracyclines are used to treat Rocky Mountain spotted fever.

A, B, C, E( Feedback: Tetracyclines are broad-spectrum antibiotics used to treat rickettsial disease, such as Rocky Mountain spotted fever, and when the use of penicillins is contraindicated. Tetracyclines are not given to children younger than 9 years of age unless absolutely necessary because these drugs may cause permanent yellow-gray-brown discoloration of the teeth.)

A client is prescribed penicillin therapy to treat an infection. Which of the following would the nurse include in the teaching plan for the client to reduce her risk of fungal superinfections? Select all that apply. A) "Yogurt can sometimes help." B) "Try drinking some buttermilk." C) "You could take Acidophilus capsules." D) "Rinse your mouth daily with an alcohol-based mouthwash." E) "Use a soft-bristle toothbrush when brushing."

A, B, C, E( Feedback: The nurse can recommend that, if the diet permits, yogurt, buttermilk, or Acidophilus capsules may be taken to reduce the risk of fungal superinfection. Also, brushing with a soft-bristle toothbrush and frequent mouth care with a nonirritating solution can be helpful.)

A nursing student is reviewing information about tuberculosis therapy. The student demonstrates understanding of the information when identifying which of the following as true about the initial phase of tuberculosis therapy? Select all that apply. A) Drugs are used to kill the rapidly multiplying M. tuberculosis. B) Drugs are used to prevent drug resistance. C) The initial phase lasts approximately 6 to 9 months. D) The initial phase lasts approximately 2 months. E) The initial phase lasts approximately 4 months.

A, B, D( Feedback: During the initial phase, which lasts approximately 2 months, drugs are used to kill the rapidly multiplying M. tuberculosis and to prevent drug resistance. The continuing phase lasts approximately 4 months and the entire treatment spans 6 to 9 months.)

A nurse is monitoring a client who is receiving penicillin. The nurse would assess the client for which of the following common GI tract adverse reactions? Select all that apply. A) Glossitis B) Stomatitis C) Esophagitis D) Diarrhea E) Gastritis

A, B, D, E( Feedback: A nurse monitoring a client taking penicillin should be aware of the common GI tract adverse reactions, including glossitis, stomatitis, gastritis, nausea, vomiting, diarrhea, and abdominal pain.)

A client is receiving antiretroviral therapy. Which adverse reactions would the nurse include in the teaching plan for this client? Select all that apply. A) Altered taste B) Peripheral numbness C) Oral candidiasis D) Rash E) Fever

A, B, D, E( Feedback: Adverse reactions associated with antiretroviral drugs are nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, and numbness and tingling in the circumoral area or peripherally or both. Oral candidiasis is not associated with antiretroviral therapy.)

A nurse is preparing to teach a client about common adverse reactions associated with rifampin (Rifadin). Which of the following would the nurse include? Select all that apply. A) Discoloration of body fluids B) Vertigo C) Joint pain D) Nausea E) Rash

A, B, D, E( Feedback: Common adverse reactions of rifampin include nausea, vomiting, epigastric distress, heartburn, fatigue, vertigo, rash, reddish-orange discoloration of body fluids, hematologic changes, and renal insufficiency.)

Which of the following represent nursing diagnoses that may be made during administration of a fluoroquinolone? Select all that apply. A) Acute Pain B) Diarrhea C) Imbalanced Nutrition D) Anxiety E) Risk for Impaired Skin Integrity

A, B, D, E( Feedback: Drug administration-specific nursing diagnoses that may be made during treatment with fluoroquinolones and miscellaneous anti-infective drugs include Acute Pain, Anxiety, Risk for Impaired Comfort, Risk for Impaired Skin Integrity, Diarrhea, Risk for Impaired Urinary Elimination, and Risk for Disturbed Sensory Perception.)

The nurse is completing an ongoing assessment of a client receiving erythromycin. The nurse would notify the primary health care provider immediately if assessment reveals which of the following? Select all that apply. A) Significant drop in blood pressure B) Increase in heart rate C) Decrease in temperature D) Increase in respiratory rate E) Sudden increase in temperature

A, B, D, E( Feedback: During ongoing assessment of a client receiving erythromycin, the nurse should notify the primary health care provider immediately if the client has a significant drop in blood pressure, increase in heart rate, increase in respiratory rate, or sudden increase in temperature.)

The nurse is reviewing the medical records of several clients with infection. The nurse would anticipate the prescriber ordering a fluoroquinolone for a client with which of the following? Select all that apply. A) Urinary tract infections B) Sexually transmitted infections C) Upper respiratory tract infections D) Bone and joint infections E) Skin infections

A, B, D, E( Feedback: Fluoroquinolones are primarily used to treat lower respiratory tract infections, bone and joint infections, urinary tract infections, skin infections, sexually transmitted infections, and some infections of the eye and ear.)

A nurse suspects that a client who is receiving a cephalosporin and has ingested alcohol may be experiencing a disulfiram-like reaction based on assessment of which of the following? Select all that apply. A) Flushing B) Respiratory difficulty C) Hypertension D) Vomiting E) Sweating

A, B, D, E( Feedback: Flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension are symptoms a nurse might observe in a client having a disulfiram-like reaction with administration of a cephalosporin and alcohol.

The nurse is preparing a teaching plan to foster client adherence to the tubercular drug treatment programs. Which of the following would the nurse include? Select all that apply. A) Reinforcing that short-term treatment is ineffective B) Reviewing the prescribed drug, doses, and frequency of administration C) Using a calendar to designate the days the drug is to be taken for alternate-dosage schedule D) Arranging for direct observation therapy with the client and family E) Instructing the client about possible adverse reactions and the need to notify prescriber should any occur

A, B, D, E( Feedback: Teaching points that can be used by the nurse to increase the likelihood for effective therapeutic outcomes include reinforcing that short-term treatment is ineffective; reviewing the drug therapy regimen, including the prescribed drug, doses, and frequency of administration; arranging for direct observation therapy with the client and family; and instructing the client about possible adverse reactions and the need to notify the prescriber should any occur.)

A client is in the initial treatment phase for tuberculosis. Which of the following antitubercular drugs would the nurse expect the client to receive during this phase? Select all that apply. A) Isoniazid B) Rifampin C) Ciprofloxacin D) Pyrazinamide E) Ethambutol

A, B, D, E( Feedback: The initial phase involves using the following drugs: isoniazid, rifampin, and pyrazinamide, along with ethambutol.)

A nurse is preparing to administer lincomycin via IM injection. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Inspect previous injection sites. B) Rotate the injection site. C) Use the abdomen for intramuscular injections. D) Note the site used for injection in the client's chart. E) Notify the physician of any persistent localized reactions.

A, B, D, E( Feedback: When giving lincomycin intramuscularly, the nurse inspects previous injection sites for signs of pain or tenderness, redness, and swelling; reports the persistence of a localized reaction to the physician; rotates the injection sites; and records the site used for injection in the client's chart.)

A client develops a mild skin irritation while receiving penicillin therapy. Which of the following would the nurse advise the client to avoid? Select all that apply. A) Harsh soaps B) Perfumed lotions C) Antipyretic creams D) Rubbing the irritating area E) Wearing rough or irritating clothing

A, B, D, E( Feedback: When skin irritation is present during the administration of penicillin, the nurse should advise the client to avoid harsh soaps, perfumed lotions, rubbing the irritated area, or wearing rough or irritating clothing.)

The nurse is preparing to administer a prescribed sulfonamide. Which of the following would the nurse do? Select all that apply. A) Have the client sit up to take the drug B) Give the prescribed drug on an empty stomach C) Be sure to administer the drug immediately after a meal D) Have the client decrease his fluid intake E) Encourage the client to drink additional fluids

A, B, E( Feedback: Oral medication should be administered to clients only when they are in an upright or sitting position. Sulfonamides should be administered on an empty stomach if tolerated with 8 ounces of water. Increased fluid intake is encouraged to prevent crystalluria.)

A nurse suspects that a patient receiving an aminoglycoside is developing neurotoxicity based on assessment of which of the following? Select all that apply. A) Paresthesias B) Tingling around the mouth C) Ringing in the ears D) Vertigo E) Muscle twitching

A, B, E( Feedback: Signs and symptoms of neurotoxicity include numbness, skin tingling, circumoral (around the mouth) paresthesia, peripheral paresthesia, tremors, muscle twitching, convulsions, muscle weakness, and neuromuscular blockade (acute muscular paralysis and apnea). Ringing in the ears and vertigo would suggest ototoxicity.)

A group of nursing students are reviewing information about administering penicillins. The students demonstrate an understanding of the information when they identify which drugs as being given without regard to meals? Select all that apply. A) Amoxicillin (Amoxil) B) Ampicillin (Principen) C) Penicillin V (Veetids) D) Amoxicillin/clavulanate (Augmentin) E) Carbenicillin indanyl (Geocillin)

A, C( Feedback: Amoxicillin and penicillin V can be administered without regard to meals, unlike the rest of the penicillins, such as ampicillin, amoxicillin/clavulanate, or carbenicillin indanyl, which should be given on an empty stomach.)

A group of nursing students are reviewing the different groups of penicillins. The students demonstrate understanding when they identify which of the following as an example of a penicillinase-resistant penicillin? Select all that apply. A) Dicloxacillin B) Penicillin G C) Nafcillin D) Oxacillin E) Ampicillin

A, C, D( Feedback Dicloxacillin, nafcillin, and oxacillin are examples of penicillinase-resistant penicillins. Penicillin G is an example of a natural penicillin. Ampicillin is an example of an aminopenicillin.)

A nurse is preparing to administer penicillin therapy. The nurse would expect to administer penicillins cautiously to clients with which of the following? Select all that apply. A) History of allergies B) Diabetes C) Asthma D) Bleeding disorders E) Hypertension

A, C, D( Feedback: Penicillins should be used cautiously in clients with renal disease, asthma, bleeding disorders, GI disease, pregnancy or lactation, and a history of allergies.)

Prior to administration of moxifloxacin (Avelox), a nurse obtains a medication history. Use of which drug would alert the nurse to contact the prescriber because concomitant use would lead to an increased risk for a severe cardiac arrhythmia? Select all that apply. A) Amiodarone (Pacerone) B) Glyburide (DiaBeta) C) Sotalol (Betapace) D) Procainamide (Procanbid) E) Ibuprofen (Motrin)

A, C, D( Feedback: There is a risk of severe cardiac arrhythmias when moxifloxacin (Avelox) is administered with drugs that increase the QT interval, such as quinidine, procainamide, amiodarone, or sotalol.)

A client should be educated to limit consumption of which of the following foods to prevent an exaggerated sympathetic-type response when taking isoniazid (INH) for the treatment of tuberculosis? Select all that apply. A) Alcohol B) Grapes C) Bananas D) Meats E) Broccoli

A, C, D( Feedback: When isoniazid is taken with foods containing tyramine, such as aged cheese and meats, bananas, yeast products, and alcohol, an exaggerated sympathetic-type response can occur.)

A patient is being discharged with a prescription for linezolid. After teaching the patient about this drug, the nurse determines that additional teaching is needed when the patient identifies that he can consume which of the following without any risks? Select all that apply. A) Alcohol B) Prunes C) Aged cheese D) Pepperoni E) Broccoli

A, C, D( Feedback: When linezolid is taken with foods containing tyramine, such as aged cheese and meats, yogurt, chocolate, caffeinated beverages, and alcohol, the risk for severe hypertension increases. Prunes and broccoli pose no risk to the patient.)

A nursing instructor is preparing a class on various antibacterial drugs interfering with protein synthesis, with the discussion focusing on quinupristin/dalfopristin. Which of the following medications would the instructor include as interacting with quinupristin/dalfopristin, thus increasing the risk for toxicity? Select all that apply. A) Lorazepam (Ativan) B) Quinapril (Accupril) C) Ritonavir (Norvir) D) Atorvastatin (Lipitor) E) Tacrolimus (Prograf)

A, C, D( Feedback: When quinupristin/dalfopristin is prescribed, it may interact with the following drugs, increasing serum levels and thus the risk for toxicity: antiretrovirals, antineoplastic and immunosuppressant agents, calcium channel blockers, benzodiazepines, and cisapride.)

A nurse is preparing to administer a prescribed cephalosporin by injection. Which of the following would be most important for the nurse to keep in mind? Select all that apply. A) Thrombophlebitis can occur when cephalosporins are given IV. B) Phlebitis can occur when cephalosporins are given IM. C) Pain can occur when cephalosporins are given IM. D) Tenderness can occur when cephalosporins are given IM. E) Swelling can occur when cephalosporins are given IM.

A, C, D, E( Feedback: Administration route reactions include pain, tenderness, and inflammation at the injection site when cephalosporins are given IM, and phlebitis and thrombophlebitis along the vein may occur when cephalosporins are given IV.)

When performing an ongoing assessment of a client receiving amoxicillin (Amoxil), the nurse should monitor the client for which of the following? Select all that apply. A) Relief of symptoms B) Development of a rash C) Increase in appetite D) Change in appearance or amount of drainage E) Decrease in temperature

A, C, D, E( Feedback: An ongoing assessment is important in evaluating the client's response to therapy, such as a decrease in temperature, relief of symptoms caused by the infection, an increase in appetite, and a change in the appearance and amount of drainage.)

The nurse is preparing a plan of care for a client who is to receive antiviral therapy. Which nursing diagnoses would the nurse most likely include related to drug therapy? Select all that apply. A) Acute Pain B) Risk for Impaired Skin Integrity C) Risk for Injury D) Risk for Imbalanced Nutrition E) Body Image Disturbances

A, C, D, E( Feedback: Drug-specific diagnoses for antiviral drugs include Risk for Imbalanced Nutrition, Risk for Impaired Skin Integrity, Risk for Injury, Body Image Disturbance, and Acute Pain.)

During ongoing assessment of clients taking fluoroquinolone, which of the following adverse reactions should be reported to the physician immediately? Select all that apply. A) Respiratory difficulty B) Drowsiness C) Severe diarrhea D) Hypersensitivity reaction E) A significant drop in blood pressure

A, C, D, E( Feedback: It is important for the nurse to report any adverse reaction to the physician prior to administering the next dose, but the nurse should notify the physician immediately if respiratory difficulty, hypersensitivity reaction, severe diarrhea, or a decided drop in blood pressure occurs.)

A nursing instructor is preparing a teaching plan for a group of nursing students about macrolide antibacterial drugs. Which of the following would the instructor expect to include? Select all that apply. A) Macrolides are broad-spectrum antibiotics. B) Macrolides are contraindicated in clients with renal dysfunction. C) Macrolides may cause visual disturbances. D) Macrolides can be used in clients allergic to penicillins. E) Macrolides can be used to treat acne vulgaris.

A, C, D, E( Feedback: Macrolides are broad-spectrum antibiotics that can be used in clients with penicillin allergies and can be used to treat acne vulgaris. Macrolides can cause visual disturbances and are contraindicated in clients with pre-existing liver disease.)

A client with tuberculosis has failed treatment and requires retreatment. Which of the following drugs would the nurse anticipate being used? Select all that apply. A) Ethionamide (Trecator) B) Rifampin (Rifadin) C) Aminosalicylic acid (Paser) D) Cycloserine (Seromycin) E) Capreomycin (Capastat)

A, C, D, E( Feedback: Retreatment drug regimens most often consist of the secondary drugs ethionamide (Trecator), aminosalicylic acid (Paser), cycloserine (Seromycin), and capreomycin (Capastat). Ofloxacin (Floxin) and ciprofloxacin (Cipro) may also be used in retreatment.)

Foods that acidify the urine may interact with chloroquine and increase the drug's excretion, thereby decreasing its effectiveness in the treatment of malaria. The nurse should counsel the client to avoid which of the following foods during treatment with chloroquine? Select all that apply. A) Plums B) Oranges C) Fish D) Eggs E) Cranberries

A, C, D, E( Feedback: The nurse should counsel the client to avoid cranberries, plums, prunes, meats, cheeses, eggs, fish, and grains.)

During treatment of parasitic infections, the primary health care provider orders daily stool specimens be sent to the lab for examination. Which of the following would the nurse document as part of the client's plan of care? Select all that apply. A) Number of stools produced B) Odor of stool C) Consistency of stool D) Frequency of stool E) Color of stool

A, C, D, E( Feedback: The nurse should record the number, consistency, color, and frequency of stools as part of the client's plan of care. Documenting the odor is not necessary.)

A nurse is developing a plan of care for a client receiving an antitubercular drug. Which nursing diagnosis would the nurse most likely include directly related to drug therapy? Select all that apply. A) Acute Pain B) Risk of Skin Integrity C) Imbalanced Nutrition D) Body Image Disturbances E) Risk for Ineffective Self Health Management

A, C, E( Feedback: Drug administration-specific nursing diagnoses that may be made during treatment with antitubercular drugs include Acute Pain related to frequent injections, Imbalanced Nutrition due to gastric upset, and Risk for Ineffective Self Health Management related to indifference, lack of knowledge, and long-term treatment.)

A nurse is preparing to administer ethambutol (Myambutol) to several clients. The nurse would expect to administer the drug cautiously to which clients? Select all that apply. A) Clients with hepatic impairment B) Clients with hypertension C) Clients with cataracts D) Clients with diabetic neuropathy E) Clients with renal impairment

A, C, E( Feedback: Ethambutol (Myambutol) should be used cautiously in clients with hepatic or renal impairment and in clients with diabetic retinopathy or cataracts.)

Fluoroquinolones should be used with caution in which of the following clients? Select all that apply. A) Clients with diabetes B) Clients with hypertension C) Clients receiving dialysis D) Clients with chronic obstructive pulmonary disorder (COPD) E) Clients with epilepsy

A, C, E( Feedback: Fluoroquinolones should be used with caution in clients with diabetes, renal impairment, or history of seizures; older clients; and clients on dialysis.)

A nurse is preparing to administer an aminoglycoside to a client. The nurse would be alert for the development of which of the following toxicities? Select all that apply. A) Nephrotoxicity B) Cardiotoxicity C) Ototoxicity D) Hepatotoxicity E) Neurotoxicity

A, C, E( Feedback: More serious adverse reactions of aminoglycosides include nephrotoxicity, ototoxicity, and neurotoxicity. A nurse recognizing these can greatly reduce permanent damage to the client's hearing, kidneys, and nerves. Aminoglycosides are not associated with cardiotoxicity or hepatotoxicity.)

Tuberculosis responds well to long-term treatment with a combination of three or more antitubercular drugs. Which of the following is true regarding the duration of treatment for clients with tuberculosis? Select all that apply. A) The initial treatment phase should last for a minimum of 2 months. B) The initial treatment phase should last for a maximum of 2 months. C) The continuation treatment phase should last for 4 to 7 months. D) The continuation treatment phase should last for 6 to 12 months. E) Prophylactic treatment should be given for 6 to 9 months.

A, C, E( Feedback: The Centers for Disease Control and Prevention recommends that treatment begin as soon as possible after diagnosis of TB and include the following: initial treatment phase lasting for a minimum of 2 months, continuation treatment phase lasting for 4 to 7 months, and prophylactic treatment given to family members of the infected individual for 6 to 7 months.)

The nurse is preparing to administer an antiviral drug to a client. Which of the following would the nurse include in the preadministration assessment? Select all that apply. A) Client's general state of health B) Blood glucose levels C) Resistance to infection D) Electrocardiogram findings E) Vital signs

A, C, E( Feedback: The nurse's preadministration assessment of the client prior to administration of antiviral drugs should include determination of the client's general state of health and resistance to infection, record of client's symptoms and complaints, and record of vital signs. Blood glucose levels and electrocardiogram findings are not needed.)

A group of nursing students are reviewing information about aminoglycosides. The students demonstrate understanding when they identify which of the following as an example? Select all that apply. A) Amikacin (Amikin) B) Amoxicillin (Amoxil) C) Vancomycin (Vancocin) D) Kanamycin (Kantrex) E) Azithromycin (Zithromax)

A, D( Feedback: The aminoglycosides include amikacin, gentamicin, kanamycin, neomycin, streptomycin, and tobramycin. Amoxicillin is an aminopenicillin. Vancomycin is a miscellaneous agent that disrupts the bacterial cell wall. Azithromycin is classified as a macrolide.)

Which of the following would the nurse include in the teaching plan for a client about the use of an antifungal cream preparation for the treatment of ringworm in the ambulatory care setting? Select all that apply. A) Clean involved area before applying cream. B) Increase the amount of cream used if skin infection worsens. C) Decrease the frequency of applying cream if skin infection improves. D) Keep towels and washcloths for bathing separate from other family members during treatment. E) Keep the affected area clean and moist.

A, D( Feedback: When instructing a client about the use of an antifungal cream preparation for the treatment of ringworm in the ambulatory care setting, the nurse should include the following: cleaning the involved area and applying the cream to the skin as directed by the physician, not increasing or decreasing the amount used or number of times the cream should be applied unless directed to do so by the physician, keeping the affected area clean and dry, and keeping towels and washcloths for bathing separate from those of other family members to avoid the spread of infection.)

When teaching a client about antiviral therapy, the nurse would include information about the possibility of which adverse reactions? Select all that apply. A) Rash B) Sedation C) Chills D) Diarrhea E) Headache

A, D, E( Feedback: Adverse reactions associated with antiviral drugs include nausea, vomiting, diarrhea, headache, rash, fever, and insomnia.)

A client with a fever is ordered to receive sulfonamide therapy for an infection. The nurse needs to evaluate the client for which of the following during the course of therapy? Select all that apply. A) Response to drug therapy B) Elevated blood glucose levels C) Mental status changes D) Occurrence of adverse reactions E) Decrease in temperature

A, D, E( Feedback: During the course of therapy, the nurse evaluates the client at periodic intervals for response to the drug, including relief of symptoms and decrease in temperature, as well as the occurrence of any adverse reactions.)

A nurse is applying silver sulfadiazine to a client's burn. Which of the following would be important for the nurse to do? Select all that apply. A) Clean and remove debris from the burned area before application B) Allow air drafts over the burn area to speed the healing process C) Apply a 1/2-inch-thick layer of cream to the burn D) Wear sterile gloves when applying the cream to the burn E) Warn client of burning sensation during and shortly following application

A, D, E( Feedback: When applying silver sulfadiazine cream to a burn, clean and remove debris from the burned area, apply cream while wearing sterile gloves, apply a 1/16-inch-thick layer to the area, keep the client away from air drafts to decrease pain, and warn the client that he or she may experience a burning sensation during and shortly following cream application.)

A group of nursing students are reviewing information about sulfonamides. Which of the following if stated by the students indicate understanding of this drug class? Select all that apply. A) Sulfonamides are well absorbed when given orally. B) Sulfonamides are poorly absorbed when given orally. C) Sulfonamides treat only gram-positive infections. D) Sulfonamides treat only gram-negative infections. E) Sulfonamides are excreted by the kidneys.

A, E (Feedback: Sulfonamides are well absorbed by the GI tract and are excreted by the kidneys. Sulfonamides treat both gram-positive and gram-negative infections.)

A nurse is conducting a class for a local community group about herbal agents. Which of the following would the nurse include as being effective against fungal skin infections? Select all that apply. A) Tea tree oil B) Gingko biloba C) Valerian root D) Fever few E) Garlic

A, E( Feedback: Tea tree oil and garlic are two herbs that researchers have identified as having antifungal properties to treat skin infections.)

A group of nursing students are reviewing information about clotrimazole vaginal preparations. The students demonstrate understanding of the drug when they identify which of the following as a trade name for the drug? Select all that apply. A) Lotrimin B) Monistat C) Vagistat-1 D) Terazol E) Mycelex

A, E( Feedback: Lotrimin and Mycelex are trade names for clotrimazole vaginal preparations. Monistat is the trade name for miconazole. Vagistat-1 is the trade name for tioconazole. Terazol is the trade name for terconazole.)

When providing care to a client taking isoniazid (INH), the nurse would monitor the client carefully for which of the following that indicate toxicity? Select all that apply. A) Peripheral neuropathy B) Visual changes C) Nausea D) Vomiting E) Hepatitis

A, E( Feedback: Signs of isoniazid (INH) toxicity include peripheral neuropathy and hepatitis.)

The nurse is providing care to a client with diabetes who is receiving sulfonamides. The nurse counsels the client about the increased risk of hypoglycemia, especially if the client is taking which of the following medications? Select all that apply. A) Tolbutamide (Orinase) B) Lisinopril (Prinivil) C) Simvastatin (Zocor) D) Losartan (Cozaar) E) Chlorpropamide (Diabinese)

A, E( Feedback: Sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide (Orinase) and chlorpropamide (Diabinese). Elderly clients may be especially sensitive to this reaction. Lisinopril, simvastatin, and losartan are used for cardiac conditions.)

After teaching a group of nursing students about fluoroquinolones, the instructor determines that the teaching was successful when they identify which of the following as an example? Select all that apply. A) Levofloxacin (Levaquin) B) Amoxicillin (Amoxil) C) Cephalexin (Keflex) D) Spectinomycin (Trobicin) E) Ciprofloxacin (Cipro)

A, E( Feedback: The fluoroquinolone drugs include ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin). Amoxicillin is an aminopenicillin. Spectinomycin is chemically related to but different from aminoglycosides.)

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? A) Monitoring fluid intake B) Monitoring blood creatinine levels C) Testing for occult blood D) Testing for increased glucose levels

B (Feedback: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.)

When developing the plan of care for a client receiving sulfonamides for treatment of a urinary tract infection, the nurse identifies actions for encouraging fluid intake and monitoring intake and output based on which nursing diagnosis? A) Risk for Fluid Imbalance B) Impaired Urinary Elimination C) Risk for Ineffective Renal Perfusion D) Stress Incontinence

B( Feedback: A client with a urinary tract infection already is experiencing an alteration in urinary elimination. Because one adverse effect of the sulfonamide drugs is altered elimination patterns, it is important to help the client maintain adequate fluid intake and output. The nurse would encourage clients to increase fluid intake to 2000 mL or more per day to prevent crystalluria and stones (calculi) forming in the genitourinary tract, as well as to aid in removing microorganisms from the urinary tract. It is important to measure and record the client's intake and output every 8 hours and notify the primary health care provider if the urinary output decreases or the client fails to increase his or her oral intake. If the client is unable to maintain adequate intake, then he or she would be at risk for fluid imbalance. If renal injury would occur, then the client would be at risk for ineffective renal perfusion. Bladder training would be an appropriate intervention to address stress incontinence.)

A 26-year-old female patient with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which of the following instructions should the nurse include in the patient teaching plan? A) If a dosage is missed, increase the next dosage to meet the daily quota. B) Ampicillin will reduce the effectiveness of birth control pills. C) Take drug on an empty stomach, an hour before or 2 hours after meals. D) Avoid use of skin care products, like moisturizers, when on penicillin therapy.

B( Feedback: Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The patient should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The patient need not avoid use of skin care products when on penicillin therapy.)

A nurse is conducting an in-service training program for a group of nurses about antibacterial drugs such as penicillins and cephalosporins. During the question-and-answer period, the audience asks for examples of conditions that can be treated by cephalosporins. Which of the following would the nurse include in the response? A) Hemolysis B) Urinary tract infections C) Nausea and diarrhea D) Jaundice

B( Feedback: Cephalosporins are used to treat respiratory infections, otitis media, urinary tract infections, and bone and joint infections, and prophylactically to treat infections that may result from a sexual assault. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporin therapy.)

A client is ordered to receive an antiretroviral agent that is categorized as a nonnucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? A) Indinavir B) Nevirapine C) Saquinavir D) Ritonavir

B( Feedback: Nevirapine is classified as a nonnucleoside reverse transcriptase inhibitor. Indinavir, saquinavir, and ritonavir are classified as protease inhibitors.)

While the nurse is obtaining a drug history from a patient, the patient tells the nurse that he is allergic to penicillins and has also experienced a rash when he took a cephalosporin. The nurse interprets this information as indicating which of the following? A) Hypersensitivity B) Cross-sensitivity C) Anaphylactoid reaction D) Anaphylaxis

B( Feedback: Once an individual is allergic to one penicillin, he or she is usually allergic to all of the penicillins. Those allergic to penicillin also have a higher incidence of allergy to the cephalosporins. Allergy to drugs in the same or related groups is called cross-sensitivity. Hypersensitivity is an allergic reaction to one substance. Anaphylactoid reaction is an unusual or exaggerated allergic reaction. Anaphylaxis or anaphylactic shock is a severe form of hypersensitivity that occurs immediately and can be fatal.)

A patient diagnosed with TB is undergoing treatment. The nurse knows that which of the following would be used for household members and other close associates of the client to help prevent the spread of the disease? A) Long-term therapy B) Prophylactic therapy C) DOT therapy D) Short-term therapy

B( Feedback: Prophylactic therapy will prevent or avoid the spreading of TB in household members and other close associates of the diagnosed client. Long-term treatment does not prevent the spreading of TB, though it may eventually cure or reduce the intensity of the disease. Directly observed therapy (DOT) is used to administer drugs two to three times weekly. Using DOT will not prevent the TB from spreading. Usually, short-term therapy is of no value in treating TB. Short-term therapy will also not prevent the disease from spreading.)

A client develops pseudomembranous colitis secondary to fluoroquinolone therapy. The nurse understands that this is the result of which organism? A) E. coli B) C. difficile C) Staphylococcus D) Group B hemolytic Streptococcus

B( Feedback: Pseudomembranous colitis is one type of a bacterial superinfection. This potentially life-threatening problem develops because of an overgrowth of the microorganism Clostridium difficile (C. diff) in the bowel.)

A patient is receiving telithromycin. Based on the nurse's understanding of potential adverse reactions, the nurse would identify which nursing diagnosis as a priority? A) Ineffective Renal Tissue Perfusion B) Risk for Injury C) Diarrhea D) Risk for Impaired Skin Integrity

B( Feedback: Telithromycin can cause visual disturbances such as difficulty focusing and accommodating to light. Therefore, the priority nursing diagnosis would be Risk for Injury related to these visual disturbances. Aminoglycosides can cause nephrotoxicity, leading to a nursing diagnosis of Ineffective Renal Perfusion. Although diarrhea and skin rashes can occur, these would not be a priority at this time.)

A patient receiving penicillin therapy tells the nurse that she feels like her mouth is irritated and that she has a sore throat. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and identifies which nursing diagnosis as most appropriate for this patient? A) Impaired Comfort B) Impaired Oral Mucous Membranes C) Deficient Knowledge D) Inadequate Nutrition: Less Than Body Requirements

B( Feedback: The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Impaired Oral Mucous Membranes. Although Impaired Comfort may be appropriate, Impaired Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the patient may experience difficulty eating due to the irritation and discomfort.)

A patient who is being discharged needs to continue taking the zanamivir using a Diskhaler and a bronchodilator. Both the inhaler and the Diskhaler are prescribed at the same time. Which instruction would the nurse include in the teaching plan for the patient? A) Zanamivir should be taken every 6 hours. B) Use the bronchodilator before taking zanamivir. C) Zanamivir used with a bronchodilator causes orthostatic hypotension. D) Risk of disease transmission is minimal during therapy.

B( Feedback: The bronchodilator should be used before the zanamivir. The drug should be taken every 12 hours, not every 6 hours. The nurse should also inform the patient that treatment with this drug does not decrease the risk of transmission of the "flu" to others. Zanamivir when used with a bronchodilator does not specifically cause orthostatic hypotension, though antivirals are known to affect the mental status of patients.)

A client diagnosed with HIV infection is receiving HAART. The client, who is alert and oriented, complains of anorexia, nausea, and vomiting. He has lost 10 pounds in the last 6 weeks. Additional assessment reveals pale, pink skin without any irritation or breakdown. He denies any complaints of pain. Which nursing diagnosis would the nurse identify as the priority for this client? A) Risk for Injury B) Risk for Imbalanced Nutrition: Less Than Body Requirements C) Risk for Impaired Skin Integrity D) Acute Pain

B( Feedback: The client's complaints along with his weight loss strongly suggest a nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements as a priority. The client is alert and oriented, so his risk for injury is significantly low. There is no evidence of impaired skin integrity at present. However, this may become a concern if the client begins to experience skin breakdown secondary to his poor nutritional status. The client denies any pain, so Acute Pain would be inappropriate.)

A nurse is preparing to administer ciprofloxacin as ordered. Which test would the nurse ensure is completed before administering the first dose to the patient? A) Urinalysis B) Culture tests C) Ulcer tests D) Stool tests

B( Feedback: The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.)

A patient with TB is undergoing initial therapy in the treatment. The nurse has to administer three or more drugs in combination to the patient. The patient wishes to know the reason for administering a combination of drugs. Which of the following explanations does the nurse offer related to the combination of medications? A) Prevents the incidence of liver dysfunction B) Slows down bacterial resistance C) Slows body's resistance to medication D) Prevents further spreading of TB

B( Feedback: The nurse should inform the patient that administering two to three drugs in combination slows down the development of bacterial resistance in the body. Administering a combination of drugs will not specifically prevent the incidence of liver dysfunction. Using drugs in combination does not slow down the body's resistance to medication, though it does reduce the development of bacterial resistance. Prophylactic treatment helps in preventing the TB from spreading further.)

A patient is receiving doxycycline as short-term therapy for malaria. Which of the following instructions would the nurse include in the teaching plan about the possible side effects of the drug? A) Avoid taking warfarin because it increases the risk of bleeding. B) Avoid exposure to the sun by wearing protective clothing. C) Take the drug with food, or immediately afterward. D) Do not drive or perform other activities requiring alertness.

B( Feedback: The nurse should instruct the patient to avoid exposure to the sun by wearing protective clothing (e.g., long-sleeved shirts, wide-brimmed hats) and by using sunscreen. Combining warfarin with quinine, not doxycycline, increases the risk of bleeding. Doxycycline should be taken on an empty stomach. Doxycycline does not impair alertness, so the patient can drive or perform other activities requiring alertness.)

A patient is prescribed metronidazole for intestinal amebiasis. Which of the following instructions should the nurse give to the patient regarding the drug? A) Take the drug on an empty stomach. B) Avoid intake of alcohol. C) Guard against effects of photosensitivity. D) Take phenobarbital for impaired sleep.

B( Feedback: The nurse should instruct the patient to avoid the use of alcohol, in any form, until the course of treatment is completed. The ingestion of alcohol may cause a mild to severe reaction, with symptoms of severe vomiting, headache, nausea, abdominal cramps, flushing, and sweating. Metronidazole should be taken with food or meals, not on an empty stomach. Photosensitivity is not one of the side effects of metronidazole. Phenobarbital should be avoided, as it increases the metabolism of metronidazole.

A patient has been prescribed albendazole on an outpatient basis for an anthelmintic infection. After teaching the patient about the therapy, which statement by the patient indicates effective teaching? A) "Easy bruising or bleeding is normal and needn't be reported." B) "I need to disinfect the bathtub or shower stall immediately after bathing." C) "I should avoid bathing daily if I have problems with my skin." D) "I need to use oral contraceptives while I'm taking this drug."

B( Feedback: The nurse should instruct the patient to disinfect the bathtub or shower stall immediately after bathing to avoid spreading the infection. Thrombocytopenia or easy bruising or bleeding is not normal and should be reported immediately. Impaired skin integrity is not associated with albendazole, so there is no need to avoid bathing daily. Instead of oral contraceptives, the nurse should recommend the barrier method during the course of therapy and for 1 month after discontinuing the therapy.)

The nurse is teaching a client and his family about administering pentamidine at home. Which statement by the client indicates a need for additional teaching? A) "I should protect the solution from direct light." B) "The entire treatment should take no more than 15 minutes." C) "I need to dissolve the drug in the correct amount of sterile water." D) "Only the pentamidine solution should go into the nebulizer's reservoir."

B( Feedback: The pentamidine treatment typically lasts about 30 to 45 minutes. The solution should be protected from light after the drug is dissolved with the proper amount of sterile water. No other drugs should be added to the reservoir.)

A client is receiving a fluoroquinolone as an extended-release formulation. Which of the following would be most important to include in the client's teaching plan? A) To chew, crush, or break the medication B) To swallow the medication whole C) To limit the daily fluid intake D) To take the drug with an antacid

B( Feedback: When an extended-release formulation is prescribed, the client needs instructions to swallow the medication whole and not to chew, crush, or break the medication. Otherwise, the amount of drug released would be too great for the body all at once. Clients should be encouraged to increase their fluid intake and to separate administration by 1 to 2 hours.)

The nurse is providing care to a patient who is receiving an aminoglycoside for a wound infection. The patient is also ordered to receive a cephalosporin. The nurse would carefully assess the patient for which of the following? A) Nausea B) Nephrotoxicity C) Increased bleeding D) Respiratory difficulty-

B( Feedback: When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. The risk for respiratory difficulty and a disulfiram-like reaction increases if alcohol is consumed within 72 hours after administration of certain cephalosporins.)

A nurse is to administer sulfasalazine to a client with ulcerative colitis. Which of the following interventions would be most important while caring for this client? A) Stop dosage if skin turns orange-yellow color. B) Regularly inspect client's stool samples. C) Give the drug on an empty stomach. D) Administer cranberry juice to the client.

B( Feedback: While providing care to a client receiving sulfasalazine therapy for ulcerative colitis, the nurse should regularly inspect all stool samples and record their number and appearance. Yellow skin or urine in clients receiving sulfasalazine is normal, and the nurse should not stop the dosage. Sulfasalazine is administered with meals or immediately afterward, not on an empty stomach. Administering cranberry juice is helpful for clients with urinary tract infections, but not for clients with ulcerative colitis.)

After teaching a group of nursing students about antiretroviral drugs, the instructor determines that the teaching was successful when the students identify that these drugs are used to treat which infections? Select all that apply. A) Hepatitis C virus (HCV) B) Human immunodeficiency virus (HIV) C) Acquired immunodeficiency syndrome (AIDS) D) Herpes simplex virus (HSV) 1 E) Herpes simplex virus (HSV) 2

B, C( Feedback: Antiretroviral drugs are used to treat HIV and AIDS.)

After teaching a group of students about antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the students identify which of the following as an example of a carbapenem? Select all that apply. A) Vancomycin B) Imipenem-cilastatin C) Meropenem D) Aztreonam E) Ceftriaxone

B, C( Feedback: Carbapenems include imipenem-cilastatin and meropenem. Vancomycin and aztreonam are classified as miscellaneous drugs that disrupt the bacterial cell wall. Ceftriaxone is a third-generation cephalosporin.)

A nurse is preparing a plan of care for an older adult client who is receiving sulfonamide therapy. Which of the following would the nurse include in the plan of care to reduce the likelihood of causing renal damage? Select all that apply. A) Administer sulfonamides once daily. B) Increase fluid intake up to 2000 mL if tolerated. C) Use sulfonamides cautiously in clients with renal impairment. D) Administer the dose intravenously instead of orally. E) Ask the prescriber to change the medication ordered.

B, C( Feedback: Older adults experience a decline in renal function with aging. Therefore, sulfonamides must be used cautiously in older clients. In addition, increasing fluid intake up to 2000 mL daily can decrease the likelihood of causing renal damage in older clients. The drug is administered throughout the day, not as a once-daily dose. Sulfonamides can affect renal function regardless of the route administered. Asking the prescriber to change the medication ordered may be appropriate but is not necessary as long as the drug is administered cautiously and the client is monitored closely.)

A client is planning to travel to an area of the world where malaria is endemic. The physician has given the client a prescription of chloroquine as prophylaxis. Which of the following would the nurse include in the teaching plan for this client about starting and ending therapy? Select all that apply. A) Begin therapy 1 month before exposure. B) Begin therapy 2 weeks before exposure. C) Continue therapy 6 to 8 weeks after leaving endemic area. D) Continue therapy 1 to 2 weeks after leaving endemic area. E) Stop therapy 2 days prior to leaving endemic area.

B, C( Feedback: The nurse should advise the client to begin malaria prophylaxis therapy 2 weeks before traveling to the endemic area and to continue therapy 6 to 8 weeks after leaving the endemic area.)

A nurse would suspect tuberculosis caused by drug-resistant organisms in which of the following clients? Select all that apply. A) Clients who are HIV positive B) Clients who have no response to therapy C) Clients who have been treated in the past D) Clients who have asthma E) Clients who smoke

B, C( Feedback: Tuberculosis caused by drug-resistant organisms should be considered in clients who have no response to therapy and in patients who have been treated in the past.)

A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should teach the client about which of the following common adverse reactions? Select all that apply. A) Constipation B) Nausea C) Headache D) Dizziness E) Dry mouth

B, C, D( Feedback: Common adverse reactions to fluoroquinolones include nausea, vomiting, diarrhea, headache, abdominal pain or discomfort, dizziness, and photosensitivity. Constipation and dry mouth are not associated with fluoroquinolone therapy.)

After teaching a group of nursing students about antitubercular therapy, the instructor determines that the teaching was successful when the students identify which of the following as a primary drug to treat tuberculosis? Select all that apply. A) Levofloxacin (Levaquin) B) Ethambutol (Myambutol) C) Isoniazid (Nydrazid) D) Rifampin (Rifadin) E) Ciprofloxacin (Cipro)

B, C, D( Feedback: Ethambutol, isoniazid, pyrazinamide, and rifampin are considered primary drugs in the treatment of TB. Levofloxacin and ciprofloxacin are considered secondary drugs.)

A nurse is reviewing the laboratory test results of a client receiving sulfasalazine therapy for ulcerative colitis. Which of the following would the nurse anticipate finding? Select all that apply. A) Pancytopenia B) Leukopenia C) Thrombocytopenia D) Aplastic anemia E) Iron deficiency anemia

B, C, D( Feedback: Leukopenia, thrombocytopenia, and aplastic anemia are hematologic changes that may occur during prolonged sulfonamide therapy, such as during ulcerative colitis treatment with sulfasalazine.)

A nurse is reviewing the laboratory test results of a client receiving penicillin therapy. Which of the following would the nurse identify as indicating an adverse hematologic reaction? Select all that apply. A) Pancytopenia B) Anemia C) Thrombocytopenia D) Leukopenia E) Hemoglobulinemia

B, C, D( Feedback: Nurses should monitor blood counts of clients taking penicillins for the following hematopoietic changes: anemia, thrombocytopenia, leucopenia, and bone marrow suppression.)

While administering vancomycin IV to a patient, the nurse suspects that the patient is developing red-man syndrome based on assessment of which of the following? Select all that apply. A) Headache B) Throbbing neck pain C) Chills D) Erythema of the neck and back E) Difficulty breathing

B, C, D( Feedback: Red-man syndrome is manifested by a decrease in blood pressure, occurrence of throbbing neck or back pain, fever, chills, paresthesias, and erythema of the neck and back. Headache is unrelated to this syndrome. Difficulty breathing might suggest an anaphylactic reaction.)

Which of the following should be included in the teaching plan when instructing a female client on the use of miconazole (Monistat) vaginal cream? Select all that apply. A) Discontinue drug during the menstrual period. B) Avoid nylon and tight-fitting garments to avoid reinfection. C) Wear a sanitary napkin after insertion to prevent staining of clothes and bed linens. D) Do not have intercourse while taking the drug to avoid reinfection. E) If there is no improvement in 2 days, stop using the drug and consult a physician.

B, C, D( Feedback: When instructing a female client on the use of miconazole (Monistat) vaginal cream, the nurse should include the following: inserting the drug high in the vagina using the applicator provided; wearing a sanitary napkin after insertion of the drug to prevent staining of clothes and bed linens; continuing the drug during the menstrual period; not having intercourse while taking the drug or advising her partner to use a condom to avoid reinfection; avoiding nylon and tight-fitting garments to avoid reinfection; stopping the drug and notifying the primary health care provider if there is no improvement in 5 to 7 days; and if abdominal pain, pelvic pain, rash, fever, or offensive-smelling vaginal discharge is present, not using the drug but notifying the physician.)

Which of the following information should the nurse obtain during the preadministration assessment of a client prescribed a fluoroquinolone? Select all that apply. A) Blood glucose levels B) Allergy history C) Signs and symptoms of infection D) Blood pressure E) Temperature

B, C, D, E( Feedback: Before administering a fluoroquinolone, the nurse identifies and records the signs and symptoms of the infections, takes a thorough allergy history, takes and records vital signs, and, if ordered, obtains cultures.)

A client receiving which of the following would the nurse identify as being at increased risk for candidal infections? Select all that apply. A) Antihypertensive therapy B) Antibiotics C) Hypoglycemic agents D) Immunosuppressive agents E) Oral contraceptives

B, C, D, E( Feedback: Clients who are at increased risk for candidal infections are those who are immunocompromised, have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids, as well as posttransplant or surgical clients.)

After teaching a group of nursing students about penicillins, the instructor determines that the teaching was successful when the students identify which of the following as a group? Select all that apply. A) Synthetic penicillins B) Natural penicillins C) Penicillinase-resistant penicillins D) Aminopenicillins E) Extended-spectrum penicillins

B, C, D, E( Feedback: Penicillins are categorized into four groups including the natural penicillins, penicillinase-resistant penicillins, aminopenicillins, and extended-spectrum penicillins.)

When reviewing the medical records of several clients who are prescribed sulfonamide therapy, the nurse would expect laboratory findings related to which bacteria? Select all that apply. A) Pseudomonas aeruginosa B) Escherichia coli C) Klebsiella pneumoniae D) Streptococcus pyogenes E) Staphylococcus aureus

B, C, E (Feedback: Sulfonamides are often used to control infections caused by both gram-negative and gram-positive bacteria, such as Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Typically, sulfonamides are not used to treat infections caused by Pseudomonas aeruginosa or Streptococcus pyogenes.)

Which of the following would the nurse include in the teaching plan as an adverse reaction for a client receiving antihelminthic therapy? Select all that apply. A) Hypotension B) Drowsiness C) Abdominal pain D) Hypoglycemia E) Nausea

B, C, E( Feedback: Antihelminthics cause several generalized adverse reactions that the client should be advised of, including drowsiness, dizziness, nausea, vomiting, abdominal pain and cramps, and diarrhea.)

A group of nursing students are reviewing information about clindamycin (Cleocin). The students demonstrate understanding of this drug when they identify that it should be used with caution in clients with which of the following? Select all that apply. A) Seizure disorder B) GI disorders C) Myasthenia gravis D) Diabetes E) Hepatic impairment

B, C, E( Feedback: Clindamycin, a lincosamide, should be used cautiously in clients with a history of GI disorders, renal disease, liver impairment, or myasthenia gravis.)

A nurse is preparing to administer ribavirin via inhalation to a client. Which of the following would the nurse need to keep in mind? Select all that apply. A) Administration is via a nebulizer. B) Solution should be discarded and replaced every 24 hours. C) Respiratory status can be worsened by the drug. D) Extrapyramidal effects can occur upon administration of the drug. E) Women of childbearing age should not inhale the drug.

B, C, E( Feedback: Ribavirin is administered by inhalation using a small-particle aerosol generator. The solution should be discarded and replaced every 24 hours. This drug can worsen respiratory status, this drug is pregnancy category X, and women of childbearing age should take care not to inhale the drug.)

The nurse is reviewing the medical record of a client who is to receive ritonavir. Which medication if found in the medication history would lead the nurse to contact the primary health care provider because the prescribed drug would be contraindicated? Select all that apply. A) Triazolam (Halcion) B) Bupropion (Wellbutrin) C) Zolpidem (Ambien) D) Lisinopril (Prinivil) E) Procainamide (Procanbid)

B, C, E( Feedback: Ritonavir (Norvir) is contraindicated if the client is taking bupropion (Wellbutrin), zolpidem (Ambien), or an antiarrhythmic drug.)

A client is being discharged with a prescription for sulfasalazine. Which of the following would the nurse include in the discharge teaching plan? Select all that apply. A) Take the drug 1 hour before or 2 hours after meals. B) Use protective sunscreen or cover exposed areas when going outside. C) Finish the entire course of sulfonamide even if you begin feeling better. D) Decrease fluid intake to prevent increased excretion of the drug. E) Keep all follow-up appointments.

B, C, E( Feedback: The nurse should teach the client to take sulfasalazine with food or immediately after a meal, to use sunscreen or cover exposed areas to prevent severe sunburn, to increase fluid intake to prevent renal calculi, to finish the entire course of drug even if the symptoms go away, and to keep all follow-up appointments.)

A nurse is preparing a teaching plan for a client who is receiving antiviral therapy. Which of the following would the nurse include? Select all that apply. A) "Only notify your physician if an allergic reaction to the antiviral drug occurs." B) "These drugs are not a cure for the viral infection, but they will shorten the course of disease." C) "Mark a calendar to designate the days the drug is to be taken so that you can keep to the ordered alternate-dosage schedule." D) "These drugs will help in preventing the spread of the infection to those around you." E) "Take precautions when you're outside because you might experience a sunburn reaction."

B, C, E( Feedback: The nurse's teaching plan for antiviral drugs should include educating the client and family that antiviral drugs are not a cure for viral infection but will shorten the course of disease; that antiviral drugs will not prevent the spread of disease to others; that some antiviral drugs cause photosensitivity, so precaution should be taken when going outdoors; that a calendar should be marked to designate the days the drug is to be taken for clients on an alternate-dosage schedule; and that the physician should be notified if burning, stinging, itching, or rash worsens or becomes pronounced.)

A nurse is preparing to administer antiviral therapy. The nurse integrates knowledge of this therapy, administering the drugs cautiously to clients with which of the following? Select all that apply. A) Hepatic impairment B) Renal impairment C) Diabetes D) Low blood cell count E) Hypertension

B, D( Feedback: Antivirals should be used cautiously in clients with renal impairment, low blood cell counts, history of epilepsy (rimantadine), and history of respiratory disease (zanamivir).)

After teaching a group of nursing students about the different generations of cephalosporins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a first-generation cephalosporin? Select all that apply. A) Cefepime (Maxipime) B) Cefazolin (Ancef) C) Cefoxitin (Mefoxin) D) Cephalexin (Keflex) E) Cefaclor (Raniclor)

B, D( Feedback: Cefazolin and cephalexin are examples of first-generation cephalosporins. Cefoxitin and cefaclor are examples of second-generation cephalosporins. Cefepime is an example of a fourth-generation cephalosporin.)

A female client receiving methotrexate for the treatment of rheumatoid arthritis is given a prescription for trimethoprim and sulfamethoxazole (Bactrim DS). The client returns to the physician's office feeling worse than before. She now has a cough and unusual bruising on the extremities. The physician orders a complete blood count and a complete metabolic profile. Which test results would the nurse expect to find? Select all that apply. A) Increased hemoglobin B) Decreased number of white blood cells C) Increased number of red blood cells D) Decreased number of platelets E) All values should be within normal limits

B, D( Feedback: The concomitant use of methotrexate and sulfonamides, like trimethoprim and sulfamethoxazole (Bactrim DS), can result in increased bone marrow suppression, leading to decreased amounts of white blood cells, red blood cells, and platelets in the blood.)

The nurse is preparing a plan of care for a client being treated with an antiviral drug. Which outcome would the nurse most likely identify? Select all that apply. A) Client remains free of other medical conditions. B) Client demonstrates an optimal response to therapy. C) Client exhibits continual changes in vital signs. D) Client demonstrates ability to manage adverse reactions. E) Client verbalizes understanding of the therapeutic regimen.

B, D, E( Feedback: Optimal response to therapy and meeting of client needs related to the management of adverse reactions and an understanding of the therapeutic regimen are outcomes that should be addressed by the nurse in the planning step of the nursing process. Continually changing vital signs would be inappropriate. Remaining free of other medical conditions would be unrealistic.)

A nurse is teaching a patient about the common adverse reactions that can occur with his prescribed therapy with cephalosporins. The nurse determines that the teaching was successful when the patient identifies which of the following? Select all that apply. A) Drowsiness B) Headache C) Constipation D) Heartburn E) Vomiting

B, D, E( Feedback: Common adverse reactions to cephalosporins include nausea, vomiting, diarrhea, headache, dizziness, malaise, heartburn, and fever.)

A nurse is preparing a plan of care for a client who is prescribed an antiparasitic agent. Which nursing diagnosis would the nurse most likely identify related to the client's drug therapy? Select all that apply. A) Impaired Comfort B) Diarrhea C) Risk for Ineffective Tissue Perfusion D) Risk for Deficient Fluid Volume E) Risk for Impaired Respiratory Function

B, D, E( Feedback: Drug-specific nursing diagnoses when discussing the treatment of parasitic infection include Diarrhea, Risk for Deficient Fluid Volume, Imbalanced Nutrition, Risk for Impaired Respiratory Function.)

A nurse is reading a journal article about spectinomycin. Which of the following would the nurse expect to find as being discussed about this drug? Select all that apply. A) Spectinomycin is used to treat chlamydia infections. B) Spectinomycin is used to treat gonorrhea infections. C) Spectinomycin is chemically unrelated to aminoglycosides. D) Spectinomycin can be used in clients with penicillin allergy. E) Spectinomycin has no known significant food or drug interactions.

B, D, E( Feedback: Spectinomycin is used to treat gonorrhea infections in clients who are allergic to penicillins, cephalosporins, or probenecid (Benemid). Spectinomycin is chemically related to but different from aminoglycosides. No significant drug or food interactions for spectinomycin are known.)

Which of the following circumstances would warrant a continuation treatment phase of 7 months? Select all that apply. A) Noninclusion of rifampin in the initial treatment phase B) Noninclusion of pyrazinamide in the initial treatment phase C) HIV-positive clients D) Cavitary disease after completion of initial treatment E) Positive sputum culture after completion of initial treatment

B, E( Feedback: Noninclusion of pyrazinamide in the initial treatment phase, positive sputum culture after completion of initial treatment, and positive sputum culture after initial treatment in a client with previously diagnosed HIV infections would warrant a continuation of the treatment phase.)

The primary health care provider has prescribed quinine for a client. The patient is also taking warfarin. Which of the following would be most important for the nurse to keep in mind about this combination when providing care to the patient? A) Quinine absorption is increased. B) Metabolism of quinine is increased. C) The patient is at increased risk for bleeding. D) The patient's risk for a heart attack is increased.

C( Feedback: Combining warfarin with quinine increases the risk of bleeding. There is no risk of increased absorption or increased metabolism and no increased risk of heart attack associated with taking warfarin and quinine.)

A patient develops a superinfection due to fluoroquinolone therapy. The patient asks the nurse why this happened. Which response by the nurse would be most appropriate? A) "Your infection was really severe, so the drug wasn't as effective as it could have been." B) "This happens when your original infection begins to clear." C) "The drug disrupts your normal bacteria so it allows other organisms to grow." D) "We really don't know why this happens; it just does sometimes."

C( Feedback: Antibiotics can disrupt the normal flora (nonpathogenic bacteria in the bowel), causing a secondary infection or superinfection. This new infection is "superimposed" on the original infection. The destruction of large numbers of nonpathogenic bacteria (normal flora) by the antibiotic alters the chemical environment. This allows uncontrolled growth of bacteria or fungal microorganisms that are not affected by the antibiotic being administered. It has nothing to do with the drug's effectiveness or the original infection being cleared.)

A patient for whom antiretroviral therapy has been prescribed informs the nurse that she is taking oral contraceptives. The nurse responds that the combination of oral contraceptives and antiretroviral therapy can lead to which of the following? A) Decreased effectiveness of antiviral therapy B) Increased risk of vaginal bleeding C) Decreased effectiveness of birth control pills D) Increased serum level of the antiretroviral

C( Feedback: Antiretrovirals decrease the effectiveness of oral birth control agents. Combining antiretrovirals with birth control pills does not, however, increase the risk of vaginal bleeding, increase serum levels of the antiretroviral, or decrease the effectiveness of antiviral therapy.)

A patient is scheduled for abdominal surgery and is ordered to receive kanamycin as part of the bowel preparation. The patient asks the nurse why he is getting this drug. Which response by the nurse would be most appropriate? A) "You have an infection now and will probably have one after surgery, so this will help control it." B) "We need to lower the levels of ammonia in your bloodstream to prevent problems." C) "The drug helps eliminate bacteria so that your GI tract is as clean as possible for surgery." D) "This is to help prevent you from developing any blood clots during and after the surgery."

C( Feedback: Kanamycin and neomycin are used before surgery to reduce intestinal bacteria. It is thought that this reduces the possibility of abdominal infection that may occur after surgery on the bowel. By destroying bacteria in the gut and washing it out with laxatives or enemas, the surgical area becomes as clean as possible before the operation. The drug is not used to control an infection preoperatively. It does help to reduce blood ammonia levels with hepatic coma, but this is not the reason for its use with this patient. The drug has no effect on preventing blood clots postoperatively.0)

A client with diabetes who is taking an oral antidiabetic agent is diagnosed with tuberculosis and is prescribed rifampin. The nurse would instruct the client about which of the following? A) Increased risk for bleeding B) Greater risk for hepatotoxicity C) Increased blood glucose levels D) Risk for increased blood pressure

C( Feedback: Rifampin interacts with oral hypoglycemic agents, leading to a decrease in the effectiveness of the oral hypoglycemic agent, thus increasing blood glucose levels. An increased risk for bleeding occurs when rifampin is given with oral anticoagulants. An increased risk of hepatotoxicity occurs when rifampin is given with isoniazid. When verapamil is given with rifampin, the effectiveness of verapamil is decreased, leading to increased blood pressure levels.)

A client is prescribed entecavir, which is supplied as a buffered powder. The nurse instructs the client to mix the powder with which of the following? A) Fruit juice B) Applesauce C) Water D) Gelatin

C( Feedback: The client should be instructed to mix the buffered powder with 4 ounces of water (not juice), stir until it is dissolved, and then drink it immediately. Using any other substance such as fruit juice, applesauce, or gelatin would be inappropriate.)

A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs needs to be administered to the client? A) Pyrazinamide and dapsone B) Rifampin and pyrazinamide C) Rifampin and isoniazid D) Dapsone and isoniazid

C( Feedback: The nurse knows that a combination of rifampin and isoniazid drugs should be used during the second phase of standard treatment. Isoniazid, rifampin, and pyrazinamide are not used together as combination drugs in the second phase of standard treatment. Dapsone is used for leprosy and cannot be used in combination with isoniazid or any other drug for TB.)

A 60-year-old client who is on sulfonamide therapy has impaired urinary elimination. She does not want to increase her oral fluid intake because of fear of incontinence. Which of the following nursing interventions would be most appropriate? A) Inform the client that there is no need to increase fluid intake. B) Inform the client that increasing fluid intake will not result in incontinence. C) Teach the client the times to take fluids to maintain continence. D) Increase fluid intake by 1000 mL instead of 2000 mL to avoid incontinence.

C( Feedback: The nurse's responsibility is to help the client overcome the fear of incontinence and to teach her when to take fluids to maintain continence. Instead of telling the client that increasing fluid intake has no effect on continence, the nurse should focus on helping the client with her problems of incontinence. The nurse should instruct the client to increase the fluid intake by at least 2000 mL, instead of only 1000 mL; however, this will not help control incontinence.)

A group of nursing students are reviewing information about fungal infections. The students demonstrate understanding of the information when they identify which of the following as a superficial fungal infection? A) Aspergillosis B) Cryptococcal meningitis C) Thrush D) Malaria

C( Feedback: Thrush is also oral candidiasis, a superficial fungal infection of the oral mucosa. Aspergillosis and cryptococcal meningitis are systemic fungal infections. Malaria is a protozoal infection.)

A client is receiving a fluoroquinolone and is also taking ibuprofen for pain relief. The nurse would be alert for which of the following? A) Increased risk for bleeding B) Decreased effectiveness of the fluoroquinolone C) Increased risk for seizures D) Delayed elimination of the fluoroquinolone

C( Feedback: When a nonsteroidal anti-inflammatory drug such as ibuprofen is used in conjunction with a fluoroquinolone, the patient has an increased risk for seizures. An increased risk of bleeding would occur with oral anticoagulants in conjunction with fluoroquinolone therapy. Decreased effectiveness of the fluoroquinolone would occur if it was given with antacids, iron salts, or zinc because of decreased absorption of the antibiotic. Cimetidine interferes with the elimination of the fluoroquinolone, leading to prolonged presence of the drug in the bloodstream.)

A patient presents to her primary health care provider for treatment of herpes simplex. While obtaining the medical history of the patient, the nurse discovers that the patient has respiratory problems and uses theophylline. The primary health care provider considers prescribing acyclovir as the drug for treatment until she reads the nursing history. The nurse understands that the primary health care provider decided against the use of acyclovir for which reason? A) Increases the risk for acyclovir toxicity B) Increases the risk of seizures in patients with respiratory problems C) Increases serum level of theophylline in patients taking theophylline D) Increased serum levels of antiviral valacyclovir

C( Feedback: When patients receiving theophylline treatment are administered acyclovir, there is an increase in the serum level of theophylline, thus placing the client at risk for theophylline toxicity. The serum levels of acyclovir do not increase. Increased levels of valacyclovir occur if the patient is taking valacyclovir, not theophylline. Taking acyclovir with theophylline does not increase the risk of seizures.)

A patient undergoing penicillin therapy shows improvement and states that he is feeling better. Which of the following interventions is the nurse most likely to perform in such a situation? A) Instruct patient to increase dietary intake. B) Inform the primary health provider immediately. C) Record assessments on patient's chart. D) Inquire about any previous drug allergies.

C( Feedback: When the patient declares that he is feeling better and is also showing improved health, it should be recorded on the patient's chart. If the condition of the patient has improved, the patient will show an increased appetite, but there is no need to instruct the patient to increase dietary intake. The primary health provider need not be informed about the condition immediately unless the patient shows signs of deterioration or complications. The nurse should inquire about previous drug allergies before the start of therapy.)

A nursing instructor is describing a situation in which a client with tuberculosis periodically visits his primary health care provider and demonstrates taking his medication in front of the nurse. The instructor is describing which of the following? A) Initial phase of treatment B) Continuation phase of treatment C) Directly observed therapy D) Adherence evaluation

C( Feedback: With directly observed therapy (DOT), the patient makes periodic visits to the office of the primary health care provider or the health clinic and takes the drug in the presence of the nurse. Nurses watch the patient swallow each dose of the medication treatment. In some cases, the nurse may travel to the patient's home, place of employment, or school to observe or administer medication. DOT can be used during the initial and/or continuation phase of treatment.)

A nurse would use caution when administering itraconazole (Sporanox) to clients with which of the following conditions? Select all that apply. A) Hypertension B) Glaucoma C) HIV D) Hypochlorhydria E) GERD

C, D( Feedback: Itraconazole (Sporanox) should be used with caution in clients with HIV infection and hypochlorhydria.)

Which of the following represent contraindications to treatment with a sulfonamide? Select all that apply. A) Children younger than 6 years of age B) Adults older than 65 years of age C) Lactating females D) Clients with group A beta-hemolytic streptococci infections E) Women in the second trimester of pregnancy

C, D( Feedback: The sulfonamides are contraindicated in clients with hypersensitivity to the sulfonamides, during lactation, in children younger than 2 years of age, near the end of pregnancy, and for infections caused by group A beta-hemolytic streptococci.)

A nurse is reviewing the signs and symptoms of a fungal superinfection with a client. The client demonstrates understanding of the information when he identifies which of the following as suggesting a fungal superinfection? Select all that apply. A) Bloody diarrhea B) Abdominal cramping C) Creamy white patches on the throat D) Intense vaginal itching E) Excoriation of the anogenital skin folds

C, D, E( Feedback: A fungal superinfection commonly occurs in the mouth, vagina, and anogenital areas, commonly manifested by creamy, white, lace-like patches on the tongue, mouth, or throat; white or yellow vaginal discharge; anal or vaginal itching or redness; and inflammation or excoriation of the mouth or the skin folds of the anogenital area. Bacterial superinfections commonly occur in the bowel, manifested by fever, diarrhea with visible blood or mucus, and abdominal cramping.)

A group of students are reviewing information about the different penicillins. The students demonstrate understanding of the information when they identify which of the following as an example of a beta-lactamase inhibitor? Select all that apply. A) Piperacillin B) Amoxicillin C) Tazobactam D) Sulbactam E) Clavulanic acid

C, D, E( Feedback: Examples of beta-lactamase inhibitors are clavulanic acid, sulbactam, and tazobactam. Amoxicillin is an example of an aminopenicillin. Piperacillin is an example of an extended-spectrum penicillin.)

A client is taking trimethoprim and sulfamethoxazole (Bactrim DS) one tablet twice daily for 14 days. Which of the following would the nurse include when teaching the client about possible adverse reactions? Select all that apply. A) Muscle pain B) Blurred vision C) Anorexia D) Crystalluria E) Photosensitivity

C, D, E( Feedback: Teaching should address potential adverse reactions that can occur while taking a sulfonamide. These adverse reactions include nausea, vomiting, anorexia, stomatitis, chills, fever, crystalluria, and photosensitivity.)

A nurse is providing care to a client with a sulfonamide allergy. The nurse would expect to administer which of the following cautiously if prescribed? Select all that apply. A) Maraviroc (Selzentry) B) Lamivudine (Epivir) C) Fosamprenavir (Lexiva) D) Ritonavir (Norvir) E) Amprenavir (Agenerase)

C, E( Feedback: If a client has a sulfonamide allergy, the antiretroviral drugs fosamprenavir and amprenavir should be used cautiously.)

After teaching a group of nursing students about sulfonamides, the instructor determines that the teaching was successful when the students identify which of the following as an example of a sulfonamide antibiotic? Select all that apply. A) Amoxicillin (Amoxil) B) Ciprofloxacin (Cipro) C) Sulfamethoxazole/trimethoprim (Bactrim) D) Clarithromycin (Biaxin) E) Silver sulfadiazine (Silvadene)

C,E (Feedback: Silver sulfadiazine (Silvadene) and sulfamethoxazole/trimethoprim (Bactrim) are sulfonamide antibiotics. Amoxicillin is an aminopenicillin. Ciprofloxacin is classified as a fluoroquinolone. Clarithromycin is a macrolide.)

A nurse is caring for a patient who is prescribed amantadine. The nurse would assess the patient for which of the following? A) Asthenia and abdominal pain B) Fever and dizziness C) Anorexia and dyspnea D) Hypotension and insomnia

D( Feedback: A nurse should monitor the patient for hypotension and insomnia, since these are adverse reactions of amantadine. Asthenia and abdominal pain are adverse reactions of adefovir. Fever and dizziness are adverse reactions of acyclovir. Anorexia and dyspnea are adverse reactions of cidofovir. Therefore, a nurse need not monitor the patient for fever, dizziness, asthenia, abdominal pain, anorexia, and dyspnea, as these are not adverse reactions of amantadine.)

A client is diagnosed with a urinary tract infection. When obtaining the client's drug history, the client reports using an herbal product in the past to prevent and relieve the symptoms. Which of the following would the client most likely identify? A) Ginger B) Feverfew C) Saw palmetto D) Cranberry

D( Feedback: Cranberries and cranberry juice are commonly used remedies for preventing and relieving symptoms of UTIs. However, if an individual suspects a UTI, medical attention is necessary.)

A patient is ordered to receive vancomycin IV. When administering the drug, the nurse would infuse the drug over which time frame? A) 15 minutes B) 30 minutes C) 45 minutes D) 60 minutes

D( Feedback: Each IV dose of vancomycin is infused over 60 minutes. Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock.)

A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs? A) Increased risk of bleeding B) Increased action of neuromuscular blocking drugs C) Increased profound respiratory depression D) Decreased absorption of tetracycline

D( Feedback: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.)

After teaching a group of nursing students about indications for linezolid (Zyvox), the instructor determines a need for additional teaching when the students identify which of the following as an indication? A) Community-acquired pneumonia (CAP) B) Vancomycin-resistant Enterococcus faecium (VREF) C) Methicillin-resistant Staphylococcus aureus (MRSA) D) Acute otitis media

D( Feedback: Linezolid is used in the treatment of vancomycin-resistant Enterococcus faecium (VREF), health care- and community-acquired pneumonias, and skin and skin structure infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). It is not used to treat otitis media.)

Pyrantel has been prescribed for a patient with roundworms. The patient demonstrates understanding of the teaching about this drug when the patient identifies which of the following as an adverse reaction that should be reported to the health care provider immediately? A) Abdominal cramping B) Headache C) Nausea D) Rashes

D( Feedback: Rashes are a serious adverse reaction associated with pyrantel and should be reported immediately. Headache, nausea, and abdominal cramping are not major side effects associated with pyrantel.)

The nurse is reviewing the medical records of several patients who are receiving fluoroquinolone therapy. Each of the patients is also receiving corticosteroid therapy. Which patient would the nurse identify as being at greatest risk for tendonitis? A) 34-year-old female B) 22-year-old male C) 45-year-old female D) 72-year-old male

D( Feedback: Tendonitis and tendon rupture risk increase when taking a fluoroquinolone. Although this can happen at any age, those older than 60 years who also take corticosteroids are at greater risk.)

A client has been receiving an aminoglycoside for several weeks and comes to the clinic complaining of ringing in his ears and some dizziness. The nurse suspects ototoxicity. When developing this client's plan of care, which nursing diagnosis would be the priority? A) Impaired Comfort B) Altered Thought Process C) Diarrhea D) Risk for Injury

D( Feedback: The development of ototoxicity would lead the nurse to identify a nursing diagnosis of Risk for Injury related to the effects of ototoxicity. Although the client's ringing in the ears could cause discomfort, the priority nursing diagnosis would be Risk for Injury. There is no evidence of impaired comfort, altered thought process or diarrhea.)

A patient has been diagnosed with amebiasis. Which of the following would the nurse do regularly when caring for this patient? A) Take vital signs every 8 hours B) Freeze any stool samples for testing C) Avoid foods that acidify the urine D) Provide the patient with small, frequent meals

D( Feedback: The nurse should ensure that the patient has small, frequent meals (five to six daily) because these may be more appealing than three large meals. The nurse should take vital signs every 4 hours, not 8. Stool samples for testing should be maintained at room temperature and not frozen. There is no need to avoid foods that acidify the urine.)

A patient has been prescribed ketoconazole. Which of the following instructions should the nurse give to the patient regarding its use? A) Cut the tablet in half and take each half one after the other. B) Take the drug with an antacid. C) Ignore any abdominal pain and fever—these are normal. D) Do not drive if drowsiness or dizziness occurs.

D( Feedback: The nurse should instruct the patient to avoid driving or performing other hazardous tasks requiring alertness if drowsiness or dizziness occurs. The tablet should not be cut in two or chewed. The drug should also not be taken with an antacid because of a decrease in absorption. Abdominal pain and fever should be reported to the primary health care provider immediately, not ignored.)

A patient with TB has been admitted to a health care facility. When providing instructions related to antitubercular drugs, which of the following should the nurse include to minimize complications related to the GI tract? A) Double the dose if earlier dose is missed. B) Take prescribed pyrazinamide without regard to food. C) Take prescribed ethambutol with food. D) Avoid the consumption of alcohol.

D( Feedback: The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds the patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of ethambutol without regard to food and to take the prescribed pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.)

A patient is being discharged from a health care facility but is required to continue antiviral therapy at home. Which of the following points should the nurse include in the teaching plan to educate the patient? A) "A slight elevation in temperature is normal and needn't be reported." B) "Double the dosage of the drug if you miss a dose." C) "Stop taking the drug as soon as the symptoms of the infection disappear." D) "Make sure to notify your primary health care provider if you develop any adverse reactions."

D( Feedback: The nurse should instruct the patient to report adverse reactions to the primary health care provider. The nurse should also tell the patient to report any increase in temperature, even if it is a slight increase. If the patient misses a dose, the next dose should be taken as soon as remembered, but it should not be doubled. The nurse should also instruct the patient to take the drug exactly as directed for the full course of therapy, even if the symptoms of the infection disappear.)

A 45-year-old patient with TB is to receive rifampin. The nurse would monitor the patient for which of the following? A) Diarrhea B) Fever C) Dermatitis D) Vertigo

D( Feedback: The nurse should monitor for vertigo as an adverse reaction of rifampin in the patient. Diarrhea, fever, and dermatitis are not adverse reactions of administering rifampin. Diarrhea is an adverse reaction of pyrazinamide. Fever is an adverse reaction of isoniazid. Dermatitis and pruritus are the adverse reactions of ethambutol.)

A client who is being discharged has been instructed to continue with sulfonamide therapy for a week. Which of the following points should the nurse include in the teaching plan to educate the client about the therapy? A) Discontinue dosage if symptoms of infection disappear. B) Take the drug a few minutes before a meal. C) Take any off-the-shelf medication if fever occurs. D) Ensure that all follow-up appointments are met.

D( Feedback: The nurse's plan should include educating the client about the importance of keeping the follow-up appointments. The nurse should instruct the client to adhere to the dosage schedule and not discontinue it even if the symptoms of the infection have gone. The client should inform the primary health care provider if fever, skin rash, or nausea occurs during the therapy. The client should be instructed to take the drug on an empty stomach (at least 2 hours before or after a meal) and not just before a meal.)

A middle-aged patient has been prescribed tetracycline as part of his treatment of H. pylori. The patient has a history of heart disease for which he is receiving digoxin. Given his history and current medications, the patient is at risk for which of the following conditions? A) Respiratory depression B) Decreased effectiveness of tetracycline C) Prolonged clotting times D) Risk of digoxin toxicity

D( Feedback: When digoxin interacts with tetracyclines, the patient is at risk for digoxin toxicity. Respiratory depression is an effect observed when neuromuscular blocking drugs interact with lincosamides. A decrease in the effectiveness of tetracycline is seen when the drug is taken with antacids, dairy products, or iron. An increased risk for bleeding with prolonged clotting times is noted when tetracycline is given with anticoagulants.)

A nurse is required to administer a parenteral form of penicillin to a patient. Which of the following interventions would be most appropriate for the nurse to do when preparing penicillin in parenteral form? A) Extract penicillin from vial and then reconstitute. B) Save excess antibiotic after reconstitution for later use. C) Use any available diluent for reconstitution. D) Shake the vial well to distribute the drug evenly.

D( Feedback: When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.)

An HIV-positive patient on antiretroviral therapy informs the nurse that he is considering taking sildenafil. The nurse informs the patient that he may experience which of the following when taking sildenafil with antiretroviral therapy? A) Feeling of dizziness B) Itching of skin C) Risk of hypotension D) Depression

c( Feedback: The nurse should educate the patient regarding the associated risks, such as hypotension, visual disturbances, and prolonged penile erection. Feeling of dizziness, itching of skin, and depression are not conditions that are specifically associated with sildenafil and antiretroviral drugs.)

A nurse is to administer mafenide to a client. The nurse would be alert for which of the following? A) Rash, itching, or other allergic reactions B) Crystals in the urine sample C) Inflammation of the mouth D) Loss of appetite

: A( Feedback: The nurse should assess for allergic reactions such as rash, itching, edema, and urticaria when administering mafenide. Topical sulfonamides like mafenide do not cause crystalluria, inflammation of the mouth, or loss of appetite.)

The nurse is obtaining a medication history of a 48-year-old patient with an ear infection who is to receive penicillin therapy. The patient reports taking a beta-adrenergic blocker for his hypertension. The nurse would identify that this patient is at increased risk for which of the following if penicillin is administered? A) Anaphylactic shock B) Higher blood pressure C) Excess bleeding D) Heart attack

A Feedback: Combining penicillins with beta-adrenergic blocking drugs increases the risk of anaphylactic shock. Beta-adrenergic blocking drugs are used to control blood pressure and heart problems, but combining them with penicillins does not increase the risk of high blood pressure or heart attack. Risk of bleeding is maximized if penicillins are combined with anticoagulants.)

The nurse is teaching a client about possible adverse reactions that can occur with tetracyclines. The nurse determines that the teaching was successful when the client identifies which of the following? Select all that apply. A) Photosensitivity B) Hypoglycemia C) Hypotension D) Diarrhea E) Stomatitis

A, D, E( Feedback: The nurse should advise the client that nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.)

A nursing student is engaged in researching information about fluoroquinolones. When reviewing the information, the student would most likely find that this class of drugs is effective in treating which type of infection? Select all that apply. A) Viral infections B) Gram-positive infections C) Fungal infections D) Gram-negative infections E) Parasitic infections

B, D( Feedback: Fluoroquinolones are effective in treating infections caused by gram-positive and gram-negative microorganisms.)

A client is receiving iron therapy for anemia. The prescriber has ordered tetracycline as treatment for the client's infection. Which of the following would be most appropriate for the nurse to do? A) Give the drugs at the same time. B) Give the iron first, then follow with the tetracycline in 30 minutes. C) Separate administration times by 2 hours. D) Withhold the iron until the tetracycline therapy is completed.

C( Feedback: Iron therapy can interfere with the absorption of tetracycline. Therefore, the nurse should give the iron 2 hours before or after administering tetracycline. The two drugs should not be given at the same time. Withholding the iron would be inappropriate.)

A client is receiving quinupristin/dalfopristin via a peripheral intravenous infusion. After the drug is administered, the nurse would flush the intravenous line with which of the following? A) Normal saline B) 0.45% sodium chloride C) Dextrose 5% and water D) Heparin

C( Feedback: Quinupristin/dalfopristin is irritating to the vein. After peripheral infusion, the vein should be flushed with 5% dextrose in water (D5W), because the drug is incompatible with saline or heparin flush solutions.)

The nurse administers cefuroxime to a patient at least 1 hour before meals, as prescribed. However, the patient experiences GI upset. Which of the following would be most appropriate for the nurse to do? A) Administer an antacid. B) Lower the dosage. C) Discontinue the drug. D) Administer the drug with food.

D (Feedback: If the patient experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a patient with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.)

Before administering the first dose to the client, which assessment should the nurse perform as part of the preadministration assessment? A) Review of renal and hepatic function tests B) Inspection of patient's stools C) Evaluation of patient's lifestyle and diet D) General history of patient's health

D( Feedback: Before administering the first dose of penicillin, the nurse should obtain and review the patient's general health history, including any allergy history, a history of all medical and surgical treatments, a drug history, and the current symptoms of the infection. The patient's stool is examined only after penicillin has been administered if the patient has diarrhea. It is not required to evaluate the patient's lifestyle and diet as part of the preadministration assessment for the first dose. Renal and hepatic function tests may be performed at intervals during penicillin therapy, usually not before it.)