Pharm EXAM #1
Which condition will place the client prescribed a benzodiazepine at risk for toxicity? A) decreased albumin B) increased calcium C) decreased potassium D) normal bicarbonate
A
Which intervention should the client be taught regarding the self-administration of hydrocodone? A) Consume a diet high in fiber. B) Decrease activity due to pain. C) Elevate the lower extremities. D) Take aspirin with the medication.
A
Which medication is the drug of choice for Legionnaires disease? A) erythromycin B) loxapine hydrochloride C) meclizine D) pravastatin
A
Which medication is the drug of choice for travelers diarrhea that is caused by an E. coli infection? A) rifaximin B) spectinomycin C) chloramphenicol D) erythromycin
A
Why is concomitant use of erythromycin and corticosteroids contraindicated? A) The client may be unable to adequately metabolize the corticosteroid. B) The effect of the corticosteroid may be greatly increased. C) The client may have an increased risk of thromboembolism. D) The corticosteroid may negate the efficacy of the erythromycin.
A
Zolpidem (Ambien) is the most appropriate choice for patients with which condition? A) difficulty in initiating and maintaining sleep B) morning awakening C) agitation and violent outbursts D) obstructive sleep apnea and respiratory problems
A
A client, diagnosed with a genitourinary infection, is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? A) The fluoroquinolone does not have adverse effects. B) The fluoroquinolone can be given orally. C) The fluoroquinolone has a nearly immediate peak. D) The fluoroquinolone has a broader spectrum.
B
A client, diagnosed with tuberculosis, will soon begin first-line drug treatment. How will rifampin most likely be administered to this client? A) orally, with food B) orally, on an empty stomach C) intramuscularly D) intravenously, as bolus
B
cefaroline (Teflaro) -broadest spectrum of all cephalosporins -only cephalosporin effective against MRSA -IV preparation only at this time
5th generation
A 69-year-old responded well to inclient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client's current clinical presentation? A) The client may be infected with microorganisms that were resistant to the cephalosporin. B) The client may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin. C) The client may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin. D) The cephalosporin may have initially caused leukopenia and made the client susceptible to secondary infection.
A
A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications no longer be effective in the treatment of the tuberculosis? A) isoniazid (INH) and rifampin (RIF) B) carbamazepine and phenytoin C) dextroamphetamine and doxapram D) propranolol and sotalol
A
A client has been ordered a fentanyl patch for chronic pain. What client teaching should be provided to the client and family upon discharge? A) Remove the patch every 3 days. B) Apply it to the chest only. C) Apply it for breakthrough pain. D) Remove it daily and clean skin.
A
A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event? A) Discontinue the infusion and inform the care provider promptly. B) Slow down the rate so that the infusion takes place over 2 hours. C) Administer oral diphenhydramine to the client during the infusion. D) Administer an STAT dose of acetylcysteine.
A
A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection. What medication should the client avoid taking concurrently with ciprofloxacin? A) antacids B) calcium channel blockers C) beta-adrenergic blockers D) diuretics
A
A client has been prescribed doxycycline. Which teaching instruction is a priority with this medication? A) Avoid sun exposure. B) Avoid unprotected sexual activity. C) Administer with an antacid. D) Chew the tablets.
A
A client is administered telavancin to treat a skin infection. The nurse should monitor which blood level to best assess for adverse effects? A) creatinine B) aspartate aminotransferase (AST) and alanine aminotransferase (ALT) tests C) creatine phosphokinase (CPK) D) differential
A
A client is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside? A) It blocks protein synthesis of the cell wall. B) It blocks the process of DNA replication. C) It destroys the integrity of the cell wall structure. D) It increases white blood cell viability.
A
A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism? A) aminoglycoside B) antifungal C) aminopenicillin D) GABA analog
A
A client is given tetracycline to treat acne-related skin eruptions. How does tetracycline work? A) It binds to the 30S ribosome to inhibit protein synthesis. B) It reduces central nervous system stimulation. C) It is a beta-lactam antibiotic inhibiting cell wall synthesis. D) It works on the final stage of cell wall synthesis.
A
A client is hospitalized due to nonadherence to an antitubercular drug treatment for a diagnosis of tuberculosis (TB). Which intervention is most important for the nurse to implement? A) observing the client taking the medications B) administering the medications parenterally C) instructing the family on the medication regime D) counting the number of tablets in the bottle daily
A
A client is prescribed daptomycin to treat a gram-negative infection caused by Staphylococcus aureus. Which symptom should be reported immediately to the physician based on the known adverse effects of daptomycin? A) weakness of the legs and arms B) decreased wound drainage C) hematuria D) shortness of breath
A
A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn? A) 08:00 B) 09:00 C)10:00 D)12:00
A
A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What would contraindicate the use of sulfamethoxazole-trimethoprim with this client? A) liver failure B) rheumatoid arthritis C) bone marrow depression D) congestive heart failure
A
A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assess is most appropriate to rule out contraindications for this medication therapy? A) Review lab results to confirm normal liver function. B) Question the client about any history of gastrointestinal upset. C) Review the medical for a history of nephrotoxic signs or symptoms. D) Confirm the ability to safely swallow oral medication.
A
A male patient is receiving pyrazinamide. The nurse assesses him for which of the following? A) elevated liver enzymes and jaundice B) elevated white blood cell count and fever C) elevated cardiac troponin levels and chest pain D) elevated creatinine kinase and muscle weakness
A
A nurse is caring for a client who has subacute bacterial endocarditis and is receiving several antibiotics, including streptomycin IM. For which of the following manifestations should the nurse monitor for as an adverse effect of this medication? A) Ataxia B) Urinary retention C) Constipation D) Complex partial seizures
A
A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor for as an adverse effect of this medication? A) Urinary retention B) Tachypnea C) Hypertension D) Irritating cough
A
A nurse is teaching a client about her prescription for acetaminophen (Tylenol) that she will take at home. This medication consists of acetaminophen and what other likely drug that enhances the analgesic effect of acetaminophen? A) codeine B) acetylsalicylic acid C) methadone D) tramadol
A
A nurse is teaching a client who has OCD and has a new prescription for paroxetine (Paxil). Which of the following instructions should the nurse include? A) "It can take several weeks before you feel like the medication is helping." B) "Take the medication just before bedtime to promote sleep." C) "You should take the medication when needed for obsessive urges." D) "Monitor for weight gain while taking this medication."
A
A nurse preparing to administer a client's first scheduled dose of tetracycline should first ensure that the client has not recently eaten what type of foods? A) dairy products B) leafy green vegetables C) any high-fat foods D) acidic foods
A
A patient is taking isoniazid. Which one of the following adverse effects does the nurse include in discharge teaching? A) numbness and tingling of extremities B) thirst and decreased urine output C) loose, watery bowel movements D) eye pain and visual disturbances
A
An adult male client with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which schedule is most likely to maximize efficacy and minimize nephrotoxicity? A) gentamicin 500 mg IV OD at 12:00 B) gentamicin 250 mg PO BID at 07:30 and 19:30 C) gentamicin 500 mg PO TID at 08:00, 12:00, and 19:00 D) gentamicin 125 mg IV QID at 06:00, 12:00, 18:00, and 24:00
A
An older adult client is assessed in the clinic for signs and symptoms of chronic bronchitis related to pneumococci. Which sulfonamide that will most likely be prescribed? A) trimethoprim-sulfamethoxazole B) tetracycline C) doxycycline D) demeclocycline
A
Following the administration of naloxone (Narcan) to a client with moderate pain, the nurse should assess for what change in the client's vital sign? A) increased blood pressure B) decreased oxygen saturation C) increased temperature D) increased respiratory rate
A
How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media? A) It extends the spectrum of antibacterial activity of penicillin. B) It extends the spectrum of the beta-lactamase inhibitor. C) It decreases the side effects of high-dose penicillin. D) It increases the absorption of the penicillin.
A
If diazepam (Valium) is administered intravenously, when will its onset of action be observed? A) 1 to 5 minutes B) 7 to 10 minutes C) more than 10 minutes D) less than 1 minute
A
A child diagnosed with night terrors is prescribed a benzodiazepine agent. What increased risk should the child be monitored for? A) development of insomnia B) development of drug dependence C) development of mood disorders D) development of hepatotoxicity
C
A client has been prescribed a once-daily aminoglycoside. What is the advantage of this method of administration? A) It is associated with less hepatotoxicity. B) It is significantly more cost-effective. C) It reduces the risk of nephrotoxicity. D) It increases adherence to treatment.
C
A client has been prescribed chloramphenicol for vancomycin-resistant enterococci. How is this medication eliminated from the body? A) through the liver B) exhaled through the lungs C) excreted in the urine D) excreted in the bile
C
A client has been prescribed phenazopyridine for urinary tract symptoms related to the infection. The client asks why she is taking this medication. What is the most appropriate response by the nurse? A) "This medicine is used to treat urinary retention." B) "This medicine will stop the blood in your urine." C) "This medicine will decrease the pain of your infection." D) "This medicine will prevent hesitancy when you're passing urine."
C
A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be prescribed? A) acamprosate calcium B) atazanavir C) erythromycin D) flumazenil
C
A client is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism? A) cefaclor B) cefamandole nafate C) cefoxitin D) cefuroxime sodium
C
A client is prescribed isoniazid and rifampin for the treatment of active tuberculosis (TB). The client's medication education should stress that initial symptom improvement is likely to take how long? A) 48 hours B) a week to 10 days C) 2 to 3 weeks D) 4 to 6 weeks
C
A client is to receive imipenem-cilastatin IM to treat P. aeruginosa. What should imipenem-cilastatin be mixed with prior to administering intramuscularly? A) meropenem B) gentamicin C) lidocaine D) epinephrine
C
A client prescribed metronidazole to treat Clostridium difficile is also prescribed which medication orally to assist in restructuring the flora of the intestinal tract? A) spectinomycin B) rifaximin C) vancomycin D) quinupristin-dalfopristin
C
A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client? A) "The administration by mouth will prevent renal damage from occurring." B) "The administration by mouth will minimize the risk of ototoxicity." C) "The administration will decrease the growth of intestinal bacteria." D) "The administration decreases the risk of airborne contamination of the wound."
C
The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? Eletriptan Ergotamine Sumatriptan Celecoxib
Celecoxib Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.
Numerous residents of a long-term care facility have developed Clostridium difficile-associated diarrhea over the past week. The nurses at this facility would anticipate that many residents would require which medication therapy? A) linezolid B) daptomycin C) metronidazole D) chloramphenicol
C
A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause? A) human immunodeficiency virus (HIV) B) drug-resistant tuberculosis C) methicillin-resistant Staphylococcus aureus D) vancomycin-resistant Staphylococcus aureus
B
A client, who sustained a burn from a gas grill, has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection? A) intrathecal B) topical C) parenteral D) oral
B
In order to minimize the chances of withdrawal symptoms, the nurse knows that the client prescribed a benzodiazepine taken daily will likely be advised to take which precaution? A) tapering the dose of drug over a prolonged period of time B) replacing the drug with a herbal supplement in anticipation of stopping the medication C) substituting the immediate-acting form of the drug with a long-acting form D) exchanging the drug for an anticonvulsant
A
Phenazopyridine, a urinary antiseptic, turns urine what color? A) Reddish-orange B) Reddish- black C) Greenish-blue D) it has no effect on urine color
A
The nurse is conducting patient teaching for a patient who will be taking alprazolam (Xanax) for treatment of anxiety. Which medication increases the amount of alprazolam in the body? A) diltiazem B) timolol C) albuterol inhaler D) bosentan
A
The nurse should question the health care provider's IV morphine prescription for which client? A) an 88-year-old female with failure to thrive B) a 45-year-old female, 1-day postoperative mastectomy C) an 8-year-old male with a compound fractured femur D) a 17-year-old female, 1-day postoperative appendectomy
A
The nurse would assess a patient taking isoniazid for A) elevated levels of serum aspartate aminotransferase B) symptoms of hyperkalemia C) decreased urine output D) hearing loss
A
What action should the nurse take when administering meperidine (Demerol) 75 mg IM every 4 hours to a young adult? A) Give the medication as ordered. B) Administer half the dose. C) Call the health care provider for a smaller dose. D) Give the dose by mouth.
A
What assessment finding would signal the nurse to the possibility that the client's infusion of vancomycin is running too quickly? A) The client is flushed and has a visible skin rash. B) The client's apical heart rate is irregular. C) The client is reporting nausea. D) The client reports pain at the intravenous access site.
A
What medication will be ordered for a client prescribed an opioid for pain who is unresponsive with respirations assessed at 6 breaths per minute? A) naloxone (Narcan) B) capsaicin C) butorphanol (Moradol) D) nalbuphine (Nubain)
A
What potential adverse reaction is most likely to develop during cefazolin therapy? A) gastrointestinal upset B) dry skin and pruritus C) drowsiness D) orthostatic hypotension
A
When administering benzodiazepines, which medications should be considered the drug of first choice? A) lorazepam (Ativan) B) estazolam (Prosom) C) temazepam (Restoril) D) triazolam (Halcion)
A
Which instruction would be most important to include when teaching parents about OTC anti-inflammatory agents? "Be sure to read the label for the ingredients and dosage." "Aspirin is best for treating your child's flulike symptoms." "Make sure to give the drug on an empty stomach or before meals." "Refrain from using acetaminophen for the child's symptoms."
"Be sure to read the label for the ingredients and dosage." Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.
A client with a history of chronic pain is scheduled to undergo a colonoscopy. What health education should the nurse provide the client? "Confirm with your provider, but you'll likely have to stop taking aspirin one week before the procedure." "Some clients have some discomfort during a colonoscopy, but the provider will likely give you an anti-inflammatory before it." "It's very important that you write down every drug that you're allergic to and bring it to your appointment." "Make sure not to take any Tylenol for at least three days before the day of the procedure."
"Confirm with your provider, but you'll likely have to stop taking aspirin one week before the procedure." Salicylates are contraindicated for clients who have had surgery or invasive procedures within 1 week because of the risk for increased bleeding. Thus the nurse would inform that client that she can resume taking the aspirin after 1 week. There is no need to avoid Tylenol and the client's allergies do not necessarily need to be written down by the client. Anti-inflammatories may or may not be given before the procedure.
A 16-year-old female client asks the nurse if she can take two Tylenol every 2 hours during exams because it helps relieve her tension headaches. What is the nurse's most appropriate response? "Why do you feel so tense regarding exams?" "Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." "Consult your health care provider." "Acetaminophen is a benign drug and will relieve your pain."
"Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." Do not exceed recommended doses of acetaminophen due to risk of life-threatening liver damage. People with liver disorders such as hepatitis or those who ingest alcoholic beverages frequently should use it with extreme caution.
A male client taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse? "This is a common side effect of this medication. You should take diphenhydramine 50 mg and omit the next dose." "Do not take any more of the medication and come into the clinic immediately to see the health care provider." "Are you sure that you do not have another disease such as myasthenia gravis?" "This is an allergic reaction to the medication and is no cause for concern."
"Do not take any more of the medication and come into the clinic immediately to see the health care provider." Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.
A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client? "The drug has no effect on inflammation." "The drug has quite a few adverse effects." "This drug is reserved for long-term therapy." "The drug can increase your risk for bleeding."
"The drug has no effect on inflammation." The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.
When conducting health education for a client prescribed an oral penicillin for an infection caused by gram-negative bacilli, the nurse should emphasize which instructions? A) the need to take the medication on an empty stomach B) the fact that a mild rash frequently follows the first few doses C) the need to increase fluid intake for the duration of treatment D) the fact that the drug should be discontinued once symptoms subside
A
cefazolin (Ancef), cephalexin (Keflex) -decent gram + -limited gram -
1st generation
cefoxitin (Mefoxin), cefuroxime (Ceftin/ Zinacef) -similar to 1st generation -slightly better gram + and gram -
2nd generation
ceftriaxone (Rocephin), ceftazidime (Fortaz) -more potent in gram - -less potent in gram + -starts treating pseudomonas -can cross the blood-brain barrier
3rd generation
cefipime (Maxipime) -broad spectrum -treats UTIs, skin infection, and pneumonia
4th generation
A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?
5 The client's weight must be converted to kilograms: 88 lbs ÷ 2.2 = 40 kg. To calculate the daily dose, multiply the child's weight by the prescribed dose: 0.125 mg X 40 kg = 5 mg
When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing? A) acute somatic pain B) chronic visceral pain C) visceral pain D) neuropathic pain
A
A nurse is teaching a client who has a new prescription for nitrofurantoin. Which of the following information should the nurse include? SELECT ALL THAT APPLY. A) Observe for bruising on the skin. B) Take the medication with milk or meals. C) Expect brown discoloration of urine. D) Crush the medication if it is difficult to swallow. E) Expect insomnia when taking it.
A, B, C
A nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory infection. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? SELECT ALL THAT APPLY. A) Pruritus B) Hematuria C) Muscle weakness D) Difficulty swallowing E) Vertigo
A, B, C, E
A nurse is teaching a client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? SELECT ALL THAT APPLY. A) Observe for pain and swelling of the Achilles tendon. B) Watch for a vaginal yeast infection. C) Expect excessive nighttime perspiration. D) Inspect the mouth for cottage-cheese like lesions. E) Take the medication with a dairy product.
A, B, D
The nurse, providing education to a client prescribed erythromycin, recognizes a need for additional instruction when the client makes which suggestion? SELECT ALL THAT APPLY. A) taking the medication with or without food B) avoiding grapefruit juice while taking the medication C) recognizing dark urine is a normal side effect D) stomach cramping is considered an adverse effect E) swallowing the medication with milk
A, C, D
The nurse prepares to administer tetracycline 500 mg PO every 6 hours to an adult client newly diagnosed with Lyme's disease. The client takes an oral contraceptive for birth control. Which measures would the nurse provide for safe and effective drug administration? SELECT ALL THAT APPLY. A) Assess baseline renal and hepatic profiles, complete blood count, and human chorionic gonadotropin (HCG). B) Administer the medication with milk or food to decrease gastrointestinal side effects. C) Instruct client about the importance of using another form of contraceptive during the antibiotic usage. D) Educate importance of wearing sunscreen and protective clothing when in the sun while taking the drug. E) Report severe nausea and vomiting, diarrhea, rash, or perineal itching to the prescriber.
A, C, D, E
A nurse reviewing a client's medication history notes an allergy to sulfonamides. This allergy is a contraindication for taking which of the following medications? SELECT ALL THAT APPLY. A) Hydrochlorothiazide B) Metoprolol C) Acetaminophen D) Glipizide E) Furosemide
A, D, E
The nurse prepares to administer ciprofloxacin 250 mg per enteral feeding tube every 12 hours to the adult client diagnosed with pneumonia and a history of renal impairment in the critical care unit. Which measures should the nurse provide for safe and effective drug administration? SELECT ALL THAT APPLY. A) Stop the enteral tube feeding for 1 hour before administering the drug and resume feeding 2 hours after providing the drug. B) Wait 1 hour before administering some other meds the client takes: sucralfate, multivitamin, iron supplement. C) Examine the random peak and trough level, and report abnormal levels promptly to prevent further nephrotoxicity. D) Crush the immediate release tablet and mix with water before administering the medication via the enteral tube. E) Monitor serum creatinine and blood urea nitrogen (BUN) and report any changes from baseline to the prescriber.
A, D, E
A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug? Acetaminophen Ibuprofen Naproxen Indomethacin
Acetaminophen Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children but they are not the most commonly used medications. Indomethacin is not indicated for fever control.
The nurse is caring for a patient who is taking isoniazid and rifampin. Which one of the following groups of symptoms is indicative of an adverse effect that is worsened by the combination of the two drugs? A) numbness and tingling of the extremities B) nausea, abdominal pain, and jaundice C) decreased urine output and elevated blood urea nitrogen D) dizziness and loss of hearing
B
A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject? A) the fact that nonadherence to treatment exacerbates the risks of adverse effects B) the need to consistently take the prescribed drugs in order to cure TB C) the need to match drug dosages carefully to signs and symptoms D) the fact that nonadherence will necessitate the use of antiretrovirals
B
A 22-year-old college student allergic to penicillin is being treated with oral erythromycin for a chlamydial infection. What assessment should the nurse prioritize during this clients course of treatment to monitor for adverse reactions? A) assessment of the client's apical heart rate B) assessment of the client's hearing C) assessment of the client's peripheral pulses D) assessment of the client's renal function
B
A client diagnosed with infective endocarditis would be most effectively treated with which medication? A) dicloxacillin B) ampicillin C) nafcillin D) oxacillin
B
A client diagnosed with insomnia is prescribed flurazepam (Dalmane). This medication has a longer half-life than 24 hours. Which contributes to the long half-life of this medication and other benzodiazepines? A) metabolism by cytochrome P450 B) presence of active metabolites C) excretion by the renal system D) movement of calcium in the cell
B
A client diagnosed with tuberculosis (TB) and begun multi-drug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question? A) "Multiple drugs are used because doctors aren't sure which drug will kill a particular TB strain." B) "The use of multiple drugs prevents the development of drug-resistant TB." C) "Multiple drugs are prescribed because the final testing results for TB can take up to 3 months." D) "Multiple drugs are used in order to speed up the course of treatment."
B
A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the family be taught to make while caring for this client at home? A) diarrhea B) respiratory depression C) lung sounds D) urinary incontinence
B
A client has been administered an opioid. For which effect should the client be regularly assessed for? A) oliguria B) level of consciousness (LOC) C) edema D) tachycardia
B
A client is administered a sulfonamide for a urinary tract infection. Which nursing intervention is most appropriate to increase the alkalinity of the client's urine and so increasing the medication's effectiveness? A) Provide at least 2000 mL of water daily. B) Administer sodium bicarbonate. C) Recommend a tub bath every evening. D) Provide orange juice daily.
B
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism? A) gram positive B) gram negative C) fungi D) virus
B
A client is prescribed ciprofloxacin. Which nursing intervention will best prevent the possible development of crystalluria? A) The nurse should limit oral fluids to 500 mL/d. B) The nurse should administer 2000 mL of oral fluids per day. C) The nurse should insert a urinary catheter. D) The nurse should administer phenazopyridine.
B
A client is prescribed imipenem-cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose? A) to eliminate adverse effects of imipenem administration B) to inhibit the destruction of imipenem C) to potentiate the therapeutic effects of imipenem D) to allow imipenem to cross the blood-brain barrier
B
A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis (TB). Which adverse effect will result in discontinuation of the medication? A) weight gain B) jaundice C) fever D) arthralgia
B
A client is prescribed midazolam (Versed) in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing? A) oral secretions B) anxiety C) hypotension D) muscle tone
B
A client is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A) triazolam (Halcion) B) midazolam (Versed) C) oxazepam (Serax) D) chlordiazepoxide (Librium)
B
A client is seen in the clinic after a bite from a tick. She has a rash over her arms and legs and arthritic pain in the joints. What is the drug of choice for treating the infection associated with Lyme's disease? A) ibuprofen B) tetracycline C) phenazopyridine D) nitrofurantoin
B
A client receiving isoniazid (INH) and rifampin has a decreased urinary output and decreased sensation in his or her great toes. Which laboratory values should be assessed? A) hematocrit and hemoglobin B) ALT and AST C) urine culture and sensitivity D) complete blood count (CBC) with differential
B
A client who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this client's most likely diagnosis? A) active tuberculosis B) latent tuberculosis C) Mycobacterium avium complex (MAC) D) human immunodeficiency virus (HIV)
B
A client, being treated for active tuberculosis (TB) with ethambutol, states difficulty in identifying the red and green on the traffic lights when driving. Based on this finding, what intervention should the nurse consider initially? A) Assess for photosensitivity. B) Discontinue ethambutol. C) Decrease the ethambutol dose. D) Administer vitamin B12.
B
A homeless individual was screened for tuberculosis (TB), and the results indicate latent TB. The community health nurse would anticipate inclusion of what intervention into the client's plan of care? A) undergoing conservative treatment for TB using adjuvant medications B) being treated for TB using first-line antitubercular drugs C) close monitoring to determine if treatment is necessary D) rescreening in 10 to 12 weeks to determine whether the TB has become active
B
A hospice client has been prescribed morphine 5 mg sub-Q every 2 hours. The medication vial reads "10 mg/mL." How many milliliters will be administered? A) 0.25 mL B) 0.5 mL C) 1 mL D) 2 mL
B
A nurse administrating an opioid medication should assess for what related side effect? A) lower extremity paresthesia B) drowsiness C) occipital headache D) polyuria
B
A nurse has noted that a newly admitted client has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug? A) somnambulism (sleepwalking) B) difficulty falling asleep at night C) early morning waking D) frequent nighttime awakenings
B
A nurse is caring for a client who has diabetes mellitus, pulmonary tuberculosis, and a new prescription for isoniazid. Which of the following supplements should the nurse expect to administer to prevent an adverse effect of INH? A) Ascorbic acid B) Pyridoxine C) Folic acid D) Cyanocobalamin
B
A nurse is planning to administer ciprofloxacin IV to a client who has cystitis. Which of the following actions should the nurse take? A) Administer a concentrated solution. B) Infuse the medication over 60 minutes. C) Infuse the solution through the primary IV's tubing. D) Choose a small peripheral vein for administration.
B
A nurse is reviewing the MAR for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administered concurrently with fentanyl? A) Ampicillin B) Diazepam C) Furosemide D) Prednisone
B
A nurse is teaching a client about taking tetracycline to treat a GI infection due to H. pylori. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A) I will take this medication with 8 oz of milk. B) I will let my doctor know if I start having diarrhea. C) I can stop taking this medication when I feel completely well. D) I can take this medication just before bedtime.
B
A nurse is teaching a client who has active tuberculosis about the treatment regimen. The client asks why four different medications are necessary. Which of the following responses should the nurse make? A) "Four medications decrease the risk for a severe allergic reaction." B) "Four medications reduce the chance that the bacteria will become resistant." C) "Four medications reduce the risk for adverse reactions." D) "Four medications decrease the chance of having a positive tuberculin skin test."
B
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A) Administer flumazenil. B) Identify the client's level of orientation. C) Infuse IV fluids. D) Prepare the client for gastric lavage
B
A patient who is receiving ethambutol comes into the clinic for a follow-up visit. Which finding on the assessment indicates a serious adverse reaction to the drug? A) a sputum culture that is negative for acid-fast bacilli B) changes in visual acuity C) poor appetite and GI upset D) dizziness and hearing loss
B
A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI? A) vaginitis B) Chlamydia C) human papillomavirus D) trichomoniasis
B
A surgical client, with highly elevated AST and ALT levels, is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication? A) Draw up half of the medication for administration. B) Notify the health care provider for a reduced dosage. C) Assess the client's respiratory status. D) Assess the client's pain tolerance.
B
An older adult client is diagnosed with generalized anxiety disorder. The use of benzodiazepines in this client population creates a specific need for which intervention? A) seizure precautions B) falls risk assessment C) frequent dysrhythmias monitoring D) education regarding sexual dysfunction
B
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose? A) Administer a 500-mL bolus of normal saline. B) Confirm the client's allergy status. C) Swab the client's nares for the presence of MRSA. D) Teach the client to expect discolored urine during treatment.
B
Extreme caution would be necessary with the use of gentamicin in which client? A) a client who is morbidly obese and who has primary hypertension B) a client who has chronic renal failure secondary to diabetes mellitus C) a client who has bipolar disorder and who is on long-term lithium therapy D) a client who has an atrioventricular block
B
In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client? A) increased diffusion and perfusion B) decreased cardiac workload C) increased level of consciousness D) decreased blood pH
B
The client's care plan specifies the use of preemptive analgesia. This approach to pain control will involve what nursing intervention? A) frequent administration of high-dose opioids B) simultaneous use of analgesics from different drug classes C) alternating administration of opioid antagonists with opioid agonists D) client-controlled analgesia (PCA) use
B
The intensive care nurse should prioritize what assessments for a client prescribed both lorazepam (Ativan) and hydromorphone? A) arterial blood gases B) respiratory rate and oxygen saturation C) deep tendon reflexes and pupillary response D) cardiac rate and rhythm
B
The nurse is preparing to administer gentamicin when the client mentions having experienced diminished hearing. What action should the nurse take based on this statement? A) Administer the dosage and notify the health care provider of the alteration in hearing. B) Hold the dosage and notify the health care provider of the alteration in hearing. C) Administer the dosage and report the alteration in hearing to the audiologist. D) Hold the dosage and document the finding in the nurses' notes.
B
The nurse is reviewing a patient's medications and sees that the patient is receiving rifampin. The nurse's greatest concern about rifampin and its drug interactions is A) it decreases the metabolism of many other drugs B) it increases the metabolism of many other drugs C) it increases the risk for GI bleeding if given with warfarin D) it increases the risk of adverse effects from antiseizure drugs
B
The nurse should teach patients taking isoniazid to avoid alcohol because of the increased risk of A) central nervous system depression B) liver damage C) drug-resistant tuberculous organisms D) rapid drug metabolism
B
The nurse who is giving isoniazid (INH) anticipates an order for which one of the following vitamins, usually given with INH? A) vitamin B3 (niacin) B) vitamin B6 (pyridoxine) C) folic acid (folate) D) vitamin D (calcitriol)
B
The pathophysiology of pain begins with a signal from what source? A) myelin sheaths B) nociceptors C) baroreceptors D) synapses
B
Unasyn is being administered to a client with an infection caused by Staphylococcus aureus. What type of anti-infective is ampicillin-sulbactam? A) extended-spectrum antipseudomonal penicillin B) penicillin-beta-lactamase inhibitor combination C) cephalosporin D) aminopenicillin
B
What adverse effect can happen if a vancomycin IV infusion is done to rapidly? A) Serotonin syndrome B) Red man syndrome C) Anaphalyxis D) Hypoglycemia
B
What drug is used as a detoxification and maintenance of opiate addicts? A) meperidine (Demerol) B) methadone (Dolophine) C) hydromorphone (Diaudid) D) hydrocodone (Hysingla)
B
What drug(s) destroys gram + and gram - bacteria by altering DNA? A) Aminoglycosides B) Fluoroquinolones C) Both A and B D) Neither A or B
B
What reaction should the nurse assess for when a client is prescribed a nonopioid analgesic in addition to a narcotic analgesic? A) antagonism B) additive effect C) interference D) increased excretion
B
What schedule of drugs is morphine classified as? A) I B) II C) III D) IV
B
Which baseline laboratory tests should a patient receive prior to starting the benzodiazepine? A) blood glucose level B) liver enzymes C) lipid profile D) thyroid panel
B
Which client has the highest risk of developing ototoxicity secondary to gentamicin? A) a man who received his first dose of IV gentamicin 12 hours ago B) a man who has required repeated courses of gentamicin over the past several months C) a woman who has a Pseudomonas infection but who has a hypersensitivity to penicillins D) a woman who is immunocompromised and who is being treated with gentamicin
B
Which hypnotic may be safely taken for long-term treatment of insomnia? A) lorazepam (Ativan) B) eszopiclone (Lunesta) C) chloral hydrate (Noctec) D) oxazepam (Serax)
B
Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy? A) cefadroxil B) cefazolin sodium C) cephalexin D) cephradine
B
Which medication can be administered to the elderly, accumulates to a small extent in the brain, and is not affected by diminished hepatic function? A) diazepam (Valium) B) lorazepam (Ativan) C) clonazepam (Klonopin) D) chlordiazepoxide (Librium)
B
Which miscellaneous antibacterial drug is administered topically in the treatment of acne? A) chloramphenicol B) clindamycin C) daptomycin D) tigecycline
B
Which teaching fact is the priority for the woman receiving treatment for acute short-term anxiety with a benzodiazepine? A) Monitor serum glucose levels. B) Avoid alcohol when taking these medications. C) Take medications with food. D) Expect a delay in therapeutic effects of several weeks.
B
Why is important to monitor the results of a serum gentamicin level? A) to identify possible changes in the client's serum osmolality B) to identify whether the drug is at a therapeutic level C) to identify whether the drug is causing hepatotoxicity D) to identify possible hemolysis following administration
B
The nurse prepares to administer nitrofurantoin 100 mg PO every 12 hours to an adult client newly diagnosed with a urinary tract infection. Which measures would the nurse provide for safe and effective drug administration? SELECT ALL THAT APPLY. A) Instruct the client that the drug is a urinary analgesic to provide pain relief of urinary tract infection symptoms. B) Inform the client that the medication may cause the urine to turn a harmless brown coloration. C) Administer the drug with a meal or snack because food helps with drug absorption and decreases onset of GI distress. D) Administering with antacids with magnesium increase the drug absorption of the nitrofurantoin. E)Educate the client that the drug is safe with pregnancy and has no adverse effects on fetal development.
B, C
The nurse prepares to administer gentamicin intravenous every 8 hours to an older adult client. Which interventions should the nurse provide to decrease nephrotoxicity and ototoxicity? SELECT ALL THAT APPLY. A) Draw the trough level 30 to 60 minutes after drug is administered, and report level above 10 to 12 mcg/mL. B) Obtain baseline assessment of cranial nerve eight and periodic measurements during therapy. C) Monitor estimated creatinine clearance and BUN at baseline and periodically during therapy. D) Obtain peak level before administering next dose of drug, and report level above 2 mcg/mL. E) Provide the client with 2 to 3 L of noncaffeinated oral fluids daily, unless contraindicated.
B, C, E
Which symptom is characteristic of acute benzodiazepine withdrawal? SELECT ALL THAT APPLY. A) bradycardia B) agitation C) lethargy D) diaphoresis E) palpitations
B, E
A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse's best response? A) "Your doctor may have been concerned about causing depression." B) "Your doctor may have been worried about the possibility of convulsions." C) "Long-term use of benzodiazepines can result in dependency." D) "Long-term use of benzodiazepines can cause insomnia."
C
A client, admitted to the surgical division after a mastectomy, has a PCA pump and states being fearful about being overdosed on morphine. Which response is most appropriate when addressing the client's concern of being overmedicated? A) "The pump will administer all of the doses, so you don't have to worry." B) "If you follow the instructions, that won't happen to you." C) "The device is preset, so you cannot receive more than you need." D) "The device will give you a placebo when you press it often."
C
A client, seen in the clinic for symptoms of persistent cough, fever, and night sweats, has recently entered the United States from the India. What is the most plausible explanation for the client's condition? A) latent tuberculosis B) bacterial pneumonia C) active tuberculosis D) emphysema
C
A college student has a tuberculosis (TB) test prior to starting the semester. The test site is noted to have a reddened, raised area. What phase in the progression of TB is associated with the inability to spread the disease to others? A) transmission B) primary infection C) latent tuberculosis D) active tuberculosis
C
A health care provider has prescribed rifampin for a patient who is being discharged to home. The nurse should include which one of the following in the discharge teaching? A) "You will have to measure your urine output while taking rifampin." B) "Rifampin increases the risk of having seizures or convulsions." C) "Ask your eye care provider about wearing your contact lenses." D) "There is no necessary follow-up blood work."
C
A nurse is assessing a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication that the nurse should report to the provider? A) Diaphoresis B) Epistaxis C) Diarrhea D) Alopecia
C
A nurse is caring for a client who has a cerebrospinal fluid infection with gram - bacteria. Which of the following cephalosproin antibiotics should the nurse expect to administer IV to treat this infection? A) Cefaclor B) Cefazolin C) Cefepime D) Cephalexin
C
A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's family asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? A) The medication will increase respirations. B) The medication will prevent dependence on the morphine. C) The medication will relieve constipation. D) The medication works with the morphine to increase pain relief.
C
A nurse is caring for a client who is undergoing preparation for extensive colorectal surgery. Which of the following oral antibiotics should the nurse expect to administer specifically to suppress normal flora in the GI tract? A) Kanamycin B) Gentamicin C) Neomycin D) Tobramycin
C
A nurse is planning discharge teaching for a female client who has a new prescription for trimethoprim-sulfamethoxazole. Which of the following information should the nurse include? A) Take the medication even if pregnant. B) Maintain a fluid restriction while taking it. C) Take it on an empty stomach. D) Stop taking it when manifestations subside.
C
A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? A) Monitor for seizures and confusion with repeated doses. B) Protect the client's skin from the severe diarrhea that occurs with morphine. C) Withhold this medication if respiratory rate is >12/min. D) Give morphine intermittent via IV bolus over 30 seconds or less.
C
A nurse is preparing to administer a penicillin V to a client who has a streptococcal infection. The client reports difficulty swallowing tablets and doesn't "do well" with liquid or chewable medications because of the taste, even when the nurse mixes the medication with food. The nurse should request a prescription for which of the following medications? A) Fosfomycin B) Amoxicillin C) Nafcillin D) Cefaclor
C
A nurse is teaching a client who has a new prescription for escitalopram (Lexapro) for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A) "I should take the medication on an empty stomach." B) "I will follow a low-sodium diet while taking this medication." C) "I need to discontinue this medication slowly." D) "I should not crush this medication before swallowing."
C
A young adult client's acne has responded well to treatment with tetracycline. However, the client has now returned to the clinical 6 weeks later with signs and symptoms of oral candidiasis. The nurse should recognize that this client's current health problem is likely attributable to which occurrence? A) a delayed (type IV) hypersensitivity reaction B) the fact that the client may have chewed the capsules prior to swallowing them C) superinfection following the eradication of normal oral flora D) a type I hypersensitivity reaction
C
An older adult client has a feeding tube in place to manage dysphagia. After developing an infected pressure ulcer, ciprofloxacin suspension has been prescribed via feeding tube. How should the nurse follow-up this order? A) The nurse should flush the client's feeding tube with free water before and after administration of the ciprofloxacin suspension. B) The nurse should dilute the suspension thoroughly before administration. C) The nurse should liaise with the care provider to provide an alternative route of administration. D) The nurse should administer small, frequent doses of the drug to minimize GI upset.
C
How does rifampin achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms? A) It is metabolized in the liver. B) It binds to acetylcholine. C) It inhibits synthesis of RNA. D) It causes phagocytosis.
C
Nitrofurantoin, a urinary antiseptic, turns urine what color? A) Red B) Green C) Brown D) Orange
C
Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction? A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction. B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat. C) Drink a full glass of water when taking a dose of the drug. D) Taper off the drug rather than abruptly stopping it.
C
The nurse is educating a client diagnosed with a urinary tract infection about the prescribed trimethoprim-sulfamethoxazole (TMP-SMZ). The client has a history of type 2 diabetes and currently takes a sulfonylurea. Which statement made by the client establishes the need for further clarification? A) "I will monitor my blood sugar carefully since the drug may lower it." B) "I will take the drug with 8 ounces of water before or after meals." C) "The drug will not affect the herbal supplement, ginseng that I take." D) "If a rash develops, the drug will be discontinued and my prescriber notified."
C
The nurse questions an order for pyrazinamide for a patient with A) active TB B) a recent heart attack C) an acute attack of gout D) a history of smoking
C
The nurse taking care of a patient with tuberculosis (TB) receives an order for levofloxacin. This drug may be used to treat A) latent TB B) active TB C) drug-resistant TB D) adverse effects of isoniazid
C
What is the most effective way for the nurse to evaluate the client's pain response after administering an opioid analgesic? A) Observe the client when he/she is not aware you are assessing him/her. B) Ask another nurse to assess the client's response to the medication. C) Using a pain scale, ask the client to describe the pain. D) Ask the family to determine the client's response to the pain.
C
What is the rationale for not administering tetracycline to children under the age of 8 years? A) It will not treat the infection effectively. B) It will increase the risk of heart failure. C) It will interfere with enamel development. D) It will increase the risk for future infections.
C
What organ system is responsible for the excretion of cefotaxime sodium from the body? A) respiratory B) hepatic C) renal D) gastrointestinal
C
When a patient is prescribed chlordiazepoxide (Librium) for acute alcohol withdrawal, which herbal supplement may increase the risk of increased central nervous system depression? A) garlic B) ginger C) St. John's wort D) Ginkgo biloba
C
When a patient receives a prescription for zolpidem (Ambien), which teaching point is most important? A) Take the medication with a high-fat meal. B) Only take the medication if acetaminophen PM does not produce sleep. C) Go to bed immediately after taking the medication. D) Take the medication if nondrug relaxation has not produced sleep.
C
Which antibiotic is used to treat infections caused by organisms resistant to other drugs, and is typically only used for critical patients? A) Penicillin B) Cephalosporin C) Carbapenems D) Monobactams
C
A nurse is caring for a client who takes paroxetine (Paxil) to treat PTSD and reports that they grind their teeth during the night. The nurse should identify which of the following interventions to manage bruxism? SELECT ALL THAT APPLY. A) Concurrent administration of buspirone B) Administration of a different SSRI C) Use of a mouth guard D) Changing to a different class of antidepressant medication E) Increasing the dose of paroxetine
C, D
Oxazepam (Serax) can be used in the treatment for patients who have which conditions? SELECT ALL THAT APPLY. A) severe agitation B) schizophrenia with hallucinations C) anxiety with depression D) opioid dependence E) alcoholism
C, E
A student nurse asks the nurse why acetaminophen and NSAIDs help to reduce cancer pain. What is the nurse's best explanation? Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Cancer rarely produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs eliminate sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs potentiate sensitization of peripheral pain receptors by increasing prostaglandin formation. Cancer rarely produces severe pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.
Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment (chemotherapy, surgery, or radiation). As with acute pain, acetaminophen, aspirin, or other NSAIDs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. NSAIDs are especially effective for pain associated with bone metastases.
A 64-year-old client seeking care for the treatment of a urinary tract infection (UTI) was prescribed nitrofurantoin. What change in the client's health status would prompt the use of an alternative medication? A) The client develops a fluid volume deficit. B) Urinalysis reveals the presence of ketones. C) The client develops leukocytosis. D) The client's UTI progresses to urosepsis.
D
A 9-year-old has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the admission orders and notes that IV demeclocycline has been ordered. After beginning this treatment, the nurse should confirm the results of what laboratory test? A) mean corpuscular volume (MCV) B) D-dimer C) bilirubin D) blood urea nitrogen (BUN)
D
A client has developed Clostridium difficile associated with pseudomembranous colitis. Which medication is effective in the treatment of Clostridium difficile? A) linezolid B) cladribine C) clarithromycin D) metronidazole
D
A client has started aminoglycoside therapy. It is time for a client's next dose of an aminoglycoside. What action should the nurse take when learning the client's creatinine level is 3.9 mg/dL? A) Administer the medication and report the creatinine level. B) Hold the dose until another creatinine level is assessed. C) Administer the medication with 100 mL of fluids. D) Hold the medication and assess the urine output.
D
A client is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication? A) assessing for the presence of asthma B) assessing for hypertension C) assessing for diabetes mellitus D) assessing for renal insufficiency
D
A client is diagnosed with multidrug-resistant tuberculosis. Which aminoglycoside medication is used in a 4- to 6-drug regimen? A) tetracycline hydrochloride B) amoxicillin C) sulfadiazine D) streptomycin
D
A client is prescribed aztreonam. What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa? A) It is a lower-cost medication. B) It is administered orally. C) It causes less GI distress. D) It has lower risk for hearing loss.
D
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication? A) It inhibits protein synthesis. B) It lowers the pH of cellular contents. C) It causes mutations. D) It inhibits cell wall synthesis.
D
A client is prescribed rifampin. What information should the nurse include in the client's medication education? A) When taking it with warfarin, an increased anticoagulant effect occurs. B) It decreases hepatic enzymes and decreases metabolism of drugs. C) It has an increased serum half-life, so it is more effective than rifabutin. D) The urine, tears, sweat, and other body fluids will be a discolored red-orange.
D
A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity? A) lactulose B) ketoconazole C) kanamycin D) cefadroxil
D
A client receiving morphine sulfate 5 mg IV every 4 hours for the past several days now states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A) a dependency on the morphine B) natural response to metastatic cancer and dying C) greater pain associated with inactivity D) a tolerance to morphine
D
A client with a diagnosis of active TB has begun second-line therapy that includes the use of pyrazinamide. When monitoring this client, the nurse should suspect that adverse effects of this drug may account for which laboratory values? A) low hematocrit and mean corpuscular volume (MCV) B) increased INR and aPTT C) increased blood urea nitrogen and creatinine D) increased AST, ALT, and GGT
D
A client, diagnosed with a community-acquired skin infection, has been prescribed linezolid. Which food should not be eaten during the period of this medication therapy? A) pasta B) garlic C) green leafy vegetables D) cheddar cheese
D
A client, diagnosed with peptic ulcer disease, has been prescribed clarithromycin. Which organism is this medication used to treat? A) Streptococcus pneumoniae B) Haemophilus influenzae C) Mycobacterium avium complex D) Helicobacter pylori
D
A client, prescribed clindamycin, is now reporting frequent diarrhea. How should the nurse best respond to this client's statement? A) Reemphasize the importance of taking clindamycin with food. B) Encourage the client to temporarily use an over-the-counter antidiarrheal. C) Encourage the client to increase his or her fluid intake until the course of treatment is complete. D) Liaise with the client's care provider to have the drug discontinued.
D
A client, prescribed isoniazid (INH) for a diagnosis of tuberculosis (TB), has a yellow color in the sclera of the eye. What other finding would lead the nurse to suspect that hepatotoxicity has developed? A) diarrhea B) numbness C) diminished vision D) light-colored stools
D
A female patient has not adhered to her drug regimen for tuberculosis. Which of the following is most effective to enhance adherence? A) explaining the importance of adherence B) having the patient's family administer the medication C) evaluating serum drug levels to determine adherence D) having nursing staff directly watch her take her medication
D
A nurse is caring for an adult client diagnosed with bacterial sinusitis. The nurse has cautioned the client against taking prescribed oral erythromycin together with antacids. What is the basis of this instruction? A) Antacids delays metabolism of the drug. B) Antacids can exacerbate nausea and reflux. C) Antacids cause a dangerous rise in gastric pH. D) Antacids decrease the absorption of the drug.
D
A nurse is preparing a client's scheduled dose of oral vancomycin. This client's current illness was most likely manifested by what sign or symptom? A) vomiting B) inflamed, swollen skin C) shortness of breath D) diarrhea
D
A nurse is preparing to administer butorphanol to a client who has a history of substance abuse disorder. The nurse should identify which of the following information as true regarding butorphanol? A) Has a greater risk for abuse than morphine B) Causes a higher incidence of respiratory depression than morphine C) Cannot be reversed with an opioid antagonist D) Can cause abstinence syndrome in opioid-dependent clients
D
A nurse is providing teaching to a client who has a new prescription for buspirone (Buspar) to treat anxiety. Which of the following information should the nurse include? A) "Take this medication on an empty stomach." B) "Expect optimal therapeutic effects within 24 hr." C) "Take this medication when needed for anxiety." D) "This medication has a low risk for dependency."
D
A patient with HIV is taking rifampin and a protease inhibitor. The nurse should assess the patient for what condition? A) a worsened allergic reaction to rifampin B) elevated blood urea nitrogen and serum creatinine C) drowsiness, lethargy, and decreased responsiveness D) increased viral load and decreased CD4 count
D
A teenager asks the nurse how tetracycline will improve the acne. Which statement should the nurse provide to the client regarding the action of tetracycline? A) "Tetracycline decreases redness and swelling of the pustules." B) "Tetracycline treats the Chlamydia organism that causes acne." C) "Tetracycline is used in combination with doxycycline to treat acne." D) "Tetracycline interferes with the production of free fatty acids."
D
A terminally ill client has developed increased respiratory secretions and labored breathing. Which medication is prescribed to decrease these symptoms? A) meclizine B) ampicillin C) naloxone D) morphine sulfate
D
Benzodiazepines are thought to work through which action? A) exciting the central nervous system B) stimulating the reticular activating system C) increasing inhibitory feelings D) enhancing the effects of gamma-aminobutyric acid
D
The nurse is educating a client newly diagnosed with a urinary tract infection about the prescribed phenazopyridine hydrochloride. Which statement made by the client establishes the need for further clarification? A) "The drug is an azo dye that acts directly on urinary tract mucosa to provide pain relief." B) "If I develop a sore throat, bleeding, or bruising, I will report the symptoms to my prescriber." C) "I will need to take the drug with food to decrease stomach upset." D) "I should report reddish-orange urine immediately to the prescriber."
D
Three days after discontinuing diazepam (Valium) with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status? A) Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B) The client may have decreased liver function. C) The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D) The adverse effects of benzodiazepines can persist for several days after stopping the drug.
D
What aspect of a client's history would contraindicate imipenem-cilastatin drug therapy? A) The client has a history of type 1 diabetes mellitus. B) The client is showing signs and symptoms of fluid volume excess. C) The client's most recent creatinine level was 140 mmol/L (high). D) The client has a documented allergy to penicillin.
D
What is the postantibiotic effect of gentamicin therapy? A) the tendency for clients to exhibit symptoms mimicking hypersensitivity after drug administration B) the tendency for adverse effects of a drug to be masked during administration C) the ability of microorganisms to proliferate between doses of antibiotics D) the ability of an antibiotic to kill bacteria even when serum concentrations are low
D
When a 5-year-old child is scheduled for a sleep electroencephalogram (EEG), which medication is a drug of choice prior to the diagnostic test? A) diazepam (Valium) B) lorazepam (Ativan) C) zolpidem (Ambien) D) diphenhydramine (Benadryl)
D
Which drug is a first-generation cephalosporin used as a surgical prophylaxis? A) cefotetan B) cefoxitin C ceftriaxone D) cefazolin
D
Which medication can be most safely administered to an older adult experiencing insomnia? A) alprazolam (Xanax) B) clonazepam (Klonopin) C) diazepam (Valium) D) temazepam (Restoril)
D
Which medication should be administered as prophylaxis for rheumatic fever? A) cyclacillin B) amoxicillin C) dicloxacillin D) penicillin G benzathine
D
Which medication will reduce the effects of sedation and respiratory depression in a client suspected of experiencing benzodiazepine toxicity? A) olmesartan medoxomil B) pancrelipase C) pamidronate disodium D) flumazenil
D
How is pain medication choice decided? A) Type of pain B) Age C) Vital signs D) Comorbidities E) All of the above
E
A salicylate is contraindicated in clients who have had surgery within the past week for which reason? Increased risk for allergic reaction Increased risk for toxicity Increased risk for bleeding Increased risk for fluid imbalance
Increased risk for bleeding Salicylates are contraindicated for clients who have had surgery within the past week because of the increased risk for bleeding. Their use in clients with an allergy to salicylates or tartrazine would increase the risk for an allergic reaction. Their use in clients with impaired renal function may increase the risk for toxicity because the drug is excreted in the urine. There is no associated risk for fluid imbalance and salicylate therapy.
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? Oral Subcutaneous Intramuscular Intravenous
Oral Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is not given via the subcutaneous, intramuscular, or intravenous routes.
An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client? Rene syndrome Excess anti platelet action Asthma Salicylate poisoning
Reye syndrome Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.
The client has been diagnosed with ulcerative colitis. What salicylates would be appropriate for treating inflammation in a client with ulcerative colitis? Select all that apply. Salsalate Balsalazide Olsalazine Mesalamine Aspirin
Salsalate Balsalazide Olsalazine Melamine Salsalate is used to treat pain, fever, and inflammation in adults but is not indicated for use as ulcerative colitis treatment. Balsalazide can be used to treat mild to moderate acute ulcerative colitis in adults. Olsalazine and mesalamine are used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Aspirin would be inappropriate because of the risk for GI bleeding.
A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the heart attack.
The aspirin is being prescribed because it reduces your risk of a second heart attack. Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.
An older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin two to three times each day. What aspect of this patient's medical history may contraindicate the use of aspirin? The patient has a diagnosis of type 2 diabetes. The patient has a history of peptic ulcer disease. The patient had a total abdominal hysterectomy 2 years ago. The patient takes an SSRI for depression.
The patient has a history of peptic ulcer disease. Due to the risk of bleeding, aspirin is contraindicated in patients with peptic ulcer disease or bleeding disorders. SSRIs, previous surgery, and type 2 diabetes do not preclude the use of aspirin.
T/F: Tetracyclines are rarely used for systemic infections.
True
Which is the antidote for acetaminophen poisoning? acetylcysteine allopurinol diclofenac sodium ketorolac
acetylcysteine A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites.
The nursing student demonstrates understanding of salicylism when listing which symptoms of this condition? Select all that apply. dizziness ringing in the ears impaired hearing weight gain mental confusion
dizziness ringing in the ears impaired hearing mental confusion Toxicity can develop from taking too much aspirin, resulting in salicylism. Signs and symptoms of this condition include dizziness, ringing in the ears, impaired hearing, nausea, vomiting, flushing, sweating, rapid and deep breathing, tachycardia, diarrhea, mental confusion, lassitude, drowsiness, respiratory depression, and coma. Weight gain is not a sign of this condition.
A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? anemia. peptic ulcer disease or gastritis. interstitial nephritis. constipation.
peptic ulcer disease or gastritis. During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.
The most common side effects caused by NSAIDs involve the: stomach. lungs. liver. peripheral nerves.
stomach. The most common side effects caused by the NSAIDs involve the GI tract, including the stomach.
A client is being discharged following an allergic reaction after ingesting aspirin. Included in patient education about the allergy, the nurse would inform the client that: the client can take NSAIDs, as long as it is with food. the client should not take aspirin or non-aspirin NSAIDs. the client should not take regular aspirin, but can take buffered aspirin. the client can take medications containing aspirin, as long as it is on a full stomach.
the client should not take aspirin or non-aspirin NSAIDs. In people who have demonstrated hypersensitivity to aspirin, all non-aspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
