Pharmacology chapters 10, 11, 12 & 13

Repeated lab work shows positive cultures for a client prescribed drug therapy for tuberculosis (TB) over 4 weeks ago. What are the likely reasons for this failure to achieve treatment goals? Select all that apply.

client has been nonadherent with medication therapy a delay in the initial diagnosis of the client infecting strain of TB is drug resistant

A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is an appropriate response by the nurse?

You will have multidrug therapy for 6 to 24 months."

Isoniazid (INH)

bactericidal- inhibits bacterial cell wall synthesis; slowing the multiplication rate of bacteria - may be used alone to treat latent TB

Latent TB treatment

daily isoniazid for 6-9 months

The primary antitubercular drugs are

ethambutol isoniazid (INH) Rifampin

Pyrazinamide

hepatotoxicity, gout

Primary Antitubercular Drugs

provide the foundation of treatment

Secondary antitubercular drugs

used for multidrug-resistant TB

Leporsy (Hansen's disease)

Mycobacterium leprae peripheral nerves affected causing sensory loss & muscle weakness

A client is receiving tenofovir as part of a therapy regimen for HIV infection. The nurse should provide what teaching related to what the client may experience?

"It's possible you might have changes in body fat distribution."

A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client?

"Your urine or sweat may become orange in color."

Mechanism of action antitubercular drugs

-Protein wall synthesis inhibitors: streptomycin, kanamycin, capreomycin, rifampin, rifabutin, others -Cell wall synthesis inhibitors: cycloserine, ethionamide, INH -Other mechanisms of action: ethambutol, INH, PAS, ethionamide

A client diagnosed with cytomegalovirus (CMV) should be educated about the possible prescription of which drugs for the treatment of this disease? Select all that apply.

1. Ganciclovir 2. Foscarnet 3. Valganciclovir 4. Cidofovir

Which of the following would the nurse report immediately in a 3 month old client receiving ribavirin 1. any worsening of respiratory status 2. refusal to take foods or fluids 3. drowsiness 4. constipation

1. any worsening of respiratory status

Mr park is to begin acyclovir treatment for his outbreak of shingles. As the nurse initiating care for him, you will check the medication administration record to see which drug he is taking for potential reactions 1. cimetidine 2. ibuprofen 3. sidenafil 4. theophylline

1. cimetidine

A client is receiving amphotericin B for a systemic fungal infection. Which of the following would most likely indicate to the nurse that the client is experiencing an adverse reaction 1. fever & chills 2. abdominal pain 3. drowsiness 4. flushing of the skin

1. fever & chills

When giving one of the topical antifungals, the nurse assesses the client for the most common adverse reactions which are 1. related to the GI tract 2. urinary retention 3. hypotension 4. related to the nervous system

1. related to the GI tract

the nurse is administering didanosine properly when 1. the antacid is not separated in the liquid 2. the drug is prepared for subcutaneous injection 3. the drug is given with meals 4. the drug is given mixed with orange juice or apple juice

1. the antacid is not separated in the liquid

When discussing the adverse reactions of an anthelmintic 1. clients must be closely observed for 2 hrs after the drug is given 2. adverse reactions are usually mild when recommended doses are used 3. most clients experience severe adverse reactions & must be monitored closely 4. no adverse reactions are associated with these drugs

2. adverse reactions are usually mild when recommended doses are used

Mycotic infections are caused by 1. bacteria 2. fungi 3. parasites 4. viruses

2. fungi

A client asks how antimalarial drugs prevent or treat malaria. The nurse correctly responds that this group of drugs: 1. kills the mosquito that carries the protozoa 2. interferes with the life cycle of the protozoa causing the malaria 3. ruptures the RBCs that contain merozoites 4. increase the bodys natural immune response to the protozoa

2. interferes with the life cycle of the protozoa causing the malaria

Which of the following statements about a virus is true? 1. they are the same size as a bacterium 2. reproduction occurs by invading a host cell 3. travel is exclusively by blood borne routes 4. there are only a limited number of viruses

2. reproduction occurs by invading a host cell

As a nurse on a pediatric unit, you are making the assignment to care for an infant receiving aerosol ribavirin for RSV. Which of the following nurses should be assigned to care for this patient? 1. Doris, a 22 yr old registered nurse 2. Ariel, a female respiratory therapist 3. Brad, a 26 yr old LPN 4. Vanessa, a 45 yr old pediatric certified nurse

3. Brad, a 26 yr old LPN

Which of the following laboratory tests would the nurse monitor in clients receiving flucytosine? 1. liver function tests 2. complete blood count 3. renal function tests 4. prothombin levels

3. renal function tests

How do a virus and a retrovirus differ? 1. require cellular material of another host cell to reproduce 2. viral content reprograms the cell to reproduce virus 3. they attack the host cell RNA instead of DNA 4. the infected cell goes back to the original function

3. they attack the host cell RNA instead of DNA

continuing phase

4 months administration of rifampin & INH

When preparing a client for pentamidine administration, the correct position is 1. laying on the left side 2. reverse trendelenburg 3. prone 4. reclining position

4. reclining position

Purified protein derivative (PPD)

A diagnostic injection given ID in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism.

pyrantel

Ability to paralyze helminth; used to treat roundworm and pinworm

Ethambutol

Adverse reactions: optic neuritis

Isoniazid

Adverse reactions: peripheral neuropathy Interactions with: foods containing tyramine- aged cheese & meats, bananas, yeast products & alcohol

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

Ans: 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.

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

Ans: 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 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

Ans: 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.

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

Ans: 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 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

Ans: 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 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

Ans: 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.

The client with a diagnosis of TB has a nursing diagnosis of ineffective self-health management. The nurse understands that the most effective method to ensure compliance to TB medications is which of the following?

Direct observed therapy

First-Line TB Drugs

Ethambutol (Myambutol) rifabutin Isoniazid (INH)* rifampin (Rifadin) pyrazinamide (PZA) rifapentine (Priftin) streptomycin

Rifampin

Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine

highly active antiretroviral therapy

HAART multiple drugs used together for treatment of human immunodeficiency virus (HIV) infection retrovirus

herpes zoster virus

HZV. shingles. caused by the varicella (chickenpox) virus. it is highly contagious. easily spread via the respiratory system.

Albendazole

Interferes with the synthesis of the parasites microtubules, resulting in death of suscepitible larvae

Which antitubercular medications must be administered on an empty stomach? Select all that apply.

Isoniazid Rifampin Rifabutin

Extrapulmonary TB

M. tuberculosis can spread from the lungs into other tissues and organs

A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?

Primary (first line) & Secondary (second line)

The nurse explains that prophylactic antitubercular therapy is suggested for which people?

Those who have been in close contact with a person with tuberculosis (TB)

Mebendazole

blocks the uptake of glucose by the helminth, resulting in depletion of the helminths own glycogen

HSV 2

causes genital infection. usually transmitted by sexual contact and causes painful vesicular lesions on the mucous membranes of the genitalia. vaginal lesions may appear as mucous patches with grayish ulcerations.

HSV 1

causes oral, ocular, or facial infections. causes painful vesicular lesions in the oral mucosa, on the face, or around the eyes.

Fluroquinolones that are effective against TB

ciprofloxacin ofloxacin levofloxacin

A client diagnosed with human immunodeficiency virus (HIV) has been infected with Mycobacterium avium complex (MAC) from an indoor pool. Which medication is the recommended treatment for this infection? Select all that apply.

clarithromycin rifabutin rifampin

A male client newly diagnosed with tuberculosis (TB) asks the nurse if medications will make him better. The nurse informs the client that sometimes treatment fails and why this happens. What are some reasons for treatment failure? (Select all that apply.)

inadequate initial drug treatment noncompliance with the therapeutic regimen

initial phase

initial: 2 months administration of rifampin, INH, pyrazinamide & ethambutol

A client has signs and symptoms of a herpes infection, and the healthcare provider has stated that acyclovir would be appropriate for the client. What routes of administration would be possible for this client? Select all that apply.

subcutaneous intramuscula roral intravenous

with a limited number of antiviral drugs and more than 200 viral diseases, antivirals are one of the drug categories where the primary health care provider may decide to prescribe a drug for an _______ even though its effectiveness is not documented; the use of a drug for a specific disorder or condition that is not officially approved bye the FDA

unlabeled use

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

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

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

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

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

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

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.

Ans: 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 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

Ans: 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 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

Ans: 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 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

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

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? 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.

Ans: 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.

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

Ans: 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.

Ans: 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)

Ans: 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.

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

Ans: 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 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.

Ans: 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 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

Ans: 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.

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)

Ans: 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

Ans: 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

Ans: 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.

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.

Ans: 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 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

Ans: 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.

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.

Ans: 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.

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.

Ans: 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 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

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

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

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

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.

Ans: 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 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

Ans: 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 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.

Ans: 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.

Ans: 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.

Ans: 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 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.

Ans: 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.

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)

Ans: 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.

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.

Ans: 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.

1. 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

Ans: 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.

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

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

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

Ans: 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.

Ans: 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 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

Ans: 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.

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

Ans: 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 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

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

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

Ans: 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.

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

Ans: 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.

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

Ans: 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 feveróthese are normal. D) Do not drive if drowsiness or dizziness occurs.

Ans: 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 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

Ans: 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 nurse is providing education to a client who is taking INH. The nurse is teaching the client to avoid which foods?

Cheese, dairy products, and bananas

A client has just been diagnosed with tuberculosis (TB). The nurse can expect to start the client on which drug for the initial phase of treatment?

INH, rifampin, pyrazinamide, ethambutol

Prior to the administration of antitubercular medications, the nurse anticipates which of the following studies to be completed? Select all that apply.

X-rayCulture and sensitivity Complete blood count Positive sputum culture

Second-Line TB Drugs

amikacin capreomycin cycloserine ethionamide kanamycin levofloxacin ofloxacin para-aminosalicyclic acid (PAS)