Pharmacology Exam 1

A patient who had been receiving clindamycin for 10 days develops profuse diarrhea. The nurse should expect to administer which antimicrobial instead? 1. Penicillin G 2. Vancomycin or metronidazole 3. Tetracycline 4. Azithromycin

2

The administration of gentamicin with general anesthetics increases the risk of: 1. hepatotoxicity. 2. neuromuscular blockade. 3. nephrotoxicity. 4. ototoxicity.

2

Prednisone 10 mg orally daily has been prescribed for a client. The nurse provides instructions to the client regarding the medication. Which statement by the client indicates that further teaching is needed?

"I can take acetylsalicylic acid (aspirin) or my antihistamine if I need it."

The community health nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching?

"I can take aspirin or my antihistamine if I need it."

The nurse realizes that the client taking metformin (Glucophage) needs further teaching when the client makes which statement?

"I should treat hypoglycemic episodes due to metformin with glucose tablets only."

The nurse reinforces instructions to a client with myxedema about the dosage, method of administration, and side effects of levothyroxine sodium (Synthroid). Which statement by the client indicates an understanding of the nurse's instructions?

"I will report any episodes of palpitations, chest pain, or dyspnea."

Which instruction should the nurse reinforce to the client with diabetes mellitus receiving acarbose (Precose)? Select all that apply

"Take the medication with each meal." "Side effects include abdominal bloating and flatus." "Take some form of glucose if hypoglycemia occurs." "Report symptoms such as shortness of breath or tiredness."

An adult client with hypothyroidism is admitted to the hospital. When reviewing the client's health record, the nurse notes that the client is taking a maintenance dose of levothyroxine (Synthroid). Which is the range of the normal adult maintenance dose of this medication?

0.1 to 0.2 mg daily

A nurse transcribes a new prescription for potassium penicillin G IV q8h and gentamicin IV q12h. Which plan represents the best schedule for administering these drugs? 1. Give the penicillin at 0800, 1600, and 2400; give the gentamicin at 1800 and 0600. 2. Give the penicillin at 0800, 1600, and 2400; give the gentamicin at 1200 and 2400. 3. Give the penicillin at 0600, 1400, and 2200; give the gentamicin at 0600 and 1800. 4. Give the penicillin every 8 hours; give the gentamicin simultaneously with two of the penicillin doses.

1

Which agent inhibits bacterial wall synthesis? 1. Penicillin 2. Trimethoprim 3. Tetracycline 4. Acyclovir

1

The home healthcare nurse is visiting a client who was recently diagnosed with type 2 DM. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. the nurse should provide which instructions to the client? Select all that apply. 1.diarrhea may occur secondary to the metformin. 2.the repaglinide is not taken if the meal is skipped. 3.the repaglinide is taken 30 minutes before eating. 4.A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5.metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6.muscle pain is an expected effect of metformin and maybe treated with acetaminophen (Tylenol).

1, 2, 3, 4 repaglinide, a rapid acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it might signify a more serious condition that warrants healthcare provider notification, not the use of acetaminophen.

The nurse is monitoring a clients receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of side effects associated with this medication? Select all that apply.p 1.insomnia 2.weight loss 3.bradycardia 4.constipation 5.mild heat intolerance

1, 2, 5

The community health nurse visits the client at home. Prednisone, 10 mg orally daily, has been prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client , indicates that further teaching is necessary? 1.I can take aspirin or my antihistamine if I need it. 2.I need to take the medication every day at the same time. 3.I need to avoid coffee, tea, cola, and chocolate in my diet. 4.if I gain more than 5 pounds a week I will call my HCP.

1. Aspirin and other OTC medications should not be taking unless the client consult with the HCP.

A client with DM visit the healthcare clinic. The clients DM previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? 1.prednisone 2.phenelzine (Nardil) 3.atenolol (Tenormin) 4.allopurinol (Zyloprim)

1. Prednisone may decrease the effects of oral hypoglycemics, insulin, diuretics, and potassium supplements.

A patient reports an urticarial reaction to penicillin G. Which antibiotic would be the safest choice? 1. Dicloxacillin 2. Erythromycin 3. Nafcillin 4. Ceftazidime

2

The nurse schedules tetracycline administration for a patient with a respiratory infection. Which administration would be the most appropriate? 1. With a meal high in dairy products 2. 2 hours after a meal containing dairy products 3. With a calcium-containing antacid to minimize gastrointestinal distress 4. With an aluminum-containing antacid to minimize gastrointestinal distress

2

The patient who has been treated with a 10-day course of tetracycline telephones complaining of a 2-day history of profuse diarrhea. The nurse should: 1. tell the patient to eat a bland diet for the next 2 weeks. 2. inform the physician because this could indicate suprainfection. 3. inform the patient that this is a normal consequence of antibiotic use. 4. tell the patient that diarrhea is one way that the body rids itself of infection

2

Which comment should be included in discharge teaching for a patient receiving tetracycline? 1. "Take the medication until you feel better." 2. "Use sunscreen and protective clothing when outdoors." 3. "Keep the remainder of the medication in case of recurrence." 4. "Take the medication with food and milk to minimize GI upset."

2

The nurse provide medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the HCP if which problem occurs? 1.fatigue 2.tremors 3.cold intolerance 4.excessively dry skin

2. Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating.

Admission assessment on a client who visit the healthcare clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data on the client suspecting that the client has a history of which condition? 1.myxedema 2.Graves' disease 3.Addison's disease 4.Cushing syndrome

2. Propylthiouracil inhibit thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicate hypothyroidism. Addison's disease and Cushing's syndrome are disorders related to adrenal function.

A patient's peak gentamicin level is 1 mcg/mL. The nurse should analyze this as: 1. a safe peak level. 2. a toxic peak level. 3. a subtherapeutic peak level. 4. evidence that the blood sample was drawn at the wrong time.

3

Sulfonamides are contraindicated for newborns because of the drugs' potential to cause: 1. hypersensitivity. 2. hematologic toxicity. 3. kernicterus. 4. renal toxicity.

3

The principal indication for the use of sulfonamides is: 1. respiratory infections. 2. sinusitis. 3. urinary tract infections. 4. conjunctivitis.

3

Which statement regarding the pharmacokinetics of penicillin G is correct? 1. Penicillin G is absorbed well when administered orally. 2. The absorption of intramuscular procaine and benzathine penicillin G occurs rapidly, producing high blood levels. 3. Inflammation increases the distribution of penicillin G into the joints and cerebrospinal fluid. 4. Penicillin G undergoes extensive metabolism in the liver before excretion by the kidneys.

3

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1.at noon 2.at bed time 3.early morning 4.anytime, at the same time, each day

3. Corticosteroid (glucocorticoids) should be administered before 9 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.

Prednisone is prescribed for a client with DM who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? 1.an additional dose of prednisone daily 2.a decreased amount of daily humulin NPH insulin 3.an increased amount of daily humulin NPH insulin 4.the addition of an oral hypoglycemic medication

3. Glucocorticoids can elevate blood glucose levels. Clients with DM need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.

The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the medication at which time? 1.with food 2.at lunchtime 3.on an empty stomach 4.at bedtime with snack

3. This medication should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

A patient is on a once-daily dosage of gentamicin. If a trough level is ordered, when should it be drawn? 1. 2 hours after completing the infusion 2. 8 hours after completing the infusion 3. 12 hours after completing the infusion 4. 1 hour before the next infusion

4

A pregnant adolescent asks a nurse whether it would be appropriate to obtain a prescription for tetracycline to clear up her acne. The nurse's best response would be: 1. "Tetracycline is effective in clearing up acne." 2. "Tetracycline may cause allergic reactions in pregnant women." 3. "Tetracycline will also help clear up any asymptomatic urinary tract infection." 4. "A tetracycline drug could be harmful to the baby's teeth."

4

For oral administration, amoxicillin is preferred over ampicillin because it: 1. is available in more dosage formulations. 2. is less likely to cause allergic reactions. 3. works better with aminoglycosides. 4. is more acid resistant.

4

How do penicillin V and penicillin G differ? 1. Penicillin G has a different mechanism of action. 2. Penicillin V is more potent. 3. Penicillin G is more likely to cause anaphylaxis. 4. Penicillin V can be administered orally.

4

Tetracyclines are not considered "first-line" antimicrobial agents because of: 1. their narrow spectrum. 2. the increased incidence of peptic ulcer disease. 3. the absence of oral formulations. 4. emerging resistance.

4

The nurse is performing a physical assessment on a patient admitted to the hospital for an infection. The patient is taking gentamicin (Garamycin) for the infection. What areas should be the focus of the nurse's assessment? (Select all that apply.) a. Skin integrity b. Sense of hearing c. Blurred vision d. Fever e. Renal function

ANS: B, E The nurse should focus on the patient's sense of hearing and renal function, because aminoglycosides can cause serious toxic effects, especially of the inner ear and kidneys. Skin integrity, blurred vision, and fever are not signs of adverse effects of gentamicin.

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone.

A Rationale: Glucose levels increase when patients are taking CORTICOsteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a complication of RA exacerbation or prednisone use. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient is likely to have an increased appetite when taking prednisone, but it will be important to avoid weight gain for the patient with RA.

A client informs the nurse that she has been taking acarbose (Precose) as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which laboratory value is noted?

A 2-hour postprandial serum glucose of 120 mg/dL

A patient is taking gentamicin (Garamycin) on once daily regimen. The prescriber orders a blood sample to be drawn for measurement of a trough level of the drug. When should the nurse draw the blood? a. 1 hour after the infusion is complete b. 8 hours after the infusion is complete c. 12 hours after the infusion is complete d. 1 hour prior to the next infusion

A patient is taking gentamicin (Garamycin) on once daily regimen. The prescriber orders a blood sample to be drawn for measurement of a trough level of the drug. When should the nurse draw the blood? a. 1 hour after the infusion is complete b. 8 hours after the infusion is complete c. 12 hours after the infusion is complete d. 1 hour prior to the next infusion

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? A."I should not take this medication with milk or other dairy products." B. "I should not worry if I experience an acnelike rash with this medication." C. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." D. "I should take this antibiotic with a calcium supplement to improve absorption."

A. "I should not take this medication with milk or other dairy products." The patient should avoid taking the medication with dairy products to help prevent chelation. An acnelike reaction would indicate an allergic response. Taking the medication with calcium-containing antacids or supplements should be avoided, because this also leads to chelation

A patient is receiving local applications of mafenide (Sulfamylon) to burn areas. Before application, it is most important for the nurse to do what? A. Administer a pain medication. B. Obtain a set of vital signs. C. Auscultate the lung fields. D. Obtain a signed consent form.

A. Administer a pain medication The sulfonamide mafenide (Sulfamylon) is used to suppress bacterial colonization in patients with burns. Local application frequently is painful. It is important to administer a pain medication before applying mafenide (Sulfamylon). Obtaining vital signs and a signed informed consent form and auscultating lung fields are not essential actions for mafenide application.

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count

A. Cardiac rhythm Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.

Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what? A. Ensure that separate IV solutions are used. B. Use two different peripheral IV sites. C. Administer the gentamicin first. D. There are no necessary precautions.

A. Ensure that separate IV solutions are used. When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

The nurse identifies which drug as a short-acting tetracycline? A. Sumycin B. Declomycin C. Vibramycin D. Minocin

A. Sumycin Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.

Of the many adverse effects of tetracycline (Sumycin), one of the most serious is pseudomembranous colitis. This disorder most likely occurs because tetracycline is a(n) a. broad-spectrum antibiotic. b. narrow-spectrum antibiotic. c. highly protein bound medication. d. acid-labile drug.

ANS: A Broad-spectrum antibiotics may have the potential to kill a "broad spectrum" of bacteria, including "good" bacteria, such as those that protect the gut; this can lead to pseudomembranous colitis. Tetracycline is not a narrow-spectrum antibiotic; it also is not highly protein bound or acid labile.

For which diagnosis would the nurse administer a sulfonamide? a. Prostatitis b. Pyelonephritis c. Urinary tract infection d. Conjunctivitis

ANS: C A sulfonamide would be indicated for a patient with an uncomplicated UTI. A sulfonamide is not indicated for prostatitis, pyelonephritis, or conjunctivitis.

The nurse is preparing to discharge to home a patient who is a construction worker and who has been prescribed a sulfonamide. Which of the following instructions would be most important for this particular patient? a. "Make sure to use sunscreen." b. "Take the medication with food." c. "Report any muscle pain immediately." d. "Report any nausea or stomach upset."

ANS: A For a patient who is a construction worker, the most important instruction is to wear sunscreen and protective clothing, because sulfonamides can cause photosensitivity. Reporting nausea and stomach upset is important, as is taking the medication with food, but these are not the most important instructions. Myalgia is not a side effect of sulfonamide therapy.

A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) q 8 h and gentamicin IV q 12 h. Which plan is the best schedule for administering these drugs? a. Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1800 and 0600. b. Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1200 and 2400. c. Give the penicillin at 0600, 1400, and 2200; give the gentamicin (Garamycin) at 0600 and 1800. d. Give the penicillin every 8 hours; give the gentamicin (Garamycin) simultaneously with two of the penicillin doses.

ANS: A Gentamicin should never be administered concurrently with penicillin, because they will interact, and the penicillin may inactivate the aminoglycoside. All these options show concurrent administration.

The nurse is performing an assessment on a patient taking penicillin G (Benzylpenicillin). The patient shows confusion and hallucinations. The nurse would be correct to assume that a. blood levels of the drug are too high. b. the patient has a history of alcohol abuse. c. an intra-arterial injection has been administered inadvertently. d. an accidental injection into a peripheral nerve has been administered.

ANS: A Neurotoxicity (seizure, confusion, hallucination) may occur if blood levels of penicillin G are too high. The signs and symptoms are clearly neurologic in nature. Nothing indicates that the patient has a history of alcohol abuse. Manifestations of an intra-arterial injection are gangrene, necrosis, or sloughing of tissue. An accidental peripheral nerve injection may result in paralysis.

With which class of drugs would the nurse be most likely to see Stevens-Johnson syndrome? a. Sulfonamides b. Tetracyclines c. Azoles d. Penicillins

ANS: A The nurse would be most likely to see Stevens-Johnson syndrome in patients taking sulfonamides. Stevens-Johnson syndrome is not likely to be seen in patients taking tetracyclines, azoles, or penicillins.

The nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? a. "I will avoid taking my medication with dairy products." b. "I will need to take my antibiotic with grapefruit juice." c. "I should take my antibiotic with a calcium-containing antacid to minimize gastrointestinal distress." d. "I should expect a slight, acne-like rash with this medication."

ANS: A The patient should avoid taking the medication with dairy products to help prevent chelation; no further teaching is required. Grapefruit juice should be avoided to prevent unexpected interactions; further teaching is necessary. Calcium should be avoided, because it also leads to chelation; further teaching is necessary. An acne-like reaction would indicate an allergic response; further teaching is necessary.

A patient reports a severe urticarial reaction to benzathine penicillin G. The nurse would expect the prescriber to order which alternative antibiotic? a. Amphotericin B b. Erythromycin (E-Mycin) c. Ampicillin/sulbactam (Unasyn) d. Ceftazidime (Fortaz)

ANS: B Erythromycin is the first-choice treatment for several infections and may be used as an alternative to penicillin G in patients with a penicillin allergy. Amphotericin B, ampicillin/sulbactam, and ceftazidime are not indicated as alternatives for patients with a penicillin allergy

A patient is receiving methenamine (Mandelamine) for the treatment of a chronic UTI. Which agent, when given concurrently with methenamine, can create a risk for crystalluria? a. Ciprofloxacin (Cipro) b. Sulfisoxazole c. Nalidixic acid (NegGram) d. Erythromycin (ERYC)

ANS: B Methenamine should not be combined with sulfisoxazole. Formaldehyde forms an insoluble complex with sulfonamides, posing a risk of urinary tract injury from crystalluria. Ciprofloxacin would not increase the risk of crystalluria, but it may increase the risk of tendon rupture. Nalidixic acid can be administered with methenamine without increasing the risk of crystalluria. Erythromycin would not increase the risk of crystalluria.

The nurse is admitting to the unit a patient who has just had a minor operation and received a general anesthetic. The nurse notices that gentamicin (Garamycin) is infusing IV. Which of the following clinical findings associated with these drug-drug interactions would most alarm the nurse? a. Diluted urine b. Decreased sensation in the lower extremities c. Hyperreflexia d. Persistent headache

ANS: B Neuromuscular blockade may occur after IV, intramuscular (IM), and oral administration of gentamicin. The risk of paralysis is increased by concurrent use of neuromuscular blocking agents and general anesthetics. Decreased sensation in the lower extremities may signal paralysis. Diluted urine is not an effect of drug-drug interactions. Hyperreflexia would not be anticipated, nor would persistent headache, which might be seen with ototoxicity related to concurrent administration of other ototoxic medications.

A patient who works as a landscaper is preparing to be discharged home. He has been instructed to take tetracycline (Sumycin) as an outpatient. Which of the following should be included in the discharge teaching for this patient? a. "Take all the medication until symptoms subside." b. "Use sunscreen and protective clothing when outdoors." c. "Take the medication with Pepto-Bismol to avoid diarrhea." d. "Take the medication with food and milk to minimize GI upset."

ANS: B The patient, a landscaper, should be advised to wear sunscreen and protective clothing when outdoors, because the medication may cause photosensitivity. The medication should be taken until it is gone, not just until the patient feels better. The patient should not take the medication with Pepto-Bismol, which may interfere with the drug's absorption. Tetracycline should not be taken with food or milk, which may reduce absorption of the drug.

A patient who has been receiving clindamycin for 10 days develops profuse diarrhea and abdominal pain and has a temperature of 101.2° F. The nurse suspects that the patient has an infection caused by C. difficile. The nurse would expect the prescriber to order a. penicillin G. b. vancomycin (Vancocin). c. tetracycline (Sumycin). d. azithromycin (Zithromax).

ANS: B Vancomycin or Flagyl should be ordered for a patient with an infection caused by Clostridium difficile (C. difficile). Penicillin, tetracycline, and azithromycin are not indicated for the treatment of C. difficile infection.

The nurse and a graduate nurse are reviewing an order for penicillin G (Benzylpenicillin). The nurse is discussing the pharmacokinetics of penicillin G with the graduate nurse. Which statement by the graduate nurse best demonstrates understanding of the pharmacokinetics of penicillin G? a. "Penicillin G is absorbed well when administered enterally and parenterally." b. "Excretion by the kidneys is subject to the first-pass effect and the cytochrome p-450 system." c. "Inflammation increases the distribution of penicillin G into the joints and cerebrospinal fluid." d. "Penicillins generally are bacteriostatic but seldom have bactericidal effects."

ANS: C In the presence of inflammation, penetration of penicillin G into the meninges, joint fluids, and the eye is increased. Penicillin G is not administered enterally. Excretion by the kidneys is not subject to the first-pass effect. Penicillins generally are bactericidal, not bacteriostatic.

The nurse is analyzing laboratory results for a patient who receives gentamicin (Garamycin) twice a day. The patient's peak gentamicin serum level is 3 mcg/mL. How would the nurse interpret this finding? a. The level would be considered a safe peak level. b. The level would be considered a toxic peak level. c. The level would be considered a subtherapeutic peak level. d. The level would be irrelevant, because a peak level is not indicated.

ANS: C Peak levels should range from 4 to10 mcg/mL for traditional dosing and from 16 to 24 mcg/mL for once daily dosing. This value should be interpreted as subtherapeutic. This value indicates subtherapeutic dosing and is not safe or toxic. Peak levels are not irrelevant in medications that have significant risk for toxicity and have a narrow therapeutic index.

The nurse is providing patient education to a young adult patient who takes tetracycline (Sumycin). Which statement by the patient indicates a need for further teaching? a. "Tetracycline can be used for acne, too." b. "Tetracycline will help my H. pylori." c. "Tetracycline will stain my teeth." d. "I should not take this with my laxatives."

ANS: C Tetracycline only stains adult teeth if it is taken when a child is 4 months to 8 years of age; This statement indicates a need for further teaching. Tetracycline is indicated for H. pylori and acne; no further teaching is needed. Tetracycline should not be taken with laxatives, because they will absorb the medication and render it ineffective; no further teaching is necessary.

A patient with type 2 diabetes is taking an oral hypoglycemic agent. She complains of feeling "poorly" since she started taking a sulfonamide for a urinary tract infection. The nurse should take which of the following actions? a. Have the patient come in immediately for re-evaluation. b. Have the patient check her blood glucose level to see whether it is high. c. Instruct the patient to check her blood glucose level to see whether it is low. d. Advise the patient to add an extra snack just prior to bedtime.

ANS: C The nurse should have the patient check her blood glucose level to see whether it is low, because the sulfonamide can intensity the effects of the oral hypoglycemic agent. The patient does not need to come in immediately, because this is not a life-threatening emergency. The nurse would not expect the blood glucose level to be high. Adding an extra snack just before bedtime will only elevate the blood glucose level even more.

A patient returns to the clinic after taking antibiotics for a UTI. When a urinalysis is performed, it is determined that the patient still has a UTI. The nurse asks the patient if she took all her medication until it was gone. The patient replied that she hates taking pills two and three times a day and asks if there is something she can "take just once and get it over with." The nurse anticipates that the prescriber will order a. ciprofloxacin (Cipro). b. cephalexin (Keflex). c. fosfomycin (Monurol). d. amoxicillin (Amoxil).

ANS: C When adherence is a concern, fosfomycin, which requires only a single dose, is an attractive choice. Cipro is ordered twice a day for 3 days. Keflex is ordered three times a day for 7 to 14 days. Amoxil is ordered three times a day for 14 days.

Eight hours after administering a sulfonamide, the nurse notes that a patient has a temperature of 104° F, pulse of 112, BP of 104/52, respirations of 20, malaise, and widespread lesions of the skin and mucous membranes. The nurse would be correct to suspect a. suprainfection. b. systemic mycoses. c. red man syndrome. d. Stevens-Johnson syndrome.

ANS: D Stevens-Johnson syndrome is manifested by symptoms such as widespread lesions of the skin and mucous membranes, together with fever, malaise, and toxemia. A suprainfection would not manifest with lesions. Systemic mycoses would not manifest with lesions. Red man syndrome is manifested by flushing of the neck that extends sometimes to the trunk and body; it typically is seen in patients taking vancomycin.

The nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy. The patient is taking a sulfonamide and begins to show a fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed a. Stevens-Johnson syndrome. b. kernicterus. c. hepatotoxicity. d. hemolytic anemia.

ANS: D Sulfonamides can cause hemolytic anemia in patients of African American and Mediterranean origin, usually because of a genetic deficiency. Red cell lysis can produce fever, pallor, and jaundice. Patients should be observed for these signs. These signs and symptoms are not characteristic of Stevens-Johnson syndrome. These signs and symptoms are not characteristic of kernicterus, which occurs in newborns. These signs and symptoms are not characteristic of hepatotoxicity.

A pregnant adolescent asks the nurse whether it would be all right to continue to take her prescription for tetracycline (Sumycin) to clear up her acne. What response by the nurse provides the best information? a. "Tetracycline is effective in clearing up acne." b. "Tetracycline may cause allergic reactions in pregnant women." c. "Tetracycline will resolve an asymptomatic urinary tract infection." d. "A tetracycline drug could be harmful to the baby's teeth and should be avoided."

ANS: D Tetracyclines can cause discoloration of deciduous and permanent teeth. Tooth discoloration can be avoided if the drugs are not taken by pregnant women or by children under 8 years of age. Tetracycline is effective in clearing up acne; however, it is not appropriate for a pregnant patient. Pregnancy does not precipitate an allergic response to tetracycline. Tetracycline may be useful in clearing up a urinary tract infection, but that is not the priority at this time.

The nurse is caring for a patient receiving gentamicin (Garamycin) intravenously (IV). What statement by the patient would most concern the nurse? "I am experiencing a. dizziness." b. ear pain." c. tone deafness." d. high-pitched tinnitus."

ANS: D The first sign of impending cochlear damage is high-pitched tinnitus (ringing in the ears). As injury to cochlear hair cells proceeds, hearing in the high-frequency range begins to decline. The first sign of vestibular damage is headache, which may last 1 to 2 days. Nausea, unsteadiness, dizziness, and vertigo then begin to appear.

A client has been prescribed acarbose (Precose) for treatment of diabetes mellitus. Client teaching regarding this medication should include which instructions? Select all that apply.

Abdominal cramping is common. Side effects include excessive flatulence. The medication should be taken with each meal.

When discussing the rationale for levothyroxine (Synthroid) with a client with hypothyroidism, the nurse should emphasize that the client can anticipate which primary expected outcome?

Achieving normal thyroid hormone levels

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone?

An increased amount of daily Humulin NPH insulin

Prednisone is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which prescription should the nurse anticipate during therapy with the prednisone?

An increased amount of daily NPH insulin

1) A nurse is monitoring a client receiving glipizide (Glucotrol). Which outcome indicates an ineffective response from the medication? 1. A decrease in polyuria 2. A decrease in polyphagia 3. A fasting plasma glucose of 100 mg/dL 4. A glycosylated hemoglobin level of 12%

Ans. 4 rationale Glipizide (Glucotrol) is an oral hypoglycemic agent administered to decrease the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in both polyuria and polyphagia would indicate a therapeutic response. Laboratory values are also used to monitor a client's response to treatment. A fasting blood glucose level of 100 mg/dL is within normal limits. However, glycosylated hemoglobin of 12% indicates poor glycemic control.

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient's regimen? a. The patient's most recent hemoglobin A1C was 6%. b. The patient takes metformin (Glucophage) every morning. c. The patient uses captopril (Capoten) for hypertension. d. The patient's admission blood glucose is 128 mg/dl.

B Rationale: To avoid lactic acidosis, metformin should not be used for 48 hours after IV contrast media are administered. The other patient data indicate that the patient is managing the diabetes appropriately.

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A. "Take Augmentin once per day and only at bedtime." B. "Augmentin may be taken with food or meals." C. "Avoid taking Augmentin with grapefruit juice." D. "Use a minimal amount of liquid to swallow the Augmentin."

B. "Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? A. "You may stop taking the pills when you begin to feel better." B. "Use sunscreen and protective clothing when outdoors." C. "You'll have to come back to the clinic for weekly blood work." D. "Take the medication with yogurt or milk so you won't have nausea."

B. "Use sunscreen and protective clothing when outdoors." Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A. Unsteadiness B. Vertigo C. Headache D. Dizziness

B. Headache Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

A patient taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus? A. Hemolytic anemia B. Neurologic deficits C. Hepatocellular failure D. Ophthalmic infection

B. Neurologic deficits Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic deficits and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A. Diarrhea B. Skin rash and lesions C. Hypertension D. Bleeding

B. Skin rash and lesions The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? A. At mealtime, when food is available B. With soy or nonmilk products C. Between meals with a full cup of water D. On awakening before breakfast

C. Between meals with a full cup of water Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

The nurse identifies tigecycline (Tygacil) as a derivative of what? A. Penicillins B. Cephalosporins C. Tetracyclines D. Macrolides

C. Tetracyclines Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.

A patient has diabetes insipidus (DI). The LPN/LVN should plan to provide information on which medication? A. Insulin B. Cortisone C. Vasopressin D. Fludrocortisone acetate

C. Vasopressin

A client is admitted with chest pain related to atrial fibrillation. Based on her blood glucose reading, metformin (Glucophage) is prescribed for the client. As the nurse reviews the client's chart and prescriptions, which finding would require the nurse to verify the metformin prescription? Refer to chart.

Creatinine result

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first? A. Elevate the lower legs. B. Place an ice pack on the site. C. Make sure the patient stays calm. D. Administer subcutaneous epinephrine.

D. Administer subcutaneous epinephrine Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child? A. Delay in long bone growth B. Early onset of puberty C. Severe face and body acne D. Discoloration of the teeth

D. Discoloration of the teeth Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery? A. Gentamicin B. Tobramycin C. Amikacin D. Neomycin

D. Neomycin In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A. White blood cells (WBCs) B. Glucose C. Ketones D. Protein

D. Protein Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.

A nurse should recognize that which sulfonamide, applied topically, has the greatest therapeutic benefit for burns? A. Sulfadiazine B. Trimethoprim (Trimpex) C. Sulfacetamide (Isopto Cetamide) D. Silver sulfadiazine (Silvadene)

D. Silver sulfadiazine (Silvadene) Silver sulfadiazine is a topical anti-infective agent used to treat and prevent infection in second- and third-degree burns. Its effects are due primarily to the release of free silver and not to the sulfonamide portion of the molecule. Sulfadiazine and trimethoprim are sulfonamides used systemically, not topically. Sulfacetamide is used for superficial infections of the eye.

A client is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. The nurse notes that the client is presently taking warfarin sodium (Coumadin) and anticipates that the health care provider will alter which medication dosage?

Decrease the dosage of warfarin sodium.

The nurse is collecting data from a client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that metformin (Glucophage) is taken daily. Based on this finding, the nurse elicits data from the client regarding the presence of which condition?

Diabetes Mellitus

A daily dose of prednisone is prescribed for a client. The nurse reinforces instructions to the client regarding administration of the medication and instructs the client to take this medication at which time?

Early morning

A client diagnosed with hypothyroidism is taking levothyroxine (Synthroid). The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information?

Full therapeutic effect may take 1 to 3 weeks.

Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. Which should the nurse tell the client is a common side effect of the medication?

Gastrointestinal (GI) disturbances

Levothyroxine sodium (Synthroid) is prescribed for a client with hypothyroidism. When should the nurse encourage the client to take the medication?

In the morning

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, added to the client's regimen, may have contributed to the hyperglycemia?

Prednisone

The nurse preparing a client for surgery reviews the client's medication record. The client is to receive nothing by mouth (NPO) after midnight. Which medication noted on the client's record should the nurse question?

Prednisone

A client diagnosed with hyperthyroidism will be taking propylthiouracil (PTU). The nurse reinforces medication instructions and determines that the client understands the information if the client states that it is most important to report which symptoms to the health care provider?

Sore throat

The nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). Which instruction should the nurse give the client?

Take the medication on an empty stomach.

The nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which sign/symptom occurs?

Tremors

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

c. Biguanides Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels