PHARMACOLOGY MODULE 4

The nurse would identify which of the following as examples of passive immunity? Select all that apply. A. Antibodies from an outside source, such as the mother's placenta and breast milk B. Immune-globulin to provide antibodies against a specific disease C. Antigen response to a pathogen D. Immunizations E. Exposure to a disease

A. Antibodies from an outside source, such as the mother's placenta and breast milk B. Immune-globulin to provide antibodies against a specific disease One example of natural immunity passively acquired is in infants, who are unable to protect against disease because of immature immune systems but instead require antibodies from an outside source, such as the mother's placenta and breast milk. Another example is receiving an immune-globulin to provide antibodies against a specific disease. Passive acquired immunity is essential when (1) time does not permit active vaccination alone, (2) the exposed individual is at high risk for complications of the disease, or (3) the individual suffers from an immune system deficiency that renders that person unable to produce an effective immune response.

The patient has been administered a toxoid. The patient is most likely being vaccinated against which disease? A. Diphtheria B. Human papillomavirus C. Hepatitis B D. Mumps

A. Diphtheria Vaccination against diphtheria is performed with administration of a toxoid. Human papillomavirus and hepatitis B both require a recombinant viral antigen vaccine; mumps requires a live attenuated virus.

The patient arrives at the health clinic complaining of experiencing sudden onset of both flatulence and heartburn. The patient tells the nurse that he has added herbal medication to his drug regimen. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A. Garlic B. Milk thistle C. Hawthorn D. Sage

A. Garlic Although both sage and milk thistle can produce occasional gastrointestinal upset, of the herbs listed, only garlic is known to produce both flatulence and heartburn.

A patient is admitted for elective surgery. The patient states that he regularly uses both herbs and natural remedies. What is the nurse's priority action? A. To determine what herbs the patient takes on a regular basis B. To determine when the patient last took herbs C. To teach the patient why natural remedies are not safe D. To have the patient cancel the surgery

A. To determine what herbs the patient takes on a regular basis The nurse should first determine what herbs the patient takes on a regular basis. It could be that the herbs will not interfere with the patient's surgery and medications. Once the nurse determines what herbs the patient takes, the nurse should ask about the last time the patient took the herbs.

The nurse is preparing to administer the tetanus vaccine to the patient. The nurse recognizes that the patient will be receiving A. inactivated bacteria. B. a toxoid. C. inactivated viral antigen. D. recombinant viral antigen.

B. a toxoid. The vaccine against tetanus is a toxoid.

Which patient will have highest priority for the nurse performing an assessment? A. The patient with a history of cardiac disease who has been taking garlic daily B. The patient with a history of dementia who is taking Ginkgo biloba C. The patient scheduled for surgery who is taking Dong-quai D. The patient who is nauseous and is taking ginger

C. The patient scheduled for surgery who is taking Dong-quai Dong-quai increases the risk of bleeding and should not be taken before surgery. Garlic will reportedly decrease high cholesterol and may help a patient with a cardiac history. Ginkgo is purported to help patients diagnosed with dementia. Ginger is purported to help decrease the risk of vomiting in nausea.

The nurse is preparing to administer the hepatitis A vaccine to the patient. The nurse recognizes that the patient will be receiving A. inactivated bacteria. B. a toxoid. C. inactivated viral antigen. D. recombinant viral antigen.

C. inactivated viral antigen. The vaccine against hepatitis A is an inactivated viral antigen.

The patient is scheduled to receive a measles vaccine. The nurse recognizes that the patient will be receiving A. inactivated viral components. B. inactivated virus. C. live virus. D. live attenuated virus.

C. live virus. The measles vaccine is a live virus.

The patient questions a nurse about herbal treatments for arthritic pain. What is the nurse's best response? A. "Ginkgo biloba has proven to be very useful as an anti-inflammatory agent." B. "High doses of vitamins have been used for many years to help maintain joint health." C. "There are no safe herbal treatments for pain; take your prescription medications." D. "Ginger has helped treat arthritic pain. Consult your health care provider."

D. "Ginger has helped treat arthritic pain. Consult your health care provider." There are demonstrated benefits for the use of some herbal supplements. However, they should always be used in consultation with the health care provider.

The community health nurse is assessing a child who has a rash. The child is found to have measles. What is the nurse's best action? A. Take no action; let the disease process run its course. B. Take the child to the nearest emergency department for treatment. C. Tell the parent to stay away from the child to avoid infection. D. Report the measles to public health officials.

D. Report the measles to public health officials. Health care providers are responsible for reporting cases of vaccine-preventable diseases to public health officials, who then make weekly reports to the Centers for Disease Control and Prevention. These data identify whether an outbreak is occurring and the impact of immunization policies and procedures.

A nurse is teaching a group of new guardians about immunizations. The nurse should instruct the guardians that the series for which of the following vaccines is completed prior to the first birthday? A. Pneumococcal conjugate vaccine B. Meningococcal conjugate vaccine C. Varicella vaccine D. Rotavirus vaccine

D. Rotavirus vaccine Rotavirus vaccine is administered only to infants less than 8 months, 0 days of age. PCV13 is a 4-dose series with final dose given between 12-15 months MCV is recommended for children age 11-12 years, followed by a booster at 16-18. The 2 doses of varicella vaccine are given first at 12-15 months, and the second at 4-6 years.

The nurse is updating a clinic history on a patient who reports experiencing increasingly frequent sunburns. The patient also mentions that he has started taking a specific herb on a regular basis. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A. Garlic B. Milk thistle C. Hawthorn D. St. John's wort

D. St. John's wort St. John's wort produces skin photosensitivity; garlic, milk thistle, and hawthorn are not known to cause this side effect.

While performing an admission interview, which question would be the most appropriate for the nurse to ask the patient in regard to the use of herbal supplements? A. "Are you aware that you must stop all herbal supplements before being admitted?" B. "Is your health care provider aware of the herbal supplements you take?" C. "What is your opinion about herbal supplements?" D. "What supplements do you take, and how often do you take them?"

D. "What supplements do you take, and how often do you take them?" The nurse needs to assess what herbs the patient takes, as this may affect the patient's treatment or interfere with medications.

The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is garlic. For which condition would the patient be taking this medication? A. Hypertension B. Thyroid disease C. Infection D. Asthma

A. Hypertension Garlic is commonly used to treat hypertension and heart disease.

Once a child has received a vaccination, what action is the nurse's priority? A. Monitor for possible anaphylaxis. B. Assess for muscle pain. C. Treat pain at the injection site. D. Assess for infection.

A. Monitor for possible anaphylaxis. Anaphylaxis is a potentially life-threatening adverse reaction to vaccines. Muscle pain and pain at the injection site can occur, but assessment and treatment of these is not the primary action. Infection is not likely from this course.

A 12-month-old child just received the first MMR vaccine. For which of the following findings should the nurse instruct the family to monitor for adverse effects of the MMR vaccine? (SATA) A. Rash B. Swollen glands C. Bruising D. Headache E. Inconsolable crying

A. Rash B. Swollen glands C. Bruising A rash and swollen glands can develop in children 1-2 weeks following MMR immunization. A temporary low plt count, causing bruising or bleeding can occur occasionally following MMR immunization. Headache is an adverse reaction that can occur following immunization with the inactivated or the live attenuated influenza vaccines. Inconsolable crying can occur in some infants following a DTaP immunization.

A patient is admitted with multiple bruises over the arms and legs. What is the nurse's first action? A. To ask the patient for a list of medications and herbal supplements B. To call the health care provider C. To notify the police about possible abuse D. To draw blood for coagulation studies

A. To ask the patient for a list of medications and herbal supplements The nurse should first assess before acting. Medications as well as supplements can cause a patient to be susceptible to bruising.

A patient admitted with angina states, "I take Dong-quai every day, and I want to keep using it." What is the nurse's most appropriate response? A. What other medications do you currently take? B. You will not be able to take this medication anymore. C. You will have to discuss this with your health care provider. D. You do not have to stop this supplement; it will help you.

A. What other medications do you currently take? The nurse must first assess to determine if the patient's medications may interact with the herbal supplement.

A nurse is caring for a client who requests information on the use of feverfew. Which of the following responses should the nurse make? A. "It is used to treat skin infections." B. "It can decrease the frequency of migraine headaches." C. "It can lessen the nasal congestion in the common cold." D. "It can relieve nausea of morning sickness during pregnancy."

B. "It can decrease the frequency of migraine headaches." Feverfew is used to decrease the frequency of migraine headaches, but it has not been proven to relieve an existing migraine headache. Aloe is used to treat tissue injury. Echinacea is used to can relieve manifestations of the common cold. Ginger root is used to relieve nausea caused from morning sickness during pregnancy.

A nurse is caring for several clients who came to the clinic for a seasonal influenza immunization. The nurse should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection? A. 1 year old who has no health problems B. 17 year old who has a hypersensitivity to penicillin C. 25 year old who is pregnant D. 52 year old who takes a multivitamin supplement

B. 17 year old who has a hypersensitivity to penicillin A 17 year old can be immunized for influenza with the LAIV nasal spray. Hypersensitivity to pcn is not a a contraindication. Children younger than 2 are not yet eligible to receive the live attenuated influenza vaccine (LAIV). The LAIV is contraindicated in pregnancy and in clients older than 50. The 1 year old, the pregnant woman, and the 52 year old should instead receive the inactivated influenza vaccine.

A nurse at a provider's office is preparing to administer RV, DTaP, Hib, PCV13, and IPV immunizations to a 4-month-old infant. Which of the following actions should the nurse plan to take? (SATA) A. Administer IPV orally B. Administer subcutaneous injections in the anterolateral thigh C. Administer IM injections in the deltoid muscle D. Give the infant a pacifier during vaccine injections E. Teach caregivers to give aspirin on a schedule for 24hr after immunization

B. Administer subcutaneous injections in the anterolateral thigh D. Give the infant a pacifier during vaccine injections SubQ immunizations may be administered in either the anterolateral thigh or the outer aspect of the upper arms to infants and children. Giving the infant a pacifier during injections is a comfort measure that should be encouraged by the nurse. IPV is given subQ. Oral polio vaccine is no longer used in the US. The deltoid muscle is not fully developed in infants and generally should not be used for IM injections until about 18 months. Use the vastus lateralis muscle for infant immunizations. Aspirin increases risk for Reye's syndrome.

A nurse is caring for a client who asks about the potential adverse effects of smoking cannabis. Which of the following manifestations should the nurse include in the response? (Select all that apply.) A. Decreased heart rate B. Dry mouth C. Hallucinations D. Hypertension E. Increased urination

B. Dry mouth C. Hallucinations Dry mouth and hallucinations are potential adverse effects of cannabis. Increased, not decreased, heart rate; hypotension, not hypertension; and decreased, not increased, urination are potential adverse effects of cannabis.

The nurse is completing the admission history for a patient who tells the nurse that he takes valerian. Based on the use of this herb, the nurse anticipates that the patient will most likely report experiencing which condition? A. Muscle aches B. Headaches C. Insomnia D. Dry eyes

B. Headaches Valerian has been shown to produce anxiety, headache, and gastrointestinal upset. It is not known to produce muscle aches, insomnia, or dry eyes.

Which information will the nurse provide to a patient receiving tetanus toxoid? A. Increase the fluid and fiber in your diet to prevent constipation. B. Soreness at the injection site is a common reaction. C. Lifetime immunity is achieved from this injection. D. Tetanus toxoid must be repeated weekly for 4 weeks.

B. Soreness at the injection site is a common reaction. Myalgia at the injection site is a common side effect of tetanus toxoid. There is no need to repeat the toxoid weekly for 4 weeks, and the vaccine should not produce constipation. The toxoid usually is given approximately every 10 years.

A nurse is reviewing a client's current medications. The client states, "I also take ginkgo biloba." Which of the following medications has the potential to interact with ginkgo biloba? A. Acetaminophen B. Warfarin C. Digoxin D. Lisinopril

B. Warfarin Ginkgo biloba can suppress coagulation and increase the risk of bleeding or hemorrhage which is further increased if the client is taking an anticoagulant, such as warfarin. Aspirin should be used with caution in clients taking ginkgo biloba, because ginkgo biloba can suppress coagulation. Antihistamines can interact with ginkgo biloba. Digoxin is not contraindicated for a client taking ginkgo biloba. Antipsychotic medications can interact with ginkgo biloba. Lisinopril is not contraindicated for a client taking ginkgo biloba.

An adult patient says, my children are being vaccinated. Are there any that I should have? What is the nurse's best reply? A. No, there are no vaccines that an adult needs. B. Yes, you need to remain current on several vaccines; check with your provider. C. Yes, you will need the same ones your children need. D. No, you have probably had all of the childhood diseases by now.

B. Yes, you need to remain current on several vaccines; check with your provider. While much emphasis is placed on regularly immunizing infants and children, adult immunizations are frequently overlooked. However, they are equally important to the health and well-being of this population.

The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response? A. "You should not use any kind of traditional remedy while you are taking this new medication." B. "If you have been drinking this tea every day, then you should continue drinking it to maintain your health." C. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." D. "Traditional remedies have no health benefits. You should stop drinking the tea; it's a waste of time and money."

C. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." Patients may derive both psychological and physical benefits from taking traditional remedies, but it is essential to ensure that the traditional remedies will not interfere with the action of the conventional medications the patient has been prescribed. Because patients may achieve health benefits or psychological comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the patient's conventional medications.

The nurse is preparing to administer vaccines to a young child. What will the nurse do initially? A. Rub the site of the vaccination with alcohol. B. Explain active and passive immunity to the child and caregivers. C. Ask the caregivers about food allergies and over-the-counter medications. D. Tell the child to lie on the stomach to receive the vaccines.

C. Ask the caregivers about food allergies and over-the-counter medications. Before immunizations are administered, children and their caregivers should be questioned regarding their use of prescription and over-the-counter medications, including herbal preparations and any food or drug allergies. Depending on the patient's allergies, the other interventions may not occur if it is determined that it is too dangerous for the patient to receive the vaccine.

The nurse is assessing a newly admitted patient who is noted to exhibit unusually low blood pressure. The patient tells the nurse that he has added herbal medication to his drug regimen. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A. Licorice B. Milk thistle C. Hawthorn D. Sage

C. Hawthorn Hawthorn is known to produce hypotension. Licorice produces an increase in blood pressure, not a decrease. Milk thistle and sage are not known to lower blood pressure.

The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is Echinacea. For which condition would the patient be taking this medication? A. Hypertension B. Thyroid disease C. Infection D. Asthma

C. Infection Echinacea is commonly used for colds, flu, and infections.

The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is ginseng. For which condition would the patient be taking this medication? A. Hypercholesterolemia B. Thyroid disease C. Inflammation D. Asthma

C. Inflammation Ginseng has been said to boost the immune system, increase a person's sense of well-being, and increase stamina. It has also been used to treat erectile dysfunction, hepatitis C, and menopausal symptoms and to lower glucose and blood pressure.

A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements. Which of the following herbal supplements should the nurse report to the provider as the potential cause? A. Glucosamine B. Saw palmetto C. Kava D. St. John's Wort

C. Kava Chronic use or high doses of kava can cause liver damage, including severe liver failure. Glucosamine can increase bleeding and should be used with caution in clients who are taking antiplatelet medications or anticoagulants. Saw palmetto can cause mild GI effects and should be used with caution in clients who are taking antiplatelet medications or anticoagulants. Garlic can cause GI manifestations and should be used with caution in clients who are taking antiplatelet medications or anticoagulants.

The patient has been administered a live virus as a vaccine. The patient is most likely being vaccinated against which disease? A. Tetanus B. Diphtheria C. Smallpox D. Anthrax

C. Smallpox A live virus is included in the smallpox vaccine. Toxoids are used to immunize against both tetanus and diphtheria. Anthrax requires a vaccine of inactivated bacteria.

A nurse is caring for a group of clients who are not protected against varicella. The nurse should prepare to administer the varicella vaccine at this time to which of the following clients? A. 24 year old client in the third trimester of pregnancy B. 12 year old child who has a severe allergy to neomycin C. 2 month old infant who has no health problems D. 32 year old client who has essential hypertension

D. 32 year old client who has essential hypertension The 32 year old who has essential htn and did not receive 2 doses of varicella vaccine earlier in life or have history of the disease should be immunized. Client in third trimester of pregnancy should wait until postpartum; this live vaccine is not safe for pregnant women. Varicella vaccine is contraindicated for clients who have severe allergy to neomycin. The 2-month-old is too young; the 2-dose varicella vaccine is given at 12-15 months and at 4-6 years of age.

A nurse is teaching about the use of medical marijuana with a group of newly licensed nurses. Which of the following statements indicates an understanding of the teaching? A. A health care provider must write a prescription for medical marijuana. B. Medical marijuana is a Schedule V controlled substance in the United States. C. Pharmacies must obtain certification prior to dispensing medical marijuana. D. The FDA does not recognize the marijuana plant as a form of medicine.

D. The FDA does not recognize the marijuana plant as a form of medicine. The FDA does not recognize nor approve the marijuana plant as a form of medicine. Cannabis cannot be legally prescribed by healthcare providers in the United States. Medical marijuana is a Schedule I controlled substance in the United States. Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for misuse. Cannabis cannot be legally dispensed from pharmacies in the United States. Certified clients can only obtain cannabinoids from an authorized cannabis dispensary after registering with their Medical Marijuana Program (MMP).