1530 Exam 4 Study Guide

a. Taking the medication with meals The most common side effect is gastric upset, so taking the medication with meals will alleviate/assist with these symptoms.

A client is ordered to receive an NSAID for osteoarthritis. Which nursing intervention will treat the side effect most commonly associated with the NSAIDs? a. Taking the medication with meals b. Using sunscreen c. Avoiding crowds d. Encouraging deep breathing

b. a decrease in length of posttreatment neutropenia. CSFs stimulate white blood cell production.

A client with leukemia is receiving colony-stimulating factors (CSFs). The nurse anticipates that the client will be affected by the medication by exhibiting: a. a decrease in the actual size of the tumor. b. a decrease in length of posttreatment neutropenia. c. an increase in fungus-destroying ability. d. diminished bacterial infection.

c. Pyelonephritis These are symptoms of pyelonephritis, characterized by fever, dysuria, flank pain, and urinary frequency.

A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition? a. Cystitis b. Dysuria c. Pyelonephritis d. Urethritis

a. Administer the vaccines as ordered. Antibiotic therapy is not generally a contraindication to the use of vaccines. Vaccines may be given in cases of mild acute illness or during the convalescent phase of an illness. All four vaccines may be given. If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. Aspirin should not be given because of the increased risk of Reye's syndrome.

A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the last day of antibiotic therapy. The provider orders varicella (Varivax); mumps, measles, and rubella (MMR); inactivated polio (IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct? a. Administer the vaccines as ordered. b. Discuss giving the MMR vaccine in 4 weeks. c. Hold all vaccines until 2 weeks after antibiotic therapy. d. Recommend aspirin for fever and discomfort.

d. the MMR and Varivax today and the DTaP and IPV in 1 week If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. In the incorrect answers, the two live virus vaccines are given only one week apart.

A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The child's parents want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents' wishes, the nurse will administer a. the DTaP and Varivax today and the MMR and IPV in 1 week. b. the IPV and MMR today and the Varivax and DTaP in 1 week. c. the MMR and DTaP today and the Varivax and IPV in 1 week. d. the MMR and Varivax today and the DTaP and IPV in 1 week.

b. Acetaminophen Medications containing salicylates are not recommended because of the possibility of developing Reye's syndrome.

A 5-year-old client has an elevated temperature as a result of a viral respiratory tract infection. What nonopioid drug should be given to decrease the child's body temperature? a. Aspirin b. Acetaminophen c. Diflunisal d. Sodium salicylate

ANS: B, C, D, E b. Wash hands frequently. c. Change sheets daily. d. Take medication until worms are no longer noted in the feces. e. Be alert for drowsiness. The child should take showers and must take the entire course of medications. It will cause drowsiness, not agitation.

A 5-year-old client is being treated for parasitic worms. What should be included in the client's care? (Select all that apply.) a. Take baths, not showers. b. Wash hands frequently. c. Change sheets daily. d. Take medication until worms are no longer noted in the feces. e. Be alert for drowsiness. f. Watch for side effects of agitation.

b. Tetracycline may cause permanent discoloration to the teeth if taken before age 8 years. Tetracycline can cause teeth discoloration in young children. The other options are not true.

A 7-year-old client is being evaluated for treatment with tetracycline. Which knowledge is most important for the nurse to share with the client and parents about tetracycline? a. Tetracycline is safe if taken during pregnancy. b. Tetracycline may cause permanent discoloration to the teeth if taken before age 8 years. c. Tetracycline causes bone marrow suppression in clients of all ages. d. Tetracycline should be taken with milk or milk products and antacids to avoid gastrointestinal side effects.

d. "Your child should wash hands well after using the toilet." To prevent the spread of pinworms, good hand washing after toileting is recommended. Patients should take showers, not baths. It is not necessary to get regular stool specimens or to wash clothing in hot water.

A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent? a. "Give your child baths every day." b. "Obtain a daily stool specimen from your child." c. "Wash your child's clothing in hot water." d. "Your child should wash hands well after using the toilet."

c. Mebendazole (Vermox) Mebendazole is used to treat pinworms. The other drugs treat other types of parasites.

A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child? a. Bithionol (Bitin) b. Diethylcarbamazine (Hetrazan) c. Mebendazole (Vermox) d. Praziquantel (Biltricide)

a. 5 mL PO BID This child should receive (10 kg ´ 8 mg) 80 mg of TMP and (10 kg ´ 40 mg) 400 mL of SMX per day. When divided into two doses, the correct dose is 40 mg TMP and 200 mg SMX, or 5 mL per dose.

A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child's dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct? a. 5 mL PO BID b. 5 mL PO daily c. 10 mL PO BID d. 10 mL PO daily

b. slowing the decline in the number of CD4 cells. The goal of antiretroviral therapy includes slowing the decline in the number of CD4 cells.

A child with AIDS is placed on antiretroviral therapy. The nurse's instructions to the child and family are based on the premise that the goals of antiretroviral therapy include: a. increasing viral load to detectable levels. b. slowing the decline in the number of CD4 cells. c. increasing resistance to opportunistic infections. d. decreasing the severity of opportunistic infections.

b. to prevent drug resistance. Multiple agents are necessary because of the ability of the TB bacteria to mutate and become antibiotic resistant.

A client asks the purpose for using isoniazid (INH) and rifampin (Rifadin) in combination to treat his tuberculosis. The nurse informs him that both agents are given: a. to prevent side effects. b. to prevent drug resistance. c. to lengthen drug therapy. d. for clients who are allergic to one of the antitubercular drugs.

c. Instruct client to discontinue penicillin when temperature is normal. The entire course of the medication should be taken to ensure eradication of the infection and decreased resistance, even if the client's temperature has normalized.

A client at an outpatient clinic is ordered to receive ampicillin (Omnipen) for an infection. Which nursing intervention related to penicillins would the nurse question? a. Verify that the client is not allergic to penicillin. b. Obtain culture before administering the first dose of medication. c. Instruct client to discontinue penicillin when temperature is normal. d. Encourage the client to increase fluid intake.

d. warfarin (Coumadin). Allopurinol (Zyloprim) increases the effects of warfarin (Coumadin). Allopurinol does not interact with diphenhydramine, metoclopramide, and propranolol.

A client diagnosed with acute gout is prescribed allopurinol (Zyloprim). The nurse is reviewing the client's medication history and will contact the healthcare provider if the client is taking: a. diphenhydramine (Benadryl). b. metoclopramide (Reglan). c. propranolol (Inderal). d. warfarin (Coumadin).

a. once The longer half-life allows for daily dosing and shorter duration of medication.

A client has a bacterial infection and is ordered to receive Zithromax. Based on its half-life, the nurse anticipates giving this drug _____ per day. a. once b. twice c. three times d. four times

b. Increasing oral fluid intake Increasing fluids decreases the amount of crystalluria.

A client has a urinary tract infection that is treated with an antibiotic. The medication has a tendency to cause crystalluria. Which nursing intervention may prevent this side effect? a. Treating with urinary antispasmodics b. Increasing oral fluid intake c. Increasing intake of acid-ash fluids/foods d. Maintaining urine specific gravity above 1.025

c. Notify the physician and describe symptoms. These symptoms may indicate a superinfection and should be reported to the physician.

A client has been receiving a cephalosporin for 20 days to treat a severe bacterial infection. The client complains of mouth pain, and the nurse assesses white patches in the client's mouth. What is the highest priority action on the part of the nurse? a. Provide mouth care with glycerin swabs. b. Encourage the client to drink more fluids. c. Notify the physician and describe symptoms. d. Administer analgesia for the mouth pain.

a. Stimulation of urination stimulate micturition The medication will increase bladder tone by increasing tone of the detrusor urinal muscle, which produces a contraction strong enough to stimulate urination

A client has decreased bladder function and is ordered bethanechol (Urecholine). The nurse anticipates what expected outcome of the medication? a. Stimulation of urination stimulate micturition b. Decreased urinary tract spasms c. Reduced urinary pain d. Prevention of bacterial growth

d. Restrict fluids when taking the antibiotic. Fluids should be encouraged with antibiotic therapy, so such an order would need to be questioned.

A client has relayed instructions from a physician regarding an allergy to a type of antibiotic therapy. The nurse would question which instruction? a. Wear a Medic Alert bracelet that indicates the allergy. b. Avoid all penicillin-type drugs. c. Inform all healthcare providers of the allergy. d. Restrict fluids when taking the antibiotic.

ANS: A, C, E, F, G a. Streptomycin sulfate c. Ethambutol (Myambutol) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide These are the medications used to treat TB. The medications in the other options are not used.

A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide

ANS: A, C, E, F, G a. Streptomycin sulfate c. Ethambutol (Myambutol) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.

A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide

b. Assess hearing acuity. Streptomycin is ototoxic and warrants monitoring of hearing function.

A client is being treated with multidrug therapy for acute tuberculosis. The drug regimen includes streptomycin. What will be the highest priority nursing intervention while the client is being treated with streptomycin? a. Assess urine output and kidney function. b. Assess hearing acuity. c. Monitor hepatic function. d. Conduct an ECG to watch for changes.

b. Call the physician to clarify the order. The dosage is inappropriate and should be 160 mg trimethoprim/800 mg sulfamethoxazole.

A client is diagnosed with a urinary tract infection and is ordered to receive 160 mg trimethoprim/200 mg sulfamethoxazole. Based on the physician's order, what is the highest priority nursing intervention? a. Call the pharmacist to clarify the order. b. Call the physician to clarify the order. c. Give the medication as ordered. d. Hold the dosage to prevent anaphylaxis.

a. Temperature within normal limits A body temperature within normal limits indicates that the medication is effective.

A client is diagnosed with an infection and is ordered to receive a sulfonamide. What would the nurse evaluate as a positive response to the treatment? a. Temperature within normal limits b. A decrease in urine output c. Increase in dysuria d. A rising white blood cell count

b. 48 In order to be effective, this medication must be administered within 48 hours of symptom onset.

A client is diagnosed with the flu. The nurse is aware that in order to be effective, neuraminidase inhibitors should be taken within how many hours of onset of flu symptoms? a. 24 b. 48 c. 72 d. 96

c. Isoniazid (INH) INH is the drug of choice in exposed family members who are not immunocompromised.

A client is diagnosed with tuberculosis. The nurse practitioner plans to treat the client's family. The nurse anticipates that which drug will be ordered? a. Streptomycin b. Rifampin (Rifadin) c. Isoniazid (INH) d. Colistin

c. It is cost-effective for providing cancer care. Receiving chemotherapy at home is less expensive because of decreased hospital costs.

A client is discharged on anticancer medications. What is an advantage of home use of these medications? a. It can be closely monitored for potency of the drug. b. Adequate hydration can be more easily provided in the home. c. It is cost-effective for providing cancer care. d. The client and family can readily monitor side effects and adverse reactions.

a. Nausea, vomiting, and diarrhea Common side effects of cephalosporins include anorexia, nausea, vomiting, headache, dizziness, itching, and rash.

A client is ordered to receive a cephalosporin to treat a bacterial infection. Regarding monitoring of the client, the highest priority action on the part of the nurse includes assessing the client for which side effects? a. Nausea, vomiting, and diarrhea b. Photophobia and phototoxicity c. Pain with urination and blood in the urine d. High fevers and sweating

d. Liquid suspension This medication does not need to go through the dissolution phase, so it is more rapidly absorbed.

A client is ordered to receive a medication to relieve inflammation. The nurse determines that the medication is needed quickly. The nurse anticipates that which drug form will be ordered so that the medication can be released rapidly? a. Tablet b. Enteric-coated pill c. Capsule d. Liquid suspension

c. acute mild Nonopioid analgesics are used for mild to moderate pain and may be available over the counter.

A client is ordered to receive a nonopioid analgesic. The nurse knows that the client is experiencing _____ pain. a. acute severe b. visceral (deep) c. acute mild d. superficial moderate to severe

c. three or more times a Medications with a short half-life should be given tid or qid.

A client is ordered to receive acyclovir (Zovirax). The nurse is aware that acyclovir is effective against various viruses and has a short half-life. The medication dose should be taken _____ day. a. once a b. twice a c. three or more times a d. once every other

b. reduce body temperature. One of the functions of NSAIDs is to reduce body temperature.

A client is ordered to receive an NSAID for a disorder. The client states that she is aware that NSAIDs are frequently taken to decrease inflammation. The nurse clarifies that these agents may also be taken to: a. decrease pulse rate. b. reduce body temperature. c. decrease blood pressure. d. increase platelet aggregation.

a. Increased risk of bleeding with anticoagulants ASA is an anticoagulant that may increase the bleeding time when used with other anticoagulants.

A client is ordered to receive aspirin after an acute heart attack. The nurse is evaluating use of this medication with other medications. The nurse is aware that aspirin can cause which drug interaction? a. Increased risk of bleeding with anticoagulants b. Decreased risk of hypoglycemia with oral hypoglycemic drugs c. Decreased ulcerogenic effect with glucocorticoids d. Increased risk of infection with amoxicillin

d. a decrease in inflammation. A decrease in inflammation is the anticipated function of this medication.

A client is ordered to receive celecoxib (Celebrex) for chronic pain caused by osteoarthritis. The nurse anticipates that the client will exhibit: a. an increase in pain level. b. an increase in bleeding time. c. erosion of the stomach lining. d. a decrease in inflammation.

a. Neutropenia and agranulocytosis Although all of these may be side effects of this medication, neutropenia and agranulocytosis causes most concern because of immunosuppression and the potential for infections.

A client is ordered to receive co-trimoxazole (Bactrim, Septra). The nurse assesses for side effects. What causes the nurse the greatest concern? a. Neutropenia and agranulocytosis b. Nausea and vomiting c. Headache and vertigo d. Fatigue and anorexia

c. prevent hemorrhagic cystitis. Cytoxan can cause hemorrhagic cystitis and irritation of the bladder wall.

A client is ordered to receive cyclophosphamide (Cytoxan). The client is advised to drink increased water and fluids to: a. prevent renal failure. b. prevent liver dysfunction. c. prevent hemorrhagic cystitis. d. increase the red blood cell count.

b. achieve the desired effect in 3 to 4 months. Gold therapy, or chrysotherapy, takes 3 to 4 months to reach effective levels.

A client is ordered to receive gold therapy. The client asks how long it will take for him to feel the effects of this medication. The nurse teaches the client that gold medications: a. achieve the desired effect in 1 to 2 months. b. achieve the desired effect in 3 to 4 months. c. alleviate symptoms immediately. d. are effective within 7 days of therapy.

a. with fluid or food. Ibuprofen may cause gastric irritation, so food or fluid will decrease this effect.

A client is ordered to receive ibuprofen (Motrin) for dysmenorrhea. The highest priority instruction that the nurse should give the client is to take the drug: a. with fluid or food. b. on an empty stomach. c. upon arising. d. nightly before sleep.

b. decreased. Tetracycline decreases the effectiveness of oral contraceptives.

A client is ordered to receive tetracycline. The client reports that she is using oral contraceptives. The nurse's recommendations are based on the fact that when tetracycline is taken with an oral contraceptive, the desired action of the oral contraceptive is: a. increased. b. decreased. c. affected in an unpredictable way. d. nullified.

b. Decreased Sulfonamides can increase the anticoagulant effects of warfarin.

A client is ordered to take the anticoagulant warfarin (Coumadin) with co-trimoxazole (Bactrim, Septra). Based on the interaction of the drugs, the client's warfarin level should be monitored and the dose may need to be adjusted in which way? a. Increased b. Decreased c. Taken every other day d. Discontinued

d. Yellow fever A client traveling to this area is at risk for yellow fever.

A client is planning on traveling to tropical South America. The nurse counsels the client to pursue which vaccine? a. Tetanus b. Pertussis c. Polio d. Yellow fever

c. St. John's wort Opioids such as morphine sulfate may increase sedation when taken with St. John's wort.

A client is prescribed morphine sulfate for management of severe pain. The client tells the nurse that he takes several herbal preparations. Which herbal preparation will be of most concern to the nurse? a. Garlic b. Ginger c. St. John's wort d. Saw palmetto

a. Stop the infusion. Redness and pain along the vein tract may mean phlebitis. The IV infusion must be discontinued.

A client is receiving IV caspofungin (Cancidas) for a severe Candida infection. During an infusion of the dose, the nurse notes a reddened area along the vein tract, and the client complains of pain. What is the highest priority nursing intervention? a. Stop the infusion. b. Speed up the infusion. c. Administer an analgesic during the infusion. d. Elevate the infusion extremity above the heart.

d. "You'll need frequent blood counts drawn." Agranulocytosis and thrombocytopenia are potentially life-threatening adverse reactions to the medication.

A client is receiving auranofin (Ridaura). Which instruction takes priority? a. "You may have a salty taste in your mouth." b. "You may experience constipation." c. "You may experience visual changes." d. "You'll need frequent blood counts drawn."

a. Pretreat with acetaminophen (Tylenol) and meperidine (Demerol). Rigors are treated with acetaminophen and meperidine.

A client is receiving interferon. What should be the highest priority nursing intervention to prevent the client from experiencing rigors? a. Pretreat with acetaminophen (Tylenol) and meperidine (Demerol). b. Provide antiemetics before treatment and around the clock. c. Infuse IV fluids as quickly as possible and assess urine output. d. Provide analgesia every 4 hours and assess for pain.

d. Nonnarcotic analgesia and comfort measures for pain Bone pain is the most common side effect of the granulocyte colony-stimulating factors.

A client is taking G-CSF, or filgrastim (Neupogen). Which nursing interventions are indicated for the most common side effect of this medication? a. Stool softeners and a high-fiber diet for constipation b. High fluid intake and vitamin C for alkaline urine c. Acetaminophen (Tylenol) and assessment for fever d. Nonnarcotic analgesia and comfort measures for pain

b. Hepatotoxicity This medication may be hepatotoxic, and liver enzymes must be monitored.

A client is taking a high dose of azithromycin (Zithromax). The client should be monitored for which adverse reaction? a. Nephrotoxicity b. Hepatotoxicity c. Neurotoxicity d. Blood dyscrasias

a. acquired active This vaccine is acquired, rather than natural, since it is administered. It is considered active because it stimulates the body's antigen-antibody response.

A client is to receive a vaccine for measles. The vaccine includes antigens that, when added to the body, create an antibody response. This is an example of _____ immunity. a. acquired active b. acquired passive c. natural active d. natural passive

b. potassium This medication can cause significant hypomagnesemia and hypokalemia.

A client is to receive amphotericin B (Fungizone). Laboratory tests should be monitored when the client is receiving this potent antifungal drug. These tests include serum _____ levels. a. calcium b. potassium c. albumin d. glucose

c. Intravenous This medication is not absorbed well by the GI tract and therefore must be given IV.

A client is to receive amphotericin B (Fungizone). The nurse is planning care for the client based on the fact that this medication is administered via which route? a. Oral b. Intramuscular c. Intravenous d. Subcutaneous

b. Administer the solution slowly to avoid pain. Erythromycin should be given slowly when given IV to avoid pain and the development of phlebitis.

A client is to receive erythromycin intravenously. What is the highest priority nursing intervention? a. Call the physician; the drug should not be given IV. b. Administer the solution slowly to avoid pain. c. Administer the solution quickly to prevent infection. d. Call the pharmacist to verify the correct route.

c. received cytotoxic agents less than 24 hours before. The medication should not be given within 24 hours of receiving chemotherapy agents.

A client is to receive filgrastim (Neupogen) as a granulocyte-stimulating factor. The nurse recognizes that this medication should not be given when the client has: a. severe myelosuppression. b. a history of hypertension. c. received cytotoxic agents less than 24 hours before. d. a neutrophil count lower than 500.

a. peripheral edema and exertional dyspnea. Signs and symptoms of excessive fluid retention include peripheral edema and exertional dyspnea.

A client is to receive oprelvekin (Neumega). The nurse confirms that the client is experiencing fluid retention related to the medication by monitoring the client for evidence of: a. peripheral edema and exertional dyspnea. b. bradycardia and hypotension. c. restlessness and hypoxia. d. hypothermia and ventricular dysrhythmias.

c. pyelonephritis. Symptoms described are indicative of pyelonephritis.

A client presents to the emergency department with severe flank pain and foul-smelling urine. The urine culture is positive. Because of the symptoms, the nurse anticipates that the client has: a. acute renal failure. b. a lower urinary tract infection. c. pyelonephritis. d. acute cystitis.

b. "Bring all your medications into the office as soon as possible and we will ensure that they are safe to take together." The nurse must ensure that there are no drug-drug interactions before beginning aggressive therapy.

A client questions a nurse about taking antiretrovirals with other medications, which may cause drug interactions. What is the most accurate statement that the nurse can give in response? a. "Make sure you do not take your antiviral medications with any other medications." b. "Bring all your medications into the office as soon as possible and we will ensure that they are safe to take together." c. "Next time you go to your doctor, let the doctor know all the medications you are taking." d. "If you have any questions about your medications, ask your pharmacist."

c. Urinary retention A common side effect of opioid agents is urinary retention.

A client receives hydromorphone (Dilaudid) following an operative procedure. The nurse assesses the client's urine output in order to monitor for which side effect of this medication? a. Urinary tract infections b. Incontinence c. Urinary retention d. Renal failure

c. naloxone. Narcan is a opioid antagonist used with overdose or oversedation caused by opioids.

A client requires an opioid antagonist after receiving an overdose of an opioid agent. The nurse anticipates that the client will be ordered: a. pentazocine. b. ibuprofen. c. naloxone. d. probenecid.

a. Intense abdominal pain ASA may cause gastric irritation and lead to ulceration. Abdominal pain may indicate this and may be a medical emergency.

A client takes aspirin regularly to deal with the pain of arthritis. Which symptom may be indicative of a serious side effect of the medication? a. Intense abdominal pain b. Frequent constipation c. Excessive perspiration d. Excessive fatigue

b. B6 INH impairs vitamin B6 absorption, so vitamin B6 is supplemented to treat and prevent peripheral neuropathy.

A client taking isoniazid (INH) complains of "pins and needles" in her fingertips. The nurse would recommend vitamin _____ to treat this neuropathy. a. C b. B6 c. D d. B12

b. administer the medication and carefully observe for allergic reaction. There is a cross-sensitivity between penicillin and cephalosporin medications. The nurse should observe for allergic reactions.

A client who reports an allergy to penicillin is ordered to receive cephalexin (Keflex). The correct action for the nurse is to: a. administer the medication as ordered with additional fluids. b. administer the medication and carefully observe for allergic reaction. c. call the physician to change the order because of the allergy history. d. administer another antibiotic after consulting the pharmacist.

d. serum blood glucose level. Interaction of these two medications may lead to hypoglycemia.

A client who takes oral hypoglycemics for type 2 diabetes mellitus is diagnosed with a severe infection and is ordered to receive levofloxacin (Levaquin). Based on the interaction of the medications, the highest priority nursing intervention is to frequently assess: a. complete blood count. b. BUN and creatinine levels. c. liver enzymes. d. serum blood glucose level.

b. Resistance Resistance is a problem with the NNRTIs; therefore combination therapy is indicated.

A client with HIV is treated with the nonnucleoside reverse transcriptase inhibitor (NNRTI) efavirenz (Sustiva). The nurse is aware that other agents may be used because of which significant problem with NNRTIs? a. Alopecia b. Resistance c. Coma d. Hepatic dysfunction

c. Trimethoprim prevents bacterial resistance to sulfamethoxazole. Use of sulfonamides leads to bacterial resistance. The trimethoprim prevents this.

A client with a UTI is ordered to receive trimethoprim-sulfamethoxazole, also known as co-trimoxazole (Bactrim, Septra). The nurse is aware that Bactrim is a combination of two drugs. What is the purpose of this combination? a. It decreases the response against disease-producing organisms. b. The two drugs have an antagonistic drug effect. c. Trimethoprim prevents bacterial resistance to sulfamethoxazole. d. It prevents toxic drug effects.

b. take daily vitamin C. Vitamin C produces acidic urine, which enhances the function of this medication.

A client with a urinary tract infection is ordered to receive methenamine (Mandelamine). The nurse knows that this medication works best when the urine pH is less than 5.5. The nurse would recommend that the client: a. maintain a low-residue diet. b. take daily vitamin C. c. eat a high-protein diet. d. drink milk each day.

c. Side effects such as nausea, vomiting, and diarrhea must be reported. The drug can produce gastrointestinal disturbances in the client receiving treatment.

A client with a urinary tract infection is ordered to receive phenazopyridine hydrochloride (Pyridium) as a urinary analgesic. What information will client teaching include? a. The medication has a high rate of adverse reactions. b. Discolored urine is evidence of an anaphylactic reaction. c. Side effects such as nausea, vomiting, and diarrhea must be reported. d. The medication will prevent future urinary tract infections.

c. Acyclovir (Zovirax) Acyclovir is given to prevent herpetic infections.

A client with a very low T4 count is placed on several medications to prevent infections. The nurse instructs the client to expect to be placed on which medication as a prophylactic agent to prevent herpes simplex? a. Ciprofloxacin (Cipro) b. Fluconazole (Diflucan) c. Acyclovir (Zovirax) d. Pentamidine (Nebupent)

c. Stop the infusion. This is extravasation produced by a vesicant drug. The infusion should be stopped.

A client with cancer is being treated with medication via intravenous therapy. The client is noted to have swelling at the IV site, pain at the IV site, and cool and pale skin. What is the highest priority nursing intervention? a. Consult the pharmacist. b. Increase the rate of the infusion. c. Stop the infusion. d. Administer pain medication.

a. decreased white blood cell The decrease in white blood cell count reduces the body's defenses to infection.

A client with cancer is on chemotherapy and neutropenic precautions. This is a priority intervention because clients taking anticancer drugs are susceptible to infections resulting from a(n) _____ count. a. decreased white blood cell b. increased white blood cell c. decreased platelet d. decreased red blood cell

b. crackers. Eating crackers is known to relieve nausea.

A client with cancer is taking an antimetabolite. The client complains of nausea. The nurse may suggest taking the drug with: a. milk. b. crackers. c. yogurt. d. a full meal.

b. hyperglycemia. An adverse reaction with the protease inhibitors is hyperglycemia and the development of diabetes mellitus.

A client with clinical AIDS is treated with a protease inhibitor. The highest priority nursing intervention based on this medication is to monitor for incidence of: a. hepatic steatosis. b. hyperglycemia. c. urinary retention. d. coma.

a. Notify the healthcare provider that the client is allergic to penicillin. Any medication allergy should be reported to the healthcare provider.

A client with otitis media is ordered to receive amoxicillin (Amoxil). The client discloses to the nurse that she is allergic to penicillin. What is the highest priority action on the part of the nurse? a. Notify the healthcare provider that the client is allergic to penicillin. b. Encourage the client to take the dose under close monitoring. c. Administer half of the amoxicillin dose under supervision. d. Report the amoxicillin order to the supervisor.

a. Elevated temperature and a sore throat TNF may cause immunosuppression and increased risk for infection.

A client with rheumatoid arthritis is ordered to receive tumor necrosis factor (TNF) as treatment for symptoms. Which manifestations are of most concern to the nurse? a. Elevated temperature and a sore throat b. Decreased range of motion and crepitation c. Constipation and abdominal pain d. Poor skin turgor and increased urine specific gravity

c. in the morning before breakfast. An early morning sputum sample is easier to obtain and will not be contaminated with food.

A client with tuberculosis is being monitored via periodic sputum testing. To obtain acid-fast bacilli, the nurse should plan to obtain the sputum specimen: a. in the evening after dinner. b. before sleep. c. in the morning before breakfast. d. before lunch and before the evening meal.

b. increased hypoglycemic response. Co-trimoxazole has hypoglycemic actions.

A client with type 2 diabetes is treated with a sulfonylurea agent. The client is diagnosed with a urinary tract infection and is ordered to receive co-trimoxazole (Bactrim, Septra). The nurse should evaluate for a(n): a. increased hyperglycemic response. b. increased hypoglycemic response. c. decreased action of the sulfonamide drug. d. prolonged action of the sulfonamide drug.

d. Drug toxicity High peak levels may indicate that the medication is above the toxic level.

A client's medication warrants peak and trough levels to be drawn. The nurse is aware that if the peak level of the drug is too high, what could occur? a. Mild side effects b. Inadequate drug action c. Slow onset of drug action d. Drug toxicity

c. Erythromycin (E-Mycin) When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

c. Report a possible superinfection to the provider. Superinfection can occur with a secondary infection. Vaginal itching and discharge is a sign of superinfection. This is not symptomatic of pregnancy. These are not common side effects and do not indicate a hematologic reaction.

A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action? a. Ask the patient if she might be pregnant. b. Reassure the patient that this is a normal side effect. c. Report a possible superinfection to the provider. d. Suspect that the patient is having a hematologic reaction.

d. Use a backup method of contraception if taking oral contraceptives. The desired action of oral contraceptives can be lessened when taken with tetracyclines, so patients taking oral contraceptives should be advised to use a backup contraception method while taking tetracyclines. Nausea and vomiting are common adverse effects. Doxycycline should not be taken with dairy products. Tetracycline may cause teratogenic effects.

A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication? a. Nausea and vomiting are uncommon adverse effects. b. The drug may cause possible teratogenic effects. c. Increase intake of dairy products with each dose of this medication. d. Use a backup method of contraception if taking oral contraceptives.

c. Instruct women to take NSAIDs during heavy menstrual flow for pain. NSAIDs may increase the client's bleeding time, which may increase bleeding time during menstrual periods.

A group of clients cared for by the nurse is ordered to take NSAIDs. Which client instruction would the nurse question? a. Instruct the client not to take aspirin and other NSAIDs together. b. Instruct the client to take NSAIDs with meals or 8 ounces of fluid. c. Instruct women to take NSAIDs during heavy menstrual flow for pain. d. Instruct the client to avoid alcohol when taking NSAIDs.

d. use condoms for up to seven days after Condoms should be used for up to 7 days after receiving the drugs to prevent endangering the client's sexual partner.

A male client is receiving chemotherapy and is concerned about endangering his female sexual partner while he is receiving the drugs. The nurse's highest priority instruction to this client is to __________ receiving the drugs. a. continue to use his preferred method of birth control while b. abstain from sexual activity for 7 days after c. use a second form of birth control while d. use condoms for up to seven days after

b. Prostatitis In a male patient, a lower UTI is most likely prostatitis with symptoms similar to cystitis.

A male patient reports urinary urgency and pain with burning on urination. The nurse understands that this patient will be treated for which condition? a. Cystitis b. Prostatitis c. Pyelonephritis d. Urethritis

ANS: B, E, F, G b. Heart rate of 80 beats/minute e. Absence of facial grimacing f. Verbalization of pain relief g. Ability to take deep breaths These indicate relief of pain and represent normal vital and objective signs.

A nurse has administered 8.0 mg morphine sulfate to an adult client in severe pain. What would the nurse evaluate as positive outcomes of this intervention? (Select all that apply.) a. Respiratory rate of 6 breaths/min b. Heart rate of 80 beats/minute c. Blood pressure 180/110 mm Hg d. Restlessness e. Absence of facial grimacing f. Verbalization of pain relief g. Ability to take deep breaths

b. immediately after meals. Taking this medication with meals will decrease GI upset.

A nurse instructs a client that gastrointestinal (GI) upset is a common side effect of anthelmintics. To avoid GI distress, the client should take the anthelmintic: a. between meals. b. immediately after meals. c. before breakfast and at bedtime. d. before lunch without milk products.

c. 2145 This is the time that an intravenous dosage of Garamycin would reach its peak level.

A nurse is administering gentamicin (Garamycin) intravenously to a client. The drug is due to be administered at 2100. The nurse should anticipate that the peak level will be drawn at which time? a. 2030 b. 2100 c. 2145 d. 2330

a. Constipation and pruritus Constipation and pruritus are known to occur with morphine use and should be assessed in patients.

A nurse is assessing a postoperative client who received morphine sulfate for severe pain 1 hour ago. What common side effects are associated with this medication? a. Constipation and pruritus b. Diarrhea and lethargy c. Tachycardia and hypertension d. Coughing and wheezing

d. Increasing fluid intake Crystalluria and kidney stones may occur related to these medications. A brisk urine flow decreases sedimentation. There is no need for this medication to be IV.

A nurse is aware that crystalluria is a common problem with sulfonamides. What is a nursing intervention to prevent this problem? a. Intravenous therapy b. Giving the medication in the morning c. Increasing intake of calcium d. Increasing fluid intake

d. Rash and pruritus These are some of the many potential side effects of this medication.

A nurse is monitoring for the side effects of acyclovir (Zovirax). The nurse anticipates that the client may experience what side effect? a. Hepatotoxicity b. High blood pressure c. Increased intracranial pressure d. Rash and pruritus

a. narrow therapeutic index. Medications with a narrow therapeutic index have a limited range between the therapeutic dose and the lethal dose.

A nurse is ordered to draw blood levels for a person receiving an antibiotic. The nurse is aware that peaks and troughs of serum antibiotic levels are monitored for drugs with a: a. narrow therapeutic index. b. large therapeutic index. c. long half-life. d. short half-life.

a. Monitoring respiratory rate Assessing respiratory rate is a priority with medications that may cause respiratory depression.

A nurse is planning the care of a client receiving opioid analgesia. What is considered a priority in planning this care? a. Monitoring respiratory rate b. Listening for adventitious breath sounds c. Assessing for speed of pupillary reaction d. Increasing the IV fluid flow rate

b. maintaining adequate fluid intake. Patients must be well hydrated to avoid nephrotoxicity.

A nurse is providing discharge instructions to a client who is taking an antiviral agent. Client teaching associated with antiviral drug therapy includes: a. reporting an increase in urine output. b. maintaining adequate fluid intake. c. decreasing sexual relations with or without the use of a condom. d. reporting any side effects such as sexual dysfunction, dyspnea, and flushing.

b. a combination of antimalarial drugs. Malaria may become resistant to single agents and respond to multiple agents.

A nurse is providing instruction to a client who asked about ways to prevent drug-resistant malaria from occurring. The nurse should suggest: a. the newest and most potent antimalarial drug. b. a combination of antimalarial drugs. c. the tetracycline group of antibiotics. d. the antimalarial drug early after diagnosis of malaria.

c. significant cost of treatment. These medications are very expensive and are often not covered by insurance.

A nurse is providing patient education about targeted cancer therapy. The nurse recognizes that the greatest disadvantage of this treatment is: a. lack of effectiveness. b. lack of research related to therapies. c. significant cost of treatment. d. extensive side effects and adverse reactions.

b. with meals. GI upset is a classic side effect of the NSAIDs; therefore the medication should be taken with meals.

A nurse is teaching a client who has been prescribed NSAIDs for osteoarthritis. The nurse instructs the client that the best time to take the medication will be: a. upon rising. b. with meals. c. on an empty stomach. d. at bedtime.

a. The varicella vaccine is contraindicated for pregnant women. The varicella and rubella vaccines are contraindicated. The influenza vaccine is allowed for clients who need it (with asthma). The pneumococcal vaccine should be given to women with asthma or other chronic illness.

A nurse is teaching a young pregnant woman about vaccines. Which statement is true about vaccines for pregnant women? a. The varicella vaccine is contraindicated for pregnant women. b. The rubella vaccine is allowed for pregnant women. c. The pneumococcal vaccine is contraindicated only for women with asthma. d. The influenza vaccine is contraindicated for pregnant women.

ANS: A, B, D a. Child who is experiencing pain from an injury b. Child who has influenza-like symptoms d. Child who has inflammation from an injury Use of ASA following a viral infection has been related to Reye's syndrome and is therefore contraindicated in children.

A nurse is working on a pediatric unit. Which clients on the unit will be candidates for treatment with aspirin? (Select all that apply.) a. Child who is experiencing pain from an injury b. Child who has influenza-like symptoms c. Child who is exhibiting fever d. Child who has inflammation from an injury

c. Start 4 weeks of antiretroviral therapy. Postexposure prophylaxis consists of 4 weeks of antiretroviral therapy.

A nurse sustains a needlestick injury and is exposed to an HIV-positive patient's blood. What is the highest priority action for the nurse? a. Wait for appearance of symptoms to receive treatment. b. Begin triple antibiotic therapy to prevent symptoms. c. Start 4 weeks of antiretroviral therapy. d. Start 10 days to 2 weeks of antibiotic therapy.

b. Amantadine HCl (Symmetrel) The primary use for amantadine is prophylaxis against influenza A. Acyclovir is used to treat herpes virus. Oseltamivir phosphate (Tamiflu) is to be taken once flu symptoms appear.

A nurse whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Influenza vaccine d. Oseltamivir phosphate (Tamiflu)

b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways.

A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs a. exert direct actions to cause relaxation of smooth muscle. b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. c. interfere with neuronal pathways associated with prostaglandin action. d. suppress prostaglandin activity by blocking tissue receptor sites.

a. converts arachidonic acid into a chemical mediator for inflammation. COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins.

A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability. c. irritates the gastric mucosa to cause gastrointestinal upset. d. releases prostaglandins, which cause inflammation and pain in tissues.

c. Rimantadine HCl (Flumadine) Rimantadine is used for treatment of influenza. Amantadine is used primarily for prophylaxis, and this patient already has symptoms. The influenza vaccine may be given later to protect against other strains. Over-the-counter medications may be used as adjunct treatment.

A patient calls the clinic in November to report a temperature of 103° F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication? a. Amantadine HCl (Symmetrel) b. Influenza vaccine c. Rimantadine HCl (Flumadine) d. An over-the-counter drug for symptomatic treatment

a. a complete blood count and serum iron levels. If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.

A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. The nurse reviews the patient's chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for a. a complete blood count and serum iron levels. b. an increased dose of the erythropoietin-stimulating agent. c. more frequent dosing of the ESA. d. packed red blood cell infusions.

a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests Cefazolin will produce an increase in the patient's BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient's nurse monitor closely? a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests b. Complete blood count and electrolytes c. Serum calcium and magnesium d. Serum glucose and lipids

a. a broad-spectrum antibiotic. Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.

A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic. c. multiple antibiotics. d. the pneumococcal vaccine.

b. Ethambutol (Myambutol) If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid? a. Ciprofloxacin (Cipro) b. Ethambutol (Myambutol) c. Kanamycin d. Streptomycin sulfate

b. "Take the medication with food." Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.

A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication? a. "Take the medicine twice daily." b. "Take the medication with food." c. "You may consume small amounts of alcohol." d. "You will not need lab tests while taking this drug."

c. 48 hours Neuraminidase inhibitors, such as zanamivir and oseltamivir, should be taken within 48 hours of onset of symptoms for best effect.

A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms? a. 12 hours b. 24 hours c. 48 hours d. 72 hours

c. Erythromycin (E-Mycin) Erythromycin is the drug of choice for treating mycoplasma pneumonia.

A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

c. Griseofulvin (Fulvicin) Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.

A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient? a. Anidulafungin (Eraxis) b. Fluconazole (Diflucan) c. Griseofulvin (Fulvicin) d. Ketoconazole (Nizoral)

a. prevent blood vessel growth in cancer tumors. The primary action of the medication is to prevent blood vessel growth in cancer tumors.

A patient is ordered to receive an angiogenesis inhibitor called bevacizumab (Avastin). During a client teaching session, the nurse instructs the patient that the primary function of this medication is to: a. prevent blood vessel growth in cancer tumors. b. inhibit DNA replication in cancer cells. c. treat opportunistic infections. d. suppress inflammatory tumor growth.

a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel For malaria prophylaxis, chloroquine is given 500 mg/dose weekly for 2 weeks prior to travel and then weekly until 6 to 8 weeks after exposure. The dosing schedule of 1000 mg once, followed by 500 mg in 6, 24, and 48 hours is used to treat acute malaria.

A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule? a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel b. 1000 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel c. 500 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours d. 1000 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours

d. IM polysaccharide for both patients While the live, oral vaccine may be given to patients older than 6 years, each capsule must be taken 48 hours apart with the last capsule given 1 week prior to travel. There would not be enough time to complete the regimen since the patients leave in 10 days. Children under age 6 cannot receive the oral vaccine

A patient is preparing to travel with a 4-year-old child to India in 10 days and is in the clinic to receive typhoid vaccines. Which vaccines will be given to the parent and child? a. Four capsules of live, oral vaccine to both patients b. Four capsules of live, oral vaccine for the parent and the IM polysaccharide vaccine for the child c. Four capsules of live, oral vaccine for the child and the IM polysaccharide vaccine for the parent d. IM polysaccharide for both patients

d. Shortness of breath and wheezing Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.

A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for? a. Hypotension and visual disturbances b. Pain and blistering at the IV site c. Pink to red urine d. Shortness of breath and wheezing

c. Report a potentially life-threatening event. Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.

A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports abdominal pain in the left upper quadrant. The nurse will perform which action? a. Administer acetaminophen 650 mg. b. Administer an antiemetic medication. c. Report a potentially life-threatening event. d. Request an order for cardiac enzyme levels.

a. Administer acetaminophen (Tylenol). The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given for nausea caused by interferon alpha. It is not necessary to obtain laboratory work when these symptoms initially occur.

A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102° F. The nurse will notify the provider of the temperature and will anticipate which order? a. Administer acetaminophen (Tylenol). b. Change to intravenous interferon alpha. c. Give diphenhydramine (Benadryl). d. Obtain a serum BUN and creatinine level.

b. slow, planned death of cancer Apoptosis refers to the slow, planned death of cancer cells.

A patient is receiving targeted therapy for cancer and is told about apoptosis. The nurse explains that apoptosis refers to ________ cells. a. duplication of cancer b. slow, planned death of cancer c. increase in the replication of normal d. decrease in the blood flow to cancer

b. Cardiotoxicity Cardiotoxicity is a known adverse effect of this drug and is manifested in shortness of breath, edema, and palpitations.

A patient is receiving the antitumor antibiotic doxorubicin (Adriamycin) to treat lung cancer. The patient is experiencing shortness of breath and palpitations. The nurse is concerned that the patient has developed which condition? a. Anemia b. Cardiotoxicity c. Hypersensitivity d. Pulmonary infection

c. Hemoglobin > 12 g/dL There is an increased risk of death and serious cardiovascular events when the hemoglobin is greater than 12 g/dL. There is no need to notify the provider of the other findings.

A patient is receiving the erythropoietin-stimulating agent epoietin alfa (Procrit). Which assessment finding would cause the nurse to notify the patient's provider? a. Blood pressure of 90/65 mm Hg b. Headache and nausea c. Hemoglobin > 12 g/dL d. Infiltration of the IV

c. Enteric-coated aspirin Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors.

A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient's provider to discuss changing from aspirin to which drug? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Nabumetone (Relafen)

c. "I should report visual changes immediately." Patients taking chloroquine (Aralen) have a risk of visual injury related to side effects of blurred vision and should report visual changes to the provider. There is no restriction on alcohol. Patient should report urine output of less than 600 mL/day, and patients should take the drug with food.

A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication? a. "I should abstain from alcohol while taking this medication." b. "I should report urine output less than 1000 mL/day." c. "I should report visual changes immediately." d. "I should take this drug on an empty stomach."

a. Counsel the patient to discuss a prescription NSAID with the provider. The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.

A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? a. Counsel the patient to discuss a prescription NSAID with the provider. b. Recommend adding aspirin to increase the antiinflammatory effect. c. Suggest asking the provider about a short course of corticosteroids. d. Tell the patient to increase the dose to 800 mg every 4 hours.

c. Monitor vital signs when getting out of bed. This medication may cause hypotension, so the nurse should assess vital signs with position changes.

A patient receives nalbuphine (Nubain) for intense pain related to a fracture. Which nursing intervention is an important part of the plan of care 1 hour after administration of this medication? a. Strain all urine. b. Elevate the head of the bed. c. Monitor vital signs when getting out of bed. d. Infuse IV fluid at a rapid rate.

c. Reassure the patient that these side effects are reversible. Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.

A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action? a. Discontinue the medication immediately. b. Inform the family that these symptoms may persist for years. c. Reassure the patient that these side effects are reversible. d. Request an order for lorazepam.

a. Complete blood count with differential A sore throat can indicate a life-threatening anemia, so a complete blood count with differential should be ordered.

A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)? a. Complete blood count with differential b. Throat culture c. Urinalysis d. Coagulation studies

c. Posaconazole (Noxafil) Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections.

A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient? a. Metronidazole (Flagyl) b. Micafungin (Mycamine) c. Posaconazole (Noxafil) d. Voriconazole (Vfend)

c. reduce viral resistance. Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.

A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to a. avoid development of psychiatric comorbidities. b. prevent dizziness, sedation, and nightmares. c. reduce viral resistance. d. prevent severe rash and hepatotoxicity.

a. significant HER2 receptors. Trastuzamab acts by binding to the HER2 protein on the surface of cancer cells that overexpress this receptor. If patients do not have this overexpression, this targeted therapy will not work. Gefitinib is used when EGFR-TK are present. Bevacizumab is used when VGEF proteins are present.

A patient who has breast cancer tells the nurse that a cousin who had breast cancer received trastuzamab (Herceptin) and wonders why this drug is not given to her. The nurse will explain that her cancer cells do not have a. significant HER2 receptors. b. epidermal growth factor receptor-tyrosine kinase. c. the BRCA1 suppressor gene. d. VGEF proteins.

b. "Two agents used together can have synergistic effects." Using two or more chemotherapeutic agents can have a synergistic effect. Combination therapy typically uses two drugs with different dose-limiting toxicities, but the use of more than one drug does not allow for using less toxic doses. Combination therapy allows cell kill in all phases of the cell cycle. Combination therapy does not shorten the length of time chemotherapy is needed.

A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct? a. "The drugs may be given in less toxic doses if two drugs are used." b. "Two agents used together can have synergistic effects." c. "Use of two drugs will increase tumorcidal activity in the G0 phase of the cell." d. "Using two agents will shorten the length of time chemotherapy is needed."

a. "This drug allows higher doses of chemotherapy." Colony-stimulating factors permit the delivery of higher doses of drugs because they counter myelosuppression. They do not have antitumor activity, cytotoxic effects, or antiviral effects.

A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of this drug's action with which statement? a. "This drug allows higher doses of chemotherapy." b. "This drug has antitumor activity." c. "This drug has cytotoxic effects." d. "This drug has antiviral effects."

b. a TB skin test. Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.

A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss a. a chest x-ray. b. a TB skin test. c. liver function tests (LFTs). d. prophylactic antitubercular drugs.

b. it may be another month before this test is negative. The goal is for the patient's sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.

A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks.

d. "Swish the liquid in your mouth and then swallow after a few minutes." Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water.

A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient? a. "Coat the buccal mucosa with the drug and then rinse your mouth." b. "Gargle with the nystatin and then spit it out without swallowing." c. "Mix the suspension with 4 ounces of water and then drink it." d. "Swish the liquid in your mouth and then swallow after a few minutes."

a. "It may take several weeks to achieve therapeutic effects." OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen.

A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient? a. "It may take several weeks to achieve therapeutic effects." b. "Unlike aspirin, there is no increased risk of bleeding with ibuprofen." c. "Take ibuprofen twice daily for maximum analgesic benefit." d. "Combine ibuprofen with acetaminophen for best effect."

d. "The drug provides symptomatic relief of pain." Phenazopyridine is used to provide symptomatic pain relief. It may be taken with antibiotics. Reddish-brown urine is a harmless side effect. It does not have antiseptic properties.

A patient who has pain with urination associated with cystitis will be discharged home with a prescription for phenazopyridine (Pyridium). What instruction will the nurse include when teaching the patient about this drug? a. "Do not take this drug concurrently with an antibiotic." b. "Report reddish-brown urine to the provider immediately." c. "This drug has antiseptic and analgesic properties." d. "The drug provides symptomatic relief of pain."

d. Treating an underlying opportunistic infection IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order? a. Administration of a high dose of corticosteroids b. Changing the regimen to a single antiretroviral drug c. Temporarily discontinuing the antiretroviral therapy d. Treating an underlying opportunistic infection

a. Erythrocytic phase The erythrocytic phase of malarial infection occurs when the parasite invades the red blood cells and is characterized by chills, fever, and sweating.

A patient who has travelled to an area with prevalent malaria has chills, fever, and diaphoresis. The nurse recognizes this as which phase of malarial infection? a. Erythrocytic phase b. Incubation phase c. Prodromal phase d. Tissue phase

c. drug resistance. Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of a. disease relapse. b. drug hypersensitivity reactions. c. drug resistance. d. drug adverse effects.

a. It can result in adverse effects on her fetus. Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reye's syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution.

A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? a. It can result in adverse effects on her fetus. b. It causes an increased risk of Reye's syndrome. c. It increases hemorrhage risk. d. It will cause increased gastrointestinal distress.

a. allows decreasing the dosing from 3 times daily to twice daily. Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir a. allows decreasing the dosing from 3 times daily to twice daily. b. can lead to increased cholesterol and triglycerides. c. may worsen insulin resistance. d. will require increased dietary restrictions.

b. Notify the provider to discuss single-dose NRTI products. Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily. Increasing fluid intake will not affect this patient's symptoms.

A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient's creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action? a. Instruct the patient to take the medication 60 minutes prior to meals. b. Notify the provider to discuss single-dose NRTI products. c. Request an order for once-daily dosing of this medication. d. Suggest that the patient increase fluid intake.

a. A week to 10 days after each chemotherapy dose Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.

A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point? a. A week to 10 days after each chemotherapy dose b. During the week immediately after chemotherapy c. Immediately prior to each dose of chemotherapy d. When the patient's temperature is elevated by 1° F

a. acute retroviral syndrome. Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection.

b. Hold the dose and notify the provider. For patients receiving cancer chemotherapy, erythropoietin-stimulating agents should not be initiated at a hemoglobin level greater than or equal to 10 g/dL.

A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patient's chart and notes a hemoglobin level of 10.1 g/dL. The nurse will perform which action? a. Administer the medication as ordered. b. Hold the dose and notify the provider. c. Reduce the dose by 25%. d. Request an order for an increased dose.

b. prevent gingival hyperplasia. Good oral care can prevent gingival hyperplasia in patients with HSV-1.

A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to a. minimize transmission of disease. b. prevent gingival hyperplasia. c. reduce viral resistance to the drug. d. shorten the duration of drug therapy.

c. inhibits both COX-1 and COX-2. Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.

A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. is an acidic compound.

d. Taking pyridoxine (B6) Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.

A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (B6)

b. Reassure the patient that this is a harmless effect. Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.

A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take? a. Obtain an order for BUN and creatinine levels. b. Reassure the patient that this is a harmless effect. c. Request an order for a urinalysis. d. Test her urine for occult blood.

a. Notify the patient's provider of this adverse reaction. The nurse should notify the provider if the patient reports these symptoms, since they may indicate erythrodysesthesia. Reassuring the patient or recommending OTC treatments is not indicated.

A patient who is taking the tyrosine kinase inhibitor sunitinib (Sutent) calls to report red, painful, and swollen palms and soles of feet. The nurse will perform which action? a. Notify the patient's provider of this adverse reaction. b. Reassure the patient that these are common side effects. c. Recommend taking acetaminophen for discomfort. d. Suggest taking diphenhydramine to help with the swelling.

c. Stop taking TMP-SMX immediately. A rash can indicate a serious drug reaction. Patients should stop taking the drug immediately and notify the provider.

A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action? a. Increase fluid intake. b. Take diphenhydramine. c. Stop taking TMP-SMX immediately. d. Continue taking the medication.

d. Glucose Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.

A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient? a. Blood urea nitrogen (BUN) and creatinine b. Electrolytes c. Fluconazole levels d. Glucose

a. Assess the patient for tinnitus. Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reye's syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.

A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for tinnitus. b. Monitor the patient for signs of Reye's syndrome. c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose.

d. Offer written and verbal information about each drug's purpose. Patients often are more motivated to adhere to a drug regimen if they understand the purpose of the medications. Patients should be encouraged to take responsibility for their medications. Side effects need to be discussed so patients can plan ways to manage these before they occur.

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take? a. Ask the patient's family members to administer the medications. b. Avoid discussing adverse effects to prevent focus on negative aspects of ART. c. Give a detailed list of medications and stress the need to adhere to the schedule. d. Offer written and verbal information about each drug's purpose.

b. decrease bacterial resistance. The combination drug is used to decrease bacterial resistance to sulfonamides. It does not broaden the spectrum, improve the taste, or decrease toxicity.

A patient who will begin taking trimethoprim-sulfamethoxazole (TMP-SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to a. broaden the antibacterial spectrum. b. decrease bacterial resistance. c. improve the taste. d. minimize toxic effects.

d. Urinary retention Urinary retention should be reported to the provider. Dry mouth, fatigue, and increased heart rate are side effects, but they do not necessarily warrant reporting immediately. Urinary retention is more serious.

A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately? a. Dry mouth b. Fatigue c. Increased heart rate d. Urinary retention

d. Acidic fruits and juices Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.

A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods? a. Green leafy vegetables b. Beef and other red meat c. Coffee, tea, and colas d. Acidic fruits and juices

b. Blood urea nitrogen (BUN) and creatinine Streptomycin can cause significant renal toxicity.

A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patient's medical record? a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose

a. Consume a low-cholesterol diet. Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes? a. Consume a low-cholesterol diet. b. Consume more acidic foods. c. Take the pill on an empty stomach. d. Take the pill with fatty foods.

c. commonly have gastrointestinal (GI) side effects. Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea, and cramps. Adverse reactions do not occur frequently.

A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs a. can cause hepatic toxicity. b. cause orthostatic hypotension. c. commonly have gastrointestinal (GI) side effects. d. have many serious adverse reactions.

b. The patient is progressing as expected. The treatment goal would be a VL of < 20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.

A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Today's lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patient's results? a. A drug-resistant strain is likely. b. The patient is progressing as expected. c. The patient's treatment goals have been met. d. Treatment failure has occurred.

b. significantly decreased. INH is known to decrease the effectiveness of phenytoin.

A patient with a seizure disorder is exposed to a person with tuberculosis. The patient is taking phenytoin (Dilantin) and prophylactic isoniazid (INH). Based on the interaction of the medications, the nurse anticipates that the effect of phenytoin will be: a. significantly increased. b. significantly decreased. c. slightly increased. d. negated completely.

b. an indication of expansion of bone marrow. Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.

A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as a. a sign of cancer metastasis. b. an indication of expansion of bone marrow. c. caused by osteomyelitis. d. worsening neutropenia.

a. assessing for proteinuria. Proteinuria is a sign of nephrotic syndrome in which the basement membranes of the nephrons have increased permeability, allowing protein to escape.

A patient with colon cancer is being treated with bevacizumab (Avastin). The nurse monitors for nephrotic syndrome, a known side effect of this medication, by: a. assessing for proteinuria. b. frequently taking vital signs. c. maintaining strict intake and output. d. assessing for dehydration.

a. Buprenorphine (Buprenex) Buprenorphine is an opioid agonist-antagonist analgesic and was developed to help decrease opioid abuse. Butophanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs.

A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient? a. Buprenorphine (Buprenex) b. Butorphanol tartrate (Stadol) c. Naloxone (Narcan) d. Pentazocine (Talwin)

c. Lamivudine/zidovudine (Combivir) Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.

A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patient's provider to order? a. Abacavir/lamivudine/zidovudine (Trizivir) b. Efavirenz/emtricitabine/tenofovir (Atripla) c. Lamivudine/zidovudine (Combivir) d. Rilpivirine/emtricitabine/tenofovir (Complera)

b. Zidovudine (AZT) Zidovudine is effective for preventing vertical transmission of HIV.

A pregnant woman who is HIV positive may transfer the HIV virus to the fetus. The nurse caring for the client anticipates that the client will receive which medication to treat potential vertical transmission of HIV? a. Acyclovir (Zovirax) b. Zidovudine (AZT) c. Isoniazid (INH) d. Ethambutol (Myambutol)

b. is more effective if given before sexual activity begins. Gardasil is most effective when the client is not yet sexually active.

A provider has ordered Gardasil to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil a. is less effective in older adolescents. b. is more effective if given before sexual activity begins. c. is more effective if given prior to the hormonal changes of puberty. d. is not effective if given after the onset of menses.

d. promote regression of her tumor. Androgen is used to treat breast cancer to promote regression of tumors. Other hormonal therapies are used in other circumstances to promote well-being.

A woman who has advanced breast cancer will begin receiving androgen therapy. The nurse will explain to the patient that androgen therapy is used to a. enhance her own estrogen production. b. give her a sense of well-being. c. minimize hot flashes. d. promote regression of her tumor.

b. Trivalent influenza vaccine The influenza vaccine is recommended for pregnant women and should be given. Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varivax is contraindicated during pregnancy.

A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? a. Gardasil vaccine b. Trivalent influenza vaccine c. MMR vaccine d. Varivax vaccine

a. Ask about alcohol consumption. Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection.

A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next? a. Ask about alcohol consumption. b. Reassure her that these are harmless side effects. c. Tell her that this signals a worsening of her infection. d. Tell her to go to the emergency department immediately.

d. Tdap Persons who work with children should receive acellular pertussis vaccine. The Tdap is given to adults. The DTaP is given to children up to age 6. The DT and Td do not contain pertussis.

A young adult patient is in the clinic to receive a tetanus vaccine after sustaining a laceration injury. The nurse learns that the patient, who works in a day care center, has not had any vaccines for more than 10 years. Which vaccine will the nurse expect to administer? a. DT b. DTaP c. Td d. Tdap

a. Schedule hearing tests and assess of urine output. Aminoglycosides are nephrotoxic and ototoxic.

A young child is diagnosed with meningitis and is prescribed an aminoglycoside. Based on the potentially toxic effects of the medication, what is the highest priority nursing intervention? a. Schedule hearing tests and assess of urine output. b. Assess urine output and bone marrow function. c. Assess renal and hepatic function. d. Assess visual acuity and color discrimination.

ANS: B, C, D, E, F, G b. Tetanus c. MMR d. PPD e. Hep B (begin series) f. IPV g. Varicella The child will not get pertussis or Hib because of advanced age. Some sources do not give MMR at the same time as PPDs because of the potential for false positives on the PPD.

An 8-year-old child enters the clinic. He has recently emigrated from another country and has received no immunizations. His parent does not believe that he has had chickenpox. Which immunizations should he receive at this visit? (Select all that apply.) a. Pertussis b. Tetanus c. MMR d. PPD e. Hep B (begin series) f. IPV g. Varicella h. Hib

c. hepatotoxicity. Tylenol is metabolized by the liver and, with extended use, may be toxic to liver tissue.

An adolescent client tells the nurse that she takes acetaminophen (Tylenol) a few times every day because of "stress headaches." The nurse advises her to see a primary healthcare provider because overuse of the medication may result in: a. nausea and anorexia. b. gastrointestinal irritation. c. hepatotoxicity. d. diaphoresis and fluid loss.

b. may increase bleeding during her period. When nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat dysmenorrhea, excess bleeding may occur during the first 2 days of a period. NSAIDs do not decrease the effect of OCPs. NSAIDs are irritating to the stomach, so patients should take with food or a full glass of water. NSAIDs will not decrease the duration of periods.

An adolescent female has dysmenorrhea associated with heavy menstrual periods. The patient's provider has recommended ibuprofen (Motrin). When teaching this patient about this drug, the nurse will tell her that ibuprofen a. may decrease the effectiveness of oral contraceptive pills. b. may increase bleeding during her period. c. should be taken on an empty stomach to increase absorption. d. will decrease the duration of her periods.

d. Lowering of tachycardia to within normal limits A lowering of the heart rate to within normal limits indicates relief of pain.

An adult client has just received morphine sulfate for severe pain. What would indicate that the pain medication was effective? a. Client lies very still in bed b. Reduction of the respiratory rate to 8 breaths per minute c. Facial grimacing and verbalization of relief of pain d. Lowering of tachycardia to within normal limits

d. Respiratory depression allows for a buildup of CO2, a vasodilator. If respiratory depression occurs, the respiratory rate may decrease, causing hypoventilation. This allows CO2 to build up, causing cerebral vasodilation and increasing intracranial pressure.

An adult client with a head injury complains of severe pain. The nurse notes that the dose of opioid is half the normal adult dose. What is the reason for this? a. Head injury patients do not experience severe pain but are disoriented. b. Respiratory depression can lead to cerebral hemorrhage. c. Opioids decrease heart rate such that the brain becomes hypoxic. d. Respiratory depression allows for a buildup of CO2, a vasodilator.

d. control of an overactive bladder. Control of an overactive bladder is the function of this medication.

An older adult client with stress incontinence is ordered to receive tolterodine tartrate (Detrol). The nurse anticipates that treatment with this medication will result in: a. decreased urination. b. decreased urinary discomfort. c. prevention of urinary tract infection. d. control of an overactive bladder.

d. Tolterodine tartrate (Detrol) Detrol is used to treat an overactive bladder. Dimethylsulfoxide (DMSO) and flavoxate (Urispas) are used to relax uterine smooth muscle. Phenazopyridine HCl (Pyridium) is used to alleviate the pain and burning sensation during urination that is experienced with chronic cystitis.

An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order? a. Dimethylsulfoxide (DMSO) b. Flavoxate (Urispas) c. Phenazopyridine HCl (Pyridium) d. Tolterodine tartrate (Detrol)

d. Wear an impermeable, disposable gown when hanging the drug. Nurses should take precautions when handling cytotoxic drugs if inhalation, ingestion, or contact with skin and mucous membranes is possible. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown. If the nurse has to prepare a solution at home, a plastic-backed pad should be used as a surface. When there is a risk of aerosol exposure, a National Institute for Occupational Safety and Health-approved respirator is necessary. Surgical masks do not provide adequate respiratory protection. Surgical scrubs are permeable.

An oncology home care nurse is preparing to administer a chemotherapeutic agent to a patient at the patient's home. What precautions will the nurse take while administering the IV chemotherapeutic agent? a. Clear a counter space for preparation of the solution. b. Don a surgical mask while administering the drug. c. Take surgical scrubs to wear during the infusion. d. Wear an impermeable, disposable gown when hanging the drug.

d. "Take the drug with food." The drug should be taken with food to avoid gastric upset.

Client teaching related to colchicine (Novocolchine) includes which instruction? a. "Take the drug on an empty stomach." b. "Keep fluid intake to no more than 1000 mL daily." c. "Take a laxative daily to prevent constipation." d. "Take the drug with food."

a. Rheumatoid arthritis and osteoarthritis NSAIDs assist with pain and inflammation. Postoperative and incisional pain should be treated with narcotics. The NSAIDs should not be used with the client who is exhibiting gastrointestinal discomfort and bleeding.

Clients with which disorders are most often responsive to the NSAID groups of medications? a. Rheumatoid arthritis and osteoarthritis b. Postoperative pain and discomfort c. Infections and incisional pain d. Gastrointestinal discomfort and bleeding

b. 8:00 AM and 8:00 PM Sulfonamides, like co-trimoxazole, are scheduled bid.

Co-trimoxazole (Bactrim, Septra) has a half-life of 8 to 12 hours. Based on this information, the nurse decides to administer the drug at which time(s) each day? a. 9:00 AM b. 8:00 AM and 8:00 PM c. 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM d. 8:00 AM, 12:00 PM, 4:00 PM, 8:00 PM, and 12:00 AM

b. above minimum effective concentration. Medication levels must be maintained above the MEC throughout therapy to ensure that bacterial resistance does not occur.

Drug concentration is important for the eradication of bacterial infection. It is desired to keep the drug dose: a. below minimum effective concentration. b. above minimum effective concentration. c. below minimum toxic level. d. above minimum toxic level.

a. Suppresses tumor growth Estrogen is given to suppress tumor growth.

Estrogen therapy is a treatment for progressive prostatic cancer and breast cancer (postmenopausal women). The nurse administers the estrogen with the awareness that what is the proposed action of estrogen? a. Suppresses tumor growth b. Kills malignant tumor cells c. Increases tumor growth d. Stimulates normal cell growth

d. Gastrointestinal upset or distress NSAIDs commonly cause gastrointestinal lining breakdown that may lead to ulceration.

In teaching a client about NSAIDs, the nurse is careful to teach about how to monitor for side effects. What side effect is of special concern? a. Tachycardia b. Polyuria c. Elevated temperature d. Gastrointestinal upset or distress

b. injection site irritation. The majority of the patients taking this medication sustain this reaction.

In teaching the client about Enfuvirtide (Fuzeon), the nurse would instruct the patient to watch for and report: a. chronic diarrhea. b. injection site irritation. c. persistent arthralgia. d. heart block.

d. toxic levels of the first drug. The indomethacin would replace the first drug, allowing more of the first medication free for active drug levels.

Indomethacin (Indocin) is highly protein bound and is ordered as a new medication for the client. The client is taking another medication that is moderately protein bound. Upon administration of both medications, the nurse should be most concerned with: a. indomethacin toxicity. b. indomethacin levels below the therapeutic level. c. an increase in medication side effects. d. toxic levels of the first drug.

a. pH of 4.8, treatment with vitamin C The acid pH of 4.8 is optimal. Treatment with vitamin C is the best way to ensure acid-ash urine.

Many of the urinary antiseptics work best with a specific urine pH. What are the optimal pH and a method to achieve this pH? a. pH of 4.8, treatment with vitamin C b. pH of 6.0, treatment with cranberry juice c. pH of 6.1, treatment with milk d. pH of 5.5, treatment with antacids

a. Blood urea nitrogen and serum creatinine Blood urea nitrogen and creatinine levels determine renal function.

Most beta-lactam antibiotics are excreted through the kidneys. The nurse should assess the client's renal function by monitoring which levels? a. Blood urea nitrogen and serum creatinine b. Creatinine phosphokinase and alkaline phosphatase c. White blood cell count and red blood cell count d. Hemoglobin and hematocrit

d. swish the liquid in the mouth and then swallow or expel the suspension. Contact with the infected lesions is ensured by the client swishing the liquid in the mouth and then swallowing or expelling the suspension.

Nystatin (Mycostatin), a polyene antifungal drug, is frequently administered as an oral suspension for Candida infection in the mouth. Client instruction regarding the administration of nystatin is to: a. dilute the oral suspension with water and then swallow the solution. b. drink the oral suspension and follow with 4 ounces of water. c. drink the oral suspension but do not follow with fluid or food. d. swish the liquid in the mouth and then swallow or expel the suspension.

d. Reassure the patient that this is a common side effect of this drug. Pruritis is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone.

One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take? a. Administer naloxone to reverse opiate overdose. b. Have resuscitation equipment available at the bedside. c. Prepare an epinephrine injection in case of an anaphylactic reaction. d. Reassure the patient that this is a common side effect of this drug.

a. Acetaminophen and diphenhydramine Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce nausea.

Prior to administration of interferon alpha, the nurse will administer which medications? a. Acetaminophen and diphenhydramine b. Heparin and meperidine c. Lorazepam and furosemide d. Narcotic analgesics and loratadine

b. is ineffective because of possible drug resistance. Multidrug therapy is more effective than single-drug therapy because of problems with drug resistance.

The client asks the nurse why more than one drug is needed to treat his TB. The most accurate response from the nurse is that single-drug therapy to treat tuberculosis: a. is effective with fewer side effects. b. is ineffective because of possible drug resistance. c. requires a short period to achieve effectiveness. d. is useful for clients with many allergies.

c. erythromycin (E-mycin, Ilotycin). Erythromycin is the drug of choice when penicillin is not an option.

The client has a hypersensitivity to penicillin. The nurse anticipates that the drug of choice for this client will be: a. cefuroxime (Ceftin, Zinacef). b. clindamycin (Cleocin). c. erythromycin (E-mycin, Ilotycin). d. gentamicin SO4 (Garamycin).

d. fluconazole. Fluconazole is a potent medication for yeast/fungal infections.

The client has been diagnosed with candidiasis (thrush). The nurse anticipates that the client will be treated with: a. co-trimoxazole. b. pyrimethamine. c. sulfamethoxazole. d. fluconazole.

a. BUN and serum creatinine Cephazolin will produce an increase in the client's BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

The client has been ordered Cefazolin. The nurse anticipates an increase in the client's _____ from this medication? a. BUN and serum creatinine b. serum potassium c. serum calcium d. serum white blood cells

b. "Increase fluid intake." The client who is being treated with Benemid should increase his fluid intake because this will promote the urinary excretion of uric acid.

The client has been ordered to be treated with Benemid. What is the highest priority instruction to give the client? a. "Take on an empty stomach." b. "Increase fluid intake." c. "Take with food." d. "Limit fluid intake."

b. with food. Kaletra should always be administered with food.

The client has been ordered to be treated with Kaletra. The nurse anticipates that the medication will be administered: a. on an empty stomach. b. with food. c. at bedtime. d. upon rising.

b. liver enzyme tests The client who is being treated with Ridaura may exhibit a slight increase in liver enzyme tests.

The client has been ordered to be treated with Ridaura. The nurse anticipates seeing an increased _____ in the client's laboratory results. a. fasting blood glucose b. liver enzyme tests c. potassium level d. calcium level

b. Decreased serum potassium Vibramycin usually causes the client to experience a decrease in the serum potassium level.

The client has been ordered to be treated with Vibramycin. What effect should the nurse anticipate seeing in the client's laboratory values? a. Increased serum potassium b. Decreased serum potassium c. Increased serum calcium d. Decreased serum calcium

d. Call the physician; this is an adverse reaction to the drug. An adverse reaction to allopurinol is the development of cataracts and retinopathy.

The client has been ordered to be treated with allopurinol. He complains to the nurse that he has noted changes in his vision. What is the most appropriate nursing intervention? a. Explain to the client that this is an expected response to the drug. b. Call the physician; this is a life-threatening response to the drug. c. Explain to the client that this is a normal side effect of the drug. d. Call the physician; this is an adverse reaction to the drug.

d. acidic fruits and juices. Acidic fruits and juices should be avoided while the client is being treated with amoxicillin.

The client has been ordered to be treated with amoxicillin. The highest priority instruction that the nurse should give the client related to diet while on the medication is to avoid: a. green leafy vegetables. b. beef and other red meat. c. coffee, tea, and colas. d. acidic fruits and juices.

a. a decreased effect of The combination of nitrofurantoin and probenecid will result in a decreased effect of both drugs.

The client has been ordered to be treated with nitrofurantoin. He is also being treated with probenecid. The nurse anticipates that the action of the two drugs will result in _____ the medication. a. a decreased effect of b. an increased effect of c. no change in the usual effect of d. an anaphylactic reaction to

a. increased; digoxin The combination of tetracycline along with digoxin may result in an increased effect of the digoxin.

The client has been ordered to be treated with tetracycline. He is also being treated with digoxin. The nurse anticipates that, based on the interaction of the two drugs, the client will experience _____ effects of the _____. a. increased; digoxin b. increased; tetracycline c. decreased; digoxin d. decreased; tetracycline

c. evidence of development of a superinfection. Development of vaginitis can be evidence of development of a superinfection.

The client has been ordered treatment with Amoxil. The client reports to the nurse that she has developed symptoms of vaginitis. The highest priority action on the part of the nurse is to recognize this as: a. an expected side effect of the medication. b. a life-threatening reaction to the drug. c. evidence of development of a superinfection. d. evidence of an anaphylactic reaction.

c. hemoglobin and hematocrit The client who is being treated with Aralen will experience a decrease in his hemoglobin and hematocrit.

The client has been ordered treatment with Aralen. The nurse expect to see decreased _____ in the client. a. serum glucose b. potassium c. hemoglobin and hematocrit d. calcium

b. Call the physician; the client is experiencing an adverse reaction to the medication. Hypotension is symptomatic of an adverse reaction to treatment with Aralen.

The client has been ordered treatment with Aralen. The nurse notes that the client's blood pressure has decreased from 130/80 to 104/60. What is the nurse's highest priority action? a. Recognize that this is an expected side effect of the medication and monitor the client. b. Call the physician; the client is experiencing an adverse reaction to the medication. c. Recognize that this is a reaction to the dosage of the medication; call the pharmacist. d. Call the physician; client is experiencing a life-threatening reaction to the medication.

b. Decreased action of the Cefaclor The interaction of Cefaclor and erythromycin will produce a decrease in the action of the Cefaclor.

The client has been ordered treatment with Cefaclor as well as erythromycin. The nurse anticipates what effect from the interaction of the medications? a. Increased action of the Cefaclor b. Decreased action of the Cefaclor c. Anaphylactic reaction to the Cefaclor d. Toxic action of the Cefaclor

b. 2 hours during the day. Denavir should be applied every 2 hours during the day.

The client has been ordered treatment with Denavir. The client should be instructed to apply the cream every: a. 8 hours around the clock. b. 2 hours during the day. c. 4 hours around the clock. d. 6 hours during the day.

d. It is an expected side effect of the medication. Insomnia is an expected side effect of treatment with Floxin.

The client has been ordered treatment with Floxin. She complains to the nurse of insomnia. What does the nurse recognize about this symptom? a. It is completely unrelated to the new medication. b. It is indicative of an adverse reaction to the medication. c. It shows that the client is achieving a toxic level. d. It is an expected side effect of the medication.

b. Decreased The dosage of the medication will be decreased when the client has renal impairment.

The client has been ordered treatment with Flumadine. The client has renal impairment. The nurse anticipates what change to the dose of medication? a. Increased b. Decreased c. Unchanged d. Held

b. to increase fluid intake to at least 2 L daily. The client who is being treated with Gantanol should increase his or her fluid intake to at least 2 L daily.

The client has been ordered treatment with Gantanol. The highest priority instruction to provide this client is: a. to take on an empty stomach. b. to increase fluid intake to at least 2 L daily. c. to take with meals. d. it may produce bloody diarrhea.

d. Administer the medication as ordered by the physician. Wycillin has a milky appearance; this appearance should not concern the nurse.

The client has been ordered treatment with Wycillin. The nurse notes that the solution is milky in color. What is the highest priority action on the part of the nurse? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

d. blood urea nitrogen (BUN) Zovirax can produce an increase in the client's BUN.

The client has been ordered treatment with Zovirax. The nurse should expect to see increased _____ in the client's laboratory levels. a. liver enzymes b. potassium c. magnesium d. blood urea nitrogen (BUN)

a. expected side effect of Brownish urine is a side effect of this medication.

The client has been ordered treatment with nitrofurantoin. She complains to the nurse of experiencing brownish, discolored urine. The nurse recognizes that this symptom indicates a(n) _____ the medication. a. expected side effect of b. adverse reaction to c. life-threatening reaction to d. anaphylactic reaction to

a. 10:45 AM Oral Zovirax peaks in 1.5-2 hours.

The client has been ordered treatment with oral Zovirax at 9:00 AM. The nurse should expect the client's serum level of the medication to peak at which time? a. 10:45 AM b. 12:30 PM c. 9:30 AM d. 2:00 PM

d. decreased urinary output. Aminoglycosides are nephrotoxic; therefore, urine output must be evaluated.

The client has been prescribed Garamycin. The highest priority nursing intervention related to a life-threatening side effect of the medication is to monitor for: a. blood pressure changes. b. decrease in pulse rate. c. nausea and vomiting. d. decreased urinary output.

c. Hold the next dose of medication and notify the physician. Aminoglycosides cause ototoxicity.

The client has been started on Garamycin. She complains to the nurse of changes in her level of hearing. What is the highest priority nursing intervention on the part of the nurse? a. Restrict fluid intake. b. Assess for paralytic ileus. c. Hold the next dose of medication and notify the physician. d. Monitor urine for sugar.

c. sausage patties with an English muffin. Sustiva is best absorbed with high-fat food, such as sausage.

The client has been started on treatment with Sustiva. To achieve maximum absorption of the drug, the client should choose a breakfast of: a. whole-wheat toast with jam. b. egg-white omelet with spinach. c. sausage patties with an English muffin. d. sliced fruit with nonfat yogurt.

b. 5 The second dose of Gardasil can be given 2 months after the first dose.

The client has received the first dose of Gardasil at age 15 years and 3 months. She safely can receive the second dose of the drug at 15 years, _____ months. a. 6 b. 5 c. 4 d. 10

a. 5 years. Ig should be delayed for 2 months after receiving the varicella vaccine.

The client has received the varicella vaccine and now requires Ig. The client is 4 years and 10 months old. The most appropriate time for the client to receive Ig is at age: a. 5 years. b. 6 years. c. 4 years 11 months. d. 5 years 2 months.

c. salicylates for 6 weeks Salicylates should be avoided for 6 weeks after receiving the varicella vaccine.

The client is an adult who has received the varicella vaccine. She has a history of arthritic-related discomfort. The most important instruction that the nurse can give this client is to avoid ________ after receiving the varicella vaccine. a. alcohol for 1 month b. dark green vegetables for 6 weeks c. salicylates for 6 weeks d. vitamin C for 1 month

d. Hold the drug and contact the physician; the drug is contraindicated. Remicade is contraindicated when the client is elderly and is experiencing cardiac arrhythmias.

The client is an older adult who has been diagnosed with cardiac arrhythmias. She has been ordered to be treated with Remicade. What should the nurse do? a. Administer the medication as ordered by the physician. b. Administer the drug after clarifying the dose with the pharmacist. c. Hold the drug and conduct the physician; the dosage should be decreased. d. Hold the drug and contact the physician; the drug is contraindicated.

d. 90 Doses of Vectibix over 1000 mg should be administered over 90 minutes.

The client is being treated with 1200 mg of Vectibix. The nurse should plan to administer the infusion over a period of _____ minutes. a. 15 b. 30 c. 60 d. 90

c. BUN and creatinine. Bactrim will produce an increase in the client's BUN and creatinine levels.

The client is being treated with Bactrim. The nurse should anticipate seeing an increase in the client's serum: a. glucose. b. potassium. c. BUN and creatinine. d. calcium.

d. morphine sulfate. Morphine sulfate should be used for severe pain.

The client is complaining of severe pain. The nurse anticipates that the client will be ordered treatment with: a. aspirin. b. acetaminophen. c. diflunisal. d. morphine sulfate.

b. increased; decreased Epoetin Alfa should cause the client to experience increase hematocrit and decreased plasma volume.

The client is being treated with Epoetin Alfa. The nurse expect to see in the client's laboratory values a(n) _____ hematocrit and a(n) _____ plasma volume. a. decreased; increased b. increased; decreased c. decreased; decreased d. increased; increased

d. Contact the physician; this is an expected side effect of the medication. Hypertension is an expected side effect of receiving the medication.

The client is being treated with Epoetin Alfa. The nurse notes that his blood pressure, which had a baseline reading of 114/82, has risen to stay consistently at 142/90 or higher. What is the highest priority action on the part of the nurse? a. Contact the physician; this is indicative of an adverse reaction to the medication. b. Contact the pharmacist; this is indicative of the drug being prepared in error. c. Contact the pharmacist; this indicates the client is experiencing an anaphylactic reaction. d. Contact the physician; this is an expected side effect of the medication.

a. stop the infusion. The infusion should be interrupted if the client begins to experience hypotension.

The client is being treated with Herceptin. The nurse notes that the client is experiencing episodes of hypotension. The highest priority nursing intervention is to: a. stop the infusion. b. increase the rate of the infusion. c. decrease the rate of the infusion. d. notify the pharmacist.

d. expected side effect of a high dose of the medication. High doses of Metronidazole may cause the client to develop reddish brown urine.

The client is being treated with Metronidazole. She complains to the nurse of experiencing reddish brown urine. The nurse interprets this finding as a(n): a. potentially life-threatening reaction to the medication. b. symptom of an anaphylactic reaction to the medication. c. sign that the medication dosage needs to be increased. d. expected side effect of a high dose of the medication.

b. decreasing the rate of the infusion. The initial infusion of the medication should be started at 50 mL/hr.

The client is being treated with Rituxan. The nurse notices that the first IV infusion of the drug has been started at a rate of 100 mL/hr. The highest priority nursing intervention is: a. increasing the rate of the infusion. b. decreasing the rate of the infusion. c. stopping the infusion completely. d. calling the physician.

c. Don gloves to administer the medication. The nurse should wear gloves if tablets of Sprycel have been broken.

The client is being treated with Sprycel. The nurse notes that the tablets have been broken. What is the highest priority nursing intervention? a. Notify the physician and hold the medication. b. Send the medication back to the pharmacy. c. Don gloves to administer the medication. d. Notify the pharmacist that tablets are broken.

a. perform oral hygiene several times daily. The client should perform oral hygiene several times daily when he is being treated with an antiviral drug.

The client is being treated with an antiviral drug. He complains to the nurse of experiencing red, swollen gums. The highest priority action on the part of the nurse is to advise the client to: a. perform oral hygiene several times daily. b. rinse his mouth with hydrogen peroxide. c. avoid using dental floss during hygiene. d. rinse his mouth with alcohol-based mouthwash.

a. liver enzymes. INH may lead to hepatotoxicity. This may be monitored by determining liver enzyme levels.

The client is being treated with isoniazid (INH). The highest priority nursing intervention is to frequently monitor: a. liver enzymes. b. red blood cell count. c. serum creatinine level. d. blood urea nitrogen level.

c. may result in hepatotoxicity developing. The combination of ketoconazole and echinacea may result in hepatotoxicity.

The client is being treated with ketoconazole. He tells the nurse that he frequently self-medicates with echinacea. The highest priority instruction that the nurse should give the client is that the combination of the two medications: a. should enhance the action of the ketoconazole. b. should diminish the action of the ketoconazole. c. may result in hepatotoxicity developing. d. may result in nephrotoxicity developing.

c. crystalluria. The combination of methenamine and a sulfonamide will result in an increased risk of crystalluria.

The client is being treated with methenamine as well as with a sulfonamide. The nurse anticipates that the interaction of these two medications will result in an increased risk of: a. pyelonephritis. b. renal failure. c. crystalluria. d. renal calculi.

b. inhibited action The combination of methenamine and sodium bicarbonate will result in an inhibited action of the methenamine.

The client is being treated with methenamine. He has been self-medicating with sodium bicarbonate as an antacid. The nurse anticipates that the interaction of these two medications will result in a(n) ____ of methenamine. a. enhanced action b. inhibited action c. toxic level d. anaphylactic reaction

a. Coordinated with meals The absorption of doxycycline and minocycline is improved with food ingestion.

The client is being treated with minocycline. The nurse anticipates what dosage schedule for the medication? a. Coordinated with meals b. Given once daily c. Given on an empty stomach d. Coordinated with bedtime

b. symptoms of UTI Treatment with nitrofurantoin should result in the client being free of signs and symptoms of UTI within 10 days.

The client is being treated with nitrofurantoin. How can the nurse determine that the drug has produced a positive outcome for the client when the client is free of _____ within 10 days. a. blood in the urine b. symptoms of UTI c. evidence of renal calculi d. flank pain

c. Call the physician; this is symptomatic of a life-threatening anemia. Observe the client for hematologic reaction that may lead to life-threatening anemias. Early signs are sore throat, purpura, and decreasing white blood cell and platelet counts.

The client is being treated with one of the sulfonamides. She complains to the nurse of experiencing a sore throat. What is the highest priority action on the part of the nurse? a. Administer the medication; this is an expected side effect of the medication. b. Call the physician; this is symptomatic of development of a superinfection. c. Call the physician; this is symptomatic of a life-threatening anemia. d. Hold the medication and call the pharmacist for clarification.

d. 72 The drug should be given every 72 hours.

The client is being treated with rifapentine. The nurse plans to administer the medication every _____ hours. a. 8 b. 16 c. 36 d. 72

a. 2 to 3 Intravenous administration of Nubain should result in relief from pain within 2 to 3 minutes.

The client is ordered Nubain intravenously for treatment of severe pain. The client anxiously asks when she can expect to have relief from the pain. The nurse anticipates that the client will have relief within _____ minutes. a. 2 to 3 b. 5 to 6 c. 10 to 11 d. 15 to 16

c. opioid addiction. Methadone is used to assist in detoxification and monitoring of people with drug addiction.

The client is ordered methadone. The client is most likely experiencing: a. opioid overdose. b. acute or chronic pain. c. opioid addiction. d. sleep apnea.

a. subcutaneous injection. Imitrex can be administered by mouth, by subcutaneous injection, or by intranasal route.

The client is prescribed Imitrex for migraine headaches. She is nauseated and cannot take the medication by mouth. The nurse anticipates that the client will receive the medication via: a. subcutaneous injection. b. intramuscular injection. c. intravenous infusion. d. sublingual route.

c. Flush the toilet twice while the client is receiving the drugs. While the client is in the home setting and is receiving chemotherapy, toilets should be flushed twice since chemotherapy remains in the body for 48 to 72 hours after administration.

The client is receiving chemotherapy while remaining in the home setting. To ensure that caregivers properly dispose of body fluids while the client is receiving these drugs, what is the nurse's highest priority instruction to the client and caregiver? a. Wear protective gloves and mask when flushing a toilet. b. Wash soiled linen in cold water to prevent staining. c. Flush the toilet twice while the client is receiving the drugs. d. Clean the toilet with undiluted bleach while the client is receiving the drug.

d. is not yet sexually active. Gardasil is most effective when the client is not yet sexually active.

The client is scheduled to receive Gardasil. The vaccine would be most effective in the client who: a. has produced a live viable birth. b. has not yet produced children. c. is sexually active on a regular basis. d. is not yet sexually active.

b. 9:45 PM The peak level of IV tetracycline occurs one half-hour to one hour after the dose is administered.

The client is scheduled to receive a dose of IV tetracycline at 9 PM. At what time should the nurse schedule her peak drug level to be drawn? a. 9:15 PM b. 9:45 PM c. 11:00 PM d. 11:45 PM

a. increased; Leukine Taking Leukine along with lithium will result in an increased effect of the Leukine.

The client is scheduled to receive treatment with Leukine. She is currently receiving treatment with lithium. As a result of the interaction of the medications, the nurse anticipates that the client will experience a(n) _____ effect of the _____. a. increased; Leukine b. increased; lithium c. decreased; Leukine d. decreased; lithium

c. decrease; acetaminophen When acetaminophen is combined with oral contraceptives, the result is a decrease in the effectiveness of the acetaminophen.

The client is taking acetaminophen on a regular basis as well as oral contraceptives. The nurse tells the client that this drug interaction will result in a(n) _____ in the effectiveness of the _____. a. decrease; oral contraceptives b. increase; oral contraceptives c. decrease; acetaminophen d. increase; acetaminophen

c. side effect of the medication Dizziness is a side effect of treatment with Imitrex but is not life threatening.

The client receiving Imitrex complains of dizziness. The nurse's highest priority intervention is to recognize that this is a(n) ________ and notify the physician. a. adverse reaction to the medication b. food-drug interaction c. side effect of the medication d. life-threatening reaction to the drug

c. on an empty stomach. Tetracycline is best absorbed on an empty stomach.

The client will be prescribed Achromycin. The nurse anticipates that this medication will be given: a. with each meal. b. with extra water. c. on an empty stomach. d. one half-hour after meals.

a. soap and water Proper skin care for the client who is incontinent while receiving chemotherapy consists of cleaning the area with soap and water after an episode of incontinence.

The client will be remaining in the home while receiving chemotherapy. Her caregiver is concerned about how her skin should be cleaned if she is incontinent while undergoing treatment. The nurse should instruct the caregiver to clean the skin with ________ after an incontinent episode. a. soap and water b. prescribed skin care products c. diluted hydrogen peroxide d. water-based lubricant

b. assess the learning needs of the client and family. Before actually preparing the materials, the nurse should assess the learning needs of the client and family members.

The client will be undergoing anticancer therapy in the home setting. The nurse is preparing written educational materials for the client and family. In preparing the materials, the nurse's highest priority intervention is to: a. ensure that materials are written at a 10th-grade level. b. assess the learning needs of the client and family. c. provide information as an audio file as well as in written format. d. provide detailed information on each medication given.

c. oral acyclovir (Zovirax). Oral acyclovir (Zovirax) is the drug of choice to prevent HSV1.

The client will need a prophylactic agent for herpes simplex. The nurse anticipates that the client will be ordered: a. ciprofloxacin (Cipro). b. fluconazole (Diflucan). c. oral acyclovir (Zovirax). d. pentazocine (Talwin).

a. all children younger than 2 years. Forms of the pneumococcal vaccine can be given to children both older and younger than age 2 years.

The director of pharmacy for a medical facility is preparing to order pneumococcal vaccine. To determine the amount to order, she must decide which populations of clients served by the facility should receive the vaccine. She anticipates that the pneumococcal vaccine will be given to: a. all children younger than 2 years. b. only children older than 12 years. c. only adults with chronic respiratory conditions. d. only older adults who are nursing home residents.

d. Sedation St. John's wort can increase the sedative effects of opioids. It does not enhance other side effects.

The emergency department nurse is caring for a patient who has received morphine sulfate for severe pain following an injury. The nurse performs a drug history and learns that the patient takes St. John's wort for symptoms of depression. The nurse will observe this patient closely for an increase in which opioid adverse effect? a. Constipation b. Pruritis c. Respiratory depression d. Sedation

a. assess liver enzymes on a regular basis. This medication is known to cause hepatic damage.

The highest priority nursing intervention for the client receiving azithromycin (Zithromax) is to: a. assess liver enzymes on a regular basis. b. instruct the client to take the drug on an empty stomach. c. administer a laxative daily to prevent constipation. d. administer each dose of medication with antacids.

c. with each meal. This medication is taken with meals to enhance absorption and reduce gastrointestinal upset.

The highest priority nursing intervention to enhance the absorption of nitrofurantoin) should be to take the drug: a. between each meal. b. 1 hour before meals and at bedtime. c. with each meal. d. either 1 hour before or 2 hours after meals.

c. before bedtime to allow the patient to sleep. Taking medications before bedtime encourages sleep and avoids daytime drowsiness.

The highest priority nursing intervention to prevent the client from experiencing fatigue related to biologic response modifiers is to administer the drug: a. with iron to prevent anemia. b. with high-calorie foods to protect the stomach. c. before bedtime to allow the patient to sleep. d. with high-fat food to provide quick energy.

c. serum creatinine levels and urinary output. Creatinine levels and urine output assess renal function associated with the nephrotoxicity that can be caused by polymyxin B.

The highest priority nursing intervention while the client is being treated with polymyxin B (Aerosporin) is frequent monitoring of: a. blood glucose and fasting blood glucose levels. b. liver enzymes and liver function studies. c. serum creatinine levels and urinary output. d. hydration and serum albumin levels.

d. "I should expect to have more frequent urination." A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness.

The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug? a. "I may experience unusual dreams while taking this medication." b. "I may need to use a laxative when taking this drug." c. "I should ask for assistance when I get out of bed." d. "I should expect to have more frequent urination."

a. cholesterol Kaletra tends to increase the client's cholesterol level

The nurse anticipates the client's laboratory values will result in increased ______ due to treatment with Kaletra? a. cholesterol b. magnesium c. potassium d. calcium

b. Give 5 mg of MS at the next dose. Older patients often minimize pain when asked, so the nurse should evaluate nonverbal cues to pain such as elevated heart rate and blood pressure and the fact that the patient is lying very still. The nurse should increase the dose the next time the pain medication is given.

The nurse assesses an older patient 60 minutes after administering 4 mg of intravenous morphine sulfate (MS) for postoperative pain. The patient's analgesia order is for 2 to 5 mg of MS IV every 2 hours. The nurse notes that the patient is lying very still. The patient's heart rate is 96 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 140/90 mm Hg. When asked to rate the level of pain, the patient replies "just a 5." The nurse will perform which action? a. Give 3 mg of MS at the next dose. b. Give 5 mg of MS at the next dose. c. Request an order for an oral opioid to give now. d. Request an order for acetaminophen to give now.

c. Leukopenia and thrombocytopenia Bone marrow suppression subsequent to this medication may cause white blood cell and platelet levels to fall.

The nurse assesses that the client is experiencing an adverse reaction to acyclovir (Zovirax) when the client exhibits which reaction? a. Paralytic ileus b. Liver failure c. Leukopenia and thrombocytopenia d. Gastric ulceration

d. Tetracycline (Sumycin) Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.

The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Clindamycin (Cleocin) d. Tetracycline (Sumycin)

b. Slow the infusion to 10 mg/min and observe the patient closely. When vancomycin is infused too rapidly, "red man" syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient's face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take? a. Request an order for IV epinephrine to treat anaphylactic shock. b. Slow the infusion to 10 mg/min and observe the patient closely. c. Stop the infusion and obtain an order for a BUN and serum creatinine. d. Suspect Stevens-Johnson syndrome and notify the provider immediately.

c. Glaucoma Urispas should not be used for patient who has gastrointestinal or urinary tract obstruction or if the patient has glaucoma.

The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered to receive flavoxate HCl (Urispas). When reviewing this patient's history, which condition would cause the nurse to notify the provider? a. Chronic obstructive pulmonary disorder b. Diabetes c. Glaucoma d. Hypotension

b. Respiratory depression The patient's respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery.

The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition? a. Paralytic ileus b. Respiratory depression c. Somnolence d. Urinary retention

c. Change the streptomycin to kanamycin. The patient's current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.

The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patient's sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action? a. Add ethambutol (Myambutol). b. Change the streptomycin to clarithromycin. c. Change the streptomycin to kanamycin. d. Order renal function tests.

b. discuss using erythromycin (E-mycin) instead of penicillin. Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.

The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to a. discuss giving a smaller dose of penicillin. b. discuss using erythromycin (E-mycin) instead of penicillin. c. request an order for diphenhydramine (Benadryl). d. suggest that the patient receive cefuroxime (Ceftin).

b. Notify the provider of the increased blood pressure. Triptans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but not potentially life-threatening. The second dose should not be given if the patient is experiencing elevated blood pressure. Intranasal sumatriptan has the same adverse effects.

The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct? a. Notify the provider of the dizziness. b. Notify the provider of the increased blood pressure. c. Plan to administer a second dose in 1 hour. d. Request an order for intranasal sumatriptan.

d. Headaches and hypertension Headaches and increased blood pressure occur as a result of the rising red blood cell count (Hct) and increased pressure in the arterial system when the client receives erythropoietin.

The nurse is administering erythropoietin. The nurse anticipates that the client will experience which side effects of receiving the medication? a. Orthostatic hypotension and dizziness b. Shortness of breath and tachypnea c. Bradycardia and agonal respirations d. Headaches and hypertension

a. Elevated BUN and creatinine Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.

The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient's medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose

d. may have comorbid illnesses that can complicate HIV. Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient a. has an increased risk of transmitting the HIV infection. b. is less likely to develop AIDS than younger persons with HIV infection. c. is less likely to respond to antiretroviral agents. d. may have comorbid illnesses that can complicate HIV.

c. Evaluate the child's pain using an "ouch" scale. Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an "ouch" scale or a faces scale to evaluate pain if the child won't respond. Waiting for severe pain is not appropriate.

The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and won't respond when the nurse asks about pain. The nurse will perform which action? a. Ask the child to rate the pain on a scale of 1 to 10. b. Encourage the child to request pain medication when needed. c. Evaluate the child's pain using an "ouch" scale. d. Plan to administer pain medication if the child begins to cry.

c. obtaining a serum drug level. Aminoglycosides can cause ototoxicity. Any changes in hearing should be reported to the provider so that serum drug levels can be monitored. The dose is correct for this patient's weight (5 mg/kg/day in 4 divided doses). A hearing test is not indicated unless changes in hearing persist.

The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss a. decreasing the dose to 50 mg QID. b. giving the dose 3 times daily. c. obtaining a serum drug level. d. ordering a hearing test.

d. A urine culture is obtained. A urinalysis, as well as a culture and sensitivity, is usually performed before initiating drug therapy. An antipyretic is indicated for fever but does not need to be timed before the antibiotic. An oral antibiotic is not indicated. A urinary analgesic is given as needed.

The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed? a. An antipyretic is administered. b. A dose of oral antibiotic is given. c. A urinary analgesic is given. d. A urine culture is obtained.

b. Notify the provider that the drug is not effective. This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.

The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only.

a. acquired bacterial resistance. Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.

The nurse is caring for a patient who has recurrent urinary tract infections. The patient's current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to a. acquired bacterial resistance. b. cross-resistance. c. inherent bacterial resistance. d. transferred resistance.

b. Complete blood count Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.

The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium

c. "You will require 4 weeks of antiretroviral therapy." Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient's blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond? a. "No treatment is necessary since the patient is receiving antiretroviral therapy." b. "We will treat you if the patient's VL is > 20 copies/mL." c. "You will require 4 weeks of antiretroviral therapy." d. "You will undergo HIV testing and will be treated if you are positive."

a. Fosfomycin tromethamine (Monurol) Fosfomycin is given as a one-time, single dose. Nalidixic acid is given 4 times daily for 1 to 2 weeks. Nitrofurantoin is given 4 times daily. Trimethoprim-sulfamethoxazole is given twice daily.

The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient? a. Fosfomycin tromethamine (Monurol) b. Nalidixic acid (NegGram) c. Nitrofurantoin (Macrodantin) d. Trimethoprim-sulfamethoxazole (Bactrim)

a. Isoniazid (INH) INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.

The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug? a. Isoniazid (INH) b. Pyrazinamide c. Rifampin (Rifadin) d. Streptomycin

c. frequency. TMP-SMX is taken twice daily. This is the correct dose, drug, and route to treat this condition.

The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct a. dose. b. drug. c. frequency. d. route.

c. Liver enzymes High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.

The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drug's side effects? a. Complete blood counts b. Electrolytes c. Liver enzymes d. Urinalysis

a. Blood urea nitrogen (BUN) and creatinine levels High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests should be performed to monitor for nephrotoxicity.

The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient? a. Blood urea nitrogen (BUN) and creatinine levels b. Complete blood counts c. Electrolytes d. Liver enzyme levels

c. Question the patient about fluid intake. Hemorrhagic cystitis is a common adverse effect of high-dose cyclophosphamide and can be mitigated by increasing fluid intake. Allopurinol is given to treat gout, which is characterized by uric acid crystalluria. Darkening of the fingernails and skin is a common adverse effect of cyclophosphamide but is unrelated to hemorrhagic cystitis.

The nurse is caring for a patient who is receiving a third dose of high-dose cyclophosphamide (Cytoxan). The nurse notes hematuria. The nurse will notify the provider and will perform which action? a. Ask whether the patient takes allopurinol (Lopurin). b. Assess the patient's skin and fingernails for darkening. c. Question the patient about fluid intake. d. Reassure the patient that this is an expected side effect.

d. Drugs with a narrow therapeutic index Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? a. Drugs with a broad spectrum b. Drugs with a narrow spectrum c. Drugs with a broad therapeutic index d. Drugs with a narrow therapeutic index

a. Inadequate drug effects Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience? a. Inadequate drug effects b. Increased risk for superinfection c. Minimal adverse effects d. Slowed onset of action

ANS: A, C, E a. Apply ice to the IV site if the patient reports pain. c. Counsel the patient to use waxed dental floss. e. Offer ice chips frequently. If the patient reports pain at the IV site, the nurse should apply ice and notify the provider. Patients should use waxed dental floss to avoid bleeding of the gums. Ice chips help with oral pain. Antiemetics should be given prior to administration of the drug. Visitors with active infections should be restricted. Patients do not need to be NPO during the IV infusion.

The nurse is caring for a patient who is receiving fluorouracil (5-FU) to treat pancreatic cancer. Which interventions are included in the nurse's plan of care for this patient? (Select all that apply.) a. Apply ice to the IV site if the patient reports pain. b. Administer antiemetics when the patient reports nausea. c. Counsel the patient to use waxed dental floss. d. Discourage visits with people who have respiratory infections. e. Offer ice chips frequently. f. Restrict to nothing by mouth during intravenous drug administration.

d. Stop the infusion immediately. Methchlorethamine is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. The nurse should stop the infusion.

The nurse is caring for a patient who is receiving intravenous mechlorethamine (Mustargen). The patient reports pain at the IV site, and the nurse assesses swelling and pallor at the site. What action will the nurse take? a. Administer an analgesic medication. b. Apply a warm compress to the site. c. Slow the infusion and notify the provider. d. Stop the infusion immediately.

2000 mL/day To prevent crystalluria, patients should consume at least 2000 mL/day.

The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patient's daily fluid intake should be at least which amount? a. 1000 mL/day b. 1200 mL/day c. 2000 mL/day d. 2400 mL/day

a. Ask about numbness or tingling in the fingers and toes. Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.

The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkin's lymphoma. The nurse observes that the patient has difficulty walking. What action will the nurse take? a. Ask about numbness or tingling in the fingers and toes. b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension. c. Assess the temperature to evaluate for infection. d. Request an order for a complete blood count and electrolytes.

c. Electrolytes TMP-SMX can result in hyperkalemia when taken with an ACE inhibitor.

The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotension-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)? a. A complete blood count b. BUN and creatinine c. Electrolytes d. Glucose

a. Decreased effectiveness of cefaclor. The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.

The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a. Decreased effectiveness of cefaclor. b. Increased effectiveness of cefaclor. c. Decreased effectiveness of erythromycin. d. Increased effectiveness of erythromycin.

a. Acetaminophen (Tylenol) PO Use of opioid analgesics is contraindicated for patients with head injuries because of the risk of increased intracranial pressure. If opioids are necessary because of severe pain, they must be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is an appropriate analgesic.

The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient? a. Acetaminophen (Tylenol) PO b. Hydromorphone HCl (Dilaudid) IM c. Morphine sulfate PCA d. Transdermal fentanyl (Duragesic)

a. Hold the dose and notify the provider. A petechial rash can indicate a severe adverse reaction and should be reported.

The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action? a. Hold the dose and notify the provider. b. Request an order for a blood glucose level. c. Request an order for a BUN and creatinine level. d. Request an order for diphenhydramine (Benadryl).

c. with food to improve absorption. Doxycycline is a lipid-soluble tetracycline and is better absorbed when taken with milk products and food. It should not be taken on an empty stomach. Antacids impair absorption of tetracyclines. Small sips of water are not necessarily indicated.

The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication a. 1 hour before or 2 hours after a meal. b. with an antacid to minimize GI irritation. c. with food to improve absorption. d. with small sips of water.

a. Contact the provider and request an order for a more potent opioid analgesic. Even though the patient reports decreased pain, the patient's vital signs indicate continued discomfort. The nurse should contact the provider to request a stronger analgesic. The pain medication should have been effective within 30 minutes. Ibuprofen is used for musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a stronger analgesic.

The nurse is caring for a postoperative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10. The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which action will the nurse take? a. Contact the provider and request an order for a more potent opioid analgesic. b. Reassess the patient in 30 minutes. c. Request an order for ibuprofen to augment the opioid analgesic. d. Suggest that the patient use nonpharmacologic measures to relieve pain.

c. Ketorolac (Toradol) Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain.

The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? a. Diclofenac sodium (Voltaren) b. Ketoprofen (Orudis) c. Ketorolac (Toradol) d. Naproxyn (Naprosyn)

a. Inhalation Ribavirin is given by inhalation to treat RSV. Oral ribavirin is used to treat hepatitis C, and intravenous ribavirin is used to treat hepatitis C and Lassa fever.

The nurse is caring for an infant who has respiratory syncytial virus (RSV) and who will receive ribavirin. The nurse expects to administer this drug by which route? a. Inhalation b. Intramuscular c. Intravenous d. Oral

c. Erythromycin 300 mg IM QID Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.

The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question? a. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid b. Azithromycin (Zithromax) 500 mg PO once daily c. Erythromycin 300 mg IM QID d. Erythromycin 300 mg PO QID

a. "Drink several quarts of water daily." Patients should drink several quarts of water daily while taking sulfonamides to prevent crystalluria. Patients should not take antacids with sulfonamides. Patients should not go out into the sun. Sore throat should be reported.

The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching? a. "Drink several quarts of water daily." b. "If stomach upset occurs, take an antacid." c. "Limit sun exposure to no more than 1 hour each day." d. "Sore throat is a common, harmless side effect."

b. "The initial dose will be twice the amount of subsequent doses." The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed.

The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching? a. "Do not take the medication during the first 2 days of your period." b. "The initial dose will be twice the amount of subsequent doses." c. "Take this medication with food to minimize gastrointestinal upset." d. "Take the drug on a regular basis to prevent dysmenorrhea."

b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. Even though pertussis is not as serious in older children, it is important to vaccinate children to prevent the spread of the disease to infants and others who are not immunized and who are at risk for significant morbidity and mortality from this disease. Vaccinating the mother will not protect the 4-year-old from getting pertussis. The DTaP vaccine may be given to children whose mothers are pregnant. Vaccinating the child does not confer passive immunity to the unborn child.

The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information will the nurse include when discussing this with the mother? a. If she gets the vaccine, both she and her 4 year-old child will be protected. b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. c. The vaccine will not be given to her child while she is pregnant. d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.

d. Request an order for oxycodone with acetaminophen (Percocet). The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain.

The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take? a. Administer the next dose of codeine one hour early. b. Ask the provider if the codeine dose can be increased. c. Contact the provider to ask if a dose of ibuprofen may be given now. d. Request an order for oxycodone with acetaminophen (Percocet).

a. teaspoons, swished and then swallowed. Nystatin is given as 1 to 2 teaspoons that is swished in the oral cavity and then swallowed.

The nurse is instructing the client on the proper way to self-administer nystatin. The client tells the nurse that he has been simply drinking a small amount of the medication from the bottle. The nurse explain to the client that the medication dosage should consist of 1 to 2: a. teaspoons, swished and then swallowed. b. teaspoons, swished and then expelled. c. ounces, swallowed twice daily. d. ounces, used to swab the oral cavity.

a. Aspirin (Bayer) Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect.

The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone)

c. Recent surgical history Bevacizumab carries a boxed warning for gastrointestinal perforations, wound dehiscence, impaired wound healing, hemorrhage, and fistula formation after surgery. The drug should not be used within 28 days after major surgery.

The nurse is performing a history on a patient who will begin taking bevacizumab (Avastin). Which aspect of the patient's history should be reported to the oncologist treating this patient? a. History of hepatitis b. Hypertension c. Recent surgical history d. Weight loss

b. Ask the patient to rate the pain on a 1 to 10 scale. To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.

The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having "bad pain." What will the nurse do first? a. Administer acetaminophen (Tylenol). b. Ask the patient to rate the pain on a 1 to 10 scale c. Attempt to determine what type of pain the patient has. d. Request an order for an intravenous opioid analgesic.

c. liver enzyme tests. Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated.

The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patient's provider and discuss an order for a. a selective serotonin receptor agonist (SSRA). b. hydrocodone with acetaminophen for headache pain. c. liver enzyme tests. d. serum glucose testing.

d. Request an order for serum blood glucose. Phenazopyridine can alter the glucose urine test (Clinitest), so a blood test should be done to monitor glucose levels.

The nurse is preparing to administer a phenazopyridine HCl (Pyridium) dose to a patient who has diabetes. The nurse notes that the patient has a positive Clinitest. What will the nurse do next? a. Encourage the patient to increase oral fluid intake. b. Hold the dose until the patient's Clinitest is negative. c. Notify the provider of the patient's hyperglycemia. d. Request an order for serum blood glucose.

c. Contact the provider to discuss using a different antibiotic. Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.

The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take? a. Administer the amoxicillin and have epinephrine available. b. Ask the provider to order an antihistamine. c. Contact the provider to discuss using a different antibiotic. d. Request an order for a beta-lactamase resistant drug.

d. Review the sensitivity results from the patient's culture. The sensitivity results from the patient's culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.

The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse's next action? a. Administer the antibiotic as ordered. b. Contact the provider to request another culture. c. Discuss the need to add a second antibiotic with the provider. d. Review the sensitivity results from the patient's culture.

b. Hold the drug and notify the provider of these adverse reactions. Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.

The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action? a. Administer the drug since these are harmless side effects. b. Hold the drug and notify the provider of these adverse reactions. c. Obtain an order for an oral form of this medication. d. Request an order for serum electrolytes.

b. increase the tone of the urinary detrusor muscle. Bethanechol is used to increase the tone of the detrusor muscle and increase bladder tone to stimulate urination. It stimulates the parasympathetic nerves. It tones the smooth muscles of the urinary tract. It does not alleviate dysuria.

The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to a. block parasympathetic nerve impulses. b. increase the tone of the urinary detrusor muscle. c. relax smooth muscles in the urinary tract d. relieve urinary pain and burning.

c. Request an order for periodic serum warfarin levels. Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action? a. Ask the provider if azithromycin may be used instead of clarithromycin. b. Obtain an order for continuous cardiovascular monitoring. c. Request an order for periodic serum warfarin levels. d. Withhold the clarithromycin and notify the provider.

d. Hold the dose and notify the provider. Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patient's oxygen saturation improves. The drug does not need to be permanently discontinued.

The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action? a. Administer the dose as ordered. b. Administer oxygen while giving the dose. c. Discuss permanently discontinuing this treatment with the provider. d. Hold the dose and notify the provider.

d. Hold the dose and contact the provider to request a serum trough drug level. Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.

The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action? a. Administer the medication and give the infant extra oral fluids. b. Contact the provider to request adding intravenous fluids when giving the medication. c. Give the medication and obtain a serum peak drug level 45 minutes after the dose. d. Hold the dose and contact the provider to request a serum trough drug level.

a. Having resuscitation equipment readily available When administering monoclonal antibodies intravenously, resuscitation equipment should be nearby, and nurses should stay with the patient for the first 15 minutes of the infusion.

The nurse is preparing to administer intravenous monoclonal antibodies to a patient who has cancer. What is an important nursing action for this patient? a. Having resuscitation equipment readily available b. Monitoring the patient's renal function during the infusion c. Observing the patient closely for development of a rash d. Performing careful intake and output

d. An antihistamine Hypersensitivity reactions to temsirolimus are common, and pretreatment with antihistamines is recommended. Other drugs are given as needed but not prophylactically.

The nurse is preparing to administer intravenous temsirolimus (Torisel). To prevent a common adverse drug effect, the nurse will expect to administer which type of drug? a. An antibiotic b. An anticoagulant c. An antiemetic d. An antihistamine

a. Increase fluid intake to 2000 mL per day. Patients who take methenamine can develop crystalluria and should increase fluid intake to prevent this effect. A reddish-brown color is a harmless side effect. Patients should have acidic urine, not alkaline urine. Methenamine taken with sulfonamides increases the risk of crystalluria.

The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform? a. Increase fluid intake to 2000 mL per day. b. Monitor the patient's urine for dark brown color. c. Order alkaline foods 3 times daily. d. Request an order for a sulfonamide antibiotic.

b. Obtain an order for 8 ounces of cranberry juice 3 times daily. Methenamine produces a bactericidal effect when the urine pH is less than 5.5. Cranberry juice will help to acidify the urine.

The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient's chart and notes a urinary pH of 6.0. Which action will the nurse take? a. Administer the drug as ordered. b. Obtain an order for 8 ounces of cranberry juice 3 times daily. c. Request an order for an increased dose. d. Restrict fluids to concentrate the patient's urine.

a. Rotarix today. Patients receiving Rotarix receive 2 doses at age 2 and 4 months only.

The nurse is preparing to administer rotavirus vaccine to a 4-month-old infant. The nurse notes that the infant received Rotarix vaccine at 2 months of age. The nurse will plan to administer a. Rotarix today. b. Rotarix today and again at age 6 months. c. Rota Teq today. d. Rota Teq today and again at age 6 months.

d. Obtaining a specimen for culture and sensitivity To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.

The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic? a. Administering a small test dose to determine whether hypersensitivity exists b. Having epinephrine available in the event of a severe hypersensitivity reaction c. Monitoring baseline vital signs, including temperature and blood pressure d. Obtaining a specimen for culture and sensitivity

a. Dose and frequency Acyclovir is used for herpes zoster, but the dose should be 800 mg 5 times daily for 7 to 10 days. The nurse should clarify the dose and frequency. For herpes simplex, 400 mg 3 times daily is correct.

The nurse receives the following order for a patient who is diagnosed with herpes zoster virus: PO acyclovir (Zovirax) 400 mg TID for 7 to 10 days. The nurse will contact the provider to clarify which part of the order? a. Dose and frequency b. Frequency and duration c. Drug and dose d. Drug and duration

a. Administer the drug and observe closely for hypersensitivity reactions. A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.

The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient's chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse's next action? a. Administer the drug and observe closely for hypersensitivity reactions. b. Ask the provider whether a cephalosporin from a different generation may be used. c. Contact the provider to report drug hypersensitivity. d. Notify the provider and suggest an oral cephalosporin.

c. Hypoglycemia Taking oral antidiabetic agents (sulfonylurea) with sulfonamides increases the hypoglycemic effect. Sulfonylureas do not increase the incidence of headaches, hypertension, or superinfection when taken with sulfonamides. Examples of antidiabetic sulfonylurea medications are glipizide, glimepride, glyburide, tolaamide, and tolbutamide.

The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect? a. Headaches b. Hypertension c. Hypoglycemia d. Superinfection

d. Set up separate tubing sets for each drug labeled with the drug name and date. Intravenous aminoglycosides can be given with penicillins and cephalosporins but should not be mixed in the same container. The IV line should be flushed between antibiotics, or separate tubing sets may be set up. Gentamicin must be infused over 30 to 60 minutes. It is not necessary to measure ampicillin peak and trough levels. Giving the drugs at the same time increases the risk of mixing them together.

The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action? a. Administer each antibiotic to infuse over 15 to 20 minutes. b. Order serum peak and trough levels of ampicillin. c. Prepare the schedule so that the drugs are given at the same time. d. Set up separate tubing sets for each drug labeled with the drug name and date.

d. Report a possible superinfection side effect of the cephalosporin. The patient's symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.

The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient's tongue and buccal mucosa. Which action will the nurse take? a. Hold the drug and notify the provider. b. Obtain an order to culture the oral lesions. c. Gather emergency equipment to prepare for anaphylaxis. d. Report a possible superinfection side effect of the cephalosporin.

d. Wear gloves when handling the tablet. Because the contents of the tablet are toxic, nurse should wear gloves if the tablets are crushed or broken. If patients are taking antacids, the medication should be given 2 hours before or after the antacid. The medication should be given with meals.

The nurse is preparing to give a dose of dasatinib (Sprycel) to a patient. The nurse notes that the patient has just completed a meal. The tablet is in the packaging but is broken in two pieces. What is the correct action by the nurse? a. Administer the medication with an antacid. b. Return the tablet to the pharmacy. c. Wait for 2 hours before giving the medication. d. Wear gloves when handling the tablet.

c. Instruct the patient to take the next dose with a full glass of water. Clindamycin should be taken with a full glass of water to minimize gastronintestinal (GI) irritation such as nausea, vomiting, and stomatitis. Giving the medication on an empty stomach will increase the likelihood of GI upset. It is not necessary to hold the next dose or to give an antacid.

The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next? a. Administer the next dose when the patient has an empty stomach. b. Hold the next dose and contact the patient's provider. c. Instruct the patient to take the next dose with a full glass of water. d. Request an order for an antacid to give along with the next dose.

d. coagulation studies. Sulfonamides can increase the anticoagulant effects of warfarin. The nurse should request INR levels. An increased dose of warfarin would likely lead to toxicity and to undesirable anticoagulation.

The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for a. a decreased dose of TMP-SMX. b. a different antibiotic. c. an increased dose of warfarin. d. coagulation studies.

a. Contact the provider; discuss giving a lower dose. Patients receiving this drug can experience sequestration of granulocytes in the pulmonary circulation and may experience dyspnea. The sargramostim infusion should be reduced in half if this occurs. Bronchospasm, pulmonary edema, and infection are not common side effects.

The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia (AML). The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next? a. Contact the provider; discuss giving a lower dose. b. Contact the pharmacist; request a bronchodilator. c. Contact the pharmacist; request an order for furosemide. d. Contact the provider; suggest administration of antibiotics.

c. Lithium (Eskalith) Lithium (Eskalith) may increase the effects of sargramostim.

The nurse reviews a medication history for a client prescribed sargramostim (Leukine) for treatment of acute myelogenous leukemia (AML). The client is being treated with all of the following medications. Which one will require the nurse to contact the healthcare provider? a. Diphenhydramine (Benadryl) b. Furosemide (Lasix) c. Lithium (Eskalith) d. Risperidone (Risperdal)

c. "You should monitor your serum glucose more closely while taking levofloxacin." Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely. Antacids decrease the absorption of levofloxacin. NSAIDs taken with levofloxacin can cause central nervous system reactions, including seizures.

The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient? a. "You may take antacids with levofloxacin to decrease gastrointestinal upset." b. "You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain." c. "You should monitor your serum glucose more closely while taking levofloxacin." d. "You should take levofloxacin on an empty stomach to improve absorption."

a. "I may stop taking the medication if my symptoms clear up." Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.

The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching? a. "I may stop taking the medication if my symptoms clear up." b. "I should eat yogurt while taking this medication." c. "I should stop taking the drug and call my provider if I develop a rash." d. "I will not consume alcohol while taking this medication."

a. "I should increase fiber and fluids while taking aspirin." Aspirin is not constipating, so patients do not need to be counseled to consume extra fluids and fiber. Abdominal pain can occur with gastrointestinal bleeding, and tinnitus (ringing in the ears) can be an early sign of toxicity, so patients should be taught to contact their provider if these occur. Taking a full glass of water with each dose helps minimize gastrointestinal side effects.

The nurse is providing teaching to a patient who will begin taking aspirin to treat arthritis pain. Which statement by the patient indicates a need for further teaching? a. "I should increase fiber and fluids while taking aspirin." b. "I will call my provider if I have abdominal pain." c. "I will drink a full glass of water with each dose." d. "I will notify my provider of ringing in my ears."

c. Report possible drug toxicity to the patient's provider. Gentamycin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to 2 mcg/mL. Peak levels give information about whether or not a drug is at toxic levels, while trough levels indicate whether a therapeutic level is maintained. This drug is at a toxic level, and the next dose should not be given.

The nurse is reviewing a patient's chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take? a. Administer the next dose as ordered. b. Obtain repeat peak and trough levels before giving the next dose. c. Report possible drug toxicity to the patient's provider. d. Report a decreased drug therapeutic level to the patient's provider.

a. "I may take acetaminophen up to 6 times daily if needed." The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose.

The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching? a. "I may take acetaminophen up to 6 times daily if needed." b. "I should increase the dose of acetaminophen if I drink caffeinated coffee." c. "If I take oral contraceptive pills, I should use back-up contraception." d. "It is safe to take acetaminophen with any over-the-counter medications."

a. "Amphotericin B may be given intravenously or by mouth." Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.

The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching? a. "Amphotericin B may be given intravenously or by mouth." b. "Patients who take this drug should have potassium and magnesium levels assessed." c. "Patients with renal disease should not take amphotericin B." d. "This drug is used for severe systemic infections."

c. "A serum drug level greater than the MEC helps eradicate bacterial infections." The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.

The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept? a. "A serum drug level greater than the MEC ensures that the drug is bacteriostatic." b. "A serum drug level greater than the MEC broadens the spectrum of the drug." c. "A serum drug level greater than the MEC helps eradicate bacterial infections." d. "A serum drug level greater than the MEC increases the therapeutic index."

b. "Have the child rinse the mouth after taking the drug." Nitrofurantoin suspension can stain the teeth, so patients should rinse the mouth after taking it. Nitrofurantoin should be taken with food, and patients should increase fluids. A reddish-brown color is a harmless side effect.

The nurse is teaching a parent about administering nitrofurantoin suspension to a 5-year-old child. Which instruction will the nurse include in the patient teaching? a. "Give the medication on an empty stomach." b. "Have the child rinse the mouth after taking the drug." c. "Limit the child's fluid intake to concentrate the urine." d. "Report brownish-colored urine to the child's provider."

a. "I should not wear soft contact lenses while taking rifampin." Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.

The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. "I should not wear soft contact lenses while taking rifampin." b. "I will need regular eye examinations while taking this drug." c. "I will report orange urine to my provider immediately." d. "I understand that renal toxicity is a common adverse effect."

c. Increase fluid intake. The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food.

The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach.

b. "You may need to stop taking this drug a week prior to surgery." Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported.

The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. "A normal serum aspirin level is between 30 and 40 mg/dL." b. "You may need to stop taking this drug a week prior to surgery." c. "You will need to monitor aspirin levels if you are also taking warfarin." d. "Your stools may become dark, but this is a harmless side effect."

ANS: A, C, E, F a. Encourage adequate fluid intake. c. Assess for fever and tarry stools. e. Take small, frequent feedings. f. Maintain a bland diet. These measures should be implemented. The other measures are contraindicated.

The nurse is teaching a patient how to manage medication-related diarrhea. What does the nurse include in the instructions? (Select all that apply.) a. Encourage adequate fluid intake. b. Use laxatives liberally. c. Assess for fever and tarry stools. d. Eat a high-fiber diet. e. Take small, frequent feedings. f. Maintain a bland diet. g. Increase milk products. h. Increase intake of caffeinated beverages.

d. "If I have gastrointestinal upset, I should take an antacid." Patients should not take these drugs with antacids.

The nurse is teaching a patient who is receiving chloroquine (Aralen) for malaria prophylaxis. Which statement by the patient indicates a need for further teaching? a. "I may experience hair discoloration while taking this drug." b. "I should not take this drug with lemon juice." c. "I should use sunscreen while taking this drug." d. "If I have gastrointestinal upset, I should take an antacid."

d. "You should report difficulty buttoning your clothes to your provider." Difficulty buttoning clothing is a sign of peripheral neuropathy and should be reported. Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve. If the IV infiltrates, the infusion should be stopped and the needle left in until attempts to aspirate residual vesicant are performed. Antinausea medication should be given prior to beginning the infusion.

The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient? a. "If you experience numbness of your hands, it will eventually resolve." b. "If your IV starts to hurt, you should pull the IV out immediately." c. "You should ask for antinausea medication at the first sign of nausea." d. "You should report difficulty buttoning your clothes to your provider."

c. "Stop taking the drug and notify your provider if you develop a rash while taking this drug." Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct? a. "Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved." b. "If diarrhea occurs, stop taking the drug immediately and contact your provider." c. "Stop taking the drug and notify your provider if you develop a rash while taking this drug." d. "You may save any unused antibiotic to use if your symptoms recur."

c. interferes with specific molecules in cancer cells. Targeted therapy differs from traditional cancer chemotherapy by taking advantage of biologic features particular to cancer cells and targeting specific mechanisms. They block the growth and spread of cancer by interfering with specific molecules within the cancer cells. Traditional chemotherapeutic agents damage cell DNA of cancer cells as well as normal cells. Targeted therapies do not directly kill or damage cancer cells or prevent metastasis.

The nurse is teaching a patient who will begin receiving targeted therapy for cancer. The patient asks how targeted therapy differs from other types of chemotherapies. The nurse will explain that targeted therapy a. damages cancer cell DNA to prevent cell replication. b. directly kills or damages cancerous cells. c. interferes with specific molecules in cancer cells. d. prevents metastasis of cancer cells.

c. Increase fluid intake while taking this medication. Patients taking acyclovir should increase fluid intake to maintain hydration. A complete blood count is not required. Dizziness and confusion should be reported to the provider. Antiviral medications have many side effects.

The nurse is teaching a patient who will receive acyclovir for a herpes virus infection. What information will the nurse include when teaching this patient? a. Blood cell counts should be monitored closely. b. Dizziness and confusion are harmless side effects. c. Increase fluid intake while taking this medication. d. Side effects are rare with this medication.

c. "I should report any low-grade temperature elevation immediately." Even a low-grade temperature should be reported because it can indicate significant infection in immunocompromised patients. Patients should eat a low-purine diet while taking this medication. Patients should brush teeth and gums with a soft bristle toothbrush. Patients should take the medication early in the day to avoid accumulation in the bladder.

The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching? a. "I should follow a diet high in organ meats and beans while taking this drug." b. "I should brush my teeth and gums vigorously twice daily." c. "I should report any low-grade temperature elevation immediately." d. "I should take the drug at bedtime to minimize side effects."

c. "I should take antiemetics prior to each dose of this medication. " Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection.

The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching? a. "I may have a low-grade fever while taking this medication." b. "I may have serious cardiovascular side effects because of this drug." c. "I should take antiemetics prior to each dose of this medication. d. "I may need to avoid people who are sick while I'm taking this drug."

b. severe fungal Because of the significant side effects associated with this medication, it is reserved for severe fungal infections.

The nurse notes that the client has been placed on amphotericin B (Fungizone). Based on the medication being used, the nurse recognizes that the client has been diagnosed with a _____ infection. a. mild fungal b. severe fungal c. mild bacterial d. severe bacterial

b. decrease the warfarin dose. When patients taking warfarin take gefitinib, the effectiveness of the warfarin is greatly increased, and bleeding risks increase. Carbamazepine and histamine2 blockers decrease the effectiveness of gefitinib, so decreasing the gefitinib dose or decreasing the carbamazapine or histamine2 blocker is not recommended.

The nurse performs a medication history on a patient who will begin targeted therapy for cancer with gefitinib (Iressa). The nurse learns that the patient is taking carbamazepine, a histamine2 blocker, and warfarin. The nurse will anticipate that the provider will make which change to the medication regimen? a. decrease the gefitinib dose. b. decrease the warfarin dose. c. increase the histamine2 blocker dose. d. increase the carbamazepine dose.

a. "I may take antacids 2 hours before taking this drug." Azithromycin peak levels may be reduced by antacids when taken at the same time so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.

The nurse provides home care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching? a. "I may take antacids 2 hours before taking this drug." b. "I should take acetaminophen for fever or mild pain." c. "I should expect diarrhea to be a common, mild side effect." d. "I should avoid dairy products while taking this drug."

b. "I will get yearly eye exams." Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids.

The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? a. "I should increase my vitamin C intake." b. "I will get yearly eye exams." c. "I will increase my protein intake." d. "I will limit fluids to prevent edema."

b. "I should take indomethacin on an empty stomach." Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily.

The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? a. "I should limit sodium intake while taking this drug." b. "I should take indomethacin on an empty stomach." c. "I will need to check my blood pressure frequently." d. "I will take the medication twice daily."

c. "I should take the drug with food and increase my fluid intake." Patients taking nitrofurantoin should take the drug with foods and increase fluid intake. The drug should not be taken with antacids. Brown urine is a harmless side effect. Tingling of extremities can indicate neuropathy.

The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching? a. "If I experience gastrointestinal upset, I may take an antacid." b. "I should notify my provider immediately if my urine is brown." c. "I should take the drug with food and increase my fluid intake." d. "Tingling of my fingers is a harmless side effect of this drug."

b. Herpes virus Purine nucleosides, such as acyclovir, are used to treat herpes simplex viruses 1 and 2, herpes zoster virus, varicella-zoster virus, and cytomegalovirus.

The nurse receives an order to administer a purine nucleoside antiviral medication. The nurse understands that this medication treats which type of virus? a. Hepatitis virus b. Herpes virus c. HIV d. Influenza virus

c. Numbness and/or tingling of the fingers and toes Symptoms of neuropathy include feelings of numbness and/or tingling in the fingers and toes.

The nurse suspects that the client may be experiencing peripheral neuropathy as a result of receiving paclitaxel (Taxol). What is the highest priority nursing intervention to use in monitoring the client for this adverse reaction? a. Decrease in levels of white blood cells and platelets b. Increase in overactive deep tendon reflexes c. Numbness and/or tingling of the fingers and toes d. Paralysis of the muscles in the lower extremities

b. Recommend acetaminophen and cold compresses. These are common, minor side effects of vaccines and can be treated with acetaminophen and cold compresses. Aspirin is contraindicated in children because of its association with Reye's syndrome. Since these are not serious adverse effects, they do not need to be reported to VAERS. It is not necessary to schedule a clinic visit.

The parent of a 12-month-old child who has received the MMR, Varivax, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action? a. Recommend aspirin or an NSAID for pain and fever. b. Recommend acetaminophen and cold compresses. c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS). d. Schedule an appointment in clinic so the provider can evaluate the child.

a. Acetaminophen (Tylenol) Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere with platelet aggregation. Aspirin carries an increased risk of Reye's syndrome in children. Diflunisal (Dolobid) is not available over the counter.

The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend? a. Acetaminophen (Tylenol) b. Aspirin (Ecotrin) c. Diflunisal (Dolobid) d. Ibuprofen (Motrin)

b. 25 The varicella vaccine should be delayed up to 11 months after the blood transfusion is received.

The parent of a toddler consults the nurse regarding the most appropriate time to have the child immunized with the varicella vaccine. The child was hospitalized at age 14 months and required a blood transfusion. Based on the child's age, the most appropriate time for the child to receive the varicella vaccine is at age _____ months. a. 22 b. 25 c. 28 d. 30

d. slow, planned cellular death. Apoptosis is programmed cell death, designed to ensure that tissues contain only healthy and optimally functional cells.

The patient asks the nurse what apoptosis means. The nurse will explain that apoptosis refers to a. alteration of cellular functions. b. inhibition of cell division. c. prevention of cell phase progression. d. slow, planned cellular death.

b. Decreased The dosage of the medication will be decreased when the patient has renal impairment.

The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication? a. Increased b. Decreased c. Unchanged d. Held

d. are usually predictable and may be treated proactively. Side effects may be anticipated and treated proactively. Side effects include high blood pressure and alopecia. They may be significant.

The patient is trying to decide whether or not to use targeted cancer therapy. In teaching patients about targeted cancer therapy, the nurse teaches the patient that side effects: a. frequently include hypotension and hirsutism. b. are generally dose limiting. c. usually are minor. d. are usually predictable and may be treated proactively.

d. Administer the medication as ordered by the physician. Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.

The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

a. Administer the vaccine as ordered. Zostavax is given to boost the immunity to varicella-zoster virus among recipients. It is not likely to cause severe reaction secondary to prior exposure, since the immune response in most recipients has declined. Zostavax, not Varivax, is approved for this use.

The provider orders Zostavax for a 60-year-old patient. The patient reports having had chicken pox as a child. Which action will the nurse take? a. Administer the vaccine as ordered. b. Counsel the patient that the vaccine may cause a severe reaction because of previous exposure. c. Hold the vaccine and notify the provider of the patient's history. d. Request an order for a Varivax booster instead of the Zostavax.

c. Wear a face shield if there is any danger of splashing. A face shield should always be worn if there is danger of splashing to prevent exposure to the nurse.

To reduce a nurse's exposure to chemotherapy drugs during IV administration, what is the nurse's highest priority nursing intervention? a. Wear a mask during administration of the medication. b. Clean up a spill with paper towels as quickly as possible. c. Wear a face shield if there is any danger of splashing. d. Wear triple-layered gloves during administration.

a. current antimicrobial therapy. Antibiotic therapy is not generally a contraindication to the use of vaccines. The nurse would need to determine the reason for the antibiotics and the severity of the infection.

Vaccines may generally be administered in the presence of: a. current antimicrobial therapy. b. immunosuppression with neutropenia. c. acute severe illness and fever. d. previous allergic reactions to vaccines.

a. Report weight loss and signs of infection or bleeding. Weight loss and signs of infection as well as bleeding are possible side effects of treatment with a biologic response modifier.

What does appropriate client teaching for clients receiving biologic response modifiers (BRMs) include? a. Report weight loss and signs of infection or bleeding. b. Severe weakness and malaise are expected side effects. c. BRM therapy has no teratogenic effects. d. Most BRM side effects persist after therapy is discontinued.

d. Alert the client to avoid operating a car or machinery due to drowsiness. The medication may cause sedation, so the client should avoid driving or operating machinery while taking it.

What is the highest priority nursing intervention for clients taking anthelmintics? a. Instruct the client that daily stool specimens must be collected. b. Inform the client that the pathogens are spread via blood. c. Instruct the client to take baths and not showers. d. Alert the client to avoid operating a car or machinery due to drowsiness.

b. The culture should be taken before the initial dose of the antibiotic is given. To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins.

When antibacterials are prescribed for the treatment of an infection and a culture is ordered, what should happen next? a. The initial dose of the antibiotic should be given before the culture is taken. b. The culture should be taken before the initial dose of the antibiotic is given. c. The culture should be taken any time after the antibiotic therapy begins. d. The culture may be taken at any time before or during antibiotic therapy.

ANS: A, C, E a. Frequent use of antibiotics c. Skipping doses e. Treating viral infections with antibiotics Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.

Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a. Frequent use of antibiotics b. Giving large doses of antibiotics c. Skipping doses d. Taking a full course of antibiotics e. Treating viral infections with antibiotics

a. Allopurinol (Zyloprim) Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects.

Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane)

ANS: A, B, C a. Edema b. Erythema c. Heat Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.

Which are characteristic signs of inflammation? (Select all that apply.) a. Edema b. Erythema c. Heat d. Numbness e. Pallor f. Paresthesia

b. Assess blood pressure for hypotension. This medication may cause hypotension, and it must be monitored closely.

Which assessment is most important when a client begins to receive an infusion of Amphotericin B (Fungizone)? a. Count apical heart rate for 1 full minute. b. Assess blood pressure for hypotension. c. Assess lower extremity motor function. d. Determine a change in pulse pressure.

a. Client who has been in close contact with a person having tuberculosis (TB) Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy.

Which client would be highest priority to receive prophylactic antitubercular therapy? a. Client who has been in close contact with a person having tuberculosis (TB) b. Client with longstanding chronic liver disease c. Healthcare professionals employed in health institutions d. Family members of a client with TB, regardless of the type of contact

d. 34-year-old woman Acute pyelonephritis, an upper UTI, is commonly seen in women of childbearing age, older women, and young girls.

Which client would be highest risk to develop acute pyelonephritis? a. 42-year-old man b. 2-year-old girl c. 18-year-old man d. 34-year-old woman

ANS: A, D, E a. Chicken pox d. Mononucleosis e. Shingles Herpes viruses cause chicken pox, mononucleosis, and shingles.

Which diseases are caused by herpes viruses? (Select all that apply.) a. Chicken pox b. Hepatitis c. Influenza d. Mononucleosis e. Shingles

b. Sulfonamides are derived from biologic substances. Sulfonamides are bacteriostatic, not bactericidal. They are not derived from biologic substances. They are not antifungals or antivirals. They act by decreasing bacterial synthesis of folic acid.

Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection? a. Sulfonamides are bactericidal. b. Sulfonamides are derived from biologic substances. c. Sulfonamides have antifungal and antiviral properties. d. Sulfonamides increase bacterial synthesis of folic acid.

a. Administration of IgG to an unimmunized person exposed to a disease Passive immunity occurs without stimulation of an immune response. Acquired immunity requires administration of immune globulin. Inherent resistance to a disease antigen describes the state of natural immunity, not acquired passive immunity. The other answers involve stimulation of an immune response.

Which is an example of acquired passive immunity? a. Administration of IgG to an unimmunized person exposed to a disease b. Administration of an antigen via an immunization c. Inherent resistance to a disease antigen d. Immune response to an attenuated virus

c. Ensure client has understanding of the purpose for each drug. Clients need to have a good understanding of the purpose, actions, side effects, and need for the medication. Clients will be more compliant if this information is worked into their daily routine.

Which is important to consider when developing a plan with the client receiving antiretroviral therapy to ensure adherence to the therapeutic regimen? a. Make no association between taking medications with daily routine. b. Avoid discussing management of anticipated side effects. c. Ensure client has understanding of the purpose for each drug. d. Avoid confusing clients by telling them about drug actions.

a. "Use a high SPF sunblock when out in the sun." Using a high SPF sunblock decreases the risk of photosensitive reactions.

Which nursing instruction related to photosensitivity is highest priority for the client receiving a sulfonamide? a. "Use a high SPF sunblock when out in the sun." b. "Avoid driving during daylight hours." c. "Take vitamin D to prevent photosensitivity." d. "Apply a moisturizer before going outside."

a. A patient with cancer Opioids are titrated for oncology patients until pain relief is achieved or the side effects become intolerable, and extremely high doses may be required. Patient with closed head injuries should receive reduced doses of opioids if at all to reduce the risk of increased intracranial pressure. Patients with hypotension should receive reduced doses to prevent further decrease in blood pressure. Patients who are 3 days post-operation should not be experiencing severe pain.

Which patient may require a higher than expected dose of an opioid analgesic? a. A patient with cancer b. A patient with a concussion c. A patient with hypotension d. A patient 3 days after surgery

d. A patient who has close contact with someone who has tuberculosis Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.

Which person should be treated with prophylactic antitubercular medication? a. A child who attends the same school with a child who has tuberculosis b. A nurse who is working in a hospital c. An individual who is HIV-positive with a negative TB skin test d. A patient who has close contact with someone who has tuberculosis

b. Nausea and vomiting Nausea and vomiting are common to most urinary antiseptics.

Which side effects are common to most urinary antiseptics? a. Dyspnea and chest pain b. Nausea and vomiting c. Peripheral neuritis d. Visual disturbances

b. Miconazole (Monistat) Topical miconazole is used to treat vaginal candidiasis.

Which topical antifungal medication is used to treat vaginal candidiasis? a. Haloprogin (Halotex) b. Miconazole (Monistat) c. Oxiconazole (Oxistat) d. Terbenafine HCl (Lamisil)

c. mutant bacteria are surviving antibiotic use. Bacteria mutate if they are in contact with antibiotics for extended periods.

With continuous use of antibiotics, antibiotic resistance result because: a. bacteria are producing fewer mutations. b. the immune system has enhanced ability to fight infection. c. mutant bacteria are surviving antibiotic use. d. fewer new antibiotics have been produced.